Background Information on COVID 19

Background Information on COVID 19

Chapter one: Background

In this chapter, there will be a discussion regarding COVID 19 with an overview of this disease in terms of understanding its impact. Moreover, the action plan of COVID 19 will explain, and the role of nurses in this pandemic situation will be examined in terms of evaluating their performances. An effect that occurs on the mental wellbeing of nursing staff will be analyzed to determine the causes of this severe fear that occurred in them. It is also necessary to understand the psychology of nurses and global health in which these nurses are working and providing their services in hospitals. Role of nurses to provide better treatment to corona patients and the ways that can better the treatment will be defined in this section. In the end, there will be a conclusion summary of the details that have presented in this section. Nurses are the frontline in fighting COVID 19 and Saudi Arabia’s climate factor contributes to increased middle East Respiratory Syndrome.

• Overview of COVID 19

1.1.1. Definition of COVID 19

Coronaviruses are a large group of viruses, which cause a range of illnesses from a common cold to critical disease, For instance: severe acute respiratory syndrome (SARS-CoV) which was recognized at the end of February 2003, and the Middle East Respiratory Syndrome (MERS-CoV) which first reported in Saudi Arabia in 2012 (Saudi Ministry of Health, 2020). A new coronavirus was reported in Wuhan, China, and caused acute pneumonia, this virus known as COVID19. Buheji & Buhaid (2020) defined it as an illness caused due to respiratory infection due to a coronavirus that leads to flu, fever, coughing and shortness of breath symptoms describe COVID 19. The termed COVID has its full form, i.e. CO stands for Corona, VI stands for Virus and D for disease, and the number 19 represents the year in which this disease has initially started (World Health Organisation, 2020). The COVID-19 spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes (Li et al, 2020). People with older age and those who are suffering from any medical conditions that are related to cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop severe illness (Fardin, 2020). It is necessary these days to understand this COVID 19 and well informed about the disease to prevent this coronavirus (Bedford, et al. 2020).  Some prevention measures should be implemented to protect from this disease that includes sanitizing hands frequently and washing hands (Saquib et.al 2019). Moreover, there must be an N95 mask on faces recommended by WHO while wearing gloves and keeping social distancing. This disease is considered as an infectious bacterium that occurred by a newly discovered coronavirus, namely COVID 19 (Buheji & Buhaid, 2020).

1.1.2. COVID 19 Epidemiology Worldwide

On 30 January 2020, an outbreak of the novel coronavirus disease 2019 was declared by the WHO. COVID 19 becomes a challenging illness for the world as most of the countries are affected by this pandemic situation, it has rapidly covered the globe and countries around the world are still suffering from this COVID 19 (Bikbov & Bikbov, 2020: Li et al, 2020). [ Table 1]. A city of Wuhan is the origin of this beta-coronavirus that occurred initially in China and was linked with seafood (Heymann and Shindo, 2020). According to the WHO report, more than five million confirmed cases had been reported till now across the globe, whereas approximately two million people are recovered from this COVID 19 (Bikbov & Bikbov, 2020). Besides that, more than 200 thousand death has occurred in this case which is alarming for the world, and there is still an increase (Sharif, 2020). On 31 December 2019, (WHO) has got information regarding a bunch of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. Meanwhile, finding the cause of this disease, on 12 January 2020 it was announced that a novel coronavirus had been identified in samples attained from cases and that preliminary examination of virus genetic arrangements recommended that this was the cause of the outbreak. This virus is referred to as SARS-CoV-2, and the associated disease as COVID-19 (Zhang, Wu, and Zhang.2020). The COVID 19 were linked with the confirmed cases were fever, the existence of pneumonia on chest X-ray, supposedly decrease in White Blood Cell Count (WBC), and also a decline in lymphocyte count (Jin et al. 2020). China was affected initially, but later they successfully overcome this disease by doing lockdown in the cities of China, particularly Wuhan (Heymann and Shindo, 2020). On the other hand, Italy has the most death rates initially due to this COVID 19, but the United States of America (USA) is facing severe backdrop in their medical treatment and facing ample of causalities (Miller et al. 2020). Furthermore, Middle East countries, particularly Saudi Arabia (SA), have also faced numerous cases in the country, As of May 26 including more than 76000 confirmed cases, of these, there are 397 critical cases, whereas death ratio is very less in the country (MOH, 2020). However, considering the penetration of COVID 19 in SA to the previous MERS-CoV cases and hospital-acquired infections, there will be a huge challenge for health care workers (HCWs) with rapidly detecting and properly isolating patients (Barry, Al Amri, and Memish, 2020). COVID 19 is still expanding, and there are still many severe cases that have been recorded around the globe every day. However, WHO is working closely, including international specialists, different country’s governments, and allies to gain a better understanding of the disease that would help in manufacturing cure, ongoing clinical trials are evaluating potential medication to discover its effectiveness (WHO, May 2020).

1.2 The socio-economic impact of COVID 19

The global outbreak has been going on for nearly six months and greatly affected societies, health, and the economy (Abusaaq et al, 2020). it is causing an economic crisis worldwide, and this crisis has caused many people to lose their jobs, which is more likely to cause increased poverty “by as much as half a billion people, or 8% of the total human population” (United Nations University,2020: p.1). likewise, increased inequality due to the necessity of many countries to regulate strict laws on allowing work under these conditions (United Nation Development Program, 2020). The measures that countries have taken, such as closing borders, isolation, and quarantine, are important to combat the spread of the virus, but this would make matters worse for the economy, for instance, the Arab region countries are expected to lose for estimated more than $42 billion, especially with the expansion of this epidemic in the European and American regions, which economically affect oil income and import (ESCWA, 2020). Furthermore, COVID 19 has the effect of changing the community’s behavior, they have now realized the seriousness of this infectious disease, which has increased spread awareness due to the easy access to information via social networks (WHO, 2020). As a consequence, some may fall victim to obsessive-compulsive disorder in handwashing and sterilizing which will raise the levels of anxiety and stress in public places, and affect negatively in the socioeconomic domains, which could be more dangerous than the virus itself in the long term (Dubey et al, 2020). Despite its great impact among society, the health sector was also affected by the COVID 19, a report from  International Council of Nurses (2020) shows that seven percent of all Covid-19 cases worldwide are among healthcare workers (HCWs), and based on limited data from National Nursing Associations, which not covered all the countries: it recorded that more than 230 thousands of HCWs suffer from the disease and more than 600 nurses died due to the virus (ICN, 2020).

1.3 COVID-19 Action plan

The World Bank (2017) emphasis that a global preparedness for a pandemic outbreak is critical to world security and must be included as a part of the strengthening health care delivery system (Corless, et al, 2018). In the context of developments in the global situation of the COVID 19 and the need to take measures to prevent the spread of the disease, the WHO provide the health sector with guidelines for COVID-19,  These include the rights and roles of HCWs and their safety, prevention of infection during health care, management of infections during work, and guidelines and instructions for the use of personal protective equipment (PPE) ( WHO,2020). likewise, the Centers for Control and Prevention (CDC) published more than 100 guidance documents to guide health care providers on how to control infection, preparedness and planning for infection prevention, clinical assessment, and planning of prevention supplies (CDC,2020). The implementation of the strategies depends on the ability of the country to monitor and manage the health system that has the capability of detecting, testing, and isolating the infected patient in record time to reduce the risk (WHO, 2020). Additionally, Saudi MOH and Saudi CDC had published COVID 19 guidelines aim at early detection of cases, reduce the risk of infection, reinforce public health measures known to reduce viral spread such as social distancing, cough etiquette, and hand hygiene (MOH,2020). Saudi government implements several actions against COVID 19 which was the establishment of the committee which include 19 ministries and authorities and was led by the ministry of health. ( Barry and  Ghonem,2020,pg.1-11) Secondly was to suspend entry of Saudi Arabia from Umrah, people were not allowed to visit holy mosque until they were disinfected, they banned citizens from the Gulf countries from entering the city, the government of Saudi stopped exporting all medical device and products. ( Al-Tawfiq and Al-Homoud,2020) The government ordered the use of fingerprint checking of employees as the virus is transmitted by air droplets. Suspension of all learning institutions including the universities in the private sector and governments across the country.

The Saudi MOH provided training courses for the nursing staff focusing on precautionary measures to address the emerging of COVID 19, which lasted for seven weeks, this training course helped raise the level of nursing staff knowledge to be able to face emergencies and prepare for the worst situation in the future (Saudi Press Agency, 2020). Although the measures that many countries are taking currently cannot prevent the epidemic from spreading, they can slow it down by reducing the increase in cases that the health system must deal with at the same time.

1.4 Nursing role toward COVID 19

Nurses considered as the defense force that is tackling this COVID 19 with affected patients, as they stand near to the patients in all stages of the disease’ journey and strive to provide maximum comfort to them (Buheji & Buhaid, 2020). They play a crucial role locally and globally in hospitals and clinical practices to control the infection and provide sufficient treatment to patients, showing effectively and efficiently care, putting their lives at risk under the circumstance of the unknown virus (Mo et al, 2020). Nurses are focused to maintain social distancing between each other and also intimating patients and their family members to follow the transmission to be protected (Kolifarhood, et.al. 2020). Nurses are required to be well educated about the diseases, and it must reflect in their nursing practice interventions (Kollie, 2016). They play a major role in providing public health education that related to the prevention of any infectious diseases and correcting the common misinformation people make about the virus (Choi, Jeffers & Logsdon., 2020). The American Nurses Association (2020) supports nursing efforts and clear in a policy brief in 2018 that nurses as leaders are key to preventing and containing disease because of their effective skills in developing and educating societies. Furthermore, the nursing role is not limited on achieving their tasks and duties, but the spirit of volunteering is essential for working as a team, this is what SPA (2020) clear in a report that Saudi government has allowed the health care workers from various specialized fields to contribute and volunteer to reduce the work hours of their colleagues. The number of volunteers was up to 78 thousand, most of them from the nursing sector. Furthermore, Nurses are provided with required to wear Personal Protective Equipment (PPE) to ensure their protection by the government (Saudi CDC, 2020). It is also necessary for the nursing staff to understand the implications of inadequate services in this situation as it could lead to a patient’s death (Almutairi, 2015). Nurses can utilize that inventory to limit which personnel is non-essential and whose services can be delayed if such boundaries are essential to avoid or control transmission (Tan, et. al. 2020). It is a challenging task to work with a smaller number of team members and provides the best hospitality to patients in isolation which could affect the nurse’s mental wellbeing. Thus, nurses should be working in their shift hours and collaborating in terms of neglecting errors to track occupational safety and health procedures in terms of avoiding health and safety risks (Cullen, et.al. 2020). Additionally, keep checking the sign of illness and self-isolate if there are any symptoms occurred rather than challenging personal life and others’ life (Almutairi, 2015). Moreover, it is also the role of nursing staff to advise management in case of any trouble faced on the field and provide detailed information regarding signs of undue stress or mental health challenges that require support interventions (Mukhtar, 2020). A nurse has to report their immediate managers to make them aware of the situation that occurs in terms of resolving issues and entertain patients in these rush hours as they must be responsive towards the diseases in terms of fulfilling the needs of society (Heymann and Shindo, 2020). Nurses play a role in mitigating the spread of the virus this will help reduce the patient’s death and slow down the spread of the disease. They assist in managing the health crisis as they are a vital link between the patients and other health workers. they play a role in determining the human response to medical treatment by assessing the patient’s condition apart from educating the public they must be trained in disaster preparedness and have knowledge and skills to respond. Other protective measures nurses should put in place other than wearing PPE include changing their work attire and showering as soon as they enter their homes. According to WHO nurses’ role towards COVID 19 include maintaining the patient confidentially, establishing occupation safety and health procedures to avoid exposing others to the risk, providing essential counseling and mental health services to the infected patients. The nurses should treat the patient with dignity compassion and respect and after using the protective equipment should take off and dispose of properly.

1.1.6 Psychological Impact and nursing wellbeing toward COVID 19

Nurses are in the frontline during the COVID 19 pandemic in providing life care for the affected patients thus they are mostly affected by psychological distress. In the recent COVID19 outbreak, supporting mental health for health workers, especially the nursing staff, is an unparalleled challenge (Walton, Murray, and Christian (2020). Mukhtar (2020) claims that the previous outbreaks such as Severe Acute Respiratory Syndrome (SARS) have a negative impact on nursing mental wellbeing as they suffered particularly from psychological distress, especially those who were working on the front lines, this caused fear, anxiety, and depression. Fear of the nurses includes being put in a position to take care of COVID 19 patients without protective equipment this can lead to contracting of the disease. All the staff must receive good quality support and communication (Al‐Dossary, 2018). There must be a rotation of shift from high-stress to lower-stress function and also initiate, engage, and monitor work breaks (WHO. 2020). However, there is still uncertainty in the staff and nurses regarding their health due to the lack of PPE and workload which could affect the nurses secure as they feel not protected (Pearce, 2020). In this situation, it becomes life-threatening for the nurses and paramedics itself, which creates disturbance and affecting nursing staff mentally and physically (Rosenbaum, 2020). The CDC (2020) implemented (Standard of Operating Procedures) SOPs to protect nurses and hospitals by wearing equipment, sanitizing, washing hands, and other guidelines that support the prevention of Coronavirus. It is very much needed that the Saudi government should consider this issue by recognizing and addressing mental health issues in nursing staff. However, The Saudi MOH (2020) has supported the HCWs mental health by offering counseling, meeting, and arranging group sessions to motivate them by compensating through different means. Furthermore, in mental health care, psychological practice has played a very crucial role in terms of the wellbeing of nurses and other paramedic staff. It also works competently in public health care initiatives in terms of creating policies and generating prevention efforts in public health policies (Walton, et. al. 2020). Nurses perform many important tasks towards patient care and even interacting in hospitals with patients of different backgrounds and ethnicities permit nurses to deliver better care (Lamadah and Sayed, 2014). Self-care is extremely significant for mental and physical health, specifically during times of extreme tension (Parsonson and Alquicira, 2019). WHO (2013) describes self-care as the capacity of the individual to encourage health, prevent disease, maintain health, and cope with illness. Despite the recommendations from the health organizations, nurses frequently deprive themselves of exercise, enough sleep, and getting good nutrition (American Nurses Association, 2018). In light of social distance, experts advise setting a daily schedule for self-care includes communication with friends and family via social media, which can make the person feel out of isolation and reduce the burden when speaking with other people (Brittany, Mathew, and Marci, 2020). The needs and welfare of nurses are no less important than the needs of patients and society, for long hours, work requires attention to physical health (Royal College of Nursing, 2020). Self-care also helps nursing staff to understand their behavior and understand their perspectives considering emotions and ideas (Blum, 2014). This also enhances communication skills and increase interpretation skills to communicate well with patients and other staff members.

Nurses working in outpatient clinics and psychiatric facilities fear contracting COVID 19 from asymptomatic patients. Most of them experienced stigma and rejection from some of their neighborhood, family, and friends. Balancing between profession and personal life such as taking care of the children who are out of school due to this pandemic is another distress the nurses face, those children are at higher risk of contracting the disease. ( Nemati and Ebrahimi,2020) The period of quarantine is additional psychological distress to nurses during this period they experience increased emotion, loneliness, and fear of testing positive after the quarantine.

Secondary traumatic stress is another effect nurses face during this pandemic this is due to primary exposure to an infected patient. (Han, and Jiang,2020) This can impact the emotional, cognitive, and behavioral functioning. Post-traumatic distress such as depression can result to sleep disturbance and loss of appetite.

1.1.7 Summary

COVID 19 is a contagious disease and hospital-related transmission is the major threat among the nurses and other healthcare workers. they are at the front line in fighting the pandemic thus more susceptible to the infection. Psychological distress affects them as they are at greater risk of contracting the virus. (Alharbi and Jackson,2020) Intense training and education should be provided. They include the use of protective equipment, ward disinfection, waste management, and sterilization of the patient’s devices.  The pandemic has affected the economy in Saudi Arabia and other countries negatively leading to poverty, loss of jobs, and inequalities in society.

Reference

Alharbi, J., Jackson, D., and Usher, K., 2020. The potential for COVID‐19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing.

Al-Tawfiq, J.A., Al-Homoud, A.H., and Memish, Z.A., 2020. Remdesivir as a possible therapeutic option for the COVID-19. Travel medicine and infectious disease.

Barry, M., Ghonem, L., Alsharidi, A., Awadh, A., Al-Shahrani, F., and Naif, H.A., 2020. Coronavirus Disease 2019 (COVID-19) Pandemic in the Kingdom of Saudi Arabia: Mitigation Measures and Hospitals Preparedness. J Nat Sci Med, pp.1-11.

Han, L., Jiang, M., Li, S., She, D., Yan, F. and Chung, Y.F., 2020. The Psychological Effect of 2019 Coronavirus Disease Outbreak on Nurses Living in Islamic Culture Dominant Region, China.

Nemati, M., Ebrahimi, B., and Nemati, F., 2020. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Archives of Clinical Infectious Diseases, 15(COVID-19).