Curtaining high mortality rate of COVID 19 through proper risk management options

ABSTRACT:
The SARS CoV 2 virus which causes the COVID 19 disease has been ravaging the world at a global scale since it was first declared as a public health emergency of international concerns on 30 January 2020 by WHO(world Health organization) and has since then continue to claim the live of thousands on a daily basis. Data from WHO shows that globally over 5,000 000 lives have been lost to this deadly plague with hundreds of new cases emerging with each passing day.
In an age with much advances in the field of science and technology many have been intrigued as to the high mortality rate caused by COVID 19, which can be attributed to the mechanism of action and of modes of transmission of the virus when compared to the MERS( middle East respiratory syndrome) and SARS( Severe acute respiratory syndrome) virus. As of 1st May 2020 no vaccine or drug has been approved by any FDA( federal drug agency) for treatment of COVID 19, and at such proper management options in Health care settings, homes and communities has been effective to help curb the spread of the virus and also reduce community transmission. Hence this article reviews some proper management options of , sanitation, hygiene and waste management for the COVID 19 virus in healthcare settings, homes and communities. It also analysis some health measure that can help reduce mortality rate even when exposed to the virus .

INTRODUCTION:

COVID 19 is a zoonotic infection caused by the SARS CoV 2 virus which belongs to the family Coronaviridae, under the Genus beta coronavirus. Other viruses belonging to this family include the Human SARS(severe acute respiratory syndrome)virus and the MERS(Middle East respiratory syndrome) virus. These family of virus affect the respiratory tract thereby causing severity of infection in both the upper and lower respiratory tract.
Symptoms of the virus varies from mild symptoms in patients with strong immune system to severe symptoms in immunocompromised individuals with some infected patients been asymptomatic, depending on the age, and medical condition of the patient. The main route of transmission of the virus is through respiratory and direct contact with infected patients. Aerosols from infected patients may land on surfaces were the virus can remain viable for hour’s, and at such it can be said that the immediate environment of a person can serve as a source of transmission. 1
In Healthcare settings proper management of infected patients and PPE(personal protective equipment) and safe hygiene practices can reduce the rate of transmission of the pathogen. Also safe hygiene practices in homes and communities can also curtain community transmission.
It should be noted that the recommendations on this article is based on scientific research from experts and from WHO guidance on safe management of waste, sanitation and hygiene practices for the COVID 19 virus. 2 Since insufficient scientific data are available on the SARS CoV 2 virus, most data given in this article are based on past studies on the human coronaviruses since the morphology and chemical structure of the SARS CoV 2 virus is similar to that of the other coronaviruses , data about survival and inactivation measures of SAR CoV 2 is been drawn from past research on the group of viruses belonging to the family Coronaviridae.

Social distancing a key to curbing the spread of COVID 19:

Since the outbreak of the COVID 19 pandemic numerous recommendations and guidelines from WHO have on several occasions outline the importance of social distancing, hence social distancing is the most important management option for COVID 19. But why is the 2 meters guideline from WHO the best management option for COVID 19?
• Research have shown that a typical cough travels 68cm, a distance shorter than the 209cm or 2m distance recommend by the WHO for social distance. On the other hand a typical sneeze will travel further up to 100cm also shooter than the 2m recommendation by WHO. Thus this implies that a person 2m apart from an infected patient is on the ‘safe zone’ outside the range of droplets projection. Aerosols containing viral particles can spray from the mouth or nose of an infected person into another person face were it is most likely to be inhaled through the mouth or nose when ever the infected patient talks or coughs. 3
• Statistical modelling from epidemiology research shows that social distancing is effective in decreasing the basic reproduction number of virus(viral infectivity is assessed using its reproduction number; based on the average number of people who become infected individuals from another infected individual within a population). For example if 25% of the population practice social distance and cut down on the number of close contact by 50% . This can in an ideal condition decrease the viral reproduction number by 20%.³

The anti inflammatory strategy:

The anti-inflammatory option can serve as an effective option in the management of COVID 19 in clinical settings and in homes as a personal protective measure. This strategy involves the use of fruits, vegetables, or medicine that contain antioxidant nutrient with anti-inflammatory properties to detoxify the inflammatory response caused by the COVID 19 virus in infected patients and also in healthy patients to boost their immune system thereby reducing the severity of infection when exposed to the virus .
But what are antioxidant and how do they reduce inflammation? As the name implies they are molecules that reduces oxidative stress( oxidative stress can be caused by foreign particles or smokes in the body)or simply put they are molecules that help prevent free radicals (A free radical is an atom or molecule that contains unpaired electrons) from harming healthy cells in the body. Thus antioxidant neutralize excess free radicals to protect healthy cells and reduce inflammation’s.⁴ To help grasp the concept of antioxidant effect against inflammation, think of the COVID 19 virus as a foreign particle, when this particle attack the cells in the respiratory tract, the immune system respond by recognizing it as a foreign particle thereby releasing free radicals and antibodies to illicit immune response. However the free radical are been released in excess (exaggerated immune response) resulting in oxidative stress and inflammation. The Inflammation when not curtained can lead to the destruction of the lungs, on the other hand if a patient has a good concentration of antioxidant, it can help prevent inflammation by reducing the amount of free radicals. Antioxidants comes in various forms they include: Enzymes(Glutathione peroxidase, methionine reductase, superoxide dismutase, coenzymes Q-10 e.t.c), vitamins ( vitamin A, C, and E, Beta-carotene e.t.c), and minerals( selenium, and zinc).5
A phase 2 clinical trials that was conducted by Dr Zhiyoung pein of department of medicine at zhongnan Hospital of Wuhan University which tests the efficacy of vitamin C infusion for the treatment of SARS( sever acute respiratory syndrome) infection associated with coronavirus shows that Vitamin C is an antioxidant that may help prevent cytokine( cytokine are signaling molecules or protein which are released in the presence of a foreign particle in the body to respond to infection and trigger inflammation) induced damage to the lungs and also shortened the duration of common cold.6 Research has also shown that in addition to detoxifing free radicals, selenium in good concentration prevents viral mutation on the other hand low selenium in the body can cause viral mutation making the virus more dangerous.7 A regular diet containing antioxidant when found in good proportion on a healthy patients can prevent or even reduced the rate of inflammation when exposed to the virus. Antioxidants can be found in fruits, vegetables, cereal food e.tc.
Medical condition determines the clinical severity of COVID 19.
While COVID 19 is a disease of the lungs other health conditions and underling illness can contribute to the severity of the infection some of these health conditions includes:
• Cardiovascular disease
• Diabetes
• Chronic kidney disease
• Chronic respiratory disease as well as people with HIV.
It should be noted however that most of these disease are more common in older people than younger ones, thus older people are more at risk to severe clinical symptoms of COVID 19 than younger ones.
Another group of people more prone to developing severe respiratory disease from COVID 19 are smokers( tobacco , mauriguana, and cigarette smokers) including those who are exposed to second hand smoke; like children of parents who are smokers. Each smoke particle of tobacco inhaled triggers inflammation which damage the lungs and airway causing a wide range of respiratory diseases.8,9 Patients with no underlining illness have more recovery rate than those with medical complications. Thus having a healthy lifestyle devoid of underling illness and any cause of respiratory complications provide a good breeding ground for a strong immune system and less clinical severity even when infected by the COVID 19 virus .

Good hygiene practice in communities and homes:

• Hand washing:

Amidst the rapid spread of the coronavirus a good personal hygiene can serve as a protection from getting infected by the virus and also reduce the risk of exposure to the virus.9 A good hand hygiene had been shown to prevent respiratory illness, but when is hand washing required and how should it be done properly? According to WHO hand washing should be done after coughing, sneezing, disposing of tissues, before and after breastfeeding, before preparing food, before eating a meal, after changing a diapers, after touching an animal and on entering the home.10 The ideal effective material to use in hand washing is water and soap or alcohol based rub containing 60% alcohol. The soap used does not need to be antibacterial since normal soaps are also effective in inactivating the coronavirus. However In communities or homes were soap or alcohol based hand rub is not available chlorinated water(0.05% chlorine) can be used as a short term measure or ash or mud can be used.10,11 It is not mandatory to use waters that meet drinking standards for hand washing, an improved water can be used provided its free from fecal contamination with less microbial load. It should be noted that water used for hand washing should be a running water that flows into a proper drainage system, and hands should not be rinsed in a basin as this might increased contamination.11

• Management of excreta and waste generated at home :

In areas with increased and frequent cases of Covid 19 proper waste management can help reduced the risk of infection of Covid 19. High priority should be given to proper management of human waste starting with. Ensuring access to regularly cleaned, accessible and functioning toilets or latrines and to the safe containment, conveyance, treatment and eventual disposal of sewage. Tissues and materials used while coughing and sneezing should be disposed in a waste bin followed by proper hand washing thereafter.12
In homes with suspected cases of Covid 19 the following guidelines should be followed;

1. Frequently touched surfaces of tables, chairs and bedroom furniture’s through outer area of suspected patient should be cleaned regularly.
2. Bedrooms and toilets should be regularly cleaned using soaps and detergents and disinfectants containing 0.1% sodium hypochlorite should be used during cleaning. High priority should be given to proper management of human waste starting with. ensuring access to regularly cleaned, accessible and functioning toilets or latrines and to the safe containment, conveyance, treatment and eventual disposal of sewage. Tissues and materials used while coughing and sneezing should be disposed in a waste bin followed by proper hand washing thereafter.12,13,14
   Safe hygiene practices in health care settings:
   • Hand washing;
   Healthcare workers should regularly observe good hand hygiene practices by regular washing their hands with running water and soap or an alcohol based rub with 70% alcohol. Hand washing should be done;
3. Before touching a patient
4. Before cleaning aseptic technique
5. After body fluid exposure risk
6. After touching a patient
7. After touching patients surrounding.13
   • Safe decontamination practices;
   Safe decontamination practice in essential in reducing the risk of exposure of clinical personnel to the Covid 19 virus. Surfaces were Covid 19 patients receive care should be properly disinfected frequently.14 But what disinfectants are more active and suitable for use? According to WHO recommendation 70% ethyl alcohol is more suitable for disinfecting smaller surfaces and clinical equipment used in the course of treatment. 0.1 % of sodium hypochlorite should be used for disinfect surfaces and 0.5% hypochlorite should be used for disinfecting surfaces with blood or body fluid spill from patients.15
   However it should be noted that surfaces should be cleaned with detergents and water before applying disinfectants in other to improve its efficacy. Regular decontamination of surfaces can serve as a protection to clinical personnel because Studies on the human coronaviruses have shown that the coronavirus has a survival time of 28 days on steel, 8 hours on aluminum, 5 days on paper, 5days on glass and a day on plastic.16 However their viability on these surfaces for such a longer time periods is dependent on temperature which appears to be a fundamental factor on surface recovery. For example at higher temperature of 30 to 40 degree Celsius the viruses have shorter persistent time and are inactive at 60 degree Celsius. While in temperature as low as 4 degree Celsius they can strive for up to 28 days on stainless steel.16
   While decontamination can serve as an effective management tool in the clinical environment, the importance of personal protective equipment(PPEs)should not be ruled out in clinical settings while treatment patients with COVID 19. These PPEs includes: heavy duty gloves , mask, eye protections such as; goggles or face shield, a long sleeve gown, boots or closed shoes.17 Proper hand washing should be carried out after removal of PPEs and the POE should be decontaminated and disposed infectious waste. 18

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