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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 13-16

SARS COVID-19 crisis – Developing nations to emulate what?


Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India

Date of Submission07-Apr-2020
Date of Decision23-Apr-2020
Date of Acceptance03-May-2020
Date of Web Publication5-Jun-2020

Correspondence Address:
Sonia Puri
Department of Community Medicine, Government Medical College and Hospital, Sector 32, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_27_20

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  Abstract 


A new public health crisis, SARS COVID 19/2019 novel coronavirus has engulfed the world in no time causing enormous affliction and mortality, collapsing health care, social devastation, and economic Wreck down. Developing nations are affected disproportionately more in contrast to developed nations. The purpose of this article is primarily to highlight the time tested strategies which must be emulated by developing nations in view of resource and time constraints.

Keywords: Contact tracing, COVID 19, developing countries, pandemic


How to cite this article:
Puri S. SARS COVID-19 crisis – Developing nations to emulate what?. Indian J Community Fam Med 2020;6:13-6

How to cite this URL:
Puri S. SARS COVID-19 crisis – Developing nations to emulate what?. Indian J Community Fam Med [serial online] 2020 [cited 2020 Sep 28];6:13-6. Available from: http://www.ijcfm.org/text.asp?2020/6/1/13/286021




  Introduction Top


SARS COVID-19 is one of the biggest humanitarian disasters that could plausibly cause more than 40 million deaths worldwide.[1] The World Health Organization (WHO) on January 30, has already declared it as a Public Health Emergency of International Concern as more than 782,365 confirmed cases and over 37,582 deaths were there in 114 countries and then pandemic on March 11.[2] The concerning issue about this infectious deadly calamity is nonavailability of protective vaccine or therapeutic cure owing to its distinct mutative behavior. The COVID-19 outbreak has afflicted many countries and has led to devastating economic, political, social, and health consequences. Epidemiologists have equated it to Spanish flu owing to its exponential peak in a short span of time.[3]

The extremely contagious COVID-19 virus spread like fire from Wuhan province of china across the globe in January.[4] The catastrophic capability of this infectious disease was underestimated in many countries such as the USA and Europe. In US, no immediate measures were taken considering it as a SARS like virus and underestimating its fatality. On the same lines owing to cognitive biases the stringent containment measures were not implemented in Europe and in Italy that led to unprecedented surge in cases making pandemic into a disaster. The tragedies that surfaced in China, Northern Italy and Spain elucidated that health care systems are not in capacity to cope with this highly transmissive deadly pandemic.[5] Even the developed nations with high Global Health Security Index (GHSI)[6] are too badly hit. The United States that ranks first in GHSI has already crossed with 52,217 deaths and more than 8,60,7000 affected patients till April 25th, much more than that of China. Italy too had around 25,000 deaths till April 23rd with case fatality of about 13%. Even Britain had recorded more than 19,506 virus deaths in around 143,464 cases till April 24th.[7]

Then what to say about developing countries? Developing countries are already facing the brunt of inadequate resources of health care, poor nutrition, and financial constraints in their public spending on health. There is already overwhelmed scarcity of resources in health sector like intensive care units and ventilators. In India, for example, there are 2.3 critical care beds per 100,000 population while Italy has 12.5 and the USA has 34.7.[8] In this situation, tackling a new infectious deadly disease without any cure as yet adds to huge burden of already taxed health care system. Furthermore, the economy unquestionably is being wrecked in a disproportionate manner as compared to developed countries. With the more unfolding of crisis, the governments are finding it difficult to balance between loss of mankind with weak health-care system and economic shutdown.

The only effective strategy to tackle is to figure out potential of its deadly nature and intervene in its budding stage promptly. And to adopt those approaches that have been successful in countries that could contain this virus like in Singapore, China, Taiwan, and South Korea. Epidemiologists state the first step in tackling pandemic as prevention of emergence and release of pathogen. For developing nations, where pathogen has already entered communities and one of the most effective modalities to contain, social distancing is a difficult option, knowledge empowerment is one of the most effective remedy. Empowering masses about modes of transmission, debunking myths, associated risks and preventive strategies is a cost effective key instrument that should be judiciously used admist scarcity of resources. This has been already exemplified by the WHO[9] that on 20th March sprung up with launching of corona messaging services in varied languages with Whatsapp and Facebook. This simple intervention had capacity to penetrate, educate, and prepare billions of people as well as stakeholders for this volcanic eruption and is especially apt for third world countries. South Korea had 240 deaths among 10,708 infected persons and with case fatality rate to be only 2.2% till April 25th.[7] This was tenable by prompt disclosure of real-time information/sensitization on COVID-19 through dedicated official websites, mass media and mobile apps that helped masses to anticipate and gear up for the tough time like nationwide lockdown.[10] This prevented them from deadly, tragic and irreversible results like that in the USA and Italy. In Taiwan, where there were only 429 cases in a population of about 24 million in late April, educating the public about the coronavirus-associated risks and precautions had been instrumental in nonescalation of cases.[11]

Next step is detection and reporting. For this, there is need for efficient screening facilities and equipment for identifying the causative agent, establishing diagnosis and providing insight into the effective infection control practices. This can be possible by intact disease and symptom surveillance system that transmits information quickly within country and across borders. In this context, Singapore is a model that must be emulated by countries desperate to check COVID fast. Singapore by its robust surveillance system could contain contacts of corona cases in no time. Singapore had accomplished this feat by high tech surveillance tools including a smart phone app, “Trace Together” that tracks users' location and proximity to other people using Bluetooth, alerting those who come in contact with cases or is at high risk for coronavirus. In addition to the citizens were updated constantly through WhatsApp twice a day that included total number of cases/suspects and advice for getting tested if came in contact. Government had established around 1000 testing clinics and they were free for all.[12] In a recent study by Harvard University's Centre for Communicable Disease Dynamics.[13] Singapore had identified three times more cases than other countries due to its disease surveillance and contact-tracing capacity. In Seoul too testing was done at a rampant speed and was free because of universal health coverage.[14] In fact, South Korea was the first country to implement “drive through testing” in critical locations when COVID cases started to escalate. By this approach virus in Daegu, the epicenter of corona outbreak could be controlled with a visible reduction in cases and fatalities. Till March 19, 2020 only there were approximately 85 drive-through testing stations and nearly 20,000 people were tested every day – more tests per head of population than anywhere else globally.[15] The New York State has now also begun to roll out these drive-through testing facilities seeing its effectiveness in their high risk areas. In Northern Italy, blanket testing[16] was done to manage the contagion and hence fatalities were less in comparison to southern part. Similar programs/strategies can be followed in developing countries too in hotspot areas.

Rapid response is the next step that is to be followed after detection for mitigating the spread of a pandemic. As its evident that treatment only can't manage the contagion, so developing countries should take prompt decisive action in adopting the evidence based varied policies of isolation, quarantine and contact tracing.[17] In Hong Kong, on being reported about case/suspect, digital maps were made. People were instructed to observe self-isolation/quarantine, social distancing and avoid visiting hot spot areas. Stringent penalty was imposed to defaulters. Taiwan has been another example of an efficient coronavirus strategy. Home to about 23 million people, it was thought to have the second highest number of COVID-19 cases owing to its proximity to China. However, they did enforce measures such sa proactive case finding (using new data and technology) and quarantine as well as resource allocation, among others. Furthermore, information from National Health Insurance Databases and immigration was sought to track the travel history of cases and find contacts. Hotline numbers were put on dedicated sites for citizens to report suspicious cases. The digital mapping along with 14-day travel history was integrated with the health insurance card data. Extensive phone tracking was done to ensure compliance with quarantine.[18] In South Korea, government opted a more viable and acceptable approach. Other than largely promoting self-isolation and social distancing, transparency about risk communication of this disease was embraced by authorities. This promoted community participation and cooperation that helped in halting the enormous surge of cases. It also made room to not implement draconian measures like that in China.

Other than the above mentioned efforts by varying countries, China's approach encompassed use of health QR codes[19] for permission to citizens for moving around in a city; frequent building and street sterilization along with thermal screening in high risk areas. The advantage of these was unburdening and rapid increase in the capacity of the health system. These early and drastic measures helped to delay the spread of the virus from Hubei to other provinces. China also judiciously used artificial intelligence empowered futuristic tech appliances such as “thermometer guns” (infrared thermometers) and ”drones” (flying robots) owing to extreme contagious potential of virus. Drones were used to disinfect rooms, communicate with isolated people, take vital information, and deliver medications/commodities. Also, identifying defaulters and ensuring compliance was done by Powerful surveillance technology including facial recognition-enabled cameras and drone.[20] Most of these countries were guarded after their experience of 2009 SARS like infection and MERS in 2015 and have preparedness in regards to policies and strategies.[21]

Sufficient strong health system and coordination with other sectors is also one the most important factors for pandemic control. Singapore has experienced in past many infectious diseases like SARS 2003, Chikungunya fever outbreak in 2008 and the 2016 Zika virus epidemic. This helped them in upgrading their health infrastructure and bolster their preparedness plans for any future emergency.[22] By their experience only, they established that to stem any infectious emergency there must be good interplay of agencies reserving their resources for any severity. In addition, the statistical data should be updated on various popular authenticated national/global sites/links along with hurdles/failures experienced by health staff in managing this problem without any inhibitions. This would unquestionably help epidemiologist, stake holders, bureaucrats, and governments to zero down in decision making of usage of appropriate fruitful strategies. Hence, on arrival of this pandemic health-care professionals were not caught off guard or left scrambled to deal with it. Rather, weeding of cases was done by strong amalgam of scientists, public health experts and health care professionals.[23] In all these countries, different sectors such as telecommunication, aviation, police, education, tourism, and private health sector worked in a coordinated manner to slow down the exponential rise. This only led to rampant smooth enforcement of measures like stopping/limiting international and domestic movement, closing educational facilities, banning public gatherings or announcing quarantine to contain plummeting COVID cases.

Hence, their tested strategies can be encashed and can be taken as line of action by third world countries. The result oriented policies like screening of international and national travellers, imposing ban on flights, social distancing, contact tracing, isolation/quarantine, closing of gyms, cinema halls etc., or national lockdown should be rigorously practiced. Although in developing countries, the recommendation of isolation and social distancing may break down for two important reasons: Low per capita living space and intergenerational cohabitation. Even because of resource crunch the testing may be feasible at amoebic scale only. Hence, upscaling of concerted efforts should be done to focus on other arenas like strictly enforcing low scalable solution of wearing masks, roping in of other streams like alternative medicine health care/private sector, creating more containment areas other than that in hospital, etc., to tackle resource shortage.

In this pandemic, India's approach was fast as well as aggressive. For this, it has already received accolades from Dr. Henk Bekedam, the WHO's representative in India.[24] Other commendable efforts so taken are announcing a $22.6 billion economic stimulus plan, to provide relief to millions of poor people hit by the nationwide lockdown. For empowering masses, a dedicated webpage-A “novel coronavirus” with detailed information/advice on corona virus along with phone helpline numbers has been created on the Ministry of Health's website. Also ”Aarogya setu” -a COVID tracker app has been launched that assesses the risk of getting infected with COVID. The promotion of interministerial coordination too helped in managing the escalating rise by judicious use of resources like creation of containment cells in railway trains/schools/colleges, roping in of alternative medicine professionals, promotion of research in vaccine/drugs against COVID, encouraging manufacturing of antimalarial drugs and even joining hands with other countries in its containment. Hence, India along with other developing countries can culminate the COVID threat with amalgam of tested strategies along with visionary approach.[25]


  Conclusion Top


Developing nations are under lot of pressure to contain virus and must opt for intensification of stringent actions in a coordinated manner to decrease mortality of millions, absorb financial blow and avoid collapsing of health care system. The need of time is in emulating and adopting those intervention models that has led to success in some of countries. Governments should establish war time-like organizational structures and seek to maximize coordination among international, national and local agencies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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