Dr Prajjwal Pyakurel
Coronavirus has created havoc around the global community. The reason being its foreign nature when it enters human cells and the body’s unpreparedness to respond to this deadly virus. To witness such a pandemic was a lifetime opportunity and I feel fortunate enough to get opportunity to investigate one of the outbreaks of coronavirus in Eastern Nepal. I was given a phone ring by one of the senior officials of the government when I instantaneously say yes as this is the opportunity which I have been seeking for a long time. I recalled my memory when I was in the corridor of counselling for Doctor of Medicine (MD) at one of the prestigious medical institution in Nepal and the dilemma which I faced to go for a clinical subject or the subject which my intuition say I have to go for it. This is the subject which I still believe is the need of the hour in the developing country like Nepal.
Sitting in my room and watching various news channels, reading scientific articles and discussing with the colleagues in the online forum of Nepalese Society of Community Medicine (NESCOM) has given me fair clue about the diseases. However,to experience the ground reality, investigating the outbreak, establishing the epidemiological link was always special.
The journey started with the 1.5 hours ride from my living place in the hilly roads of eastern Nepal. I was curious and excited and discussing with the colleagues from health department of government about various aspects of COVID-19. When we reach the district we were briefed about the situation by the chief of the health department. I could read the frenzy face of the government health officials and the desperate help they were seeking from our team. There was panic among the people of the district as I couldn’t see anybody moving out of the house. The hospital was closed which was the focal point for the outbreak and there was huge political and social pressure to open the hospital. The work started from the very next day. We felt that the more we delay the more will be the outburst.
The contact tracing team which the district health officials has kept standby where briefed. Our investigation was focused on obtaining minor and minor clues so that we did not miss the pre-symptomatic ones as they were the source of infection in 45% of the cases. We as a team started thinking the epidemiological link for the disease as the source of infection was not identified. Finally, we were able to suspect the common source among all the COVID-19 positive cases identified in a district and were desperately waiting for their PCR results.To our utmost surprise the commonsource which we suspected was found tot be PCR -ve. However, we still felt that the common source should be monitored for a period of maximum two incubation period (28 days) for clinical signs and symptoms. The next twist which we faced was the one of the cases whom we thought was the centre point for all the cases had travelled with pillion rider 1 month back and he was found to be RDT +ve. His family members samples was sent for PCR testing and the results are awaited. This again gave us the new dimension if this was the community transmission.
Predictions, assumptions, opinions, discussions are obvious in a disease like COVID-19 where lot of things are still unknown and is the area of research in coming decade. Experience sharing by all the people working in such an investigation is crucial so that the wider audience in the health sector understand the disease at local context for appropriate investigation and management. Epidemiologist, Public Health Officers, Statisticians and Social Scientist expertise’s should be sought for effective case investigation and contact tracing so that such outbreaks could be dealt more effectively at local context.
-(Dr Pyakurel is assistant professior of public health and community medicine, BPKIHS)