Public health pandemic plan

Epidemiologists are sometimes described as “disease detectives”. The world over, they are tasked with identifying the origin of an outbreak and get to the root of the situation.

While doctors and healthcare professionals battle a disease on the ground by treating infected patients, public health officials and epidemiologists help us understand diseases, how they spread in communities and what actions must be taken to stop them from occurring again.

Right from the outbreak, public health officials are tasked with finding out about the origins of the disease and to recommend measures for the local population to prevent it. Some of the key steps to finding out about the outbreak of the disease include:

• Demographic information
• Information on symptoms of illness
• The use of healthcare and access to it in the outbreak area
• Vaccination status (if the disease is known)
• Line of treatment during the investigation period

Public health officials also help in determining the various signs of the onset of a disease, and how mild or severe symptoms are observed among people. By observing certain factors, they are also able to find out who is more likely to contract an infection in a population. For instance, while researching COVID-19, public health officials and epidemiologists were able to ascertain that senior citizens, as well as people living with underlying diseases, were most at risk of this respiratory illness, which presented with pneumonia-like symptoms.

A case study in the Indian Journal of Medical Research earlier this year outlined the role of India’s public health department in preparing for the COVID-19 outbreak.

While India had reported over two million cases and more than 41,585 deaths as of 7 August 2020, the numbers have been lower than they might have been in a country with such a large population.

Even though testing facilities and the number of tests were low in the beginning, India had collected more than 2.2 crore test samples by 6 August 2020, according to data from the Indian Council of Medical Research (ICMR).

Contact tracing was also used to track down the origin cases where the disease may have spread to a number of people via local transmission. 

On a government level, the National Disaster Management Authority (NDMA) had introduced the National Disaster Management Guidelines on the Management of Biological Disasters in 2008, following outbreaks and other biological disasters such as the Bhopal gas tragedy of 1984.

The Ministry of Health and Family Welfare also issued a set of guidelines for emergency response and preparedness for the outbreak, which include the following:

• Emergency COVID-19 response: Immediate support to enhance disease detection by increasing surveillance, screening at ports of entry, strengthening laboratory and diagnostic systems and local containment.
• Strengthening national and state health systems to support prevention and preparedness: To provide core public health, prevention and patient management functions for managing COVID-19 and future disease outbreaks. Revamping hospitals for infection control, revamping infectious disease hospitals and district hospitals, and equipping them with isolation rooms, building and upgrading testing systems and laboratories, expanding point-of-care testing, improving disease surveillance and health information systems and development of the public health workforce.
• Strengthening pandemic research and multi-sector, national institutions and platforms for One Health: Assessment and upgrade of national protocols for animal and human infections, strengthen established mechanisms to respond to existing and emerging zoonotic diseases, improve biosafety and biosecurity management.
• Community engagement and risk communication: Focus on enforcing social distancing measures, promoting safe and good hygiene practices, ensuring continuity of such practices through community campaigns and via media, facilitating remote learning infrastructure for teachers and students.
• Implementation management and monitoring and evaluation: Strengthening public structures for coordination and management, strengthening capacity for health emergency and disease outbreak management with the help of technology like artificial intelligence and big data analytics to improve preparedness and response to pandemics.
• Contingency emergency response component: Providing immediate and effective response to said crisis or emergency.

Past pandemics such as the severe acute respiratory syndrome (SARS) outbreak of 2002 or the swine flu outbreak of 2009 have helped shape the modern understanding of new and infectious diseases. Countries with large populations or areas with greater population density have already been identified as high-risk zones, especially while dealing with disease outbreaks.

Since the first COVID-19 case was reported in India in late January, public health officials and epidemiologists in the country have been working closely with government and health authorities to get to the root of the problem. 

Past outbreaks in India such as the Nipah virus infection outbreak in Kerala in 2018 played an important role in the state’s response towards COVID-19, as it was able to begin testing patients, isolate suspected cases as well as put restrictions in place much earlier than the rest of the country. As a result, the state was able to not only test far more people than the national average, they were also able to arrest the spread of the disease by taking necessary steps.

In the same manner, South Korea was also able to stop the spread of the new coronavirus infection much quicker than the rest of the world. South Korea was the second country where the COVID-19 outbreak took place after China but it put lockdowns in place early, tested patients rapidly and took necessary steps to keep their populations safe from catching the infection. (The infection has returned to South Korea in recent months, as the country tried to reopen schools and nightclubs.)

Germany also experienced a high rate of infection in the country, similar to other European countries such as Italy, Spain, France and the United Kingdom. But while each of those countries has had a high number of fatalities, Germany has had a significantly lower number of deaths. The reasons for this include provisions to monitor patients at homes and widespread obeyance of public health measures.

Some measures had to be put in place following the outbreak of COVID-19. These are important lessons in understanding the role of public health in tackling the outbreak:

• Identify the line of treatment and standardise it across the country
• Set up containment zones and areas
• Ramp up testing facilities and laboratories for quicker results
• Swift communication of preventive measures

Public health experts and epidemiologists play a vital role in navigating the rest of the healthcare community through the understanding of a new disease, as well as effectively establishing a link between patients showing similar symptoms or the number of deaths caused by the same infectious disease. Epidemiology also finds the link between causes and risk factors and the disease.

Public health officials and epidemiologists have played a vital role in identifying the key areas of infection, identifying clusters in various parts of the country as well as tracing the root of the infection, all in the hope to limit the spread of the disease by suggesting preventive measures in the case of diseases that have no known cure or vaccine yet.