To contain coronavirus, monitor and communicate – analysis
The media is flooded with reports of an increasing number of coronavirus cases and deaths in various parts of the world. While China was the epicenter of the epidemic, it has now spread to Europe, the United States (USA), West Asia and India. In February, several Indian students from Wuhan (China) were evacuated and quarantined. This was the first political response of the Government of India on the growing epidemic. Subsequently, some cases have been detected and confirmed in several states, but they are mostly from urban areas. So far, there have been no deaths in India, but the fear is palpable between the middle and upper middle classes, thanks to the media coverage of the coronavirus.
All epidemics evoke fear and panic, as they result in deaths. However, in its management, three elements must be addressed: science, common sense of the public health system and the political support of the government. Today the virus is better understood and the nature of the disease it produces. Current evidence suggests that about 80% of infected cases are mild, 18% are severe and only 2% require intensive intervention. Because there are no medications available, cases need close monitoring and treatment of secondary complications if the need arises. Special attention is needed for the elderly and other vulnerable sectors of the population. Therefore, monitoring is key to contain the epidemic.
Chinese data on coronavirus deaths show that a large proportion of deaths have been among the elderly. The number of deaths is higher among the elderly, compared to the young. Those with pre-existing conditions are much more at risk than others. This understanding is essential for lay people to be informed about the nature of the disease, together with a rational public health system that can respond to contain the spread through monitoring and surveillance strategies.
We also need to learn from the strengths and failures of handling several outbreaks of viral influenza in the recent past, such as avian and swine flu (H1N1) that has spread and continues to spread throughout the country.
Data from the National Center for Disease Control show that there have been 884 cases of H1N1 virus this year, resulting in 14 deaths. Of that, 70% of cases are from four states. Tamil Nadu represents 172 cases, followed by Delhi (152), Karnataka (151) and Telangana (148). Mortality from H1N1 is highest in Uttar Pradesh (51 cases and seven deaths), followed by Andhra Pradesh and Telangana.
Health is a state issue and the response of the public health system needs political support. The contrast in response to a viral outbreak either H1N1, nipah virus or coronavirus is seen in how the UP and Kerala governments have responded to public health emergencies. In a recent speech, UP Prime Minister Yogi Adityanath dismissed the problem of the coronavirus and advocated yoga as a way to overcome it. It may be worth noting here the number of cases and deaths reported due to swine flu in the state: there have been 884 new cases and 14 deaths in the state this year.
Unlike UP, Kerala has managed to contain several outbreaks of the nipah virus effectively. The strategy to address the coronavirus in Kerala has involved isolation, quarantine and surveillance of positive cases in hospitals and the community. The Union government could take clues to Kerala’s strategy to control viral outbreaks. Clearly, there will be variations in effectiveness, since not all states have strong public health systems and the political imagination and support necessary to achieve what Kerala has been able to do.
The flu season has returned, but how prepared are we to handle the variety of cases? The experience of dengue, swine flu and other outbreaks shows that the lack of preparation and response of the public health system has caused panic, which has led to an urgency of testing and treatment in hospitals by people. Although there are guidelines issued by the National Center for Disease Control, their implementation and monitoring are deficient in the public and private sectors. Irrational drug use, testing and hospitalization only increase patient anxieties.
An important aspect of the public health strategy to deal with epidemics is communication. The government should communicate with the general public and health personnel about the latest virus outbreak.
The government must have a nodal person who coordinates with the ministry of health and can provide the relevant data and advice. At present, this does not exist and, as a result, the media often sensationalize the problem and make citizens anxious. In the absence of authentic information, social networks become the main source of information and misinformation.
Rama Baru is a professor at the Center for Social Medicine and Community Health at Jawaharlal Nehru University.
The opinions expressed are personal.