24rd January 2020 : The Hindu Editorials Notes: Mains Sure Shot
Note – Today there are no important articles. The two articles on budget are not so relevant because they are predictions. So another important topic has been discussed.
Question – In the context of the spread of coronavirus in China taking the shape of an epidemic, what are the ways to deal with epidemic outbreaks?
Context – The spread of coronavirus in China,
What is coronavirus?
- The coronavirus is a family of viruses that can cause a range of illnesses in humans including common cold and more severe forms like SARS and MERS which are life-threatening. The virus is named after its shape which takes the form of a crown with protrusions around it and hence is known as coronavirus.
- Coronaviruses cause diseases in mammals and birds that include diarrhea in cows and pigs, and upper respiratory disease in chickens. In humans, the virus causes respiratory infections, often mild, but in rare cases potentially lethal.
- There has been a deadly outbreak of coronavirus in China which has brought it to the global forefront.
What is important for us is what is an outbreak, an epidemic and a pandemic and what is the difference between them?
- An outbreak is the sudden occurrence of a disease in a community, which has never experienced the disease before or when cases of that disease occur in numbers greater than expected in a defined area.
- So what exactly is an epidemic? It is an occurrence of a group of illnesses of similar nature and derived from a common source, in excess of what would be normally expected in a community or region. A classic example of an epidemic would be Severe Acute Respiratory Syndrome (SARS). The epidemic killed about 774 people out of 8,098 that were infected. It started as an outbreak in Asia and then spread to two dozen countries and took the form of an epidemic. The same is true for Ebola, which is now being termed an epidemic.
- A pandemic on the other hand refers to a worldwide epidemic, which could have started off as outbreak, escalated to the level of an epidemic and eventually spread to a number of countries across continents. The 2009 flu pandemic is a good example. Between the period of April 2009 and August 2010, there were approximately 18,449 deaths in over 214 countries. The flu virus (H1N1) probably originated in Mexico and within two months, sustained human-to-human transmission in several countries on different continents was reported, prompting the WHO to announce the highest alert level (phase 6 pandemic) on June 12, 2009.
How to deal with epidemics?
- Epidemics of infectious diseases are occurring more often, and spreading faster and further than ever, in many different regions of the world. The background factors of this threat are biological, environmental and lifestyle changes, among others.
- A potentially fatal combination of newly-discovered diseases, and the re-emergence of many long-established ones, demands urgent responses in all countries. Planning and preparation for epidemic prevention and control are essential.
- Because new infectious disease threats usually start locally, it is important to understand their dynamics in order to deny them the opportunity to spread further among people and overwhelm health systems. The dynamics of epidemic and pandemic diseases typically occur in four phases, although not all epidemic diseases necessarily go through each phase.
- The first phase is the introduction or emergence in a community. The second phase is an outbreak with localized transmission, where sporadic infections with the pathogen occur. In the third phase, the outbreak amplifies into an epidemic or pandemic – the pathogen is able to transmit from human to human and causes a sustained outbreak in the community, threatening to spread beyond it. The fourth phase is reduced transmission when human-to-human transmission of the pathogen decreases, owing to acquired population immunity or effective interventions to control the disease.
So how to respond to these stages?
- Anticipation: In this first stage of response, emergence cannot be predicted, but it can certainly be anticipated, and the anticipation of risks enables a focus on the most likely threats. Anticipation encompasses forecasting the most likely diseases to emerge, and the quick identification of the drivers that will worsen the impact or facilitate the spread. Preparedness plans, based on lessons learned from past experiences, should contain a variety of scenarios to allow for a reactive response to the unexpected.
- Early detection: Emerging and re-emerging diseases include new ones about which there is little scientific knowledge. These, therefore, often require investigation into their sources at the same time as the use of coordinated, rapid-containment measures. New diseases require new interventions. And because they appear irregularly or rarely, there is a need for constant vigilance, proactive risk assessment and the development of new management tools.
- Containment: Effective and rapid containment of emerging diseases is just as vital as early detection in order to avoid a large scale epidemic. Rapid containment should start as soon as the first case is detected regardless of the etiology, which is most likely to be unknown. It requires skilled professionals to safely implement the necessary countermeasures. Pre-training of these professionals is essential to guarantee the safety and efficiency of the operations.
- Control and mitigation: Once the infectious disease threat reaches an epidemic or pandemic level, the goal of the response is to mitigate its impact and reduce its incidence, morbidity and mortality as well as disruptions to economic, political, and social systems.
- Elimination or eradication: Control of a disease may lead to its elimination, which means that is sufficiently controlled to prevent an epidemic from occurring in a defined geographical area. Elimination means that the disease is no longer considered as a major public health issue. However, intervention measures (surveillance and control) should continue to prevent its re-emergence.
- Eradication of a disease – much more difficult and rarely achieved – involves the permanent elimination of its incidence worldwide. There is no longer a need for interventions measures. Three criteria need to be met in order to eradicate a disease: there must be an available intervention to interrupt its transmission; there must be available efficient diagnostic tools to detect cases that could lead to transmission; and humans must be the only reservoir
India : National disaster and epidemic preparedness:
- India’s Central Government and state governments are empowered to regulate health-related matters. The Epidemic Diseases Act is the main legislative framework at the central level for the prevention and spread of dangerous epidemic diseases.
- The Act empowers the central government to take necessary measures to deal with dangerous epidemic disease at ports of entry and exit.
- The Act also empowers the states to take special measures or promulgate regulations to deal with epidemics within their state jurisdictions.
- In such emergencies the states delegate some of these powers to the deputy commissioners in the districts, typically through state health acts or municipal corporation acts.
- Thus, responsibility for directly addressing the crisis rests with the deputy commissioner at the district level.
- Preparedness and alertness are the only solutions to contain the spread of a disease during an epidemic outbreak. The government must keep itself prepared and evaluate its preparedness compared to the WHO guidelines and other developed countries periodically.