Epidemiology Assignment: COVID-19, Screening, and Correlation

This assignment delves into critical aspects of epidemiology in the context of the COVID-19 pandemic. The student analyzes a recent newspaper article concerning the rising cases of COVID-19, discussing the implications of a new diagnostic blood test, including its sensitivity and specificity, and whether it can be considered a gold standard. The assignment then explores mass versus selective screening methods, evaluating the guidelines established by the Ontario Ministry of Health and Long-Term Care (MOHLTC), and assesses the relevance of these guidelines to registered nurses. The final section examines the phrase "correlation does not imply causation," explaining its meaning, importance in epidemiology, and providing examples of its correct and incorrect application. Throughout the assignment, the student emphasizes the importance of understanding these epidemiological concepts for future registered nurses in managing and mitigating the spread of infectious diseases.

Running head: EPIDEMIOLOGY
EPIDEMIOLOGY
Name of the Student
Name of the University
Author note

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Question 1) Select a recent newspaper article related to COVID 19. You can attach the
article to the assignment or provide a working URL at the beginning of your response.
a) Describe the main issue discussed in the newspaper article and what it is about
b) Consider that there is a new diagnostic laboratory blood test being used for
COVID 19. What are the consequences for sensitivity and specificity for this
test and its use ?
c) Is the COVID 19 diagnostic test a gold standard? Why or why not?
d) How is either the newspaper article that you selected or the concept of
learning about sensitivity and specificity relevant to you as a future registered
nurse?
Answer 1
URL: https://www.theglobeandmail.com/canada/article-nearly-half-of-canadas-covid-19-
cases-now-acquired-through-community/
a) The main issues described in the newspaper are on the rising cases of COVID-19
cases in Canada and demand in increasing the test options even if the people are showing
mild symptoms. In the last few days, it had been observed that almost half of Canada’s
population are getting acquired through community spread, with a significant shift in the
number of infections, deaths as well hospitalisation all over the country (The globe and mail,
2020). On March 23, 2020 it was reported that Canada would be facing crucial 2 weeks as
hospitals would be facing an influx for severely ill patients. Canada had already faced a
confirmed case of 1500 people with COVID-19 out of which 20 were reported dead. Public
Health Agency of Canada have reported 44 percent of COVID-19 cases occurring due to
community transmission only. Hence, it is clear that the virus is getting transferred only by
visiting friends or shopping in supermarkets and not due to international travel. On March 22,
it was reported by Horacio Arruda, health director of Quebec public health that in Quebec
about 40 to 60 percent of the cases are from local transmission. Horacio Arruda informed that
epidemiological situation that is being observed were expected. The newspaper article also
informed that there are some cases in Ontario, that people are not being tested with mild

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symptoms. Hence, people are feeling that the true degree of the disease is immensely
miscalculated. They want the government to take serious step about warning people to
prevent going in the social gathering. This would prevent from further spread of disease. The
paper gave a clear idea about the issues which focusses on the trauma of the people of getting
infected with the disease and the feeling that the still needs to take some serious measures to
prevent it. As a result, they want governments to do more to warn people they could become
infected if they continue to interact with friends, extended family or others.
b) The sensitivity of the test imitates the likelihood that the screening test would be
positive in the people suffering from the disease (Remolina, 2020). In comparison, the
specificity of the test reveals the possibility that the screening test would be negative amid
those people who are not suffering from the disease.
The use of the test is to differentiate between a healthy individual and people
suffering with COVID-19 (Guastalegname & Vallone, 2020). These test would help in
identification of an individual even with minor symptom and hence required treatment can be
provided.
c) Yes, COVID-19 diagnostic test is of gold standard. COVID-19 is a pandemic virus
that had affected the whole world. As per the report of March 26, 2020, COVID-19 has
affected about 492,056 people in the world and the death have exceeded to about 22175
(Coronavirus disease 2019 (COVID-19), 2020). Italy followed by Spain have faced the major
deaths. Hence, diagnostic tests are recommended and it is of gold standard so that early
diagnosis and prevention can be done. People suffering from the disease can be quarantined
that would prevent from further spread. In Canada, a total of 3409 cases were identified for
COVID-19 as per March 25, 2020 with 35 deaths. It have stated that the diagnostic test for

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COVID-19 would bring the situation of this pandemic under control, hence considered to be
of gold standard.
Henceforth, it had been observed that that the diagnostic test of COVID-19 is
precarious to trace the virus, having an understanding of epidemiology, transmission
suppression as well as informing case management about the people with symptom is
necessary. World Health Organisation (WHO) has rationalised the Laboratory Testing
Strategy as per the 4Cs transmission situations.
d) The news articles chosen as well as the concept have strong relevance towards
future nurse. The COVID-19 is highly pandemic and is affecting numerous people and
causing several deaths. The measures taken by the government to prevent COVID-19 would
create an impact on nurses as well as other health care people as they have to continue the
treatment for people with the disease that requires serious protection. As it is communicable
disease, if nurses donot take proper it might infect the nurse (Borasio, Gamondi, Obrist, Jox
& for the COVID-19 task force of palliative ch, 2020). Future registered need to find a proper
diagnostic measure for the people with COVID-19 positive sensitivity. The diagnostic tool is
still not discovered as the disease is new and hence development of the diagnosed tool and
the use depends on the researchers, health professionals as well as nurses. Every nursing
concept have separate guidelines, hence it is responsibility of the nurses to set guidelines and
work accordingly. COVID-19 is a pandemic destroying the world hence, immediate cure and
treatment guideline is necessary.

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Question 2) The Ontario Ministry of Health and Long-Term Care (MOHLTC) has
created guidelines for COVID 19 screening:
http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/
2019_guidance.aspx
a) What is mass screening versus selective screening and give an example for how each
would work? You can use COVID 19 or another health condition to describe your
example.
b) When considering these screening guidelines, is the MOHLTC recommending mass
screening, selective screening or another form of screening? Describe your answer.
c) Do you agree with these screening guidelines or do you think another priority group
should be screened? (e.g. young children, older adults etc.) Describe your answer.
d) Why are screening guidelines/protocols important for registered nurses to be aware
of? Describe your answer with rationale.
Answer 2
a) Mass screening is defined as the screening for the whole population or subgroups.
It is conducted to all the people irrespective of the risk status for the individual. Whereas
selective screening is conducted only for people who are under higher risk.
Recently COVID-19 is taking spreading and taking over the world causing thousands
of deaths. It initially originated from Wuhan province of China and then it spreaded all over
the world. In Canada, on 25th January, 2020, a plausible confirmed incident of COVID-19
was proclaimed in Ontario for an individual who came back from Wuhan, China. Further
incidents have been see in Ontario and all of the infected cases was traced to be coming from
the affected areas, which have an enduring COVID-19 transmission (Dong, Du & Gardner,
2020). Hence, the health risk postured to the people of Ontario became high. Therefore, the
whole area or community with infected case requires mass screening, as it had been
spreading in that area. Every household need to be tested to check if they are infected with
the virus, even a person with or without symptoms needs diagnosis as this virus starts
showing affect after 10 days of infection (Heymann & Shindo, 2020). Mass screening would

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help in rapid control of the disease as this virus is pandemic. A person from the community
diagnosed with COVID-19 virus can be quarantined and this would help in prevention of the
virus further.
On other hand, selective screening would not be effective for COVID-19, as it means
screening is done with people under high risk. However, in case of COVID-19 even though
the infected person comes in contact with a healthy person in super market, the healthy
person gets infected with the virus (Bai et al., 2020). However, the person might not show
any symptom at present and is avoided of screening. It is therefore recommended to undergo,
mass screening in case of COVID-19.
b) The Ontario Ministry of Health and Long-Term Care (MOHLTC) have
recommended Active and Passive screening. Active screening includes where patient are
screened over phone before setting an appointment. However, patient without phone
screening, trained staffs are recommended to screen the patient in the clinic depending on the
case (Gao et al., 2020). Then a primary screening is conducted behind barrier in order to
protect from spreading. On other hand, passive screening is conducted by putting a note on
the office entry regarding precaution that are to be taken. It provides the patient with proper
hand sanitizer and it need to be noticed that the patient covers their nose and mouth while
sneezing and coughing.
c) The screening guideline is very primitive. It is tough to diagnose any patient
suffering from the disease through phone or by using mask and sanitizers. Different priorities
need to be set for young children and older adult. Both of them have poor immunity, hence
different preventive measures are required for them so that they donot get infected with the
virus. They need to have different screening process (Paules, Marston & Fauci, 2020). The
children and older people do not go out and hence use of mask for a kid as well as for old

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person becomes suffocative for them. Hence, it is required that proper diagnostic or screening
technique need to be delivered for them. A better method of screening helps in early
diagnosis that would lead to control of the disease from spreading from one person to
another.
d) The screening guidelines are very important for the nurse. As the nurses have to
treat the patient suffering from the disease and hence there are chances that they might get
infected if proper protections are not taken. Therefore, it is required that the nurse uses
protection mentioned in passive screening. The nurse must be aware screening guidelines as
they can protect themselves from getting infected. The nurses, had to do their duty of serving
the patient. Hence, screening guidelines are required for them. Even it is suggested that if a
nurse has a symptom of flu, they must undergo active screening and hospital authority can fix
an appointment for them. Even it would be beneficial that the hospital authority conducts
mass as well selective screening for nurses so that any nurse diagnosed with infection can be
treated and spread of infection can be controlled (Desai & Patel, 2020). Nurses, are more
prone to infections as they are handling the infected patients hence following the screening
guidelines is highly recommended for them. The screening guidelines are generated by the
government of Canada therefore all nurses must abide by the rules and must be aware of it.

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Question 3) The phrase “correlation does not imply causation” is used regularly in the
media.
a) What does this phrase mean and why is it relevant to epidemiology?
b) Provide an example to describe the correct use of this phrase. Describe the
example in detail.
c) Provide an example to describe a misinterpretation or incorrect use of this
phrase. Describe the example in detail.
d) Why is it important for registered nurses to fully understand the terms
‘correlation’ and ‘causation’? Describe your answer with rationale.
Answer 3
a) The expression "correlation does not imply causation" means the incapability to
rightfully infer a cause as well as effects connexion amid two elements uniquely on the basis
of observed connotation or correlation amid them. It is a myth where two actions stirring
together are considered to have developed a cause in addition to effect affiliation (Bonchi,
Hajian, Mishra & Ramazzotti, 2019).
It also plays an important role in epidemiological studies. It exhibited that disease can have
lower efficacy rate depending on the precautionary measures. It fails to create a relation or
link between the cause and treatment of the disease. It is difficult to identify the real cause of
COVID-19, the way the virus started spreading. Epidemiological studies identify the cause,
distribution and control of the disease. However, COVID-19 has created pandemic and there
is no control of the disease. However, it does not classify the cause behind a disagreement. It
does not imply that the subsequent assumption is incorrect.
b) Randomised controlled trials are considered to be the gold standard nevertheless
sometimes in case of epidemiology, there are some practical and ethical factors that forces
researchers to examine. In some cases, this observational studies have risk biasness, a
variable that is hidden and study group that do not reflect the whole population (Winer et al.,

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2016). However, studying illustrative sample is dynamic; it helps researchers to relate results
for the people outside of the study.
HRT (Hormone replacement therapy) elsewhere diagnosing symptoms linked with
menopause, was addressed for theoretically reducing CHD (Coronary Heart Disease) risk.
Nevertheless, it was later understood that randomised controlled studies, which includes the
comprehensive scale of Women's Health Initiative, that are demonstrates either a destructive
connection, or a statistically inconsequential one, among HRT as well as CHD.
c) Recently, the COVID-19 cases can be considered to be negative implication of the
phrase. It had been assumed that the virus and human are two variables and humans are
getting infected with the virus. However, it is very difficult to deduce the actual cause of the
viral infection. However, it is clear from the research prospective that virus is causing the
infection and it is destroying the immunity of the body (Wang, Horby, Hayden & Gao, 2020).
As the immunity of the body gets hampered the functioning of human body starts decreasing
and hence it leads to cell death. The phrase is defined as incapability to reasonably infer a
cause and effect connection amid two variables totally on the basis of a pragmatic link or
correlation among them. Hence, the cause of the disease can be predicted in case of viral
infection with the use to various diagnostic tools (Perlman, 2020). The reasoning behind the
spread of virus is very legitimate and proven, therefore it is clear that once the virus infects a
human body, it gets communicated to another human body through various means and hence
it spreads from one person to another. Therefore, it can be understood that the phase is
misinterpreted that it is difficult to diagnose the cause of infection and death. However, it is
effect and activity of the virus that is spreading from one person to another causing death.
d) It is very important for nurse to understand the term correlation as well as causation
because they are interrelated. Correlation means connection among two elements whereas
causation means act to cause something. As a nurse it is very important to identify the cause

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of the disease, that would help them in further diagnosis (Cartwright, 2017). The diagnosis
measures would be further helpful for the patients to get treated. As a nurse it is also the
responsibility to identify the two elements involved. Once, the two variables in the diseases
are known it can be cured or similarly an antidote would be created for removing the disease.
As the nurses and healthcare people deals with patients it very important for them to identify
the causing agents and find a proper solution to it (Solari-Twadell & Ziebarth, 2020). Hence,
both the term would help the nurse in understanding the patient suffering and further help
them to explain it to patient and set some guidelines that a patient must follow to prevent the
disease.

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