By Katerina Papadopoulou Travel Health January 27, 2024

COVID 19 Public Health Aspect

Summary

Case fatality rate of 2.3% globally
As of February 23, 2020, there were 76,936 reported cases in mainland China and 1,875 cases in locations outside mainland China in 56 countries
There have been 2,462 associated deaths worldwide
Declared a public health emergency by Health and Human Services HHS on January 31, 2020. [1]
Medically fragile patients with pre-existing conditions including lung disease, poorly controlled diabetes and cardiac disease are at increased risk for complications
Elderly patients are at increased risk
- 50-59 y/o has 1.3% mortality
- 60-69 y/o has 3.6% mortality
- 70-79 y/o has 8% mortality
- 80 and above y/o has 14.8% mortality
SARS-CoV-2 has a R0 of 2.5
- Measles has an R0 value of approximately 12-18 in unvaccinated people
- Seasonal influenza has an R0 of 1.2
There is concern for the ability to have a second re-infection after the initial infection has cleared[2]

Cases and Epidemiology by Geography

March 7th, 2020[3]
- Global cases 105,559
  - Deaths 3,555
  - Recovered 58,354
- China 80,652 cases
  - 2,959 deaths in Hubei, China
- South Korea 7,041 cases
  - 44 deaths in South Korea
- Italy 5,883 cases
  - 233 deaths in Italy
- Iran 5,823 cases
  - 145 deaths in Iran
- Germany 799 cases
- France 716 cases
  - 11 deaths in France
- Spain 500 cases
  - 10 deaths in Spain
- Japan 461 cases
  - 6 deaths in Japan
- USA 376 cases
  - 12 deaths in King County, Washington
- Switzerland 268 cases
- UK 206 cases
- Netherlands 188 cases
- Belgium 169 cases
- Sweden 161 cases
- Norway 147 cases
- Singapore 138 cases
- Hong Kong 108 cases
- Malaysia 93 cases
- Bahrain 85 cases
- Austria 79 cases
- Australia 63 cases
- Kuwait 61 cases
- Canada 54 cases
- 54 cases in Iraq
  - 4 deaths in Iraq
- Thailand 50 cases
- Iceland 50 cases
- Greece 46 cases
- United Arab Emirates 45 cases
- Taiwan 45 cases
- India 34 cases
- San Marino 23 cases
- Denmark 23 cases
- Lebanon 22 cases
- Palestine 22 cases
- Israel 21 cases
- Portugal 20 cases
- Czech Republic 19 cases
- Vietnam 18 cases
- Ireland 18 cases
North America
- See appendix
South America
- See appendix
Asia
- See appendix
Europe
- See appendix
Africa
- See appendix
Australia/Pacific
- See appendix
Most commonly effected age
- Eighty-seven percent of patients were aged 30 to 79 years (38,680 cases)[4]
Vulnerable populations
Medically fragile patients with pre-existing conditions including lung disease, poorly controlled diabetes and cardiac disease are at increased risk for complications[5]
Elderly patients are at increased risk

Communicability and Transmission

R0 (R naught) is the basic reproduction number and predicts how many people one infected person spread the disease to another person[6]
- R0 means the disease will likely die out on its own. One sick person usually does not infected another person, or less than one person.
- R1 means that one sick person infects at least one other person
- Measles has an R0 value of approximately 12-18 in unvaccinated people
- Seasonal influenza has an R0 of 1.2
- Smallpox R0 is 7
- SARS-CoV-2 has a R0 of 2.5
There is concern for the ability to have a second infection after the initial infection has passed[7]
Contact transmission (fomite to face)
- A patient with COVID19 coughs and large droplets containing virus particles spread outward
- These droplets settle on surfaces in a room, creating a thin film of the virus
  - Virus particles may be shed in other body fluids including
    - Sputum
    - Nasal secretions
    - Stool
    - Saliva
    - Urine
    - Blood
  - Most human coronavirus particles can survive for approximately 1 week on surfaces[8]
    - Animal coronavirus can persist for weeks or months on inanimate surfaces
  - Virus particles persist on fomites in the environment
  - An un-infected person touches the contaminated surface hours or even days later
  - The uninfected person then touches their nose or mouth, transmitting the infection
  - Regular cleansing of environmental surfaces prohibits spread
    - 70% ethanol
    - 5% sodium hypochlorite solution (bleach)
  - Handwashing and/or high concentration ethanol neutralizes the virus

Case Fatality Rates

Age[9]
- 0-9 y/o has no deaths reported as of yet
- 10-19 y/o has 0.2% mortality
- 20-29 y/o has 0.2% mortality
- 30-39 y/o has 0.2% mortality
- 40-49 y/o has 0.4% mortality
- 50-59 y/o has 1.3% mortality
- 60-69 y/o has 3.6% mortality
- 70-79 y/o has 8% mortality
- 80 and above y/o has 14.8% mortality
Sex
- In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male.
Comorbidities
- Medically fragile patients with pre-existing conditions including lung disease, poorly controlled diabetes and cardiac disease are at increased risk for complications[10]

Comparison to Other Major Viruses41

Ebola
- Identified 1976
- 33,5577 cases
- 13,562 deaths with fatality rate of 40.4%
- 9 countries
Nipah
- Identified in 1998
- 513 cases
- 398 deaths with fatality rate of 77.6%
- 2 countries
SARS
- Identified in 2002
- 8,096 cases
- 774 deaths with fatality rate of 9.6%
- 29 countries
MERS
- Identified in 2012
- 2,494 cases
- 858 deaths with fatality rate of 34.4%
- 28 countries
COVID-19
- Identified in 2020
- 83,774 cases
- 2,867 deaths with fatality rate of 3.4%
- 56 countries