Prabin Sharma
The strongest nation or those deemedvulnerable, today the entire world is fighting to compete against Covid-19. According to World Health Organization, Coronaviruses are a large family of viruses, which may cause illness in animals or humans. In humans, it is known that many coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19. The outbreak began inin December 2019 in Wuhan, China.
The WHO and CDC are closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus first identified in Wuhan, Hubei Province, China. Cases of COVID-19 also are also recorded globally in a growing number of countries internationally, including the United States. There are ongoing investigations and enquiries to learn more. Till date, Nepal has reported nine cases of COVID-19 disease so far, eight of them in people who had recently returned from abroad, while one was transmitted locally. Similarly one case was completely cured.
During the coronavirus pandemic of 2019-20, the word lockdown is being used for actions related to mass quarantines. Lockdowns can restrict movements or activities in a community while allowing some organizations to function normally, or limit movements or activities such that only organizations that provides essential needs and emergency services can function normally. Unexpectedly as the novel coronavirus continues to spread, most of the countries placed their citizens on various forms of lockdown although that's not a common term used before by Nepalese people. Countries around the world have introduced the largest and most restrictive mass quarantines as far as they can with their available resources. The Ministry of Health and Population (MoHP) in Nepal has declared that the virus is still in phase 2 of transmission in Nepal, which means we still have opportunity to break the chain of infection. With the last 3 new cases in Nepal, Government has announced the extension of lockdown period. A countrywide lockdown came into effect on 24 March, and is scheduled to end on 15 April. Government of Nepal has declared that anyone who breaks the lockdown rules could be punished with simple imprisonment for a period that may extend up to some month or with a fine.
The current testing proceduresincludes of assessing whether patients have a fever along with symptoms of an acute respiratory disorder and if they have preexisting conditions; and then evaluating if they have been in contact with someone who may have had Covid-19 within 14 days of presentation, or has been in an affected country. Those arriving in Nepal are checked for fever, and even if they don’t present any symptoms, are asked to have a practice self-quarantine. If there is a fever, they are placed in isolation and sent to a designated hospital. With these, most of the health services in the country have been severely disrupted by the spread of coronavirus. Patients with other diseases have started to claim that they don’t get basic health care, which is their basic health, right. After confirmation of 3 new cases and latest announcement made by government officials people are not permitted to travel from one local level to other one making lockdown more strict to break the chain of infection. But being negligentseveral people can be seen in the street either single or in-group moving here and there with several reasons. This could be problematic for themselves and other too as they are in high risk to get transmission. With these all in many places community people started blocking the roads and boarders with bamboo, cutting trees, big stones/rocks. People are also blocking the suspension bridge removing its different parts and connections.
Nepal established health-desks at the international airport as well as on border checkpoints with India, starting in mid-January. Land borders with India as well as China were later completely sealed off, and all international flights suspended. All academic examinations were cancelled, and schools and colleges were closed. Quarantine centers and temporary hospitals are being setup across the country. Laboratory facilities are being upgraded and expanded. Hospitals have been setting up ICU units and isolation beds.
Supporting the decision of government, most of the health professionals are trying as much from their level to handletoday’s situation and we all have a huge respect for them. But still some of the complaints by public through social media and national news regarding ignorance and unsupportive behaviors of health professionals in health facility cannot be ignored. We are public and we must accept that not all the public hasappropriate information to compare simple health problem and Covid-19 in today’s context. So in this condition it’s not the fault of general public to visit health facility with simple health problem. It’s all because the whole world is now scared of coronavirus and psychologically also people get nervous of getting infected with coronavirus. This could be the reason why they visit health facility with simple health problems. On other side, health service providers are also complaining about not getting sufficient amount of full package set of Personal Protective Equipment (PPE). Health service providers are also human beings and they too are in full risk of getting infected by coronavirus. Many of house owner are asking health worker to left the house where they are staying in rent, which is totally inhuman. Keeping own health at full risk how can a person be ready to deal with number of patients visiting health facility? They are using PPE made by themselves by using locally available resources. So government must accept that we are already delay in implementing preventive activities and delivering messages to local levels along with necessary equipment’s and materials to health sectors.
The goal of the National Safe Motherhood Program is to reduce maternal and neonatal morbidity and mortality and to improve the maternal and neonatal health through preventive and promotives activities as well as by addressing avoidable factors that cause death during pregnancy, childbirth and postpartum period. Evidences suggest that three delays are important factors behind the maternal and new born. How can we maintain healthy pregnancy and safe delivery in this lockdown situation? This is a serious public health issue in Nepalese context right now.
In general, pregnant women are at increased risk for infection and serious illness due to physiological and immunologic changes in their bodies so pregnant women should be considered an at-risk group.UN also says that COVID-19 pandemic could have huge knock-on effects on women's health. In emergency situation and for those women who need immediate referral, this coronavirus outbreak could severely disrupt access to safe motherhood services at a time when women need these services most. Among the risk groups, pregnant and lactating women living in hard to reach area of remote geographical settings in Nepal who need antenatal care and post natal care but are still unsure whether to attend a health facility or not, will health service provider be ready to treat them in this situation after reaching the heath facility traveling many hours of distance? This is how some of them are struggling with lockdown in Nepal in present context. Some of the situation during pregnancy could be more serious and may need a immediate referral are also being trapped as the roads are blocked by local people themselves with bamboo, cutting trees, big stones/rocks. People are also blocking the suspension bridge removing its different segments and connections. Some of the irresponsible ambulance service providers and Travel/Transportation pass system areother issue faced by people in this situation. Not all the people have access with this system and many of them are getting in problem either by local government or police personnel’s (in some places) deputed in road. Though they get access to health facility and services, most important thing to remember is that who are taking care of her? How many people were involved in bringing her upto health facility? Are those who got contact with her safe with coronavirus transmission? In our practice generally 5-6 people in minimum are in close contact with pregnant and lactating women regularly. So knowingly or unknowingly again she is in full risk of transmission, which is always ignored in society like ours.
Looking towards our social practice, many of people used to visit pregnant and lactating women in name of joyous as we consider this situation as a happy moment in family and society. People forget about how risk is to make crowd in present context and start visiting and getting close contact touch with pregnant women, lactating mother and newborn baby. Do they wash their hand with soap and water during this period or do they use hand sanitizer? Probably most of them don’t in rural context. So there could be high chance of transmission of coronavirus in that group including pregnant women, lactating mother and newborn baby as they fail to maintain the proper social distancing. This context should be viewed in other way also. What if every people stay in his or her home following the lockdown? Who will take care of pregnant women, lactating mother and newborn baby? So its responsibility of family members in this situation to take care of them and if the situation gets serious, community people should help to those family psychologically and physically in close coordination with responsible stakeholders and authority. But all the precautions must be applied to prevent and protect everyone from transmission.
Similarly, during pregnancy and lactating period women need more nutritious food for good health of mother and child both. As the lockdown period is extended in different phase, many of pregnant and lactating women may not get easy access to the nutritious food as much they need which is again a issue for health of mother and child. So its responsibility of local government to identify such family and support them with special packages as soon as possible.
In this context, we all should be prepared for future situation, which is still unsure. All pregnant and lactating women including those with confirmed or suspected COVID-19 infections also have the right to high quality care before, during and after childbirth. This includes antenatal, newborn, postnatal, and mental health care and these all should not be disturbed at any cost. If COVID-19 is suspected or confirmed, community people, all the stakeholders and health workers should take all appropriate precautions to reduce risks of infection to themselves and others, including hand hygiene, and appropriate use of protective clothing like gloves, gown and medical mask.
Pregnant women and lactating mother should take the same precautions to avoid COVID-19 infection as other people. One can help protect themselves by:
• Washing hands frequently with an alcohol-based hand rub (if available) or soap and water.
• Keeping space with others and avoiding crowded spaces.
• Avoiding unnecessarily touching own eyes, nose and mouth and that of babies too.
• Practicing respiratory hygiene. This means covering mouth and nose with bent elbow or cloth piece/tissue when you cough or sneeze. Then dispose of the used tissue immediately.
• Anyone with fever, cough or difficulty breathing, seek medical care early. Call before going to a health facility, and follow the directions of your local health authority.
• Take proper care of newborn baby and do not allow other people to touch baby unnecessarily.
At last, all pregnant women and women who have recently delivered normal and including those who may be suspected by COVID-19 should attend their routine care appointments and government should make it possible with all its resources.
-Sharma is Public Health Professional