Covid -19 pandamic

 COVID-19: Origin and how it became a Pandemic

   COVID-19 is an infection caused by the family of viruses known as Coronaviruses. Coronaviruses are known to cause infections in both humans and animals.

Coronavirus infections range from common cold to severe respiratory or lung infection. COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain. SARS-CoV2 was unknown before the outbreak that started in Wuhan, China in December 2019.

On 11/03/2020, the WHO declared COVID-19 a Pandemic. A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”.

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COVID-19 Infection

COVID-19 infection is most commonly associated with symptoms like fever, dry cough and lethargy/ tiredness.

Other symptoms include ache/pain, sore throat, nasal congestion, conjunctivitis, loss of taste or smell, headache , breathing difficulties and diarrhoea in some patients.

Anyone can be infected with COVID-19 irrespective of age or sex or religion or nationality.The elderly and people with underlying health conditions such as diabetes, lung/heart problems, high blood pressure or cancer are at higher risk of developing more symptoms and worsening. These are called co-morbid conditions, the presence of these will make an individual more susceptible to get infected by the virus.

But that does not rule out the possibility of the younger population getting infected. Anyone who develops breathing difficulty/chest pain or loss of speech or movement should be considered as a severe case of infection.

How does COVID-19 infection spread?

The infection usually spreads from an infected person to normal individuals. Droplets or aerosols from the nose and mouth of infected persons generated while coughing, sneezing or speaking are the primary route of spread. These heavy droplets generally tend to sink to the ground quickly but when in close proximity of 1 metre or less, a person can breathe in these droplets and acquire infection.

Similarly touching droplets resting on surfaces of doorknobs, tables, handrails followed by touching or rubbing eyes, nose or mouth can result in acquiring the infection

Testing of COVID-19

It is recommended that people with symptoms undergo testing. We have an antigen and RT PCR test currently available in our medical field of expertise. The RT PCR test is a global standard system, it is costly(varies from Rs.500-1500 in various states) and the result is accurate ,but time-consuming (approx. 24 hours). It tests for viral RNA presence and Virus genetic material may be detected.

The Antigen tests (cost varies from Rs.150 to Rs.300) check the presence of protein, the accuracy is lesser as compared to RT PCR. It is an easily accessible test. The virus particle is detected. For checking antibodies present, a blood sample is taken and if the virus enters a person's body, it will take around 7 – 8 days to get this antibody test back positive.

In the current scenario, COVID-19 cases are increasing which has raised red flags across general public and government officials. It is also essential for us to understand the possibility of the disease persisting for a longer duration than expected.

Moreover, the COVID infection has long-term health effects which needs to be studied and managed.

Therefore public has to come forward and partner with the local government bodies to create an efficient system to fight this disease.

Enable the administration to make effective decisions and policies based on real data.

The awareness that such data creates among the general public will motivate them to comply more strictly with the social distancing norms advocated by the administration.

The million dollar question is 'When will this pandemic end?' but it still remains a question unanswered by all major world bodies or governments across the world, even when multiple vaccines are available and all governments across the globe are engaged in aggressive public vaccination drives.

The first step forward is to create a good public awareness regarding COVID-19, safety precautions to be followed, existing facilities that can be utilized and the proposed plan of action for the future.

Every individual will have a role in rebuilding or reinventing methods to revive various sectors/segments of the community. It is time that the citizen, especially the youth step up and partake more in this fight against the virus.

Major challenges during a pandemic:

One of the most significant problems that we still face one year into dealing with the pandemic is the limitation faced by the mainstream healthcare facilities of any state or nation due to the uncertainty in the number of patients.

For example, the overall healthcare infrastructure of Kerala has ~100,000 beds for 330 lakh people in Kerala which is very comfortable during regular times but will fall short during pandemics. This ratio for Kerala is among the best in comparison to other states in the country.

Even with Kerala's sincere efforts from the early stages of the pandemic, we are experiencing an unprecedented surge in the number of Covid positive cases.

To summarise, the three key challenges that we should be prepared for during a pandemic are:

1.Uncontrolled spread of the infection: The uncontrolled spread of infection in the community due to lack of adequate precautions and awareness in the general population.

2.Large volume of patients: Even the most advanced nations across the world fail due to the sheer volume of patients that a pandemic creates in a short period of time. Therefore it is essential to tackle this by preventing an uncontrolled spread.

3.Augmenting our Healthcare Infrastructure to meet the load: Our existing healthcare infrastructure may be inadequate to cater to those who are affected by the pandemic and for regular patients. The healthcare system of any state should be able to absorb the load created by the increased number of sick people so that the system doesn't collapse due to overload.

For example, augmenting the healthcare system for the Coronavirus in Kerala is done by creating Corona First-Line Treatment Centers where community halls/auditoriums etc. are temporarily converted to clinics. This model is explained in detail in subsequent chapters.Ensuring Correct and Prompt Treatment for regular patients. It is important that the healthcare facilities should also be available to other people who might need medical attention for regular diseases like cardiac, kidney, diabetic problems or antenatal care, etc.

Even with the introduction of vaccines, the virus persists to spread rapidly in many parts of the world. Our lack of understanding of the nuances of the virus even after 1 years time, and the rapid rate at which the virus is mutating are all great causes of concern.

The highest level of care must be taken in preventing the spread of the infection from one individual to the other.

General Advice

• Always wear a mask in public places.

• Limit your movement. The lesser people you interact closely with, the less likely you and the people around you are to being sick.

• Encourage repeated hand washing. Carry a hand sanitizer and use it wherever soap and water are not available. Wash your hands as soon as you get home. Wash your hands or sanitize before you touch your eye, nose or mouth.

• Maintain social distancing. Limit contact even while running errands. For example, at the grocery store, do not touch the items unnecessarily. Maintain 1-meter distance from anyone and avoided touching common surfaces like cash counter etc.

• Respiratory hygiene and cough etiquettes must be observed by all.

• Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.

• Establish a system to ensure proper disposal of masks/tissue papers.

Information is the best weapon we have to fight the virus. It is very important that everyone in the public is aware of the best practices to curb the transmission of the virus. Also data relating to the capacity of the healthcare facilities also play a crucial role.Communicating such real-time accurate data of the healthcare capacity within each district 

Proper usage and disposal of masks:

During the initial phase, WHO warned us that the common populace using masks could potentially lead to danger. But when the virus started to spread, it has become a norm for the society to be trained on how to use a mask. Now, wearing a mask is a necessity. It helps in decreasing the spread of the disease. While we sneeze, we need to cover our mouth and nose. If someone who is a carrier of the virus sneezes, it could act as a vector and go unnoticed as he or she is asymptomatic. We need to wear a mask to prevent the spread of the virus occurring due to our daily activities and it must be worn properly. The major problem we see nowadays is that people tend to forget the importance of wearing masks and pull their masks away from the nose and mouth. Careless touching of the outer side of the mask should also be avoided.

Proper disposal of used masks and PPE kits:

If it is a cloth mask, boiled water can be used to clean the mask. Surgical masks or N95 masks are not recommended because they are to be used by medical personnel, wherein burning the mask is one way of disposing it. N95 is recommended for aerosols or peoplewho are in contact with those tested positive for COVID-19.

We can only ensure proper waste management if everyone does their part. If we touch an area that people frequently use, we need to wash our hands properly since the probability of getting the disease by touching our eyes and mouth increases. If we are wearing gloves, need to be extremely careful since we need to dispose of it after each use. So the best practice is the use of hand sanitizer.

Hand Hygiene:

One must be extremely careful while washing their hands or while using a hand rub.

The following steps must be followed:-

Home Quarantine:Asymptomatic patients are advised to stay at home.

Clinical eligibility for home quarantine

• The patient is covid postive by any of the confirmatory tests.

• The patient is asymptomatic.

• The patient does not have any other health conditions.

• Psychologically fit and willing for room isolation.

• If patient is less than 12 years of age, a guardian may accompany the child.

Social eligibility criteria for home quarantine

• The house has adequate road access and communication facility.

• Facility for room isolation with attached bathroom and adequate ventilation.

• The Covid positive patient should not come in contact with another vulnerable individual.

• An adult healthy individual should be willing to act as a caretaker .

• The family should have adequate community and social support.

Self care

• A balanced diet.

• Take warm water and fluids.

• Adequate rest and sleep for 7-8 hours.

• Self monitor for symptoms and red flag signs.

• Maintain a diary of daily symptoms.

• Promptly respond to any communication from health authorities.

• The caretaker and the patient should wear a 3 layer mask while interacting for food or other necessities.

• The patient should not use any other part of the house for any purpose.

• The patient should not share common household objects.

• Wash clothes in the bathroom and disinfect all objects in the room daily. Wash hands frequently.

• Burn general waste. Biodegradable waste should be buried under the soil.

• If any symptoms start developing , the patient must be moved from the house according to severity.

How does our government respond during times of disaster?

In the event of any disaster, the decision making authority must be as decentralised as possible, in order to ensure quick communication and better understanding of the field conditions. This ensures that the decisions made by the authority are quickly implemented on the field.

One of the key decision-making authoritiesduring the time of any disaster is the District Collector.

Every district has rural and urban areas.

Urban areas are divided into Corporations/Municipalities/Panchayats and further divided into divisions.

The rural areas are divided into Blocks, Panchayats and Wards.

Every ward has a Ward Level Team. The official members of this team are:

Ward Member who is an elected representative from the public.

ASHA Worker (Accredited Social Health Activist) is a community health worker who is trained by the Health Department and nominated by the Local Self Government Department (LSGD).

Asha Workers report to the Subcenter (a grassroot level office of the health department for approximately 5000 population) where there is a Junior Health Inspector (JHI) and Junior Public Health Nurse (JPHN). Higher on the hierarchy is the Primary Health Centre (PHC), at Panchayat level, it's called Family Health Centre or Community Health Centre (CHC). These centres have a doctor, a pharmacist and a lab with basic support systems. At Least 10-20 people work here.These centres take care of the public health needs. Above this is the Taluk hospital, and further above is the Jilla or General Hospital. At this level there is usually a separate centre for Women and Children.

The medical colleges that we commonly hear about are part of a separate Medical Education system under the Director of Medical Education (DME). Nursing colleges may be under either the medical education system or under the general hospitals.

We shall read about the structure of the health system in the coming chapters.

Anganwadi Worker is appointed by the Social Justice Department to work for the welfare of Mothers and Children. They are in the payroll of the State Government.Anganwadi workers are monitored by ICDS (Integrated Child Development Services) Supervisor and Child Development Project Officer (CDPO). They have officers at block and the district levels.

The Department of Social Welfare has a special wing in the collectorate. Social Security Mission is a program/wing similarly supported by the Social Welfare Department under the State Government Program. They supervise and support the ICDS and CDP. It is ultimately under the control of the Health Minister.

Kudumbashree ADS Chairperson ( Applicable to the state of Kerala )

The objective of Kudumbashree is Poverty Alleviation through Women Empowerment. Women in the community can form their own Self-Help groups(Ayalkootam). An ayalkootam has 10-20 women members. An average ward may have 10-15 such Self-Help Groups (Ayalkootam).

Each Self-Help Group (Ayalkootam) nominates 1 person to form an Area Development Society (ADS) within every ward. The ADS has a Secretary and a Chairperson. The ADS Chairperson will have direct control over all the Self-Help Groups (Ayalkootam) within the ward. This ADS chairperson is also part of the Ward Level Team.

Kudumbashree is an independent society that has its own election mechanism till the Panchayat Level. Above the Ward Level there is CDS (Community Development Society). From each Self Help Group, one nominated person forms the ADS (Area Development Society) at the Ward level and one person from each ADS is nominated to form the CDS.Although only women from the community form these groups, the benefits reach the whole family. Therefore, out of 400 families in a ward, on an average, at least 100-150 families will be part of this society. Thus, the benefit reaches to at least 30% of the community.

Ward Level Team also includes other stakeholders like:Non Governmental Organisation (NGOs), Community Based Organisations (CBOs) Eg: Rotary club, Lions Club, may even be political organisations, Residents Associations, representatives of churches, temples etc.

These are individuals or groups who are actively involved in various sectors and activities in the community.

The different members of the team may have their own agendas or designated roles but in the time of crisis, they all come together and work with unity.

This team is self-sufficient to a large extent in dealing with any problem within the community without much external support.This team is the most effective body at the field level.They are the ones who ultimately work with the community. Many times, we underestimate the power and effectiveness of the ward level team. Our goal is to empower this team to be more efficient and work alongside them to overcome various challenges.

These four official members of the ward level team belong to different arms or departments of the state and community. The hierarchy of the system must be understood from bottom to top. This will be explained in detail in the coming chapters.

Introduction

India is prone to a number of disasters. The super cyclone of Odissa(1999),the Gujarat earthquake(2001), the Tsunami(2004) and Kerala floods( 2018,2019) were just a few of the disasters that led to heavy loss of life and left many stranded. We need to be aware of potential hazards, their frequency of occurring, where they might occur and the problems that may result in a disaster.

The National Disaster Management Authority (NDMA), headed by the Prime Minister of India is responsible for the management of disasters in the country. As per the Disaster Management Act, 2005, State and District statutory bodies are created for smooth functioning.

Every state in the country has a State Disaster Management Authority that is responsible for taking steps towards mitigating the damage and destruction after a disaster and to make sure the state is prepared.A well-coordinated and unified response of various departments of the State, its agencies, the Central Government, its departments and agencies appropriate to the demands of the district administration minimizes the loss of time wasted in response and improves the process of recovery.

Disaster management:

Disaster Management can be defined as the preparedness, response and recovery methods in order to lessen the impact of disasters. A disaster disrupts the normal function of the society to the extent that it cannot function without outside help.

Disasters can be classified as natural, technological or complex emergencies. Let's take a look at the natural disasters in Kerala. 

In August 2018,Kerala was hit by incessant rains followed by one of the worst floods that the state has witnessed in decades. All the dams of the state were filled to capacity and gates had to be opened to keep the dams safe. Hundreds died and thousands of homes were affected and damaged. More than a million people had to take shelter in relief camps. Normal life came to a standstill. The heavy rain acted as a triggerfor more than 600 landslides in the state.

The entire nation came forward to lend a helping hand to the Kerala flood victims. Central Government, State Governments, Union Territories, Multi National Corporations, Big Business Houses, Celebrities, Sportsmen and women, schools, colleges, and common people have contributed to Kerala’s Chief Minister’s Relief Fund generously. Apart from these generous donations, it was the local community coming together for rescue missions and volunteering in relief camps that had an enormous impact on the return to normalcy.

Awareness and preparedness are the most effective prevention and mitigation measures against all disasters.

Prevention Of Natural disasters

Floods and Landslides being the most common natural disaster in the state, prevention methods of floods and landslides can be categorised into three.

• .Vegetative measures: Preserving vegetation, grasses and trees can minimize the amount of water infiltrating into the soil, slow the erosion caused by surface-water flow, and remove water from the soil.

• Structural Measures: Retaining and Diverting water using dams,floodplains,levees etc Constructing piles & retention walls Improving surface & subsurface drainage Rock-fall protection

• Management measures: Integrated river basin approach Public awareness, participation and insurance Land use zoning & risk assessment Flood forecasting and warning systems

However, it is impossible to be prepared for any kind of disaster since it is impossible to predict or foresee it. The Corona Pandemic took the world by surprise. There may occur many more kinds of disasters that may require the community and state to respond to differently.

The community is the first responder to any disaster. It is important that we prepare ourselves to face and respond to disasters.

Community Contingency Plan

A community contingency plan is a set of activities that a neighbourhood, community or group of people agree to follow inorder to respond well in times of an emergency. Developing a contingency plan involves making decisions in advance about the management of human and financial resources, coordination and communications procedures, and being aware of a range of technical and logistical responses.

The planning process can be answered with three questions.

What is going to happen?

What are we going to do about it?

What can we do ahead of time to get prepared?

Prepare:Planning should be specific to each context and take into consideration a number of factors including: the government’s disaster-response plans and capacity; reception and coordination of national, regional or global inputs; potential sources of donor support; the likelihood of disaster occurrence; and the vulnerability of the population.

District Emergency Operations Centres

The DEOC is under the direct control of District Incident Commander. The first dedicated district emergency operations centre with 24 hours staff from Revenue, Police and Fire & Rescue and a full-time medical doctor on-call started functioning at Alappuzha district of Kerala on 5th September 2014. Presently all DDMAs have operating District Emergency Operations Centres.

Rainfall:Several states in India witness very heavy rainfall during the months from June to September. Most vigil actions are to be taken and sustained till warning is withdrawn, in the districts predicted to be affected by the rainfall.

Warning Systems:Initially, Emergency time functions are activated by SEOC and DEOC. All necessary forces are pre-positioned as per the direction of the state incident commander. The defense wing along with the central force is ready to move into any location in the state.

Standard Operating Procedure:

• BSNL and Police are deployed with all the proper equipment to set up emergency communication systems.

• All hospitals and health care sectors in the district are predicted to be affected and instructed to function in the full strength of 24 hours as per requirements by making necessary human resource arrangements from the district level. Medical teams should be kept ready for field-level disaster management. Ensure control measures for epidemic prevention. Low lying PHC/CHC/Hospitals should be evacuated within 24 hours of receiving an Extremely Heavy Rainfall Warning.

• Tahsildar will be initiating the procedure to set up the relief camps and instruct to Quarry blasting to be banned until at least 24 hours of rain-free situation arises in the quarry locality based on the evaluation by the village officers. Local Self Governments will be coordinating with the relocating the vulnerable population to the relief camps and other safe locations.

• The transport department will take control of all cranes and earthmovers in the district for deployment in the event of major calamities.

• The electricity boards and public works department will ensure that the emergency repair teams are ready for deployment.

• Police will Stop vehicular traffic other than that of emergency services via Ghat roads prone to landslides & flash floods. Tourism & Forest Department issue advises for tourists not to stop on the sides of streams and rivulets that intersect Ghat.

• Holidays are declared in the district and all mass gatherings along with the social events are restricted by the district administration. The public is advised to remain indoors and those in landslide/flood-prone areas to move to safer locations.

WHEN FLOODING APPEARS LIKELY

• Tune in to radio or Tv for warnings and advice

• Keep vigil about warnings from local authorities

• Keep the emergency kit ready

IF YOU NEED TO EVACUATE

• Inform volunteers or DMT the address of the place you are moving to.

• Raise furniture, clothes, appliances onto beds or tables

• Turn off power

• Put sandbags in the toilet bowl or cover all drains to prevent sewage back-flow

• Lock your house and take the route to nearest shelter

• Do not get into water of unknown depth and current

DURING FLOODS

• Drink boiled water

• Don’t eat heavy meals

• Use raw tea, rice water, tender coconut water etc during diarrhoea

• Do not let children remain on empty stomach

• Use bleaching powder and lime to disinfect surroundings

• Avoid entering floodwaters

• Do not eat food that got wet in floodwaters

• Use halogen tablets to purify water before drinking it

• Be careful of snakes

Man made disasters:Disasters that are caused by human beings are called man-made disasters. Examples are nuclear bombs, transportation accidents etc.

The most serious threats occur due to nuclear, biological and chemical warfare which are collectively known as WMD or Weapons of Mass Destruction.

• Nuclear Weapons:

Nuclear weapons are the most dangerous weapons on earth. One can destroy a whole city, potentially killing millions, and jeopardizing the natural environment and lives of future generations through its long-term catastrophic effects. The dangers from such weapons arise from their very existence. Although nuclear weapons have only been used twice in warfare—in the bombings of Hiroshima and Nagasaki in 1945—about 13,400 reportedly remain in our world today and there have been over 2,000 nuclear tests conducted to date. Disarmament is the best protection against such dangers, but achieving this goal has been a tremendously difficult challenge