By Kaaren Mathias, Public health physician (Emmanuel Hospital Association) and HSG Board member (South East Asia Region), with input from Katherine Reyes (HSG Board member for the Western Pacific)
The rapid and devastating rise in cases of Covid-19 in the last few weeks has spun the world into a dizzy anxious whirl of action (laying in supplies of hand sanitiser, onions and rice) and inaction (staying back from the office/Netflix fests/missed conferences and social events). There are vast volumes of information and media articles and Facebook shares on how to avoid face touching, how to social distance and how to namaste rather than shake hands. South Asia is ahead on the namaste front.
I live near the one million strong city of Dehradun in North India. Two days back, the first case of Covid-19 was identified in our state of Uttarakhand. The non-profit I work with (the Emmanuel Hospital Association) has teams working in informal and disadvantaged urban areas around the city. People live very close, along dirty open sewer canals and under plastic tarpaulins – in such settings infection control is hugely challenging.
Community health systems are vital to help flatten the curve
Along with many others in community health systems, we recognise that the next few days will be critical to slow spread of the infection which perhaps inevitably has come to our city and will arrive and spread to many others through South Asia this month. Our community health workers are armed with information and hand sanitiser, and plan to hold dozens of corner meetings to share skills and knowledge to limit Covid spread in the next few days and weeks.
Key to limiting the impact of the epidemic in India and globally, is ‘flattening the curve’. This means slowing the spread of the epidemic over time. Slower spread to others, means fewer people infected, means health resources are better able to meet demands, means more knowledge on the bug and treatment, means lives are saved.
Image credit: Sam Whitney, CDC
There are many strategies to flatten the curve and right at the front are the roles of health systems that conduct core surveillance and contact management for containment as well as basic case management capacity. This is a prerequisite but next is the central role of strategies to limit spread in communities:
Sharing information and building skills
Community health workers, teachers, community leaders and workers from non-profits (i.e. community health systems) who share knowledge and skills to slow spread of the virus in communities is very important: e.g. encouraging social meeting only outdoors, hand washing, self-isolating, social distancing, hand washing, avoiding touching our faces, limiting travel and working from home, hand washing and reducing face-to-face social contact. The virus has fewer opportunities to spread if people are less mobile and interact with each other less. Community health systems must be at the centre to give information to people on how to care for themselves and where to seek help.
Providing support to the most vulnerable
Identifying and supporting people who are most at risk of severe illness (i.e. those over 60 years, those with long term health conditions, those who are already weak or undernourished) must be coordinated by people in community health systems and may also involve delivering groceries or supplies (perhaps by youth volunteers who are relatively lower risk).
Coordinating and linking with public health systems
People with knowledge of the local context, geography, existing social structures and community (I.e. community health systems.) will be essential for surveillance, and to support, coordinate and link with those who are self-isolating or quarantined. Supporting those in self-isolation with information, answers to questions, connections to social support will be key to controlling Covid-19 in densely populated urban areas where spread is most difficult to control.
Support to frontline community workers will include supply of brochures in pictorial formats with simple language that can be shared, supply of masks, hand sanitiser, access to advice and coordination.
Linking and collaborating with other sectors
This epidemic is another example of how health is determined by so many other sectors. We must work with other education, trade, sports, event organisers and religious leaders to ensure consistent and clear communication. A large part of the battle is on the hearts of the people, to trust government advice and to trust each other. We must contextualize the recommendations locally to people in different settings.
We don’t know what the situation in one week’s time will be, but we do know that clear information, courageous decisions, coordination and community health systems will be key to flattening the curve and saving lives in South Asia and beyond.
Image credit: Pooja Bhatt