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How Shoe-leather Public Health Works

Beyond Biomedical and Statistical Approaches in COVID-19

The evolving COVID-19 pandemic requires that data and operational responses be examined from a public health perspective. While there exist deep contestations about the epidemic control strategies to be adopted, past experience seems to be corroborated in the present epidemic that a contextually rooted “shoe-leather public health” approach provides the most effective interventions and operational strategies, more so in a society as diverse as ours. Drawing from this, an analysis of the COVID-19 situation in India is put forth, and debates on mitigation strategies, optimisation of testing, and the essential steps for a comprehensive set of interventions in order to minimise human suffering are addressed.

Humankind has encountered a rapidly spreading, relatively low virulence “new” virus in 2019, or so it is thought with the present knowledge. Identified as a member of the coronavirus family, it has been named SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and the disease it causes—COVID-19 (coronavirus disease 2019). As of 10 April 2020, globally, more than 1.5 million persons were detected as having been infected with the virus with nearly 93,000 deaths across 212 countries, increasing to 7.5 million cases and 4,50,000 deaths by 15 June 2020 (WHO 2020a).

Every epidemic and pandemic comes with its own characteristics, inherent uncertainties about its dynamics and prognosis. Additionally, context specificities operate to make issues more complex. Therefore, the response has to evolve as the epidemic unfolds and new knowledge about it becomes available. Previous experience provides lessons in terms of principles and enables “making sense” from limited and uncertain data as it becomes available. This is assisted by statistical modelling exercises based on assumptions made from historical experience and from other parts of the world. However, in all epidemics, much of the right assumptions and effective res­ponses have come from an “epidemiological imagination” coupled with a grounded sense of the context.

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Updated On : 4th Nov, 2020

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