Issues during emergency preparedness and management, lessons learned from a cross sectional study:
Considering the severity of the COVID-19 and the way it spreads from human to human within the initial country, China, and internationally via human commute to and from infected places , it is confirmed that COVID-19 is highly contiguous and can easily transmit as it has invaded 212 counties and infected 3,308,772+ individuals worldwide. Therefore, both local and international authorities should apply highly precautionary steps towards controlling the transmission of the virus through health personal capacity building, massive information exchanges and furnishing the health facilities with the basic needs that can assist health personnel to manage any suspected COVID -19 case regardless of disease stages/ severity. I trust that there are a number of documentation on COVID-19 cases identification, guidelines, SOPs and patient notification forms available in the countries with support of WHO, UNICEF, Government, donners and NGO’s partners. However, with current high number of health personnel who are infected and continue to get infected, the poor hygiene practice and life style of people specially in hard to reach areas, e.g. in counties like Afghanistan, there is an assumption that the public and professional awareness about COVID-19 management, self-protection and precautionary measures may need more efforts. For instance, in Afghanistan, there is no study to indicate the level of awareness / preparedness of health facilities and health professionals in the county despite a relatively high number of COVID-19 confirmed cases. I personally think the stated vital steps should be taken place in the country to identify gaps and filled them based on evidence. One could use lessons learned from pervious epidemics and emergencies to reason implementation of such key steps; For instance, I would like to share an example of lessons learned from Ebola outbreak in 2014 in this regard. We conducted a short study that included 72 health facilities and interviewed 72 health care providers in 3 local governmental areas (Kura, Fagge and Karaye) in Kano state of Nigeria from August to October 2014 the study exhibited some interesting findings that really indicates a path to fulfil the gaps in the state for preparedness and response phase of an epidemic. Here is a descriptive summary of the results:
91% of health care providers had heard about Ebola. 93% knew that Ebola is an emergency; however, only 40% of them said they know the definition of Ebola. Out of this only 2% was able to define the disease as per Ebola national guideline.
15% of respondents were able to name two symptoms of Ebola
When health care providers were asked if they had received any trainings about Ebola, only 12% responded, “ Yes”.
17% knew about SOPs and guidelines (however they did not have any SOPs or guidelines in the health facilities).
Knowledge of assigned lab technicians with regards to the disease in the laboratories for Ebola test, the temperature for sample shipment, the responsible contacts points in case of suspecting Ebola case, and availably of guidelines and notification forms in health facilities were lower than 5%.
In response to what precautionary steps the health facility will take in case of suspecting Ebola case, 41.7% were able to indicate the standard options requested in SOPs
When they asked about the expected support from the government regarding for Ebola control, about 40.3% suggested provision of proper training
33.3% suggested provision of equipment, while 20% them requested both training and equipment.
4.2% of the respondents suggested provision of other items by government which includes drugs and supplies, establishment of research and Isolation center, conducting public sensitization events, contact tracing system, establishment of effective surveillance system, establishment of points of screen, creation of diagnostic and referral system , and support human resources (staffing).
It is worth to mention that among those who interviewed, about 65% were the person -in- charge and 35% the second -in -charge for health facility. Out of 72 personals interviewed, 81% were male, and age ranged from 24 to 62 years. 14% had the highest level of education, university graduate, 60% had med- level diploma, 25% classified under the “other categories”., The respondents work experience ranged from one to 36 years.
Although we could not publish the study in any journal, the findings helped in pointing out the bottlenecks that could potentially create problem in the phase of emergency at health facility and health care provider levels.
The intention for sharing this piece of information is just to remind ourselves as public health professionals that despite of hard work and efforts that we use to control the outbreaks, especially now that the world fights with COVID-19 pandemic, we should step forward strategically and use evidence based approaches in pandemic and epidemics situations. There is always a need to look back periodically to identify the issues/gaps that we lift behind unknowingly which could have a huge impact in achieving results. There is a need to tackle issues in timely manner so that we reduce the risk of transmission and numbers lost. An humble suggestion with regards to the current situation would be effective communication, Communicating and Communicating ! Additionally, it is key to ensure that target papulation (in this case health care provider) correctly understand, communicate and apply gained knowledge in practical world. Note that not only they can protect their patients, but also themselves from getting infected given they are the vital part of team for pandemic and epidemic control.
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