In this September 1947 photo hundreds of Muslim refugees crowd on top a train leaving New Delhi for Pakistan(AP)
In this September 1947 photo hundreds of Muslim refugees crowd on top a train leaving New Delhi for Pakistan(AP)

To contain coronavirus, monitor and communicate

Science, a functioning public health system, and government support are critical in managing epidemics
By Rama Baru
UPDATED ON MAR 06, 2020 12:26 PM IST

The media is flooded with reports of an increasing number of coronavirus cases and deaths from various parts of the world. While China was the epicentre of the epidemic, it has now spread to Europe, the United States (US), West Asia, and India. In February, several Indian students from Wuhan (China) were evacuated and quarantined. This was the first political response by the Government of India on the growing epidemic. Subsequently, a few 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 among the middle and upper-middle classes, thanks to the media coverage of the coronavirus.

All epidemics evoke fear and panic since they result in fatalities. However, in its management, three elements need to be addressed: Science, common sense of the public health system, and political support from the government. There is a better understanding today about the virus, and the nature of the disease it produces. The current evidence suggests that around 80% of the infected cases are mild, 18% are severe, and only 2% require intensive intervention. Since there is no medication available, the cases need close monitoring, and treatment of secondary complications if the need arises. Special attention is needed for the elderly and other vulnerable sections of the population. So monitoring is key to containing the epidemic.

The Chinese data on coronavirus fatalities shows that a large proportion of fatalities has been among the elderly. The number of deaths is higher among elders, as compared to the young. Those with pre-existing conditions are much more at risk than others. This understanding is essential for the layperson so that they are informed about the nature of the disease, along with a rational public health system that can respond to containing the spread through monitoring and surveillance strategies.

We also need to learn from the strengths and failures of managing several viral influenza outbreaks in the recent past such as the avian and swine flu (H1N1) that has and continues to spread across the country.

Data from the National Centre for Disease Control shows that there have been 884 cases of H1N1 virus this year, resulting in 14 deaths. Of that, 70% of the cases are from four states. Tamil Nadu accounts for 172 cases, followed by Delhi (152), Karnataka (151) and Telangana (148). The fatality due to H1N1 is highest in Uttar Pradesh (51 cases and seven deaths), followed by Andhra Pradesh and Telangana.

Health is a state subject and the response of the public health system needs political support. The contrast in response to a viral outbreak whether H1N1, nipah virus or coronavirus is seen in how UP and Kerala governments have responded to public health emergencies. In a recent speech, UP chief minister Yogi Adityanath dismissed the problem of the coronavirus and advocated yoga as a way of overcoming it. It maybe worthwhile here to highlight that the number of reported cases and deaths due to swine flu in the state: There have been 884 new cases and 14 deaths in the state this year.

In contrast to UP, Kerala has managed to contain several outbreaks of the nipah virus effectively. The strategy to tackle the coronavirus in Kerala has involved isolation, quarantine and surveillance of positive cases in hospitals and the community. The Union government could take cues from 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 required political imagination and support to achieve what Kerala has been able to do.

The influenza season is back, but how prepared are we to handle the variety of cases? Experience of dengue, swine flu and other outbreaks shows that lack of preparedness and response from the public health system has resulted in panic, leading to a rush for testing and treatment in hospitals by people. While there are guidelines issued by the National Centre for Disease Control, its implementation and monitoring are poor in the public and private sector. Irrational use of drugs, testing and hospitalisation only add to the anxieties of patients.

An important aspect of the public health strategy to deal with epidemics is communication. The government must communicate with the general public and health personnel on the latest virus outbreak.

The government must have a nodal person who coordinates with the health ministry and can provide the relevant data and advice. This is lacking at present, and, as a result, the media often sensationalises the problem, making citizens anxious. In the absence of authentic information, social media becomes the main source of information and misinformation.

Rama Baru is professor, Centre for Social Medicine and Community Health, Jawaharlal Nehru University.
The views expressed are personal
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