Pandemics and Epidemics Explained

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Context: According to the latest assessment of the World Health Organisation (WHO), COVID-19 can be characterized as a pandemic now. According to the WHO, a pandemic is declared when a new disease for which people do not have immunity spreads around the world beyond expectations. On the other hand, an epidemic is a large outbreak, one that spreads among a population or region. It is less severe than pandemic due to a limited area of spread.

Relevance:
Prelims: Current events of national and international importance.
Mains: GS II-

  • Issues relating to the development and management of Social Sector/Services relating to Health, Education, Human Resources.

Introduction
  • The coronavirus outbreak that began late last year in China has now spread to 29 countries, touching every continent except South America and Antarctica.
  • While most of these cases are still in China, the virus is gaining a foothold in other countries, raising fears that the world is on the brink of a pandemic.
  • All pandemics start with an outbreak of a new disease in a specific geographic location. If that outbreak becomes larger, but still remains confined to a specific region, it becomes an epidemic.
  • At that point, the WHO may declare a public health emergency of international concern to raise awareness about it.
  • But once a disease spreads globally, with multiple epidemics across different continents, it truly becomes a pandemic.
Pandemic
  • A pandemic is an epidemic of disease that has spread across a large region; for instance multiple continents, or worldwide.
  • A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic.
  • Further, flu pandemics generally exclude recurrences of seasonal flu.
  • Throughout history, there have been a number of pandemics, such as smallpox and tuberculosis. One of the most devastating pandemics was the Black Death, which killed an estimated 75–200 million people in the 14th century.
  • The only current pandemic is HIV/AIDS, which started in the 1980s. Other recent pandemics are the 1918 influenza pandemic (Spanish flu) and the 2009 flu pandemic (H1N1).
Phases of Disease Outbreaks
  • In the grand scheme of things, a pandemic is the highest possible level of disease or a measure of how many people have gotten sick from a particular disease and how far it has spread, but before a common illness reaches pandemic proportions, it has to exceed a few other levels, according to the Centers for Disease Control and Prevention (CDC):
    • Sporadic:
      • When a disease occurs infrequently and irregularly.
    • Endemic:
      • A constant presence and/or usual prevalence of a disease or infection within a geographic area. (Hyperendemic, is a situation in which there are persistent, high levels of disease occurrence.)
    • Epidemic:
      • A sudden increase in the number of cases of the disease—more than what’s typically expected for the population in that area.
    • Pandemic:
      • An epidemic that has spread over several countries or continents, affecting a large number of people.
  • Example:
    • When Coronavirus was limited to Wuhan, it was an outbreak. It became an epidemic when it spread across China. It is now a pandemic as it spreads worldwide.

Biggest Pandemics
  • There have been a number of significant epidemics and pandemics recorded in human history, generally, zoonoses which came about with the domestication of animals, such as influenza and tuberculosis.
  • There have been a number of particularly significant epidemics that deserve mention above the “mere” destruction of cities:
    • Plague of Athens, from 430 to 426 BC:
      • During the Peloponnesian War, typhoid fever killed a quarter of the Athenian troops and a quarter of the population over four years.
      • This disease fatally weakened the dominance of Athens, but the sheer virulence of the disease prevented its wider spread; i.e. it killed off its hosts at a rate faster than they could spread it.
      • The exact cause of the plague was unknown for many years.
    • Antonine Plague, from 165 to 180 AD:
      • Possibly smallpox brought to the Italian peninsula by soldiers returning from the Near East; it killed a quarter of those infected and up to five million in all.
    • The plague of Justinian, from 541 to 750:
      • It was the first recorded outbreak of the bubonic plague. It started in Egypt, and reached Constantinople the following spring, killing (according to the Byzantine chronicler Procopius) 10,000 a day at its height, and perhaps 40% of the city’s inhabitants.
    • Black Death, from 1331 to 1353:
      • The total number of deaths worldwide is estimated at 75 million people. Eight hundred years after the last outbreak, the plague returned to Europe.
      • Starting in Asia, the disease reached the Mediterranean and western Europe in 1348 and killed an estimated 20 to 30 million Europeans in six years; a third of the total population, and up to a half in the worst-affected urban areas.
      • It was the first of a cycle of European plague epidemics that continued until the 18th century.
    • Spanish flu, from 1918 to 1920:
      • It infected 500 million people around the world, including people on remote Pacific islands and in the Arctic, and resulted in the deaths of 50 to 100 million people.
      • Most influenza outbreaks disproportionately kill the very young and the very old, with higher survival rates for those in between, but the Spanish flu had an unusually high mortality rate for young adults.
      • Spanish flu killed more people than World War I did and it killed more people in 25 weeks than AIDS did in its first 25 years.
      • Mass troop movements and close quarters during World War I caused it to spread and mutate faster; the susceptibility of soldiers to Spanish flu might have been increased due to stress, malnourishment, and chemical attacks. Improved transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease
Phases of Pandemics
  • The World Health Organization (WHO) provides an influenza pandemic alert system, with a scale ranging from Phase 1 (low risk of a flu pandemic) to Phase 6 (a full-blown pandemic):
    • Phase 1:
      • A virus in animals has caused no known infections in humans.
    • Phase 2:
      • An animal flu virus has caused infection in humans.
    • Phase 3:
      • Sporadic cases or small clusters of the disease occur in humans. Human-to-human transmission, if any, is insufficient to cause community-level outbreaks.
    • Phase 4:
      • The risk for a pandemic is greatly increased but not certain.
    • Phase 5:
      • The spread of disease between humans is occurring in more than one country of one WHO region.
    • Phase 6:
      • Community-level outbreaks are in at least one additional country in a different WHO region from phase 5. A global pandemic is underway.
Prevention tips
  • In the event of a pandemic, follow the advice of public health authorities, and the instructions issued in your work environment.
  • Take advantage of the vaccine as soon as it is offered, in order to protect yourself and those close to you, and not contribute to the spread of the disease among the general population.
  • Wash your hands often with soap and water or rub them with an alcohol-based antiseptic gel, foam or liquid.
  • Keep such products out of the reach of children. Also frequently clean your living environment with soap and water or household detergents.
  • Cough and sneeze without contaminating your environment and avoid touching your nose, eyes, and mouth, which are the gateways of the virus in the body.
  • Avoid contact with sick people and their personal items.
  • If you have to take care of a sick person, protect yourself from the secretions, and do not drink water or eat food that had been in contact with this person.
  • Avoid contact with animals that appear sick, and avoid handling animals that are found dead.

Epidemic Diseases Act, 1897

  • Context: 
    • The Centre has asked states and Union Territories to invoke provisions of Section 2 of Epidemic Diseases Act, 1897, so that Health Ministry advisories are enforceable. At present, at least 60 COVID-19 cases have been confirmed in India.
  • About Epidemic Diseases Act of 1897:
    • It is routinely enforced across the country for dealing with outbreaks of diseases such as swine flu, dengue, and cholera.
    • It was introduced by the colonial government to tackle the epidemic of bubonic plague that had spread in the erstwhile Bombay Presidency in the 1890s.
  • Provisions of the 1897 Epidemic Diseases Act:
    • It empowers state governments/UTs to take special measures and formulate regulations for containing the outbreak.
    • It also empowers the state to prescribe such temporary regulations to be observed by the public or by any person or class of persons as it shall deem necessary to prevent the outbreak of such disease or the spread thereof.
    • The state may determine in what manner and by whom any expenses incurred (including compensation if any) shall be defrayed.
    • The State Government may take measures and prescribe regulations for the inspection of persons traveling by railway or otherwise, and the segregation, in hospital, temporary accommodation or otherwise, of persons suspected by the inspecting officer of being infected with any such disease.
    • It also provides penalties for disobeying any regulation or order made under the Act.
    • These are according to section 188 of the Indian Penal Code (disobedience to order duly promulgated by public servant).
    • It also gives legal protection to the implementing officers acting under the Act.
  • Criticism:
    • Historians have criticized the Act for its potential for abuse.
    • Using powers conferred by the Act, colonies authorities would search suspected plague cases in homes and among passengers, with forcible segregations, evacuations, and demolitions of infected places.
    • In 1897, the year the law was enforced, freedom fighter Bal Gangadhar Tilak was punished with 18 months’ rigorous imprisonment after his newspapers Kesari and Mahratta admonished imperial authorities for their handling of the plague epidemic.
  • Examples of implementation:
    • In 2018, the district collector of Gujarat’s Vadodara issued a notification under the Act declaring the Khedkarmsiya village in Waghodia taluka as cholera-affected after 31 persons complained of symptoms of the disease.
    • In 2015, to deal with malaria and dengue in Chandigarh, the Act was implemented and controlling officers were instructed to ensure the issuance of notices and challans of Rs 500 to offenders.
    • In 2009, to tackle the swine flu outbreak in Pune, Section 2 powers were used to open screening centers in civic hospitals across the city, and swine flu was declared a notifiable disease.

 

Public Policy for Handling Pandemics
  • Following the H1N1 pandemic Influenza, the Government of India issued the ‘Clinical management Protocol and Infection Control Guidelines’.
  • But an overarching strategy is needed for handling a pandemic in the Indian context where the responsibilities lie divided between the central, state and local governments.
Case Study 1: Pandemic Interval Framework
  • U.S. Centers for Disease Control and Prevention (CDC) has developed a Pandemic Interval Framework (PIF) to guide executives on the kind of public health action required at various stages of the progression of a pandemic.
  • The six intervals and the action to be taken at each interval is summarized below.

Table: Public Health Action at Different Intervals
Intervals Public Health Actions
Investigation of cases of novel virus infection

  • Targeted monitoring and investigation.
  • Risk assessment of that virus with certain tools.
Recognition of the potential for transmission
  • Focus on control of the outbreak.
  • Treatment of sick persons.
Initiation of a pandemic wave
  • Occurs when people are easily infected with the novel virus
Acceleration of a pandemic wave
  • Focus on the use of appropriate non-pharmaceutical interventions like the closure of schools and social distancing and
  • Use of medications (antivirals) and vaccines.
  • The goal is to reduce the spread of the disease and prevent illness.
Deceleration of a pandemic wave
  • Continued vaccination, monitoring of pandemic virus circulation.
  • Reducing the use of non-pharmaceutical interventions.
Preparation for future pandemic waves
  • Continued monitoring of pandemic virus activity.
  • Preparing for potential additional waves of infection.

 

Case Study 2: How Kerala Handled Nipah Virus Outbreak
  • The Nipah outbreak in Kerala was a serious challenge because of high mortality rates (it killed nearly 70% of those affected during a previous outbreak in Bangladesh), lack of vaccines or specific treatment and Kerala’s relative inexperience in handling virus outbreaks.
  • That the very second case was diagnosed correctly points towards an alert medical community in the state.
  • All contacts were traced, surveillance was carried out by a team of medical officials and district administration and potential cases were isolated.
  • In this way, every single case reported thereafter was traced back to the first case or its related contacts.
  • All contacts of all the cases (around 2000 people) were followed up on a daily basis.
  • All suspected cases were moved to the isolation facility set up at Government Medical College, Kozhikode.
  • An isolation protocol was established. Health personnel was trained and required safety gear was provided.
  • For those infected, anti-viral drugs and life support measures were provided.
  • The state health minister actively supervised these efforts and the outbreak subsided in around five weeks.
  • The deaths were limited to 16.

Case Study 3: China’s use of technology to manage the spread of COVID-19
  • Aggressive use of surveillance technology by the Chinese government aided by technology companies.
  • Tech giants such as Alibaba and Baidu offer Artificial Intelligence (AI) gene sequencing tools.
  • Infrared and facial recognition technology to identify and screen travelers.
  • AI-enabled temperature measurement using thermal cameras.
  • Use of robots and drones to remotely disinfect hospitals, deliver food and enforce quarantine measures.
  • Apps that alert users when they are close to infected areas.
  • Based on ID numbers and travel history, users of various tech platforms are assigned a QR code which instructs them whether they need to be in quarantine or are free to travel.

Conclusion
  • India faces a clear and present danger from the spreading of COVID-19.
  • The central, state and local governments need to synchronize their actions to identify and isolate potential cases as in the case of the Nipah virus outbreak in Kerala.
  • Key institutions must be identified as resource centres and to act as nodal points for contact tracing, testing, communications, and case management. Special focus must be on point of entry screening.
  • The use of technology like the Chinese example, but without the authoritarian measures, will greatly help in the fight against the virus.
  • Further, in the long-term perspective, a well-researched pandemic/epidemic management strategy delineating the roles of different authorities and action points at various stages need to be formulated.



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