The Coronavirus disease 2019 (COVID-19) has challenged the existing scientific knowledge and socioeconomic issues, and transformed the local and global societies over the period of pandemic. This article is an overview of the science behind the COVID-19-causing virus and the consequences of the unprecedented pandemic of 2020 to June 2022.
Author: Soee Park
Editor: Minjae Shin
Globally, over 557 million cases of COVID-19 are confirmed as of 16 July 2022 (WHO Coronavirus, 2022). Over the last 7 days as of the same date, the daily confirmed cases ranged from around 0.49 to 1 million. Since December 2021 when the new virus causing 'pneumonia'-like symptoms was announced by the Chinese government (Chilamakuri & Agarwal, 2021), the transmission of the COVID-19 has rapidly turned into the world's greatest pandemic due to the advanced transportation and trade network. The pathogen of the COVID-19 is now referred to as "severe acute respiratory syndrome coronavirus 2" (SARS-Cov-2), officially named by the international virus classification committee (Fathizadeh et al., 2021). The virus itself and the resulting pandemic shifted the worldwide lifestyle and led to both medical and socioeconomic consequences. To this date, the national and global response to continuous waves of variants are evolving, settling with an eased restriction policy. This article will review the science behind the virus, and major consequences of the pandemic on the global healthcare system and society.
Science behind the SARS-CoV-2
SARS-Cov-2 has a specifically-adapted structure for the process of infection. In general, viruses are small microbes that are often noted as "obligate intracellular parasites" as they are acellular and rely on the host cells for reproduction and survival (Parker et al., 2018; Gelderblom., 1996). The viruses are classified based on the size and shape, their genomes (either DNA or RNA, "single-stranded or double-stranded, and linear or circular") and the mode of replication (Gelderblom., 1996). The SARS-Cov-2 is around 60-140 nm in diameter and is usually spherical in shape with the anchored proteins. The protein called SARS-Cov-2 trimeric Spike glycoprotein gives the rough look of the virus' surface. It consists of two subunits, one of which is a N terminal of the spike 1 (S1) subunit that functions as a binding site to the angiotensin-converting enzyme 2 (ACE2) receptor on human cells (Chilamakuri & Agarwal, 2021; Mouffak et al., 2021). The virus has a 'single-stranded RNA', which is newly seen in humans and is one of the largest among those of other viruses. Because the RNA-consisting viruses are more prone to the genetic mutations compared to those with DNA genome, the variants rapidly evolve and adapt easily to the environment (Gelderblom., 1996). Commonly acknowledged, the replication of COVID-19 depends on the respiratory droplets and aerosols. The SARS-Cov-2 belongs to the family Coronaviridae and further to the Betacoronavirus genus, which is one of the four genera of coronaviruses that also the SARS CoV (that trended in 2002-4) and the MERS CoV (that trended in 2012) belonged to (Pal et al., 2020; Chilamakuri & Agarwal, 2021). They cause similar symptoms such as "fever, cough, … and lower respiratory signs"(Hu et al., 2020).
Involving the structures above, SARS-CoV-2 follows a general (yet specialized) route for replicating within and between the host cells. After the virus has invaded the host and its S1 subunit binds to the ACE2 receptor, another subunit called S2 fuses with the host's membrane with the help of the host protease (TMPRSS2) that activates the viral spikes and cuts the ACE2 enzymes (Mouffak et al., 2021; Chilamakuri & Agarwal, 2021). Followed by the pH-dependent endocytosis of the virus that involves the acidification of the endosomes, the viral genome is released directly to the cellular ribosomes where it enters a regular cycle. The genome is translated, replicated, and transcribed to synthesize the component proteins (eg, nucleocapsid that packages the viral genome) and form a new "virion" that is released for further replication via exocytosis. In theory, treatment drugs can be transported to a target region and inhibit a specific step of this process of replication. For example, an antiviral drug Arbidol (known as Umifenovir) inhibits the fusion of the virus with the membrane and is used against the influenza virus in Russia and China (not in the USA though) (Chilamakuri & Agarwal, 2021); this is under clinical trials for SARS-CoV-2 treatment. The drugs may inhibit the enzymes and viral proteins that take part in the replication, manipulate the concentrations of nutrients involved, or itself be the antibodies (eg, Sarilumab, which is under trials).
Challenges and chances on the healthcare system
The COVID-19 pandemic has raised important questions to the current healthcare system. According to the British Medical Association, more than 20% of the healthcare staff, who are working in an Aerosol-Generating Procedure area in the UK during the pandemic, "felt pressured … to see a patient without adequate protection" sometimes or often (COVID-19: The Impact, 2022). This jumps to more than 30 to 40% in case of the ethnic minority doctors, accordingly, raising the need to alleviate the inequity within the workers and improve the occupational system during the medical emergency. Also, the healthcare professionals were exposed to the transmission of the virus and many were unavoidably isolated, even within the healthcare network.
The infection and mortality rates in Africa were marked significantly low during the pandemic with total confirmed cases of around 9.2 million, accounting for only 1.64% of the world's total cases as of 16 July 2022 (WHO Coronavirus, 2022). However, modeling analysis by a team from the WHO regional office for Africa suggested a total of 505.6 million SARS-CoV-2 infections (including unreported and undetected cases) in the African region during 2020 and 2021 (Cabore et al., 2022). They used the epidemiological compartmental model called SEIRD (susceptible, exposed, infected, recovered and dead). Such a significant disparity between the recorded and estimated infections urges the advancement of surveillance systems (of hospitalizations and more) that helps accurately interpreting the damage of pandemic on developing regions.
On the other hand, the pandemic has brought a spotlight on telemedicine and relevant remote technologies that increase access to healthcare worldwide. The number of hospital visits has dropped in many regions including Taiwan, China, and the US, especially for internal medicine, family medicine and more (Chang, 2020). This is mainly due to the fear and anxiety over the infection of COVID, and in turn, prevents the senior citizens, children and others from visiting the clinics when needed. However, this has encouraged the development of remote methods of diagnosis, data-based study of prognosis, and digital resources of learning (Chang, 2020; Allen et al., 2020). The virtual doctor-doctor or doctor-patient meetings increased in number over the pandemic, not only for the diagnosis and treatment of COVID (Omboni et al., 2022). People can seek out diagnosis and treatment advice anywhere in the world over the digital environment, although such utilization is limited when the patient has no access to electronic devices or when the healthcare infrastructure is not well adapted for the service. Telemedicine is a good solution to the increased avoidance of the clinical visits and can even improve the worldwide access to health-related services. Also, any academic conferences and education, which share advanced knowledge on healthcare throughout countries, can be held virtually and made available for more (Allen et al., 2020). Some staff including physicists and dosimetrists can work from home, saving costs for infrastructure and supporting work-life-balance of the staff. Nevertheless, these transformations of the healthcare system are challenged by digital misinformation, limited interests of patients in low- and middle-income countries due to illiterature, limited engagement of clinicians in virtual environments, and lack of national policies (Omboni et al., 2022).
Changes and challenges on the society The impact of the pandemic on the world's economy is profound. Within and across all nations, many households were not able to afford the basic consumptions due to income losses and the global poverty increased significantly ("Chapter 1. the Economic", 2021). The income losses were more significant in the populations that were initially disadvantaged (ie, youths, women, self-employed who were not given formal education), expanding the economic disparities and inequality. Similarly, smaller businesses were more influenced than the major ones. During its economic recovery, many emerging economies were left with large debts to cover while it also dealt with an increased number of people living in extreme poverty (Impact of COVID-19, 2022). The report from the International Monetary Fund states that the aggregate outputs of advanced economies exceed its pre-pandemic forecast by 0.9% when those of emerging economies drop by 5.5% (Agarwal & Gopinath, 2021). This, according to reports by the World Bank and by the United Nations, is because it takes more time for the developing economies to regain its losses of livelihood and income ("Chapter 1. the Economic", 2021; COVID-19 Pandemic, 2022). Also, the global GDP would drop by $ 5.3 trillion than initially projected if the COVID-19 continues for another 5 years, with the important note that if any nation is left with the virus, the 'pandemic' has not ended (Agarwal & Gopinath, 2021). Further, according to the OECD Economic Outlook published in June 2022, the recovery of the GDP is profoundly affected by the Russo-Ukraine war (therefore disruptions in supply chains) and "the shutdowns in China due to a zero-COVID policy" (OECD Economic, 2022).
There are several studies that identify risks of prolonged mental disorders during and after the pandemic. For example, fully citing the study by a team at the University of Amsterdam, the COVID-19 pandemic has led to the dilemma of depressive and anxiety disorders (Bockting&Lokman, 2022). According to their analysis, the high infection rates have exposed oneself, one's family and friends to the fear and concerns over the transmission; and the lockdown later caused social isolation and limited access to the healthcare services, leading to the rise in the depressive and anxiety disorders. The study points out that such mental disorders would likely continue even after the pandemic is over, as the past episode of the disorder itself is often the trigger for the next. Furthermore, the COVID-19 pandemic has imposed another burden on the people with or at risk of eating disorders. Eating disorders such as binge-eating disorder (ie, eating excessively) and bulimia nervosa(ie, eating excessively, then inducing vomits or misusing laxatives) are "self-inflicted", meaning they are triggered by the negative stigma oneself has about their own body shape and eating habits (Zipfel et al., 2022). Those tend to hesitate seeking out help, and thus are at higher risks of suffering from the disorders when the access to healthcare services is limited during the pandemic.
The pandemic has indeed caused social stigmatization, since the very beginning in particular. Stigmatization refers to the public discrimination, or disapproval, that bases on the distinct characteristic of an individual or a group ("STIGMATIZATION," n.d.). During the pandemic, the fears of infection and social isolation have likely led to stigmatizing and blaming a particular group as a source of the disease (Bhanot et al., 2021). A qualitative study done in September, 2021, points out that many COVID-19 patients have experienced being isolated, labeled and blamed for catching the disease and felt pressured to disclose their infection history in fear of societal stereotypes (Chew et al., 2021). The wrongful perceptions on the COVID-19 infections are mainly due to the misinformation about the transmission process of virus and the disease's prognosis, which have been and can be further corrected via public addressments by governments and expert groups. Also, the misinformation about the patient group has directed the discrimation towards Asians, Chineses in particular, in most countries (Strassle et al., 2022). The disease indeed has originated from Wuhan, China, and any international travels to the near cities were restricted from the beginning (Abdelhafiz & Alorabi, 2020); these are facts. But the stigma that the Chinese populations are the source of the COVID are entirely false, created over fear and anxiety. In 2021, a study associated a greater tendency for anti-Asian sentiments with the social media hashtag of 'Chinesevirus' which is meant to refer to the COVID-19 (Chou & Gaysynsky, 2021). Furthermore, the United Nations has emphasized a need to address the social isolation of elderlies (who need the most support) during the pandemic, having announced an opposition to the wrongful perception that they are less prioritized for vaccinations and healthcare services than the working populations (Everyone Included, n.d.). The UN has encouraged the young generations to publicly support those in need (and minority groups) in person and via social media, in order to directly mitigate the COVID-related social stigma.
Conclusion
Everyone from any community and nation has the human right for the highest attainable standard of health (Constitution, n.d.). The WHO makes this clear, referring to "one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". During the pandemic, the maintenance of physical, mental and social health was challenged for the patients and families, healthcare workers, those of developing countries (emerging economies), those of different ethnicity/race, those at risk of mental disorders, and essentially every global citizen. It is important to 'know' what problems we are facing as a global community and take a step forward, reaching out to the minorities.
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