Pandemic Control COVID 19: The Results of Analytical Studies of Ten Health Systems in the Word. Scopus Review

Abstract

OBJECTIVES Description of the epidemiological situation of COVID-19 and analyze and compare between ten-health systems control epidemic around the word for use in public health system settings. METHODS This study was a descriptive, exploratory analysis of all cases of COVID-19 in the world especially in the ten countries. We conducted a Scopus review of the literature. Thirty articles are been recolted. RESULTS The estimates of human transmissibility (R0) range from 2 to 3. Pre-symptomatic transmission has been reported. The Incubation period is 5.1 days; the overall global case fatality rate is currently approximately 6%. The countries are characterized into three categories of pandemic control: excellent level of control fo r Germany, South Korea, Hong Kong and turkey a medium level for China, Morocco and a low level for the USA, France, Spain and Italy. CONCLUSION The present descriptive, exploratory analysis offers important new information to the international community on the Corona virus Pandemic in world. Important questions remain including determination of infectiousness period, identification of transmission routes, and effective treatment and prevention methods including further test development, drug development, and vaccine development.

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Journal of Clinical Cases and Reports
ISSN: 2582-0435 Clinical Review | Vol 3 Iss S4
Citation: Zaadoud Brahim, Pandemic Control COVID 19: The Results of Analytical Studies of Ten Health Systems in the Word. Scopus
Review. J Clin Cases Rep 3(S4): 3-8.
2582-0435/© 2020 The Authors. Published by TRIDHA Scholars.
3
Pandemic Control COVID 19: The Results of Analytical Studies of Ten
Health Systems in the Word. Scopus Review
Zaadoud Brahim
Department of Biophysics and Clinical MRI Methods, Clinical Neurosciences Laboratory, University of Fez, Ministry of
health, Morocco
Correspondence should be addressed to Zaadoud Brahim, zaadoud@gmail.com
Received: June 08, 2020; Accepted: June 21, 2020; Published: June 28, 2020
ABSTRACT
OBJECTIVES
Description of the epidemiological situation of COVID-19 and analyze and compare between ten-health systems control
epidemic around the word for use in public health system settings.
METHODS
This study was a descriptive, exploratory analysis of all cases of COVID-19 in the world especially in the ten countries. We
conducted a Scopus review of the literature. Thirty articles are been recolted.
RESULTS
The estimates of human transmissibility (R0) range from 2 to 3. Pre-symptomatic transmission has been reported. The
Incubation period is 5.1 days; the overall global case fatality rate is currently approximately 6%. The countries are
characterized into three categories of pandemic control: excellent level of control for Germany, South Korea, Hong Kong
and turkey a medium level for China, Morocco and a low level for the USA, France, Spain and Italy.
CONCLUSION
The present descriptive, exploratory analysis offers important new information to the international community on the
Corona virus Pandemic in world. Important questions remain including determination of infectiousness period,
identification of transmission routes, and effective treatment and prevention methods including further test development,
drug development, and vaccine development.
KEYWORDS
COVID 19; Pandemic; Health systems; Control diseases

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1. INTRODUCTION
In the past two decades two highly pathogenic human
coronaviruses, responsible for severe acute respiratory
syndrome (SARS-Cov) and responsible for Middle East
respiratory syndrome (MERS-Cov), [1,2] have emerged
in two separate events. A recent emergence, rapid
kinetics around the world and a "Severe" Infection
noticed On 29 December 2019 in China a clustering of
cases of unusual pneumonia with an apparent link to a
market that sells live fish, poultry and animals to the
public [3]. Officially named coronavirus 2 (SARS-Cov-
2). On 30 January 2020, the World Health Organization
declared that the outbreak of SARS-Cov-2 constituted a
public health emergency of International concern.
2. EPIDEMIOLOGY
The Chinese Centers for Disease Control (CDC) recently
reported that most of the confirmed cases were classified
as mild or moderate, 13.8% as severe, and only 4.7% as
critically ill. [4]. Advanced age (>60), male sex, and
comorbidities (particularly hypertension) are believed to
be risk factors for severe disease and death from SARS-
Cov-2 infection. Male sex was more predominant in
patients who died than in those who recovered. Chronic
hypertension and other cardiovascular comorbidities
were more frequent among deceased patients than
recovered patients [5]. Wang and al, report a relatively
high mortality rate for COVID-19 of up to 14.1%, which
is higher than in recent reports [6]. In accordance with
the recent reports on characteristics of patients with
COVID-19 who needed management in intensive care
units [6-8]. The median estimated incubation period is
five to six days (range 0 days to 14 days) [9]. The median
age of patients with a confirmed case is around 59 years
[10]. In adults, the most common symptoms at
presentation are cough (68%), fever (44%), fatigue
(38%), myalgia/arthralgia (15%), and headache (14%)
[10]. Initial data indicate that more than 80% of patients
have asymptomatic to moderate disease and recover, but
about 15% may get severe disease including pneumonia,
and around 5% become critically unwell with septic
shock and/or multi-organ and respiratory failure [11].
3. METHOD
Study design
This study was a descriptive, exploratory analysis of all
cases of COVID-19. We have opted for a comparative
and analytical approach to 10 data countries.
Pandemic control criteria
We have integrated the elements of primary and
secondary prevention as input to the health systems and
efficiency criteria as output.
Population data
Descriptive epidemiological indicators case number,
death and recovered and prevalence, Number of new
cases (Incidence); Case fatality ratio (CFR), Attack rate;
Basic reproduction rate (R0); Generation interval.
The management of the epidemic was very different
between the three groups in Asia (group A); the
European countries and the USA (group B) and Morocco
(Group C). the criteria for choosing countries was a
reasoned choice to encompass the different control
strategies and the continents most affected by COVID 19
and a representativeness of the continents especially for
Morocco which represents the African continent and the
developing countries. In Group ‘A’ for East As ian
countries (Chine, South Korea and Hong Kong), which
have mobilized effectively against the pandemic:
Targeted containment not generalized Good hygiene,
screening at will, monitoring and geolocalization of
contaminated persons Wearing a protective face mask is
mandatory in public places. In Group ‘B’ Europe
countries and United States (Italy, Spain, France,
Germany, United Kingdom and Turkey), most of the
containment decisions announced by the governments of

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Global Emergence of COVID-19
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these countries were taken late and Group ‘C’ for
Morocco.
The analysis
Confirmed cases, demographic and clinical
characteristics were summarized using descriptive
statistics. Case fatality rates were calculated as the total
number of deaths (numerator) divided by the total
number of cases (denominator), expressed as a percent.
Will be presented in the form of static and dynamic
comparative tables analysing the results in focus of the
interventions carried out with effectiveness indicators
(Deaths/1 million population, Critical care beds 100000
population, Hospital overcrowding, Research
investment). The ranking of countries is based on the
sum of scores from one to three assigned to each
variable.
Data source
31 Articles and report written on COVID 19 until April
15, 2020.
4. RESULTS
Transmission and dynamic of transmissibility
Recent epidemiological reports have provided evidence
for person-to-person transmission of the SARS-Cov-2 in
family and hospital settings [10,12].
Transmissibility (R0) range
An infectious disease outbreak can be characterized by
its reproductive number ‘R0’. Early estimates of the
attack rate in China range from 3% - 10%, mainly in
households [13]. The current estimates of R0 for the
SARS-CoV-2 outbreak in China range from 2.5 to 2.9,
with an associated all-age case fatality ratio estimated to
be 2.3% [14]. DHS Science and Technology High-quality
estimates of human transmissibility (R0) range from 2.2
to 3 [15]. SARS-CoV-2 is believed to spread through
close contact and droplet transmission, with fomite
transmission [6]. Pre-symptomatic or asymptomatic
patients can transmit SARS-CoV-2; between 12% and
23% of infections may be caused by asymptomatic or
pre-symptomatic transmission [16]. Modellers have
suggested reproductive rates (R0) of 3.8 (95% confidence
interval, 3.6 - 4.0) [17] and 2.6 (1.5 - 3.5) [18].
Clinical and symptoms
Asymptomatic transmission
Pre-symptomatic transmission has been reported;
exposure in these cases occurred 1 days - 3 days before
the source patient developed symptoms [19].
There is some evidence that spread from asymptomatic
carriers is possible, although it is thought that
transmission is greatest when people are symptomatic
[20]. Estimating the prevalence of asymptomatic cases in
the population is difficult. A modelling study found that
approximately 700 people with confirmed infection
(18%) were asymptomatic [21]. A recent modelling study
suggested that asymptomatic individuals might be major
drivers for the growth of the COVID-19 pandemic [19].
Incubation period
The best current estimate of the COVID-19 incubation
period is 5.1 days, with 99% of individuals exhibiting
symptoms within 14 days of exposure. Fewer than 2.5%
of infected individuals show symptoms sooner than 2
days after exposure [22]. The reported range of
incubation periods is wide, with high-end estimates of
11.3 and 18 days [10].
Clinical symptoms
Individuals can test positive for COVID-19 despite
lacking clinical symptoms. Individuals can be infectious
while asymptomatic [23] and asymptomatic individuals
can have similar amounts of virus in their nose and throat
as symptomatic individuals. Infectious period is
unknown, but possibly up to 10 days - 14 days [24].
Experimentally infected macaques were not capable of
being reinfected after their primary infection resolved
[25].

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Clinical diagnosis
PCR protocols and primers have been widely shared
among international researchers though PCR-based
diagnostic assays do not differentiate between active and
inactive virus [10].
Mortality rate and contagiousness
The overall global case fatality rate is currently
approximately 6% based on World Health Organization
data as of 13 April 2020. The case fatality rate varies
between countries; for example, it is currently higher in
countries such as France, Italy, and Spain, and lower in
countries such as the US, Germany, and Australia. The
case fatality rate is estimated at approximately 2%
overall, but ranges from 0.2% in people under 50 to
14.8% in those over 80, and is higher among those with
chronic comorbid conditions [11] . Based on data from
EU/EEA countries, 32% of the diagnosed cases have
required hospitalization and 2.4% have had severe illness
requiring respiratory support and/or ventilation. The
crude fatality rate was 1.5% among diagnosed cases and
11% among hospitalized cases. The likelihood of
hospitalization, severe illness and death increases in
persons over 65 years of age and those with defined risk
factors including hypertension, diabetes, cardiovascular
disease, chronic respiratory disease, compromised
immune status, cancer and obesity [26]. The confirmed
case fatality ratio (CFR) is the total number of deaths
divided by the total number of confirmed cases at one
point in time appears quite constant oscillating between
2% - 3% [27]. The case fatality rate was highest among
critical cases (49%), it was also higher in patients aged
80 years and older (15%), males (2.8% versus 1.7% for
females), and patients with comorbidities (10.5% for
cardiovascular disease, 7.3% for diabetes, 6.3% for
chronic respiratory disease, 6% for hypertension, and
5.6% for cancer) [28]. Another study found the case
fatality rate in China to be 6.4% in patients aged ≥60
years versus 0.32% in patients aged. In Italy, the case
fatality rate was 8.5% in patients aged 60 years to 69
years, 35.5% in patients aged 70 yeras to 79 years, and
52.5% in patients aged ≥80 years [29]. In a cas e series of
1591 critically ill patients in Lombardy, the majority of
patients were older men, a large proportion required
mechanical ventilation and high levels of positive end-
expiratory pressure, and the mortality rate in the intensive
care unit was 26% [30]. In the US, the case fatality rate
was highes t among patients aged ≥85 years (10% to
27%), followed by those aged 65 years to 84 years (3%
to 11%), 55 years to 64 years (1% to 3%), 20 years to 54
years (<1%), and ≤19 years (no deaths ). Patients aged
≥65 years accounted for 80% of deaths [26]. The res ults
of the ten countries are summarized in a table 1. This
(table 1) shows that there are several three categories of
countries those with a very high contamination rate (+
4000 cases/million) USA and Spain, those with a high
rate (between 2000 and 4000) UK, Italy, France and
Germany, those considered medium (between 1000 and
2000) Turkey and those with a low rate (-1000) China,
South Korea, and Morocco.
Table 1: Evolution over time of cases, deaths and test in
different countries.
The classification according to percentage of
deaths/registered cases (-3%) for South Korea, Turkey
and Morocco; (3% - 6%) for China, USA and Germany;
(6% - 9%) and (+9%) for Spain, Italy, France and UK.
The classification according to the number of tests per
million inhabitants (+40000) for Italy and Spain; between
30000 and 40000 for Germany; USA and UK; between
20000 and 30000 for France and (-20000) for Turkey,
China; Morocco and South korea. It is noted that there is
no correlation between the number of cases and deaths so
there is a correlation between the number of tests

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Global Emergence of COVID-19
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performed and the number of deaths. Where other
elements are needed to explain these results and
especially the elements of the fight against the epidemic.
5. CONCLUSION
COVID-19 epidemic has spread very quickly. The
present descriptive, exploratory analysis offers important
new information to the international community on the
Corona virus pandemic in world. Important questions
remain including determination of infectiousness period,
identification of transmission routes, and effective
treatment and prevention methods including further test
development, drug development, and vaccine
development.
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