How the largest slum in India flattened the COVID curve? A Case Study

Mumbai-The economic capital of India, shrivelled with panic as its infamous slum ‘Dharavi’ recorded its first positive case of COVID-19 on 1st April 2020. Dharavi is the largest slum in India and one of the most densely populated areas in the world. Its narrow lanes, teeming with people and chock-a-block with settlements, make physical distancing practically impossible- posing as an excellent breeding ground for the deadly virus. However, with a policy of ‘chasing the virus’ based on strategy of ‘Tracing Tracking Testing and Treating’ Dharavi flattened its epidemic curve within a hundred days. This was achieved through the immediate public health response with strict containment measures, aggressive active and passive surveillance and integration of resources from government and private sectors to provide essential services. In this paper, we have summarized the ongoing measures for successful prevention and control of COVID-19 in Dharavi, which could provide useful learning for other similar settings worldwide.   Conflicts of interest: None declared.   Acknowledgments: To the health staff and officers of Brihan Mumbai Corporation.   Author Contributions: MS conceptualized the idea and wrote the first draft; MD & MS reviewed and edited the final version. All authors have read and agreed to the published version of the manuscript

How the Kurnool district in Andhra Pradesh, India, fought Corona

Background: Kurnool, one of the four districts in the Rayalaseema region of the Indian state of Andhra Pradesh, emerged as a COVID-19 hotspot by mid-April 2020. Method: The authors compiled the publicly available information on different public health measures in Kurnool district and related them to the progression of COVID-19 from March to May 2020. Results: Two surges in pandemic progression of COVID-19 were recorded in Kurnool. The ini-tial upsurge in cases was attributed to return of people from other Indian states, along with return of participants of a religious congregation in Delhi, followed by in-migration of workers and truckers from other states and other districts of Andhra Pradesh, particularly from the state of Maharashtra (one of the worst affected states in India) and Chennai (the Koyambedu wholesale market - epicenter of the largest cluster of COVID-19 in Tamil Nadu). In a quick response to surging infections the state government launched operation ‘Kurnool Fights Corona’ to contain the outbreak. Kurnool had taken a targeted approach to testing, scaled up testing in areas with high case load, and conducted contact tracing for each positive case, along with requisitioning oxygenated beds in the district hospitals to meet the anticipated spurt in the number of positive cases. This combined approach paid rich dividends and from 26th April to May 9th, the growth curve flattened. Conclusion: Although the in migration of laborers and return of residents from other Indian states and abroad during the COVID-19 pandemic was a complex challenge, the timely actions of testing, tracing and isolation conducted by the district authorities in Kurnool greatly reduced transmission. Although this response assessment is based on a single district, the perspectives have revealed some important lessons regarding risk communication, preparedness and response for pandemics which will facilitate consolidation of the policy and program response to pandem-ics in future. Acknowledgement: Dr Sanjoy Sadhukhan (Professor, AIIH&PH) and District Authorities of Kurnool for their support.Conflicts of interest: None

How the Kurnool district in Andhra Pradesh, India, fought Corona

Background: Kurnool, one of the four districts in the Rayalaseema region of the Indian state of Andhra Pradesh, emerged as a COVID-19 hotspot by mid-April 2020. Method: The authors compiled the publicly available information on different public health measures in Kurnool district and related them to the progression of COVID-19 from March to May 2020. Results: Two surges in pandemic progression of COVID-19 were recorded in Kurnool. The ini-tial upsurge in cases was attributed to return of people from other Indian states, along with return of participants of a religious congregation in Delhi, followed by in-migration of workers and truckers from other states and other districts of Andhra Pradesh, particularly from the state of Maharashtra (one of the worst affected states in India) and Chennai (the Koyambedu wholesale market - epicenter of the largest cluster of COVID-19 in Tamil Nadu). In a quick response to surging infections the state government launched operation ‘Kurnool Fights Corona’ to contain the outbreak. Kurnool had taken a targeted approach to testing, scaled up testing in areas with high case load, and conducted contact tracing for each positive case, along with requisitioning oxygenated beds in the district hospitals to meet the anticipated spurt in the number of positive cases. This combined approach paid rich dividends and from 26th April to May 9th, the growth curve flattened. Conclusion: Although the in migration of laborers and return of residents from other Indian states and abroad during the COVID-19 pandemic was a complex challenge, the timely actions of testing, tracing and isolation conducted by the district authorities in Kurnool greatly reduced transmission. Although this response assessment is based on a single district, the perspectives have revealed some important lessons regarding risk communication, preparedness and response for pandemics which will facilitate consolidation of the policy and program response to pandem-ics in future

How the largest slum in India flattened the COVID curve? A Case Study

Mumbai-The economic capital of India, shrivelled with panic as its infamous slum ‘Dharavi’ recorded its first positive case of COVID-19 on 1st April 2020. Dharavi is the largest slum in India and one of the most densely populated areas in the world. Its narrow lanes, teeming with people and chock-a-block with settlements, make physical distancing practically impossible- posing as an excellent breeding ground for the deadly virus. However, with a policy of ‘chasing the virus’ based on strategy of ‘Tracing Tracking Testing and Treating’ Dharavi flattened its epidemic curve within a hundred days. This was achieved through the immediate public health response with strict containment measures, aggressive active and passive surveillance and integration of resources from government and private sectors to provide essential services. In this paper, we have summarized the ongoing measures for successful prevention and control of COVID-19 in Dharavi, which could provide useful learning for other similar settings worldwide

A study on risk perception, cognitive awareness and emotional responses to identify unmet training needs of frontline health care workers for COVID-19 containment in India

Aim: Frontline Health Care Workers (FLHCWs) are the key workforce in the fight against ongoing COVID-19 pandemic. They hail from the community and are responsible for supporting the health system in generating awareness, implementing preventive strategies, contact tracing and isolating potential cases. In their job responsibilities, FLHCWs thus may perceive heightened risk of exposure to the virus, leading to overwhelming emotional response and psychological distress. The objective of this study was to investigate risk perception, cognitive awareness and emotional responses among FLHCWs trained to deal with Covid 19, to identify unmet needs of this training in India.   Methods: A cross-sectional study was conducted in a total of 131 frontline workers selected by a multistage sampling process from two states (Odisha and Himachal Pradesh) of India. The FLHCWs were interviewed personally (when feasible) with the help of a predesigned pretested semi-structured questionnaire.   Results: The findings suggested that majority (90%) of the FLHCWs perceived that they are susceptible to nCoV-19 infection and 77.1% of FLHCWs felt high probability of them getting infected with the nCoV-19. Almost 90% of them responded that it is something they think about all the time and 41% of FLHCWs admitted that they feel helpless in the situation. About 63% of FLHCWs perceived that the nCoV-19 infection was a severe illness and 35% perceived it to be very severe and life threatening. Although most of them had received some unstructured and non-uniform training on preventive measures against COVID-19, yet only 38% felt that the knowledge was adequate to protect themselves from the nCoV-19 infection. The training sessions lacked psychological component for capacitating them with coping skills to address their emotional and psychological responses.   Conclusion: The FLHCWs experienced heightened risk perception and symptoms of emotional distress in significant numbers even after trainings. A more inclusive public health policy dialogue to address the emotional and psychological coping skills is needed for capacitation of these frontline workers to address the challenges of Pandemic response now and in future.   Conflicts of interests: None declared.   Acknowledgments: We would like to thank all participants to our study, whose time is even more precious in this difficult situation for all the country, who participated

A study on risk perception, cognitive awareness and emotional responses to identify unmet training needs of frontline health care workers for COVID-19 containment in India

Aim: Frontline Health Care Workers (FLHCWs) are the key workforce in the fight against ongoing COVID-19 pandemic. They hail from the community and are responsible for supporting the health system in generating awareness, implementing preventive strategies, contact tracing and isolating potential cases. In their job responsibilities, FLHCWs thus may perceive heightened risk of exposure to the virus, leading to overwhelming emotional response and psychological distress. The objective of this study was to investigate risk perception, cognitive awareness and emotional responses among FLHCWs trained to deal with Covid 19, to identify unmet needs of this training in India.Methods: A cross-sectional study was conducted in a total of 131 frontline workers selected by a multistage sampling process from two states (Odisha and Himachal Pradesh) of India. The FLHCWs were interviewed personally (when feasible) with the help of a predesigned pretested semi-structured questionnaire.Results: The findings suggested that majority (90%) of the FLHCWs perceived that they are susceptible to nCoV-19 infection and 77.1% of FLHCWs felt high probability of them getting infected with the nCoV-19. Almost 90% of them responded that it is something they think about all the time and 41% of FLHCWs admitted that they feel helpless in the situation. About 63% of FLHCWs perceived that the nCoV-19 infection was a severe illness and 35% perceived it to be very severe and life threatening. Although most of them had received some unstructured and non-uniform training on preventive measures against COVID-19, yet only 38% felt that the knowledge was adequate to protect themselves from the nCoV-19 infection. The training sessions lacked psychological component for capacitating them with coping skills to address their emotional and psychological responses. Conclusion: The FLHCWs experienced heightened risk perception and symptoms of emotional distress in significant numbers even after trainings. A more inclusive public health policy dialogue to address the emotional and psychological coping skills is needed for capacitation of these frontline workers to address the challenges of Pandemic response now and in future

The Influence of Electromagnetic Field Pollution on Human Health: A Systematic Review

Objective: Recent technological advances have exponentially expanded globally; harbouring upon Electromagnetic fields (EMF). The utilization of Electromagnetic field has become universal from everyday usage of electronic appliances such as micro wave ovens, tablets and portable computers to telecommunication systems mobile phone towers, radio- television broadcast systems and electronic power transmission systems resulting in electromagnetic field and associated radiations. EMF can have biological effects on cell at microlevel and have the potential ability to cause cell dysfunction manifesting in various biological effects. This review tried to gather evidence from the existing literature about the biological effects of EMF on human health. Materials and Methods: We did extensive literature search using PubMed and Cochrane database using key words, “electromagnetic fields”, “Extremely low frequency electromagnetic fields (ELF-EMFs)”, “biological effects”, “health effects”, “public health”. We included 20 studies conducted from Dec 2009 to Dec 2019 in our systematic review. Data from each study was extracted by two independent researchers and discrepancies were resolved by consensus. Results: Significant biological effects of EMF exposure were reported on human health ranging from anxiety, depression, sleep disturbance, increased risk of Alzheimer’s disease and ALS (Amyotrophic Lateral Sclerosis), hypersensitivity to infertility and increased risk of multiple carcinomas. Conclusion: Application of preventive measures in order to minimize the exposure becomes the need of the hour especially so in occupational settings

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global, regional, and national burden of upper respiratory infections and otitis media, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021

Background: Upper respiratory infections (URIs) are the leading cause of acute disease incidence worldwide and contribute to a substantial health-care burden. Although acute otitis media is a common complication of URIs, the combined global burden of URIs and otitis media has not been studied comprehensively. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to explore the fatal and non-fatal burden of the two diseases across all age groups, including a granular analysis of children younger than 5 years, in 204 countries and territories from 1990 to 2021. Methods: Mortality due to URIs and otitis media was estimated with use of vital registration and sample-based vital registration data, which are used as inputs to the Cause of Death Ensemble model to separately model URIs and otitis media mortality by age and sex. Morbidity was modelled with a Bayesian meta-regression tool using data from published studies identified via systematic reviews, population-based survey data, and cause-specific URI and otitis media mortality estimates. Additionally, we assessed and compared the burden of otitis media as it relates to URIs and examined the collective burden and contributing risk factors of both diseases. Findings: The global number of new episodes of URIs was 12·8 billion (95% uncertainty interval 11·4 to 14·5) for all ages across males and females in 2021. The global all-age incidence rate of URIs decreased by 10·1% (–12·0 to –8·1) from 1990 to 2019. From 2019 to 2021, the global all-age incidence rate fell by 0·5% (–0·8 to –0·1). Globally, the incidence rate of URIs was 162 484·8 per 100 000 population (144 834·0 to 183 289·4) in 2021, a decrease of 10·5% (–12·4 to –8·4) from 1990, when the incidence rate was 181 552·5 per 100 000 population (160 827·4 to 206 214·7). The highest incidence rates of URIs were seen in children younger than 2 years in 2021, and the largest number of episodes was in children aged 5–9 years. The number of new episodes of otitis media globally for all ages was 391 million (292 to 525) in 2021. The global incidence rate of otitis media was 4958·9 per 100 000 (3705·4 to 6658·6) in 2021, a decrease of 16·3% (–18·1 to –14·0) from 1990, when the incidence rate was 5925·5 per 100 000 (4371·8 to 8097·9). The incidence rate of otitis media in 2021 was highest in children younger than 2 years, and the largest number of episodes was in children aged 2–4 years. The mortality rate of URIs in 2021 was 0·2 per 100 000 (0·1 to 0·5), a decrease of 64·2% (–84·6 to –43·4) from 1990, when the mortality rate was 0·7 per 100 000 (0·2 to 1·1). In both 1990 and 2021, the mortality rate of otitis media was less than 0·1 per 100 000. Together, the combined burden accounted for by URIs and otitis media in 2021 was 6·86 million (4·24 to 10·4) years lived with disability and 8·16 million (4·99 to 12·0) disability-adjusted life-years (DALYs) for all ages across males and females. Globally, the all-age DALY rate of URIs and otitis media combined in 2021 was 103 per 100 000 (63 to 152). Infants aged 1–5 months had the highest combined DALY rate in 2021 (647 per 100 000 [189 to 1412]), followed by early neonates (aged 0–6 days; 582 per 100 000 [176 to 1297]) and late neonates (aged 7–24 days; 482 per 100 000 [161 to 1052]). Interpretation: The findings of this study highlight the widespread burden posed by URIs and otitis media across all age groups and both sexes. There is a continued need for surveillance, prevention, and management to better understand and reduce the burden associated with URIs and otitis media, and research is needed to assess their impacts on individuals, communities, economies, and health-care systems worldwide. Funding: Bill & Melinda Gates Foundation