DISEASE OUTBREAKs – Endemic, Epidemic, Pandemic

Disease Outbreaks – Endemic, Epidemic, Pandemic

The world is scared of the new coronavirus outbreak. Around 80,000 confirmed cases, more than 2,500 deaths and numbers keep growing every day.

A disease outbreak can spread rapidly killing thousands. It is declared when more cases of a disease than expected are recorded in one area, either within a small community or several countries.

An outbreak could be a single case of a contagious disease new to a community or not seen for a long time, lasting for a few days or several years.

There are three types of outbreak:

Endemic: An outbreak of a disease that exists permanently, in continuity, in a particular region or population not spreading to other communities.
It occurs at a predictable rate in a certain area or among a set population.

Chickenpox is endemic as it occurs at a high but predictable rate, amongst youngsters.

Endemics remain in a steady state but do not disappear from a population.

Epidemic: An outbreak of a transmissible, infectious disease that attacks a community and rapidly spreads amongst a large number of people, through one or several communities.

Between 2013 and 2016, the Ebola epidemic in West Africa killed 11,300 people.

In 2003, SARS epidemic killed nearly 800 people.

In 1968, Hong Kong influenza killed one million people.

In 1957, Asian influenza killed two million people.

In 1918, Spanish influenza killed 40-50 million people.

Pandemic: A pandemic is the worldwide spread of a new infectious disease. It stretches over a larger area, infects more people and causes more deaths than an epidemic. A pandemic causes severe economic and social disruption due to high rates of illness and worker absenteeism, especially when affectting key services such as transportation, communication, or power.

In history, there have been a number of devastating pandemics including the Black Death which killed more than 75 million people in 1350.

In 2009, a pandemic of swine flu killed 14,286 people worldwide.

A viral pandemic occurs when:
▪ A new subtype of virus arises. As humans have little or no immunity to it, everyone is at risk.
▪ The virus spreads easily from person to person
▪ The virus begins to cause serious illness worldwide. With the speed of air travel today, public health experts believe that pandemic outbreaks could spread much more quickly. All parts of the world may not be affected at the same time.

The New Coronavirus
The new coronavirus is a new strain of the large family of viruses that has not been previously identified in humans. It is related to the common cold.

Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Several known coronaviruses are circulating in animals that have not yet infected humans.

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and death.

Standard recommendations to prevent infection spread include regular hand-washing and covering mouth and nose when coughing and sneezing. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

While the new coronavirus is more widespread in China than SARS, in terms of case numbers, the mortality rate remains considerably lower at approximately 2%, according to WHO.

How do viral infections spread?
Viruses are very small infectious agents that can only replicate inside other living cells.
They can be spread from person to person in several ways:
▪ coming into close contact with a person who has a viral infection
▪ contact with the body fluids of a person with a viral infection
▪ transmission from mother to child during pregnancy or birth
▪ coming into contact with contaminated surfaces

Which infections are treated with antibiotics?
Antibiotics are used to treat bacterial infections and are not effective against viral infections.

Over-prescription of antibiotics is dangerous. It can lead to antibiotic resistance.

Antibiotic resistance occurs when bacteria adapt to resist to certain antibiotics making bacterial infections more difficult to treat.

When prescribed, the entire course of antibiotics must be taken as when not taking all the doses, not all the bacteria are killed.

How are viral infections treated?
Treatment is typically focused on relief of symptoms supporting the body to clear the infection. Antiviral medication that inhibits the viral life cycle may help to treat the condition.

The fear!
WHO characterised, globally, the coronavirus epidemic as a “very grave threat”. The need to aggressively prevent a new pandemic is real, even if the threat to us is not immediate.

The present epidemic carries an extra charge of fear only because the virus is new, initially unknown and the danger it poses, though limited so far, cannot be precisely calculated.

People are frightened and there is good reason for that. The appearance of any virus that threatens our existence comes as a nasty shock as we do not normally think of ourselves as living in an ocean of viruses and bacteria, inside and outside our bodies.

Best health wishes,
Maria Alice

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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service. Medical Director – Grupo Hospital Particular do Algarve/ Hospital S. Gonçalo de Lagos