Infectious Disease Analysis: COVID

Coronavirus disease 19 (COVID-19) Among Older Adults

Coronaviruses, commonly abbreviated as CoVs, relate to a family of viruses known to trigger the onset of moderate flu-like symptoms in human beings. The Severe Acute Respiratory Syndrome coronavirus 2’s (SARS-CoV-2) causes COVID-19 and is currently declared a worldwide pandemic by the World Health Organization (WHO) (Wolff et al., 2020). COVID-19’s typical clinical manifestations include muscle dyspnea, cough, fever, and other breathing problems. Non-specific symptoms associated with this disorder include muscle pain, fatigue, sore throat, runny nose, and headache. Furthermore, some patients often experience digestive symptoms, including vomiting and diarrhea. Some of the common COVID-19 complications include heart problems such as cardiac injury and cardiomyopathy, severe lung conditions, acute kidney injury, multi-organ failure, myopathy, as well as septic shock, and sepsis (Nanda et al., 2020). Other complications include secondary bacterial infections, hypoxemic respiratory failure, pneumonia, and liver dysfunction.

SARS-CoV-2’s primary mode of transmission is through infected respiratory droplets. Viral infections usually occur by indirect or direct contact with oral, conjunctival, or nasal mucosa, upon the inhalation of respiratory particles or their deposition on the above-mentioned membranes. Brief and prolonged exposures (fifteen minutes and over and within six feet) to symptomatic and infected individuals have also been linked to high transmission risks. Kumar et al. (2020) further indicate that the gastrointestinal tracts and conjunctiva are also vulnerable to infection and may act as portals of transmission. The Food and Drug Administration (FDA) sanctioned the use of remdesivir (Veklury), an antiviral drug, in COVID-19 treatment (Nanda et al., 2020). The agency also authorized the emergency use of baracitinib (Olumiant), bamlanivimab, imdevimab, and casirivimab, as well as convalescent plasma therapy (Mueller et al., 2020). Supportive care to relieve patients’ symptoms involves pain relievers and cough medication or syrup administration, fluid intake, and adequate rest.

Older people aged 60 and above and those with underlying health conditions, such as diabetes and cancer, are at a high exposure risk to severe COVID-19 illness than their counterparts. Generally, women are highly resistant to COVID-19 compared to men due to high coronavirus receptors’ expression and sex hormones in males as well as lifestyle choices (Nanda et al., 2020). COVID-19 disproportionately affects Latino and African-American adults across all age groupings throughout the U.S. According to Mueller et al. (2020), black Americans are infected with the virus at approximately three times the rate of non-Hispanic whites. Furthermore, the incidence of SARS-CoV-2 infection among older Latinos in the U.S is five times the rate of Caucasians (Mueller et al., 2020). Individuals aged 50 and above account for 95% of U.S deaths linked to COVID-19 (Mueller et al., 2020). This paper presents a comprehensive review of the health determinants related to COVID-19, a description of the disorder’s epidemiological triad, and an assessment of the nurse practitioner’s role in managing infectious diseases.

Determinants of Health

The HealthyPeople 2020 categorizes the health determinants into five major categories: genetics and biology, individual behavior, health services, and policymaking. Proper regulatory procedures help promote aging adults’ health by minimizing their exposure to communicable diseases and enhancing healthcare access. Social health indicators refer to the physical conditions and social aspects of one’s surroundings. Some of the common social factors impacting older adults by increasing their susceptibility to COVID-19 and its severity and complications include social norms, particularly discrimination, socioeconomic conditions, and residential segregation (Nanda et al., 2020). Other aspects include the lack of public transport in rural regions to facilitate hospital visits, and the inaccessibility to resources to meet their day-to-day needs, such as healthy foods.

The availability and access to quality health services significantly influence the likelihood of COVID-19 exposure and subsequent complications among this population segment. Restricted or lack of access to healthcare services may be due to high care costs, language barriers, and insurance coverage deprivation. Limited healthcare access may impact an older person’s ability to engage in preventive care, and trigger delayed treatment, hospitalizations, as well as unmet needs (Nanda et al., 2020). On the other hand, individual behavior relates to the actions implemented by a person, either deliberately or unintentionally, which impact their health positively or negatively. Individual departments such as poor dietary intake, physical inactivity, and improper handwashing techniques may facilitate chronic conditions’ onset such as diabetes which are COVID-19 risk factors. Genetic and biological elements impact the elderly at a significant level compared to youths. Old age has been linked to several COVID-19 risk factors, including the presence of underlying conditions.

Epidemiological Triad (Environment, Host, and Agent)

The agent refers to the microbe causing the disorder, in this case, SARS-CoV-2. Coronaviruses are categorized into four major sub-groups: delta, gamma, beta, and alpha. According to Chen (2020), seven of this virus’s strains, including SARS-CoV-2, can infect humans. SARS-CoV-2’s life cycle within a human’s body encompasses the following phases: release, maturation, biosynthesis, penetration, and attachment. The aforementioned virus typically coheres to the angiotensin-converting enzyme 2 (ACE 2), the targeted cell receptor within the host’s body; it accesses its cells through membrane fusion or endocytosis (Kumar et al., 2020). SARS-CoV-2’s RNA later enters the host cells’ nucleus to initiate the replication process, following viral contents’ release inside the human cell. The viral mRNA is usually involved in viral proteins’ biosynthesis. The newly formed viral particles are later released; this later causes non-specific manifestations, including respiratory symptoms, headache, myalgia, and fever.

The term host relates to the organism which harbors the disorder, in this case, the elderly. Specific aspects increase aging adults’ susceptibility to SARS-CoV-2; the presence of underlying conditions and old age. Examples of these comorbidities include malignancy, diabetes, cardiovascular disease, hypertension, and chronic obstructive pulmonary disorder. According to Azuma et al. (2020), aging affects pulmonary functions, pathology, and physiology, which, in turn, impacts tolerance and responsiveness in older people. Mueller et al. (2020) also associate old age with debilitated adaptive/innate immune defense and physiological functioning of several vital organs; this consequently increases this populace segment’s vulnerability to COVID-19. Men, irrespective of their age, are more susceptible to COVID-19 than their counterparts. The environment refers to the external elements that allow or cause disease transmission. They include the factors that promote the virus’ survival, including humidity, air temperature, sunlight, and opportunities for exposure to contaminated surfaces and respiratory droplets (Kumar et al., 2021). The COVID-19 virus can survive on glass surfaces, stainless steel, and plastic at room temperature for between two and four days.

Role of the Nurse Practitioner

Nurse practitioners (NPs) offer a broad health care service range, including the management and diagnosis of complex, chronic, and acute health issues, disease prevention, health promotion, counseling to communities, groups, families, and individuals, and health education. Furthermore, they serve as researchers, patient advocates, and interdisciplinary consultants (‘Scope of practice,’ 2019). During an infectious disease outbreak, NPs may execute the following roles:

• Collect and evaluate infection data, trends, and facts from different healthcare personnel.
• Offer education and training to other medical practitioners and civilians regarding prevention techniques.
• Create plants to prevent infected patients from spreading the disorder throughout the healthcare facility and other patient care settings.
• Act as a leader or coordinator of the Infection Prevention and Control (IPG) program.
• Reinforce and oversee the implementation of practices aimed to control the infection as per the CDC guidelines.
• Assess, supervise, order, and interpret laboratory and diagnostic tests related to the disease.
• Ascertain a particular pathogen’s origin by researching its composition and makeup.
• Employing approaches to ensure infection rates decrease significantly.
• Coordinate with physicians and scientists to develop therapies for the disorder.
• The NP may also oversee the professional practice model’s implementation, which supports nurses’ control over nursing care delivery and the surrounding in which care is provided.

References

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Chen, J. (2020). Pathogenicity and transmissibility of 2019-nCoV: A quick overview and comparison with other emerging viruses. Microbes and Infection, 22(2), 69–71. Web.

Kumar, A., Prasoon, P., Kumari, C., Pareek, V., Faiq, M. A., Narayan, R. K., Kulandhasamy, M., & Kant, K. (2020). SARS‐CoV‐2‐specific virulence factors in COVID‐19. Journal of Medical Virology, 93(3), 1343–1350. Web.

Kumar, S., Singh, R., Kumari, N., Karmakar, S., Behera, M., Siddiqui, A. J., Rajput, V. D., Minkina, T., Bauddh, K., & Kumar, N. (2021). Current understanding of the influence of environmental factors on SARS-CoV-2 transmission, persistence, and infectivity. Environmental Science and Pollution Research, 28, 6267–6288. Web.

Mueller, A. L., McNamara, M. S., & Sinclair, D. A. (2020). Why does COVID-19 disproportionately affect older people? Aging, 12(10), 9959–9981. Web.

Nanda, A., Vura, N. V. R. K., & Gravenstein, S. (2020). COVID-19 in older adults. Aging Clinical and Experimental Research, 32, 1199–1202. Web.

Scope of practice for nurse practitioners (2019). American Association of Nurse Practitioners. Web.

Wolff, D., Nee, S., Hickey, N. S., & Marschollek, M. (2021). Risk factors for Covid-19 severity and fatality: A structured literature review. Infection, 49, 15–28. Web.