Call to avert acceleration of COVID-19 from India’s Sabarimala pilgrimage of 25 million devotees

Rationale The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. Key findings Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013–2015, outbreak in Democratic Republic of Congo 2018–2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. Recommendations The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.

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“… 68 There was also a call to act to mitigate potentially serious consequences of the Hindu pilgrimage in India. 69 …”

Section: Public Health Emergency Of International Concern (Pheic)mentioning

confidence: 99%

Public health emergencies of international concern: a historic overview

Wilder‐Smith

Osman

2020

Journal of Travel Medicine

168

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“…The state of Kerala (population 34 million) was the first to report the Corona Virus Disease 2019 (COVID-19) case in India on January 30, 2020 in three medical students who returned from Wuhan, China [1]. Prompt quarantine measures effectively stopped transmission from these cases.…”

Section: Introductionmentioning

confidence: 99%

"How Universal is the Use of Facemask During COVID-19 Pandemic? A Photo-Epidemiology Study from the Indian State of Kerala"

Koya

2021

BJSTR

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Background & Objectives: Kerala state was the first to report COVID-19 case in India and was initially successful in curbing the spread of the virus. However, Kerala witnessed a surge of cases subsequently. This study aimed to estimate the prevalence of face mask use and social distancing in public places in Kerala.Methods: We did a cross-sectional photo-epidemiology study; wherein photographs of people in public places were taken across Kerala. Photos were analysed to determine the usage of mask, whether it was properly worn and the type of mask. Crowding was taken as a surrogate for social distancing. We compared mask use and crowding across district zones with low, medium and high COVID-19 burden. Results:We analysed 1445 photos capturing 4500 people with clear view of the face. Prevalence of mask use was 96% across the state. We found near complete mask use in the districts with high COVID-19 burden (99%) compared to districts with low (96%) and medium burden (95%). 20% of the people in public spaces either did not wear a mask or wore it improperly. Crowding was higher in high burden districts with a weak but positive correlation with case burden. Conclusion:Prevalence of face mask use was high across all districts in the Kerala State, but a considerable number of people were unprotected due to improper or non-usage of masks. Crowding in high burden districts indicate that inadequate social distancing could have contributed to increased cases, despite a high compliance to mask usage even in these districts.

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“…Kerala was the first state to report COVID-19 in India on 30 January 2020 that prompted the state to be a trailblazer in pandemic mitigation in India and the State achieved successful pandemic mitigation (zero cases reported on 3 May 2020), hailed as a model for India. 3 However, Kerala’s COVID-19 cases exponentially increased in later months (10 000 cases/day on 7 October 2020, 8402 cases per million). Phylogenetic studies revealed that Kerala’s resurgence of cases may have originated from internal transmission within India than from returning international emigrants.…”

mentioning

confidence: 99%