Never have we seen an epidemic on the scale of what the world witnessed in February 2020 beginning with China, and then, moving across the world. India has been witnessing epidemics and pandemics which are well-documented in past two centuries. But, are we prepared for the COVID-19 pandemic? With a dedicated public health cadre and infrastructure, Tamil Nadu is well-armed and prepared for the past 100 years. But, is this enough for what the future is about to bring?
Epidemics in Tamil Nadu
The history of Tamil Nadu public health practitioners handling epidemics and pandemics dates back to the era of small pox which killed millions in early 1900s, Plague in 1938 and 1995, Vibrio Cholerae in 1987 and 1992, Flu H1N1 in 1918, Leptospirosis in 1996 etc,. More than half of these outbreaks happened before antibiotics were discovered and millions of people were killed. This became better after the development of newer antibiotics, advanced diagnostics and infection prevention and control measures.
From what the experts have observed, very rarely does a disease turn out to be a pandemic in a short period of time — 3-4 weeks. It causes great human suffering in the form of morbidity, mortality and has a huge impact on nations with low resources — which may be poor data systems, inadequate healthcare professionals and low access to medicines and diagnostics.
China was able to stabilize and bring the epidemic to a halt by adapting the best methods of prevention and control — ‘cordoning’ and fast action in terms of adopting IPC strategies.
Swine flu epidemic, 2009
Roughly 10 years ago, in 2009, as a City Health Officer of Chennai, my team admitted nearly about 3,500 passengers from Chennai international airport, railway stations and inter-state bus terminals who were suffering from fever, cold and cough following the declaration of pandemic of H1N1by WHO. We identified and quarantined people with fever, cold and cough and who had travelled from the affected areas.
Subsequently, we did a contact tracing exercise to identify people and followed up with them for symptoms.
We observed them for 10 days. All our sanitary inspectors were instructed to do epidemiological investigations on all these patients with contact tracing and the contacts were brought to the hospital for symptoms and if required, investigations were done following treatment at Communicable Diseases Hospital (CDH).
Admitted suspects were given throat wash for use 5 times daily with warm saltwater followed by nutritious diet which included vegetable soup with pepper, ginger, garlic and coriander which was prepared in large quantities every day. They were put on mild antibiotics, antihistamines and mucolytic agents, followed by Tamiflu (branded drug), if they were positive along with Vitamin A therapeutic dosage. None of the quarantined patients went in for complications and there were nil deaths.
The same procedure was followed in 1992 and 1993 during outbreak of new cholera NON O139, that we named as MADRAS STRAIN, which became a pandemic affecting many countries. The Chennai city epidemic task force was developed under IAS officer R. Poornalingam with experts (physicians, public health personnel, microbiologists, environmental/water engineers) and a similar state task force was developed under the State Health Secretary.
Similarly, this unusual epidemic, which has spread around 186 countries, could be prevented and controlled in India through implementing and practising ‘personal distancing’ to prevent the spread of the strain. China and Germany, the countries seem to be successfully containing this disease with quarantining, testing a large number of symptomatics and vulnerable people, apart from physical distancing.
There is a need to move ahead swiftly, here:
India with second highest population needs to have one testing centre per district including all medical colleges (732 districts) and quarantine/treatment centres well established in all the 536 medical college hospitals and all private hospitals with more than 100 beds to test and treat for free as it is a pandemic preparedness strategy.
The vulnerable population, especially elders, diabetics, those with cardiovascular diseases, respiratory diseases, people on chemotherapy, retro-viral drugs for HIV etc., have to be supported by our health system with an uninterrupted supply of drugs.
A large number of people in the informal sector will have to be protected by social security measures.
The Hospitals should be regulated with the stringent measures of practising Universal Work Precautions, control of nosocomial infections, strengthening barrier nursing procedures, establishing sufficient negative pressure rooms in all the hospitals and sufficient number of ventilators and required gadgets for critical care.
Tamil Nadu could set an example like China and Germany because we have a wonderful public health system in place, along with our past experiences in handling epidemics and with the support of the government determined to stop this epidemic from spreading.