Non-Pharmacological Intervention

Non- pharmacological Interventions.

The technique that is essential to fight pandemics irrespective of whether we adapt to ‘Zero Covid Strategy‘ or the strategy of ‘Living with the Virus‘.

( How could our ancestors survive Epidemics and Pandemics without any idea of what causes a disease ? )

R.K.Mahapatra

Any epidemic has two possible interventions.

1. Pharmacologic Interventions– These include appropriate Drugs, Vaccines.
2. Non Pharmacologic Interventions:– They are Masks, Social distancing, Isolation of contacts, Lock downs or these can be “Boiling water before drinking” as in cholera or “Avoiding rat falls” during a plague epidemic..
   • They are the earliest preventive measures that is undertaken even before a cause and treatment of the disease could be ascertained. In the history of mankind, NPIs have been the mainstay of our controlling every epidemic, be it Cholera, Plague or Influenza.
   • Home sapiens have survived for million years on this earth fighting against billions of viruses, bacteria, fungi by precautions which in total come under the Non Pharmacological Interventions.

Only two of the hundred organisms that afflict us, the Small Pox and the Polio are eradicated by a specific vaccine. In most cases like AIDS, Hepatitis, Cancer we are yet to formulate a  successful cure. We have to live with them and control them by social measures.

Lock downs and Social Distancing, Mask and Sanitisation are the recent NPIs that has been adapted by all nations to fight the Covid-19 pandemic.

Here is a brief review of the pandemic on record to highlight these techniques and their dramatic effects.

A short account of What happened in Wuhan exactly 2 years ago on this day.

[ I have restricted myself strictly to those events that are available on record]

-R.K.Mahapatra

  Wuhan is a sprawling and ancient city. There is some uncanny similarities between Wuhan and my town Bhubaneswar. Both boast of more than 3000 years old human settlements. Wuhan is the capital of the Hubei state of Peoples Republic of China. The population of Hubei is 58 million and Wuhan is 84 lakhs. That way Hubei is one and half time bigger than our state Odisha and Wuhan is almost 10 times as populous as our capital Bhubaneswar.

  It derives its name from the merger of two provincial capitals ‘Wu’ and ‘Han’ situated on both side of Yangtze River. It has the dubious distinction of becoming the war time capital of China in 1937 during the Japanese invasion of World War-2. Since then it has been a manufacturing and transportation hub with dozens of railways, expressway and waterways. It also boasts of world’s largest power station (capacity 22,500 MW) and of course the Wuhan Institute of Virology (WIV)

Wuhan Institute of Virology is the maximum security bio-lab  of BSL-4 category.

It also has a medical college and state level medical centres.

The Wet Market of Huanan.

This is the biggest seafood market in Wuhan. It sells fishes and meat of every animals under the sun. Though Bats, Pangolins, Civet Cats are forbidden animals, you can get them here on a premium. Live animals are often butchered in front of the customer for his satisfaction. The pavement gets splashed with blood and animal debris. So the pavement has to be hosed down often to keep it clean. It derives the name Wet market from this.

8 December, 2019:

As per the reputed medical journal The Lancet, the first case of one Atypical Pneumonia ( later on to be known as Covid-19) was reported from the wet market of Huanan on 8th December,2019. This article, published on the 24th January 2020 presents the earliest published record of the first 41 cases of such pneumonias. 

The first case World: report from the Journal of Clinical Cases

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176616/

26 December, 2019:

Officially, a lady doctor of the state Government hospital of Wuhan reported 07 cases of atypical pneumonia linked to this wet market on 26 December, 2019. Later on China honoured this doctor with a meritorious award for the first informant of the pandemic to world to cover up its earlier inaction. It is almost impossible that there were no SARS cases prior to 26 December. If she is the official Public Information officer for the state Government, she has utterly failed in her duty.

How the world came to know ?

But this information was leaked in the Social media by an Ophthalmologist who was punished by the Chinese Government authority. On 30 December, 2019 Dr Li Wenliang shared the same information in a social media group WeChat. He had also added that these are cases of SARS by a Corona virus. This message has crossed national border and irked the communist authority of Wuhan. In 2003, another such pandemic of Coronavirus had started from China. The country had suffered ignominy because of bad handling of that pandemic in those days.

A huge party meeting was scheduled at Wuhan on 12 jan 2020. The last thing the city needed was a Coronavirus epidemic immediately ahead of such a mega event. .

So Dr Li was taken up by the City Police for creating rumour. He was released only after giving an undertaking. Till 11th of January, the city authorities actively denied any epidemic in the city.

Now we know that the virus had been circulating undiagnosed for at least one month prior to that. At least thousand cases of flu patients must be attending every day by that time.

Unfortunately, Dr Li succumbed to the virus and became Immortal by this one social media posting.

While Deng was rewarded by the Chinese Government, Death of Dr Li made him the most remembered icon of the whole world. Later on the authority begged apologies for their inappropriate action.

The Authority sprang to action.

In the week after the Party meeting, Beizing sent a High level committee of 6 renowned physicians to investigate the situation. The Committee reported back to the cabinet on 19th January, 2020 that the situation at wuhan was alarming. Hospitals have no more vacant beds and flu patients are simply pouring in.

On 20 January 2020, Premier Xi Jinping publicly acknowledged the epidemic and the Republic sprang into unprecedented actions as only China is capable of. A  brand new 1000 bedded, 30 Intensive care Unit hospital was created in mere 10 days to isolate the extra ordinary avalanche of flu like case everywhere.

23 January, 2019:

At 2 am of 23 Jan, the government notified that the city of Wuhan would be shut down. Those were early days. No body knew what does a shut down order mean. 

The unfortunate Chinese lunar New year on 25 January 2020 simply augmented the spread.

One of the biggest festival of china was scheduled on 25 January 2020. Wuhan being a transport hub, at least 12 million trips had already passed through the city carrying the virus into whole China and the world at large. 

Right on this 25th January day of celebration, the whole country was put under one of the weirdest lock down. Of course, the whole world would emulate China later on.

30 January, 2020

Although, by 31 December, 2019,  WHO  had received the information that a cluster of cases of Pneumonia had occurred in Wuhan, China, it could never ascertain the gravity of this event. It remained non committal. That’s real unfortunate. By the 30th of January, 2020 when WHO finally declared this novel pneumonia cases as a Public health Emergency, It was probably 90 days late. On that it had reported a total of 7818  cases, of which only 82 case are outside China on 30 Jan. They could not imagine in their wildest guess that this virus is going to spread into 221 nations, affecting 250 million human beings. At least 5 million souls will die. ( This is on record. We shall never come to know the actual death figures. This indecision had brought a lot of flak to this world body.

Alas, had the Chinese Government and the WHO both not given the virus a Lee way of those precious 60 days.

Other Nations :

First case: USA

https://www.nejm.org/doi/full/10.1056/NEJMoa2001191

First case: India

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530459/

The first case found its way to USA by 15 January 2020. India recorded its first case at Thrissur, Kerala on January 27, 2020. Both of these had travelled from Wuhan carrying the virus inside them and had reported to their local hospitals of their own for flu like symptoms. The first Covid-19 case travelled to Bhubaneswar on march 16, 2020 by the rajdhani express. He was a student in Italy.

Zero covid strategy of China:

By now the massive authoritarian Government of PRC had scrambled back to contain the outbreak. The scale of social control that China could impose within such a short notice on its billion plus population was unprecedented in the history of mankind. It was the largest imposition of the public health measures on the humanity. Of course later on the whole world had to follow the same measures in total or in parts to contain the virus. But in China the compliance to such austerity was 100%. The result was also equally dramatic.

Certain measures that China imposed to be followed by other nations like India etc are listed below.

• Stay at home: No one was allowed to move out of his house. Permission was given once in a week for purchasing essentials.
• Movement of people was totally banned. they were permitted to come out once in a week for the essentials, that too with permission.
• ( Imagine the Government was denying any epidemic only one week ago.)
• Food and essentials are delivered at the customers door step online. The delivery companies have to certify that their workers wore masks and are free from fever, ILI.
• Vehicles on such emergency duties are sanitised at regular intervals.
• Shoppers had to keep 6 feet distance between each other.
• Mask adherence in public was 100% mandatory. Non essential movement was totally banned.
• all public entertainment places were shut down.
• Elevators are restricted to 4 people at a time. It was provided with disposable stick cushions to press the buttons without touching.
• Every person’s temp was checked at every entrance to public places.
• Schools are closed and moved on line.
• State owned Military electronics company released an App, in which every citizen’s name and id number was entered. Their movement and exposure was regularly traced.  
• The rules are enforced by authority at the grass root level so that there will be no scope for violation.

The strictest lock down that was only possible in a communist country like china could reduce the number of covid cases from thousands per day in the February to fifties in March. By the 1st of April, China reported Zero covid cases . It had been able to maintain Zero Covid since then for one and a half year at a stretch. This is one of the most commendable achievement of NPI ( Some under reporting not withstanding. )

Of course, these non pharmacological interventions do not cure or eradicate the pathogens. They can at best flatten the curve. This prevents the pandemic inundating our health care resources. These also buy us sufficient time, so that our scientists can find out a definite solution. Thus they have given us breathing time to come out with effective vaccines and definite drugs against the pathogen. without them, the virus is going to come back with vengeance.

Lately the cases have reappeared in China and the Communist behemoth is on its job.

These are the examples of NPI that has enabled China to follow its Zero Covid strategy till date. the other two countries who had tried to maintain Zero Covid ie. Australia and New Zealand, have lately dropped the idea and have joined the rest of world in the strategy of Living with the Virus.

Whatever strategy you may adopt, it is these Non Pharmacological Interventions has remained and will remain our best bet against every epidemic for time immemorial.