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COVID-19: An International Public 

Health Concern 

 

Israel Oluwasegun Ayenigbara1 
 
1Department of Health Education, School 
and Community Health Unit, University 
of Ibadan, Ibadan, Nigeria 

 

Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2020.466 |   http://cajgh.pitt.edu 

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Abstract 

This review presents a synopsis on the current COVID-19 pandemic, with focus on preventive measures. COVID-19 is a new viral 

infection, and is in form of a positive-sense, single-stranded RNA Coronavirus which belongs to an expanded group of viruses 

which were identified six decades ago. Importantly, the new COVID-19 belongs to the group of SARS-CoV, and it originated in 

bats but infected humans through smuggled pangolins. At first, the mode of transmission of infection was animal-to-person, but 

person-to-person and community transmission of the virus has been confirmed in many parts of the world. With an incubation 

period of between two-fourteen days, signs and symptoms of infection are mild to high respiratory illness; characterized with 

cough, breathing problems (shortness of breath), high temperature (Fever), tiredness (Fatigue) and nausea. Presently, no vaccines 

or specific treatment is available for COVID-19, in light of the aforementioned; prevention is the only substantial and less expensive 

option. With the envisaged explosive community transmission of COVID-19 in the coming weeks in places with limited daily 

testing, especially in African countries, it is recommended among many that social distancing which includes avoiding any form 

of contact with people; either through greetings, hugging or shaking of hands and large gatherings, avoid contact with animal items, 

dead or alive animals, sick and dead people from areas experiencing COVID-19 epidemic, and basic hygienic practices like 

thorough washing of hands with clean water and antiseptic soap for the duration of at least twenty seconds should be practiced 

always. However, in the absence of the aforementioned, an alcohol-based hand gel should be used on the hands frequently. 

Furthermore, health care workers should adhere strictly to the standard preventive measures in areas of heightened COVID-19 

epidemic. 

Keywords: COVID-19 infection; reservoir of infection; mode of transmission; signs and symptoms; preventive measures 

COVID-19: An International Public 

Health Concern 

 

Israel Oluwasegun Ayenigbara1 
 
1Department of Health Education, School 
and Community Health Unit, University of 
Ibadan, Ibadan, Nigeria 

Research 

Introductions 

A recently discovered coronavirus named 

officially as “COVID-19” is currently spreading at a fast 

rate in China, and numerous cases of the new infection 

has now been confirmed in many countries as well. With 

the continuous upsurge in the number of laboratory 

confirmed cases and mortality, scientists, physicians and 

health care workers around the world are working 

assiduously to know more about the epidemiology of the 

new virus, so as to enable appropriate measures to be put 

in place to forestall and limit its rapid spread [1, 2]. 

Generally, Coronaviruses belongs to an expanded family 

of viruses which were identified exactly six (6) decades 

ago [2]. The first sets of viruses which belong to the 

Coronaviruses family were indentified in chicken 

(infectious bronchitis virus) and in humans, namely 

human coronavirus 229E and human coronavirus OC43; 

symptoms manifest as common cold [3]. Over the years, 

numerous members of the Coronaviruses family were 

discovered, they are SARS-CoV (2003), HCoV NL63 

(2004), HKU1 (2005), MERS-CoV (2012), and the 

current COVID-19 pandemic which was discovered at 

the end of 2019; majority of these viruses had resulted in 

the severe infections of the respiratory system, and some 

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causes sickness in people [3, 4]. In addition, many other 

coronaviruses affect animals like cats, bats and camels 

[4]. Importantly, many individuals are infected with 

coronaviruses during their lifetime, but signs and 

symptoms are usually not severe, although, mild 

pneumonia can result in some cases [2]. 

The Novel COVID-19 pandemic is a positive-

sense, single-stranded RNA coronavirus [5, 6, 7]. The 

World Health Organization (WHO) was alerted of the 

first suspected cases of the infection in late 2019 (31st 

December 2019), which was just over three weeks after 

the manifestation of signs and symptoms in the suspected 

cases [8, 9]. More findings of the new COVID-19 

infection revealed that the novel virus was genomically 

identified in a sample from a person with pneumonia in 

Wuhan Province, China [10]. Although, this current 

COVID-19 pandemic is unprecedented, and scientist, 

researchers and health workers around the world are still 

getting to know more about its epidemiology in entirety. 

With the increase in the number of confirmed cases and 

deaths been reported every day in the world, the current 

situation is now a pandemic. Hence, this review paper 

gives a synopsis of the current COVID-19 pandemic 

under its probable Reservoir Species, Mode of 

transmission, Signs and Symptoms, Current situation 

around the world, Africa and Nigeria, and importantly, 

Preventive measures to be adopted to forestall the spread 

of the pandemic. 

 

Sources of Information 

This is a review research on COVID-19 

pandemic, and discussion were outlined under probable 

Reservoir Species, Mode of transmission, Signs and 

Symptoms, Current situation around the world, the 

African continent and Nigeria, and importantly and 

Preventive measures were provided. Sources of materials 

for the review were gotten from the various international 

and national health authorities such as the World Health 

Organization and the US Centers for Disease Control and 

Prevention publications. Furthermore, major scientific 

documents included in this review were also gotten from 

PubMed databases. 

 

Reservoir Species 

The new COVID-19 belongs to the group of 

SARS-CoV. In 2015 and 2017, two genome sequences 

from Rhinolophus sinicus with a resemblance of 80% had 

been published; the third unpublished virus genome from 

Rhinolophus affinis with a resemblance of 96% to the 

current COVID-19 pandemic was mentioned in an article 

from the Wuhan Institute of Virology [11, 12]. For 

comparison, this sequence of mutation is the same to the 

ones seen over a decade ago in the H3N2 human flu 

epidemic [11, 13]. Furthermore, pairwise protein 

sequence analysis of seven conserved non-structural 

proteins domains proves that COVID-19 belongs to the 

species of SARSr-CoV. In addition, the virus causing the 

current COVID-19 pandemic was isolated from the 

bronchoalveolar lavage fluid of a critically ill patient; the 

virus uses the same cell entry receptor-angiotensin 

converting enzyme II (ACE2) as that of SARS-CoV [14, 

15, 16]. Animals sold as human food consumption are the 

first source of transmission of the current COVID-19 

outbreak due to the fact that majority of the first sets of 

human causalities noted and confirmed infected cases 

were workers at the Huanan animal Market in Wuhan 

province, before exposure to larger contacts of humans 

and animals [17]. 

 

Mode of Transmission 

The first sets of patients from the COVID-19 

outbreak in Wuhan province, China were workers or 

buyers at the main animal market in the province, 

indicating transmission through animal-to-human [6, 18]. 

Importantly, there has been an upsurge in the number of 

sick individuals from the COVID-19 who have not had 

exposure or contact to the Wuhan main animal markets 

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whatsoever, this indicates that human-to-human and 

community transmission of COVID-19 is happening [6, 

19, 20, 21]. Specifically, person-to-person spread of the 

COVID-19 outbreak was affirmed on 20th January 2020 

in Guangdong, China, by the Chinese authority [22]. It is 

now known how the human-to-human transmission of 

the current COVID-19 pandemic occurred, for instance, 

when person-to-person transmission occurred with 

Middle East Respiratory Syndrome (MERS) and Severe 

Acute Respiratory Syndrome (SARS) infections 

happened, it occurred through respiratory droplets from 

sick patient’s, and infected coughs or sneezes from sick 

patients, the same way many respiratory pathogens 

circulates to humans, and the human-to-human 

transmission generally occurred between close contacts 

[6]. Importantly, human-to-human transmission of 

viruses varies, some viruses have high virulence and are 

highly contagious, while other viruses are less so [6]. The 

person-to-person spread of the current COVID-19 

pandemic is primarily spread between people via 

respiratory droplets from coughs and sneezes [23, 24]. As 

of 29th February 2020, community transmission of 

COVID-19 pandemic has been confirmed in China, 

Germany, Hong Kong, Iran, Italy, Spain, France, Japan, 

Singapore, South Korea and the United States of America 

[25, 26]. Furthermore, there is a possibility that the 

current COVID-19 pandemic might be spread through 

fecal oral route of transmission as a healthy six-month-

old baby with COVID-19 had persistently positive 

nasopharyngeal swabs to day sixteen (16) of admission 

[27]. Firstly, this scenario pinpoints the task in 

establishing the exact incidence of COVID-19 

transmission as asymptomatic individuals can excrete the 

virus which can pose a major threats in areas where there 

are not good drinking water supply, e.g. in the developing 

countries. Secondly, these set of individuals can be the 

causative link to some undetected transmission of the 

virus in the community [27].  

 

Signs and Symptoms 

The time for the manifestation of signs and 

symptoms of COVID-19 is between two to fourteen days, 

as this was the time range the signs and symptoms began 

to appear after an exposure to MERS virus [28]. 

Although, some studies caution that the average 

incubation period of COVID-19 is between six and half 

days, and ranges from zero to twenty-four days, and the 

basic reproductive number (R0) of the pandemic is 

between 2 to 3.5 at the early phase regardless of different 

prediction models, which presently in comparison, is 

more than SARS and MERS [29]. Specifically, 

individuals with confirmed cases of COVID-19 have 

signs and symptoms of low to high respiratory illness; 

characterized with cough, breathing problems (shortness 

of breath), high temperature (Fever), tiredness (Fatigue) 

and nausea [17, 30, 31, 32]. Furthermore, chronic 

inflammation of the lung (pneumonia), malfunctioning of 

the kidney (kidney failure) and death have also appeared 

in patients with severe cases of COVID-19 [33, 34, 35, 

36]. Importantly, in hospitalized individuals, specific 

vital signs parameters such as body temperature, blood 

pressure, pulse (heart rate) and breathing rate (respiratory 

rate) were stable during admission, but infected patients 

had an abnormally low count of leukocytes (leucopenia) 

and abnormally reduced number lymphocytes in their 

blood (lymphopenia) [17, 37]. Also, few numbers of 

individuals with COVID-19 experienced serious signs 

and symptoms, and majority of hospitalized patients have 

one or two fundamental health conditions such as 

diabetes, cardiovascular diseases and hypertension [38] 

(Table 1). 

 

Current Situation of COVID-19 Infection in the 

World, Africa, and Nigeria 

The WHO was notified of numerous cases of 

pneumonia on 31st December 2019, specifically in 

Wuhan, Hubei Province of China [41]. After preliminary 

investigation, the virus did not match any existing 

viruses, and this heightened concerns among scientists 

because the route of transmission was not known since it 

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is a new virus [41]. On 7th January, approximately a week 

later, the Chinese government confirmed they had 

identified the new virus, and it is a coronavirus which 

belongs to the group of viruses that include the common 

cold, and viruses such as SARS and MERS [41]. With 

the evolving nature of this current pandemic, and the 

frequent changes in statistics and figures, as at 29th March 

2020, there have been 697,994 confirmed cases of 

COVID-19 from 202 countries and territories and one 

conveyance ship, and 33,421 deaths recorded, with 

majority of the world’s population on lockdown to avert 

the further spread of the infection [42]. Explicitly, the 

Western Pacific Region (Nineteen countries and 

territories affected) has a total number of 104,146 

confirmed cases, with 3,660 deaths; the European Region 

(Sixty countries and territories affected) has a total 

number of 397,719 confirmed cases, with 24,246 deaths, 

the South-East Asia Region (Ten countries affected) has 

a total number of 4,333 confirmed cases, with 164 deaths, 

the Eastern Mediterranean Region (Twenty-one 

countries and territories affected) has total number of 

46,623 confirmed cases, with 2,828 deaths, the Region of 

the Americas (Fifty-one countries and territories 

affected) has a total number of 141,282 confirmed cases, 

with 2,461 deaths, the African Region (Forty-one 

countries and territories affected) has a total number of 

3,179 confirmed cases, with 55 deaths, while the 

Conveyance Diamond Princess ship has a total number 

of 712 confirmed cases, with 7 deaths [42]. Presently, the 

European Region with Sixty countries and territories 

affected with a total number of 397,719 confirmed cases 

and 24,246 deaths have now overtaken the Western 

Pacific Region which included China as the current 

epicenter of the current COVID-19 pandemic [42]. The 

African region with Forty-one countries and territories 

affected has the lowest number of confirmed cases and 

deaths with 3,179 and 55 respectively. However, massive 

sensitization and heightened preventive measures which 

includes rigorous contact tracing and wider testing 

should be intensified so as to prevent against explosive 

community transmission and mortalities of COVID-19 

due to the weak health care system in the African 

continent [42]. Initially, the majority of confirmed cases 

of COVID-19 has been in China where the outbreak 

started, however, massive COVID-19 cases and 

mortalities have occurred in other countries as well, for 

instance in the United States of America, Italy, Iran, 

France, Britain, France and Spain [43, 44]. The exact 

number of individuals who have contracted the virus 

could be far higher as people with mild symptoms are not 

been detected due to shortages in test kits, especially in 

developing countries [44].  

The COVID-19 Pandemic spread to the Africa 

continent on 14th February 2020, with Egypt recording 

the first confirmed case of the virus on the continent, 

while the first recorded case in the sub-Saharan Africa 

was in Nigeria; both cases were imported transmission 

[45, 46, 47]. Afterwards, subsequent cases of COVID-19 

have come from imported cases from Europe and the 

United States rather than from China; the country where 

the infection broke out [48]. Presently, according to the 

WHO classification of regions, Forty-one Africa 

countries and territories have reported a total number of 

3,179 confirmed cases and 55 deaths from COVID-19 

pandemic, these figures are expected to rise in the coming 

weeks [42]. Also, confirmed cases of infection and deaths 

from COVID-19 pandemic have been reported in some 

African countries (Egypt, Morocco, Tunisia, Sudan, 

Libya and Somalia) which are classified in the Eastern 

Mediterranean region by the WHO [42]. As at 28th March 

2020, Botswana, Burundi, Comoros, Lesotho, Malawi, 

São Tomé and Príncipe, Sierra Leone, and South Sudan 

remains the only African countries who have yet to report 

any cases of COVID-19. Importantly, numerous 

preventive measures have been implemented to abate the 

spread of COVID-19 in different countries in Africa, 

these include travel restrictions, school closures, border 

closures, flights and event cancellations [49, 50]. 

Although, explosive community transmission of the 

infection is predicted in the African continent due to 

limited testing and inadequate contact tracing, however, 

the experience gathered during the Ebola and Lassa fever 

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epidemics could help in the continents battle to contain 

the COVID-19 pandemic [49].  

In Nigeria, with the rapid changes in infection 

statistics, a total of 111 confirmed cases and a single 

death have been recorded, with three patients discharged 

after treatment from COVID-19 as at 29th of March 

2020, and confirmed cases have mild to moderate signs 

and symptoms that are currently receiving care [51]. In 

all, Lagos state has the highest number of confirmed 

cases in Nigeria with sixty-eight patients, followed by 

Abuja, Oyo, Ogun, Enugu, Bauchi, Osun, Edo, Benue, 

Ekiti, Kaduna and Rivers with combined confirmed cases 

of forty-three [51]. Unfortunately, limited COVID-19 

tests are been done in Nigeria due to shortages of test kits, 

hence, the number of infection cases due to community 

transmission is predicted to increase sharply in the 

coming weeks. Although, as precautionary measures to 

avert the rate of infection, the president ordered the 

cessation of all none essential movements in Lagos and 

the capital Abuja; the two cities with the highest number 

of confirmed cases for an upward reviewable duration of 

fourteen days which starts on Monday, 30th March 2020 

[52]. Importantly, Several countries in the world have 

also put up various preventive measures to curtail the 

spread of COVID-19, some of which are travel bans to 

and from the countries that are massively affected, 

compulsory quarantine, lockdown of cities, restricted 

access to some specific places, compulsory checking at 

borders, airports and railway terminals, and presently, the 

Chinese authorities have stopped and banned wildlife 

trade nationwide, at least until the current pandemic has 

ended, as this was believed to be the source of the current 

COVID-19 pandemic and the SARS epidemic almost 

twenty years ago [44]. 

 

Prevention of COVID-19 Infection 

Presently, no vaccines or specific treatment is 

available for COVID-19, but there are ongoing studies on 

preventive vaccines, and some drugs are currently been 

used for the treatment of this current pandemic [53, 54, 

55, 56, 57, 58, 59]. In light of the aforementioned, 

prevention is the only substantial option against COVID-

19. Firstly, if traveling to locations where there are 

confirmed cases of COVID-19 outbreak, it is pertinent to 

avoid any form of contact either through greetings, 

hugging, kissing or shaking of hands. Also, contact with 

sick people, items that come from animals such as 

uncooked meat should be ultimately avoided [2, 60]. 

Furthermore, basic hygienic practices like thorough 

washing of hands with clean water and antiseptic soap for 

the duration of twenty seconds should be practiced 

always. However, in the absence of the aforementioned, 

an alcohol-based hand gel should be used on the hands 

frequently [60]. As recommended by the CDC and 

WHO; contact with unwashed hands should be avoided 

on the nose, mouth, eyes and the ears. Furthermore, 

reduce and minimize close contact with people, 

especially sick individuals, self isolation when sick, 

fourteen days compulsory quarantine after returning from 

locations that have recorded cases of the COVID-19, 

cough and sneeze on a tissue paper, afterwards dispose 

the tissue paper in a waste bin, clean and disinfect 

frequently touched objects and surfaces; all these are 

imperative preventive measures to be adopted in the 

prevention of the current COVID-19 [42, 61].  

For health workers, Infection control training 

should be to all clinical staff, installation and provision 

of protective shields, frequent disinfection of equipment, 

and provision of eye protective equipment should be 

provided to all medical staff treating COVID-19 patients 

[62]. Also, as precautionary, medical workers should 

measure their own body temperatures before and after 

work, and promptly report any symptoms of upper 

respiratory tract infection, vomiting or diarrhea [62]. 

Furthermore, universal masking, hand hygiene, and 

appropriate use of personal protective equipment (PPE) 

should be well implemented by medical workers [63]. In 

addition, medical staff should be extremely careful with 

blood samples collected for diagnosis, as there is still a 

risk of transmission of COVID-19 virus through the 

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transfusion of labile blood products, as more and more 

asymptomatic infections are being found among the 

current COVID-19 cases [63]. Also, to promptly identify 

patients and prevent further spreading of infection, 

physicians should be aware of the travel or contact 

history of patients with compatible COVID-19 signs and 

symptoms [64]. 

 

Conclusions 

COVID-19 belongs to the group of SARS-CoV, 

and it originated from bats, but infected humans through 

smuggled pangolins. At first, the mode of transmission of 

the current pandemic was animal-to-person, but person-

to-person and community transmission of the COVID-19 

has been confirmed in many parts of the world. With the 

continuous rise in the number of confirmed cases and 

mortality rates across all countries and regions in the 

world, category of people with the highest causalities are 

older people, especially those with underlying medical 

conditions; hence, preventive measures should be 

focused more on this vulnerable group. From this review, 

it was concluded that the COVID-19 is indeed an 

international public health concern due to the vast 

majority of countries that have reported confirmed cases 

of infection and deaths. However, even without the 

present breakthrough in the urgent search for specific 

treatment and vaccines, the spread of the current COVID-

19 pandemic can be reduced and ultimately stopped with 

strict adherence and compliance to basic infection 

preventive measures that have been provided in this 

review. Furthermore, rigorous contact tracing should be 

implemented in African countries and in countries where 

limited testing has been carried as a result of shortages in 

test materials and equipment to prevent against the 

envisaged explosive community transmission of 

COVID-19. 

 

Recommendations 

Based on the findings of this review, the 

following recommendations are further made; 

1. Avoid unnecessary travel at this time, especially 

to areas with confirmed cases of COVID-19 

outbreak. 

2. Place self on compulsory fourteen days 

quarantine and isolation when returning from 

locations with the confirmed cases of COVID-

19 even if there is manifestation of any signs and 

symptoms or not.  

3. Strict testing as border points, airports and 

terminals should be enforced to prevent against 

imported cases of the COVID-19. 

4. Rigorous contact tracing should be done to 

identify people who might have had contact 

with patients who are infected with COVID-19 

to further prevent against the community 

transmission of the virus. 

5. With the high numbers of causalities as a result 

of COVID-19 among older people, large 

gatherings of people, especially the elderly 

should be banned for now.  

6. Although, there are few cases of the COVID-19 

in Africa. Nevertheless, health education and 

sensitization programmes on preventive 

measures should be heightened to enlighten the 

public due to the vulnerable health care system 

in the continent.   

Countries experiencing increasing number of 

cases from the COVID-19 should be open with their 

statistics, as this would help relevant health authorities to 

putting up appropriate preventive measures, hence 

helping to reducing further the number of infections. 

 

Acknowledgements 

Great thanks are given to unknown reviewers 

for valuable comments. 

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