COVID-19

EPIDEMIOLOGY AND
RESPONSE
GROUP IV

OCTOBER 24, 2020

 Group Members
• Martha Shoarega • Selamawit Assefa
• Nahom Tadele • Semere Negash
• Semira Hassen
• Orion Daniel • Shemisa seid
• Rahel Gashu • Shewit Abate
• Rediet Mesfin • Sifessa Desalegn
• Roman Getachew
• Ruhama Enyew
Outline
• Introduction

• Cause

• Epidemiology

• Clinical manifestation and diagnosis

• Prevention and control

• Current response to control the disease in Ethiopia

• Way forward
Introduction
• Coronaviruses are family of respiratory viruses

• A novel coronavirus emerged in 2019 in the city of Hubei, province of China after
rapid increase of surge of viral pneumonia that eventually identified as SARS-CoV-2
Cont’d
Cause
• Large family of viruses that cause respiratory illness
• Belongs to Coronaviridae family

• First isolated in the 1960s

• Circulates among animals and humans (zoonotic)

Cont’d

• SARS- CoV-2,

• Largest known RNA Virus,

• Uses SARS CoV receptor, ACE2 to host cell entry

• Use TMPRSS2 (Trans-membrane protease, serine 2)

• Diameter 125 nm average

• Spike 74

• Has lipid bilayers (membrane, Envelope (E) and spike (S))

Epidemiology
Covid19 cases up to October 23, 2020
Covid19 World Africa Ethiopia

Total cases 42,169,196 1,698,949 91,693

Recovered 31,268,238 1,392,218 45,260

Death 1,144,930 40,814 1,369

Transmission

• Direct Person to person – primary mode

 Air borne inhalation
 Environmental contamination
 Vertical transmission – uncommon
 Animal contact – No evidence of major source of
infection
How Contagious is covid19?
• R0 (Attack rate or transmissibility)

• Represents the average number of people to which a single infected person will
transmit the virus

• WHO’s estimate (1.4 - 2.5 )

• Preliminary studies had estimated 1.5 -3.5

• An outbreak with a reproductive number of below 1 will gradually disappear

• The R0 for common flu is 1.3 and for SARS it was 2.0
Clinical Features
• Mild upper respiratory tract illness: above 80% of cases
• Fever in 43%

• Cough in 50%

• Sore throat in 20%

• Nasal congestion in 10%

• Headache in 34%

• Myalgia in 36%
 Cont’d

• Other symptoms include

• Diarrhea in 19%

• Vomiting in 12%

• Abdominal pain in 10%

• Smell or taste disorders in 10%

• Anosmia and dysgeusia

• Delirium and confusion especially in old patients

• Dermatologic: Covid toes (Reddish-purple nodules on the distal digits)

Cont’d…

• Pneumonia- the most serious presentation

• Cough

• Fever

• Shortness of breath

• With finding on chest imaging- Bilateral infiltrates

Spectrum of Severity
Mild disease (no or mild pneumonia) was reported in 81 percent.

Severe disease (eg, with dyspnea, hypoxia, or >50 percent lung involvement on imaging

within 24 to 48 hours) reported in 14 percent.

Critical disease (eg, with respiratory failure, shock, or multiorgan dysfunction) in 5

percent.

The overall case fatality rate was 2.3 percent; no deaths were reported among noncritical

cases.
Risk factor for disease Severity
• Severe illness may occur in a healthy individual but more common in patients with advanced age or
comorbidities such as:
• Cardiovascular disease

• Diabetes mellitus

• Hypertension

• Chronic lung disease

• Cancer (in particular hematologic malignancies, lung cancer, and metastatic disease)

• Chronic kidney disease

• Obesity

• Smoking
Diagnosis
• SARS-COV 2 RNA PCR (RRT-PCR)- gold standard
Nasopharyngeal swab specimen- 70- 80% sensitivity

Nasal swab specimen from both anterior nares- 94%

Nasal mid-turbinate swab- 96%

Oropharyngeal swab specimen- 34-40%

Broncho alveolar lavage; Tracheal aspirate- 94%

 Supplementary Laboratory findings

• Lymphopenia

• Neutrophilia
• Elevated levels of serum alanine aminotransferase and aspartate aminotransferase

• Elevated lactate dehydrogenase level

• High C-reactive protein (CRP) level

• High ferritin levels

• Elevated D-dimer
Additional tests
• Serologic test
• IgG and IgM antibodies

• To identify prior or latent infection

• Limited use in diagnosis cause they take several days to weeks of infection to be
reactive.

• Stool PCR testing

• Viral culture: not usually used for safety reasons

Imaging
• Chest radiograph: typically demonstrate bilateral air-
space consolidation
 Cont’d

• Chest CT: bilateral, peripheral ground-glass opacities with or without

consolidation.
• With a sensitivity of up to 97%; specificity of 25-30%

• NPV of 95% and PPV of 70-85%

Chest Ct scan of a patient with Covid 19 Pneumonia

Management
• Mainly supportive

• Vaccines – clinical trials are under way

• Remdesivir – got FDA approval on Oct 22, 2020 for treatment of

covid19 for hospitalized patient age 12 and above
 26

Big concept
PREVENTION IS THE BEST MEDICINE!!!
PREVENTION AND CONTROL
Public health measures
• break chains of person-to-person transmission
• time-tested and core

• identification,

• isolation, testing, and clinical care for all cases, and

• tracing and quarantine of all contacts

Personal measures
• Frequent hand hygiene,

• Physical distancing,

• Respiratory etiquette,

• use of masks if ill or attending to someone who is ill, and

• environmental cleaning and disinfection at home

Physical and social distancing measures
• physical distancing,
• reduction or cancellation of mass gatherings,
• avoiding crowded spaces in different settings (e.g. public transport,
restaurants, bars, theatres),
• working from home,
• staying at home, and
• supporting adaptations for workplaces and educational institutions
Physical and social distancing measures
 Movement measures
• limiting movement of persons locally or nationally,

• offering guidance regarding travel,

• arranging orderly travel in advance to avoid congestion at travel hubs,

including train stations, bus terminals and airports
 Covid 19 every day prevention action
• There are a number of various action to prevent COVID-19 infections these includes:

-Avoid touching your mouth , Eyes and nose.

- Avoid close contact with people who are sick.

* remember that some people with out symptoms can still spread The virus.

- Stay at home when you are sick.

- cover your cough or sneeze With a tissue and dispose of it properly.

Continue

• Use a face covering when A physical distance is difficult or going to a closed

places.

Physical distancing should be at least 2 meters (6ft).

. Clean and disinfect frequently touched objects and surfaces.

. Perform hand hygiene frequently with soap and water Or alchol based hand rub

* hand rub should at least contain 60% alcohol.

Monitor your health daily

• Be alert for symptoms , watch For fever, cough and shortness of

breath and other symptoms of covid.

* especially Important if you are running Esential errandes, going in to

the offices, work place and in settings where it may be difficult to keep
a physical stand of 6feet.

. Take your tempreature if symptoms develop.

ASSESSMENT OF THE CURRENT
CONTROL OF THE DISEASE IN
ETHIOPIA
 Various measure
The government of Ethiopia has taken various measure in responding to control and preventing spread
of covid 19:

1. Public health measure

2. Economic measure

3. Social measure

1. Public health measure

- case identification, contact tracing , isolation and quarantine of all traveler.

- providing easily accessible hand washing station to public.

- mandatory face mask in public setting and creating awareness through different media platform.
Continue…
2. Economic measure
- tax exemptions, interest rate reduction , loan rescheduling
- 5 month state of emergency where rent is controlled, layoff is illegal and
job security where no employee cant be fired.
- launched the P.M dr abiy –jackma initiative has delivered coronavirus donation which
includes medical supplies to 46 countries.
3. Social measure
- physical distancing , public service closure , limit public gathering like religious gathering,
region launched.
- school closures and lock down (partial lock down , state of emergency and stay home)
- transportation- public transportation has been recalled to carry limit passengers and the
air lines was closed most flight schedule to different countries.
-Granted pardon for 20,420 prisoner
- Postponed parliamentary and presidential elections.
Major obstacles
• According to WHO report , Ethiopia scored 52% i.e. has work to do to prepare
for epidemic , the WHO reports stated that Ethiopia has committed to improve
preparedness.
• With the second largest population in Africa and In being a developing country.
Ethiopia faces major obstacles and hurdles to overcome this pandemic such as
- the pandemic affected access to health services, social service, such as
E.g. difficult in buying medicine
- shortage of medical personnel
- shortage and high prices of medicine
- lost follow up of chronic illness.
 Continue..
• Also health facilities are not adequate to treat patient and where self
isolation after being infected is not feasible because of economic and
housing conditions.
• Transportation – double fold of transportation fees proved another financial
strain to those living in low income housing.
• Where school can be conducted virtually through Skype/zoom here in
Ethiopia that is not an option can be implemented.
• Here in Ethiopia despite the government trying to educate its citizens
regular behavioral and sociocultural norms is proving to be a challenge
.There is still a huge lack of knowledge. Some of citizens don’t even know
why the safety measures are put in place and how to adequately protect
themselves.
Impact of covid 19 on the regular health service
- The WHO in a three week period of survey in may 2020 by
involving 155 countries has revealed that more than 53% of
services for hypertension, 49% for diabetic mellitus ,42% for
cancer and 31% for cardiovascular emergency treatment have
been disrupted because of the covid 19 pandemic.
- 94% of the ministry of health staff working in the area of non-
communicable diseases was partially or fully reassigned to covid
19 activities.
- WHO had also disclosed that 68 countries have suspended the
vaccination program.
- Unfortunately and exceptionally , many of the non-communicable
disease could not allow individuals to buy more time like the
majority of the communicable disease. E.g cancer patient may
advance from operable to non-operable stage, remission with
radiotherapy & chemotherapy becomes impossible.
Continue
• The same is true for poorly controlled hypertension disease, diabetic
mellitus, chronic kidney failure and cardiac or heart emergencies.
• These days , a few surviors of covid 19 are also pubilically and
privately expressing their grievances with the discrimination and
stigma can worsen the spread of the virus and severity of illness.
• Also most of low income countries will suffer from mental illness due
to decreased income, stress .
 Moving forward With corona

 The COVID 19 pandemic has shown many of the over looked cracks in
countless parts of our lives and moving forward those flaws should be
addressed. Here we will try to classify the challenges that were faced in to
major groups and moving forward ideas to each

1. Inter-sectoral cooperation
- Acknowledging and addressing the political & policy issues effect on the
health sector.
- major players in the prevention like water, sanitation and hygiene sectors
need to have fundament structural evaluation and changes.
- Manage the mistrust and unattainable expectation of the public on the
2. Socio-economic aspect

- Urban area slums should be addressed, their living conditions & basic
living demands in line with social distancing & staying at home.

- Continued gov’t support to vital sectors like agriculture, manufacturing,

basic exchanges of goods, health sectors

- Managing job loses and safety net programs

3. Health institutions and staff
- Work on the quality to quantity disproportion that is clearly seen should be managed

- Balancing the basic response with combating COVID 19

- Up-to-date disaster preparation in all institutions country wise, what to do, how, when and
who will be responsible for what.

- Staff burn out, dissatisfaction, low level motivation at work place need to be addressed.

- Be very wary of the Non-Covid health problems including other communicable and non-
communicable diseases which have long been ravaging this country and are expected to be
even more pronounced due to the strain the pandemic puts on the healthcare system.
4. Public health aspect
- Deeper researches into how the virus is presenting, how its affecting us, response, prevention, what is
working and what isn’t according to our context should be conducted.
- More work on the general public on general health conditions, healthy living styles, exercise & etc
should be done.
- Widening, strengthening and sustaining public awareness campaign should be done incessantly

- Mental health of the general public, health care workers and those suffering from actual mental health
disorders, as most neglected part of COVID19 response and adverse effect of social isolation needs more
focus moving forward.
 5. THE Education system

• One of the major impacts of the COVID-19 is its effect on the entire educational system.

• Advance planning and parental information are needed about this academic year, that is, when schools

(kindergarten, primary, secondary, and university education) would be opened, which by our

opinion the government had given good emphasis and is well on the way on the implementation of the

plans

• Yet, there are a lot of wrinkles to iron on practicality of some of the plans including availability of

teachers, students (especially in the rural areas), adequate classrooms, risk of cluster formation and

meeting the adequate standard in the limited time of the year.

Key role players
- Mass media in the time of 21st century can alter the perception of a society in a powerful
and positive way if fed the right information.

- Religious institutions have unprecedented capacity to influence the public in their

respective beliefs especially applying preventive behaviors.

- All government administrative branches should work in tandem in planning and

implementing of strategies on how to continue with COVID 19

- Other NGOs and Foreign partnership should be as strong and supportive as ever be

- But, most of all, the large population takes the lion share of responsibility in complying
with the preventive measures the government puts forward
Additional challenges in the way forward

• The political tension takes our eyes off the ball and makes effective communication and response difficult

• Failure to keep peace and security, leading to people migrating into and concentrate into a small area will aggravate

the already rampant community transmission

• The ongoing locust swarm endangers large population to hunger (who thinks of a virus when one is famished)

• Natural disasters like the flooding we have seen in different regions which also leads to the aforementioned scenario

• Difficulty in keeping/sustaining the supply chain of materials needed to combat the pandemic

• ***AND WE ARE JUST POOR****

References
• Assessment of COVID-19 Effects and Response Measures in Ethiopia: Livelihoods and Welfare
Implications: Degye Goshu, Mengistu Ketema, Getachew Diriba and Tadele; Ferede Policy
Working Paper 04/2020
- Assessment of covid-19 effects and response measures in ethiopia:livelihoods and walfare
implications done by degeye goshu, mengistu ketema, getachew diriba published on july 2020
- The corona virus disease 2019(covid 19) strategic response plan for the WHO African region,
4 may 2020 by WHO.
- National comphrensive covid 19 clinical management hand book of ethiopia-second edition
sep 2020 minister of health of ethiopia.
- Containment of covid 19 in ethiopia and implications for TB care and research published 16
sep 2020 by hussen mohammed, lemessa jira, tsegahin manyazewal.
- Uptodate 2020