Understanding Corona Virus (COVID-19) Pandemic

Origin

The Corona virus (Covid-19) is a member of the coronavirus family that made the jump from animals to humans late last year. It is supposed to have originated at Huanan seafood wholesale market in the Chinese city of Wuhan. Unusually for a virus that has made the jump from one species to another, it appears to have high transmission rate in humans.

Scale of problem

By the time this piece was being written, there have been over 198,742 confirmed cases and 7,989 deaths world over. 107,974 is the number of currently active cases and over 82,779 people have recovered from the illness. There are now more cases outside of China, large outbreaks of the disease have been reported in multiple places, including Spain, Italy, and Iran.

Problem in India

There are four stages of any virus transmission “Stage 1 is imported cases. Stage 2 is local transmission. Stage 3 is community transmission. Stage 4 is an epidemic. As stated by Dr. Balram Bhargava, Director General ICMR, “we are currently at Stage 2, and we are not worried as long as we are here”. So far 148 cases have been reported in India of which 131 are active cases. There has been 3 death to the disease and 14 people have successfully recovered from the disease.

Symptoms

The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention immediately.

Diagnosis and Treatment

According to the ICMR, since there is no community transmission of the virus as yet, the main persons being monitored are those who have traveled abroad to high-risk countries in the last 14 days and those that have had contact with such people. These people are advised self-quarantine for 14 days, and THEN if they show any symptoms they are to be tested in government designated labs. The test is done in two stages. The Primary test- A health professional collects samples of saliva or mucus from a patient’s nose or throat, or both. The nucleic acid from the sample is then extracted and sent for testing where it is screened against the Wuhan strain of the coronavirus.

Secondary test- Once a patient is confirmed through the primary testing, their sample is re-tested in specialized laboratories. Once this comes out to be positive as well, doctors can say that the patient is infected with the novel coronavirus.

How it spreads

• The virus is believed to spread mainly from person-to-person.
• Between people who are in close contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes.
• These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Precautions

The virus appears to have a higher mortality rate than common illnesses such as seasonal flu. Currently there is no vaccine to prevent coronavirus disease 2019 (COVID-19).The best way to prevent illness is to avoid being exposed to this virus.

• Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
• If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
• Cover all surfaces of your hands and rub them together until they feel dry.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Put distance between yourself and other people if COVID-19 is spreading in your community.
• This is especially important for people who are at higher risk of getting very sick.
• Stay home if you are sick, except to get medical care.
• Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
• Throw used tissues in the trash.
• Immediately wash your hands with soap and water for at least 20 seconds as stated above.

How Coronavirus can affect India

Op-ed by Prof. K. Srinath Reddy

Even before the World Health Organization (WHO) declared a pandemic, the world recognised the novel coronavirus (Covid-19) as a rapidly expanding global threat that raced across continents at startling speed. Perhaps, WHO delayed the declaration to prevent panic from hindering the evolution of effective health system responses in countries which had never encountered this virus before. Now the whole world has to deal with it, in terms of health and economic impacts.

India first recorded cases among Indians residing in Wuhan, where the virus emerged, followed by Italian tourists and others with international travel history or contact with infected foreign visitors. The initial response was to screen travellers from countries reporting cases and, as more countries joined that list, extending it to all international travellers. Case and contact tracing, with a 14-day quarantine, aimed to prevent spread within India. Entry to foreign visitors has now been shut for a month to keep out new sources of infection.

Will this be enough to shackle the virus or will it become a community infection with widespread transmission within India?

Greener National Health Service (NHS) Campaign To Tackle Climate ‘Health Emergency

NHS Chief Sir Simon Stevens has announced that NHS and its staff will step up action to tackle the climate “health emergency” this year, helping prevent illness, reducing pressure on A&Es, and saving tens of thousands of lives. The initiative follows the launch of the Climate Assembly UK this week, which is discussing how the country can best get to 'net zero'.

The causes of air pollution and climate change are often the same, so the ‘For a greener NHS’ campaign will help address both. The health and care system in England is responsible for an estimated 4-5% of the country's carbon footprint. Air pollution is linked to killer conditions like heart disease, stroke and lung cancer, contributing to around 36,000 deaths annually. A recent study by Kings College London looking at nine English cities demonstrated that on high pollution days there are 673 additional out-of-hospital cardiac arrests and hospital admissions for stroke and asthma, with spikes in ambulance 999 call outs. Last month a group of 175 doctors warned that air pollution is directly adding to current pressures in accident and emergency departments.

The changing climate is leading to more frequent heatwaves and extreme weather events such as flooding, including the potential spread of infectious diseases to the UK. Almost 900 people were killed by last summer’s heatwaves while nearly 18 million patients go to a GP practice in an area that exceeds the World Health Organisation’s air pollution limit.

Scientists believe perhaps a third of new asthma cases might be avoided by cutting emissions while Lyme Disease and encephalitis are among conditions expected to become more common as temperatures rise. Health chief Sir Simon Stevens has today announced three steps the NHS will take during 2020 to tackle this problem. First, NHS England is establishing an expert panel to chart a practical route map this year to enable the NHS to get to 'net zero', becoming the world's first major health service to do so.

Dr Nick Watts, of University College London, will chair the NHS Net Zero Expert Panel. He is a medical doctor and executive director of Lancet Countdown, the independent international expert group that tracks the links between climate change and health. The NHS in England is the only health-care system in the world that is routinely reporting on greenhouse gas emissions. The Expert Panel will look at changes the NHS can make in its own activities; in its supply chain; and through wider partnerships - thereby also contributing to the government’s overall target for the UK.

These include the Long Term Plan commitment to better use technology to make up to 30 million outpatient appointments redundant, sparing patients thousands of unnecessary trips to and from hospital. It is estimated that 6.7 billion road miles each year are from patients and their visitors travelling to the NHS. It will also look at changes that can be made in the NHS's medical devices, consumables and pharmaceutical supply, and areas the NHS can influence such as the energy sector as the health service moves to using more renewable energy. The Panel will submit an interim report to NHS England in the summer with the final report expected in the Autumn, ahead of the COP26 International Meeting in Glasgow.

Climate Health and Air Monitoring Project (CHAMP)

In 2018, the low cost air quality monitoring project was launched in our member hospitals as a part of our mass awareness program on air quality. We installed low-cost air quality monitors in hospitals in 6 cities. The early response has been great in terms with patients and hospital staffs lauding the work of knowledge dissemination on air quality. But, the work also saw a lot of hurdle in terms of sensor longevity and manual resource issues in maintaining these low-cost monitors in different locations. Thus, as a long-term measure other sources of disseminating information on air quality were assessed. As a result, going forward we will be using real-time air pollution data and forecasts (generated by satellite modeled data). In the last couple of months, we have reached out to many providers who are modelling air quality data and have finalized our partnership with Urban Emissions. The data with district level granularity has been shared with us. Right now, we are updating our backend android application system to modelled data source from the low cost monitoring database. Meanwhile, the HELP members in India are impressed with our 2018 hospital monitoring work and many have reached out to host TV monitors in their facility and become part of CHAMP. As of now, 25 members have signed up and started procuring TV monitors of their choice and size to host.

CHAMP Hospitals

• AJ Hospital, Mangalore
• Narayana Health, Bangalore
• Madhuraj Hospital Pvt. Ltd., Kanpur
• Dayanand Medical College, Ludhiana
• Frontier Lifeline Hospital, Chennai
• Rainbow Children's Hospital, Bangalore
• Medica Synergie Pvt Ltd, Kolkata
• Sikkim Manipal Institute of Medical Sciences, Gangtok
• Apple Saraswati, Kolhapur
• Bangalore Baptist Hospital, Bangalore
• Pushpagiri Eye Institute, Secunderabad
• Bhagat Hospital, New Delhi
• Arulrhaj Hospital, Tuticorin
• Aster DM Healthcare, Kochi
• M.S.Ramaiah Memorial Hospital, Bangalore
• Dr Mehta's Hospitals, Chennai
• Ruby Hall Clinic, Pune
• PSG - IMSR, Coimbatore
• PSG – IMSR, Mettupalyam
• AIMS, Kochi
• Lalitha Superspeciality Hospital, Guntur
• Asarfi Hospital, Dhanbad
• Gangasheel Advanced Medical Research Institute, Bareilly
• CHAI, Secunderabad
• Nanavati Hospital, Mumbai

Kindly write to us to host an AQI TV monitor in your hospital.

Upcoming Events in 2020

Doctor’s Report Release- March 2020

At present, in India, an understanding of doctor’s approach and capabilities around the issue of air pollution are mostly anecdotal. Such existing anecdotal understanding does not help us to conclusively say how far aware or prepared Indian doctors are in the context of health impact of air pollution. In order to address this gap we carried out a short term research study titled ‘Knowledge, Attitude and Practice of Health Practitioners towards Health Effects of Air Pollution from Secondary and Tertiary cities in India’. Through this research we aim to understand doctor’s awareness, capabilities and preparedness vis-à-vis air pollution.

• Objective: To understand the knowledge and awareness of doctors about the health impacts of air pollution, their communication on air pollution to their patients, does air pollution feature as a priority within the health community
• Method: Key informant interviews with Cardiologists, Pulmonologists, Pediatricians and General Physicians.
• Research sites: Kochi, Ahmedabad, Lucknow and Raipur

Preliminary Findings:

1. Air pollution is not a universal concern.
2. Air Pollution is Defined Exclusively from the Domain of Respiratory Diseases.
3. Geographical Location or Demographic Details do not Determine Awareness.
4. Awareness about the air quality index and surge in respiratory illness.

AQI Monitoring work (CHAMP)

The work started in 2018 with 6 hospitals hosting AQI monitors and TV screens in hospital waiting area. The TV screen disseminates AQI data and IEC on air pollution impacts. The phase 2 of this work has seen the network expand to 25 cities by end of December, 2019. The work and no. of monitors will keep increasing in the months to come. SC member’s assistance is required in recruiting more hospitals in the coming months. Also, an effective communication with radio, social and print media is required in the cities where we put up monitors. We need State Coordinators to help us regionally in cities they are based on for recruiting hospitals as well as in media dissemination support.

State Coordinators

Effective internal communication is one of the most important part for any platform to grow. For this, we have identified state coordinators who are leaders in their profession and possess a greater reach in their respective domains. State coordinators will act as the focal point in their respective states for the HELP initiatives going forwards. HELP members could reach out to them in case of queries with respect to HELP initiatives. Please get in touch with HELP secretariat in case you need to connect to your state coordinator.

• Dr. C.M Bhagat - Delhi
• Dr. Amandeep Kaur –Punjab
• Dr. N.Babu – Tamil Nadu
• Dr. Naresh Shetty- Karnataka
• Dr. Sanjeev Singh- Kerala
• Dr. Jeet Patwari- Assam
• Mr. Nishant Jaiswal- Maharashtra
• Dr. Anoop Hajela- Madhya Pradesh
• Dr. Sudarshan Karupati- Andhra Pradesh.

Plastic Audit

Plastics pollution is one of the biggest issues in our country. Various State and local bodies have banned single use plastics. As a HELP, we recommend State Coordinators to run plastics free campaign in hospitals, where they could request the visitors to not carry any single use plastics into their campus. HELP Secretariat will be happy to create IEC materials, messages and help run this campaign with interested hospitals.

Biomedical Waste manual release.

Safe treatment and disposal of biomedical waste is a prerequisite to ensure environmental, occupational as well as public health. An important aspect of working towards improved waste management is through raising awareness among healthcare facility staff about the risks associated with mishandling of biomedical waste and best practices as per the regulatory framework. In order to strengthen the implementation of recent biomedical waste management (BMWM) regulations in India, Centre for Chronic Disease Control along with Health Care Without Harm, US and Centre for Environmental Health, Public Health Foundation of India has developed a pictorial guide on the biomedical waste. The guide has a significant pictorial component and is aimed to get utilized in the capacity building exercises conducted across HELP network hospitals and beyond. The final draft of the pictorial guide has been submitted to the Ministry of Environment Forests and Climate Change and UNEP to get their endorsement. As soon as the endorsement is finalized the pictorial will be officially launched and disseminated widely. Kindly watch out for this space or write to us to know more and get involved.