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THE ORIGINS OF ‘CRISIS’, ‘PANDEMIC’, ‘EPIDEMIC’ AND ‘OUTBREAK’ IN THE SPREAD OF NOVEL CORONAVIRUS

By Rayvenn Shaleigha D’Clark

From 23 March, we all must stay at home (BLF, 2020). 


The spread of the novel coronavirus SARS-CoV-2 was officially defined as a pandemic by the World Health Organization (WHO) on March 11, 2020, due to its sudden emergence and expansion around the world.

The Government has now published a Coronavirus Action Plan and this also talks about the role for self-isolation, which could potentially include wider groups of people across the UK, in order to safeguard against people who have symptoms such as a cough or fever. This recognises that we are seeing more cases of coronavirus in the community and concerns that the virus may begin to spread. 

‘In the midst of a global crisis, the truth is a powerful tool. It has become overwhelmingly apparent that the news has rarely been so relentless, so bewildering…’ declares The Guardian in their press statement immediately following a 2020 report on the unfolding COVID-19 pandemic. 

Please use the NHS 111 online coronavirus service if you feel you cannot cope with your symptoms at home or your condition gets worse – Use the 111 coronavirus service – Only call 111 if you cannot get help online.

For all the latest news and updates on Coronavirus, please access the following links:

  • https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

  • https://www.gov.uk/coronavirus

  • https://www.nhs.uk/conditions/coronavirus-covid-19/

  • https://www.bbc.co.uk/news/health-51849070

In this article, I thought it necessary to demystify for our younger audiences (many of whom may never have experienced a global pandemic such as this) the origin of the terms and the distinction between the different characteristics being attributed to the virus, as well as offer practical ways to prepare oneself, your loved ones and finally, a brief history (for further context) of how many previous events, similar to COVID-19 have affected the world throughout history.

I was personally inspired to write this piece of content after watching a video that was posted on Linkedin. Now to be clear, I seldom use Linkedin as a form of social media, but under current conditions (‘beggars can’t be choosers’) I feel it necessary to seek out different forms and formats for reportage in order to be able to give myself the best change and gain some sense of ‘truth’ in a media system that has been undeniably tainted with sensationalist ‘fake’ news. 

All jokes aside, however, I have always thought that we should all take the coronavirus seriously; not just in understanding the personal (economic) loss or physical restrictions we will face, or the risk of boredom that we all may fall into, but that this is real life and so, at this point any information we (collectively and culturally) have about it, its effects, how to prepare and protect against it is beneficial. However, please also understand (and be mindful) that in this context it is important to streamline the flow of corona related content as it is, for many, overwhelming and continues to contribute to ongoing anxiety for a lot of people – especially communities of colour – who feel that they have lost their sense of agency in being effectively cut off from their wider community. In my personal experience, my angst surrounds the sense of loss I feel at being unable to kiki with my only remaining grandparent, my grandmother Evonne.

So this piece of content is dedicated to all of those who are still very unsure about what COVID-19 actually is and aims to provide a clear and digestible context for corona whilst also presenting the opportunity to share your own knowledge, thoughts and feelings and ‘feel-good’ articles or resources on the subject. 

However, we need to be careful to not spread false information and personal opinion.

*Trigger Warning*

Feel free to view the following video featuring The Telegraph’s Global Health Security Editor Paul Nuki who breaks down ‘what happens when you catch coronavirus’ and all the ways in which you could become infected with COVID-19 and how your body reacts to this virus.

Read the explanation on what happens to your body here as we all need to protect others from bad information.

This might also help a bit and this has only recently made its way into the public realm in contrasting against the scaremongering in debunking this ‘fake news’ related post that is making the rounds – Corona ‘fact-checked’: Coronavirus graphics you may have been sent on WhatsApp are not actually from Unicef, courtesy of Fun Fact, available via https://fullfact.org/health/coronavirus-graphics-unicef/ (11th Mar 2020)

Full Fact is the UK’s independent fact-checking charity who provide free tools, information and advice so that anyone can check the claims we hear from politicians and the media.

EXTRACT: You’ve probably seen a surge in misleading and unsubstantiated medical advice since the Covid-19 outbreak. If followed, it can put lives at serious risk. We need your help to protect us all from false and harmful information.  We’ve seen people claiming to be health professionals, family members, and even the government – offering dangerous tips like drinking warm water or gargling to prevent infection. Neither of these will work. The longer claims like these go unchecked, the more they are repeated and believed. It can put people’s health at serious risk when our services are already under pressure. Today, you have the opportunity to help save lives. Good information about Covid-19 could be the difference between someone taking the right precautions to protect themselves and their families, or not. Could you help protect us all from false and harmful information today?

Etymology: Crisis

The first known use of crisis can be dated back to the 15th century, borrowed from Latin word ‘crisis’ meaning  ‘judgment, critical stage’, borrowed from Greek ‘krísis’ which is the ‘act of separating, decision, judgment, event, outcome, turning point, sudden change.’

Etymology: Pandemic

The first known use of pandemic can be dated back to the 15th century borrowed from the Latin ‘pandemus’, from Greek ‘pandēmos’ meaning ‘of all the people’, from pan- + dēmos people.

Etymology: Epidemic

The first known use of epidemic dates back to the 17th century, borrowed from the French word ‘épidémique’ which characterises a disease affecting a large number of individuals.

Etymology: (Disease) Outbreak

The first known use of outbreak dates back to 1562 and can be defined (more generally) as a sudden or violent increase in (infectious/behavioural) activity.

Definitions: Crisis

A crisis is a time of intense difficulty or danger when a difficult or important decision must be made; affecting an individual, group, community, or whole society.

Crises are deemed to be negative changes in security, economic, political, societal, or environmental affairs, especially when they occur abruptly, with little or no warning.

Definitions: Pandemic

A pandemic is the global outbreak of a new disease and most people do not have immunity.

A pandemic is an epidemic of disease (first classification) that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of people. 

NOTE: Widespread endemic disease (such as recurrences of seasonal influenza) with a stable number of infected people is not a pandemic.  Feelings of fear, anxiety, sadness, and uncertainty are normal during pandemics.

Overlap:

While the terms may suggest that there is a specific threshold by which an event is declared an outbreak, (epidemic or pandemic) the distinction is often blurred, even among epidemiologists.  

Part of the reason for this is that some diseases become more prevalent or lethal over time, while others become less. But epidemics don’t always become pandemics, and it’s not always a fast or clear transition.

Epidemiologists are cautious about how they describe a disease event so that it is placed in the appropriate context, and also recognise that certain terms can incite undue panic and cause confusion. 

In addition, even when the word is used to define health issues, it may not accurately depict the scale or progression of a disease. In other instances, an epidemic may fall short in describing the scale of the problem and be better defined as a pandemic.

Definitions: Epidemic

An epidemic is a term that is (broadly) used to describe any problem that has grown out of control, or concerning a wide geographic area and affects an exceptionally high proportion of the population.

An epidemic is an event in which a disease is actively spreading. In addition, from an epidemiologic standpoint, terms like these direct the public health response to better control and prevent a disease.

Definitions: (Disease) Outbreak

An (disease) outbreak is a sudden increase in occurrences of something unwelcome, such as a rare (extinct) disease. An outbreak can last days or years. 

It may affect a small and localised group or impact upon thousands of people across an entire continent. As such, four linked cases of a rare infectious disease may be sufficient to constitute an outbreak. NOTE: It is important not to confuse a local epidemic (affecting just a city) with a pandemic because that implies the outbreak spread all over the world.

Examples: Crisis

Our global climate crisis is not just environmental but also economic because the world economy is going to be affected by it.

Examples: Pandemic

  • COVID-19 (WHO, March 12, 2020).

  • The Back Death (‘The Plague’) lasted from 1346–1353.

  • The ongoing aids/HIV pandemic in Africa (1920s). 

  • The Smallpox pandemic (last natural outbreak in the United States was in 1949).

  • The (SARS) pandemic of 2003.

  • The swine flu pandemic of 2009-2010 (H1N1) 

  • [The ongoing global] Tuberculosis (TB) pandemic which is the leading infectious cause of death worldwide.

Overlap:

Not only are people widely calling COVID-19 both an epidemic and pandemic, but they are also calling it an outbreak. 

On the other hand, a disease outbreak is also roughly synonymous with an epidemic.

Outbreak patterns are useful in identifying the transmission method or source and future prediction of the rate of infection.

Examples: Epidemic

The U.S. has been experiencing an opioid epidemic since 2017 (according to the U.S. Department of Health and Human Services).  The spread of infections, such as meningitis, sepsis, tuberculosis, malaria, and the Zika virus (2016)  are considered be epidemics

Examples: Disease Outbreak

There are several outbreak patterns and each will have a distinctive epidemic curve. Examples include:

  • The Ebola outbreak in West Africa in 2014-2016.

  • The Zika outbreak of 2016.

  • Seasonal influenza outbreak – particularly the 2009 case in the U.S.

  • The 2002 SARS coronavirus outbreak.

  • The 2012 MERS coronavirus primarily in the Arabian Peninsula and Saudi Arabia).

Types/Stages: Crisis

What are the types of crisis?

Technological, financial and natural crisis’.

What are the stages of a crisis?

  • Prodromal Stage (discovery)

  • Acute Stage (pre-crisis, public visibility) 

  • Chronic Stage

  • Resolution Stage (post-crisis)

Types/Stages: Pandemic

How do you prepare for/prevent a pandemic?

Preparing for a pandemic is a community effort that we can all take part in to lessen the impact of the illness on our communities and around the world.

A few well known strategies to prepare for a pandemic include:

  • Public awareness

  • Vaccination

  • Immunisation

  • Testing

  • Social distancing (in some cases)

  • Herding (in some cases)

Types/Stages: Overlap

The designation of the differences between preparedness and response which was redefined by WHO in 2009.

The WHO checklist is intended to be comprehensive and has been divided into the following main sections: 

  • Preparing for an emergency

  • Surveillance 

  • Case investigation and treatment 

  • Preventing spread of the disease in the community 

  • Maintaining essential services 

  • Research and evaluation

  • Implementation, testing and revision of the national plan

Types/Stages:

How do you prepare for/prevent a pandemic?

  • Phases 1 through 3 concerns predominantly animal infections. 

  • Phases 4 concerns sustained human-to-human transmission

  • Phase 5 through 6 (pandemic) concerns widespread human transmission

  • Post-peak concerns resolution alongside the possibility of a recurrence of the event

  • Post-pandemic concerns disease activity at seasonal levels

Types/Stages:

Types of outbreaks

Communicable outbreaksEnvironmental factors such water, sanitation, food and air quality 

Chemicals outbreaks – Exposure to chemicals or over-exposure to ionizing radiation.

Behavioral risk related Sexually transmitted diseases or malnutrition)

Zoonotic outbreaks – The disease is endemic to an animal population which is transferred to humans.

Patterns Occurrence

Endemic – A communicable disease which is characteristic of a particular place, or among a particular group, or area of interest or activity.

Epidemic – Found to infect a significantly larger number of people at the same time than is common at that time, and among that population, and may spread through one or several communities.

Pandemic – Occurs when an epidemic spreads worldwide.

Image Source

  • Visual Capatalist, n.d. Visualizing The History Of Pandemics. [image] Available at: <https://www.visualcapitalist.com/history-of-pandemics-deadliest/> [Accessed 21 April 2020].

Bibliography

  • Verywell Health. 2020. A Timeline Of COVID-19 (Coronavirus). [online] Available at: <https://www.verywellhealth.com/coronavirus-overview-4783291> [Accessed 21 April 2020].

  • Verywell Health. 2020. What Is Coronavirus (COVID-19)?. [online] Available at: <https://www.verywellhealth.com/coronavirus-covid-19-timeline-4798671> [Accessed 21 April 2020].

  • Barr, S., 2020. What Is Herd Immunity And Is It An Option For Dealing With The UK Coronavirus Outbreak?. [online] The Independent. Available at: <https://www.independent.co.uk/life-style/health-and-families/coronavirus-herd-immunity-meaning-definition-what-vaccine-immune-covid-19-a9397871.html> [Accessed 21 April 2020].

  • Healthline. 2020. Herd Immunity: What It Means For COVID-19. [online] Available at: <https://www.healthline.com/health/herd-immunity#stats> [Accessed 21 April 2020].

  • Davey, M., 2020. What Is A Pandemic And Does It Change The Approach To Coronavirus?. [online] The Guardian. Available at: <https://www.theguardian.com/world/2020/mar/14/what-is-a-pandemic-coronavirus-covid-19> [Accessed 21 April 2020].

  • YouTube, 2020. Coronavirus: What Is The UK’s Lockdown Strategy? – BBC Newsnight. [image] Available at: <https://www.youtube.com/watch?v=-sFLgK1f-4M> [Accessed 21 April 2020].

  • Davies, G. and Diver, T., 2020. UK Coronavirus Lockdown: What Are The Rules, And When Will It Be Lifted?. [online] The Telegraph. Available at: <https://www.telegraph.co.uk/news/2020/04/21/coronavirus-lockdown-uk-guidelines-rules/> [Accessed 21 April 2020].

Keywords/Definitions:

The Centers Disease for Disease Control and Prevention (CDC) 

CDC is a Health and Human Services agency that works to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

The World Health Organisation (WHO)

The World Health Organisation is a global Organisation dedicated to promoting health, keeping the world safe, and serving the vulnerable which began on 7th April 1948.

GOV.

gov.uk is a United Kingdom public sector information website, created by the Government Digital Service to provide a single point of access to HM Government services. GOV is a public sector information website which was launched on 31 January 2012

The National Health Service (NHS)

The National Health Service is the publicly-funded healthcare system of the United Kingdom. It is made up of four separate systems that serve each part of the UK: The National Health Service in England, NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland. They were established together in 1948 as one of the major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery. Each service provides a comprehensive range of health services, free at the point of use for people ordinarily resident in the United Kingdom,

Epicentre

An epicentre is a ‘focal point, as of activity.’ If a country or region is called the epicentre of pandemic disease, that means an accelerating number of cases are being confirmed there than anywhere else in the world. Sometimes an epicentre is called a ‘hotspot’. 

COVID-19 and SARS

Coronaviruses are a large family of viruses with some causing less-severe disease, such as the common cold, and others causing more severe disease such as the Middle East respiratory syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) coronaviruses.

Corona Symptoms

The main clinical features reported include a fever, cough or chest tightness, myalgia (muscle pain), fatigue (tiredness) and dyspnoea (breathing difficulty). However, a variety of abnormalities may be expected lung infiltrates appear to be common to viral pneumonia).

Public Health England has issued guidance on the investigation and initial clinical management of possible cases.

Herding or ‘Herd Immunity’

Herding is the act of bringing individual animals together into a group (herd). Herding can also refer to ‘Herd immunity’ which is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby providing a measure of protection for individuals who are not immune

Vaccine

A vaccination is a treatment which makes the body stronger against an infection. Vaccination involves introducing the immune system to something which acts very similar to a particular virus or bacteria, which helps the build immune levels so it can become stronger when it is fighting against the real infection. Therefore, biological preparation is required to produce a substance that can be used to stimulate the production of antibodies and provide immunity and act as an antigen to combat the disease without inducing the (microorganism, its toxins, or the surface proteins) disease more directly.

Remote Working (not to be confused with ‘flexible working’)

Remote working or ‘telecommuting’ is a working style that allows professionals to work outside of a traditional office environment where ‘remote’ employees can execute their projects from home or via mobile work and flexible workplace; this is a work arrangement in which employees do not commute or travel to a central place of work.

[Biological] Transmission

Biological transmission occurs when the pathogen (germ) reproduces (within a biological vector) that can be transmitted from one host to another. There are five main routes of disease transmission: aerosol, direct contact, fomite, oral and vector, achieved through direct contact (droplet) and indirect transmission (e.g. airborne transmission which can both ‘mechanical’ or ‘biologic’)

Social Distancing

Social distancing also called ‘physical distancing’ is a set of non-pharmaceutical interventions or measures used to prevent the spread of a contagious disease by maintaining a physical distance between people, reducing close contact and therefore the transmission of disease.

Quarantine

The act of placing an object or person in a state, period, or place of isolation away from the general populous. This is more explicitly used with people or animals that have arrived from elsewhere or been exposed to an infectious or contagious disease.

Lockdown

Lockdown is an emergency protocol that usually prevents people or information from leaving an area. The protocol can usually only be initiated by someone in a position of authority. In regards to COCID-19, Boris Johnson has placed the UK on a police-enforced lockdown with drastic new measures in the fight against the coronavirus outbreak alongside a potential ‘traffic light system’ on how the country will start to ease back to normality starting with small, low-risk businesses reopening, to school closures being lifted and eventually, bars and restaurants returning to normal.

Projections

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200316-sitrep-56-covid-19.pdf?sfvrsn=9fda7db2_2

A projection is an estimate or forecast of a future situation based on a study of present trends. In regards to COVID-19, this looks at forecasting the peak, risk assessment (preparedness and response, recommendations and advice), disease guidance, surveillance (incl. recording the number of deaths and new cases), transmission classification, epidemic curve, strategic outcomes and resolution of COVID-19 (in future tense).

‘Isolation’ versus ‘self-isolation’ versus ‘social distancing’

Isolation is the process or fact of isolating and/or being isolated.

Self-Isolation applies to people who have symptoms of a disease and people who live with them. Self-isolation is about protecting others and slowing down the spread of disease. It is very important that anyone who has a virus/disease/infection or might have been exposed to it limits the number of people they come into contact with for 14 days. This is the most effective way of preventing the disease from spreading. This category concerns people who are identified as being a close contact of someone with coronavirus and returning travellers are high risk.

https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Social Distancing concerns ways to avoid catching and spreading disease. This is about significantly limiting face-to-face contact if you can and making sure that essential visitors (such as health care services, carers or family members) follow handwashing and hygiene advice scrupulously. In the case of COVID19, you can go outside for a walk to the park or into your garden if you stay more than 3 steps (2 metres) from others.

Social Shielding

Social shielding applies to people whose long-term lung condition means they are at very high risk of severe illness from coronavirus. Shielding is a way to protect people who are extremely vulnerable from coming into contact with a disease by minimising all interaction between them and other people.

‘Essential’ & ‘Non-Essential’ Workers (hierarchical, but needing distinction)

  • Evening Standard – Coronavirus: Who are the key workers who can send their children to school amid coronavirus crisis?

  • BBC News – UK applauds the NHS and other key workers

  • 5 News – Coronavirus: Who are ‘key workers’ and why are they struggling?

[Partial] definitions as defined by https://www.dhss.delaware.gov/dhss/dph/php/files/defessnonessshocrole.pdf

Essential Employee Designation – An employee who is indispensable to the emergency service function and is required to assist in meeting its operational needs. This includes financial services, retail (sale of goods and services), health and wellness (nurses and doctors), key personal service (homecare such as plumbers, electricians and other providers who are important to the safety, sanitation and essential operation and nursing assistants), key public services (payroll and transport), supply chain (agriculture, import/export).

Non-essential Employee Designation – An employee who presence at work during an emergency is not required to assist in meeting operational needs. The employee is not required to report to work during an emergency. These are the businesses largely agreed to be nonessential art largely recreational in nature, as related to Arts & Culture, including galleries/museums, theatres/cinema, gyms and recreation centres, salons and spas, shopping malls and sporting and concert venues.

Furloughed

https://www.gov.uk/guidance/claim-for-wage-costs-through-the-coronavirus-job-retention-scheme

To be furloughed is to be granted a temporary leave of absence from work due to special needs of a company or employer, which may be due to economic conditions at the specific employer or in the economy as a whole. 

If you cannot maintain your current workforce because your operations have been severely affected by coronavirus (COVID-19), you can furlough employees and apply for a grant that covers 80% of their usual monthly wage costs. This is a temporary scheme in place for 4 months starting from 1 March 2020, but it may be extended if necessary and employers can use this scheme anytime during this period. 

Job Retention Scheme – It is designed to help employers whose operations have been severely affected by coronavirus (COVID-19) to retain their employees and protect the UK economy.

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