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A walk in the Park

This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

Facebook: http://www.facebook.com/pages/Community-Medicine-for-ALL/429533760433198  

[Alternatively, you may join the group communitymedicine4ALL: 

http://www.facebook.com/groups/456698611060927/%5D

Twitter: @DocRoopesh

A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at commed4all@gmail.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

Note 1. Those who wish to contact me on facebook are requested to kindly send a personal message introducing themselves along with the request. This will help save time and effort of all concerned. Please do not expect me to visit your page to try and identify you/ your areas of work/ interest, etc. It is common courtesy to introduce oneself to another when interacting for the first time. I am merely requesting that the same civil courtesy be extended here, too. Henceforth, I may not accept any friend requests/ requests to join the group on facebook unless accompanied by a note of introduction (except when I already know the sender).  

Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

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Non-Pharmacological Interventions for Pandemic Mitigation: What you should know (Part 1)

Introduction

In the previous article, I discussed some aspects of pandemic containment and mitigation. This is the first article in a series that will discuss various non-pharmacological interventions for pandemic mitigation.

Non-pharmacological interventions (NPIs) include all measures or actions, other than the use of vaccines or medicines, that can be implemented to slow the spread of pandemic in a population.

In the early stage of viral epidemics and pandemics, NPIs are often the most accessible interventions, because of the time it takes to make specific vaccines available and because most locations do not have large stockpiles of antiviral drugs. Therefore, these mitigation measures will play a major role in reducing transmission in community settings. They are the only set of pandemic countermeasures that are readily available at all times and in all countries. The NPIs that will be discussed in this series include (not necessarily in this order):

  1. Hand hygiene
  2. Respiratory etiquette
  3. Face masks for symptomatic persons
  4. Isolation of sick individuals
  5. Travel advice
  6. Contact tracing
  7. Quarantine of exposed individuals
  8. Surface and object cleaning
  9. School measures and closures
  10. Face masks for public
  11. Avoiding crowding
  12. Internal travel restrictions
  13. Border closure
  14. Entry and exit screening
  15. Workplace measures and closures
  16. Lockdown  

Most of the strategies and interventions in use against COVID-19 were developed to deal with influenza epidemics and pandemics. In many respects, the current COVID-19 pandemic is similar to an influenza pandemic:

  • It is caused by a new variant of an existing virus (similar to antigenic shift in influenza viruses).
  • Disease transmission is mainly through contact (direct/ indirect), respiratory droplets/ droplet nuclei, with airborne (aerosol) transmission also suspected.
  • There is no vaccine against the disease at present (similar to the initial months in an influenza pandemic).
  • The population is susceptible to disease, and there is no innate immunity against the disease.

Despite the above, one cannot equate the COVID-19 pandemic with an influenza pandemic, as there are several differences between the two. Moreover, there are several gaps in our knowledge about COVID-19 and SARS-CoV-2 which preclude a comparison between the two viruses/diseases.

Nevertheless, we can examine the evidence for and against each NPI in the context of an influenza pandemic, and obtain a broad understanding of the possible usefulness of each NPI in COVID-19 pandemic mitigation.

It is important to note that even in the context of an influenza pandemic, the evidence base for NPIs is not very extensive or robust. Due to this one has to often make recommendations based on plausibility, reasoning and logic rather than scientific evidence.

The findings and recommendations presented in this article are mainly drawn from a 2019 World Health Organization publication: ‘Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza’. The document was prepared by a Guideline Development Group that undertook systematic reviews to evaluate the evidence. The strength of recommendations were classified as:

  • Recommended- the group is confident that the desirable effects outweigh the undesirable results
  • Conditionally recommended- the group believes that the balance between benefits and harms is uncertain, and some conditions should apply when implementing the recommendation
  • Not recommended- the group is confident that the disadvantages outweigh the advantages