Novel Coronavirus disease 2019 (COVID-19): new challenges and new responsibilities in developing countries

ABSTRACT

Novel coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus, which belongs to the genus Coronaviridae with its high mutation rate. From the current perspective, we discuss the current status of COVID-19, new challenges, and potential interventions to control the pandemic in developing counties such as Pakistan.

KEYWORDS:

• COVID-19
• interventions
• pandemic
• vaccination

Background

Since first reported in Wuhan, China, in late December 2019, the outbreak of the novel coronavirus now known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has spread globally. Cases have now been reported in essentially all countries.¹ No previous coronavirus outbreaks have been as large or persistent as the current pandemic of COVID-19. The number of cases in the current outbreak now exceeds the number from all previous outbreaks combined.² Indirect effects include disruption of standard medical care, substantial economic losses, insecurity, and social disruption in affected countries. Extensive mobility and travel have caused COVID-19 to reach essentially everywhere.

The Centers for Disease Control and Prevention (CDC) has been working intensively with partners to help stop the outbreak all across the globe. The CDC has issued detailed guidelines regarding identifying, isolating, diagnosing, and treating patients.^3,4 There is also specific guidance for traveling in order to minimize the risk of exposure to the travelers.⁵

Fundamental interventions to control COVID-19 infection

Stopping the outbreak of COVID-19 will take months. Three fundamental interventions that have been very beneficial in stopping previous outbreaks of infectious diseases, i.e., MERS and SARS can slow and eventually this one as well. These interventions are the following

1. Exhaustive case and contact finding

2. Effective response to patients and the community

3. Preventive interventions

1) Rapid identification of infected individuals requires accessible diagnostic and treatment facilities. In the current COVID-19 outbreak, the number of patients has far exceeded local capacity, which has resulted in a vicious cycle in which more cases lead to overloading of facilities which leads to more cases. Laboratory diagnosis of patients with COVID-19 via real-time polymerase chain reaction is sensitive and specific and this is now widely available in the affected areas.

2) Responding to cases involves isolation and treatment of patients, contact tracing, and monitoring each contact for at least 14 days post-exposure. It is difficult to isolate and care for patients with COVID-19 as the disease is particularly infectious. Strict attention to personal protective equipment i.e., gown, glove, mask, and eye protection is the key while dealing with the COVID-19 patients. An improvised control in hospital infection throughout the affected region would prevent a substantial number of COVID-19 cases. Soap and water or alcohol-based hand sanitizers could be used to decontaminate surfaces and are easily available in remote settings.

3) Provision of supportive care and therapies can significantly improve the survival rate. Contacts need to be identified and their temperature monitored daily for 14 days after exposure. If anyone develops fever, he/she needs to be immediately isolated and tested.

Following are the three key preventive interventions.

1. First is infection control in health-care settings. The greatest risk of transmission is not from patients with diagnosed infection but from delayed detection and isolation. As the early symptoms of COVID-19 (fever, cough, running nose and weakness) are nonspecific, there is a potential risk that patients infected with COVID-119 may confuse these symptoms with other respiratory disorders i.e. flu and may expose family caregivers, health-care workers, and other patients before confirmed diagnosis.

2. Second, educating and supporting the community to keep social distancing and wearing facemasks to prevent contact with body fluids and sneezing droplets, until the outbreak is controlled. This will close the second major route of dissemination of COVID-19. Although, this is a culturally sensitive issue and therefore requires culturally appropriate outreach and awareness to people.

3. Avoid eating the meat of wild animals can reduce the risk of initial introduction of COVID-19 into humans at least temporarily until the confirmed source of COVID-19 is established.

If a single case is missed or a single contact becomes ill and is not isolated or there is a single lapse in infection control, another chain of transmission can restart another outbreak.

The quest for vaccine against COVID-19 and panic in developing countries

In addition to the above-mentioned control efforts, the quest for a vaccine against the novel SARS-CoV-2 is recognized as an urgent need. Currently, there is also a lack of knowledge regarding specific immune responses against SARS-CoV-2, which poses a challenge for vaccine development. Initial studies suggest that SARS-CoV-2 shares between 80% and 90% of its genetic material with the SARS-CoV.^6,7 Also, cell entry mechanisms and the human cell receptor usage by SARS-CoV-2 are very similar to that of SARS-CoV.^8,9 Due to this apparent similarity between these two viruses, previous research that has provided an understanding of protective immune responses against SARS-CoV may potentially be leveraged to aid vaccine development for SARS-CoV-2.

Once the vaccine for COVID-19 is developed, the problem will be to assure that the vaccine gets to all those who need it. In the current scenario of the COVID-19 pandemic, countries also have to compete with each other for vaccines. Mostly, pandemics tend to most affect developing countries with very fragile and unstructured health-care systems. There is a constant fear in poor nations that limited vaccine supplies will be purchased by developed countries, leaving poorer countries short of vaccine. WHO should bring together all the stakeholders, governments, and vaccine makers to a single agreement that ensures an equitable distribution of vaccines to all nations.

Fate of other vaccination programs under the fear of coronavirus outbreak in developing countries

All governments and their affiliated health departments are paying full attention to contain the COVID-19 outbreak. In this abnormal situation, underdeveloped countries may utilize all their available resources (lab facilities, infrastructure, and professional medical and paramedical staff) and health-care budget/funds to overcome COVID-19 outbreak for a period of time, thus ignoring the other very critical vaccination programs against already prevailing diseases in the country. If so, resurgence of these diseases might occur without adequate vaccination. As an example, Pakistan has many prevailing endemic and epidemic infectious diseases, including Poliomyelitis. Poliomyelitis has long been very challenging for Pakistan to control, and many factors have compromised the success of vaccination programs including insecurity, mass migration and displacement, and restricted access to the vulnerable population.¹⁰ During the COVID-19 outbreak, the Government of Pakistan has taken aggressive actions, i.e., total lockdown and social distancing. Also, all health-associated resources are being pushed to contain COVID-19, so there is a fear that the number of Poliomyelitis cases may rise in the coming months.

Childhood vaccination prevents >2 million deaths per year worldwide and is widely considered to be highly effective by the scientific community.^11,12 During the COVID-19 pandemic, childhood vaccination programs in Africa and Asia such as tuberculosis, Measles, Diphtheria, and Tetanus may also be hit hard.

The World Health Organization (WHO) and CDC should develop policies and guidelines to ensure how to prevent the resurgence of already prevailing diseases under the current scenario. If possible, WHO should provide support to developing countries with fragile economies in terms of funding and resources, so that other vaccination programs are not sacrificed inadvertently during the COVID-19 outbreak.

Conclusion

COVID-19 is a powerful reminder that any outbreak can be a risk everywhere. The WHO should aim to strengthen public health systems in developing countries that need it most to stop outbreaks before they become emergencies. We believe that stopping outbreaks in a way that leaves behind stronger systems to identify, stop, and prevent future health threats is a moral imperative.

Disclosure of potential conflicts of interest

The authors declared no conflict of interest.