key: cord-0991143-01mttzlt authors: Matta, Dr. Shanker; Arora, Dr V.K.; Chopra., Dr K.K. title: LESSONS TO BE LEARNT FROM 100 YEAR OLD 1918 INFLUENZA PANDEMIC viz a viz 2019 CORONA PANDEMIC WITH AN EYE ON NTEP date: 2020-10-08 journal: Indian J Tuberc DOI: 10.1016/j.ijtb.2020.09.032 sha: 82d972c9a50790f902b85fa31ed4e6ecb04b3fb6 doc_id: 991143 cord_uid: 01mttzlt The present article is about the 1918 H1N1 flu pandemic also called the “Spanish flu,”which killed 50 million plus people worldwide, and the coronavirus pandemic (Covid-19) which has spread in the world at an alarming pace.Till date there are 11,327,790 cases and 532,340 (As on 07/07/2020) deaths globally. Aim of this article is to draw conclusions, share knowledge from both the pandemics and apply these lessons in other health programmes so that we are better prepared for future pandemics. The 100-year anniversary of the 1918 pandemic/10-year anniversary of the 2009 H1N1 pandemic are milestones that provide an opportunity to reflect on the vast work that lead to the discovery of sequencing and reconstruction of the 1918 pandemic flu virus. The effort has helped the public health community to prepare for pandemics, like 2009 H1N1, and future pandemic threats (1). The 1918 H1N1 flu pandemic also called the "Spanish flu," killed 50 million plus people worldwide, and almost 675,000 people in the United States . More than half of the world's population had been infected. Examining the 1918 influenza pandemic is an opportunity to consider the current corona virus (SARS CoV-2 or COVID-19) crisis from a different perspective, and draw conclusions for other health programmes like NTEP so that the country is better prepared to deal with such situations in the future. only when the patient's illness is advanced and respiratory symptoms occur, but in case of SARS-CoV-2, transmission can occur in the early phase of the illness, when the patients are asymptomatic (40%). Spread in case off Covid-19 is wider due to urbanization and increase in international travel during the last two decades. Hence, isolation after the onset of symptoms and temperature screening might be ineffective in preventing virus transmission .SARS-CoV-2 has been proven to hold higher transmissibility and wider community spread when compared with other betacoronaviridae. Severity of SARS-CoV-2 is much less when compared to SARS. (6, 8, 15, 16, 17) Steps taken for disease containment Confusion prevailed during Influenza pandemic, whether to isolate the cases or not, -An article (1) stated that a closing order was introduced for the whole city in the same way as with Covid -19 pandemic. A 15 member Committee recommended this policy change. The number of new cases began to decline after 10 days. (1)Other measures taken were as follows limiting crowding in places with restricted access to fresh air J o u r n a l P r e -p r o o f Street car regulations aimed to keep the air in the street cars fresh by mandating open windows and limiting the number of passengers to 84 (streetcars had a seating capacity of 46) (5, 18, 19) Regulating business hours of stores/theaters to keep street car congestion to a minimum. (5) Buildings with less than six stories were no longer permitted to use their elevators. The hospitality/hotel industry was affected. Later the authorities started operating the elevators although only one person per 5 square feet was permitted. During the present time various businesses have been affected due to the Covid 19 pandemic .Worst affected are the tourism/airline/hospitality industry etc. As per the protocols of Covid -19 a patient with mild symptoms like muscle aches, cough, sore throat/fatigue, should be isolated at home and use a medical mask. (13) WHO suggested measures like frequent hand washing with an alcohol-based hand rub/soap and water, avoiding touching eyes, nose, and mouth, and practicing respiratory hygiene, use of face masks for personnel. Measures implemented to contain 1918 Pandemic affected the day-to-day lives of citizens. Closure of public places in Minneapolis was announced in advance, so people rushed to complete those activities that would soon be banned, resulting in the very same crowded conditions the ban wanted to prevent. Similar sequence of events followed during the covid-19 pandemic. Various businesses struggled to pay their the ground level staff /employees. This was seen in the Covid epidemic also. All influenza cases in 1918 were to be reported to a physician, who in turn had to isolate the case in his/her home and notify the health department. Various issues came up. Physicians as well as the patients were hesitant to bring attention to cases. The physicians were not reporting the cases to prevent homes from being quarantined. Symptomatic cases wanted to escape isolation by not seeking medical attention/seeking medical attention when they became very ill. They did not approach the health authorities for many days and many cases developed pneumonia. During Covid 19 pandemic also, people were hesitant to approach the J o u r n a l P r e -p r o o f health authorities due to the fear of being quarantined. Due to shortage of inspectors, houses were not released promptly from isolation. As per an article (1) telephone operators went on strike due to which reporting of cases, isolation, as well as their release from such a measure were affected . People in the 1918 pandemic did not approach the health authorities for many days and many cases developed pneumonia(cut and paste elsewhere) Physicians/Nurses who fell ill and even died as a result of assisting in the fight against the pandemic scared other nurses and physicians away. As per the article linking a disease with the name of a foreign/minority community is closely related to the desire to separate those who are viewed as threats of contagion. During this process Air travel bans are implemented for disease control. Xenophobia, helps to explain the call for travel bans. As per the article air travel plays a less important role in the spread of pandemics than is commonly believed. Young adults were the most affected groups during the influenza pandemic. Researchers thought that the elderly were spared due to previous exposure to other viruses, giving them immunity to the 1918 viral strains. However, given that seasonal flu typically kills the very old, today's aging population will be another challenge in future pandemics. Researchers reported that banning public gatherings/ hand washing helped to reduce levels of infection and death during the 1918 pandemic but only if they were applied early and for the entire duration of the pandemic. In 1918, the use of gauze masks, more stringent sanitation laws, and vaccination campaigns were deployed. Directions for wearing the masks were issued to the public. An acute shortage of masks was observed (22). Fabric masks were used by the public as seen in the present pandemic. Sanitation laws were introduced that called for the sterilization of dishes and cups in restaurants , bars and the banning of roller towels and common drinking cups in public restrooms. In the US two vaccines were administered, and neither of them were effective as neither According to researchers, providing emergency vaccines during future pandemics should take in account different age groups, viral and host factors. -------------- J o u r n a l P r e -p r o o f everywhere. Airplane travel facilitates the rapid spread of pathogens, and even communication technology enables the spread of fear and misinformation. Public health capacity building and disaster preparedness are the key elements which have to be strengthened and refined for preventing epidemics. Another area of concern is the circulation of unreliable news on digital platforms which may prove dangerous during any epidemic. At this juncture the role of governments is to remove these misconceptions and provide correct information. In case the Tuberculosis and HIV becomes a public health emergency of national concern, following measures may be adopted considering the lessons learnt from the In the event of a public health emergency, TB programs can help to mitigate potential shifts in staff assignments and resources (24) ---------According to CDC the following measures may be adopted Contact information for patients is updated, and staff contacts the patients telephonically.Communicate any changes or updates in service to community partners. Providing additional medications to patients, if health department operations are likely to be affected. If policies and procedures are in place, consider alternative treatment delivery methods, such as electronic directly observed therapy (e DOT).A Module on management of TB patients during Epidemics/pandemics may be compiled by the NTEP programme so that the staff can be accordingly trained As per an article, A plan is needed which is ahead of time and which incorporates clear lines of responsibilities and roles. Plans for surge capacity/community containment must be discussed with stakeholders and consensus must be achieved .Clear responsibilities may be assigned to all the NTEP staff. NTEP has to ensure that there are sufficient CBNAAT/ TruNat machines at all the centers to handle a situation in case an epidemic strikes. The programme also has to ensure that there are spare machines available to handle the high load of patients. The programme has to ensure all report are being entered on the Nikshay portal which is happening currently. Integrated digital adherence technologies (IDAT) like MERM box, 99 DOTS may be adopted in the programme. Drugs dispensing systems may be made simpler by issuing monthly drugs to patients as is happening now. Other interventions, like getting in touch with patients telephonically to counsel the patients, use of telemedicine/videoconferencing for monitoring of adherence and side effects and time to time training of staff to handle patients during epidemics would prove beneficial.).According to an article by WHO (25) all measures should be taken to ensure continuity of services for people who need preventive and curative treatment for TB. Health authorities should continue to maintain support for essential TB services, during emergencies like COVID-19. 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