Untitled Document

EDITORIAL

Year : 2020  |  Volume : 3 |  Issue : 1 |  Page : 1-2

 DOI : https://doi.org/10.46319/RJMAHS.2020.v03i01.001
The pandemic and we
Rashmi Kundapura
Professor, Department of Community Medicine, K.S. Hegde Medical Academy, Nitte Deemed to be University, Deralakatte, Mangalore.
E-mail: dr.rashmi.kundapur@gmail.com

COVID 19 pandemic is the most talked about illnesses presently due to its huge impact on all the aspects of human life and its existence.  Whole mankind is worried and emotions are almost same all over world.  There is panic, helplessness, fear, anxiety and hope, prayers for activities.  The fear of unknown is towards just a tiny virus.
Yes, novel corona virus has changed the world but is it because of the pandemic itself or because of how all of us have responded to it?  Who should speak and who should respond?
When I ask these questions to myself, it reminds me of many epidemics and pandemics about which I read in medical history books, the most striking story, is the story of John Snow. The story is about the epidemic of Cholera in UKduring 1854.[1] During that time people never knew about bacteria and treatment of Cholera. But John snowcontained the outbreak of cholera in the vicinity of Golden Square, central London, in the late summer of 1854, and the subsequent removal of the handle from the Broad Street pump, have become an enduring feature of the folklore of public health and epidemiology. Itis unique specially in the quest and thinking of human being to ask and answer 6 questions ie What, Why, When, How, Where and Who which I quote from a children’s book byRudyard Kipling in his "Just So Stories" (1902), in which a poem, accompanying the tale of "The Elephant's Child", opens with
I keep six honest serving-men (They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.[2]
Certain key activities performed by epidemiologists to support outbreak response and control includes: Calculating epidemiological parameters: R0, incubation rates, serial intervals, secondary attack rates; establishing standardized case definitions for suspect, probable and confirmed cases; creating standardized alert, case investigation and clinical record forms.1In the current scenario when things are still not very clear about how virus evolved; prevention is the only cure.  Understanding transmissibility remains crucial for predicting the course of the epidemic and the likelihood of sustained transmission. Understanding from previous outbreaks likepandemic influenza has shown that as an epidemic evolves, we face an urgent need to expand public health activities in novel agent and characterize its possible impact.[3] During such event’s epidemiologic investigations, surveillance and containment are crucial activities for an effective public health response for right and quick decisions from the knowledge which is available at that point.3It is the epidemiological knowledge which is taking a lead until a vaccine or cure is available to fight an illness which is unknown not only to civilisations but to human immune system as well. 
Even before the declaration of the Pandemic by WHO, based on these principles and evolving epidemiological knowledge, India was among first country to start screening of passengers at airports in January 2020. Concurrent implementation of Screening, Isolation, and Quarantining of infected and suspect cases as well as other surveillance and containment measures reduced the rate of spread. Unlike other countries, strict surveillance measures especially Contact tracing using various technologies and use of “Enforced Social Distancing” India reasonably contained rapid progress of the infection and slowed down the spread by lockdown.  Looking at the steps taken by Govt of India so far looks very timely and important public health steps.  All these actions seem to have not only delayed the epidemic and flattened the curve to get time for preparedness but to also reduce the absolute number of cases. 
Planning and preparedness efforts for Covid-19 pandemic are widespread and ongoing, it is in a much higher scale which was likely not imagined in 1918 at the worst pandemic of 20th century.   Before vaccine against this specific emerging pandemic virus strain becomes available, non-pharmaceutical interventions as simple as handwashing and physical distancing with cough etiquette proposed by public health professionals can offer strategies for persons and communities to help slow spread of the virus.[4] Preventive strategies have seen to be effective in countries that imposed control measures at an early stage to contain the spread among communities and nations.[4] Public health interventions to combat the spread of a Pandemic should be based on the basis of the country specific epidemiological need compatible with the health policy, health care delivery system and other governance. Beyond this pandemic we must continue working towards sustained preparedness against future emergent infectious diseases and unforeseen pandemics.
Complete lockdown of a nation is one of the boldest step in the history of public health intervention, for preventing an emerging pandemic.  It has been done in many countries toprotect population from the clutches of an impending pestilence.  However some critics have warned on the impact of the enforced social distancing on the population and on nations’ economy. There is a reservation among many epidemiologists about epidemiological basis of this decision making.  These are because of TV technocrats, bureaucrats and technocrats are going on in decision making which should be avoided. The data non availability in major epidemiological institutions and not accepting the data sharing. Even the websites are not updated with good data, there is a reservation on data. This kind of apprehension and reservations might not be good for pandemic control measures.  Plan should be made to share data with professional organisations and academicians for scientific data analysis to augment the capacity of government in wise decision making. It is important that a public health professional need to share credible information so as to make people aware and thereby reduce panic in this era of lot of false information and myths being promoted on social media.  Though local government and WHO are playing their part but still the epidemiologist should come up with robust data and evidences to burst the myths.[4,5]  It feels very disheartening that at the time of this pandemic public health infrastructure across the country is in bad shape where many states do not have even state level epidemiologists.6Government should take timely measures to strengthen epidemiological services along with strengthening of public health care infrastructure of the country to fight such challenges now and in future. 
‘Though one size does not fit all but the epidemiologist fits all the pandemics’
References
1.     Brody H, Rip MR, Vinten-Johansen P, Paneth N, RachmanS..Map-making and myth-making in Broad Street: the London cholera epidemic, 1854. The Lancet 2000; 356 (9223): 64–8
2. “Rudyard crippling short stories” 3rd chapter available in https://shodhganga.inflibnet.ac.in/bitstream/10603/95853/9/09_chapter%204.pdf downloaded on 20/05/2020
3.     Lipstich M, Swerdlow DL, Finelli L. Defining the Epidemiology of Covid-19 - Studies Needed. N Engl J Med. 2020 Feb 19
4.     Bartlett P C, Judge L J, The role of epidemiology in public health, Rev Sci Tech. 1997 Aug;16(2):331-6. doi: 10.20506/rst.16.2.1020
5.     Outbreak response: Epidemiologist [Internet]. [cited 2020 Apr 11]. Available from: https://www.futurelearn.com/courses/disease-outbreaks/0/steps/62648
6.     Enanoria WT, Crawley AW, Tseng W, Furnish J, Balido J, Aragón TJ. The epidemiology and surveillance response to pandemic influenza A (H1N1) among local health departments in the San Francisco Bay Area.BMC Public Health. 2013 Mar 27;13(1):276. 
7.     Dharmshaktu NS. The Lessons Learned from Current ongoing Pandemic Public Health Crisis of COVID 19 and its Management in India from Various Different Angles, Perspectives and way forward. EpidemInt2020; 5(1): 1-4.
8.     Ma Y, Zhao Y, Liu J, He X, Wang B, Fu S, et al. Effects of temperature variation and humidity on the death of COVID-19 in Wuhan, China. Sci Total Environ. 2020 Mar 26;138226. https://www.sciencedirect.com/science/article/pii/S0048969720317393.


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