Inculcate Social Distancing to Combat Coronavirus Outbreak
Compiled & Shared by-Dr. Rajesh kr singh, Livestock consultant, Jamshedpur, Jharkhand,9431309542
rajeshsinghvet@gmail.com
The COVID-19 outbreak is an emerging, rapidly evolving situation for which social distancing measures may be justified and implemented as a core component of the response.WHO has already released the advisiory related to this.
Many cities have encouraged social distancing by banning large gatherings, encouraging telecommuting and closing schools. Govt.advised avoiding crowded public transportation if possible. Social activities are now discouraged, but what does social distancing mean for essential activities?
Social distancing measures are an important part of mitigating pandemic influenza. They complement individual approaches in decreasing the likelihood of its spread.
Objectives of social distancing measures —————
Social distancing aims, through a variety of means, to decrease or interrupt transmission of COVID-19 in a population (sub-)group by minimising contact between potentially infected individuals and healthy individuals, or between population groups with high rates of transmission and population groups with no or a low level of transmission. Community-level measures are needed when containment is no longer feasible in order to delay the peak of the epidemic and decrease the peak magnitude to protect healthcare capacity . There are several different types of social distancing measures , which can be categorised in ‘layers’ in ascending order. Each progressive layer of measures includes all measures from the previous layers.
Social distancing measures for pandemic influenza——–
1.Isolation of cases ——–
Confirmed or suspected cases of COVID19 are isolated, meaning either hospitalised (usually for moderate or severe cases) to provide care, or recommended to self-isolate at home (mild cases) • In a situation of widespread community transmission, a blanket recommendation for individuals with symptoms to stay home may be given • Isolation of cases can be voluntary or mandatory. • Separate sick from the healthy persons and provide appropriate care by trained personnel who should wear personal protective equipment (PPE)
2. Quarantine of contacts ————• Healthy person(s) who have had a high- or low-risk contact with a confirmed COVID19 case, according to the investigation • Quarantine of cases can be voluntary or mandatory • Usually recommended to self-quarantine in a safe area or at home, and self-monitor for appearance of COVID-19-compatible symptoms; if symptoms are detected, a test may be carried out promptly • Rationale includes prompt diagnosis and separation from other healthy persons to avoid transmission, even during asymptomatic or subclinical phases of the disease
3. Stay-at-home recommendations—————– • Blanket recommendation for the public to stay at home and avoid mass gatherings and close contact with persons, particularly targeting the known high-risk groups • Recommendations for voluntary social distancing of persons, particularly the high-risk groups, in order to reduce transmission, avoid increased morbidity, and thereby decrease the pressure to the health system
4. Closure of educational institutions ———–• Schools (including day care centres, kindergartens, primary and secondary schools) • Closure of higher educational institutions (including universities, research institutes, etc.) • Preventing contact among children is a known prevention measure in influenza outbreaks and pandemics • Universities and other educational institutions are also areas where large numbers of people congregate in confined spaces • In studies of influenza outbreaks, both measures usually have the biggest effect when applied early in the transmission phase and when they last until the circulation of the pathogen decreases (i.e. after several weeks) • Need to also prevent meeting/gathering of youths outside school in order to ensure effectiveness
.Proactive school closure ——–The objective of proactive school closure is to reduce influenza transmission among children as they are at greater risk of transmission and more susceptible to most respiratory viral infections than adults. It also may be more feasible than some other interventions (e.g. closing all workplaces). Proactive school closure appears to be moderately effective in reducing the transmission of influenza, with studies suggesting that school closure reduces transmission of influenza by up to 50%, delays the epidemic peak by a week or two (depending on the timing of the closure) and attenuates epidemic waves. School closure may be acceptable to a large proportion of the population but only for a limited period. Practical implementation of school closure needs to take into account the objectives of the closure and the legal framework by which it can be enacted, which can vary between jurisdictions. For a short-duration closure, it is relatively more effective to close after a longish delay from the first day of infection; for long-duration closure, it is better to initiate closure as soon as possible.
.Reactive school closure ——As with proactive school closure, the objective of reactive school closure is to reduce influenza transmission among children in school settings. Its effectiveness varies, but has generally been found to be moderately effective overall. As with proactive school closures, the indirect economic and social impacts of reactive school closure are likely to be massive, but reduced in scale commensurate with the number of schools closed. Similar primary and secondary impacts would be expected. The secondary effects of reactive closure are likely to be much less than proactive closure because reactive closure requires detection in a school before closure and thus does not occur across all schools at once, in turn affecting a smaller proportion of households. This means that reactive closure would affect relatively few schools, particularly when the incidence is low. When used as a sole intervention, limited school closure was found to be significantly more cost-effective compared to continuous school closure.
5. Workplace closure——– The objective of workplace closure is to reduce transmission of influenza following introduction of the virus into workplace settings. Proactive workplace closure is not considered as a measure due to the difficulties obtaining evidence of certainty of transmission, but reactive closure is worth considering after introduction of the virus, especially in parallel with local school closures. An intermediate step would be to temporarily minimise or eliminate meetings in the workplace to reduce transmission. some businesses would need to increase operations in a pandemic (e.g. medical supplies) while being forced to have reduced outputs due to staff absenteeism. Workplace closure is likely to be acceptable to employees, particularly if they are sufficiently compensated, but not acceptable to business owners unless there was some form of compensation for them also. The timing of workplace closures is most effective when it takes place at the same time as school closures.
6. Working from home——- The objective of home working is to allow employees who may or may not be infectious to work from home and thus reduce transmission outside the home. Working from home is potentially moderately effective in reducing transmission of influenza. In a trial conducted in Japan, a workplace policy of being able to remain at home on full pay was shown to reduce the overall risk of infection with the 2009 pandemic influenza by about 20%, and a United States study suggests that teleworking when a family member is affected may reduce the risk of acquisition of severe influenza symptoms among employees by about 30%.Working from home is likely to be highly acceptable, especially on a full-pay policy and where computing technology already exists and should be considered during the ‘initial action’ stage and onward.
7.. Voluntary isolation of cases ———-
The objective of voluntary isolation of cases is to reduce transmission by reducing contact between infectious cases and uninfected people.The few modelling studies that have attempted to measure the impact of isolation of affected cases at home (e.g. in Japan39 and Mexico40) suggest that its overall effectiveness is moderate, but may be particularly useful where access to antiviral resources is limited.
Consideration may need to be given to support mechanisms such as financial, social, physical, and other needs of the patient and caregivers, if voluntary home isolation of infected cases is used to limit the spread of influenza in the community during a pandemic. An important practical issue is to precisely define the isolation period. The current standard period for isolation in Australia is 14 days, or until resolution of the fever (if that period is longer). Selfisolation should be considered during the Initial Action stage and onward.
8. Voluntary quarantine of contacts—— The aim of isolating household contacts (i.e. quarantine) is to reduce transmission of influenza through seclusion of individuals with potential infection in the home.
Modelling studies show that isolation of household contacts of index cases is moderately effective in reducing the peak case load and in delaying the peak of a pandemic.
Home isolation of direct contacts of index cases could result in a substantial number of people being absent from work, leading to major economic loss for individuals, businesses and the community.Home isolation of contacts who share the same facilities as index cases significantly increases the risk of acquiring the infection among the contacts, with consequent disruptions to work and society. Since those affected by isolation and quarantine are likely to report distress due to fear and risk perceptions, consideration should be given to support their psychological, financial, social, physical and other needs. It is particularly important to consider that contacts remain highly susceptible to acquiring the infection from the index cases if they are quarantined in the same rooms and share the same facilities. Quarantining of household contacts should be considered during the Initial Action stage and onward.
9. Cancellation of mass gatherings ———The objective of cancelling mass gatherings is to reduce transmission of influenza by limiting the number of potentially ill contacts that an individual is exposed to. It also reduces the chance of developing illness away from home. Certain types of mass gatherings may be particularly associated with magnified risk of transmission of influenza, with key factors being event duration, degree of crowding, type of venue, and event timing in relation to the period either side of the epidemic peak. The public should be encouraged to avoid mass gatherings during an epidemic or pandemic but the evidence is not strong enough to advocate legislation or proscription to cancel events. There is some evidence that it is possible to safely organise a mass gathering in the midst of pandemic influenza by taking rigorous control measures. The public may be prepared for cancellation of mass gathering,but acceptability would vary depending on the type and significance of the gathering.
10. Measures for special populations ————-Measures to limit outside visitors and limit the contact between the inmates/patients in confined settings, such as: • Long-term care facilities, either for the elderly or persons with special needs • Psychiatric institutions • Homeless shelters • Prisons • These institutions house a large percent of people in high-risk groups for severe disease and poor outcome, are often are densely populated, and outbreaks of COVID-19 can lead to significant morbidity and mortality • Measures should be applied early in the outbreak and should be continued until the circulation of COVID-19 decreases in the community.
• Cultural events (theatres, cinemas, concerts, etc.) • Sporting events (football, indoor and outdoor athletic games, marathon runs etc.) • Festivals, faith-based events • Conferences, meetings, trade fairs, etc. • The aim is to avoid transmission among large numbers of people in confined spaces • For some events – even though they may be conducted outdoors (e.g. football matches) –, attendees may be in close contact on public transportation, at the entrance and exit, etc.
11. Cordon sanitaire/mandatory quarantine of a building or residential area(s) ————• Refers to the quarantine and closing off of a building or whole residential area (city, region, etc.) • Aims at limiting the contact between hightransmission areas and those with no or low levels of transmission • This measure implies that the measures above (e.g. school and higher education closures, cancellations of mass gatherings) are also implemented in order to maximise social distancing within the cordon sanitaire.
When to initiate and end social distancing measures—————
Due to the relatively high transmissibility of COVID-19 and the limited effectiveness of most social distancing measures, the impact of such measures on the peak magnitude of the epidemic and the potential delay of the peak depends on how early the measures are taken in the context of the local epidemiological situation. Observational and modelling evidence from past pandemics (e.g. influenza pandemics) and from the experiences with COVID-19 in China indicates that the early, decisive, rapid, coordinated and comprehensive implementation of social distancing measures are likely to be more effective in slowing the spread of the virus than delayed actions : it is estimated that if a range of non-pharmaceutical interventions, including social distancing, had been conducted one week, two weeks, or three weeks earlier in China, the number of cases could have been reduced by 66%, 86%, and 95%, respectively, together with significantly reducing the number of affected areas . There is no one-size-fits-all method of deciding on the best time to enact social distancing measures. In an epidemiological situation between scenario (localised outbreaks, which start to merge, becoming indistinct) and scenario (widespread sustained transmission of COVID-19) , the detection of COVID-19 cases and/or deaths outside of known chains of transmission provides a signal that social distancing measures should be implemented. In addition, data support the simultaneous implementation of several layers of social distancing at once, rather than one by one. As a means of facilitating public acceptance of the measures, it is important that an anticipated end-date is established, but it should also be made clear to the population that this could be extended if circumstances require it. It is also important to plan for, and to communicate to the public, the possibility that social distancing measures could be re-imposed if there is a future wave of transmission.
