Editorial The pandemic and we Rashmi Kundapura Professor, Department of Community Medicine, K.S. Hegde Medical Academy Nitte Deemed to be University, Deralakatte, Mangalore. E-mail: [email protected] DOI -10.46319/RJMAHS.2020.v03i01.001 COVID 19 pandemic is the most talked about illnesses establishing standardized case definitions for suspect, presently due to its huge impact on all the aspects of probable and confirmed cases; creating standardized human life and its existence. Whole mankind is worried alert, case investigation and clinical record forms.[1] In and emotions are almost same all over world. There is the current scenario when things are still not very clear panic, helplessness, fear, anxiety and hope, prayers for about how virus evolved; prevention is the only cure. activities. The fear of unknown is towards just a tiny Understanding transmissibility remains crucial for virus. predicting the course of the epidemic and the likelihood [3] Yes, novel corona virus has changed the world but is it of sustained transmission. Understanding from because of the pandemic itself or because of how all of previous outbreaks likepandemic influenza has shown us have responded to it? Who should speak and who that as an epidemic evolves, we face an urgent need to should respond? expand public health activities in novel agent and [3] When I ask these questions to myself, it reminds me of characterize its possible impact. During such event's many epidemics and pandemics about which I read in epidemiologic investigations, surveillance and medical history books, the most striking story, is the containment are crucial activities for an effective public health response for right and quick decisions from the story of John Snow. The story is about the epidemic of [3] Cholera in UK during 1854.[1] During that time people knowledge which is available at that point. It is the never knew about bacteria and treatment of Cholera. But epidemiological knowledge which is taking a lead until John snow contained the outbreak of cholera in the a vaccine or cure is available to fight an illness which is vicinity of Golden Square, central London, in the late unknown not only to civilisations but to human immune summer of 1854, and the subsequent removal of the system as well. handle from the Broad Street pump, have become an Even before the declaration of the Pandemic by WHO, enduring feature of the folklore of public health and based on these principles and evolving epidemiological epidemiology. It is unique specially in the quest and knowledge, India was among first country to start thinking of human being to ask and answer 6 questions screening of passengers at airports in January 2020. ie What, Why, When, How, Where and Who which I Concurrent implementation of Screening, Isolation, and quote from a children's book by Rudyard Kipling in his Quarantining of infected and suspect cases as well as "Just So Stories" (1902), in which a poem, other surveillance and containment measures reduced accompanying the tale of "The Elephant's Child", opens the rate of spread. Unlike other countries, strict with[2]: surveillance measures especially Contact tracing using I keep six honest serving-men various technologies and use of “Enforced Social (They taught me all I knew); Distancing” India reasonably contained rapid progress Their names are What and Why and When of the infection and slowed down the spread by lock And How and Where and Who.[2] Address for Correspondence: Certain key activities performed by epidemiologists to Rashmi Kundapura, Professor, Dept. of Community support outbreak response and control includes: Medicine, K.S. Hegde Medical Academy, Nitte Deemed Calculating epidemiological parameters: R , incubation to be University, Deralakatte, Mangalore. 0 E-mail: [email protected] rates, serial intervals, secondary attack rates; Attribution-NonCommercial-ShareAlike Res J Med Allied Health Sci | Jan-June. 2020 | Volume 3 | Issue 1 4.0 International Licence 1 Rashmi Kundapura, The pandemic and we DOI -10.46319/RJMAHS.2020.v03i01.001 www.rjmahs.org down. Looking at the steps taken by Govt of India so far credible information so as to make people aware and looks very timely and important public health steps. All thereby reduce panic in this era of lot of false these actions seem to have not only delayed the information and myths being promoted on social media. epidemic and flattened the curve to get time for Though local government[4] and WHO[5] are playing preparedness but to also reduce the absolute number of their part but still the epidemiologist should come up cases. with robust data and evidences to burst the myths. It Planning and preparedness efforts for Covid-19 feels very disheartening that at the time of this pandemic pandemic are widespread and ongoing, it is in a much public health infrastructure across the country is in bad higher scale which was likely not imagined in 1918 at shape where many states do not have even state level [6] the worst pandemic of 20th century. Before vaccine epidemiologists. Government should take timely against this specific emerging pandemic virus strain measures to strengthen epidemiological services along becomes available, non-pharmaceutical interventions with strengthening of public health care infrastructure as simple as hand washing and physical distancing with of the country to fight such challenges now and in cough etiquette proposed by public health professionals future. can offer strategies for persons and communities to help 'Though one size does not fit all but the epidemiologist slow spread of the virus.[4] Preventive strategies have fits all the pandemics’ seen to be effective in countries that imposed control References measures at an early stage to contain the spread among [4] 1. Brody H, Rip MR, Vinten-Johansen P, Paneth N, communities and nations. Public health interventions RachmanS. Map-making and myth-making in Broad to combat the spread of a Pandemic should be based on Street: the London cholera epidemic, 1854. The Lancet the basis of the country specific epidemiological need 2000; 356 (9223): 64–8 compatible with the health policy, health care delivery 2. “Rudyard crippling short stories” 3rd chapter available in system and other governance. Beyond this pandemic we https://shodhganga.inflibnet.ac.in/bitstream/10603/958 must continue working towards sustained preparedness 53/9/09_chapter%204.pdf downloaded on 20/05/2020 against future emergent infectious diseases and 3. Lipstich M, Swerdlow DL, Finelli L. Defining the unforeseen pandemics. Epidemiology of Covid-19 - Studies Needed. N Engl J Complete lockdown of a nation is one of the boldest step Med. 2020 Feb 19 in the history of public health intervention, for 4. Bartlett P C, Judge L J, The role of epidemiology in preventing an emerging pandemic. It has been done in public health, Rev Sci Tech. 1997 Aug;16(2):331-6. doi: many countries to protect population from the clutches 10.20506/rst.16.2.1020 of an impending pestilence. However some critics have 5. Outbreak response: Epidemiologist [Internet]. [cited warned on the impact of the enforced social distancing 2020 Apr 11]. Available from: https://www. on the population and on nations' economy. There is a futurelearn.com/courses/disease-outbreaks/0/steps/ 62648 reservation among many epidemiologists about epidemiological basis of this decision making. These 6. Enanoria WT, Crawley AW, Tseng W, Furnish J, Balido J, Aragón TJ. The epidemiology and surveillance response are because of TV technocrats, bureaucrats and to pandemic influenza A (H1N1) among local health technocrats are going on in decision making which departments in the San Francisco Bay Area. BMC Public should be avoided. The data non availability in major Health. 2013 Mar 27;13(1):276. epidemiological institutions and not accepting the data 7. Dharmshaktu NS. The Lessons Learned from Current sharing. Even the websites are not updated with good ongoing Pandemic Public Health Crisis of COVID 19 data, there is a reservation on data. This kind of and its Management in India from Various Different apprehension and reservations might not be good for Angles, Perspectives and way forward. Epidem Int 2020; pandemic control measures. Plan should be made to 5(1): 1-4. share data with professional organisations and 8. Ma Y, Zhao Y, Liu J, He X, Wang B, Fu S, et al. Effects of academicians for scientific data analysis to augment the temperature variation and humidity on the death of capacity of government in wise decision making. It is COVID-19 in Wuhan, China. Sci Total Environ. 2020 important that a public health professional need to share Mar 26;138226. https://www.sciencedirect.com/ science/article/pii/S0048969720317393. Attribution-NonCommercial-ShareAlike 2 4.0 International Licence Res J Med Allied Health Sci | Jan-June. 2020 | Volume 3 | Issue 1.