C/NUR 600: Epidemiology Final Assignment - Analysis of Key Questions

This assignment presents answers to three epidemiology questions, each explored in detail with supporting evidence. The first question examines the COVID-19 pandemic, discussing Alberta's projections, rapid diagnostic tests, and the limitations of diagnostic accuracy, as well as the role of a registered nurse during this pandemic. The second question focuses on mass versus selective screening, the MOHLTC's active screening process, screening guidelines for vulnerable populations, and the role of registered nurses in screening programs. The third question delves into the phrase "correlation is not causation", illustrating its correct use and misinterpretation through examples related to chamomile consumption and smoking. The answers are supported by academic and empirical sources, adhering to APA 6th edition format.

Running head: QUESTION AND ANSWER
Question and answer
Name of the Student
Name of the University
Author Note

1QUESTION AND ANSWER
Answer 1:
a) https://www.thestar.com/news/canada/2020/04/07/alberta-has-revealed-its-
covid-19-projections-province-expects-between-400-and-3100-deaths-in-
probable-scenario.html
An article was published in Toronto Star dated April 7, 2020, stated that the province
Alberta will be experiencing 400- 3100 probable deaths by the end of summer 2020 due to
the current scenario pandemic status of COVID 19. The premiere of province Alberta, Jason
Kenney who became the current leader displayed the adverse scenarios and probabilities of
this pandemic. Kenney also stated that the probabilities depends on the way public decide to
execute social distancing, personal hygiene and various health measures in Alberta. The
number of COVID- 19 positive cases is accounting for 800,000 based on the Alberta Health
services projections. Kenney also said that this scenario can be elevated by the million of
other infections at the same time resulting in 500 to 6600 deaths by August. He also stated
that the province will have equipments to take this projection as a challenge and deal with it.
According to the Alberta models social distancing will remain till the end of May. Along with
this province has set goals to fight this pandemic that includes 20,000 diagnosis in a day,
returning immune people to work, tracking of COVID-19 infected people, facilitating use of
mask and install screening at the border area. By this date, Alberta has recorded 1400 cases of
infected people with 26 deaths. The pandemic is followed by economic crisis of the province

2QUESTION AND ANSWER
due OPEC countries falling out on dumping oil into the market and fall in the benchmark
prices of oil, unemeployment will reach upto 25% in the province (Leavitt, 2020).
b)
A new diagnostic test used in the laboratory for diagnosis of COVID-19 would be
rapid diagnostic test. It is a qualitative assay which is easy for use and can be applied at point
of care. Using blood samples by pricking finger or saliva or nasal swab samples, an
indication will be shown as coloured lines for positive or negative results. It usually test for
serum antibodies such as IgG and IgM of the patient against COVID-19 virus or the viral
antigens. These test kits are generally given healthcare providers and lab-based researchers to
the confirm the presence of this virus in patients. It is approved and validated by US
government or US-FDA for use. It provides result within 10 minutes where the sensitivity is
93.8% and 95.6% when tested for a total of 128 COVID-19 positive and 250 COVID-19
negative patients against SARS-COV2 virus (JHCHS, 2020).
c)
None of the diagnostic tests for COVID-19 is a gold standard test because the
accuracy that is measured as specificity and sensitivity is not exactly 100%. The sensitivity
and specificity may be near about 100% but is not exactly accurate. It has been shown that
rapid test can detect IgG and IgM against SARS COV-2 with 100% specificity but not 100%
sensitivity where sensitivity for IgG is 87.9% and for IgM is 97.2% (JHCHS, 2020).

3QUESTION AND ANSWER
d)
As a future registered nurse, I should act on the frontline in response to COVID-19. I
should have knowledge and prepared plan in infection control. I will receive education on
protocols and procedures to be used in the health care facility so that I can identify, control
and care for patients who show symptoms related with coronavirus disease which will
prevent the spread of the disease in the community. As the disease can be controlled by
maintaining isolation or quarantine of the patients or suspected individuals, therefore I will
follow the guidelines provided by CDC for preventing spread of the disease in future. I will
educate the patients on hand hygiene and social distancing as urgent requirements to curb
occurrence of any pandemic related to this virus. In order to detect and evaluate the testing of
this virus, I will follow the clinical guidelines in conducting the diagnosis and use the gold
standard test kit for accurately identifying the presence of the virus in the patient along with
observations of the clinical symptoms of the patients. According to the article in Alberta
province, it stated has if adequate precautions and regulations regarding this disease spread is
not followed then, the death rate can increase rapidly. Therefore it will be my duty to educate
patients and other individuals on following guidance of separation and hygiene in order to
stop community spreading. Alongside patients it is my duty to keep the other healthcare staffs
safe and protected from the spread of the disease and infection control. Ensuring proper
clothing including PPE and masks and use of personal hygiene in order reduce the affect of
this diease spread on healthcare workers (Centers for Disease Control and Prevention, 2020).

4QUESTION AND ANSWER
Answer 2:
a)
Mass screening is the procedure of all-population or subgroup screening. This is given
to everyone regardless of the individual's risk status. Whereas selective screening is the
screening of only for certain groups who are marked as a high risk or vulnerable group by the
researches during a epidemic. Mass screening with protocoscopy for rectal cancer and related
lesions in the overall population and regular check-up associated with standard endoscopy for
patients with high-risk may minimize overall occurrence and CRC mortality. Mass screening
associated with reverse passive faecal occult blood check for hemagglutination including a
risk evaluation questionnaire can recognise subjects identified as high-risk community.
Selective screening is important in screening of a foetus having a sibling with down
syndrome. Down syndrome is a genetic hereditary disease, and the probability of having a
down syndrome baby added up the probability of having the second baby with the disorder.
So, the foetus are the high risk group of having down syndrome and meets perfectly the
criteria of selective screening (Wulff et al., 016).
b)
MOHLTC recommending an active screening process where they are screening every
individual by asking question related to the symptoms, previous travel history within 14 days,
exposure to any diseased hotspot or the diseased person and medical condition including

5QUESTION AND ANSWER
problem in the airway. The screening process then shift towards the people matching any one
of the criteria. The screening method is almost like selective screening focusing selective
population. However, the screening’s first step consider all the citizens. The active screening
is an effective strategy to avoid exposure to the risk group and yet perform the primary
screening. The technique is modern and user friendly and at the same time ensures the safety
of the health worker, eliminate more spread of infection (Find.gov.on.ca, 2020).
c)
Screening guideline should specially focus on the older people and people with
immunity system with association to any comorbid condition. The claim can be supported by
a recent study of Wuhan which includes 191 people, of which 137 were discharged, and 54
later died in the hospital. 91 (48%) of patients have comorbid condition among them the most
widespread condition was found to be hypertension that is found in 58 [30%] patients; the
second condition is diabetes found in 36 [19%] patients and cardiovascular disease, which is
found in15 [8%] patients. Multivariable analysis has demonstrated the rising chances of death
correlated with old age in hospitals. Survivors have the longest recorded period of viral
shedding 37 days (Zhou et al., 2020).
d)
Registered nurses (RNs) offer several clinical programs in a range of environments to
health-care users. Many activities nurses perform on a regular basis provide a special

6QUESTION AND ANSWER
commitment to patient care, and some of the activities can achieve so by certain members of
the nursing team. Due to the broad complexity of the profession, nurses carry on multiple
tasks when meeting clients 'health care needs. Registered nurses have the experience,
abilities, skills and capacity to take the lead in screening techniques. RNs deliver treatment to
communities and promote primary health care including person-centred care through the
spectrum of interactions and resources of health care (Price et al., 2015). They have a deep
grounding in philosophy, health and sciences, arts, education, clinical study, and ethics in
nursing. RNs are able to work professionally, skilfully, sensitively and ethically to perform a
successful screening. Decision making by family doctors, other health care providers and
consumers about preventive health tests has been more complicated and divisive. Preventive
health screening proposed as among the most effective approaches in health care to promote
early detection, recovery and enhance the quality of life and avoid premature mortality for a
long time. It has been repeatedly explained to Canadians that the more diligent the patient
is regarding screening, and the more frequently they are tested, the safer and the better secure
they are expected to be. The goal of the screening guideline supports the professionals some
standards of nursing that are decision making and clear understanding of the diseases.
Understanding the possible advantages and drawbacks associated with a screening approach
is essential to educated practitioner and decision taking (Bell et al., 2017). This decision-
making includes an appreciation of the main variables impacting the combination of
advantages and disadvantages, the nature of the evidence supporting the screening strategy.

7QUESTION AND ANSWER
Hence it can be stated that the professional standard of nursing is intertwined with the clinical
guidelines and so to perform a successful screening it is crucial to have a profound
knowledge about the screening guidelines (Austin et al., 2015).
Answer 3:
a)
"Correlation is not causation" implies that the association of two events doesn't
automatically imply one triggers the other. Correlation is an indicator of how strongly the two
events are related. It is a quantitative tool that indicates, how closely the set of variables are
associated monotonically and are increasing together. It doesn't inform about the details of
the relationship and factors they are based on but it only suggests the connection exists
(Shipley, 2016). Causation is the next advanced step to correlation. This states that any
increase in the one variable would trigger the value of another variable to shift informing or
supporting the fact that one aspect enables another occur. The factor also can ne stated as
cause and effect of each other. In epidemiology, the phrase is relevant concerning the risk
factor and the disease causing factors (Shipley, 2016). Statistical correlation of a risk factor
with an illness does not automatically cause one to conclude a causal link. Alternatively, the
lack of an interaction does not automatically mean that a causal connection is not present.
The decision as to whether an observable statistical correlation constitutes a cause-effect
connection between exposure and disease includes inferences well beyond the evidence of a

8QUESTION AND ANSWER
single sample and entails examination of factors like interaction size, accuracy with results
from other experiments and biological legitimacy (Rohrer, 2018).
b)
The right way of using the phrase can be elaborate by the fact that mortality is lower
in people who consume camomile. 29% reduced the probability of death (all-cause mortality)
for consumers of chamomile relative to non-users and reported that this effect was
statistically important, especially for women. The consuming this herb is connected to longer
lives. The decreased incidence was statistically important for women despite age changes,
drinking, health illnesses and other established explanatory variables. However, for certain
considerations, the mathematical adjustment measures just the effect of the calculated
variations. In certain ways, the people who use chamomile may vary from others. For
example, usage of herbal tea is a sign of a "healthier" lifestyle. "Other unknown variables,
such as chamomile frequency and length, physical activity level and diet consistency, should
be considered (Grinthal, 2015).
c)
The misinterpretation of the phrase can be understood by the relation between
smoking and lung cancer. Many studies associate smoking with lung cancer; however, some
researches question the direct association which mark smoking as the cause. They claimed
that smoking and lung cancer can have correlation but it is not the cause of the disease. While

9QUESTION AND ANSWER
scientific differences are often made between connection and affiliation, both words are
synonymously used in this article. There is not yet enough evidence to support the widely
accepted theory of direct trigger of smoking with lung cancer. If the understanding is not
clear, then confusion in scientific science may make successful therapies to be dangerous
(Barrowman, 2014).
d)
It is important for healthcare professionals to have knowledge on causation and
correlation with regard to patient care. Registered nurses (RN) who are given responsibility
of patient care and providing best treatment in improving health outcome should understand
the causes of a disease and if there is any association or correlation among the factors or
causes. Understanding causation and causal relationship will help the nurse in evaluating the
situation and identify the exact causes while participating in decision-making process. This
will allow the registered nurses provide safe care with minimal errors in a healthcare setting.
Having a knowledge on the causation and correlation will impact the decisions they take that
in turn will affect the health outcome of their patients. Identifying the relevant cues can help
them in deciding best alternatives for treatment and understanding the differences between
factors that cause a disease. Sometimes RN can suggest medications on the basis of external
factors causing a disease without even diagnosis. However these medications can have high
risk with patient safety. Therefore it is necessary to identify the exact cause of a disease to
prevent medication errors and undesired health risk (Cloete, 2015). There are various diseases

10QUESTION AND ANSWER
that do not show similar symptoms in all patients or have different factors contributing to a
particular disease varying among different individuals. Some believes are that smoking is a
causal factor of heart disease alone however it can show effect on other parts of the body
such as brain, lungs and oral cavity. Therefore RN need to understand that there may be
correlation between smoking and heart disease but it is not always necessary that smoking is
a causation factor for heart disease (Nies & McEwen, 2014).

11QUESTION AND ANSWER
References:
Austin, C. A., Mohottige, D., Sudore, R. L., Smith, A. K., & Hanson, L. C. (2015). Tools to
promote shared decision making in serious illness: a systematic review. JAMA
internal medicine, 175(7), 1213-1221.
Barrowman, N. (2014). Correlation, causation, and confusion. The New Atlantis, 23-44.
Bell, N. R., Grad, R., Dickinson, J. A., Singh, H., Moore, A. E., Kasperavicius, D., &
Kretschmer, K. L. (2017). Better decision making in preventive health screening:
Balancing benefits and harms. Canadian family physician Medecin de famille
canadien, 63(7), 521–524.
Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019 (COVID-19).
Centers for Disease Control and Prevention. Retrieved 8 April 2020, from
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html.
Cloete, L. (2015). Reducing medication errors in nursing practice. Cancer Nursing
Practice, 14(1).
Find.gov.on.ca. (2020). Search Results | Ontario Ministry of Health and Long-Term Care.
Find.gov.on.ca. Retrieved 8 April 2020, from http://find.gov.on.ca/index.php?
q=screening&page=1&owner=moh&lang=EN&Search.x=0&Search.y=0.
Grinthal, T. (2015). Correlation vs. causation. American Scientist, 103(2), 84-85.
JHCHS. (2020). Global Progress on COVID-19 Serology-Based Testing. Johns Hopkins
Center for Health Security. Retrieved 8 April 2020, from
http://www.centerforhealthsecurity.org/resources/COVID-19/Serology-based-tests-
for-COVID-19.html.

12QUESTION AND ANSWER
Leavitt, K. (2020). Alberta has revealed its COVID-19 projections. Province expects between
400 and 3,100 deaths in ‘probable scenario’. thestar.com. Retrieved 8 April 2020,
from https://www.thestar.com/news/canada/2020/04/07/alberta-has-revealed-its-
covid-19-projections-province-expects-between-400-and-3100-deaths-in-probable-
scenario.html.
Muntean, W. J. Nursing Clinical Decision-Making: A Literature.
Nies, M. A., & McEwen, M. (2014). Community/Public Health Nursing-E-Book: Promoting
the Health of Populations. Elsevier Health Sciences.
Price, D., Baker, E., Golden, B., & Hannam, R. (2015). Patient care groups: a new model of
population based primary health care for Ontario. Toronto: Primary Health Care
Expert Advisory Committee confidential draft, 11.
Rohrer, J. M. (2018). Thinking clearly about correlations and causation: Graphical causal
models for observational data. Advances in Methods and Practices in Psychological
Science, 1(1), 27-42.
Shipley, B. (2016). Cause and correlation in biology: a user's guide to path analysis,
structural equations and causal inference with R. Cambridge University Press.
Shipley, B. (2016). Cause and correlation in biology: a user's guide to path analysis,
structural equations and causal inference with R. Cambridge University Press.
Wulff, C. B., Gerds, T. A., Rode, L., Ekelund, C. K., Petersen, O. B., Tabor, A., ... & Shalmi,
A. C. (2016). Risk of fetal loss associated with invasive testing following combined
first‐trimester screening for Down syndrome: a national cohort of 147 987 singleton
pregnancies. Ultrasound in Obstetrics & Gynecology, 47(1), 38-44.

13QUESTION AND ANSWER
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., ... & Guan, L. (2020). Clinical course and
risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a
retrospective cohort study. The Lancet.