Working together let us do more to promote quality health care, in line with the United Nations Millennium Development Goals to halve poverty by 2014.
Deur samewerking kan ons meer doen om die kwaliteit van gesondheidsorg te verbeter, in lyn met die Verenigde Nasies se Millennium-ontwikkelingsdoelwitte om armoede teen 2014 te halveer.
Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 . It was first identified in December 2019 in Wuhan, Hubei, China, and has resulted in an ongoing pandemic. The first confirmed case has been traced back to 17 November 2019 in Hubei. As of, more than cases have been reported across countries and territories, resulting in more than deaths. More than people have recovered. Common symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste. multi-organ failure, septic shock, and blood clots. The time from exposure to onset of symptoms is typically around five days, but may range from two to fourteen days. The virus is primarily spread between people during close contact, most often via small droplets produced by coughing, sneezing, and talking. The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances. Transmission may also occur through smaller droplets that are able to stay suspended in the air for longer periods of time. Less commonly, people may become infected by touching a contaminated surface and then touching their face. Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using CT imaging for routine screening. Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others, quarantine, covering coughs, and keeping unwashed hands away from the face. The use of cloth face coverings such as a scarf or a bandana has been recommended by health officials in public settings to minimise the risk of transmissions, with some authorities requiring their use. Health officials also stated that medical-grade face masks, such as N95 masks, should only be used by healthcare workers, first responders, and those who directly care for infected individuals. There are no vaccines nor specific antiviral treatments for COVID-19. The World Health Organization declared the COVID‑19 outbreak a public health emergency of international concern on 30 January 2020 and a pandemic on 11 March 2020. Signs and symptoms Fever is the most common symptom of COVID-19, In one study, only 44% of people had fever when they presented to the hospital, while 89% went on to develop fever at some point during their hospitalization. Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains. Symptoms such as nausea, vomiting, and diarrhoea have been observed in varying percentages. Less common symptoms include sneezing, runny nose, sore throat, and skin lesions. Some cases in China initially presented with only chest tightness and palpitations. A decreased sense of smell or disturbances in taste may occur. Loss of smell was a presenting symptom in 30% of confirmed cases in South Korea. As is common with infections, there is a delay between the moment a person is first infected and the time he or she develops symptoms. This is called the incubation period. The typical incubation period for COVID‑19 is five or six days, but it can range from one to fourteen days with approximately ten percent of cases taking longer. An early key to the diagnosis is the tempo of the illness. Early symptoms may include a wide variety of symptoms but infrequently involves shortness of breath. Shortness of breath usually develops several days after initial symptoms. Shortness of breath that begins immediately along with fever and cough is more likely to be anxiety than COVID-19. The most critical days of illness tend to be those following the development of shortness of breath. A minority of cases do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested, and their role in transmission is not fully known. Preliminary evidence suggested they may contribute to the spread of the disease. In June 2020, a spokeswoman of WHO said that asymptomatic transmission appears to be "rare," but the evidence for the claim was not released. The next day, WHO clarified that they had intended a narrow definition of "asymptomatic" that did not include pre-symptomatic or paucisymptomatic transmission and that up to 41% of transmission may be asymptomatic. Transmission without symptoms does occur. COVID-19 spreads primarily when people are in close contact and one person inhales small droplets produced by an infected person coughing, sneezing, talking, or singing. The WHO recommends of social distance; Aerosol transmission in such locations has not been ruled out. Surfaces are easily decontaminated with household disinfectants which destroy the virus outside the human body or on the hands. Sputum and saliva carry large amounts of virus. Some medical procedures are aerosol-generating, and result in the virus being transmitted more easily than normal. Estimates of the number of people infected by one person with COVID-19, the R0, have varied. The WHO's initial estimates of R0 were 1.4–2.5, however an early April 2020 review found the basic R0 to be higher at 3.28 and the median R0 to be 2.79. The virus may occur in breast milk, but it's unknown whether it's infectious and transmittable to the baby. Virology Severe acute respiratory syndrome coronavirus2 is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature. It is thought to have an animal origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples . Pathophysiology The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2, which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow. The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine. The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. A high incidence of thrombosis and venous thromboembolism have been found in ICU patients with COVID‑19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Another common cause of death is complications related to the kidneys. Autopsies of people who died of COVID‑19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung. Immunopathology Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein1, macrophage inflammatory protein 1-α, and tumour necrosis factor-α indicative of cytokine release syndrome suggest an underlying immunopathology. Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients. Lymphocytic infiltrates have also been reported at autopsy.]] The WHO has published several testing protocols for the disease. The standard method of testing is real-time reverse transcription polymerase chain reaction . The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within a few hours to two days. Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value. Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop polymerase chain reaction tests to detect infection by the virus., antibody tests were in development, but not yet widely used. Antibody tests may be most accurate 2–3 weeks after a person's symptoms start. The Chinese experience with testing has shown the accuracy is only 60 to 70%. The US Food and Drug Administration approved the first point-of-care test on 21 March 2020 for use at the end of that month. The absence or presence of COVID-19 signs and symptoms alone is not reliable enough for an accurate diagnosis. Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying people who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count. A study asked hospitalised COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers . Along with laboratory testing, chest CT scans may be helpful to diagnose COVID‑19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection. Pathology Few data are available about microscopic lesions and the pathophysiology of COVID‑19. The main pathological findings at autopsy are: Macroscopy: pleurisy, pericarditis, lung consolidation and pulmonary oedema Four types of severity of viral pneumonia can be observed: minor pneumonia: minor serous exudation, minor fibrin exudation mild pneumonia: pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation severe pneumonia: diffuse alveolar damage with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome and severe hypoxemia. healing pneumonia: organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis plasmocytosis in BAL Blood: disseminated intravascular coagulation ; leukoerythroblastic reaction Liver: microvesicular steatosis Prevention A COVID-19 vaccine is not expected until 2021 at the earliest. The US National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. The US Centers for Disease Control and Prevention and the World Health Organization recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symtomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Distancing guidelines also include that people stay at least apart. After the implementation of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate of less than one, meaning the disease is in remission in those areas. The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. The CDC further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items. Sanitizing of frequently touched surfaces is also recommended or required by regulation for businesses and public facilities; the United States Environmental Protection Agency maintains a list of products expected to be effective. On 7 July 2020, the WHO said in a press conference that it will issue new guidelines about airborne transmission in settings with close contact and poor ventilation. For health care professionals who may come into contact with COVID-19 positive bodily fluids, using personal protective coverings on exposed body parts improves protection from the virus. Breathable personal protective equipment improves user-satisfaction and may offer a similar level of protection from the virus. The CDC recommends those who suspect they carry the virus wear a simple face mask. Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity. Supportive treatments may be useful in those with mild symptoms at the early stage of infection. The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health have published recommendations for taking care of people who are hospitalised with COVID‑19. Intensivists and pulmonologists in the US have compiled treatment recommendations from various agencies into a free resource, the IBCC. Prognosis The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. Pregnant women may be at higher risk of severe COVID‑19 infection based on data from other similar viruses, like severe acute respiratory syndrome and Middle East respiratory syndrome, but data for COVID‑19 is lacking. According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, A European multinational study of hospitalized children published in The Lancet on June 25, 2020 found that about 8% of children admitted to a hospital needed intensive care. 4 out of 582 children died, although the actual mortality rate could be “substantially lower” since milder cases that did not seek medical help were not included in the study. Comorbidities Most of those who die of COVID‑19 have pre-existing conditions, including hypertension, diabetes mellitus, and cardiovascular disease. The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 97% of people had at least one comorbidity with the average person having 2.7 diseases. According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, people transferred to an ICU had a median time of seven days between hospitalisation and death. In a study by the National Health Commission of China, men had a death rate of 2.8% while women had a death rate of 1.7%. In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest. According to March data from the United States, 89% of those hospitalised had preexisting conditions. Most critical respiratory comorbidities according to the CDC, are: moderate or severe Asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Current evidence stemming from meta - analysis of several smaller research papers, also suggest that smoking can be assosiated with worse patient outcomes When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage. Complications and long-term effects Complications may include pneumonia, acute respiratory distress syndrome, multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID‑19 have elevated liver enzymes reflecting liver injury. Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome . Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage. This may also lead to post-intensive care syndrome following recovery. Immunity It is unknown if past infection provides effective and long-term immunity in people who recover from the disease. Some of the infected have been reported to develop protective antibodies, so acquired immunity is presumed likely, base
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We have set ourselves the goals of further reducing inequalities in health care provision, to boost human resource capacity, revitalise hospitals and clinics and step up the fight against the scourge of HIV and AIDS, tuberculosis (TB) and other diseases.
Ons het vir onsself ten doel gestel om ongelykhede in gesondheidsorg verder te verminder, om mensehulpbronkapasiteit te verhoog, om nuwe lewe in hospitale en klinieke te blaas en die geveg teen die aanslag van MIV en Vigs, TB en ander siektes te verskerp.