Anatomy of an epidemic – Times of India (blog)

It is just right, that the Health Ministry has chosen the IMA (Indian Medical Association), Indias largest voluntary autonomous body of doctors from all fields. The key features that make it suitable for the Gorakhpur enquiry, is that this body would be looking into the matter medically, and not with an eye of punishment. I am quite sure, with a vast, mostly non-government aided practicing experience, many must already be knowing what in all probability would mainly be a viral epidemic. Surely there would be areas of suggestions for improvement of overall care and preparedness.

Another advantage, it is not answerable and should not lean to any political entity, nor can itbesqueezed around by protocol, as it is not a Constitutional body, unlike the MCI. That it shall use true scientific principles, is understood.

If you look from the point of advantages of adversity, it is just as well that awareness has finally spread, systems are upgraded, and if this turns out to be a viral epidemic, the best standards of epidemic control, and prevention shall have to be put in place.Gorakhpur is a city that has had many trysts with epidemics.

To put it lightly, sometime back I happened to open the topic with a gentleman from the place. A citys description is best stated in its own language. This is what that gentleman said, Aap bas yoon samajhiye ki Baman (brahmin), Bimaari (disease), aur Bihari (no offence, every community has a sore point) sey Gorakhpur trust (infested, soft T) hai! Never had a better summary, which the IMA team may keep in mind!

The first reported viral epidemic in Gorakhpur was in 1978 (Japanese, JE), where 1022 cases were reported, with 297 deaths. After that the road has been rather bumpy.

The year 2005 was rather tragic. The outbreak reported was 5,737, mostly JE. 1344 children died.

But to get the full view, the Directorate of National Vector Borne Disease Control Program (NVBDCP), has reported 26,668 between 2010-2017. The break up was 24,668 of Acute encephalitis syndromes (AES), an all-encompassing terminology WHO, though it settles down to a condition of fulminant encephalitis, as against the known virus JE. There were 4,093 deaths in the same period for AES, and 307 in the JE cases.

Gorakhpur has the dubious reputation of being the world capital of JE, though the total worldwide population at exposure, and that which may suffer is close to 3 billion, which would include South-East Asia prominently.

This years epidemic was unfortunate, but such is the story of all vagaries of nature. The BRD Medical College, may have expanded a bit, but that it should be epidemic ready, is difficult to imagine. For that matter, which medical facility shall have 2,000 extra ICU beds ready where the disease does not accept anything as a cure, and supportive care is all that can be given.

One may overstock antibiotics, saline drips, ventilators, even rooftops with oxygen, but the real process that takes down the patient is the inflammation inside the brain that causes increase in the respiratory rate-a central process, but not a lung pathology that would be amenable to oxygen.

However, medicine has a place for palliation and one can understand the emotions of those who felt that oxygen was in shortage. Ventilators, oxygen are what can be done as a palliation, and as a physician I would go a step further in what soothes the patients relatives. But the fact is that the gasping stage many patients reach due to disrupted central ventilatory centre, is not because of loss of oxygen, and even ventilatory support is less likely to change course.

However, I cannot say that such prop-ups facilities should not be ready. The outcome of the disease may not change though. I suppose this is a key question the IMA enquiry committee may like to take. Till we have vaccines that ensure protection, and till we have medicines that are curative, some actions can be initiated to change or dampen the incidence of the disease.

It is widely stated that Gorakhpur, a densely populated town, close to the Himalayan foothills of Nepal, has many water-bodies, and water pooling after the rains start, which is the period between May and November. Being a vector-borne disease, regular fogging in such areas should start to keep the population of vectors down.

Generic sprays and mosquito repellent ointments should be for free distribution (much like free condoms as disease prevention).

Health workers may be doubled to keep appropriate control over the still waters. Mosquito sprays and creams should be checked and supplied at every house. Expenses need not be high, and would also create extra rural jobs.

Surely, the enquiry shall bring better facilities to the BRD Medical College that may reduce fatalities in other diseases. Should doctors be suspended or dismissed? There may be specific cases, but I fail to understand any direct action or omission that would throw the blame directly on them.

Transferring doctors? That would be the best gift!

The inspection by IMA pending, the remedial aspects are technical, mostly regarding the methods of mitigating the vector population, and giving a first shield to the population.

A few years ago, Rotary International and IMA, made India Polio-free.

Innovative epidemiologic techniques need to be put in place. May I add to the vocabulary, Technical mosquito nets You got me wrong The ones that keep the mosquitoes trapped in, the way they do in Punjab!

To make the tragedy bearable, may I be spared this one:

Badaltey zamaaney, mein khayaal kuchh aisa aaya, Parwaana bhesh badalkar, kahin Qaatil bankey to na aaya(In a changing world, a thought just came to mind,Was a killer vector, impersonating the romantic drone?)

PS: One of the theories regarding King Tut is that he suffered malaria shortly before he occupied his Grand tom.

DISCLAIMER : Views expressed above are the author's own.

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Anatomy of an epidemic - Times of India (blog)