Dr Mukesh Poudel
Epidemics of emerging and re-emerging infectious disease result in devastating health, social and economic consequences. The evolution of new infections that emerge often without warning from the natural environment keeps us on a continuous threat. The remarkable progress towards the development of new vaccines, antibiotics and other treatments and technologies, once made experts speculate "the time to close the book on the problem of infectious diseases". But, Since 2009 there have been six PHEIC declarations: the 2009 H1N1 (or swine flu) pandemic, the 2014 polio declaration, the 2014 outbreak of Ebola in Western Africa, the 2015–16 Zika virus epidemic, the 2018–20 Kivu Ebola epidemic, and the 2019–20 novel corona virus outbreak which reminds world of a degree to which people remain vulnerable to infectious diseases, known and unknown. The recent outbreak of novel corona virus - 2019 in Wuhan city, Hubei province of china that has been declared a global pandemic on 11th march is a great alarm this year on the fact that epidemics may arise at any time with unexpected magnitude and can spread faster and further than before becoming global very rapidly.
Nepal is highly vulnerable to natural disasters such as extreme droughts, floods, landslides, fires, and epidemics that affect the nation annually. The massive earthquake of 7.8 MW magnitude hit Nepal in 2015 making hundreds of thousands homeless and resulting in more than eight thousand lost lives. But the earthquake of the same magnitude, the same year, in Japan resulted in zero deaths and earthquake of 8.3MW magnitude in Chile resulted in only 15 deaths. This suggests that despite, a disaster of high magnitude, the massive casualty could be prevented by early preparedness plan, mitigation of risks and reduction of vulnerability towards the hazard.
Last year only, a dengue outbreak in Dharan flared up and went beyond the control with cases increasing day by day. The failing attempt of containment of cases led to a spread of disease at an alarming rate. The clouds of insecticide fuming in the cities were not being able to control the vectors and spread of disease. Later, the disease crossed the borders and cases were being notified from various regions all over Nepal. The Facebook pages were flooded with information and education about dengue, its preventive measures and vectors for the disease. Flashing news on an increasing number of cases were sorrowful and even more frustrating was the failing attempt and actions towards the control of disease and its transmission. The good part was that the fatality due to the disease was very low, thanks to the Lord Pashupatinath!! Future ahead, if another strain of dengue circulates and infects the previously infected individual it will lead to a major catastrophe. It may be obvious because the person infected before will be exposed to vector (Aedes mosquito) later this year too due to the unchanged environmental conditions that favour vector breeding. There is an urgent need of action taken towards it very soon as the favourable season for vector breeding is on its way and we can't stop it. But what we can do is prepare for the possible epidemic and prior action targeting the integrated vector control.
The news of outbreaks of diarrhea in different areas of Nepal that flashes in the news portal of Epidemiology and disease control website is very woeful in this modern century which shows the level of sanitation and hygiene we are in and the vast need of improvement required. Scrub Typhus once considered an exotic disease in 2016 infected more than 300 people in 2019 and was reported from as many as 20 districts. With so many identified cases Scrub typhus was still considered one of the most under-reported and misdiagnosed febrile illnesses. Lack of effective diagnostics for early detection of a new disease, health workforce, preparedness and our unhygienic behaviors increases the transmissibility of the disease and poses a continuous risk of an epidemic.
These were the past experiences of our preparedness and action towards the epidemic. This year is also not safe from infectious diseases. Many infections may be harbouring in nature within the country and we need to prepare for the import of new infections not prevalent in the country as we have announced a visit Nepal 2020 and are excited to welcome a big mass of tourists from all over the globe. The illnesses like Influenza, Kalazar, Malaria, Dengue, Severe acute respiratory infections, Acute Gastroenteritis pose a continuous threat of epidemic and some new infections may cross borders of Nepal in 2020 like novel Corona virus, Zika virus, Chikungunya virus which has caused epidemic before in many other countries. The risk of Zika virus and Chikungunya is even more as we have the abundance of vectors (Aedes mosquito). The unpredictable power of nature may give us a new challenge at any point in time.
Health has always become a priority from ancient time and the quest for health will always remain a great challenge. Talking about epidemics and disaster all we can do is the mitigation of risk factors, preparedness and planning a way forward. The potential risk or consequence of epidemic and disaster is directly proportional to the magnitude of hazard and vulnerability of the population while inversely proportional to the capacity to face the situation. The magnitude of hazard may be unpredictable and we are not able to take control over that but we can reduce the vulnerability and increase the capacity to reduce the consequence of the impact that may occur. We can reduce vulnerability by maintaining a good sanitary environment, hygiene, mitigation of risk factors and we can increase the capacity by effective risk communication, early detection facilities, building health workforce, and effective response for proper management. We should come up with vigorous ideas before the occurrence of the epidemics to cope with its effect. It wasn’t raining when Noah built the ark that is why we should take action before the occurrence of the epidemic to minimize its occurrence and in case if it occurs, to facilitate early response and reduce the consequence.
-(Dr Poudel is Consultant Doctor at Ministry of Social Development, Bagmati Province)
