Introduction
The coronavirus disease is a respiratory infection that is believed to spread from one person to another, especially if they are in close contact (Harvard Health Publishing, 2020). When an infected person sneezes or coughs, droplets are produced, which may land on the noses and mouths of people nearby or be inhaled directly, thereby infecting them (Zhang et al., 2020). Infected persons, even the asymptomatic ones, can emit aerosols while breathing or speaking. If one is infected with the virus, then another individual can inhale these aerosols and contract the virus.
There are different ways to prevent or reduce the spread of the virus among the population. Among these ways is contact tracing, whereby people coming into proximity with an infected person are quickly identified and quarantined immediately before spreading the disease further (Xiao & Torok, 2020). Social distancing is another means that can be used in preventing the spread of the virus (Norwegian Institute of Public Health, 2020). In social distancing, people are required to maintain a distance between one another, a distance in which the droplets can travel when one sneezes or coughs, preferably six feet apart.
Wearing a face mask out in public can also be used in preventing people from contracting the virus (Zhang et al., 2020). The Centers for Disease Control (CDC) has recommended people wear surgical or nonsurgical masks when out in public. A mask is worn to prevent one from inhaling airborne microorganisms since they remain in the air for a couple of hours. Even though the N95 type of masks is the most effective, the medical institutions recommend the public to reserve them for the health workers considering their lives are on the line while attending to coronavirus patients.
The Problem
For the last seven months, the world has been dealing with the coronavirus disease 2019 (Covid-19) pandemic. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak started in Wuhan, China, in September 2019, before spreading around the globe with the current data showing that to date, close to 16 million people have been infected in 188 countries with over 643,800 reported deaths (John Hopkins University, 2020). This disease is highly infectious, and thus it spreads fast through close contact when small droplets produced through talking, sneezing, and coughing are transmitted from an infected person to another individual. The droplets could also fall on different surfaces, and the virus could remain active for a given period depending on the nature of the materials.
Therefore, people could become infected if they touch such surfaces and proceed to touch their faces, noses, or mouths. Recent studies have also shown that the droplets could remain suspended in the air for some time, which means they could be inhaled, leading to infection (Stadnytskyi et al., 2020). The virus remains highly contagious for the first three days after an infected person becomes symptomatic, and this understanding informs the various prevention strategies that have been put in place to ensure the safety of populations. This paper discusses the population demographics of those affected by Covid-19 in the US, the current initiatives that have been enacted to protect populations, the involved agencies, and funding sources coupled with how DNP could utilize this information in the capstone project.
Population Demographics
Covid-19 affects people of all genders and across all ages. However, according to the Centers for Disease Control and Prevention (CDC) (2020), older adults and people with underlying medical conditions are more vulnerable to infection as compared to other population cohorts. The functionality of various body systems, including the immune system, decreases with age, which makes it a risk factor in Covid-19. Similarly, people with underlying medical conditions could have compromised immunity, thus making them highly susceptible to infections and death. According to a study by Wortham et al. (2020), out of a sample of 10,647 people who died of Covid-19 in the US, those aged over 65 years accounted for over 74.8 per cent, and at least one underlying medical condition was present in 76.4 per cent of the total cases. The condition disproportionately affects men accounting for 60.6 per cent of deaths reported in the above sample (Wortham et al., 2020). Additionally, CDC (2020) states that other at-risk groups in the population include racial and ethnic minorities, those living in rural areas, the homeless, breastfeeding and pregnant mothers, those with disabilities, and people with behavioral and developmental disorders.
Current Initiatives to Prevent the Spread of Covid-19
The US government, in collaboration with the relevant agencies, has come up with a raft of measures to ensure population safety and health. The first step that the government took was to sensitize people to sanitize their hands through frequent washing of hands with soap. In case water and soap are unavailable, people are advised to use hand sanitizers. The aim is to ensure that if a contact has been made with the virus from various places, it is effectively washed to avoid infection. The second measure undertaken is that of social distancing. In public spaces, it is a requirement for people to maintain a distance of at least 6 feet from one another. In addition, people are required to wear facemasks when in public spaces, especially in cases whereby maintaining the recommended social distancing is not possible. The masks are supposed to cover the mouth and noses to achieve two functions. First, when people sneeze, talk, or cough, the resulting droplets are contained within the mask, thus preventing transmission. Second, when the mouth and noses are covered, a person would not inhale droplets from various sources.
Additionally, different state governments in the US took radical measures, including closing down places where people are likely to be congested. Schools, places of worship, malls, and other related areas have been shut down. In most cities, total lockdowns were imposed, and authorities asked people to stay at home. Only those involved in the provision of essential services were allowed to leave their houses. The concept behind these measures was to prevent the transmission of the virus and stop new infections, which would effectively flatten the infection curve. Normally, the virus takes 14 days for an infected person to become symptomatic. Therefore, it was assumed that within the first 14 days of lockdown, those infected would have shown first symptoms and isolated from the population for specialized treatment. As such, new cases would be minimal, leading to the reopening of the economy.
Agencies Involved in the Fight against Covid-19
In the US, the fight against Coid-19 is a multiagency collaboration effort involving various agencies drawn from both the federal government and the private sector. Some of the federal agencies and departments involved in this fight include the Centers for Disease Control and Prevention, Director of National Intelligence, Drug Enforcement Administration Diversion Control Division, Food and Drug Administration, National Institute of Health, and White House, among other related bodies. Additionally, various private entities, including philanthropic organizations, multilateral and bilateral donors, and development banks, have come together to contribute to this fight in different ways, including donating medical equipment and giving financial assistance. The US government is the leading financier of this fight having allocated more than $130 billion to hospitals and other healthcare providers and extended over $150 billion in grants to local governments (US Department of Health & Human Services, 2020). The monies given are geared toward creating awareness, enforcing preventing regulations, and buying protective equipment, among other related initiatives to ensure that the public is assured of its safety and health.
The Justice, Legal, and Regulatory Effects of COVID-19
The impact of COVID-19 must be analyzed in consideration with various components, including justice, legal, regulatory, data, and advanced practice issues. First, the criminal justice system has been affected by COVID-19, which brought several difficult decisions. The central dilemma is connected to the preservation of public safety. Most scholars have predicted that coronavirus will stimulate increases in certain types of crimes, including domestic violence and online fraud (Miller & Blumstein, 2020). However, other offenses, such as residential burglary, will decline, bringing new challenges to the justice apparatus.
Furthermore, the United States government took different legal and regulatory actions while responding to COVID-19. Such legal and regulatory interventions involve intensive domestic and international travel constraints (Mello & Haffajee, 2020). Additionally, recent regulations include stay-home recommendations and social distancing. On the 27th of March, all fifty states had declared the Covid-19 virus as an emergency. After that, the executive power appeared to be particularly strong, as regulation varied from interrupting standard business processes to limiting movement and civil liberties.
As the COVID-19 pandemic continues to pose a threat to the planet, data gathering is especially important. An effective way of data gathering is urgently required to comprehend the spread of the virus and discover the part of the population infected both in the United States and globally. Moreover, data is used in the case fatality rate (CFR) and infection fatality rate (IFR) for every age group of the population (Szapudi, 2020). In most countries, including the United States, only people with symptoms are tested. Thus, the primary issue is the cost and accessibility of the PCR tests for the COVID-19.
Moreover, the ongoing coronavirus pandemic has put additional constraints on all healthcare specialists, including doctors and advanced practice registered nurses (APRNs). Medical professionals’ main goal is to provide appropriate care to patients in unique ways that were not applicable in usual circumstances. Some of the main challenges are avoiding overload in intensive care units (ICUs), preventing the spread of the infection, and educating individuals on the most suitable practices in a quickly evolving environment (Diez-Sampedro, 2020). COVID-19 is highly contagious; thus, APRNs need to consider various issues, including the need for personal protective equipment (PPE), new regulations, testing guidelines, and more.
Moreover, global health is vital in both worldwide safety and the U.S. population’s security. Therefore, the discussion about justice, regulation, and data gathering are particularly crucial in the context of Healthy People 2020 objectives. In particular, the objective GH-3, which advocates for the expansion of Global Disease Detection (GDD) Regional Centers, as they help to identify and contain possible health emergencies (U.S. Department of Health and Human Services, 2020). Moreover, the objective GH-5, arguing for the promotion of testing capacities from GDD Regional Centers, is especially actual as data gathering is one of the central issues in the context of a global pandemic (U.S. Department of Health and Human Services, 2020). Overall, the COVID-19 crisis had drawn the attention of medical specialists and political leaders worldwide to the need for cooperation.
Legally, the focus of COVID19 limiting policies centers around the concept of containment. Various mandates enforced social distancing, differing from state to state, that limited the number of people in a given public area. Furthermore, individual businesses were designated as essential or nonessential, influencing whether they could remain open (Miller & Blumstein, 2020). However, the United States lacks a unified national strategy, with a different implementation of containment strategies across various cities and states (Miller & Blumstein, 2020). The Federal government has only provided guidelines that states are free to use or adjust at need.
Determining the effectiveness of various state legal responses is difficult, as the conditions and severity of the outbreak are not evenly distributed across the United States. California was one of the first states to issue shelter-in-place orders (Friedson et al., 2020). A preliminary study conducted in California found that shelter-in-place did have limited but positive short-term effects, including a one to three percent reduction in mortality rates (Friedson et al., 2020). However, interstate travel is still often allowed, limiting the study of the effects of containment policies.
Overall, the Federal Government of the United States severely lacks a unified strategy. As containment policies were left in the hands of state and city governors, the U.S. response was inconsistent (Mello & Haffajee, 2020). United decisionmaking could help the situation, allowing state governments to coordinate and offset the issues of free travel and patchwork restrictions within the United States. The Defense Production Act could be used to boost test kit production (Mello & Haffajee, 2020). Thus, a stronger Federal response is necessary as state-level containment does not appear to be effective.
Without a strong Federal response, the United States’ public health system will take the brunt of the issues caused by COVID-19. Large-scale outbreaks can lead to staff shortages in hospitals as human resources are put on overtime to manage the influx of patients. Nurses, in particular, must be especially cautious when dealing with patients to protect themselves from COVID-19 and to limit its spread. Without State or Federal assistance, competition for protective gear may endanger nurses and healthcare workers in different areas.
In conclusion, the justice, regulatory, and legal responses in the United States have been varied. Many states have instituted shelter in place orders and determined which businesses are deemed essential or not. The legal and regulatory orders put out by State governments appear to have limited effectiveness, as the containment response is not unified across the country, and some areas have no travel restrictions. Lack of intensive enough testing inhibits accurate data for some areas. The public health system is likely to be stressed while current infection rates continue, putting nurses at risk.
Review of the Literature
The COVID-19 pandemic poses an extraordinary challenge for healthcare systems around the world. Due to the novel character of the virus causing the disease, no cure is currently available, forcing healthcare providers and policymakers to focus on spread prevention (GĂĽner et al., 2020). Such efforts are stymied by the virus’s high transmission rate, with studies suggesting that one afflicted individual may infect two to eight others (Diaz-Quijano et al., 2020, 43). Further complications arise from the widespread asymptomatic and pre-symptomatic transmission, limited herd resistance, and insufficient compliance (Asad et al., 2020). Those difficulties make it critical to assess the effectiveness of commonly employed prevention methods now that sufficient data has been gathered about their results. The present paper will examine the literature on different aspects of transmission prevention, such as social control measures, behavioral adjustments, and the use of protective equipment. The review will encompass primary sources from different countries to ensure a representative and informative sample. This review aims to investigate the current state of scientific knowledge about COVID-19 prevention and identify prospects for further research.
Social control measures for preventing the spread of COVID-19 among the population include the implementation of quarantines and travel restrictions. Quarantines, which involve the separation and observation of potentially infected individuals, have proven to be the single most effective prevention measure. An early study by Nussbaumer-Streit and others indicates that quarantines can almost halve infection and death rates (as cited in Güner et al., 2020, 575). Much of its effectiveness appears to hinge on the early implementation of strict quarantine rules (Güner et al., 2020). China’s experience containing the initial outbreak presents particular interest, as it involved especially drastic interventions that met with apparent success. Kraemer et al. (2020) have shown that the introduction of travel restrictions in and around Wuhan has disrupted the initial correlation between human mobility and COVID-19 incidence and significantly slowed its spread. Many other countries have since implemented travel restrictions for people arriving from high-risk locations and other risk groups, as well as facilitated testing to identify possible pandemic vectors (Güner et al., 2020). Early identification and the implementation of control measures seem indispensable for effective prevention.
Behavioral adjustments, such as social distancing and adherence to hygienic and sanitary rules, constitute one of the most common interventions carried out to combat the pandemic. Social distancing includes maintaining a maximum distance from others and avoiding large public gatherings. The high transmissibility of the virus necessitates maximum feasible social distancing, including a transition to remote work and study and minimal commercial activities (Diaz-Quijano et al., 2020). The outbreak report of Asad et al. (2020) illustrates the exceptionally high risks of infection that exist in healthcare settings due to the high concentration of COVID-19 patients, including infectious asymptomatic or pre-symptomatic individuals. In such and similar cases where meetings cannot be avoided, the thorough observance of hand and cough hygiene is essential for minimizing the risk of human or airborne transmission, respectively (Asad et al., 2020). Cleaning high-touch areas such as door handle with bleach or ethanol solutions also help slow the spread (GĂĽner et al., 2020). The success of behavioral adjustments hinges on maximal adherence to the published rules from the entire community.
The use of protective equipment such as masks, gloves, and respirators has been accepted as a vital preventive measure in healthcare and everyday life. Asad et al. (2020) recommend the “liberal use of masks” (p. 6) in healthcare settings based on their study of a hospital outbreak. Fisman et al. (2020) confirm the substantial success of masks and other facial protection in reducing the rates of COVID-19 acquisition and transmission, especially in populations with low overall mask usage. An analysis performed by Chu and colleagues supports those findings, suggesting that mask use reduces the risk of viral infection by 85% (as cited in Fisman et al., 2020, p. 5). Hand sanitizer and portable gloves help maintain the abovementioned hygienic and sanitary standards (Güner et al., 2020). As such, the usefulness of protective equipment is not in doubt, though its availability may still pose problems.
Though several months have passed since the start of the pandemic, many of the questions connected to its spread and how it could be contained remain practically unanswered. In the absence of a cure, social control measures such as quarantines present the most promising option for containment, with studies of the early Chinese experience appearing to prove its efficacy. Maximal social distancing is necessary to further slow the spread, with the widespread observance of hygienic and sanitary rules proving indispensable insofar as contact cannot be avoided entirely. The effectiveness of using masks and other protective equipment has likewise been confirmed. Although all of those strategies have proven useful, the exact success rates of specific interventions are inevitably challenging to measure. As the pandemic continues to spread in different countries, more data will become available on the comparative effectiveness of various prevention strategies. More information on the long-term outcomes of prevention measures in countries that were afflicted earlier should emerge over time as well. That should make it possible to refine the current understanding of the utility of various social control measures, behavioral interventions, and protective equipment in pandemics.
Conclusion
Covid-19 has become a global pandemic since it was first reported in November 2019, in Wuhan, China. Currently, its cases have been reported in almost all countries around the globe. The virus enters the body through the mouth, nose, and ears when people make contact with infected droplets. Therefore, to address the problem of rapid transmission, the US government created public health and safety measures, which have been implemented in various states across the country. Lockdowns were enforced in various states to allow people to stay at home, as a strategy of preventing further spread through new infections. Various government agencies, departments, and private sector stakeholders have been involved in this fight. Information gathered in this paper will be important in the capstone project, as it forms the basis upon which the final research will be conducted and developed.
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