COVID 19- How to tackle community spread?

COVID 19- How to tackle community spread?

Corona virus infection of 2019 (COVID 19) which started first in China is now showing all features of a pandemic with more than 100 countries affected. It appears to be a fast spreading viral infection and needs community participation to contain it. Disease is mild with mortality risk of about 3.4%. However it has created panic all over the world. The main concern is international travel and the ability of the virus to spread through contacts. This can be attributed to the high reproductive number (R0 value) of 2.28 the virus boasts coupled with the fact that the virus chose the most populous country in the world to wreak havoc. This high R0 value stresses the need for strict infection control and management to contain this illness.

As per preliminary reports death rate is not very high, but may differ from one country to other due to climate, geographical, ethnic and genetic factors. Most important factor in containing this epidemic is through community participation. Govt. should issue directions regarding the measures to be undertaken for controlling the spread. These directions are binding to all citizens across the region. Restricting international travel is one important measure, especially travel in and out of most affected countries is to be strictly restricted. Avoidable travel, travel for tourism purpose etc. can be cancelled or postponed to a later date.

Next important measure is surveillance in international airports; where in all international passengers are screened by a team of health care providers. Symptomatic should be isolated in health care facilities and treated and asymptomatic contacts can be quarantined in their homes so that mixing with other public is strictly restricted for at least 14 days. All contacts and suspects should be tested for presence of viral antigen.

Since the initial symptoms of the disease are like any other flu illness, even a minor running nose has created an undue fear amongst the people. Seeking early professional advice puts these patients at a higher risk of acquiring Covid 19 from the hospitals. Hence, self-quarantine is of paramount importance and needs to be stressed. Patients need to initially isolate themselves from their immediate kin, wear a surgical mask and follow strict hygiene measures to restrict transmission. Initially, symptomatic measures such as anti pyretics, adequate hydration and nasal decongestants may be taken. Professional help need only be sought if the symptoms persist.

A monitoring cell under the district health authority is to be formed and that is responsible for treating symptomatic, tracking contacts, allaying fear among public and to give directions to the public. There will be state cell to coordinate district activities and to provide money and materials to the district units. Health centers designated for quarantine of suspects should have chambers with negative pressure to contain the spread of the virus. Health workers should also be equipped with adequate supplies of gloves, N95 masks, respirators, goggles, face shields, gowns and aprons. It cannot be emphasized enough that these workers, being at the forefront of combating this illness, need to be protected at all costs. All details about each individual case so far reported should be traced with special details regarding mode of acquisition, age, travel and contact history, symptoms and signs, investigation reports, severity of disease, co morbidities, course of the disease and outcomes.

Contact tracing of a case suspect is of paramount importance to prevent spread in the community, especially in a highly populous country like India. Both primary and secondary contacts should be tracked and put on strict home quarantine. Meticulous planning and sincere effort done by the Govt. of Kerala in this direction is a model being appreciated by all.

There should be directions to avoid mass gatherings especially, festivals, meetings, marriage celebrations where large number of people are exposed.  It will be better to close all educational institutions for a period till containment is achieved. News bulletins, public awareness programmes through social media are essential to give updated information to the public. At the same time care should be taken not to create panic among citizens. Awareness about cough hygiene, hand hygiene and other general measure with special emphasis on early reporting and reassurance are the need of the hour.

WHO has declared Covid 19 as a pandemic and wanted all the countries to take urgent measures to contain the disease. The report from China is hopeful that number of new cases reported is coming down drastically. Hope that, with the concerted efforts of all we will be able stop the onslaught of 2019-nCoV.