Year : 2020 | Volume
: 6 | Issue : 1 | Page : 9--12
Time to win the war against COVID-19: How and where community medicine professionals can contribute?
Prajna Paramita Giri, Vikas Bhatia
Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
Prajna Paramita Giri
Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha
A coordinated and multidisciplinary approach is needed to fight against coronavirus. In the absence of any proven therapy and vaccines, the nonpharmaceutical interventions or public health measures will play major role in containment coronavirus spread. The community medicine specialists can contribute to the public health as well as health-care services in combating the pandemic. Domains where community medicine professionals can contribute: The community medicine professionals can contribute at micro, meso, and macrolevel of framework of health system which refers to the patient/individual interaction level, the health care organization and community level, and the policy level, respectively. At micro level, faculty and residents of community medicine department can play a pivotal role in pandemic preparedness in the areas catered by Urban Health and Training Center and Rural Health and Training Centers of Medical Colleges. Considering district at the mesolevel, if the district has a medical college, then the department of community medicine can take the lead in preparing a District Pandemic Preparedness and Response plan in consultation with relevant stakeholders. At the macro level of framework, community medicine specialists can contribute in a larger way such as developing the guidelines and policies related to COVID-19. Where whole-society or the community is the key to control pandemic, the community medicine professionals can play the important role in the response mechanism for COVID-19 as well as for future pandemic.
|How to cite this article:|
Giri PP, Bhatia V. Time to win the war against COVID-19: How and where community medicine professionals can contribute?.Indian J Community Fam Med 2020;6:9-12
|How to cite this URL:|
Giri PP, Bhatia V. Time to win the war against COVID-19: How and where community medicine professionals can contribute?. Indian J Community Fam Med [serial online] 2020 [cited 2021 May 13 ];6:9-12
Available from: https://www.ijcfm.org/text.asp?2020/6/1/9/286027
In the wake of COVID-19, one big challenge is availability of medical supplies such as intensive care unit beds, ventilators, and personal-protective equipment (PPE). However, in times of this pandemic, are there enough human resources available to work at forefront? Are we prepared enough to face a pandemic like COVID-19? Every country has ever-prepared defense forces to protect her from the invasion of enemy or to tackle the unrest. The question arises, does a country need its armies to remain prepared to fight against the enemy as and when required or the country prepares the army only when there is an attack or impending threat by the enemy? If pandemic or disaster can be compared with war, perhaps sparing a few, most countries do not have enough preparedness. Most of the countries lack arrangement in place for mitigating pandemics/disasters. If unprepared or hurried planned mitigation measures are implemented at the time of disaster/pandemic crisis, it puts enormous pressure on health workforce jeopardizing the entire health system and the outcome may not be of the desired level.
From the experience of past pandemics, it was understood that, a coordinated and multidisciplinary approach is needed to fight against coronavirus. Studies have shown that nonpharmaceutical interventions or public health measures have played a major role in the containment of epidemics and pandemics., To overcome this unprecedented challenge of COVID-19, the community medicine specialists can contribute to the public health as well as health care services in combating the pandemic. For the ease of understanding how and where the community medicine professionals can contribute, let us classify the level of engagement of different community medicine professional in health system as micro-, meso- and macrolevel framework which refers to the patient/individual interaction level, the health care organization and community level, and the policy level, respectively. The functions of each level are not fixed and are likely to vary across contexts.
Domains Where Community Medicine Professionals Can Contribute Significantly
In the context of COVID-19, the role of community medicine professionals in all level is crucial. At microlevel, all community medicine professionals can strongly contribute. However, the maximum contribution can be done by faculty members, residents in different medical colleges, and primary physicians working in private and government set ups. The involvement of the whole society as a unit is the key to combat a pandemic like COVID-19. The fraternity of community medicine understand the dynamics of the community better. Most of the medical colleges have rural and urban health and training centers attached to the Department of Community Medicine, where faculty, residents and other paramedical staff are posted who have good access to the community. Thus, in any pandemic preparedness we can play pivotal role in planning and coordination, situation monitoring and assessment in that area. Through these centers and beyond, the majority of the activities for containment of the pandemic at individual level as well as community level, like creating awareness about hand washing, cough etiquette, social distancing, avoiding gathering, use of mask etc., can be carried out. In collaboration with the local bodies, village headmen, medical officers of nearby PHCs, the faculty and residents can train the frontline workers (FLWs) about the pandemic, on personal protective measures such as hand washing and use of mask and can support them during this phase in countering the possible stigma. Communication is one of the pillars of any preparedness. In the era of Internet and social media, there is no dearth of information. However, the authenticity, reliability, and usability of information is lacking. In these situations, IEC materials in local language (leaflets, videos) can be developed by the community medicine department and can be widely distributed in the community for their understanding of the disease and its pandemic potentials, addressing the myths, and misconception about the disease. Faculty and residents can take initiative in addressing the queries of general public of those areas by a helpline number (mobile number) which can be displayed at the health centers or can be with FLWs. We can provide supportive supervision for home and institutional quarantine. Applying different preventive measures, we can help in reducing the spread of the disease in that community, and at the same time, we can provide health care to the people who need it the most.
Preventive interventions are more effective in primary care settings, and this is particularly important for preparing and responding to a pandemic. The most common challenge anticipated during pandemic is surge of cases at the primary health-care system. The efforts of primary care physician in managing these cases and enhancing the capacity, perhaps by curtailing other nonessential services, can be instrumental in lessening the case burden on secondary and tertiary health centers. They can be engaged in effective surveillance of acute respiratory infection, implementation of pandemic control measures. The primary care physicians who do not have community medicine or public health specialization, can be mentored by medical college faculty through training on emergency/pandemic preparedness and enable them with the skill of handling pandemics. In Odisha, the newly appointed doctors through state public service commission undergo induction training during their initial phase of service and emergency/pandemic preparedness is one of the important parts of the training agenda. Community medicine department of different medical colleges is mainly involved in this training. One example is AIIMS, Bhubaneswar imparting training to the Medical Officers of Odisha since 2015, and about 226 doctors had been trained on epidemic preparedness in 12 batches till date.
In the three levels of health system framework, the mesolevel refers to region (districts/state) or institutions (hospital). The community medicine professionals working at various levels and in different position can contribute. Considering district at the mesolevel, the pandemic preparedness and response involve the nonhealth sectors too. A district pandemic preparedness and response plan can be developed in consultation with relevant stakeholders. If the district has a medical college, then the department of community medicine can take the lead in preparing a district specific plan and implementation of the plan. Formation of a rapid response team, mapping of affected area, mapping of contact and cases, defining containment zone, active surveillance, contact tracing, supervision of quarantine facilities are the major area where community medicine professionals can render their services.
In India, Integrated Disease Surveillance Program (IDSP) was implemented with the objective to detect and respond to early warning signals of disease outbreaks. Under this program, surveillance units at Center, State, and District level have been integrated, and surveillance activities are decentralized. The community medicine professionals should be placed at the IDSP unit at district/state and as they can contribute immensely in the prepandemic as well as pandemic period as a virtue of their expertise.
In hospital setting, the framework for the overall management of hospital and cases during pandemic can be chalked out. The hospital should have a separate patient waiting area and consultation room for suspected cases of COVID-19. There should be adequate arrangement of handwashing for patients as well as health-care providers. The development of Standard Operating Procedures for social distancing, avoidance of gathering/crowding at OPD and pharmacy, screening of patients, proper use of PPE by health-care providers, management of biomedical waste generated during care of COVID-19 patients is important area where the department of community medicine should take the charge and also the department can take the charge of screening clinics for COVID-19 in the medical college hospital.
At the mesolevel, inter-sectoral co-ordination (health and non-health sectors) is of paramount importance. Even within the health sector interdepartmental co-ordination is crucial, for example, in COVID-19 management, a team consisting of pulmologist, microbiologist, community medicine specialist, and professionals from the hospital administration in case of hospital setting or Chief District Medical Officer/Additional District Medical officer/equivalent official at district need to work in co-ordination on every aspect of the pandemic situation.
At the macrolevel of framework, the policies are made and decisions are taken. Knowledge, evidence, and expert advice are crucial for rational policy-making. Community medicine professionals have a great, inherent responsibility at this level. Except for a countable number from premier institutions, our fraternity at highest level is occasionally represented. We have eminent epidemiologists, researchers, public health experts amongst us, but we are not visible as a community to influence the policy-makers in the decision-making. At this level, we can contribute in a larger way such as developing the guidelines about the disease concerned, prevention, or containment of the pandemic (by studying the epidemiological trend, formulating the mathematical, and epidemiological models), clinical case finding and laboratory confirmation criteria and disease surveillance, policies regarding the distribution of logistics, PPE, protecting the rights of medical professionals and other health-care workers, medical indemnity policies during pandemic situation, and lot more.
As of now, there are 536 medical colleges in India having MBBS course and among them, 294 colleges have MD (Social and Preventive Medicine/Community Medicine) course. If we assume, for MBBS course (with 100 seats), at least five faculty for the department of Community Medicine/Social and Preventive Medicine are required, then we have 2680 faculty members (MD community Medicine/MD Social and Preventive Medicine. Again, if we assume that every year at least two MD students pass out from the medical colleges having MD course, then 588 young community medicine professionals join the cohort. At any point of time, we have more than 3000 active community medicine specialists in India. Can this health work force be engaged in pandemic preparedness and response? Yes, of course. Because community medicine bridges the gap between public health and clinical medicine. The authors have affirmed about the role of faculty members influencing the national programs and policies., Therefore, a model can be developed as follows: Let the department of Community Medicine/Social and Preventive Medicine of one medical college take the charge of the public health activities of at least one district where it is situated or if the district has more than one medical colleges, then the adjacent district and develop a blue print/plan an emergency (pandemic) preparedness and response in co-ordination with the district administration after conducting the situational analysis of that district. The state government may take the lead in distributing the districts among the medical colleges if there are more medical colleges clustered in few districts and no medical college in some of the district. All the faculty, resident would remain prepared to work in the time of epidemic/pandemic in that district. In this endeavor, the two major associations of community medicine professionals in India, namely Indian Association of Preventive and Social Medicine and Indian Public Health Association can take the lead. The office bearers and governing council members/central council members of these associations can take the leadership role and can represent the community medicine fraternity at the state and central level and work in co-ordination with policy-makers to bring out the desired changes in the health system of our country.
The pandemics like COVID-19 where the whole-society or the community is the key to control pandemic, we, the community medicine professionals can play the pivotal role in shaping the response mechanism for COVID-19 as well as for future pandemic. This is high time that government should develop a robust mechanism to involve the community medicine professionals from medical colleges as well as from other areas where they are working for timely implementation of public health interventions which can minimize the social and economic disruption caused by pandemics. We all have to work together and join hands against this deadly virus.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||Aledort JE, Lurie N, Wasserman J, Bozzette SA. Non-pharmaceutical public health interventions for pandemic influenza: An evaluation of the evidence base. BMC Public Health 2007;7:208.|
|2||Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. Published online April 10, 2020. doi:10.1001/jama.2020.6130. Available from: https://jamanetwork.com/journals/jama/fullarticle/2764658. [Last accessed on 2020 Apr 12].|
|3||Samuels F, Amaya AB, Pose RR, Balabanova D. Pathways to Progress: A Multi-Level Approach to Strengthening Health Systems. Findings on Maternal and Child Health in Nepal, Mozambique and Rwanda, and Neglected Tropical Diseases in Cambodia and Sierra Leone. Development Progress Research Report; 2014.|
|4||Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83:457-502.|
|5||Patel MD, Phillips CB, Pearce C, Kljakovic M, Dugdale P, Glasgow N. General practice and pandemic influenza: A framework for planning and comparison of plans in five countries. PLoS One 2008;3:e2269.|
|6||Waithaka D, Tsofa B, Barasa E. Evaluating healthcare priority setting at the meso level: A thematic review of empirical literature. Wellcome Open Res 2018;3:2.|
|7||Micro Plan for Containing Local Transmission of Coronavirus Disease (COVID-19). Available from: https://www.mohfw.gov.in/pdf/ModelMicrop lanforcontainmentoflocaltran smissionofCOVID19.pdf. [Last accessed on 2020 Apr 12].|
|8||Available from: https://www.nhp.gov.in/integ rated-disease- surveillance-program-(idsp)_pg. [Last accessed on 2020 Apr 12].|
|9||Available from: https://www.mciindia.org/CMS/inform ation-desk/college-and-course-search. [Last accessed on 2020 Apr 14].|
|10||Minimum Standard Requirements for the Medical College for 100 Admissions Annually Regulations; 1999. Available from: https://www.mciindia.org/CMS/wp-cont ent/uploads/2017/10/Minimum-Standard-Require ments-for-100-Admissions.pdf. (Amended – Up To January 2018). (Published In Part Iii, Section 4 of The Gazette of India Dated The 29th April 1999). Medical Council Of India, New Delhi, dated the 30th March 1999. Page No-18-20.|
|11||Pandav CS. Role of faculty of medical colleges in national health policy and program development. Indian J Community Med 2010;35:3-6.|
|12||Garg R, Gupta S. Are we really producing public health experts in India? Need for a paradigm shift in postgraduate teaching in community medicine. Indian J Community Med 2011;36:93-7.|