Medical students have become increasingly visible working side by side with other health care providers giving support and spreading awareness in their communities to help raise the standards of living for their surrounding communities so their knowledge and awareness and practice are an important aspect to achieve optimum health and people look up to them as they are the doctors of the future.
Since December 2019, an outbreak of severe respiratory infection emerged in the city of Wuhan in China [1, 2]. The disease was linked to the Wuhan's Seafood Market, which deals in fish and many other animal species like bats and snakes[3] On the 7th of January 2020, the Chinese Centre for Disease Control and Prevention (CCDC) isolated the causative agent from throat swab samples and the name Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was given to this virus. The World Health Organization (WHO) then renamed it as Corona virus disease-19 (COVID-19) [4].
Coronaviruses are a large family of enveloped RNA viruses found in a broad range of animals including camels, cattle, cats, and bats. In relatively rare events, vectors can transmit coronaviruses to humans with continued circulation resulting in human-to-human exposure.
COVID-2019 is the third coronavirus emerging in the human population in the past two decades, having been preceded by the SARS-CoV outbreak in 2002 and the MERS-CoV outbreak in 2012. All of these viruses originated in bats [5]. Initially, 2019-nCov patients were shown to have some link to the Wuhan market suggesting animal-to-person transmission. However, an increasing number of cases appear to have resulted from human-to-human contact as growing numbers of patients were shown not to be exposed to animal markets [6]. This spread has now resulted in a worldwide pandemic which has put global health institutions on alert. At present, no antiviral medication or vaccine is available for COVID 19 infection and infected patients are managed with supportive care [6].
The symptoms of COVID-19 infection appear after an incubation period of approximately 5.2 days (1 to 14 days) [7]. The period from the onset of COVID-19 symptoms to death ranges from 6 to 41 days with a median of 14 days [8]. This period is dependent on the age of the patient and status of the patient's immune system. It was shorter among patients more than 70-years old compared with those under the age of 70 [8]. The most common symptoms at onset of COVID-19 are fever, cough, and fatigue, while other symptoms include sputum production, headache, hemoptysis, diarrhea, dyspnea, and lymphopenia [8, 9, 10, 11]. Clinically the disease presents as an acute respiratory distress syndrome and acute cardiac injury, leading to death [10]. In some cases CT scanning shows multiple peripheral ground-glass opacities in subpleural regions of both lungs [12].
It is important to note that there are similarities in the symptoms between COVID-19 and earlier beta coronavirus such as fever, dry cough, dyspnea, and bilateral ground-glass opacities on chest CT scans [8]. However, COVID-19 showed some unique clinical features that include the targeting of the lower airway as evident by upper respiratory tract symptoms like rhinorrhea, sneezing, and sore throat [13, 14]. In addition, based on results from chest radiographs upon admission, some of the cases show an infiltrate in the upper lobe of the lung that is associated with increasing dyspnea with hypoxemia [15]. Importantly, whereas patients infected with COVID-19 developed gastrointestinal (GI) symptoms like diarrhea, a low percentage of MERS-CoV or SARS-CoV patients experienced similar GI distress. Therefore, it is important to test fecal and urine samples to exclude a potential alternative route of transmission, specifically through health care workers and patients [13, 14].
Comorbidities were found in almost 50% of patients with COVID-19. Hypertension is the most commonly recognized one, followed by diabetes mellitus and heart diseases [16]. Infection with COVID-19 has been reported in all ages, even children, with 54.3% of those infected being males [17].
In comparison between the patients that recovered from the infection and those who died, the latter had more abnormalities associated with their coagulation profile manifesting as a longer prothrombin time, shorter activated partial thromboplastin time (APTT) and lower platelet counts. Also, D-dimer elevation was commonly found in the severely ill COVID-19 patients [18]. It may be that inflammatory injury by COVID-19 infection can lead to coagulopathy, platelet aggregation, and thrombosis, with an increased platelet consumption and destruction [19]. On the other hand, an elevation in aspartate aminotransferase (AST) was detected in (62%) of cases admitted in the ICU in comparison with (25%) of patients who did not need admission in the ICU [20].
From the above it seems the world now has a viral pandemic on its hands which has new features and for which no treatment is currently available. For all intents and purposes this viral infection seems set to be around for many years to come with the current pandemic expected to last till 2021 [21]. Therefore, knowledge and awareness and practice of COVID19 infection among medical students is important because they will be in the front line against this virus in the future.
In this study we plan to study the knowledge, attitude and practice of medical students in 19 universities in Sudan about COVID 19.