The Viral Storm and Outbreak Control

Umar Majeed

COVID-19 can be defined as an ill-ness caused by another living agent, or its products, that can be spread from one person to another. An emergency condition can be defined as a state of disarray that has occurred during or after a regional conflict, or a natural disaster (i.e. flood, earthquake, hurricane, drought). Infectious disease during an emergency condition can raise the death rates in comparison to other causes. Many deaths in emergency conditions occur by COVID-19 in few weeks.

As of March 12, 2020, Coronavirus disease 2019 (COVID-19) has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 3·7%, compared with a mortality rate of less than 1% from influenza. Recently the total number of coronavirus cases topped 2.1 million worldwide as many countries, including the United States, Spain, Italy, the United Kingdom and others continued to report new cases. So far, the world has reported 2,242,868 coronavirus-affected cases and 154,142 deaths. A total of 3,557,493 have recovered from the Covid-19 infection. There is an urgent need for effective treatment. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Accumulating evidence suggests that a subgroup of patients with severe COVID-19. Of note, there is no dependable performance assessment tool in improving COVID-19 surveillance regarding outbreaks of infectious disease although the Centers for Disease Control (CDC) has proposed viable mechanisms for public health in general.

We recommend identification and treatment of hyper inflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality. The emergency department (ED) is the front-line response system in many developed countries and can act as the primary entry method for COVID-19 disease. The prevention of transmission is paramount in keeping the ED a safe environment and limiting spread. Hand hygiene prevents harbouring transient flora by reduction of Viral counts. The recommendation is to use alcohol-based materials such as foam with an alcohol by volume of 60-70%, or if suspected C. difficile, hand washing with vigorous physical manipulation to reduce the number of spores of pathogens. This must be coupled with Standard Precautions, which involves the use of barriers such as gloves, gowns, masks, and eye wear, in order to prevent infection of the healthcare worker. Other safeguards such as airborne droplet, regular droplet, and contact precautions are necessary to prevent spread of unique vectors. Airborne particles are small (less than or equal to 5 micrometers) and remain in the air for several hours.  N95 mask or powered air-purifying respirators are required. Isolation rooms that have high ventilation (several changes in the air system per hour), and negative pressure should also be used.

Patients suspected of respiratory infection that does not qualify under airborne should wear a surgical mask, in addition to the provider, and this is usually enough to prevent major spread.  If able, a separate room or at least an area blocked by curtains is preferred contact precautions are used for pathogens infecting mucosal or skin surfaces. Use of protective gowns and gloves is usually enough unless suspicion of a higher level of precautions exists.

Vaccinating health care personnel against pathogens is highly efficient in decreasing the risk of transmission of many infectious diseases. This is not a replacement for standard precautions, airborne, droplet, contact precautions, or hand hygiene, but is another measure of safety to undertake. COVID-19 Control An epidemic, or outbreak, can occur when several aspects of the agent (pathogen), population (hosts), and the environment create an ideal situation for spread. Infectious agents are plentiful, mutate rapidly, and can become resistant to drugs if not destroyed completely. Low vaccination rates, poor nutrition, age (young and elderly), and immunosuppression all contribute to infectious risk. Overcrowding, poor regional design and hygiene due to poverty, dirty drinking water, rapid climate changes, and natural disasters, can lead to conditions that allow easier transmission of disease. Once it has been established that an emergency condition exists, there must be a prompt and thorough response for COVID-19 control.  A camp should be created, and the disease managed rapidly. The overall goals are rapid assessment, prevention, surveillance, outbreak control, and disease management. For more detailed information on the logistics of COVID-19 control, please view the World Health Organization (WHO) field manual.

In addition to the COVID-19 prevention involves, Social distancing, Quarantine, Isolation, sanitation and cleanliness. First social distancing, also called “physical distancing,” means keeping space between yourself and other people outside of your home. To practice social or physical distancing:

Stay at least 6 feet (2 meters) from other people

Do not gather in groups

Stay out of crowded places and avoid mass gatherings

Also, keeping space between you and others is one of the best tools we must avoid being exposed to this virus and slowing its spread locally and across the country and world. Second, quarantine is used to keep someone who might have been exposed to COVID-19 away from others. Someone in self-quarantine stays separated from others, and they limit movement outside of their home or current place. A person may have been exposed to the virus without knowing it (for example, when traveling or out in the community), or they could have the virus without feeling symptoms.

Quarantine helps limit further spread of COVID-19. 

Third, isolation is used to separate sick people from healthy ones. People who are in isolation should stay home. In the home, anyone sick should separate themselves from others by staying in a specific “sick” bedroom or space and using a different bathroom (if possible).

Fourth, cleanliness covers many aspects of what has already been discussed in the emergency room setting. Of note, full biohazard precautions should be taken with viral hemorrhagic fevers such as Ebola (to be discussed below).

Water must be available for up to seven liters per person per day (in the most extreme situations), and it must be clean. This can rise to 20 liters per person per day if considering bathing as well as cooking. Diseases spread in contaminated water are plentiful, and their evasion is of utmost importance in emergency conditions. Biological quality (less than 10 fecal coliforms per 100 ml of water) is important.  Chlorine can be used to disinfect water. Chemical quality is of less importance than biological quality. Areas for excretion should not be near water sources, and they should be maintained with detail for sanitation. Pits to dispose of the contents should be created. Solid waste should be buried and/or burned. Liquid waste (i.e. bathing) should be diverted into either storm water drains, or if in a dry area, to an isolated, separate pond, for disposal later. Medical waste could be incinerated, preferably near the camp itself, making sure the contents do not travel to other dwellings.  Otherwise, they should be buried after being sealed in a metal container.

Moreover, the surveillance and early warning systems should be set up in emergency conditions. This involves watching diseases on a continuum, finding trends, and reporting outbreaks earlier rather than later.  This is a data collection phase, similar to the rapid assessment phase, but on a larger scale, and primarily involves interpretation of the data collected in order to create an efficient and effective public health response to the threat.

Preparation, detection, confirmation, response, and evaluation  

An epidemic can be defined as outbreaks and vice versa according to the WHO.  The first step of “preparation” covers much of what we have already discussed:  setting up camp with isolation wards, gathering stockpiles of treatment supplies (medicines, vaccinations, tools), and collecting competent healthcare workers as well as a laboratory.

Next, “detection” involves the development of an early warning system for epidemics such as acute watery diarrhoea, measles, and others using laboratory confirmation, or clinical diagnosis as well as epidemiology to assess if the statistical analysis of the cases meets outbreak standards. “Response” involves confirming the diagnosis, formulating a hypothesis for the source, pathogen, and method of transmission, writing an investigation report, and ultimately, controlling the event by treatment, but moreover, prevention specific to the disease.

Lastly, “evaluation” involves changing public health policies as needed, writing an outbreak report, and assessing the previous steps in detail in terms of success and appropriateness.

• Author is a Research Scholar at Jamia Millia Islamia, New Delhi. He can be reached at: [email protected]

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