community response network 101

 

community response network 101

September 12, 2022

Community Response 

Community Response 

Introduction to CRN 101:

Objectives:-

Community Response Network (CRN 101) is a simple course designed to give a student a basic understanding of disaster management and how government systems work in general.

 

The objective of CRN 101 course is to educate and create awareness about various government systems involved in the mitigation of disaster management. It covers a brief introduction to various government systems and how these systems coordinate together at times of disasters.

 

THE DIFFERENT GOVERNMENT SYSTEM AND THEIR INTERCONNECTION:

The local self government :

The topics discussed were:

Tiers of panchayat system which included divisions in rural and urban areas.

Health systems which included Health care infrastructure and department under health systems. 

Revenue System which contains 3 levels District, Taluk and Panchayat level. 

Law Enforcement and Women in Police.

The 3-tier panchayat system

 

RURAL AREA 

The ward members from various Wards report to a Panchayat Committee. The Panchayat committee also has appointed members along with the elected members. The Panchayat Committee has a President (Elected Member) and Secretary (government appointed member) and various standing committees (e.g.: Standing Committee on health, welfare, finance).

 

URBAN AREAS

The Municipalities (Municipals Councils/Nagar Palinka /Nagar Palinka Parishad) and Corporations (Municipal Corporations) are the local government in India that administer urban areas with a population of more than 25 thousand and more than 10 lakhs respectively. Some states in India have City Councils (Nagar-Panchayat) as an additional division. The area administered by a municipality or corporation is divided into territorial constituencies known as wards. Members are elected to the wards committee on the basis of adult franchise for a term of five years. These members are known as councilors. The number of wards is determined by the population of the city.

 

HEALTH SYSTEM

The public-health care system in India is based on a three-tiered health-care system to provide preventive and curative health care in rural and urban areas. It consists of sub-centres, primary health centres and community health centres.

 LAW ENFORCEMENT

The constitution of India delegates the maintenance of law and order primarily to the states and territories. All senior officers in the state police forces and federal agencies are members of the Indian Police Service (IPS). They are appointed by the Cabinet from the Indian Police Service. Further down the hierarchy are the officers of the rank of Inspector General of Police. The districts are headed by District Police Chiefs who are usually in the rank of Superintendent of Police. There are exceptions in the police districts of Thiruvananthapuram city and Kochi city where the heads are of the rank of Inspector General of Police and the police district of Kozhikode which is headed by an officer of the rank of Deputy Inspector General of Police.

 

COORDINATION OF THESE SYSTEMS IN DIFFERENT LEVELS

THE RESPONSE TO COVID -19

 

Treatment of a covid-19 patient:

 

First Principle: Separating COVID and Non COVID by creating a parallel COVID Healthcare System & utilizing existing Healthcare system for Non COVID patients A clear demarcation between a non-COVID Patient and a COVID Patient has to be made.

 

Second Principle: Decentralization of the existing system to the panchayat and ward level We cannot build hospitals overnight and thus have to protect the existing healthcare system from crashing due to an overload of patients. This is done by decentralizing the treatment through a three-tier system under the direct supervision of the district administration. Activation of three tier covid health care system.

 

Vaccines:

A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future.

GENERAL GUIDELINES

 Proper usage and disposal of masks: During the initial phase, WHO warned us that the common populace using masks could potentially lead to danger. But when the virus started to spread, it has become a norm for the society to be trained on how to use a mask. Now, wearing a mask is a necessity. It helps in decreasing the spread of the disease. While we sneeze, we need to cover our mouth and nose. If someone who is a carrier of the virus sneezes, it could act as a vector and go unnoticed as he or she is asymptomatic. We need to wear a mask to prevent the spread of the virus occurring due to our daily activities and it must be worn properly. The major problem we see nowadays is that people tend to forget the importance of wearing masks and pull their masks away from the nose and mouth. Careless touching of the outer side of the mask should also be avoided.

 

Proper disposal of used masks and PPE kits:

If it is a cloth mask, boiled water can be used to clean the mask. Surgical masks or N95 masks are not recommended because they are to be used by medical personnel, wherein burning the mask is one way of disposing it. N95 is recommended for aerosols or people who are in contact with those tested positive for COVID-19.

We can only ensure proper waste management if everyone does their part. If we touch an area that people frequently use, we need to wash our hands properly since the probability of getting the disease by touching our eyes and mouth increases. If we are wearing gloves, need to be extremely careful since we need to dispose of it after each use. So the best practice is the use of hand sanitizer.

Revenue system

In pre-independent India, there was one person who was in charge of collecting tax revenues from the public. This person was the “Collector” in the “Revenue” Department.

The taxation system in India is such that the taxes are levied by the Central Government and the State Governments. Certain minor taxes are collected by the local authorities too.

The Revenue system functions alongside the Local Self Governments.

At Panchayat Level, there is the village officer who has authority to collect various taxes within the panchayat and is also the custodian of all land-title records within the panchayatAt Taluk Level there is a Tahsildar and higher still in the line of hierarchy is the Revenue divisional officer.The District Collector heads the revenue system within a district in addition to many other administrative responsibilities including that of the District Magistrate.

 Panchayat Level:

Each ward has a ward level team. At Panchayat level, this body is supervised by the Panchayat Monitoring Committee (LSG level monitoring committee), comprising of:-

·        Panchayat President

·        Medical Officer

·        ICDS (Integrated Child Development Scheme) Supervisor

·        CDS Chairperson

Block Level:

At the block level, we have:-

·        The Block President

·        Block Medical Officer

·        CDPO (Child Development Program Officer)

-Tahsildar

-Police

-Assistant. Engineer - KSEB

-Assistant. Engineer - Water authority etc

District Level:

Similarly, all corresponding officers at a district level form a committee here. There is the Zilla Panchayat President, ICDS district officer, District Medical Officer, Collector, RTO, Water Authority representative, Police etc.

3 –Tier healthcare system:

Various initiates were implemented by different state governments during this COVID pandemic, one of the effective initiative by Government of Kerala was introducing a 3-tier system for pandemic treatment.

First Line Treatment Centre

The First Line Treatment Centre (FLTC) cater to patients who are below the age of 60 years and have mild symptoms with no significant comorbidities. Generally, this population will be advised to maintain home isolation with symptomatic treatment but will be admitted at this facility if they are unable to maintain home isolation due to any reasons.

SECOND LINE TREATMENT CENTRES (SLTC)

Second Line Treatment Centres (SLTC) will be formed by the Government Taluk Hospitals and designated private hospitals. SLTC will be catering to patients with moderate symptoms and those above 60 years / having any comorbidities with moderate symptoms.

These facilities will be equipped with adequate infrastructure and equipment to monitor all the mandatory baseline investigations and provide any emergency interventions.

SLTC will conduct all laboratory investigations and chest X-ray to attain a clearer status of the patient's health.

APEX CENTRES

Apex Centres will be set up in the hospitals with advanced facilities like the medical colleges and private hospitals of each district. These facilities will be equipped to cater to all severe cases of COVID-19. Apex facilities will have ICU beds, ventilators, dialysis machines and well trained human resources to cater to all complicated cases of COVID-19.

More hospitals may be notified by the district administration as Apex Centres for COVID-19 as and when the need arises.

District Administration at Ernakulam has successfully conducted two Mockdrills to test the feasibility of this 3-Tier Healthcare system and the efficient working of other systems like the Ambulance system, Teleconsultation system etc in sync with this 3-Tier healthcare system.

ACTIVATION OF THESE TREATMENT CENTRES:

There are 3 Phases to the way COVID-19 is treated.

Phase 1 is when a panchayat only has 3 or less than 3 cases in a population of 10,000. During this phase, all the COVID-19 patients are treated in the Apex Centres.

Phase 2 is when any panchayat starts to have more than 3 cases in a population of 10,000. Then, the SLTCs are activated. All the mild and moderate cases will be treated in the SLTCs while only the critically ill will be sent to the Apex Centres.

Phase 3 is when a Panchayat starts to have more than 10 cases in a population of 10,000. Then, FLTCs are activated to treat the asymptomatic and mildly symptomatic patients. The SLTCs continue to treat the moderately symptomatic patients and Apex Centres only treat the most severely ill.

When number of cases still goes up, the panchayat boundaries of such Hotspots are sealed to contain the virus.

Vaccines:A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future.

Widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the restriction of diseases such as polio, measles, and tetanus from much of the world.

Production of vaccines

On average, it takes between 12-36 months to manufacture a vaccine before it is ready for distribution. Successful manufacturing of high-quality vaccines requires international standardization of starting materials, production and quality control testing, and the setting of high expectations for regulatory oversight of the entire manufacturing process from start to finish, all while recognizing that this field is in constant change.

Any licensed vaccine is rigorously tested across multiple phases of trials before it is approved for use, and regularly reassessed once it is introduced. Scientists are also constantly monitoring information from several sources for any sign that a vaccine may cause health risks.

Post Vaccination in India

Right after getting vaccinated, you are monitored for 30 minutes for any possible Adverse Event Following Immunisation(AEFI) before leaving.

AEFI is classified into :

·        Minor AEFI : Common and self-limiting reactions.

Eg: pain, swelling at site of injection,fever, irritability,tiredness,dizziness and nausea

·        Severe AEFI: Disabling or rarely life-threatening, no long term problems.

Eg: High fever, allergic reactions

·        Serious AEFI: require inpatient hospitalisation, may cause significant disability

If you develop symptoms at the site,

All vaccinators and supervisors at the site will be trained to provide primary treatment.

If needed, cases are referred to the nearest hospital/health facility and are reported to the appropriate authorities.

Treatment of covid 19 patients

There are two key principles that have to be made the foundation stone in this war.

First Principle:“Separating COVID and Non COVID by creating a parallel COVID Healthcare System & utilizing existing Healthcare system for Non COVID patients”.

A clear demarcation between a non-COVID Patient and a COVID Patient has to be made.

When the existing healthcare systems are overburdened as the COVID-19 cases rise, we need to create an alternative parallel healthcare system exclusively for COVID-19 patients.

This way, other patients, like cardiac patients, antenatal cases, orthopedic patients etc. can easily avail the mainstream healthcare systems.

Second Principle:”Decentralization of the existing system to the panchayat and ward level”

We cannot build hospitals overnight and thus have to protect the existing healthcare system from crashing due to an overload of patients.

This is done by decentralizing the treatment through a three-tier system under the direct supervision of the district administration.

Categorisation of covid patients:

Based on the severity of symptoms of COVID-19, patients are categorized into symptomatic (with symptoms) or asymptomatic (no symptoms).

Symptomatic patients are sub classified into Mild, Moderate and Severe.

Mild category

Mild category consists of patients with mild symptoms of fever/sore throat/dry cough/rhinitis or diarrhoea. Patients belonging to this category generally can be managed in home quarantine with symptomatic treatment with the help of Tele-Health Helpline Unit.

The tele-health helpline unit is situated in the district control room. The members are doctors, nurses, pharmacists, information technology and management experts. They will receive calls for help from the patients and RRT members. The helpline will give expert advice to patients and help in transferring the patients to hospitals or treatment facilities.

Those who are unable to maintain home quarantine due to any constraints can be managed at the First Line Treatment Centres (FLTC).These patients can be shifted from home to FLTC using double chambered auto-rickshaw.

Moderate Category

Moderate Category is formed by patients whose symptoms have worsened despite symptomatic management or those with comorbidities like uncontrolled diabetes mellitus, hypertension, chronic kidney disease, coronary artery disease, malignancies, etc. along with moderate symptoms.

Pregnant women and immunocompromised individuals with moderate symptoms are also included in this category. These group of patients can be managed at Secondary Level Treatment Centres (SLTC).

Such patients are shifted to an SLTC using a double chambered ambulance.

Severe Category

Severe Category is the third group of patients who exhibit severe symptoms or symptoms of Acute Respiratory Distress Syndrome. These are the patients who require the highest level of care.

Common features noted are breathlessness, drowsiness, drop in pressure, blood stained sputum while coughing or bluish discoloration of skin which are important red flag signs that have to be kept in mind during the management of these patients.

In the pediatric age group, influenza-like illness is an alarming sign to be kept in mind.

Worsening of underlying comorbidities/diseases is also a common feature seen in these patients. Hence it is ideal to manage them at the highest level centres or the Apex Centre.Shifting of severe category patients will require ICU ambulances to ensure proper monitoring and supportive care is given during the shift to an Apex Centre.

COVID-19: Origin and how it became a Pandemic

   COVID-19 is an infection caused by the family of viruses known as Coronaviruses. Coronaviruses are known to cause infections in both humans and animals.

Coronavirus infections range from common cold to severe respiratory or lung infection. COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain. SARS-CoV2 was unknown before the outbreak that started in Wuhan, China in December 2019.

On 11/03/2020, the WHO declared COVID-19 a Pandemic. A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”.

COVID-19 Infection

COVID-19 infection is most commonly associated with symptoms like fever, dry cough and lethargy/ tiredness.

Other symptoms include ache/pain, sore throat, nasal congestion, conjunctivitis, loss of taste or smell, headache , breathing difficulties and diarrhoea in some patients.

Anyone can be infected with COVID-19 irrespective of age or sex or religion or nationality.The elderly and people with underlying health conditions such as diabetes, lung/heart problems, high blood pressure or cancer are at higher risk of developing more symptoms and worsening. These are called co-morbid conditions, the presence of these will make an individual more susceptible to get infected by the virus.

But that does not rule out the possibility of the younger population getting infected. Anyone who develops breathing difficulty/chest pain or loss of speech or movement should be considered as a severe case of infection.

How does COVID-19 infection spread?

The infection usually spreads from an infected person to normal individuals. Droplets or aerosols from the nose and mouth of infected persons generated while coughing, sneezing or speaking are the primary route of spread. These heavy droplets generally tend to sink to the ground quickly but when in close proximity of 1 metre or less, a person can breathe in these droplets and acquire infection.

Similarly touching droplets resting on surfaces of doorknobs, tables, handrails followed by touching or rubbing eyes, nose or mouth can result in acquiring the infection

Testing of COVID-19

It is recommended that people with symptoms undergo testing. We have an antigen and RT PCR test currently available in our medical field of expertise. The RT PCR test is a global standard system, it is costly(varies from Rs.500-1500 in various states) and the result is accurate ,but time-consuming (approx. 24 hours). It tests for viral RNA presence and Virus genetic material may be detected.

The Antigen tests (cost varies from Rs.150 to Rs.300) check the presence of protein, the accuracy is lesser as compared to RT PCR. It is an easily accessible test. The virus particle is detected. For checking antibodies present, a blood sample is taken and if the virus enters a person's body, it will take around 7 – 8 days to get this antibody test back positive.

General Advice

·        Always wear a mask in public places.

·        Limit your movement. The lesser people you interact closely with, the less likely you and the people around you are to being sick.

·        Encourage repeated hand washing. Carry a hand sanitizer and use it wherever soap and water are not available. Wash your hands as soon as you get home. Wash your hands or sanitize before you touch your eye, nose or mouth.

·        Maintain social distancing. Limit contact even while running errands. For example, at the grocery store, do not touch the items unnecessarily. Maintain 1-meter distance from anyone and avoided touching common surfaces like cash counter etc.

·        Respiratory hygiene and cough etiquettes must be observed by all.

·        Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.

·        Establish a system to ensure proper disposal of masks/tissue papers.