Discussion and Conclusions

The COVID-19 pandemic caused by the coronavirus (SARS-CoV-2) has wreaked havoc on public health and economies around the world. ^{Reference Gorenkov, Khantimirova and Shevtsov9}

One of the most notable features of SARS-CoV-2 infection is that most people are asymptomatic, while others have progressive, even life-threatening viral pneumonia and acute respiratory distress syndrome. Although factors influencing the severity of the disease (eg, increasing age, male gender, high body mass index, etc.) have been identified, these risk factors alone do not explain all the variability in disease severity observed among infected individuals. ¹⁰

The importance of the contribution of host genetics to the susceptibility and severity of infectious diseases is being actively studied and includes rare innate immunity errors, common genetic variations in single-nucleotide polymorphisms (SNPs), and the ability of the virus to mutate. ^{Reference Ganna11,Reference Oude Munnink, Nieuwenhuijse and Stein12}

Determining genetic factors that contribute to the susceptibility and severity of COVID-19 is of considerable research interest. It may reveal new biological insights into the pathogenesis of the disease and identify mechanistic targets for therapeutic developments or repurposing of existing drugs, since the treatment of the disease remains a very important goal despite successful development of vaccines. In particular, susceptibility to respiratory viruses such as influenza is inherited and is known to be associated with specific genetic variants in the host. In the case of COVID-19, 1 known genetic locus on chromosome 3p21.31 is associated with hospitalizations. As with other viral diseases, there are several examples of loss of function options that affect the underlying immune processes that lead to severe illness in young adults, such as the TLR711 gene and some genes involved in type 1 interferon signaling, including the receptor subunit IFNAR212. ^{Reference Logunov, Dolzhikova and Shcheblyakov13,Reference Pairo-Castineira, Clohisey and Klalric14}

Scientific work on the study of human genes associated with the incidence of coronavirus, carried out in the United Kingdom in 2000, made it possible to determine the goals for the therapy of COVID-19 with existing drugs. It was found that low expression of the IFNAR2 gene or high expression of the TYK2 gene are associated with severe forms of the disease. These studies have shown that these genetic variants, related to key mechanisms of host antiviral defense and mediators of inflammatory organ damage in COVID-19, can respond to targeted treatment with existing drugs. ^{Reference Logunov, Dolzhikova and Shcheblyakov13}

An important problem is the study of virus mutations, which seem to be a constant necessary evolutionary process, namely, linking certain genomic changes of the virus with its ability to spread, affect the severity of the disease, and also develop resistance to therapy, host immunity, or vaccines. And this issue requires careful and comprehensive research.

The issues of the spread of the virus and the clinical aspects of combating it are of considerable scientific interest. COVID-19 is a complex clinical syndrome with a wide variety of clinical manifestations. The proportion of people who are asymptomatic ranges from 20 to 75%. Most patients who do show symptoms develop only mild (40%) or moderate (40%) illness, approximately 15% develop severe illness, and <5% develop critical illness with complications such as respiratory failure, acute respiratory distress syndrome; population groups with diseases such as diabetes, hypertension, heart disease, chronic diseases are more at high risk of a serious course. Old age, smoking, and major noncommunicable lung diseases and cancer are risk factors for serious illness and death. ^{Reference Chmielewska, Barrett and Townsend15–Reference Nagy, Pongor and Győrffy18}

Current clinical treatment for COVID-19 consists of prevention and infection control measures and supportive care. The spectrum of medical treatments for COVID-19 is growing and evolving rapidly. It is believed that 2 main processes affect monitoring in health-care settings. The first phase of the development of infection is primarily due to the replication of SARS-CoV-2. Later in the course of infection, the disease is triggered by an enhanced immune/inflammatory procoagulant response that leads to tissue damage. ^{Reference Mironov and Zabozlaev19,Reference Nikiforov, Suranova and Chernobrovkina20}

Based on this understanding, antiviral therapy is expected to be most effective in the early stages, while immune/anti-inflammatory therapy may be more effective in the later stages of COVID-19.

An extremely important problem is the impact of the epidemic on health workers and the development of measures to protect them, strengthening the prevention of infections and infection control in medical organizations. Currently, the extent of the spread of COVID-19 infection in health-care facilities in the context of Kazakhstan is unknown, and it is also unknown whether there are specific risk factors associated with the infection of health-care workers. ^{Reference Imai, Dorigatti and Cori21,22}

At the global level and in countries, there are only limited data on the problem of infection of medical workers with the SARS-CoV-2 virus. Recently, the WHO published a summary of the extent of SARS-CoV-2 infection in health-care workers. ²³

Health-care workers account for approximately 14% of COVID-19 cases, according to data collected primarily from the WHO Region of the Americas and the WHO European Region as part of WHO’s global COVID-19 surveillance. However, the proportion of health-care workers infected varies widely, from 2% to 35% in countries that filled more than 75% of the health-related variables in the reported data. Infection rates of health-care workers were influenced by timing of reporting, fluctuations in transmission patterns at the population level, and adherence to prevention of infections and infectious control (PIIC) in facilities.

According to a recently published report by the International Council of Nurses, which conducted a survey in 50 countries, mainly in Europe and America, infections of medical workers account for between 1% and 32% of all confirmed cases of COVID-19. ²⁴

In responding to the pandemic, an internationally accepted quantification of the burden of disease will be of great strategic importance, which will identify the impact of the pandemic on public health. There are several ways to determine the burden of disease. Indicators such as prevalence and incidence characterize the magnitude and severity of the health problem. Pooled health indicators such as disability-adjusted life years (DALYs) are often used to represent the burden of disease. One DALY is 1 year of “healthy” life wasted, and the burden of disease can be seen as a measurement of the difference between an effective health condition and an ideal situation free of disease and disability in old age. ²⁵

Using the Global Burden of Disease, Injury and Risk Factors (GBD) study, data on mortality and DALYs associated with COVID-19 can be obtained, and excess population mortality can be calculated as a proportion of the impact of COVID-19 and other causes. associated with crisis conditions.

The increased rates of COVID-19 cases and deaths in high-income countries are associated with the fact that, in these countries, a significant proportion of the population consists of older people with non-communicable diseases, including cardiovascular diseases. ^{Reference Solanki, Kelly and Cornell26–Reference Hendren, de Lemos and Ayers29}

The information component in the fight against the epidemic has become an extremely important problem and very much in demand. Any preventive measures taken must be based on facts, exclude misinformation, and induce rational, adaptive, and protective behavior of the population. However, little is currently known about the interactions of changing epidemiology, pandemic management measures, media activity, population perceptions of risks, psychoemotional consequences, and public health behavior.

Coronavirus is a new infection with many more questions. Study conducted during the influenza A (H1N1) pdm09 pandemic in 2009-2010 showed that the ultimate public perception of risks and behavior is influenced by the media and is not always based on the correct interpretation of the epidemiological and scientific evidence. ^{Reference Qiu, Shen and Zhao30}

From a psychological point of view, this means high uncertainty regarding the likelihood of contagiousness, the potential severity of the disease and the ability to control the process with preventive measures. These problems require a scientific explanation. With regard to general mental health, several studies using different methods (repeated cross-sectional and longitudinal studies) have recorded an increase in stress, anxiety, and depression among all categories of the population. ^{Reference Ushakov, Yurevich and Nestik31,32}

Therefore, the analysis of the socio-psychological consequences of the COVID-19 pandemic for the adult population makes it possible to understand this process in Kazakhstan and demonstrates the role of the media and other electronic means of communication in a pandemic.

Thus, the solution to the above problems will provide an opportunity to comprehensively and scientifically strengthen the system of public health measures to allow the control of the spread of possible newly emerging respiratory infections, including COVID-19. According to the report of the Ministry of Healthcare, further improvement in health care needs to occur in the following areas: affordable medical care with priority to villages, further strengthening of primary health care, stimulating the growth of the competencies of medical workers, hiring health-care professionals, patient medicinal and biological safety. All these areas will be implemented using digital technologies. ³³