ROLE OF WHO DURING COVID-19

NAME OF THE STUDENT:

BURIDI DAALU RAJA ASHISH

ROLL NO.: 19LLB027

SEMESTER: 2

NAME OF THE PROGRAM:

5 YEAR (B.A., LL.B. / LL.M.)

NAME OF THE FACULTY MEMBER:

PROF. NIRMALA DEVI

DATE OF SUBMISSION: 12TH DEC

DAMODARAM SANJIVAYYA NATIONAL LAW UNIVERSITY

NYAYAPRASTHA “, SABBAVARAM,
VISAKHAPATNAM – 531035, ANDHRA PRADESH

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ACKNOWLEDGEMENT:-
I would like to express my gratitude to “PROF. NIRMALA DEVI” who have given me the
golden opportunity to do this wonderful Research paper on the TOPIC “ROLE OF WHO
DURING COVID-19”, which also helped me in doing a lot of research and through which I
came to know so many new things.

Secondly, I would also like to thank my friends who also helped me a lot in completion of
Research Paper within the limited time.

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 ABSTRACT
COVID-2019 disease is also referred to as acute respiratory disease 2019-nCoV, Novel corona
virus in December 2019 and has contaminated more than 20 million individuals including over
80,000 individuals who died as of 25 August 2020 from the Pandemic. The World Organization
for Health (WHO) has announced as a public health emergency of international significance, the
corona virus outbreak (2019-20) (PHEIC)

On January 30, 2020, and a pandemic on March 11, 2020. It is possible to stop viruses by
adopting Proper hygiene of the personal and respiratory systems and the prompt preservation of a
distance from society. Even though the front line and recognizable picture of health care
professionals could be physicians and nurses. Inside the

There are other health professionals behind the scenes in the ongoing battle against the virus,
such as Epidemiologists regulate the day and night outbreak Data and knowledge are the subject
of disease prevention and managing. The epidemiologist/surveillance officer/doctor conducting
the epidemiological investigation should close the case inquiry forms for all Covid-19 cases that
meet the standard / surveillance case definition.

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 TABLE OF CONTENTS

1. SYNOPSIS 5
2. INTRODUCTION 6
3. HISTORY OF COVID-19 7
4. SYMPTOMS OF COVID-19 7
5. ROLE OF WHO IN COVID-19 AND MEASURES TO BE TAKEN 10
6. CONCLUSION 25
7. BIBLIOGRAPHY 25

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 SYNOPSIS

OBJECT OF THE STUDY:

The object of the study is to know about Importance of the WHO during COVID-19

SCOPE OF THE STUDY:

The scope of study is limited to WHO during COVID-19

SIGNIFICANCE OF THE STUDY:

The study helps to understand the Role of WHO during COVID-19

LITERATURE REVIEW:
Information is taken from secondary sources like articles, online sources

ARTICLES

1. “SPOTLIGHT ON INDIA’S ENTERTAINMENT ECONOMY” BY JOHN NENDICK.

2. “MENTAL HEALTH IN THE TIMES OF COVID-19 PANDEMIC” BY DEPARTMENT OF PSYCHIATRY.

3. MENTAL HEALTH AND PSYCHOSOCIAL CONSIDERATIONS DURING THE COVID-19 OUTBREAK BY

WORLD HEALTH ORGANIZATION.

RESEARCH METHODOLOGY:
The research methodology is doctrinal type of research.

TYPE OF RESEARCH:
The research is descriptive, explanatory.

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INTRODUCTION:
COVID2019 disease is also known as 2019-nCoV acute respiratory disease, Novel corona virus
pneumonia, Wuhan pneumonia. In December 2019, the first case of corona virus disease 2019
(COVID19) was reported in Wuhan, China, during an outbreak of viral pneumonia. An initially
it was regional epidemic and now expanded to a global pandemic affecting at least 309 countries
with significant morbidity and mortality.

Infectious diseases refer to diseases with medical symptoms and signs caused by growing
pathogenic biological agents or infections in individuals/hosts/organisms, and are also called
infectious diseases or infectious diseases.

(1) The virus was identified as COVID19 (new corona virus), called Severe Acute Respiratory
Syndrome Coronavirus 2 (SARS-CoV-2), an enveloped single-stranded RNA virus that has the
same characteristics as SARS-COV-1 Similar phylogeny.

(2) The World Health Organization (WHO) has declared the corona virus outbreak (2019- 20) as
a public health emergency of international concern (PHEIC) on 30th January 2020 and a
pandemic on 11th March 2020.

(3) The WHO has also prepared guidelines to fight corona virus by introducing eight pillars of
support:

1. Country level coordination, planning and monitoring

2. Risk communication and community engagement

3. Surveillance, rapid response teams and case investigations

4. Points of entry

5. National laboratories

6. Infection prevention and control

7. Case management

8. Operational support and logistics

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Although many details of the emergence of the virus (such as its origin and ability to spread
between humans) are still unknown, it seems that human-tohuman transmission is causing more
and more cases. In view of the outbreak of severe acute respiratory syndrome corona virus
(SARSCoV) in 2002 and the outbreak of Middle East respiratory syndrome coronavirus (MERS-
CoV) in 2012, 2019- nCoV is the third occurrence of humans in the past two decades
Coronavirus. This puts global public health institutions on high alert

In India total 2,967,844 Cases of COVID-19 have been reported, including 56,202 Deaths as of
2nd August 2020.

Public health supervision, field investigation, analysis, research, evaluation and contact. From
disease surveillance to field evaluation and policy formulation, Epidemiologists usually revolve
round collecting scientific and fitness records from the field, lookup or historic data, evaluation
of gathered data, and presentation of findings. The findings can be used to advance public fitness
initiatives or find out how illnesses originate, spread, and can be treated. Although people are
living longer and many illnesses are no longer harming humanity as they used to,
epidemiologists are nonetheless important. Epidemiologists play a crucial function in outbreak
control.

(6) China responded quickly by informing the World Health Organization (WHO) of the
outbreak and sharing sequence information with the international community after discovery of
the causative agent. The WHO responded rapidly by coordinating diagnostics development;
issuing guidance on patient monitoring, specimen collection, and treatment; and providing up-to
date information on the outbreak. Several countries in the region as well as the United States are
screening travelers from Wuhan for fever, aiming to detect 2019-nCoV cases before the virus
spreads further.

HISTORY OF COVID-19

2019, Chinese authorities had notified W.H.O of several cases of pneumonia of unknown
etiology. The outbreak was reported in a seafood wholesale market in Wuhan, China in
December last year, and 66% of employees showed symptoms. On January 20, Washington State
in the Northwest Pacific confirmed the first known case of COVID-19, and the person returned
from Wuhan on January 15.

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(7) The novel coronavirus was declared a public health emergency on January 30, and was
named COVID-19 on February 11, 2020.

(8) Kerala, India reported its first case of COVID-19 infection. On January 27, 2020, a 20-year-
old woman went to the emergency department of Thrissur General Hospital in Kerala. She had a
history of dry cough and sore throat one day. There is no history of fever, rhinitis or shortness of
breath. She revealed that due to the COVID19 outbreak there, she returned to Kerala from
Wuhan, China on January 23, 2020.

(9) In the first COVID-19 case reported in Rajasthan on March 2, 2020, a 69-yearold Italian
tourist among 23 tourists from Italy tested positive for COVID-19. (10) In Rajasthan on August
22, 2020 had a total of 67,954 cases with 933 deaths and 51,698 discharged.

SYMPTOMS OF COVID-19.

The first people infected with COVID-19 are related to animal and seafood markets. This fact
indicates that animals initially transmitted the virus to humans. However, people with newer
diagnoses have no relationship or contact with the market, thus confirming that people can
spread the virus to each other. There is currently little information about the virus. In the past,
respiratory diseases caused by coronaviruses (such as SARS and MERS) have been spread
through close contact. Common symptoms include

1. Fever

2. Breathlessness

3. Cough

4. It may take 2–14 days for a person to notice symptoms after infection

5. Expectoration

6. Myalgia

7. Loss of smell (anosmia) or loss of taste (ageusia)

The Director-General also pointed out that the risk of serious complications increases with age.
According to WHO. Severity grades the percentage of people with COVID-19 is mild disease,
from which a person can recover more than 80% of serious diseases, causing breathing
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difficulties and pneumonia. About 14% of serious diseases, including septic shock, respiratory
failure and More than one diseased organ about 5% fatal disease 2%.

(12) According to M.O.H.F.W. In India, the most common sign and symptoms of COVID-19.
Positive patients experience fever, Body-ache, fatigue, weakness, a dry cough and some patients
have a history of pain, nasal congestion, diarrhea, sore throat, or runny nose. These symptoms
are usually moderate and started regularly. Some people become infected, but they do not have
any symptoms and do not feel bad. Most people (about 80%) recover without any special
treatment. About 1 in 6 people who develop COVID-19 will become seriously ill and have
trouble breathing. Older people and those with underlying health problems, such as high
diabetes, heart problems or blood pressure, are more likely to develop serious illnesses. People
with a fever, cough, and shortness of breath should seek medical attention. (13) Corona Virus

SPREAD FOLLOWING WAYS:

Coughing and sneezing without covering the mouth can disperse droplets into the air. Touching
or shaking hands with a person who has the virus can pass the virus between individuals. Making
contact with a surface or object that has the virus and then touching the eyes, nose or mouth.
Some animal coronaviruses, such as feline coronavirus, may spread through contact with faces.
However, it is unclear whether this also applies to human corona viruses.

The National Institutes of Health (NIH) suggest that several groups of people have the highest
risk of developing complications due to COVID-19. These groups include: People aged 65 years
or older, Young children, Women who are pregnant Coronaviruses will infect most people at
some time during their lifetime. Coronaviruses can mutate effectively, which makes them so
contagious. To prevent transmission, people should stay at home and rest while symptoms are
active. They should also avoid close contact with other people. Covering the mouth and nose
with a tissue or handkerchief while coughing or sneezing can also help prevent transmission. It is
important to dispose of any tissues after use and maintain hygiene around the home.

ROLE OF EPIDEMIOLOGIST IN DISEASE OUTBREAK

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Epidemiology is art of science in which we study distribution (frequency and pattern) and
determinants of health related events in populations and the use of this study in the prevention
and control of health problems. At the time of outbreak of any health related problems,
Epidemiologists are actively engaged, and use epidemiological method to find out the cause of
outbreak. Once an understanding has been reached that an assessment should be carried out
before or generally at the same time as emergency operations, the role of the epidemiologist is
collection of useful data from a field, analyses and summaries complex epidemiological data for
making various policies to control and prevent health problems. Epidemiologists are front line
health worker in every pandemic situation. Epidemiologists give active participation in public
health policy making. Responsibilities for Epidemiologist

 Identify health problems in an affected community

 Find out origin and a mode of the transmission of disease.
 Obtained data from disease survey clinical study ,Interview study
 Analyze complex epidemiological data and find out conclusions.
 Creates a plan of action for stop health crises in population
 Create reports detailing various component of disease.
 Presenting epidemiological data for policy making.
 Communicates with policy makers on public health.
 Manage multiple roles in a project at once.
 Create various public health awareness programs and supervise them.
 Conducting various studies to gain more information regarding health problems.

ROLE OF WHO DURING COVID-19 AND MEASURES TO BE TAKEN

Epidemiologist Following Step for Disease Outbreak

Epidemiologist is a backbone of investigation of a disease outbreak. The main objective of

investigation a disease outbreak is

1. Define the outbreak in the term of time place and person.

2. Line list responsible factors for origin of disease.

3. Find out cause, source, and various modes of transmission of a disease.

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4. Make recommendation to prevent disease recurrence.

In investigation main aim is find out the correct cause of morbidity and mortality in specified
population and implement its appropriate disease control to reduce and prevent mortality.

According CDC Applied Epidemiologists approach the investigation of a disease outbreak

using the following 12 steps:

Step1.Prepare for field work

Preparing for the field work is totally depended on epidemiologists. He can decide to conduct a
field investigation before conforming increase in cases or after conforming increase in cases.
Most of time epidemiologists discover that increase of number of a particular disease in a
specified population then they decide to go in a field. According to CDC field preparation can be
divided into 2 categories.

1. Scientific issue

2. Management and operational issue.

Step 2. Establish the existence of an outbreak

This is 2nd step of outbreak investigation. In this step epidemiologist compare disease frequency
with available data of the corresponding period of past 2-3 years. The applied epidemiologist
must compare local and regional disease patterns and prevalence prior to the increased cluster of
cases at the outbreak site. The applied epidemiologist asks: Is this a real outbreak?

Step 3. Verify the diagnosis

This step is closely linked with existence of disease. To verify the diagnosis epidemiologist can
use this three investigation method.

1. Medical Investigation

2. Laboratory investigation

3. Epidemiological investigation

With the help of clinician, disaster response team, laboratory testing result, survey findings
epidemiologist scientifically collect all evidence to prove disease outbreak in a population.

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Epidemiologist will look into epidemiological and environmental aspect of outbreak. Basic aim
is identify the source of problem.

Step 4. Define and identify cases

It is a standard criterion for deciding that an individual should be classified as having the health
condition of interest. The applied epidemiologist, again, working with team members and and
local public health officials set about trying to identify all individuals who “fit” the case
definition. Epidemiologist conduct descriptive epidemiologic studies the disease outbreak in
terms of person, time and place.

Step 5: Find cases systematically and record information;

Epidemiologist design an epidemiological case sheet to collect relevant information like(name,

age ,sex ,occupation, social class, travel history, sign and symptoms of illness ,personal contact
at home, work, school, and other place. special events .former medical history and many more.
Demographic data, clinical information, and risk factor information along with other pertinent
data. These data are, then, assembled in a way that helps describe the disease cluster and how it
moved through the specific population.

Step 6- perform descriptive epidemiology:

Collecting and identify basic information of the person with disease in this steps epidemiologist
define outbreak in time, place, and person. This steps help epidemiologist to find out following
things; Compressive characteristic of the outbreak. Identify population at risk for the disease.
Provide basic clues about etiology and mode of transmission.

Step 7. Develop hypotheses

The applied epidemiologist uses the knowledge and expertise in hypothesis generation to posit a
working hypothesis for the disease outbreak given the available data from Steps 2 thru 5.

Step 8. Evaluate hypotheses epidemiologically

At this step, the applied epidemiologist uses available data (mainly from Step 5) to statistically
evaluate the working hypothesis (calculating and evaluating rates, discussed above) along with

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evaluating the tentative data and conclusions with other public health personnel on‐site to
establish face validity.

Step 9. Refine hypotheses and carry out additional studies

Additional data are still coming in to the applied epidemiologist from the impacted community.
This additional data are further evaluated to determine if the “new” data and the related
conclusions comport with the earlier conclusions in Step 7. If not, the working hypothesis would
need to be refined.

Step 10 Compare and reconcile with lab and environmental studies

The epidemiologist playing major role. Epidemiology can suggest vehicles and guide appropriate
public health actions, while laboratory evidence can confirm findings.

Step11 Implement control and prevention measures.

Once the working hypothesis has been confirmed, the applied epidemiologist, again working
with local public health personnel, develop and deploy appropriate disease control measures.
These basic disease control measures were previously discussed in the response at Lecture 3,
Item 11 (above). The disease control measures must be implemented and assessed to confirm
effectiveness in arresting the disease.

Step 12. Communicate findings

For the applied epidemiologist, “the investigation is not complete until the results are
disseminated to the appropriate parties” (Gerstman, 2003, p. 363). The applied epidemiologist
must deliver an oral report to local officials summarizing the above steps; this oral briefing
should be in “plaiblanguage” and present the main findings of the outbreak investigation. A
scientific report must, also, be prepared to document the initial activities, interim actions, final
actions taken, and any recommendation for local public health officials to consider following the
outbreak investigation (CDC, 2006).

DISEASE SURVEILLANCE

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The important information in disease surveillance are - who many gets the disease, how many
get the disease, where did they get the disease, why did they get the disease, and what needs to
be done as public health response.

The components of the surveillance activity are:

(a) Collection of data

(b) Compilation of data

(c) Analysis and interpretation

(d) Follow-up action

(e) Feedback.

The epidemiologist ensures proper data collection, which is one of the stages of disease
surveillance. Other steps include reporting, data collection, data analysis, evaluation, and action.

The collected samples are sent to COVID-19 laboratories for analysis, then tested, and then
efforts are made to isolate the patient if positive. Disease monitoring is the continuous scrutiny of
occurrences of health events that allow for timely response in its control and serves as an
effective way to control disease. Disease surveillance also means looking out for new and
emerging diseases and an example is “Mad Cow disease” in the 1980s”.

(17) Disease surveillance has been recognized as an effective disease prevention and control
strategy, in particular for diseases that are prone to epidemics. Disease surveillance is the first
link in the response to emerging infections such as COVID-19. Disease surveillance includes an
epidemiologist, a public health laboratory, and a healthcare system that includes 4 core
components: namely collection, analysis, dissemination and response.

(18) FIELD INVESTIGATION

Surveillance provides the information needed to operate. After the observation, the
epidemiologist conducts an investigation. Field studies are the means by which data is pushed
into action, the primary function of epidemiologists who conduct research in others to identify
disease causes and risk factors. This may be the identification of the patient's travel history, the
treatment plan to date, and the identification of contacts with the patient. It is invaluable to

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understand community values and the vocabulary they used to identify health and disease. (19)
Fields experience from previous outbreaks helps the epidemiologist recognize the data that is
most critical in identifying threats and planning and evaluating strategies for a specific situation.
Field studies help to understand the prevalence of diseases, especially new diseases, and are
often carried out in response to serious public health problems.

(20) COMMUNICATING

As health communicators, we can help by delivering reliable information to the public accurately
and in a timely manner, so that people can make decisions based on facts instead of rumors. Part
of the reason is to be aware of any inaccurate information that peoples may share on social media
or elsewhere. We can also be careful not to exaggerate the facts, but instead focus on helping
people understand their personal health risks and what measures should be taken to control the
spread of diseases.

 Who is at the greatest health risk?

 When does this information apply to them?

 What actions can they take?

Public health information epidemiologists and other public health professionals have played an
active role in disseminating public health information provided by surveillance and health
information to public health care providers and decision makers. (21) This is important because
effective communication is a means for epidemiologists to influence policy, and there is an
increasing need for epidemiologists to influence the public when designing, interpreting and
reporting their work. Communication about increased exposure prompts outbreak investigation.

(22) CONTACT-TRACING

1. Contact identification

For all cases that meet the criteria/surveillance cases, contact identification is an important part
of the epidemiological investigation Definition of Covid-19. These cases are classified as
suspicious, probable and confirmed.

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The epidemiologist conducting the epidemiological study should complete the case inquiry
forms for all Covid-19 cases that meet the standard / surveillance case definition. After
completing the inquiry form, the epidemiologist should systematically identify potential contacts.
Contact identification therefore starts with the case. The contacts are identified by asking for
activities related to the case and activities and roles of those around the case (living / deceased)
from the onset of the disease. Although some information may be obtained from the patient,
much of it will come from those close to the patient. IN In some cases, the patient will die or has
already been admitted to a restricted isolation unit. It is an epidemiologist's visit to the patient's
home is mandatory. The following information you should get:

All persons who lived with the case (alive / deceased) in the same household from the onset of
the disease. All persons who visited the patient (alive / deceased) at home or in a medical facility
from the onset of the disease. All places and people visited by the patient from the beginning of
the disease, e.g. hospitals, clinics, traditional healer, temple, relatives, etc.

All these places and people should be visited and contacts identified. During the home visit, the
contact identification / follow-up teams should inquire about who may have been exposed patient
(alive / dead) but not identified and listed as a contact for the above process. They should be
given priority high-risk contact categories, people who in the last 14 days.

2. Contact listing

All persons considered having significant exposure (belonging to the categories described
above) should be listed as contacts, using the contact form. Efforts should be made to physically
identify and inform each contact listed their contact status, what those means, the activities that
will follow, and the importance of early care if they develop symptoms. Contacts should also be
provided with preventive information to reduce the risk of human exposure near them. Stay
home and limit close contact with other people. Avoid crowded places, socializing, and using
public transport. Report any suspicious signs and symptoms such as fever, cold, cough, and
difficulty breathing immediately (please tell phone numbers for the contact team, supervisor or
Covid-19 hot line / call center)

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3. Contact follow-up

The epidemiologist / supervisor / contact tracing physician should assemble a competent team
involving local supervision and FLW (ASHA, AWW, ANM & Supervisors) to track all contacts
listed. An effective contact tracing system depends on trust with the community, which in turn
favors the optimum cooperation. Communities should ensure they are collaborating with tracking
teams and allowing targeting symptomatic contacts with designated isolates. Involvement of
relevant community members (especially local leader) in tracking contacts is crucial in
cultivating good relationships, trust and confidence. Local supervision FLWs (ASHA, AWW,
ANM and supervisors) should be involved as early as possible in the response. Local
surveillance staff and FLW are closely supervised by trained epidemiologists.

RIGHTS, ROLES AND RESPONSIBILITIES OF HEALTH WORKERS, INCLUDING OCCUPATIONAL

SAFETY AND HEALTH

Health workers are at the front line of any outbreak response and as such are exposed to hazards
that put them at risk of infection with an outbreak pathogen (in this case COVID-19). Hazards
include pathogen exposure, long working hours, psychological distress, fatigue, occupational
burnout, stigma, and physical and psychological violence. This document highlights the rights
and responsibilities of health workers, including specific measures needed to protect
occupational safety and health.

Health worker rights include that employers and managers in health facilities:

• Assume overall responsibility to ensure that all necessary preventive and protective measures
are taken to minimize occupational safety and health risks 1;

• Provide information, instruction and training on occupational safety and health, including;

1. Refresher training on infection prevention and control (IPC); and

2. Use, putting on, taking off and disposal of personal protective equipment (PPE);

1
Including implementation of occupational safety and health management systems to identify hazards and assess
risks to health and safety; infection prevention and control (IPC) measures; zero-tolerance policies towards
workplace violence and harassment.

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• Provide adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap
and water, cleaning supplies) in sufficient quantity to healthcare or other staff caring for
suspected or confirmed. COVID-19 patients, such that workers do not incur expenses for
occupational safety and health requirements;

• familiarize personnel with technical updates on COVID-19 and provide appropriate tools to
assess, triage, test and treat patients and to share infection prevention and control information
with patients and the public;

• As needed, provide with appropriate security measures for personal safety;

• provide a blame-free environment for workers to report on incidents, such as exposures to

blood or bodily fluids from the respiratory system or to cases of violence, and to adopt measures
for immediate follow up, including support to victims;

• advise workers on self-assessment, symptom reporting and staying home when ill; • maintain
appropriate working hours with breaks;

• consult with health workers on occupational safety and health aspects of their work and notify
the labor inspectorate of cases of occupational diseases;

• Not be required to return to a work situation where there is continuing or serious danger to life
or health, until the employer has taken any necessary remedial action;

• Allow workers to exercise the right to remove themselves from a work situation that they have
reasonable justification to believe presents an imminent and serious danger to their life or health.
When a health worker exercises this right, they shall be protected from any undue consequences;

• Honor the right to compensation, rehabilitation and curative services if infected with COVID-
19 following exposure in the workplace. This would be considered occupational exposure and
resulting illness would be considered an occupational disease,

• provide access to mental health and counselling resources; and

• enable co-operation between management and workers and/or their representatives.

Health workers should:

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• follow established occupational safety and health procedures, avoid exposing others to health
and safety risks and participate in employer-provided occupational safety and health training;

• Use provided protocols to assess, triage and treat patients;

• treat patients with respect, compassion and dignity;

• maintain patient confidentiality; • swiftly follow established public health reporting procedures
of suspect and confirmed cases;

• provide or reinforce accurate infection prevention and control and public health information,
including concerned people who have neither symptoms nor risk;

• put on, use, take off and dispose of personal protective equipment properly;

• self-monitor for signs of illness and self-isolate or report illness to managers, if it occurs;

• advise management if they are experiencing signs of undue stress or mental health challenges
that require support interventions; and

• report to their immediate supervisor any situation which they have reasonable justification to
believe presents an imminent and serious danger to life or health.

NOTE FOR POLICY MAKERS

In the current situation, the policy makers are working on several policies related to prevention,
treatment and containment of COVID-19. The pandemic has demonstrated beyond doubt that
policy making is an acutely dynamic process during a crisis and the dissemination of information
happens in real time. Advances in technology have made this task easier for policy makers.
Despite the dynamic nature of policy making, the broad framework involves the established
aspects of care during disasters and after.

One important aspect that the policy makers need to be “mindful” about is the mental health of
people, certain areas that need attention currently are enumerated below:

For the community: ·

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  The mental health professional associations and other related institutions should assemble
experts with expertise in post-disaster psychological crisis intervention, to frame
guidelines and provide technical guidance and emergency psychological crisis
intervention under the coordination of the government's health authority ·
 Psychological crisis intervention should be integrated into the overall system of pandemic
prevention and control, with the premise of reducing potential psychological damage
caused by the pandemic and promoting social stability. ·
 Psychological crisis interventions for the high-risk population and mental health
education for the general population must be planned and operationalized. Helplines are
lifelines in such situations. A good control room with ready answers for FAQs is a must
for running such helplines.

For persons with mental illness: ·

 The management and treatment of severe mental disorders should not be interrupted as
far as possible and emergency care services must remain functional and be bolstered to
handle additional influx of patients anticipated during the situation; the management and
community care of at-home patients with severe mental disorders should be ensured
through liaison existing community outreach programs, like the district mental health
program (DMHP)
 The mentally ill patients may be highly susceptible, considering their poor awareness and poor
general health condition. Institutions where severely mentally ill are admitted need to take
measures such as:
i) Provide adequate medical supplies
ii) Educate these patients about basic preventive measures like hand sanitization, maintaining
physical distance
iii) Reduce visitors to the hospital
iv)Monitoring temperature regularly
v) Avoid group interactive activities
vi) Create isolation wards for infected patients to be shifted

ALCOHOL POLICIES:

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Substance use disorders treatment services need to continued uninterruptedly, there need to be
community outreach programmes in which the mental health team can provide timely intervention to this
group

SOCIAL CONCERNS AFFECTING MENTAL HEALTH:

Psychological intervention medical team can be formed as standalone team or be part of the general
medical team attending to patients affected by the pandemic. The staff should consist of psychiatrists,
with clinical psychologists and psychiatric nurses participating and the teams should formulate
interventions plans separately for different groups eg:

i) Confirmed cases who are hospitalized with severe symptoms

ii) Suspected cases and close contacts of confirmed cases

iii) Patients with mild symptoms who are in home quarantine

iv) Health care personnel working with COVID 19 patients

v) General public

 Understand the mental health status of various groups of the society affected by the pandemic.
Timely identification of high-risk groups especially those with prior mental health issues, are
essential to prevent extreme events such as suicide and other impulsive behavior
 Interventions should be based on a comprehensive assessment of risk factors leading to
psychological issues, including poor mental health before a crisis, bereavement, injury to
self or family members, life threatening circumstances, panic, separation from family and
low household income

TRAINING FOR MENTAL HEALTH PROFESSIONALS (MHPS):

 The mental health team also need to be aware of the various schemes or policies the
government has made in order to alleviate public anxiety about the pandemic and its
economic impact
 Telepsychiatry services should be emphasized upon and policies should be framed for the
same. Online training programmes in telepsychiatry for the mental health professionals
across the country need to be conducted, keeping in mind the framework that professional
bodies may have laid down

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  Online training sessions for the mental health professionals across the country should be
conducted regarding their role in this time of pandemic COVID-19
1. Documentation of all these activities is of paramount importance. Research
should be an essential component of all planned public mental health
interventions. This will ensure a better understanding about risk factors, patterns
of help seeking, treatment outcomes and costs of health care, specifically to the
Indian context.

MENTAL HEALTH ASSESSMENT OF COVID-19 PATIENT IN HEALTH CARE & COMMUNITY

SETTINGS

INTRODUCTION

COVID-19 pandemic has left in its wake an unprecedented challenge for mental health services
across the world. With almost all affected, mental health service delivery to address the
psychological consequences at the individual level has become near impossible. The existing
health services is at its break point to control the spread and reduce mortality of COVID-19.
Policy makers though aware of the mental health consequences are prioritizing capacity building
of the health services and attempting to reduce the socio-economic hardships of communities
following COVID-19. Front-line personnel including medical professionals however face the
daunting task of dealing with the distress and trauma of individuals, families and communities on
a daily basis. In addition, most have to deal with their own emotions and anxieties. The vast
majority of frontline personnel have limited mental health competencies. This chapter is a frame-
work for a simple mental health assessment by front-line personnel. The assessment may be
integrated into the health care response or frontline response to the COVID-19 pandemic. A few
theoretical concepts have been added to ensure a greater clarity for medical professionals.

Mental health issues noted in (biological) disaster zones including COVID-19 can be classified
into an acute phase during the outbreak (approximately 2-6 months) and long-term phase after
the control of the outbreak (>6 months). a) Acute Phase (during the outbreak) – Issues to be dealt
with include immediate mental health impacts such as fear, denial, anxiety, insomnia,
dissociative symptoms, depressive symptoms, suicidal ideas/attempts, substance withdrawal and
relapse of pre-existing mental health problems. Besides, stress related issues of the health care
providers and frontline personnel need to be addressed. b) Long-term phase (after the control of
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the outbreak) – Issues commonly presenting include grief, survivors guilt, depression, substance
use, relapses of pre-existing mental illness, PTSD, and somatization disorders. The major
stressor during this period will be the direct and the indirect socio-economic impact of COVID-
19. Along with the diagnosable mental health issues, the affected community also harbours a
large number of the worried well. Mental health professionals should be aware of this
phenomenon and restrain themselves from labelling this population with mental disorder and
treating them aggressively with medications (Please read the Section on Worried Well for more
details). In addition, all health care and frontline personnel should be aware that mental health
issues post-covid-19 (or any disaster), represent emotional reactions of normal people in
abnormal situations and for a majority these symptoms are self-limiting.

The assessment of mental health issues in this section will focus on the psychological issues in
the acute phase of the COVID-19 outbreak.

CASE FINDING

There are possibly three streams for case-detection/identification of mental health issues that
need to be focussed in the acute phase of COVID-19.

1. Case Identification by front-line medical and non-medical personnel (including police officers,
Members of Local Self Government, Community/health workers) - Points of entry into the
country/state –Airport/Railway Station/State borders etc. - Home quarantine visits - Other
Medical Emergencies

2. Case Identification by health care professionals (non-psychiatric) - Hospital

quarantine/isolation - Routine out-patient assessment for other illness

3. Self-referral/Walk-ins to mental health professionals

4. Identification of frontline medical and non-medical personnel in need of help/support for

stress management or burnout

5. Screening of the high-risk (vulnerable) population once Community Transmission is

established

Who are the most Vulnerable?

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· Children

· Senior citizens

· Pregnant women

· Persons with disability

MENTAL HEALTH ISSUES OF HOME QUARANTINE

Quarantine is defined as the separation of people who have been exposed to a contagious disease
to ascertain whether they become sick, thereby reducing the risk of them infecting others.
Isolation, in contrast, is where a person diagnosed to have a contagious disease is separated from
the general population to avoid transmission of the disease to healthy people.

Social distancing is another term that has acquired prominence recently in the context of the
COVID-19 pandemic. Social distancing refers to certain measures taken to stop or slow down
the spread of highly contagious diseases which include limiting large groups of people coming
together, closing down public buildings such as schools, universities, canceling public events,
etc. Presently governments across the world and in India are using a combination of these
measures to stop the spread of the COVID-19 pandemic.

While considered essential under the present circumstances, quarantine can be a taxing and
distressing experience for many. Based on studies from previous epidemics/ pandemics we shall
identify some of the mental health concerns which people in quarantine face and propose
solutions/remedial measures for the same. It must be acknowledged at the outset that we could
not find any intervention studies which have examined the effectiveness of the various remedial
measures. Rather, these measures are proposed based on the problems people in quarantine had
faced in previous epidemics.

Counselling for home quarantined using telephone helplines and telepsychiatry

For subjects in home quarantine, supportive counselling can be provided by telephone helplines
and telepsychiatry platforms. These have an important advantage over face to face counselling,
as they provide specialist services, which can be accessed from the convenience of peoples'
homes without endangering the health personnel and the larger community.

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CONCLUSION

Fighting outbreaks like the new coronavirus requires teamwork between different health
professionals and other sectors. Epidemiologists play a pivotal role in the event of outbreaks,
especially new ones. This is because they are on the front line, identifying likely cases and
contacts for those cases, using available data to determine the best policy, and determining the
impact of these policies. This is done using data that is essential in the fight against epidemics.
With this data, epidemiologists act as a basis for health professionals in the event of an outbreak,
collaborating with other sectors. While the impact of very low levels of toxic pollutants on large
populations is unknown, action needs to be taken now to protect future public health. The threats
of groundwater contamination require a serious preventive policy. According to a number of
assessments, the significant risk of groundwater contamination is not prevented by current
remediation practices. It should be considered that if exposure becomes general and nearly
uniform due to groundwater contamination, current epidemiological techniques may not be able
to identify any related health effects.

BIBLIOGRAPHY:

ARTICLES

1. “SPOTLIGHT ON INDIA’S ENTERTAINMENT ECONOMY” BY JOHN NENDICK.

2. “MENTAL HEALTH IN THE TIMES OF COVID-19 PANDEMIC” BY DEPARTMENT OF PSYCHIATRY.

3. MENTAL HEALTH AND PSYCHOSOCIAL CONSIDERATIONS DURING THE COVID-19 OUTBREAK BY

WORLD HEALTH ORGANIZATION.

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