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Integrated Infectious Disease Capacity Building – The Way Forward

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Experts from the pharma and healthcare industry deliberated on the prevention of infectious disease and the importance of capacity-building in the second edition of the Healthcare Transformation Summit (HTS).

Giving the opening thoughts on the topic, Dr. Vandana Khare, Joint Director, Health Services, Madhya Pradesh, said, ” Prevention means to improve, preserve and to restore the health and also to minimize the suffering and distress. We can also add to the economic and social condition of India. Preventions are actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The common public should suffer less from the diseases and should not face the disabilities and this will help in balancing the economic condition of the country.”

Elaborating about the successful prevention of disease Khare said, “We need to know the cause behind the diseases. What is the mode of transmission and identify the risk factors and risk groups. In COVID-19 we are analyzing the modality of the disease is due to co-morbidities like diabetes, hypertension, or age. The availability of prophylactic and early detection and treatment measures is vital. Government organizations are working on all these factors and partnering with the other public and private sector. The level of prevention varies — primary, secondary, and tertiary prevention. In primary prevention health promotion and specific protection is necessary this is applied infectious disease like COVID-19 and TB. Secondary Prevention is also the same which includes pre-symptomatic diagnosis and treatment. Primordial prevention is the new terminology that came in after COVID-19 it consists of actions and measures that inhibit the emergence of risk factors in the form of environmental, social, economic, behavioral conditions and cultural patterns of living.”

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“World Health Organisation (WHO) has recommended the following approaches for the primary prevention of chronic diseases which are population (mass) strategy and high – risk strategy if it is related to COVID-19 population mass strategy is directed at the whole population irrespective of individual risk levels and it is also directed towards socio-economic, behavioral and lifestyle changes. COVID-19 has transmitted to every level of the socio-economic group. A high-risk strategy aims to bring preventive care to individuals at special risk and this requires detection of individuals at high risk by the optimum use of clinical methods. Early diagnosis and treatment are a must because it creates complications and patients get dependent and they become lifetime sufferers of the disease. The person who has suffered from COVID is now facing many other disabilities as well. The objective of preventive medicine is to intercept or oppose the cause and thereby the disease process. This permits the inclusion of treatment as one of the modes of intervention,” she added.

Informing that COVID has set the benchmark for all infectious disease control, Dr. T Arun, Secretary, Department of Health & Family Welfare, Government of Puducherry, said, ” The pandemic has opened up all the loopholes in the administration and we are trying to rectify it in a positive manner whether in case of contact tracing, setting up of our laboratories, mopping up our hospital infrastructure. Pre covid in Arunachal Pradesh there were no ventilators in the whole state but now they have few ventilators so that is how each and every state were able to mobilize their own resources and the funding from the central government also increased, the timely funds from NGOs, private companies and CSR helped to improve the healthcare infrastructure.”

“Initially there was only one testing laboratory in India but within the span of five months we have more than one lakh laboratories, the central government could mobilize its resources in terms of testing. As far as mortality rate is concerned our country had the lowest death rate when compared to others. The centre and the state governments have tremendously worked hard. Two percent fidelity is common in many diseases so we should have a multipronged approach involving the health and other sectors. We have to focus on each and every disease in a way that we are focusing on COVID be it malaria, dengue. If the same kind of momentum continues for other diseases be it communicable or noncommunicable we can easily see the changes. What is required is political willpower, administrative willpower, and multi-pronged strategies involving all the other departments,” Arun added.

Giving his views on the topic, Naresh Hasija, Associate Vice President, Viatris, said, “We as a country have stood very strong against COVID-19, and the pandemic has given very strong lessons for other infectious diseases like tuberculosis where we have taken an oath of elimination by 2025. We are on the right track be it the elimination of Tuberculosis or fighting with COVID-19. Capacity building is one area where private partners can surely come forward and we have done this in the past for the pharmacist of the state, hospitals, and for nursing. Created good modules and imparted those in states and we can continue to contribute in that manner.”

Hassija further said, “When we started working for viral Hepatitis in Punjab and Haryana state there infection rate was high and we used to struggle for RTPCR, viral load pricing was so high and as a company, we came forward and assisted, helped patients. In COVID-19 diagnostic space, RT PCR is available near to you and I am extremely confident with this pandemic the treatment for tuberculosis and viral hepatitis has gained a maximum advantage.”

Highlighting that Gujarat as a state has managed COVID-19 very well, Hassija said, “Gujrat was the first state, which wanted treatment for moderate to severe patients, the kind of interest Gujarat administration was taking for their population was immense and they have managed it very well. There should be protocols on infectious disease and education of these protocols is very important to people who are treating COVID-19 on the ground if they are knowledgeable and they know what has to be given in mild, moderate, and severe cases. I see the current pandemic as an example this as brought in a lot of learning and knowledge dissemination has happened fastest we have never seen this kind in history.”

Adding to it Dr. Manisha Shrivastava, Medical Superintendent, All India Institute of Medical Sciences (AIIMS), Bhopal, said,” Pandemic has been a great learning and experience for everyone and we have come a long way. When a program to eradicate Tuberculosis was launched we thought that an integrated approach will be required. Just sitting in a lab or going to the fields, clinicians giving medicines we don’t integrate the private to the public system. After the first lockdown was announced, the central government immediately deputed task forces, the standard system of reporting and the health ministry gave regular updates. AIIMS became an integral part of training and taking the lead because we had — infrastructure and a national biological lab. We were the first ones to start COVID-19 testing. Leadership from institutes like AIIMS can handhold and recognize other labs with the help of ICMR. An appropriate COVID-19 behaviour campaign was initiated right from wearing a mask, hand hygiene, and social distancing. COVID 19 taught us how country can come together with health administrators, police, public surveillance people got together in an online control group and WhatsApp group to create awareness. Talking about capacity building the country is creating a database of healthcare workers for vaccination and going forward we should maintain this as a database. After COVID-19 our next campaign is on eradicating tuberculosis and the same manpower, laboratories, and capacity-building measures can be used.”

Explaining that infectious or communicable diseases contribute significantly to the mortality rate of the country and it needs due attention, Dr. H.K.Bhavsar, Additional Director, National Health Mission, Government of Gujarat, said, “It is important that we prevent any infectious disease. Keeping ourselves clean and hygienic can prevent not just COVID-19 but so many other diseases. When the pandemic struck the state lacked resources but managed, identified some private hospitals and district centers, and designated them as COVID-19 hospitals. Every data was recorded, we get to know how many patients are there and how the treatment is going on, all the protocols were followed had strict surveillance. To start with we had five RTPCR laboratories in our state; now all 20 medical colleges have RTPCR facilities are available. The state has a central database training, which trained around 10000 people, paramedical, and nursing staff. Biomedical disposable waste training was also given to the staff. Initially, the death rate was very high but now it’s quite less. The state has also developed feedback mechanisms from patients, developed a strategy to take follow up with the discharged patients, and our team had proper follow-ups, tracked every patient.”

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