International Journal of Health Sciences and Research

Vol.10; Issue: 9; September 2020

Website: www.ijhsr.org
Short Communication ISSN: 2249-9571

COVID-19: Role of Epidemiologist in Public Health

Emergency, India
Deepanshu Sharma1, Shahzaad Hussain2, Azmi Rani3, Punit Jha4, Bhawna Sati5
1,2
MPH Scholar, Department of Public Health, Maulana Azad University, Jodhpur, (JSPH), Rajasthan, India
3
WHO Consultant, Polio Eradication Initiative Program, Afghanistan.
4
MCH Consultant, UNICEF, Bijapur, Chhattisgarth, India.
5
HOD, Department of Public Health (JSPH), Maulana Azad University, Jodhpur, Rajasthan
Corresponding Author: Bhawna Sati

ABSTRACT

COVID-2019 disease is also known as 2019-nCoV acute respiratory disease, Novel corona virus in
December 2019 and has infected more than Twenty million people with over Eighty Thousand people
who died of the pandemic till 25 August 2020. The World Health Organization (WHO) has declared
the corona virus outbreak (2019-20) as a public health emergency of international concern (PHEIC)
on 30th January 2020 and a pandemic on 11th March 2020. Viruses can be prevented by adopting
proper personal and respiratory system hygiene and maintaining a distance from society timely.
Although doctors and nurses may be the front line and visible image of health care workers. In the
ongoing fight against the virus, there are other health workers behind the scenes, such as
Epidemiologists control the epidemic day and night Data and data are the focus of disease prevention
and control. The epidemiologist/surveillance officer/doctor conducting the epidemiological
investigation should close the case inquiry forms for all Covid-19 cases that meet the standard /
surveillance case definition.

Keywords: COVID-19, Epidemiologist, Outbreak.

INTRODUCTION Respiratory Syndrome Coronavirus 2

COVID2019 disease is also known (SARS-CoV-2), an enveloped single-
as 2019-nCoV acute respiratory disease, stranded RNA virus that has the same
Novel corona virus pneumonia, Wuhan characteristics as SARS-COV-1 Similar
pneumonia. In December 2019, the first phylogeny. (2)
case of corona virus disease 2019 (COVID- The World Health Organization (WHO) has
19) was reported in Wuhan, China, during declared the corona virus outbreak (2019-
an outbreak of viral pneumonia. An initially 20) as a public health emergency of
it was regional epidemic and now expanded international concern (PHEIC) on 30th
to a global pandemic affecting at least 309 January 2020 and a pandemic on 11th
countries with significant morbidity and March 2020. (3) The WHO has also prepared
mortality. guidelines to fight corona virus by
Infectious diseases refer to diseases introducing eight pillars of support:
with medical symptoms and signs caused by 1. Country level coordination, planning
growing pathogenic biological agents or and monitoring
infections in individuals/hosts/organisms, 2. Risk communication and community
and are also called infectious diseases or engagement
infectious diseases. (1) 3. Surveillance, rapid response teams and
The virus was identified as COVID- case investigations
19 (new corona virus), called Severe Acute 4. Points of entry

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 Deepanshu Sharma et.al. COVID-19: role of epidemiologist in public health emergency, India

5. National laboratories well as the United States are screening

6. Infection prevention and control travellers from Wuhan for fever, aiming to
7. Case management detect 2019-nCoV cases before the virus
8. Operational support and logistics spreads further.

Although many details of the History of COVID-19

emergence of the virus (such as its origin 2019, Chinese authorities had
and ability to spread between humans) are notified W.H.O of several cases of
still unknown, it seems that human-to- pneumonia of unknown etiology. The
human transmission is causing more and outbreak was reported in a seafood
more cases. In view of the outbreak of wholesale market in Wuhan, China in
severe acute respiratory syndrome corona December last year, and 66% of employees
virus (SARSCoV) in 2002 and the outbreak showed symptoms.
of Middle East respiratory syndrome On January 20, Washington State in the
coronavirus (MERS-CoV) in 2012, 2019- Northwest Pacific confirmed the first known
nCoV is the third occurrence of humans in case of COVID-19, and the person returned
the past two decades Coronavirus. This puts from Wuhan on January 15. (7)
global public health institutions on high The novel coronavirus was declared
alert a public health emergency on January 30,
In India total 29,67,844 Cases of and was named COVID-19 on February 11,
COVID-19 have been reported, including 2020. (8)
56,202 Deaths as of 2nd August 2020. (4) Kerala, India reported its first case
Public health supervision, field of COVID-19 infection. On January 27,
investigation, analysis, research, evaluation 2020, a 20-year-old woman went to the
and contact. From disease surveillance to emergency department of Thrissur General
field evaluation and policy formulation, (5) Hospital in Kerala. She had a history of dry
Epidemiologists usually revolve round cough and sore throat one day. There is no
collecting scientific and fitness records from history of fever, rhinitis or shortness of
the field, lookup or historic data, evaluation breath. She revealed that due to the COVID-
of gathered data, and presentation of 19 outbreak there, she returned to Kerala
findings. The findings can be used to from Wuhan, China on January 23, 2020. (9)
advance public fitness initiatives or find out In the first COVID-19 case reported
how illnesses originate, spread, and can be in Rajasthan on March 2, 2020, a 69-year-
treated. Although people are living longer old Italian tourist among 23 tourists from
and many illnesses are no longer harming Italy tested positive for COVID-19. (10)
humanity as they used to, epidemiologists In Rajasthan on August 22, 2020 had
are nonetheless important. Epidemiologists a total of 67,954 cases with 933 deaths and
play a crucial function in outbreak control. 51,698 discharged. (11)
(6)

China responded quickly by Symptoms of COVID-19

informing the World Health Organization The first people infected with
(WHO) of the outbreak and sharing COVID-19 are related to animal and
sequence information with the international seafood markets. This fact indicates that
community after discovery of the causative animals initially transmitted the virus to
agent. The WHO responded rapidly by humans. However, people with newer
coordinating diagnostics development; diagnoses have no relationship or contact
issuing guidance on patient monitoring, with the market, thus confirming that people
specimen collection, and treatment; and can spread the virus to each other. There is
providing up-to date information on the currently little information about the virus.
outbreak. Several countries in the region as In the past, respiratory diseases caused by

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 Deepanshu Sharma et.al. COVID-19: role of epidemiologist in public health emergency, India

coronaviruses (such as SARS and MERS) virus between individuals. Making contact
have been spread through close contact. with a surface or object that has the virus
Common symptoms include and then touching the eyes, nose or mouth.
1. Fever Some animal coronaviruses, such as feline
2. Breathlessness coronavirus, may spread through contact
3. Cough with faces. However, it is unclear whether
4. It may take 2–14 days for a person to this also applies to human corona viruses.
notice symptoms after infection The National Institutes of Health (NIH)
5. Expectoration suggest that several groups of people have
6. Myalgia the highest risk of developing complications
7. Loss of smell (anosmia) or loss of taste due to COVID-19. These groups include:
(ageusia) People aged 65 years or older, Young
The Director-General also pointed children, Women who are pregnant
out that the risk of serious complications Coronaviruses will infect most people at
increases with age. According to WHO. some time during their lifetime.
Severity grades the percentage of people Coronaviruses can mutate effectively, which
with COVID-19 is mild disease, from which makes them so contagious. To prevent
a person can recover more than 80% of transmission, people should stay at home
serious diseases, causing breathing and rest while symptoms are active. They
difficulties and pneumonia. About 14% of should also avoid close contact with other
serious diseases, including septic shock, people. Covering the mouth and nose with a
respiratory failure and More than one tissue or handkerchief while coughing or
diseased organ about 5% fatal disease 2%. sneezing can also help prevent transmission.
(12)
It is important to dispose of any tissues after
According to M.O.H.F.W. In India, use and maintain hygiene around the home.
(14)
the most common sign and symptoms of
COVID-19. Positive patients experience
fever, Body-ache, fatigue, weakness, a dry Epidemiology of COVID-19
cough and some patients have a history of Data provided by the WHO Health
pain, nasal congestion, diarrhea, sore throat, Emergency Dashboard report 22,536,278
or runny nose. These symptoms are usually confirmed cases of COVID-19, including
moderate and started regularly. Some people 789,197 deaths (as of 6:48 pm CEST, 21
become infected, but they do not have any August 2020).
symptoms and do not feel bad. Most people
(about 80%) recover without any special Table-1 the number of cases of COVID – 19 outbreak
according to WHO situation reports on August 11, 2020.
treatment. About 1 in 6 people who develop S. No. Country Cases
COVID-19 will become seriously ill and 1 America 12,028,928
2 Europe 3,909,981
have trouble breathing. Older people and 3 South-East Asia 3,383,904
those with underlying health problems, such 4 Eastern Mediterranean 1,790,071
5 Africa 984,140
as high diabetes, heart problems or blood 6 Western Pacific 438,513
pressure, are more likely to develop serious
illnesses. People with a fever, cough, and The latest epidemiological information
shortness of breath should seek medical about this epidemic can be found in the
attention. (13) following sources:
 WHO's new coronavirus (COVID-19)
Corona Virus Spread Following Ways: dashboard.
Coughing and sneezing without  The Coronavirus Global Cases COVID-
covering the mouth can disperse droplets 19 site of the Johns Hopkins University
into the air. Touching or shaking hands with Center for Systems Science and
a person who has the virus can pass the Engineering, which uses publicly

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 Deepanshu Sharma et.al. COVID-19: role of epidemiologist in public health emergency, India

available resources to track the spread of belong to the same subgroup beta corona
the epidemic. virus, the similarity at the genome level is
Current evidence for COVID-19 only 70%, and the new group shows genetic
suggests that the causing virus (SARS-CoV- differences compared to SARS-CoV. took
2) has a zoonotic source closely related to place during the Spring Festival in China,
the SARS-like coronavirus from bats. It is which is the most famous traditional festival
an encapsulated beta RNA coronavirus in China, with nearly 3 billion people
related to the severe acute respiratory traveling across the country. These
syndrome virus (SARS) and the virus has conditions have created favorable conditions
been shown to use angiotensin converting for the transmission of this highly
enzyme receptor 2 (ACE2) to enter cells. contagious disease and serious difficulties in
People infected with the new coronavirus epidemic prevention and control. (16)
are the main source of infection. Direct
human transmission occurs through close Table 2: State/UT wise list of COVID confirmed cases. (As on
22.08.2020 at 01:53 PM). (5)
contact, mainly through airway droplets, S.No. State Cases Deaths
which are released when an infected person 1 Delhi 158604 4270
2 Haryana 52164 585
coughs, sneezes or talks. These droplets also 3 Rajasthan 68566 938
can land on surfaces where the virus 4 Kerala 54182 204
5 Maharashtra 657450 22013
remains alive. Infection can also occur when 6 Gujarat 84311 2867
a person touches an infected surface and 7 Uttar Pradesh 177239 2797
then touches the eyes, nose, or mouth. The 8 Madhya Pradesh 50640 1185
9 Bihar 117671 588
median incubation period is 5.1 days (range 10 Goa 13484 135
2-14 days). The exact time a person with
COVID-19 is contagious is uncertain. Role of Epidemiologist in Disease
According to the current evidence, the Outbreak
infectious period begins 2 days before Epidemiology is art of science in
symptoms appear and lasts up to 8 days. which we study distribution (frequency and
The extent and role of preclinical / pattern) and determinants of health related
asymptomatic infections in transmission events in populations and the use of this
remains under investigation. (15) study in the prevention and control of health
In December 2019, many cases of problems. At the time of outbreak of any
pneumonia were reported that occurred in health related problems, Epidemiologists are
Wuhan City and source searches pointed to actively engaged, and use epidemiological
the Huanan Seafood Market. The first case method to find out the cause of outbreak.
of the COVID-19 epidemic was detected Once an understanding has been
with unexplained pneumonia on December reached that an assessment should be carried
12, 2019, and 27 cases of viral pneumonia, out before or generally at the same time as
seven of which were severe, were officially emergency operations, the role of the
announced on December 31, 2019. epidemiologist is collection of useful data
Etiological studies were performed on from a field, analyses and summaries
patients. who were admitted to hospital complex epidemiological data for making
because of similar viral histories of these various policies to control and prevent
patients increased the likelihood of infection health problems. Epidemiologists are front
from animals to humans. On January 22, line health worker in every pandemic
2020, the new CoV was considered to be situation. Epidemiologists give active
derived from wild bats and belongs to participation in public health policy making.
Group 2 coronavirus containing the Responsibilities for Epidemiologist
coronavirus associated with severe acute  Identify health problems in an affected
respiratory syndrome (SARS-CoV). community
Although COVID-19 and SARS-CoV

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 Find out origin and a mode of the conforming increase in cases or after
transmission of disease. conforming increase in cases. Most of time
 Obtained data from disease survey epidemiologists discover that increase of
,clinical study ,Interview study number of a particular disease in a specified
 Analyse complex epidemiological data population then they decide to go in a field.
and find out conclusions. According to CDC field preparation can be
 Creates a plan of action for stop health divided into 2 categories.
crises in population 1. Scientific issue
 Create reports detailing various 2. Management and operational issue.
component of disease.
 Presenting epidemiological data for Step 2. Establish the existence of an
policy making. outbreak
 Communicates with policy makers on This is 2nd step of outbreak
public health. investigation. in this step epidemiologist
 Manage multiple roles in a project at compare disease frequency with available
once. data of the corresponding period of past 2-3
 Create various public health awareness years. The applied epidemiologist must
programs and supervise them. compare local and regional disease patterns
 Conducting various studies to gain more and prevalence prior to the increased cluster
information regarding health problems. of cases at the outbreak site. The applied
epidemiologist asks: Is this a real outbreak?
Epidemiologist Following Step for After assessing the evidence, the answer is
Disease Outbreak either “yes” or “no.” If “yes,” then they
Epidemiologist is a backbone of move to step 3.
investigation of a disease outbreak. The
main objective of investigation a disease Step 3. Verify the diagnosis
outbreak is- This step is closely linked with existence of
1. Define the outbreak in the term of time disease. To verify the diagnosis
place and person. epidemiologist can use this three
2. Line list responsible factors for origin of investigation method.
disease. 1. Medical Investigation
3. Find out cause, source, and various 2. Laboratory investigation
modes of transmission of a disease. 3. Epidemiological investigation
4. Make recommendation to prevent With the help of clinician, disaster
disease recurrence. response team, laboratory testing result,
survey findings epidemiologist scientifically
In investigation main aim is find out the collect all evidence to prove disease
correct cause of morbidity and mortality in outbreak in a population.
specified population and implement its Epidemiologist will look into
appropriate disease control to reduce and epidemiological and environmental aspect
prevent mortality. of outbreak. Basic aim is identify the source
of problem.
According CDC Applied Epidemiologists
approach the investigation of a disease Step 4. Define and identify cases
outbreak using the following 12 steps: It is a standard criterion for deciding
that an individual should be classified as
Step1.Prepare for field work having the health condition of interest.
Preparing for the field work is totally The applied epidemiologist, again,
depended on epidemiologists. He can decide working with team members and local
to conduct a field investigation before public health officials set about trying to

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identify all individuals who “fit” the case

definition. Step 9. Refine hypotheses and carry out
Epidemiologist conduct descriptive additional studies
epidemiologic studies the disease outbreak Additional data are still coming in to the
in terms of person, time and place. applied epidemiologist from the impacted
community. This additional data are further
Step 5: Find cases systematically and record evaluated to determine if the “new” data and
information; Epidemiologist design an the related conclusions comport with the
epidemiological case sheet to collect earlier conclusions in Step 7. If not, the
relevant information like(name, age ,sex working hypothesis would need to be
,occupation, social class, travel history, sign refined.
and symptoms of illness ,personal contact at
home, work, school, and other place. special Step 10 Compare and reconcile with lab
events .former medical history and many and environmental studies
more. The epidemiologist playing major role.
Demographic data, clinical information, and Epidemiology can suggest vehicles and
risk factor information along with other guide appropriate public health actions,
pertinent data. These data are, then, while laboratory evidence can confirm
assembled in a way that helps describe the findings.
disease cluster and how it moved through
the specific population. Step11 Implement control and prevention
measures
Step 6- perform descriptive epidemiology: Once the working hypothesis has been
Collecting and identify basic information of confirmed, the applied epidemiologist, again
the person with disease in this steps working with local public health personnel,
epidemiologist define outbreak in time, develop and deploy appropriate disease
place, and person. This steps help control measures. These basic disease
epidemiologist to find out following things; control measures were previously discussed
Compressive characteristic of the outbreak. in the response at Lecture 3, Item 11
Identify population at risk for the disease. (above). The disease control measures must
Provide basic clues about etiology and mode be implemented and assessed to confirm
of transmission. effectiveness in arresting the disease.

Step 7. Develop hypotheses Step 12. Communicate findings

The applied epidemiologist uses the For the applied epidemiologist, “the
knowledge and expertise in hypothesis investigation is not complete until the
generation to posit a working hypothesis for results are disseminated to the appropriate
the disease outbreak given the available data parties” (Gerstman, 2003, p. 363). The
from Steps 2 thru 5. applied epidemiologist must deliver an oral
report to local officials summarizing the
Step 8. Evaluate hypotheses above steps; this oral briefing should be in
epidemiologically “plaiblanguage” and present the main
At this step, the applied epidemiologist uses findings of the outbreak investigation. A
available data (mainly from Step 5) to scientific report must, also, be prepared to
statistically evaluate the working hypothesis document the initial activities, interim
(calculating and evaluating rates, discussed actions, final actions taken, and any
above) along with evaluating the tentative recommendation for local public health
data and conclusions with other public officials to consider following the outbreak
health personnel on‐site to establish face investigation (CDC, 2006).
validity.

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Disease Surveillance primary function of epidemiologists who

The important information in disease conduct research in others to identify
surveillance are - who many gets the disease causes and risk factors. This may be
disease, how many get the disease, where the identification of the patient's travel
did they get the disease, why did they get history, the treatment plan to date, and the
the disease, and what needs to be done as identification of contacts with the patient. It
public health response. is invaluable to understand community
The components of the surveillance activity values and the vocabulary they used to
are: identify health and disease. (19) Fields
(a) Collection of data experience from previous outbreaks helps
(b) Compilation of data the epidemiologist recognize the data that is
(c) Analysis and interpretation most critical in identifying threats and
(d) Follow-up action planning and evaluating strategies for a
(e) Feedback. specific situation. Field studies help to
The epidemiologist ensures proper understand the prevalence of diseases,
data collection, which is one of the stages of especially new diseases, and are often
disease surveillance. Other steps include carried out in response to serious public
reporting, data collection, data analysis, health problems. (20)
evaluation, and action.
The collected samples are sent to Communicating
COVID-19 laboratories for analysis, then As health communicators, we can
tested, and then efforts are made to isolate help by delivering reliable information to
the patient if positive. the public accurately and in a timely
Disease monitoring is the continuous manner, so that people can make decisions
scrutiny of occurrences of health events that based on facts instead of rumors. Part of the
allow for timely response in its control and reason is to be aware of any inaccurate
serves as an effective way to control information that peoples may share on
disease. Disease surveillance also means social media or elsewhere. We can also be
looking out for new and emerging diseases careful not to exaggerate the facts, but
and an example is “Mad Cow disease” in instead focus on helping people understand
the 1980s”. (17) their personal health risks and what
Disease surveillance has been measures should be taken to control the
recognized as an effective disease spread of diseases.
prevention and control strategy, in particular  Who is at the greatest health risk?
for diseases that are prone to epidemics.  When does this information apply to
Disease surveillance is the first link in the them?
response to emerging infections such as  What actions can they take?
COVID-19. Disease surveillance includes Public health information
an epidemiologist, a public health epidemiologists and other public health
laboratory, and a healthcare system that professionals have played an active role in
includes 4 core components: namely disseminating public health information
collection, analysis, dissemination and provided by surveillance and health
response. (18) information to public health care providers
and decision makers. (21) This is important
Field Investigation because effective communication is a means
Surveillance provides the for epidemiologists to influence policy, and
information needed to operate. After the there is an increasing need for
observation, the epidemiologist conducts an epidemiologists to influence the public
investigation. Field studies are the means by when designing, interpreting and reporting
which data is pushed into action, the their work. Communication about increased

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exposure prompts outbreak investigation. 2. Contact listing

(22)
All persons considered having
significant exposure (belonging to the
Contact-Tracing categories described above) should be listed
1. Contact identification as contacts, using the contact form. Efforts
For all cases that meet the should be made to physically identify and
criteria/surveillance cases, contact inform each contact listed their contact
identification is an important part of the status, what those means, the activities that
epidemiological investigation Definition of will follow, and the importance of early care
Covid-19. These cases are classified as if they develop symptoms. Contacts should
suspicious, probable and confirmed. also be provided with preventive
The epidemiologist conducting the information to reduce the risk of human
epidemiological study should complete the exposure near them.
case inquiry forms for all Covid-19 cases Stay home and limit close contact
that meet the standard / surveillance case with other people. Avoid crowded places,
definition. After completing the inquiry socializing, and using public transport.
form, the epidemiologist should Report any suspicious signs and symptoms
systematically identify potential contacts. such as fever, cold, cough, and difficulty
Contact identification therefore starts with breathing immediately (please tell phone
the case. The contacts are identified by numbers for the contact team, supervisor or
asking for activities related to the case and Covid-19 hot line / call center)
activities and roles of those around the case
(living / deceased) from the onset of the 3. Contact follow-up
disease. Although some information may be The epidemiologist / supervisor /
obtained from the patient, much of it will contact tracing physician should assemble a
come from those close to the patient. IN In competent team involving local supervision
some cases, the patient will die or has and FLW (ASHA, AWW, ANM &
already been admitted to a restricted Supervisors) to track all contacts listed. An
isolation unit. It is an epidemiologist's visit effective contact tracing system depends on
to the patient's home is mandatory. The trust with the community, which in turn
following information you should get: favors the optimum cooperation.
All persons who lived with the case (alive / Communities should ensure they are
deceased) in the same household from the collaborating with tracking teams and
onset of the disease. All persons who visited allowing targeting symptomatic contacts
the patient (alive / deceased) at home or in a with designated isolates. Involvement of
medical facility from the onset of the relevant community members (especially
disease. local leader) in tracking contacts is crucial
All places and people visited by the patient in cultivating good relationships, trust and
from the beginning of the disease, e.g. confidence. Local supervision i FLWs
hospitals, clinics, traditional healer, temple, (ASHA, AWW, ANM and supervisors)
relatives, etc. should be involved as early as possible in
All these places and people should be the response. Local surveillance staff and
visited and contacts identified. During the FLW are closely supervised by trained
home visit, the contact identification / epidemiologists.
follow-up teams should inquire about who
may have been exposed patient (alive /
dead) but not identified and listed as a
contact for the above process. They should
be given priority high-risk contact
categories, people who in the last 14 days.

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groundwater contamination, current

epidemiological techniques may not be able
to identify any related health effects.

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