**4. Basic requirements for controlling an epidemic in an area**

#### **4.1 Strengthening of inadequate Public Health System**

Public Health is defined as a combined system of science & art of preventing diseases, promoting health and protecting lives in a defined geographic area through organised community based efforts. Primary health care is the backbone of public health. Primary health care is an essential health care that should be made available, accessible, acceptable and at a cost that every citizen of the country can afford. Primary health care is based on four principles – Equitable Distribution, Multi-sectoral Approach, Inter-sectoral Coordination and Appropriate Technology. This means resources for improvement of public health infrastructure need to be provided as per felt need of that area; underdeveloped area should receive more resources. In countries with weak public health infrastructure such as India, Bangladesh, Pakistan, Nepal, several African countries among others need their public health strengthened. This means increase of trained human resources (doctors, nurses, public health experts, field workers, etc.), construction of health establishments as per requirements, adequate supply of logistics, storage and transport facilities of vaccines maintaining appropriate temperature, strengthening of immunisation services, strengthening of maternal & child health services, improvement of malnutrition scenario, control of communicable and non-communicable diseases, improvement water and sanitation services etc. Improving all of the above together require an abundance of resources and appropriate planning for judicious usage. Most of the above mentioned countries are not in a position to afford them. Moreover, strong political will appears to be the most important determinant for the said improvement apart from having the resources. Mass awareness is another important issue that helps in generation of demand. Without demand generation by public, things do not move in right direction. A number of social activists, NGOs etc. work to mobilise people to be aware, understand their own needs and generate their demand. Policy makers of the country must be aware of major public health problems of the country so that they can prioritise while developing an appropriate policy for right place at right time. One wrong public health decision will incur heavy cost that the country could have had avoided altogether. Similarly, if an important public health decision is delayed particularly during a public health emergency situation, consequences are increased morbidity & mortality along with other indirect consequences such as loss of job, loss of economy as is being observed in recent COVID 19 epidemic.

#### **4.2 Epidemic preparedness for control of epidemic**

#### *4.2.1 Epidemic preparedness team*

An epidemic preparedness team comprising an experienced epidemiologist as the chairman, a clinician and a microbiologist as members, is needed to be formed to review the situation of their designated area at regular interval. They need to assess the situation of different regions (based on previous years' situation), the logistic supports needed by them and the services that are necessary for prevention & control of epidemics round the year. They ought to be responsible for arranging necessary training

*Control of an Epidemic of SARS-CoV-2 by Assessing Transmissibility of Its Infected Cases... DOI: http://dx.doi.org/10.5772/intechopen.96201*

of subordinate staff that will be required for epidemic control. They should develop a set of guidelines/standard operating procedure including dos and don'ts for use by the health workers while dealing with an epidemic. They are also to be responsible for taking necessary measures for tackling any emerging and re-emerging epidemics well in advance such as establishing an effective surveillance system for early detection, creation of a reliable diagnostic services, constructing temporary shelters for emergency evacuation of affected population during public health emergency if needed etc.

#### *4.2.2 Integrated Disease Surveillance Programme*

Integrated Disease Surveillance Programme (IDSP) is an important activity for early detection of an epidemic. Surveillance is defined as the process of continuous collection of required information for necessary action such as prevention & control of diseases. Diseases under surveillance are usually classified into groups. Group A comprises diseases where immediate action is needed (within 24 hour), Group B diseases are less severe where necessary actions are taken usually within a week while Group C are diseases where actions are needed to be taken usually within a month. Continuous collection of information on occurrence of various cases from the entire area are sent promptly at the IDSP office to cover the designated geographical area. Based on the reported case/s from a particular area, necessary actions need to be taken by the designated staff as per need of the situation. This is to be done continuously 24-hour x 7 days, round the year to enable early detection of epidemic with necessary intervention. With the advent of newer technology, surveillance can be strengthened further with the help of drones, mobile phone based applications, electronic communication system etc. to collect information from the remote areas.

### *4.2.3 Regular analysis of data with epidemiological interpretation to assess the situation*

Regular analysis of data with epidemiological interpretation is an essential component for early detection of epidemic in an area. Various soft wares are available and used for this purpose such as SPSS, Strata, Epi Info etc. If there is an evidence of existence of epidemic prone case(s) with tendency to increase compared to occurrence of them earlier, it must be brought to notice of IDSP authority/Epidemic Preparedness Team for immediate action/control measures. An all-time functional alert system needs to be generated to alert the authority whenever such a situation arises. This will help detect an epidemic at its early stage. Since timely intervention can reduce the damaging effect of an epidemic to a great extent, detection of an epidemic at its early onset is of utmost importance.

### *4.2.4 Early and prompt action for containment of epidemic immediately on detection*

On receiving information, the epidemic investigation team must move to the spot immediately to verify the existence and magnitude of problem. Steps are needed initially towards controlling epidemic with verification of diagnosis and confirmation of epidemic. Diagnosis may be confirmed by isolating organism from the biological samples collected from the few cases from the affected area. If necessary, required assistance from a nearby laboratory may be sought for isolation of organism and confirmation of diagnosis with the help of microbiologist/virologist present in the epidemic investigation team. Confirmation of epidemic is done by comparing data of present situation with that of previous years. If it is clearly in

excess (>2 standard Deviation of average number of cases of previous 3 years), epidemic is confirmed. Once epidemic is confirmed, rapid searching of cases is needed by house to house visit through health workers for further management. While visiting houses and identifying cases, relevant information is collected using a relevant questionnaire to assess the possible source of infection. Once the source(s) are identified, every attempt is to be made to break the chain of transmission, so that epidemic starts to subside. Searching of more number of cases should continue in the community till cases cease to occur. Whenever new cases are identified, they need referral to appropriate health centre for further management. Disposal of infectious material must be taken care of to avoid further spread.

### *4.2.5 Development of suitable strategy based on felt needs*

An important action is making the community aware about the disease, its prevention measures, dos and don'ts, etc. Handling the media is an important aspect since rumours about the disease cause unnecessary panic. Epidemic team members will remain at the spot till epidemic subsides with regular communication to their coordination centre and higher management authority for necessary guidance and support.
