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Public Health

Covid19, Pandemics, Public Health & Anthropology

A cultural interventionist perspective by Bhaskara Venkatesh

Social scientists, anthropologists, in particular, have for some time been recognized as potentially important players in emergency public health efforts, particularly in outbreak response. In 1996, Paul Farmer called for a ‘critical anthropology of emerging infections’—a new field that could identify the social, economic and political factors underpinning health emergencies and thus positively shape the course of health interventions. In the years that followed, Farmer’s call was met by a contingent of researchers eager to use anthropological skills to support outbreak response.

Public health hazards like epidemics or even pandemics have scale and it cut across various cultural, social geographies across the globe, like the ongoing pandemic of COVID 19.

Epidemics do have a pattern, which eminates at one cultural/ social setting and spreads across. In the past 5 decades the world has witnessed and suffered from, Ebola (since 1976 on and off) Sars (2003) H1NI/Swine flu (2009), Zika (2015) and now COVID19 (2019).

Human history has a list of pandemics, with varying fatalities mostly viral in nature with some bacterial pandemics such as Plague being an exception.

Viral pandemics are predominantly “zoonotic” in nature which is inter-species, as human interactions with animals led to transmissions of the virus from animals to humans leading to large breakouts of the epidemic, like H1N1 from birds, COVID19, (pangolins/ bats), Sars (pigs), Ebola (bats).

Why Anthropology?

‘Anthropology is the study of what makes us human.’ Anthropology studies differences in humans (and other primates) through space and time. All humans share the same fundamentals of genetics, physiology, and neurology. Similarly, they share the same basic needs for food, shelter, security, reproduction and social expression. However, the environments, mechanisms, and interactions that humans use to meet their needs vary widely and manifest in surprisingly diverse social, ecological and epigenetic differences among and between individuals and populations. Anthropology starts from these shared fundamentals to examine diversity and variation.

Anthropology encompasses many different subfields, from primatology to museum anthropology. What they have in common is the emphasis on understanding human social and biological variation through a holistic, that is to say multifactorial, perspective: accounting for the influences of history and people’s natural, social and built environments, because of this holistic approach, anthropologists’ subject matter (if not their methods) may overlap with history, economics, sociology, psychology and, increasingly, the health professions.

Given the central importance of social practices in public health emergency (eg, health and hygiene behaviors), emergency responders will most frequently encounter sociocultural anthropologists, who study human social variation: differences in human behaviors, customs, values and outlooks?

There exists an academic debate public health continues to be dominated by a biomedical approach to health. In public health, infectious disease management is a high-priority area due to a large number of existing and emerging infectious diseases, such as malaria, measles, diarrheal diseases, tuberculosis, Ebola, Zika, Nipah, etc. All of these poses numerous and complex challenges in detecting and managing them. Anthropological interventions in disease management during outbreaks have proven significantly effective especially to manage epidemics of the social scale.

In recent decades, Anthropology along with other social sciences like psychology, sociology, social statistics, have effectively intervened in controlling infectious diseases like HIV / AIDS and the management of Tuberculosis through DOTS.

In the current COVID-19 crisis, epidemiologists and other health experts are working tirelessly to understand the scale of the problem and to help develop strategies to mitigate risks associated with it.

Anthropological social interventions such as social distancing, rigorous social communication of personal hygiene, generating awareness across various segments to prevent the spread is considered and proven effective in mitigating the spread of COVID-19 and reducing the risk of the scale and pressure on health institutions during the outbreak and further on.

It is imperative to focus on inter disciplinary collaboration and approaches involving epidemiologists, social, behavioral scientists and other disciplines in designing innovative, culturally sensitive and precise public health interventions to respond to crises and also enable us to be better prepared for such public health emergencies in future.

About the author

Bhaskara Venkatesh is a master’s in Anthropology and works as a senior manager with the technology industry.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873540/

https://science.thewire.in/health/how-the-social-and-behavioural-sciences-can- help-us-beat-the-pandemic/

Categories
Public Health

Is the lockdown working for India in its fight against #Covid19

Well yesterday on a rare occasion when I met one of my neighbors, we had a small discussion on the lockdown. My neighbor was of the opinion that the lockdown was hurting India more than Covid19 itself. He went on to say that daily wage laborer which is most of the rural and unorganized sectors were given no warning and now will drop into extreme poverty.

His arguments jarred me at that instant. As a doctor, I had taken an oath to save lives and this is not an ideal discussion, saving lives is a priority and economics of survival is slightly outside the scope of the Hippocratic Oath.

As we near the 21 days of lockdown, the government of India has released the statistics of the lock down. According to the reports the numbers, we seem to be doing well because of the lockdown.

“If India had not implemented either containment or nationwide #lockdown – case growth by 41%, 8.2 lakh #COVID2019 cases by Apr 15″

– statistical analysis by the Ministry of Health and Family Welfare, Government of India

The government figures give 3 scenarios

  1. No containment or lockdown- 820,000 cases of Covid19
  2. Containment but no lockdown- 120,000 Cases of Covid19
  3. The current number of cases -7,447
(Ministry of Health and Family Welfare Government of India)

Clearly it is evident that according to the government the Lockdown and Containment have worked. But a lot has to be seen how we ride out of this storm.

I always believe that India like Abhimanyu from Maharashtra, Knows how to get into the Chakravyuh, now the question is unlike Abhimanyu who failed to find his way out and meet his doom, would India navigate successfully out of this Covid19 Chakravyuh?

Only time shall tell…..

Categories
Public Health

COVID19 Vaccine: Where do we stand

(The following is a guest post by Dr Sumeet Kad)

As countries are implementing extreme measures to arrest the growing concerns due to COVID-19, all eyes are collectively hoping for an elixir – a viable vaccine. Various research organizations, government institutions, academia and pharma giants across the globe are working and collaborating at an unprecedented pace to formulate a vaccine. According to the World Health Organization (WHO), there are already two clinical trials underway and more than 60 vaccine candidates in pre-clinical evaluation.  On average, 10.7 years are taken from the pre-clinical stage for the vaccine to be developed. A vaccine for the EBOLA virus was released after 5 years. However, analysts are being Panglossian and expect a vaccine to be available in early-mid 2021. To augment the fight against coronavirus, innovative regulatory mechanisms, enhanced manufacturing processes, and new technologies platforms have come to the forefront. Many countries are adopting several initiatives in their quest for a cure or vaccine.

mRNA Vaccine

Pfizer is partnering with BioNtech for utilizing mRNA (messenger RNA) technology to develop the vaccine. This vaccine is expected to go for human trials in April. The mRNA technology platform is widely used for finding a cure of infectious diseases due to the low cost involved in production and its better safety profile. Sanofi has also undertaken mRNA vaccine research and hope to begin the clinical testing by end of this year.

Indian organizations such as Pune-based Serum Institute of India, largest vaccine manufacturer in the world, is collaborating with two American companies to develop a covid19 vaccine. Over 20 research institutes in India are working overnight to develop coronavirus vaccine.

Blood Plasma Therapy

The underlying principle behind the blood plasma therapy is that the blood of a cured COVID-19 patient would have developed certain antibodies that can help a severely ill patient combat the virus and help in recovery. The same therapy has been successfully implemented for treatment of other infectious diseases in past such as SARS, MERS and HINI. ICMR (India Council of Medical Research) considers this as a viable option of treatment in the absence of a vaccine and could try it out in few states in India. Maharashtra, Delhi, Tamil Nadu and Kerala are waiting for Government’s nod to conduct convalescent plasma therapy trials on patients.

There have been few studies in China and US highlighting that few COVID patients have recovered using this therapy.

Anti-malarial and Anti-viral Drugs

Although there is no robust study which substantiates the effectiveness of the anti-malarial drug- Hydroxychloroquine (HCQ) to fight of coronavirus, many countries are vouching its use. India is the biggest producer of this drug and has agreed to export it to US, Israel and other countries in need. The potential usage of this drug against COVID-19 is under investigation in numerous trials. If proven effective, then this could a potential savior as the drug is cheap and can me made easily available where required. ICMR in India has recommended HCQ for asymptomatic healthcare workers involved in the care of suspected or confirmed cases of Covid-19.

Clinical trials are also in motion to check the efficacy and safety of an influenza anti-viral drug -favipiravir for Coronavirus patients. It is widely produced by Japanese drug-maker Fujifilm.

Protein & Vitamin Supplements

Sesderma, a Spanish firm has claimed to successfully treat 75 COVID19 patients in Spain with its immune-strengthening supplemental drug. The company plans to work with ICMR in India for further clinical trials and is successful, this drug could be potential solution to end the pandemic.

Clearly, swift work is being carried out to speed up the process to discover a potential solution that could end this crisis. The challenges for developing a vaccine are multifold but human resolve has been able to overcome massive hurdles in the past. It’s a matter of time and till then the entire human race is hoping for the miraculous Covid19 killer.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care.

Categories
Mental Health

Managing your mental health and wellness during Covid 19

(This is a guest post by Dr Kiran Manduv)

People around the world are experiencing a pandemic for the first time in 2 or 3 generations. In addition to the rapid spread of the virus, the daily increasing numbers of deaths has triggered anxiety among a lot of people worried about their own safety and that of their families. That is doubly so, if any of their loved ones are under quarantine, or worse develop a medical problem.

Access to medical care is becoming difficult as most hospitals have stopped non emergency medical care. The risk of picking up the virus if people visit a hospital is stopping many from seeking urgent medical care unless it becomes unavoidable due to the severity. Add to this, the exponential spread and relative ease with which the virus is affecting large number of people in the community, has led to large scale panic. The critical shortage of masks and hand sanitizers is a problem faced not only by the general public but also the medical community.

The virus can spread between people even before they start showing symptoms and this has led to a degree of uncertainty among all, as no one can be sure whether they are already infected and might start showing symptoms in the next few days. The huge numbers of the toll taken by the virus many advanced countries is having a numbing effect on people who wonder what they will do if the same thing happens in their neighbourhood or the local community.

Whole cities and countries are under lockdown. Being unable to travel and worrying about loved ones stuck in distant places obviously leads to anxiety.  Loss of earning capabilities for daily wage labourers and for private ventures are the other consequences that we are seeing.  Disruption of supply chains, global economies coming to a standstill and crashing of the markets have led many prominent economists to declare the advent of recession that is supposed to be worse than the 2008 global financial crisis. So feeling helpless is natural in the face of it all.

Here I will list down a few of the things that people can do to in their homes to try to proactively cope with the unprecedented situation. One of the most important things one could do is to cut down on the smart phone usage. This will benefit the person who manages to do this admittedly difficult task. It allows us to stay away from the barrage of bad news coming from all over the world, most of which we cannot do anything to help. This advice is particularly relevant to the children, who out of boredom, might take to excessive usage of the smart phone, which will have a deleterious impact on their future psychological development.

At the same time, one must make sure to be updated with the basic recommendations to stay protected and also keep track of the progression of the virus in ones locality, as regular updates are being released by the government in this regard. Here are three activities that would be helpful

  • Physical exercise is one of the most important things to do. It can elevate the mood, relieve anxiety and fatigue and lift a person out of the morose feeling that many are experiencing stuck in their houses. Any exercise is good but aerobic exercise is especially advised, if possible. Using a treadmill, jogging in the house are some of the options. Most importantly, physical exercise also acts as an immune booster and we need all the immunity we can get in these dangerous times.
  • Anxiety and depression can be staved off by simple home based activities. Yoga and meditation is highly recommended but may be difficult for the uninitiated. Such people can start with simple postures like the Surya Namaskaar etc.
  • Breathing exercises are particularly effective. Even short periods of practice of breathing exercises will have disproportionate benefits. The most effective types are such simple practices including Anulom-Vilom, Bhastrika and Kapalbhati. More patient practitioners can try mindfulness based meditations. These are widely available on platforms like YouTube etc. It is pertinent to note that, just like with physical exercise, breathing exercises and relief from anxiety also have a positive impact on the immunity. Getting adequate sunlight has well proven benefits too, in this regard.

There are also unexpected benefits from the lockdown. People can now spend more time with their families and can give quality time to their spouses and their children. Catching up on old TV classics like the Ramayana, Mahabharata and Chanakya can be an enjoyable together- time for the family and essential cultural education for the millennials. Interpersonal interaction with family and friends has its own intrinsic therapeutic potential and catching up with relatives and friends by phone can help in re establishing old neglected ties and also lead to a sense of oneness in the extended family and the local community that we’re all in this together and can get courage and reassurance from each other.

One should also try to make the best use of the time to catch up on long neglected hobbies, practice of the arts and intellectual pursuits like reading, writing and any special projects like that we all have planned but never find the time to do. One can enrol oneself in online courses that have been made free by many MOOC providers and upskill themselves and be job-market-ready once the lockdown is over. Gardening is an especially rewarding activity as it promotes both physical and psychological well being.

Some people are also disturbed because of the sudden lack of access to cigarettes and alcohol. This is a valid concern for people used to daily consumption of these substances.  Instead of worrying about availability and going out to find these substances, this lockdown can be viewed as a good opportunity to quit these harmful substances.  Having some anxiety and sleep disturbances after quitting alcohol is common and can be dealt with by taking mild sedatives (which are prescription drugs and can be obtained only on the advice of a doctor).

More severe withdrawal symptoms will result in withdrawal seizures and delirium which cannot be managed at home and will need the attention of a medical doctor, preferably a psychiatrist.  Intense craving for nicotine after running out of cigarettes is common. Paradoxically, accepting that there is no availability of cigarettes and deciding to quit smoking itself will result in a significant reduction of craving. Craving can also be reduced by taking tobacco chewing gums that are available in pharmacies over the counter.

Taking a counter viewpoint, it is a God-send opportunity for many who want to quit smoking, but the intense craving for cigarettes and the easy availability in daily life (when there is no lockdown) prevents them from quitting as they befool themselves that they will smoke ‘for just one more day and quit the next day’. The lockdown and the close monitoring of their loved ones in the family, who re also restricted to their homes during the lockdown can enable a person to make a serious attempt at quitting smoking.

Finally, one should realize that there are many whose livelihoods and the usual sources of income are disrupted badly due to the lockdown. The domestic help, the daily wage laborer could do with a bit of a helping hand. Giving them their complete monthly salary for the period of the lockdown is something that a lot of us can afford to do. Participating in the local residential committee’s meetings to take care of the small things to ensure the continuity of basic services and the protection of the community will ensure that one has a sense of purpose and oneness during these days. With patience, courage, and togetherness, we can tide over this crisis.

About the author

Dr Kiran Manduva did his MBBS in 2001 and studied Psychiatry from NIMHANS in 2005. He is interested in deaddiction, psychotherapy for victims of sexual abuse and neuroscience. He is especially interested in novel public health approaches to make psychiatric care accessible to all.

Categories
Public Health

Covid19 – India Fights Back: An Analysis

The following is a guest post by Sanjeev Prakash

Since my last update, India’s positive cases have almost grown three fold. This, in a period of five days. Although, the spurt has been attributed to a gathering in Delhi, there are some interesting facts that come to light.

Testing vs Positive Rate

There have been a lot of comments on the testing rate and the fact that India has done less tests when compared to the population. That’s true, when compared to all the other countries that are reporting a high number of cases India has tested less.(See Table Below)

The interesting fact arises when we look at the percentage of positive cases w.r.t tests. India’s positive% is the second lowest and almost comparable to South Korea. All the other countries are in excess of 10%, even Germany that has tested extensively.

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This could lead to two possible interpretations with respect to India

  1. The virus is not virulent enough in India or we are showing a better immunity due to vaccinations, environment etc. 

There are various theories about this

  • That the BCG vaccination strategy in India has led to greater immunity in India
  • That the strains of virus in India are not as virulent as those in Europe and the US
  • That the hotter weather in India has slowed the progress of the virus

Each of these theories are just that, theories. There is a call from experts asking that these theories not be used to make generalizations, they need to be scientifically tested. Before we sink into a sense of complacency and let our guards down.

2. We are not testing the right people

I am tilting towards the first interpretation. The second interpretation according to me does not hold true because now India has also started testing asymptomatic contacts of positive patients

Effect of the Delhi Religious Event

Looking at the daily growth rates of Indian Cases till day 16 (after reaching 100 cases) India was showing a downward trend. Day 17 (31st March 2020) was the day when cases from the religious events started flashing across the country. This has resulted in the trend being reversed and it’s now showing a slightly upward linear trend.(See Graph “Daily Growth rate….”) Thankfully, the exponential trend curve is still flat.

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If we look at the speed at which a country doubles its cases after 100 cases, India has reached almost the average speed of the other countries. India took 3 days to move from 1600 cases to 3200 cases which is the average days taken for the other 7 countries that are part of this study. (See Graph – Days for below)

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Predicted Number for 15th 

If the daily growth rate does not slow down in the next few days, we are looking at around 56K cases by the end of the lock-down. This takes in account an average daily growth rate of 29% for the next 11 days.

As of today morning my model is correctly predicting the incidence for Italy, Iran, Korea, Spain and Germany. I have taken an allowable limit of +-1% error rate. India’s daily growth rate slowed down a bit yesterday hence the high positive error. (See table below )

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Countries with the strictest quarantine strategies have fared better in dealing with the crisis. 

“Social distancing was the key in reversing the outbreak in Wuhan and the wider Hubei region. The earlier a lockdown is put in place in the epicentre of an outbreak, the smaller it ends up being.” (https://www.thehindu.com/news/cities/chennai/a-look-into-key-aspects-of-virus-pandemic/article31201598.ece)

This shall probably help in India’s fight against the pandemic, too.

We can probably conclude looking at the data above that besides the blip due to the religious gathering in Delhi, India seems to have things in control. The factors behind this may be the proactiveness of the administration, the Indian climate,  vaccinations, genetics or something else, we shall only know in the days to come. 

About the Author

Sanjeev Prakash is an Analytics and Marketing professional with more than 12 years of experience in Analytics, Data Management, Sales, Brand Management, Corporate Communications, Market Research and Customer Relationship Management. Sanjeev has an MBA from IMT Ghaziabad and a degree in economics.

(Article also published on LinkedIn : https://www.linkedin.com/pulse/covid19-india-fights-back-sanjeev-prakash/?trackingId=D3q6XmsjQ%2B%2BWS1bIqQe8ow%3D%3D)