- Insha Pun
Every health care and public health professionals would agree that among the many challenges to public health, infectious diseases are the most unique; they can pose a threat to entire human existence and history. Infectious diseases include a range of disorders that are caused by microorganisms such as bacteria (tuberculosis), virus (COVID 19), fungi (ringworm) or parasite (Malaria). Their occurrences are unpredictable and they can have an explosive effect at the global level infecting tens of millions of people and killing other millions. What is more, few viruses that cause the infectious diseases have an edge over our immune system, once reaching our body, they can replicate and mutate at a daunting rate using our own immune system, this, in turn, makes our body “a powerhouse” and a “producer” of the strains of the virus. These evolving characteristics of most of the viruses make it untameable to medicines and drugs and thus making the entire global community vulnerable to emerging and re-emerging infectious diseases.
The current COVID 19 pandemic is a stark reality!
Outbreaks, epidemics, endemics and pandemics??
First thing first... let us get these terms right!
While an outbreak is the occurrence of illnesses often in a small, localized area, but in numbers which are unusually high. The terms as endemics, epidemics, and pandemics are derived from the common root word “demos” meaning people or population. Endemic refers to any illnesses that inflict human beings in a particular area (localized) and are often seen time and again. For example, malaria is endemic in Terai Nepal during pre-monsoon and monsoon season. The word epidemic indicates an outbreak of a disease taking a toll in increasing number of people and spreading over a larger geographic area. Lastly, a connotation of the pandemic is given when it has gained much momentum and has gone international, is out of control and above all the global efforts. This is especially marked by local transmission in the affected countries. To put these terms into context and to increase our understanding let us take an example of the COVID 19 disease. When there was an unusual and unexpected spike in the pneumonia cases (caused due to an unknown case, back then) among the market-goers in Wuhan, China, the authorities declared it an “outbreak”. Within weeks, multiple positive cases started to spring in places other than Wuhan and were difficult to contain, it became an “epidemic”. Ultimately, the virus was picked up by people in other countries outside China via local transmission (and not just limited to imported cass) the situation was overwhelming to the global efforts and was called a “pandemic”.
Historical chronicles:
As per the WHO report 2018, the first two decades of the 21st century has seen almost 1307 epidemics of infectious events occurring in almost 172 countries. Few examples to reiterate are: Severe Acute Respiratory Syndrome (2003, Asian countries), H1N1 Influenza pandemic (2009, worldwide spread), Cholera outbreak (2010, Haiti), Middle East Respiratory Syndrome (2012, Middle East), Ebola epidemic (2014, West Africa), the Zika virus epidemic (2015 more than 70 countries), and the current COVID 19 (2019 to ongoing, across the globe). As of 14 April 2020, the coronavirus cases are reported in well over 1.9 million people and the death toll has exceeded eleven hundred thousand. The COVID 19 pandemic has grappled the entire global community and incapacitated the world’s supreme powers and has revealed the shortcomings of the global public health care system. All these cases at hand acutely teach us an important lesson (among others) that “how vulnerable is the entire mankind to these emerging and re-emerging infectious diseases”.
Here and now: COVID 19
Each nation is grappling to this havoc with its own might, the frontline warriors being the health professionals and people who come in close contact with the patients with COVID 19. One of the many strategies that countries around the world have adopted against the disease is the “lockdown”. Some countries are lax at its implementation and some are strict and some even responding with curfews. Hospitals are running short of personal protective equipments, ventilators, supplies and intensive care units altogether to accommodate the overwhelming number of new cases identified each day. Research on moral injuries in the US even points out the susceptibility of health care workers and first responders of COVID 19 to psychological trauma that could possibly lead to similar cases as post-traumatic stress disorder. Meanwhile, the economic impact is taking a toll at the global level, with the global market share plummeting and some stock index falling to its lowest since 1987. Moreover, the Oxfam international predicts that the economic fallout can push half a billion population into poverty.
A moment for reflection
Amid such huge medical, economical, societal and above all global effects, this is a right time to ponder and dig deep. After all, despite the lessons learnt during the last two decades of recurrent outbreaks and epidemics, where did we fell short? Did we become complacent or did we lack in the preparation or is it due to the rapid unprecedented globalization facilitating mass international travel, or is it attributable to the selfish encroachment of human beings in the animal and microbial ecosystem. Well, here is a possible answer... the staggering amount of people infected with novel coronavirus acutely suggests that every aforementioned reason (and many more) played their part.
Way forward: creating pro active citizens and Strengthening School health and nutrition program
As per the article published in the New England Journal of Medicine titled “The Perpetual Challenge of Infectious Diseases” co-authored by Dr. Anthony Fauci, explains that one enlightening characteristic of these emerging and re-emerging diseases is that they are subject to prevention and eradication. While the latter part requires the development of vaccines which may take a year or so to develop and another 2 or 3 years for its worldwide availability. The interventions addressing the former requires two strategies viz preventing infection spread in the community and stopping the unnecessary anthropogenic encroachment to microbial and animal ecosystems
To prevent the undue anthropogenic interference in the biological ecosystem, the inter-professional collaboration among the experts on human and animal health and microbial ecosystem should be strengthened. Moreover, the “one health approach” that stresses the ecological relationship between human, animal and environmental health should be brought to immediate disposal. Given the ever-increasing encroachment of human beings into the natural ecosystem, such concepts should be prioritized especially in the developing world and local (contextual) solutions should be explored.
Meanwhile, the preventive interventions at the community are absolutely plausible and can be initiated right after the lockdown period ends. The first institutions that can be effectively mobilized are the schools and universities. We can prepare an army of proactive people who can focus on prevention and promotion of health during the actual outbreak instead of reacting helplessly. Thus, this is the right time that our country ensures nationwide expansion and strengthens the “School health and nutrition program (SHN)”. A research conducted among different stakeholders in Nepal concluded that SHN program had positive impact on students, schools and communities, to adopt healthy behaviours (Shrestha, R.M., Ghimire, M., Shakya, P. et al, 2019). Through SHN program, we can reach to school students and thereby communicate what is already known and unknown about infectious diseases. WHO recommends that proactively communicating such information early on ensures the engagement of the “at-risk population” for alleviating confusion and allaying fears myths and misconceptions during outbreaks. In addition to this, a customized awareness program and integration of the topics on infectious diseases to the school curriculum can contribute to bring a systemic awareness. This strategy is all the more a requirement in Nepal, where we see yearly bouts of emerging and re-emerging diseases (endemic to Nepal) like water and foodborne infection(cholera, typhoid, Hepatitis A and E), acute respiratory infection in under 5 children, vector-borne diseases (malaria, dengue) and other airborne infections.
To recapitulate, the booming world population, globalization occurring at a breakneck speed, encroachment on animal and microbial ecosystem and climate change all but contribute towards many such future emerging and re emerging infectious diseases. Therefore, this fact should ignite us to work towards a society which is prepared to face another round of outbreaks with minimal human and economic loss. This requires that we intensify “one health approach” and tap onto the resources that we already have such as school children and university students.