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Frontline_July2018-NIPAH_After the outbreak

 7/30/2018  257

Reference Article: After the Outbreak by RAJEEV SADANANDAN /Frontline

ON May 18, 2018, the outbreak of Nipah virus was concerned. By June 11, the outbreak was declared over. Kerala’s health care system and social capital won the battle against Nipah, but it is important to review the lessons learnt in order to prepare for future invasions as there is a strong possibility of the infection recurring.

Having a Good Surveillance

  • With the destruction of habitats and the impact of global warming, it is likely that many organisms that existed commensally with wild animals will cross over to humans.
  • When a microbe moves from one species to another, it could become much more virulent than it was in the host animal.
  • The reaction time for health or veterinary services would be very short.
  • We have to be prepared for the unexpected and be vigilant for any emerging infections.
  • In Kerela an alert team of doctors detected the second case saving many lives. However, had the first case, been picked up in time, most of the deaths could have been avoided.

Standard Universal Practices in Hospitals:

  • A good health system needs to have adequate precautions to protect workers and patients against any infection, known or unknown.
  • Many hospitals in India are inadequately equipped and the staff lack the needed knowledge and skills.
  • Most of the infections in this outbreak occurred in hospital settings.
  • While most of them could not have been prevented, but, a review of infection prevention and control practices in hospitals can go a long way in preparedness for such events

Tackle with the social norms (Burials)

  • In past outbreaks, such as HIV and Ebola, lack of precautions during burial rites had become an occasion for the spread of the virus. 
  • The National Centre for Disease Control has issued guidelines for burial.
  • Religious and political leaders stepped in to convince families of the need to comply with burial guidelines.
  • There was no spread from burials after the notification.

Providing quality care

  • Guidelines:
    • Based on experience of managing Ebola, guidelines had been developed for treating epidemics that are highly infectious and where mortality rates are high.
    • Kerala adopted these in managing the epidemic.
    • More than 2,000 contacts were under constant surveillance & were verified twice daily
  • Emergency Infrastructure
    • Any case reporting positive was shifted to the dedicated treatment facility in specially equipped ambulances, which were on standby in strategic locations
    • Two existing buildings at the Government Medical College were evacuated and converted to triaging, observation and treatment areas, each firewalled from the other.

Protecting the Health care workers

  • A burnout among the medical staff is usual in such situations. Some of the staff may try to avoid duty. These have to be firmly dealt with.
  • At times like this senior faculty and officers should be in constant interaction with front-line personnel to boost their morale.
  • In Kozhikode normal working hours were reduced and the staff was constantly boosted
  • To compensate working hours, additional personnel from other hospitals were readied for deployment if entire health system was seen to be pulling together.

Having a Unified Command Structure:

  • An event like this needs response from multiple agencies.
  • While inputs need to be taken from different stakeholders, the final chain of command has to be clear
  • A centralized command, with adequate financial and administrative powers, has to be established to manage the response.
  • In Kozhikode, this was set up under the leadership of the District Collector, with the Director of Health Services and the local Medical College providing the technical support.

Holistic Social Mobilisation

  • A united efforts from State ministers, different Business Houses and the Civil Society at large went a long way in mitigating NIpah Virus Outbreak in Kerela.
  • An overt display of social capital kept the morale up when the extent of danger was unknown and scenario was depressing

Management of Communicaiton

  • Daily review of the data followed by a press briefing was carried on by Core Group
  • The print and visual media were briefed by experts and they carried reports educating the public on the disease, prevention and mitigation strategies, what to do in different conditions, and a set of FAQs.
  • They also keept the morale of the team high.
  • Social Media Management:
    • Health Department operated Facebook and Twitter accounts and as a result its reach quadrupled during this period.
    • The cyber cell of the Kerala Police remained on its toes to tackle rumour mongers.

Cross Border Cooperation:

  • When the virus can move across territories, the response has to be global too.
  • India needs to have a mechanism for mounting a response, coordinating the best expertise sourced nationally or internationally.
  • It is important to realise that an effective response to emerging viruses, for which India does not have the required expertise, needs international cooperation.
  • When at a loss for remedies, Kerala reached out to all international contacts as was possible.
  • It was aided by Prof. Christopher Broder and Queenslan Governement
  • ICMR should do away with red-tapism and assemble the best international expertise in epidemiological investigations and management protocols for Nipah.

Medical Research Facilities:

  • The outbreak also underlines the need for continued research into emerging diseases.
  • The interest generated by the Kerala episode has revived investment in this area.
  • India has a substantial stake in developing a drug for Nipah infections and it should take the leadership in this area.

Documentation:

  • In any new epidemic the "process and lessons learnt" have to be documented for guidance in future.
  • This is the third episode of Nipah infection in India.
  • Failure in development of national guidelines forced India had to use the ones issued by the Government of Bangladesh.
  • To avoid this in future, a standard operating procedures for outbreak investigation, public health response and case management should be developed and made available to all States.

Summing Up:

  • India has be vigilant against recurrence of Nipah in any part of India.
  • It is also important that India develop a national policy on Nipah surveillance, containment, case management and impact mitigation
  • Further lessons learnt from Kerela episode need to be codified for preparedness against Medical Disaster

 

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