مجله فرهنگ و ارتقای سلامت (فرهنگستان علوم پزشکی جمهوری اسلامی ایران)
سال چهارم شماره 1 (پیاپی 9، بهار 1399)

The third outbreak of the coronavirus began in China in 2019 and spread to more than 160 countries. This epidemic emphasizes the importance of paying attention to emerging infectious diseases. The purpose of this article is to review emerging infectious diseases, their importance and management.

This review article was prepared using reliable, up-to-date national and international documents and personal experience. of the author

The most important methods for management of emerging diseases are: strengthening active surveillance of infectious diseases, improving diagnostic methods to identify pathogens, strengthen communication and active cooperation with national and international institutions, promoting current diagnostic antimicrobial tests, promoting the use of antimicrobial drugs by physicians, increasing expert personnel, accurate and timely reporting of disease cases at the national and international levels.

Monitoring, early detection and rapid response of prevailing, emerging and recurrent infectious diseases requiring policy-making, planning, educating, support, and action by countries and health systems. This will lead to a resilient, flexible, and intelligent health system to deal with public health crises.

The COVID-19 pandemic led to health related problem, and adire socio-economic and political situation throughout the world. This study aimed to review epidemiological trends of the COVID-19 pandemic in Iran, and the implemented strategies to control the disease.

This narrative review is based on literature review, content analysis of implemented strategies for prevention and control of COVID-19 during the two months following the first case diagnosis in Iran.

In Iran, the cumulative frequency of confirmed cases based on the positive result of PCR test from February 19, 2020 to April 14, 2020 was 74877, and cumulative frequency of deaths was 4683 cases. Effective strategies were modification of community behavior, physical distancing, active case finding, and isolation of the cases.The pattern of epidemiological trends of the COVID-19 varied across the provinces.

Active case finding, isolation at home or hospice, contact tracing and active screening led to decreasethe burden of disease, and increasethe health system responsiveness.

Risk communication (RC) and community engagement are perquisite for management of epidemics. Triumph of RC depends on adjustment of message and considering the characteristics of the sender and the audience according to the context and situation.

This article has been prepared using scientific and relevant articles and guidelines.

For effective RC , the essential steps include public participation; planning; credibility ; deference of other sources of communication ; financing & ethical considerations. For success in RC one should consider community culture, people's beliefs and their understanding of the event . The people’s right to be  worried in epidemics should be recognized by the authorities and participatory strategies rather than compulsive one should be prioritized.

In the pandemic of COVID-19, series of successful and nonsuccessful experiences happened. The of review of these experiences may help the policy makers in their future efforts .

Corona viruses are old viruses which are divided into three groups. Groups one and three viruses induce disease in animals, and human viruses such as MERS and SARS are in group two.

This study was performed using international scientific sources and new researches findings.

Corona viruses are in the form of tiny spherical particles, and genome of the virus, which contain a single-stranded RNA, it causes changing in pathogenesis and severity of the virus and its sensitivity to antiviral antibodies. Attaching the virus to the cell is the first step in affecting a host. This is very important step and determines the tropism and the onset of viral infection. After virus binds to the cell by S protein, it fuses to the cell membrane and release the viral RNA genome inside the host cell cytoplasm. Human coronaviruses enter and grow in the epithelial cells of the upper respiratory system, and also alveoli and the lower respiratory system. But in COVID-19, it is not obvious the organs which virus penetrates and grows. The best diagnostic test is RT-PCR, but sometimes report false-negative results. It is very useful if this test used with clinical symptoms and radiological images. Serological methods have been used for some coronavirus and SARS viruses. One of the serological methods is testing serum level of IgG and it is useful in determining the asymptomatic infection or exposure to virus. The exact date of the virus's appearance is not known, but seems it existed some time before December 2019, or that it was not tested or reported.

Physiopathology of the virus, involved cells and tissues, established level of immunity and the pathogenesis mechanism and future random mutations of the virus are not fully understood. It is hoped many of these issues will become clear in the future.

The incidence of COVID-19 by the coronavirus SARS-CoV-2 with symptoms of acute respiratory syndrome in December 2019 in Wuhan, China, has spread rapidly and change to a global epidemics.

SARS-CoV-2 virus phylogenetic study performed to identify the genetic diversity of the prevalent viruses in Iran and compared with 6 selected countries.

Phylogenetic study of SARS-CoV-2 virus showed the genetic variations generated in the virus genome are not currently sufficient to distinguish significant phylogenetic differences between the genome of viruses obtained from different geographical areas (19 countries from different continents) but can form variety of clusters. A study of the SARS-CoV-2 virus mutations showed that the prevalent viruses in Iran had six single-nucleotide (SNP) genetic variations in non-structural and structural genes and one insertion of six nucleotides in the RNA-dependent RNA polymerase gene region. Comparing the genetic variations of viruses in Iran with the six selected countries (India, the United States, Nepal, Italy, Spain and France) indicate the uniqueness of genetic variations of the prevalent viruses in Iran.

Studies show there is a direct connection between mutations in the SARS-CoV-2 virus genome and changes in pathogenesis. Therefore, regular assessment of the virus genetic diversity in each country can provide valuable data for the development of vaccines and drugs.

In the view of the World Health Organization, disaster is a serious and sudden interruption in the function of society that causes severe environmental, financial or life endangerment; the capacity of the injured and their resources are not enough to compensate for the injured. In Iran, thirty unexpected catastrophes out of forty natural disasters were seen. In these events, psychological and social issues were often neglected.

This Review article, assessed the literature as well as, the author’s personnel experiences in the COVID-19 pandemic and previous disasters in Iran.

In the case of the new pandemic of the COVID-19 virus or the Corona virus, stress and anxiety was high and may weaken the immune system and make one vulnerable to viral or psychosomatic disease. The vulnerability for psychological disorders such as phobia, obsessive-compulsive disorder, generalized anxiety disorder, panic attack, depression, post-traumatic stress disorder, recurrence or exacerbation of psychological disorders is high. It seems that psychological aspects of the disease need to be considered seriously.

Keeping calm, retaining a "positive psychology" in actions and behavior is important. Positive psychology includes having an optimistic view, high hopes , a self-care view and resiliency. Due to these issues, different roles can be rendered for different groups, including the role of the government and non-governmental organizations; in the psychological aspect, the role and responsibility of the media, the role and responsibility of the community are important. In disaster management, all governmental and non-governmental organizations need to do their duties properly, people need to get involved and participate as well. The armed forces can help control people, the media, research centers as well as the cultural, religious, and social institutions can help victims overcome the tragedy and adapt following the crisis.

The communicable and highly contagious pandemic caused by the coronavirus, has caused spirituality to increase in the Islamic Republic of Iran.

In this study Islamic literature such as the Holy Quran, hadiths and articles were used to explain the increase of "spiritual health" during the Corona crisis.

Although during the Corona crisis, closure of religious centers was one of the most important concerns of the experts in spiritual health, we observed  a considerable increase in spiritual health. Patience, trust in God, and hope for divine kindness, as well as faith are the most important issues promoting spiritual health in the society.Patients: The feeling of imminent death is one of the most important issues promoting spiritual health. Patients' relatives often pray more than before and request "health and well-being from God."Therapists often show characteristics of self-sacrifice in caring for patients, and this has been shown to have a long lasting effect on members of the health system, elevating their rank in society.The invoking of the community to instigate and implement the recommendations of the healthcare officials by the Supreme Leader of Iran played an important role in motivation of the caregivers as well as promotion of the healthcare system.

The coordinated actions and the relentless efforts and endeavors of the various groups of the people involved in the Corona crisis, underscored the enormous capacity of the Islamic Republic to act as an ethical paradigm that can be a model for implementing the role of the Supreme Leader throughout the world.

The principles and goals of Islamic medical ethics set the criteria for professional behavior in all situations especially in accidents and disasters. In this study, the altruistic manifestations of moral behavior in performing professional duties for victims of accidents and disasters were reviewed as well as during the COVID-19 epidemiological crisis.

This study was performed by using expert medical ethics opinions which were obtained through focus group discussion methods and reviewing national and international references.

Objectives, principles, foundations, values, norms and indicators of Islamic medical ethics in crises and disasters, favorable approach in patient care, ethical manifestations, and also professional challenges and shortcomings in crises and disasters were reviewed. Modeling of Islamic medical ethics and Islamic ethical and spiritual patterns in crises and disasters with lessons learnt from the COVID-19 pandemic were presented in this study.

The first and most important issue in unforeseen events and disasters is to prevent life-threatening and human losses. Preserving lives of victims, protecting human rights and dignity, and observing all of standards of medical ethics and Islamic professional etiquette that are necessary in all circumstances are important in disasters.

To combat biological threats, health system and health care units play an important role through prediction and prevention. However, probability of biological threats cannot be predicted thus, sufficient preparation is needed for defense against these threats.

This study was performed by using references from websites and scientific articles.

The goal of passive defense is to secure and reduce the vulnerability and secure the infrastructure needed to provide security. Bioterrorism is the use of microorganisms or toxins to produce weapons that cause disease or death. The biological factors used in bioterrorism are divided into three categories the first category, has rapid spread, and very high mortality rate. The second category has easy diffusion and low mortality rate. The third category are pathogens that can be used in bioterrorism  by manipulating and engineering them. Bioterrorism causes psychological, social and biological damages. Biological threats may be classical or modern. Passive defense in bio- attacks play an important role in minimizing the consequences of these events.

Biological defense is the responsibility of the country's defense organization. Integration of public health and public health monitoring, as well as coordination of scientists and health care providers, is necessary.

This advocacy paper concerns the progressive prevalence of water pipe tobacco smoking and its adverse effects on health of the Iranian community. One of the urgent adverse health outcomes is spreading Coronavirus disease2019 (COVID-19). Negligence of authorities, exploitation of profiteers and users unawareness have imposed the community dangerous conditions. Heavy taxation and its serious deterrent effects is the most cost-effective policy to reduce water pipe use and other forms of exposure to tobacco in Iran. In order to prevent disease, disabilities and morbidity and mortality caused by tobacco use (especially water pipe use), It is necessary to make and implement obvious and deterrent policies, have information transparency and public education. this paper aims to encourage country's official and health policy makers to make comprehensive decisions, actions and urgent measures to prevent water pipe use in public places and make community awareness about its deadly hazards.

Due to the rapid impact of the Corona outbreak on economic activity, different countries have implemented a variety of short-term plans to deal with the Corona. This paper focuses on the extent to which governments are intervening in the fight against corona. We evaluate and compare the financial support packages in different countries according to available statistical data.

The description of economic interventions is done by collecting statistical data from government reports and international organizations. The statistical sample includes 46 countries with the highest number of patients until May 20, 2020.

A comparison of the success rate of the health system (ratio of the number of net recovered people to the number of people suffering from COVID-19) and the share of government financial support in countries affected by the coronavirus prevalence indicates a positive correlation coefficient of 0.26.

The high rate of recovery in patients with COVID-19 in Iran has been achieved while the Iranian economy is subject to US brutal sanctions. The experience of Corona Crisis Management in Iran shows that the general mobilization of facilities and capabilities can turn any threat into an opportunity for the country's progress, growth and excellence.

The immune system has complex interactions with the endocrine system and the central nervous system (CNS).

Library studies and international databases were used.

Stressors can regulate the immune system through production of catecholamines and glucocorticoids derived from the sympathetic-adrenal medulla (SAM) and hypothalamic-pituitary-adrenal (HPA) axes. By their binding receptor on the immune cells, glucocorticoids regulate multiple functions of the immune system such as cytokine production, proliferation, migration, and also anti-viral responses. In this review, two types of stress and immune system responses are briefly explained. Moreover, interactions among the immune system, the endocrine system, and the central nervous system as well as effect of stress on the function of immune cells are discussed.

Interactions between CNS, endocrine and immune systems and the effect of various stressors on immune system cells have been shown in various studies to be beneficial or harmful depending on the severity and duration of stress; but the effect on the immune system compared to the nervous system cannot be disputed. Lifestyle is one of the factors associated with stress and immunity. By improving in lifestyle, people can reduce long-term stress in their lives and benefit from the beneficial and protective effects of short-term stress on improving their immune function.

Mass gatherings are human community held for specific purposes and ceremonies, worldwide. Many of them originate from the beliefs, culture and traditions of societies. Several gatherings of religious, national, sports, political, scientific, are held in the Islamic Republic of Iran, which some of them are on very large scales. The aim of this paper is key planning considerations for the organizers of mass gatherings in the context of the novel coronavirus (COVID-19) outbreak.

This paper published by using the WHO’s Public health for mass gatherings key considerations and other reliable national and international references and websites.

Meeting organizers should consider three phases in planning appropriate preparedness measures (Planning, Operational, and Post-event phases). Specific actions to be taken in each phase are discussed:In Planning phase: Liaison with local and national public Health authorities; Risk assessment; Specific action plan for COVID-19; Capacity and resource assessment; and Risk communication and community engagement plan In Operational phase: Risk communication; Surveillance of participants; Testing and diagnostic arrangements; Treatment facilities; Decision-making; and Operational practices for reducing event-related transmission of the COVID-19 virus.
In Post-event phase: Support the response of authorities, if public health authorities suspect that transmission of the COVID-19 virus has occurred; Risk communication; Use and fallow the lessons identified;

A basic medical action plan must be created for every mass gathering event. Providing safety, security and health of the participants during the ceremonies is one of the most important tasks, have been considered in the mission of various organizations such as police, fire stations, hospital emergencies, etc. According to the services they provide, health organizations play an important role in providing and restoring health before, during and after gatherings.

This policy summary presents essential and practical strategies relevant to COVID-19 outbreak and includes four sections namely. 1- confronting the coronavirus epidemic (identifying the most effective activities at the community level, designing evidence based diagnostic and treatment guidelines, minimizing socio-economic adverse effects, promoting spiritual health of community etc.) 2- professional and immediate executive priorities (improving outpatient and inpatient care standardizing and expressing diagnostic procedures, designing clinical and paraclinical guidelines) 3- Recommendations for confronting the epidemic (unified command and public coordination of management, health education) scientific and research recommendations (prevention priority at all levels for policymakers, structural, executive, educational, research etc.)

In this policy summary, the most important strategic and effective issues regarding the SARS-COV-2 virus outbreak and its related disease, COVID-19are presented. This summary prepared in five sections consists of goals, strategic recommendations, immediate executive recommendations, and other executive recommendations effective in curbing casualties of this disease.

In continuation of the two previous policy summaries, the necessary strategic and executive issues are discussed in the context of the corona disease. The primary health care network is the most important achievement of the Islamic Republic of Iran providing, maintaining and promoting health of the community. Optimal use of the potential capacity of the country's health care network is a definite national necessity. Valuable experiences and strategies for strengthening it in the future are presented in this policy summary; it can be summarized as follows: Ensuring political commitment for equity in health, determining indices based on social factors which affects health status, achieving health priorities in all of the policies, extensive and integrated implementation of different levels of health services, comprehensive participation of people, maintaining economy, increasing human resource capability, medical education and research integration in various health services and programs, using the capacities of the country's primary health care network for achieving anti-corona programs.

Health management consists of organizations, individuals and activities with a main goal for providing, maintaining and promoting health and disaster management. It is a process which includes the prediction, prevention, reduction, preparedness, response and recovery in serious events. The promotion of health management in disasters, must consider political commitment of officials the people's health rights, priority of prevention over treatment in the general policies, informing and empowering people for their rights, considering stewardship of the health system as well as providing health resources and services which are duties of the Ministry of Health and Medical Education, These include monitoring health indicators, promotion of mental health, reforming the society for people's participation and, promoting higher education and health research in the field of disasters.

Health promotion is important in advancing Sustainable Development Goals by focusing on "Health for All and All for Health"; this can create the necessary hype to promote comprehensive health, media and clinical literacy of the community and promote prevention. The Iranian Health Education and Promotion Association emphasize the priorities of health in the current situation.The greatest responsibility of the headquarters and officials of the Ministry of Health is transparency, accountability, trust building and informing community to promote prevention, self-care and improve community health. Using the capacity of non-governmental organizations by establishing public participation makes use of lessons learned by other countries of the world. The current systematic approach, in addition to coordinating all relevant organizations and institutions, makes it possible to plan short and medium-term strategic programs for management of crises. This management and distribution of tasks help to overcome the crisis at hand and create a culture of harmonious management by using formal and informal social capital.