Multidisciplinary approach in handling the corona outbreak

1. Multi disciplinary
approach – To
prevent and control
Covid – 19 outbreak
Prof Dr Jeyadeepa R
Officiating Principal
IQ City Institute of Nursing
Sciences

2. Objectives
At the end of the session participants
1. Appraise the impact of Corona outbreak
2. Define the multi disciplinary approach
3. Explain the principles of multidisciplinary approach
4. Describe the measures taken to prevent and manage the
outbreak

3. Pandemic attacks in the world
Year Name of the attack Statistics
14th Century Bubonic Plague – black death 75 to 200 million deaths
1665 Great Plague of London Killed 20% of the population
1918 - 1919 Spanish Flu 500 million people affected and
50 million deaths
1957 Asian Flu 1.1 million deaths
1968 Hong Kong Flu 1 million deaths
1980 HIV/ AIDS 65 million infection and 25 million
deaths
2009 Swine Flu 60.8 million cases 5,75,400 deaths
Koren Miller, 28th Jan 2020

4. Incidence
• Covid – 19
– 3155 deaths
– 92722 infected across 77 countries and
territories
WHO, Times of India dtd 5th March 2020

5. Impact
• Threat to human health
• Loss of trust and reputation
• Loss of life
• Economic impact
• Social disruption
• Threat to country’s resources and its use

7. Multi disciplinary approach
• It is combining or involving several
academic or professional specializations
in an approach to a topic or problem
• Oxford English dictionary

8. Multi disciplinary approach
• Use of knowledge and skills from various
discipline
• It brings together individuals with
specialist knowledge and skills to work
together in order to provide coordinated
care through an agreed treatment
plan.

9. Why MDA?
• No single profession can provide the
knowledge, skills and resources to meet
the requirements of today’s patients
with complex health needs

10. Goals
• Reduce morbidity and mortality
• Minimize disease transmission
• Protect health care personnel
• Preserve health care system functioning
• Minimize social disruption
• Protect health, jobs, tourism and economy

11. Principles of MDA
Shared goals Clear roles Mutual trust
Effective
communication
Measurable
processes and
outcome

12. • Situation awareness at all levels
– Global, national and sub national
• Inter sectoral coordination at all levels
Guiding principles

13. Guiding principles - contn
• Adherence to core capacities for disease
preparedness and response
– Surveillance
– Lab diagnostics
– Hospital preparedness
– Logistic management
– Capacity building
– Risk communication
Need scale and
extent will increase
exponentially as
Per evolving
scenario

14. Strategic approach - 1
• Only travel related cases
– Continued activities at points of entry
surveillance
- Concurrent review and strengthening of all
core capacities

15. Strategic approach - 2
• Local cluster of indigenous cases (with no
travel history)
– Cluster containment strategies
– Listing of contacts
– Deciding on the containment zone
– Perimeter control ( Exit and entry control)
– Focused actions on containment zone
• Isolation, home quarantine of contacts, social
distancing measures and communicating the risk to
the public

16. Strategic approach - 3
• Large outbreak
– Abandon cluster containment strategy and
points of entry surveillance
– Ensure essential service to minimize morbidity
and mortality
– Exit screening
– Mitigation measures
• Triage of patients
• Surge capacity of hospitals for isolation
• Ventilator management
• Large scale IEC activities

17. Strategic approach - 4
• Covid – 19 becomes endemic
– Programmatic approach shall be followed
– Routine surveillance as an epidemic prone
disease and sentinel surveillance to know
public health burden of the disease

18. Working with states - 1
• Oversight mechanism
– Senior officers from MoHFW deployed to
guide the state level activities and stress on
the need for continued vigil
– Bi weekly video conference with ministries and
departments

19. Working with states - 2
• Plans and procedures
– Cluster containment plan shared with all states
and UTs
– Mitigation plan for anticipated COVID
pandemic is being prepared
– Guidelines/protocols/SOPs shared with states

20. Working with states - 3
• Surveillance at POE
– Strengthened based on risk assessment at
point of entry also for personnel drawn from
the state Governments

21. DISEASE SURVEILLANCE
ECOSYSTEM
Epidemiologist
Public Health Nurse
Vaccine-Preventable
Program Staff
Infections Disease
Program Staff
Environmental
Health Staff
Emergency
Preparedness
Staff
Pharmacy Staff
Disease Contacts
What are we missing?
Disease Case
Medical Staff Syndromic Systems
Laboratory Staff
Electronic
Systems
Paper Phone
Email
Scientific Technologies C
orporation
2
1
Health Promotion
Staff

22. Source: http://www.uic.edu/sph/prepare/courses/ph490/resources/epilesson.pdf
Surveillance

23. Strategy frame work for surveillance
• Developing a consensus
• Phasing
• Establishing strong coordination
mechanism
• Evaluating existing surveillance system
• Advocacy
• Resource generation
• Involvement of NGOs
• Capacity building
• Community participation
• Use of new electronic tools
• A syndromic approach

24. Working with states - 4
• Laboratory support
– Along with 15 existing labs additional 35 labs
are activated
• Expand the network of laboratories
• Expand collective testing capacity
• Improve accessibility for all states/ UTs to the lab
oratory network
• Reagents for testing additional 30000 to 50000
samples being procured

25. Working with states - 5
• Logistic support
– Central inventory of 50000 PPE kits and 2lakh N -
95 masks
– Further procurement is being done for additional 1
.5 lakh PPE kits and 3 lakh N -95 masks
– Indigenous manufacturers identified to manufactu
re PPE (coverall) with minimum acceptable standar
ds with combined capacity of 30000 coveralls per
week
– Logistics has been provided to Kerala, Maharashtr
a, Puducherry, Uttarakhand, Mizoram, Bihar, UT of
Ladakh so far

26. Working with states - 5
• Risk communication
– Material identified for immediate roll out for
creating awareness on simple public health
measures
Bridging the
gap

27. Working with states - 6
• Capacity building
– National level training of trainer workshop is co
nducted on 6th March 2020
– ToTs being done for ESIC, Defense, Railways,
Parliamentary forces, Steel ministry run
hospitals
– In second phase – State level ToTs to be
initiated in second week of March, 2020
– This is to be followed by district level and
hospital level training

28. Administrative measures
• Adequate training
• Adequate staff patient ratio
• Surveillance process
• Ensuring the public understood the process
• Monitoring compliance
• Appropriate treatment
• Measures to meet mental health needs

29. Environmental and engineering control
• Basic health care infrastructure
– Proper ventilation and cleaning
– 1 meter distance between patients
– Cleaning and disinfection procedure
– Prepared to meet any emergency
– Logistics procurement and supply management
– Use of NGOs and volunteers for auxiliarywork

30. Political support
• Policy making
• Resource mobilization
• Fund allocation
• Capacity building
• Create international network

31. Media
• Provide right information
• Alleviate fear
• Vital role in maintaining social harmony
• Tele counselling services
• Helpline service

32. Measures taken in Kerala
• Successfully handled Nation’s first three
positive cases
• 28 days quarantine
• Strong chain of command – from health
department to field workers
• Intense surveillance
• Adopted protocols from ICMR and National
Institute of virology
• Training for health workers
• Daily review meetings
• Support from patient, family and public
• Specific instructions on case definition

33. Measures taken in Kerala
Agent
HostEnvironment

34. Measures taken in Kerala
• Adequate medicines were available
• Special diet and supplements were given
• Stress levels were taken care of
• 411 are under surveillance – 388 in home and 23
in isolation wards
• Anxiety, stigma and frustration are the
common psychological problem identified
• Motivational message, SMS, tele counselling serv
ice
• So far 3646 tele counselling services are
provided

35. Summary
Patient
Political
support
Healthcare
Public
Media

36. THANK YOU