2019-nCoV Outbreak Preparedness & Response Arunachal Pradesh

1. 2019-nCoV
Outbreak Preparedness & Response
Arunachal Pradesh
Introduction
Infection Prevention and Control
P&R Status
Dr. Bikash Bage,
Dept. of Sociology,
Rajiv Gandhi University
Arunachal Pradesh

2. Cross Platform Dialogues: A National Webinar Series Across 8
Disciplines
Social Science Research in Sociology of Health and Environment

3.  Coronaviruses -large family of RNA viruses
 Structure -petal shaped spikes surrounding
the virus and resembling the ‘solar corona’,
hence the name.
 They mostly infect animals, including
camels, cattle, cats and bats.
 2019- Novel Coronavirus belongs to group
of newer Human Coronaviruses including
SARS, MERS which have evolved and
infect and spread amongst humans usually
causing severe respiratory illness and
outbreaks.

4. Current Outbreak:
 31st December 2019:
WHO was alerted to several cases of pneumonia in Wuhan
City, Hubei Province of China of unknown etiology
 31st Dec 2019 – 3 rd Jan 2020:
44 cases with pneumonia of unknown etiology in China
 7th Jan 2020 :
China isolated a new type of coronavirus
 12th Jan 2020:
China shared the genetic sequence of the new coronavirus
which did not match any other known virus
 Temporarily named “2019-nCoV.” 2019- novel coronavirus

5. MODE OF SPREAD:
 Initially, many cases had some link to a
large seafood and animal market,
suggesting animal-to-person spread.
 However, now It is suggested that person-
to-person transmission might be occurring
 It is thought to be similar to Influenza,
SARS, i.e. commonly through respiratory
droplets produced when an infected
person coughs or sneezes

6. CLINICAL SIGNS/ SYMPTOMS
 For confirmed 2019-nCoV infections,
reported illnesses have ranged from infected
people with little to
no(asymptomatic)symptoms to people being
severely ill and dying.
 Symptoms can include: Fever, Cough,
Shortness of breath.
 In severe illness: Severe Acute Respiratory
illness, Pneumonia, Renal failure, Death
 Symptoms of 2019-nCoV may appear in as
few as 2 to 14 days after exposure –
Incubation period(Window period)

7. PREVENTION
 There is currently no vaccine
 The best way to prevent infection is to avoid
exposure and preventing transmission
 Avoid all non essential travel
 Observe good personal hygiene
 Wash your hands often with soap and water
for at least 20 secs. If soap and water are not
available, use an alcohol-based hand sanitizer.
 Avoid touching your eyes, nose, and mouth
with unwashed hands(open membranes).
 Avoid close contact with people who are sick.
 Stay home when you are sick.

8. PREVENTION
 Observe respiratory etiquettes-
While coughing or sneezing cover mouth and
nose with flexed elbow or tissue, then throw
the tissue in the trash.
Clean and disinfect frequently touched
objects and surfaces
 Food Safety
 The consumption of raw or undercooked
animal products should be avoided
 Avoid direct unprotected contact with live
animals

9. Preparedness and Response: Infection
Prevention and Control Measures in a hospital
setup
 Should be initiated at first point of contact
with a suspected patient
 All Standard precautions need to be
undertaken: HAND HYGIENE USE OF PPE
(Personal Protective Equipment)
 SHARP INJURY WASTE MANAGEMENT
DISINFECTION
 APPLY CONTACT PRECAUTIONS
 APPLY AIRBORNE PRECAUTIONS – when
performing Aerosol Generating Procedure

10. Personnel Protective Equipment(
PPE)
 The use of protective gears should be
made mandatory for all the personnel if
chances of close contact with suspected
or diagnosed patient is
anticipated/inevitable.
 N-95 masks only to be used for people
who are likely to come in close contact
with the patient(One meter) or while taking
samples or doing procedures which can
generate aerosols.

11. COVID Care Centres are experiencing
anxious time at present for various reasons:
 Anxious Staff
 Anxious Residents
 Anxious Relatives
 Staff off sick
 Staff Self Isolating
 Staff shielding
 PPE Shortage, Increase in cost & Scammers
 Constantly changing guidelines
 Conflicting guidelines from different regulatory bodies
 Experts on Facebook pages
 Monitor the guidelines daily and be prepared to change accordingly at moments notice.
 Conduct Zoom meetings daily and weekly with a number of groups to remain up to date and
compliant.
 Ensure we have communicated the correct information at the right time to the relative people in a
clear and concise manner.
 Ensure we have all the evidence necessary to prove what, when, how and to whom we did things
for future investigation.

12. TREATMENT
 There is no specific antiviral treatment
recommended
 Issues on asymptomatic released
HOW?
Answer: Immune System
 People infected with 2019-nCoV
should receive supportive care to help
relieve symptoms.
 For severe cases, treatment should
include care to support vital organ
functions.

13. COVID-19 and Social Interaction in
Academia
 COVID-19, a pandemic that has caused many health related effects,
thus impacting a multitude of individuals worldwide.
With the continual increase of COVID-19 health effects, many
systematic structures are forced online platform
One of the major fields that have been moved to an online platform is
Academia. Large number of colleges and universities are making
substantial changes to how to provide education, with many closing
campuses and moving to online classes.
Before the spread of the Covid-19 pandemic, social interaction was
highly valued. Nowadays, due to the Covid-19, social interactions
have been forced to change.
In future, social distancing will be inscribed into society, unless other
interventions such as vaccines, drug therapies and aggressive
quarantine measures can be put into place.

14. Social Interactions Before COVID-19
In person interaction before COVID-19
● Human interaction was valued and expected.
● In person gatherings were encouraged
● Individuals in systematic Institutions were able to continue their daily routines.
● Education provided full access to schools and Universities.
● Classrooms remained the primary source of learning.
● Many careers remained open and allowed flexibility.
● Virtual platforms were utilized for everyday communications, but did not
replace face-to-face interaction.
Online Interaction before COVID-19
● Normality has changed forcing individuals to accommodate the new changes.
● Education- allowed for online access (online classes etc), but online education
was not the dominant form.
● Discussion boards, chatrooms, and email platforms were the main online
features for online education.
● Zoom and other platforms like it, were typically utilized for work meetings,
international calls, and for interactions with friends/family.
● The usage reports for these companies were low.

15. Social Interactions During COVID-19
 Although we are aware that drastic changes have to be made
to maintain the health and overall control of the coronavirus,
In what ways are we fighting to maintain the human needs
and social interactions during the pandemic?
● Students continue online classes via Zoom with hopes of
reopening of institutions in the fall.
● Necessary stores remain open such as, grocery stores and
emergency services. To prevent the spread of the virus,
masks are required and a limited number of people are
allowed within essential stores at a time.
● Other than Zoom, social media applications have also
expanded and are now opening new application to help
maintain small business.

16. Social Interactions Post COVID-19
 The way we think toward social interaction
will forever be shadowed by the pandemic
of 2020.
 How often we clean and wash our hands,
the amount of time we spend on social
media, our familiarity with online
purchasing, and our connection to
technology will all continue to grow to
become a norm (New Normal).

17. Social and Psychological Support
 The mental health of the population is at risk as a result of the coronavirus crisis.
International study reveals that 1 in 2 people felt down, depressed, or hopeless about the
future.
 A UN policy briefing found that during the pandemic:
● 47% of healthcare workers in Canada reported needing psychological support
● 50% of healthcare workers in China reported depression
● 42% of healthcare workers in India reported moderate psychological distress
SUPPORT
 Listen for the different voices Encourage people to share their emotional reactions,
recognising that different people will tell you in different ways.
 Look for the things that unite people in a positive way, how can we collectively contribute
and articulate it.
 Communicate! Make sure what you communicate doesn’t have a particular weight or
message to one group or need
 Give as much information as you can – silence creates a vacuum in which anxiety can
thrive.
 Keep communicating what you are doing to keep people safe and well
 Service users and staff
 Create moments of calm Acknowledge the uncertainty, worries and anxiety
 Find the positives stories
 Encourage and provide the moments of calm, space and reflection
 Create the moments of calm

18. Status of Covid-19 &
Pandemic Management
in India Arunachal Pradesh
 Health is a state subject ‐
pandemic allows centre to take charge
 Centre used provisions of disaster mana
gement act, 2005 and Epidemic Diseas
es Act, 1897 to take control of public hea
lth
 Centre listed restrictions‐
States allowed to enhance restrictions b
ut not relax without consent from centre

19. Management: Indian States
 Kerala model
Public health geared to managing pandemic,
Experiences from Nipah, Contact tracing and
isolation, managed by public health facilities
 Odisha model
Increased testing, effective resource
allocation, swift private sector partnerships,
infrastructure set‐up, capacity building of
human resources in health care, and
incentives for citizens to test, PPP Model.

20. What is Hospital Preparedness?
 Every hospital, in collaboration with other
hospitals and public health agencies, will
be able to provide appropriate care to
COVID‐19 patients requiring
hospitalization maintaining essential
medical services in the community, both
during and after a pandemic.
 This definition recognizes that what
constitutes “appropriate care” and the
criteria for hospital admission may well
change during a pandemic.

21. Guidelines followed ‐ COVID Preparedness
 Prevention & preparedness phase:
No infectious diseases emergency: Conduct annual Mock drill
 Standby phase:
Global Outbreak potential to reach your country: Review released Advisory &
Propose an action plan
 Initial action phase:
Pandemic declared by WHO: Hospital Incident Command System
activated Screening /Triaging Cohorting measures strengthened
 Targeted action phase:
Pandemic declared by WHO Wide spread community outbreak:
Develop communication to empower & engage with the stakeholders including
community Strengthen & implement strategy
 Stand down phase:
Infectious disease emergency abated: Health services return to normal activities
Discontinue heighted surveillance activities that are no longer required
Monitor for second wave and / or resistance to antibiotics/ antiviral
Transition to routine infectious disease control or interim arrangements

22. Priorities DHFW, GoAP
State Covid-19 Control Room
Task Force-COVID-19: Daily Monitoring and surveillance: Reports
Clinical Experts (Infectious Diseases, Infection control, Microbiology/Patho
logy)
Operation representatives –
Inpatient, Outpatients and other clinical services , Nursing
Admin, General Admin
Medical Admin
Logistics/ Finance
Infection Control Officer/ Safety Officer / Quality Manager/ Risk Manager
Patient care and staff safety
Operation management –day to day functioning & Surge planning
Coordination with health authorities
Rapid & evidence based decision making
Flow of materials and funds

23. Initial Planning/ Sub Committees
 Administrative Controls
 Patient Flow
 Infection Control Practices
 Manpower including staff health
 Training & Relocation of HR
 Logistics
 Clinical Management
 Financial Management

24. Triage and Patient Flow
 Patient: Triaging @ FLU clinic or Emergency
 NON COVID Patient:
Admitted/managed in Non COVID ward/ICU
 COVID Suspect Patient :
COVID‐19 Negative: Re-testing : Negative
NON COVID Patient: Discharge
 Testing:COVID‐19 Positive:
Admitted/managed in COVID Isolation ward/ICU
 After Care -tive Discharged
If +ive Tertiary Intensive Care

25. Govt. SoP in Care centre
 Masks made and Sanitiser whener and
wherever made
mandatory for all patients and visitors
 Flu clinic at the entrance
All patients screened with thermal scanners
 Patient interviews with checklists
 Full protection and PPE in ED, Flu clinics
 COVID wards in isolated buildings
 Patient Cohort
 Separate route and lifts
 Staff movement

26. Administration and Challenges in Arunachal
Pradesh
 Essential services and Commodities : District
Administration
 Essential Consumables-HLL/Creating additional beds
and CCC/ hospitals
 Support services ‐ Transport
 Entry restriction & Visitor management : Police
 Food and refreshments for Front line workers
 Tele‐consult and Telemedicine
 Infection Control, Spraying and disinfecting Sanitization
od colonies, vehicles etc.
 Waste Management/Vehicles/ Ambulance.
 Cremation/ burial
 Civil Society against Transition of Govt. facilitation of
COVID-19 Management

33. IPR, Lower Subansiri chapter
tS3tpuonsohredm
·
THE GRATITUDE GARDEN
"To know even one life has breathed easier because you have lived, this is to have succeeded"
The first batch of our Doctor, nurses, laboratory technicians, drivers and chowkidaars who took care of the 25 covid 19 positive cases from 7th
July to 21st July.
Let's all express our gratitude to them. In any given moment we have two options;to step forward into growth or step back into safety.
THANK YOU FOR PUTTING OUR NEEDS/SAFETY BEFORE YOURS.

34. COVID-19 Warriors who survived

35. SHTF
 5 numbers of BLS Ambulance from DHS Office,
Naharlagun on 26/7/2020. additional 20
 All-Central Arm Police Forces for enhanced
coordination in fighting COVID19 in the State. The
health of our Jawans , Frontline workers, and
Healthcare workers is highest as the safety and
security of our borders can’t be negotiated.
 Example of human grit, dedication and determination
to serve the needy ones. Braving corona pandemic as
well as the inclement weather, a team of Health
Workers reached out to some Pregnant women at
Mechuka.
 20 Teams of Health workers for collection of samples
from sectors of capital complex to determine the
status of COVID-19 cases.

36. AP State Control Room Information Centre
COVID-19
 Helpline No. +91-360-2292774/2292775/2292777 Toll Free No. 104/1075
Call Status Report
 Total Calls 7718
 Distress Call 71
 Outside State Call 3614
 Lock Down Query 309
 Health Related 104
 General Query 3584
 Law & Order Calls 34
 Suspected Cases 02
 Calls received from Confirmed Cases 0
 Medical Consultations today 0
District Control Rooms Helpline No. for Essential Commodities
 Deputy Commissioner DFCSOS/SDFCSOS
 Superintendent of police
 DMOs and DRCHOs (20:45:00 HRS on 25th July 2020)

37. Registration Form For Incoming Citizens
 Please Note : Itanagar Capital Region to observe extended lockdown from Monday, 20th July, 5 AM to 3rd August, 5 AM as
a reactionary measure to the recent spike in Covid cases in the Capital Region. Therefore the Papum pare district incoming
visitor online registration made for arrival date from 4th July to 3rd August stands cancelled for all civilian citizens. Only
Army, Paramilitary forces (CRPF,Assam Rifles, BSF, CISF, ITBP, NSG & SSB ), BRO and BRTF personals can register
online.
 Primary Applicant Details
 Primary Applicant Name *
 Father's Name *
 Preferred Quarantine
Accommodation *
 Preferred Arrival date at check gate *
 Gender *
 Age *
 Primary Applicant Mobile No *
 Occupation *
 Domicile Type*
 Domicile District*
 IDType *
 ID Card No.*
 Family/Other Members Accompanied (If Any)
 Serial #1
 Other Details
 Coming From
State *
 Coming From District *

38. Arunachal Pradesh Covid-19 threat began with the beginning of the unlocking process during the month of June. With the
arrival of the returnees across the country
 It is a crucial time to be more positive, and to maintain sound mind and good health, but one cannot
come to a conclusion regarding the spread of the pandemic. Rather, we can say that the real fight
against the pandemic begins right now.
 The people of the state, including the bureaucrats and the politicians, are on the same boat and are
fighting the virus. But the real fighters are the frontline Covid-19 workers and the common people, not
the people in power. At the present juncture, the main function of the state government is to extend
every logistic support to the police personnel, the health workers and the voluntary Covid-19 warriors.
 We cannot deny the fact that providing health infrastructure for hassle-free treatment of Covid-19
patients is an important task at the hands of government. At the same time, logistic support from the
government to the health workers, the police personnel and the volunteers is most important.
 Hopefully, the doctor community, police personnel and the common citizens of the state will get
enough time to prepare themselves in the fight against Covid-19. The majority of the health workers,
who were not mentally prepared at the initial stage, are now doing a wonderful job without caring about
their own lives.
 Now the onus of fighting Covid-19 lies on everyone.
 Conduct antigen tests in all the districts, and that no fee will be charged for the test till 3 August.
 “Taking serious note of the rising numbers of Covid-19 cases, the health department has sped up its
testing procedure for the safety of the people of the state,” said Libang.
 ALS and 20 BLS ambulances under the NESIDS for district hospital
 Dedicated Covid hospitals in Midpu(30 beeded) and the MLA apartments (45 bedded).
 He directed the officials of the health department to monitor the work and update him on a daily basis.
 The health department has updated the SOP for truck drivers and their attendants,
 Covid care centre (CCC)
 Mandatory rapid antigen tests at the PoE before entering the state.
 If a person is negative on RDT Ag but is symptomatic, RT-PCR/TrueNat test must be conducted for
confirmation.

39. Some Occurrences in the process of Response to COVID-19 in AP.
 mostly among vegetable vendors and businessmen, and possibility of transmission from
truck drivers to vendors.
 door-to-door and ward-wise random testing carried out till 26th July 2020 About 13235
people have been tested in the ICR since 10 July. Out of these, 314 people have tested
positive. Complaint lodged against persons evading CCC admission
 Sanitizing foot-operated sanitizing machines and liquid sanitizer in government offices
 Driver engaged in Covid-19 duty beaten up
 The Arunachal Times Private schools allowed to charge tuition fees
 NESO urges MHRD, UGC against conducting final sem. Exams of colleges and
University.
 40-bedded hospital with ICU, OT and dialysis facilities at MLA Apartment
 Dedicated Covid health centre (DCHC) , Midpu to be made operational by 31 July 2020.
 DCHC Midpu is almost on the verge of completion. However, the Covid hospital at MLA
apartments will take some time to get ready,” he said.
 20% of Covid-19 cases in the state are from the armed forces.
 ACCI facilitates antigen tests for traders
 Single umbrella SoP
 Plasma therapy treatment for Covid-19 patients- TRIHMS and Pasighat and Zonal
hospitals
 14 TrueNat machines to start testing for Covid-19. 12 more machines procured
 State acquired 1.5 lakhs antigen test kits for two months. Rs 7 crore for kits.

40.  50 ventilators under the PM Care Fund, distributed across the state and 20
ambulances for Covid Special Care.
 During the remaining period of the lockdown, local transmission would be contained.
may not be another lockdown; source of transmission identified.
 Covid-19+ve38-year-old Covid-19 positive woman delivered healthy baby at the
Tomo Riba Institute of Health & Medical Sciences (TRIHMS) by caesarian section on
22/7/20.
 TRIHMS reopen cancer, emergency casualty wings
 Contractors urge govt. to let hardware shops open
 Indigenous knowledge system (IKS) on Covid-19 in Arunachal. Some rituals ensure
social distancing, which has been one of the keys to stop the spread of the virus.
Passed down by ancestors, at the same time we should ask ourselves why headlines
can be misleading and how people who have no clue romanticize our knowledge
system without asking once if there is a healthcare system in place.
‘How indigenous quarantine rituals helped Arunachal become Covid-free’ is one of
the many headlines. Age-old quarantine rituals may have helped in stopping mass
spread.
Covid-19 patient succumbed without a single dose of Remdesvir tablet . The health
department held responsible
CCC in Lekhi and the Covid hospital, TRIHMS, are not being administered even low-
cost vitamin tablets for boosting their immunity, junk food- designated quarantine
centres must provide free food, medicines and accommodation.
 #Husband alleges medical negligence in infant and wife’s death; Northeast Human

41. Social Research :
Social Model of Health
 Social Model of Health Definition: • The
Social Model of Health takes into account
the SOCIAL, CULTURAL,
ENVIRONMENTAL and ECONOMIC
determinants which AFFECT health and
produce INEQUITIES within the
population rather than the disease or
injury itself. Key Point: • If these
determinants can be addressed, many
diseases eg CVD, diabetes mellitus Type
2, obesity can be prevented

42.  Social Model of Health • Addresses the
broader influences on health eg social,
cultural, environmental & economic
factors, rather than the disease or injury
itself • It does this by taking into account
the social determinants of health E.g.
access to health care, SES, social
connectedness as if you have those, you
will have a higher health status and
many diseases can be prevented or
managed. • Works together with the
Biomedical Model of health

43.  Addresses the broader determinants of health: •
Acknowledges the influence of GENDER, CULTURE,
RACE, ETHNICITY, SES, GEOGRAPHICAL,
LOCATION and the influence they can have on health
status & health Acts to reduce social inequities: • If
community/government can improve SES, or social
exclusion or issues with race or gender, health status
will improve Empowers individuals & communities: •
People will change their behaviour if they feel they have
control and know how to do it Acts to enable access to
health care: • If people have affordable, cultural and
geographical access to health care, their health status
will improve Involves intersectoral collaboration: • Many
different organisations and community groups can work
together to improve health status

44.  Social Model of health Advantages?
• Promoted good health and assists in preventing
diseases
• Promotes overall wellbeing
• Relatively inexpensive
• Focuses on population groups that are in need
• Education is passed on
• Health isn’t the responsibility of just the individual but
also health sectors
 Disadvantages?
• Not every condition can be prevented
• Does not promote the development of technology and
medical knowledge
• Does not address the health concerns of an individual
• Health promotion messages can be ignored.

45. COVID-19: impact of social determinants of health
 While COVID-19 has increasingly demonstrable that social inequalities in health are profoundly, and unevenly, impacting
COVID-19 morbidity and mortality.
 Many social determinants of health—including poverty, physical environment (eg, smoke exposure, homelessness,
congestion), and race or ethnicity—can have a considerable effect on COVID-19 outcomes. Homeless families are at
higher risk of viral transmission because of crowded living spaces and scarce access to COVID-19 screening and testing
facilities.
 It is also poignant that physical distancing measures, which are necessary to prevent the spread of COVID-19, are
substantially more difficult for those with adverse social determinants and might contribute to both short-term and long-
term morbidity.
 School closures increase food insecurity for children living in poverty who participate in school lunch programs.
Malnutrition causes substantial risk to both the physical and mental health of these children, including lowering immune
response, which has the potential to increase the risk of infectious disease transmission (Dunn CG, Kenney E,
Fleischhacker SE, Bleich SN. 2020. Feeding low-income children during the Covid-19 pandemic. N Engl J Med.; 382: e40)
 People or families who are homeless are at higher risk of infection during physical lockdowns especially if public spaces
are closed, resulting in physical crowding that is thought to increase viral transmission and reduce access to care (Tsai J,
Wilson M.2020. COVID-19: a potential public health problem for homeless populations. Lancet Public Health.; 5: e186-
e187)
 Being able to physically distance has been dubbed an issue of privilege that is simply not accessible in some
communities (Yancy CW. 2020. COVID-19 and African Americans. JAMA. published online April 15.
DOI:10.1001/jama.2020.6548)
 The effect of social determinants of health and COVID-19 morbidity is perhaps underappreciated (Federico MJ, McFarlane
2nd, AE, Szefler SJ, Abrams EM. 2020.
 Additionally, mitigating social determinants—such as improved housing, reduced overcrowding, and improved nutrition—
reduces the effect of infectious diseases, such as tuberculosis, even before the advent of effective medications (Butler-
Jones D, Wong T. 2016. Infectious disease, social determinants and the need for intersectoral action. Can Commun Dis
Rep.42: 118-120) •
 It is projected that recurrent wintertime outbreaks of SARS-CoV-2 will likely occur after this initial wave, necessitating
ongoing planning over the next few years.
 • Studies are required to measure the effect of COVID-19 on individuals with adverse social determinants and innovative
approaches to management are required, and might be different from those of the broader population.

46. MOVING FORWARD
 As the lessons of COVID-19 are considered, social
determinants of health must be included as part of
pandemic research priorities, public health goals, and
policy implementation.
 While the relationships between these variables needs
elucidating, measures that affect adverse determinants,
such as reducing exposure, regular income support to
low-income households, access to testing and shelter
among the homeless, and improving health-care access
in low income neighborhoods have the potential to
dramatically reduce future pandemic morbidity and
mortality.
 More broadly, the effects of COVID-19 have shed light
on the broad disparities within our society and provides
an opportunity to address those disparities moving

47. Thank You