Dr. Sanjeeb Sapkota

The pandemic status has not been given to the infection caused by coronavirus but this can change. Many scientists are predicting it is a matter of when and not if (for it be pandemic).
To be a pandemic the organism and
the disease it causes need to meet at least four criteria.
First, the organism must be a brand new. Second, it must originate from a non-human or animal source and that humans do not have immunity against it. Third, it must cause infection from animals to humans, and cause infection among humans when they are in close contact and most importantly it must cause widespread human to human transmission in the community in more than one country in two different continents.
Up to now, the coronavirus or Covid-19 has met the three out of the above requirements. It is a brand-new virus that was not known to humans three months ago, and it was known only to have been harboured in animals (we do not know which one for sure, but scientists are leaning on snakes and bats). It is capable of being transmitted from animals to human and the transmission occurs when humans are close in contact.
Important Criteria
But it has not met the most important criteria- it must cause sustained widespread human to human transmission in multiple countries and continents. Once this happens, then this infection is declared pandemic. But for now, it is given the status of disease with multiple epidemic foci and not a pandemic as of yet. Some experts say the designation to pandemic is deliberately being delayed to avoid panic. The viral infection was not given ‘outbreak of international public health concern’ until January 31, almost a week later when it was due.
Pandemic or not yet, this disease has spread to 46 countries including South America and Africa, the two continents which had not reported the cases. A global reported number of cases is over 83,000 and over 2800 death. The actual number of cases is always higher than the reported ones, because not all sick go to clinic or to a doctor or not everyone with the infection are tested.
It is important to note that pandemic does not necessarily mean the disease is highly fatal. It means it is caused by new virus and it is highly transmissible or infectious but not necessarily fatal. Human body has seen this virus for the first time and its immunity machinery need to make effort to make antibodies against it. Reports show almost half of people who were infected have become disease free.
There are few instances when predicting the outcome of the disease has gone wrong. In 1976, where an army private died and 13 other were hospitalised in Fort Dix, New Jersey, USA due to an unknown respiratory infection, the experts were convinced that this was due to a new strain of H1N1 influenza that resemble the strain that caused the 1918 pandemic influenza. They feared that it would be responsible for the new pandemic.
This had led to a massive nationwide immunization in the USA, the biggest public health venture the human kind has ever taken. Almost 40 million people were immunised in 10 weeks. Then the immunisation was abruptly stopped amid increased criticism of the large number of deaths and disabilities by its major adverse effect: Guillain Barre Disease.
In 2005, the United States predicted H5N1 strain of Influenza virus would cause pandemic and made pre-pandemic plans. Since 2004 and until September of 2005 it infected hundreds of people in China, Vietnam, Laos, Nepal, Bhutan, Turkey, Romania, Croatia, Kuwait, Egypt, Indonesia and Cambodia and killed many. The case fatality rate of the infection was much higher than seasonal influenzas. A high ranking WHO official said it could kill 5-15 million people worldwide.
But it did not. The threat of H5N1 Influenza causing pandemic disappeared then and for now. The pandemic did happen few years later in 2009 but with another strain of influenza virus that was much milder: 2009 H1N1 Influenza A.
The coronavirus, when it causes widespread community-wide human to human transmission, will be called a pandemic.

Avoid Misinformation, Panic
The following are the steps that governments, private sectors and individuals can take prior to, during and after when the coronavirus is declared a pandemic to minimise chaos, disease and death. The government, private sector, media and non-profit organisations must work in a concerted way in ensuring misinformation, panic is kept away or minimised among the public and credible, trustworthy information is passed along. All need to work to maintain calm.
A pandemic is a period of vulnerability and volatility. People panic easily and unnecessarily. Media, fake news and propaganda fuel their panic. Wrong news and information can be mistaken as real and true news. The government should produce appropriate and adequate vaccine expeditiously. Vaccines from the seed candidate virus that is causing the human infections are impactful compared to the vaccines produced from close but not exact virus. Preparations have begun on the vaccine against coronavirus but it takes months before it is available. All efforts need to be made to cut down unnecessary delays name of ‘safety of the vaccine’.
The government should research and produce effective antivirals. So far, no antiviral has been identified as effective against the coronavirus. But once such is available, the government should stockpile and distribute them on time. Antibiotics against the counter secondary infections need to be stockpiled as well. Pneumonia is the eventual cause of death due to coronavirus infection and antibiotics are needed to treat it.
Children are the easiest conduit of the transmission of coronavirus, both for receiving the infection and passing it to other. School districts and headmasters should train the teachers and students on ways to minimise the transmission of infections. Schools are one of the places where the virus can find its safe haven. School closure should happen if it is deemed community spread of the virus is occurring. Closing school temporarily and keeping children away from sick pals go a long way towards breaking the chain of transmission of the virus.
Individuals should avoid contact with the infected person. The viruses are found in the small droplets coming out of the cough, sneeze, saliva and secretions of an infected individual. These droplets cannot travel more than 6 feet away from the infected individual. If a healthy person is within the 6 feet from the sick individual and he touches these droplets and takes them to nose, eyes and mouth, the viruses enter the body. Washing hands with soap and water for 20 seconds kills the virus. Hand sanitizer that has alcohol also kill the virus.

Rely On Government
People should rely on the government sources for the news, information and guidance. Believe in your government!
The sick people should stay home and not be at work. Offices, corporations and offices should prepare contingency plan in case of high absenteeism. Each office should prepare its continuity of operation or COOP that guides employees in stepwise manner steps to be taken during the pandemic.
If you suspect you have symptoms of coronavirus, self-isolate, wear a mask and take measures to lower the severity of symptoms like anti-fever medication, lots of liquid etc. Cover your cough of sneeze with tissue and discard them safely that does not come in contact with other. If you are over aged 60 and over, have pre-existing medical conditions like diabetes, hypertension, asthma or bronchitis, seek immediate medical care.
Health care workers, nurses, doctors, paramedics are the ‘fire fighter’ to distinguish the fire of the ‘pandemic. They should be protected, kept healthy, kept from being over-exerted.
Once the virus enters the person then the person is at the mercy of his immunity to ward off the virus. Cough, sneeze, salivation are all defense mechanism of human body to ward off foreign invaders. However, these defense sometimes are so overwhelming that it harms the human body itself.
For example, continuous cough even there is not much trigger for the cough. The reason for death in the infected person is pneumonia. Prompt antibiotic intake and or hospitalisation is necessary to minimise the impact of pneumonia and avoid death.
Coronavirus have been detected in the stools. It is transmitted feco-orally. Flushing toilets, washing hands thoroughly after defecation are critical in preventing the spread of the virus. Pre-Pandemic drill and exercise help. Schools, offices agencies public sector should practice mock pandemic scenarios and exercise. A pandemic czar appointed by the president of the United States should oversee and coordinate activities prior to, during and following pandemic influenza.

(Dr. Sanjeeb Sapkota is a medical epidemiologist based in the USA and is the chairperson of the Health Committee of Non-Resident Nepali Association.)