What we know we don’t know is when and where our next disease outbreak will be: Kang | Parami News

According to the Ministry of Health and Family Welfare, during the COVID-19 pandemic in India, around 5,30,000 people died; it was the highest number in the second wave. Pandemic disease has shown strength and weakness in India’s healthcare system which gave a very important lesson on preparedness, response strategy and resilience.

In today’s interconnected world fast trans-border spread of infectious diseases is becoming an escalating global threat like never before because diseases can be transmitted across national borders at an unprecedented rate with profound consequences. Due to its huge diverse population along with unique socio-economic dynamics; India is prone to rapid spread of infectious diseases.

When pathogens range from new viruses to antibiotic-resistant bacteria, India’s role becomes key not only for her citizens but also for regional and global health security as described by the World Health Organization (WHO).

This reactive approach that is advocated by experts is said to be holistic rather than proactive measures in preparing future pandemics. The holistic approach calls for surveillance systems, better health infrastructure community participation and forward looking policies.

Devastating outcomes

At Bangalore International Centre (BIC), Gagandeep Kang who is a microbiologist/virologist delivered a talk titled Outsmarting Outbreaks: The Future of Contagion where she stated that infectious diseases have been there historically in India with serious impacts on lives.

For over three decades Dr. Kang was based at Christian Medical College (CMC) Vellore where she developed national rotavirus and typhoid surveillance networks used to estimate disease burden, test vaccines and influence policy decisions among other things.

Presently she serves as Director- Global Health team at Bill & Melinda Gates Foundation comprising enterics/diagnostic/epidemiology/genomics portfolios. She became the first ever Indian woman elected Fellow of Royal Society; won Infosys Prize in 2016; co-authored Till We Win: India’s Fight Against The COVID-19 Pandemic.

It was through safer water and sanitation, drugs and vaccines, that the extension of human lifespan in 20th century resulted from our ability to control scourges of the past such as smallpox, tuberculosis, plague and malaria.

She emphasized how society has been shaped by science, but climate change brings about new threats. In view of this fact she makes a strong case for India to be prepared for its people and the world as supported by data and modeling showing emerging technologies because it is the most populous nation on earth.

A healthcare worker and Delhi civil defence volunteer arranging collected swab samples of passengers for RT PCR test during the Covid-19 pandemic at Delhi Cantt Railway Station in New Delhi.

Pandemic vs epidemic

Dr. Kang said there have been so many outbreaks over a period of time that viruses have been named using all English alphabets A-Z.

Cases of endemic diseases occur continuously in a population or region with low spread. By way of contrast, an epidemic is characterized by the sudden increase in cases spreading throughout large populations while a pandemic entails sudden increases across several countries, continents or the entire globe.

Over the past three decades, outbreaks have become more numerous and varied from A to Z; that is to say AIDS to Zika. This upsurge is brought about by such factors as increased trade, population density, deforestation and climate change among others, signaling a new era of heightened epidemic risk. She also adds that viruses are responsible for most large outbreaks that can easily be spread.

Dr. Kang explained how to identify infectious disease epidemics and pandemics that India has had over time. “When we had smallpox there was no understanding of the differences between bacteria, viruses or parasites. Even malaria was called “mal aria” or “bad air” because people thought it was travelling in swamps in the air that gave you malaria and did not understand that it was mosquitoes that spread the disease,” she said. It’s only when Robert Koch who otherwise known as ‘father of microbiology’ developed ‘Koch’s Postulate’, which contained certain rules used to establish connection between microbe and disease.

London Cholera outbreak where John Snow identified pump on Broad Street as cholera cause

He then made a map of all cases of Cholera being described in London, took his map onto which he marked where all houses with Cholera got their water sources from. The outcome showed everyone got their water from the street pump except those households without cholera who obtained it from elsewhere.

“John Snow immediately removed the handle of the pump, and the outbreak stopped,” Dr.Kang added. “We continue using his principles till today and must continue doing so if we are going to be able to link diseases with populations and think about ways to control them.”

Healthcare workers are checking people for COVID-19 by knocking on doors in the Mumbai slum area of Mukund Nagar, Dharavi during India’s national stay-at-home period.

What is its stage now?

Dr. Karg was questioned about why there is a certain reluctance to vaccines even now when the whole world is dying from the pandemic like COVID-19. “There has been hesitation and mistrust over vaccines in India for long time. There are people who believe in vaccines, people who are a little hesitant but can be convinced and some who are rabid and cannot be convinced no matter what you do. The important part is figuring out where on the spectrum most people are and whether it is worthwhile to invest time in them and convince them to take vaccines.”

According to Dr.Kang, infectious diseases will always pose as threats. “There will be endemic diseases, emerging and re-emerging diseases and bioterrorism in the future too. Infectious diseases particularly those that are transmitted by individuals without symptoms can easily go global.” Antibiotics will become ineffective. “Combination of infectious with noncommunicable diseases reduces our ability to prevent or cure illnesses using our tools,” she said. “All of this we already know.”

How, when and where?

Nonetheless, what we do not know, yet is the time at which it will occur, the geographical area in question and even how big it will be. To what extent are countries willing to cooperate and share their data as well as resources? In fact, this is something India and other countries in the world should work on according to Dr. Kang.