COVID Chaos is a book about the 2019 SARS-CoV-2 Pandemic that was written real time, spanning the time from March 31, 2020 through December 31, 2021, by two Emeritus Professors of Infectious Diseases (Adult - RJS, Pediatrics - JSA). RJS's and JSA's careers began with the HIV pandemic, involved collaboration with the 2009 Influenza pandemic, and now are finishing up with the Coronavirus pandemic. The authors have broad experience with outbreaks, from the local level (RJS had career long responsibilities for controlling outbreaks at medical school hospitals and worked taking care of COVID-19 patients during the pandemic), all the way up to the pandemic level (JSA wrote a book about the 2009 Influenza pandemic and has worked with the WHO for the past 10 years.The aim of the book is to give the reader some insight into the global impact of the SARS-CoV-2 outbreak during the first two years, from multiple perspectives (patient, healthcare provider, global citizen, public health, economic, geopolitical). An attempt was also made to understand how SARS-CoV-2 caused disease, both its pathogenesis at the individual patient level, and globally, as to how it was so successful at causing a pandemic and how it compares with other organisms capable of causing outbreaks, epidemics and pandemics. It is written to be of interest to anyone who likes to read and wants to know more about what happened during the COVID-19 pandemic and why.COVID Chaos was written by two infectious disease physicians, who each have over 35 years of experience caring for patients with a large variety of infectious diseases. Additionally, both did research in understanding the pathogenesis of infectious diseases, and collectively have many years of experience handling outbreaks at the local level, have been involved with guideline documents making recommendations for reducing infections at the national level, and have global experience managing international infectious diseases.The book begins with three first person accounts from physicians involved in COVID-19 care during the early pandemic, when it was overwhelming hospitals.It then tracks its course from Wuhan, China, to other parts of the world, while comparing and contrasting public health interventions, both at the hospital and local community level, all the way up to country level.The book attempts to understand the broad spectrum of COVID-19 disease, both clinically and pathophysiologically, as well as its global collateral damage. It explores in depth SARS-CoV-2 vaccine development, testing and the geopolitical problems with vaccine deployment, and attempts to understand the origin of SARS-CoV-2 and its place in the pantheon of other organisms causing pandemics.The book concludes with some late breaking pandemic events at the end of 2021 (Omicron variant, etc.) and a global photo essay about the pandemic.
Author(s): Robert J. Sherertz, Jon S. Abramson
Publisher: World Scientific
Year: 2023
Language: English
Pages: 547
City: Singapore
Contents
List of Abbreviations
Foreword
Sherertz – Abramson Collaboration
Prologue: Overwhelmed Hospitals
1. Making of a Pandemic
1. Introduction
2. Coronaviruses — Structure and Replication
3. Evolution of Human Coronaviruses
4. Differences Between Outbreaks, Epidemics and Pandemics
5. Factors Affecting the Severity of a Pandemic
6. Impact of Genetic Mutations on Viral Transmission and Mortality
7. Containment, Mitigation and Flattening the Curve
8. Pandemic Waves
References
2. Path of Destruction
1. The SARS-CoV-2 Outbreak Begins and Spreads Across the Globe (December 2019–March 11, 2020)
a. Spread through all regions
b. Initial attempts to contain and mitigate the spread of SARS-Cov-2 vary across regions and countries
c. WHO Director General declares the COVID-19 pandemic
2. The COVID-19 Pandemic Intensifies (March 12, 2020–December 31, 2020)
a. WHO develops the Solidarity Call to Action and the Access to COVID-19 Tools Accelerator programs to help create equity in supplies, drugs and vaccine availability
b. Formation of the WHO Task Force to investigate the origins of SARS-CoV-2
3. Success of Containment and Mitigation Policies Vary Across Regions and Countries
a. Asian region with spotlight comparing China and India
b. European region with spotlight comparing Sweden and Norway
c. Americas regions with spotlight comparing the United States and Canada
d. African region with spotlight comparing South Africa and the rest of the region
e. Eastern Mediterranean region with spotlight comparing Iran and Jordan
f. Antarctica
References
3. Disorganized Global Response
1. Overview
a. WHO issues technical reports on how countries can contain and mitigate the spread of SARS-CoV-2
b. Effectiveness of various containment and mitigating steps
i. Government policies
2. Lessons Learned from How Various Regions/Countries Responded to the Pandemic
a. Asia
i. China vs. India
b. Europe
i. Sweden vs. Norway
c. Americas
i. US vs. Canada
d. Africa
i. South Africa vs. the African Region
e. Eastern Mediterranean Region
i. Iran vs. Jordan
3. Conclusions
References
4. Airborne Assassin
1. Clinical Presentations
a. Case #1 — Risk of transmission
i. No symptoms vs. symptoms
ii. Superspreaders
iii. Risk of transmission to healthcare workers
iv. How well do personal protective equipment work?
v. SARS-CoV-2 survival on surfaces
b. Case #2 — Mild COVID-19 pneumonia
i. COVID-19 presentations at Emergency Departments
ii. Laboratory abnormalities
iii. Imaging: Chest computerized tomography vs. chest X-rays
iv. Diagnostic testing: PCR vs. antigen vs. antibodies
v. Risk factors for COVID-19 admissions
c. Case #3 — COVID-19 with embolic and thrombotic events
i. Deep venous thrombosis
ii. Pulmonary emboli
iii. Myocardial infarctions and strokes
d. Case #4 — COVID-19 reinfection with fatal outcome
i. Reinfection vs. persistent infection
ii. Treatment effectiveness
iii. Overall impact of treatment on mortality
iv. Ethics
e. Case #5 — MIS-C in children
f. Case #6 — Pregnant females with COVID-19
g. Case #7 — Immunocompromised patients
h. Case #8 — Central nervous system manifestations
i. Case #9 — “Long Haulers” or “Long COVID”
2. Pathogenesis of COVID-19
a. ACE2 receptor
i. Role of binding to ACE2 receptor (angiotensin-converting enzyme 2 receptor)
b. Lung disease
c. Heart disease
d. Immune response
i. Are asymptomatic COVID-19 infections due to persistent immunity from prior nonSARS-CoV-2 coronavirus infections?
ii. Are the most severe COVID-19 pneumonias a conse quence of cytokine storm?
e. Coagulopathy
f. SARS-CoV-2 mutation
References
5. Vaccine Salvation?
1. Development of COVID-19 Vaccines
a. Two recent technologies used to make the SARS CoV-2 spike protein antigen
i. Viral-vector vaccines
ii. mRNA vaccines
2. SARS-CoV-2 Variants
a. Potential impact of SARS-CoV-2 variants alpha (B.1.1.7) and beta (B.1.351) on transmission, Case Fatality Rate (CFR) and vaccine efficacy
b. Potential need for repeated vaccination with new variant strains
3. COVID-19 Vaccine — Challenges in Delivery and Distribution
a. WHO develops programs to create equitable vaccine distribution
i. Solidarity program and access to COVID-19 tools (ACT)-Accelerator programs
ii. COVAX — COVID-19 vaccine access program and facility
b. Prioritizing groups for vaccination
i. High risk including elderly and healthcare workers
ii. Do people known to have been infected with SARS-CoV-2 need vaccination or can they wait?
c. Delivery of vaccines to vaccinations sites
i. How well did various countries do in rolling out vaccines?
4. Vaccine Hesitancy
a. Overview of issues impacting vaccine hesitancy
b. COVID-19 and vaccine hesitancy
i. Examples of vaccine hesitancy across regions and countries
ii. How vaccine hesitancy in one region can affect another region
c. Overcoming vaccine hesitancy
5. Conclusion
References
6. Collateral Damage
1. Introduction
2. Impact on Birth Rate
3. Impact on Other Diseases
a. Drug shortages
b. Declining outpatient visits and elective surgeries
c. Increasing TB, malaria, HIV, and sexually transmitted infections
d. Decrease in vaccination rate for routine preventable diseases
e. Decreased in incidence of influenza and RSV infections
f. Psychological impact: Community and healthcare workers
g. Excess deaths due to COVID-19 versus other causes
4. Misinformation, Countering Misinformation
5. Ethical Issues
a. Drug trials
b. Equipment shortages
c. Racial disparities
d. Prisoners
e. Immigrants
f. Vaccines
i. Exclusion of pregnant women
ii. Vaccine passports
iii. Jumping the line for vaccines
iv. Should vaccines be mandated?
v. Countries using vaccines to advance their foreign policy agenda
g. School closure — Impact on children, families and teachers
6. Conclusion
References
7. Origin Story
1. What is an Infectious Disease?
2. What is an Emerging Infectious Disease (EID)?
3. When and Where did COVID-19 Become an EID?
4. What was the Source of SARS-CoV-2?
5. Why are Bats the Likely Animal Long-term Host for SARS-CoV-2?
6. Is there an Intermediate Host for SARS-CoV-2?
7. How does COVID-19 Compare with Other Coronavirus-caused Infections?
8. Does the Recent Appearance of More Lethal Coronaviruses Globally Suggest that these Viruses have the Ability to Evolve Rapidly?
9. Is there any Possible Explanation for How a Coronavirus can Suddenly Appear in the Human Population and Cause Disease?
10. Are these Three New Coronavirus-caused EID (COVID-19, MERS, SARS) Isolated Events, or Are they Part of a Larger Global Phenomenon?
11. What Risk Factors can Play a Role Increasing the Likelihood of an EID Event?
a. Transition to an agricultural society
b. City size
c. War
d. Famine
e. Slavery
f. Colonization
g. Ignorance = Undiscovered
h. Climate change
12. Summary
References
8. Pantheon of Plagues
1. Epidemiology Definitions
a. What defines an outbreak, an epidemic or a pandemic?
2. Outbreaks
3. Epidemics
4. Pandemics
5. Superspreaders
6. Global Trends
7. Summary of Factors Leading to Pandemics
References
9. Are There Geopolitical Solutions?
Introduction
1. Improve WHO and member countries pandemic capabilities
2. Determine the impact of mitigation strategies on global economies
3. Study the relationship between longCOVID and persistent SARS-CoV-2 infection
4. Evaluate the relationship between the immune system and 2nd SARS-CoV-2 infections
5. Find way s to decreas e global vaccine inequity
6. Improve education for all ages during a pandemic
7. Understand the importance of bat reservoirs related to SARS-CoV-2 evolution and human adaptation
8. Investigate the reasons for the asymptotic increase in global epidemic/pandemici nfectious diseases
9. Learn from all countries how best to handle future pandemics (investigation, early mitigation, global treatment trials, vaccine development and deployment)
References
10. Epilogue
1. COVID-19 Pandemic Continues
a. Endemic disease is likely
b. Excess mortality
2. COVID-19 Vaccines
a. Global availability
b. Impact of SARS-CoV-2 variants
3. Collateral Damage
a. Economic impact
b. Other (non-COVID vaccines) vaccination programs
c. Tuberculosis, HIV, and malaria control and mortality
4. COVID-19 Clinical Updates
a. Immunocompetent adults
b. Long-COVID = Persistent infection
c. Immunocompromised patients
d. Treatment effectiveness
5. SARS-CoV-2 Mutations
6. SARS-CoV-2 Origin: Revisited
References
11. The Human Side
Acknowledgments
Index
Figures and Tables
