Just-in-time Epidemiology Super-course as of May 8 2015

Just-in-time Epidemiology Super-course as of May 8, 2015. Nepal Earthquake 2015: Epidemiology of Population Health Concerns Dr. Drona Rasali, DVM, Ph. D, FACE* Dr. William Osei, MD, MPH, FACE* *Both authors are Fellows of American College of Epidemiology, Members of Canadian Public Health Association and Adjunct Professors, Faculty of Kinesiology and Health Studies, University of Regina

#Nepal Earthquake Aftermath: Why is it so deadly? quake Earth eople M 8. 2 14, a y six p nd pril, 20 n Chile. Onl aged a n 1 A O rther omes dam ed no 500 h Just over one year later, a M 7. 8 rock ith 2, w laced. earthquake strikes Nepal. Over 7, 500 died; le disp people (and counting) have been 80, 000 killed, entire towns and villages flattened and millions of people left homeless. A huge part of the answer is, of course, building standards and wealth. (Source: Kate Ravilious, Science writer)

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NEPAL: SATURDAY, APRIL 25, 2015 11: 56 AM

#Nepal Earthquake: Mt. Everest Avalanche Disaster Mt. Everest Base-camp rescue operation

Destruction of Kathmandu’s historical monuments

Destruction of Kathmandu’s historical monuments

Destruction of Kathmandu’s historical monuments

Base of the fallen View Tower (Dharaha): A Heritage site, which was Kathmandu’s most popular landmark is gone.

Crumbled village houses in a hilly slope of Gorkha district, not far away from the Earthquake epicentre

Kathmandu’s largest common park space Tundikhel is home for many affected people

#Nepal. Earthquake: Role of social media Ø Social media is playing a huge role in making the whole world converged at #Nepal. Earthquake.

Earthquake Disaster: Trimodal Health Phases Second Phase • From minutes to hours afterwards • Early trauma management is crucial, Initial Phase • Golden 24 -hour when most causalties recover, while most fatalies occur as • Within seconds well to minutes • Adequate first aid and organised • High mortality evacuation by local people required due to physical • Rapid Medical Response Team begin to injuries instant appear to deal with the acute injuries incompatibility • Capacity of the medical and surgical with life system to cope with a large number of casualties • Primary care needed as soon as 24 to 48 hours after the disaster Third Phase • Days to weeks after the disaster • Prevent and treat complications such as sepsis, multiple organ failure and psychological problems • The large number of displaced persons and lack of essential resources such as safe water, food, energy and shelter • Then, weeks to months: Long-term health issues, daily urgent medical needs, mental health and stress, environmental pollution and infectious disease concerns, public health issues and special needs populations etc. Adapted from: Epidemiology of Disasters, Accessed at: http: //www. mimms. org. au/aboutmimms/epidemiology-disasters

#Nepal. Earthquake: Injuries Ø Broken bones due to severe injuries are common occurrence leading to varying degrees of disability in the long run. Civilians and soldiers carry injured people to a van for hospital transfer

#Nepal. Earthquake Aftermath: Deaths and Diseases Ø 7, 652 deaths reported as of May 6; the number speculated to reach 10, 000. Ø Initial medical evacuation of critically wounded by international aid agencies like Médecins Sans Frontières (Doctors Without Borders) and the Red Cross by helicopter from outlying areas, initially cut-off from the capital city, Kathmandu, and treating others in mobile and makeshift facilities Ø 16, 362 people reported injured as of May 6, but deemed to be an underestimate in this disaster Ø Concerns about epidemics due to the shortage of clean water supply, the makeshift camp living conditions and the general lack of sanitary toilets

#Nepal. Earthquake Aftermath: Emergency Health Services Ø All hospitals and health centres in the affected areas servicing beyond their capacities. A total of 50, 665 patients have been treated in different hospitals in and outside the Kathmandu valley as of 5 May 2015; Bir Hospital, the largest one in the capital, is taking the greatest burden. Ø The first foreign medical teams (FMTs) to arrive in the capital were the National Army teams from India and China. Bhutan Army team, with its self-sustained field hospital set up in Nuwakot, was one of the most helpful because they spoke Nepali. Ø Initial medical evacuation of critically wounded by international aid agencies like Médecins Sans Frontières (Doctors Without Borders) and the Red Cross by helicopter from outlying areas, initially cut-off from the capital city, Kathmandu, and treating others in mobile and makeshift facilities

#Nepal. Earthquake Aftermath: People’s lives Ø Hundreds of people missing; some survivors are still to be found. Ø 2. 8 million momentarily displaced either because their houses have been destroyed or because they are too afraid of aftershocks to remain at home. Ø Two million children affected in some way by the events of less than two weeks ago Ø Agrarian country now with concerns of expected crops harvests reduced or lost this season - only a short time left to plant crops before the onset of the Monsoon rains. Ø Almost 24, 000 classrooms were damaged or destroyed in the disaster leading; possibly, about a million children not returning to school when reopen. Ø Tens of thousands girl survivors reportedly preyed upon by human traffickers

#Nepal. Earthquake Aftermath: Crisis Mapping “Thousands of people in remote parts of Nepal are still in need of medical help and basic supplies. But with roads damaged and buildings collapsed, knowing what aid is needed and where, is a challenge. One group of Nepalis, backed by a global community, is trying to change that by "crisis mapping" Nepal. ” - Saira Asher BBC News

#Nepal. Earthquake: Crush syndrome Ø People who have been trapped under rubble remain at risk of crush syndrome where the kidneys start to fail. Ø The body releases toxins in response to massive and sustained injuries- and these can overwhelm the kidneys as they try to flush them out. Ø Dialysis - artificial kidney machines - can help. But according to MSF, Kathmandu's main hospital only has eight. (Source: Smitha Mundasad, Health reporter, BBC News)

#Nepal. Earthquake: Logistic Dilemma Ø Home Minister over an interview projected the need for about one million tents for makeshift camps; all internal and external resources can provide only one tenth (100, 000 tents) Ø One average-sized cargo aeroplane can transport only 500 tents; delivery of foreign consignments of tents will take time and space. Kathmandu airport is the only one international airport in the country. Ø Major highways are severely damaged. All the equipment and supplies need to reach the affected areas; requiring thousands of truckloads move around torn roads or mountain trails.

#Nepal. Earthquake: Health Surveillance Ø Hospital based health and disease surveillance initiated in the fourteen most affected districts. Ø These hospitals provide daily reporting on trauma and outbreaks of potential diseases/syndrome such as acute watery diarrhea, bloody diarrhea and fever of unknown origin. Ø This syndromic approach will help detect potential outbreaks. Ø Several events of diarrhea have been reported from different sources in the affected districts and verified by Rapid Medical Response Teams (RMRT) from respective district health offices with samples collected. Of the 10 samples collected from four districts (Bhaktapur, Dhading, Kathmandu, and Lalitpur), eight stool samples showed no growths of Vibrio cholera, Shigella or Salmonella. (Source: WHO Situation Report# 11, 6 May 2015).

#Nepal. Earthquake: Health System Challenges Ø Nepal’s Health System has a surge of at least 60, 000 extra people needing urgent health care. Ø Hospitals are overloaded Ø Vaccinations against major outbreak infections will be delayed. Immunizations against measles, meningitis, whooping cough and other diseases that have high potential for spread in overcrowded situations such as in camps, should be assiduously offered. Ø Lack of transportations to many affected areas is making intervention harder Ø Most affected people have to live in the open Ø Clean water and hygienic environment are major concerns.

#Nepal. Earthquake: Surveillance Recommendations Ø Population based surveillance is not feasible; hospital and pharmacy based syndromic surveillance of injuries and disease outbreaks should be intensified. Ø Air lifting of lab samples collected from Gorkha district and around should be arranged by a dedicated helicopter. It may also be used for mobility and logistic purposes of rescue and surveillance. Ø Surveillance of outbreaks of food-water borne and airborne diseases in humans and zoonotic diseases among animals should be organized in a coordinated manner to link the transmissions of infectious diseases. Ø Surveillance of affected people for any mental health issues will be increasingly important. Ø All displaced children should be offered full immunizations according to their age and the Nepal's schedule

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