Nepal Earthquake 2015: Epidemiology of Population Health Concerns

1. Just-in-time Epidemiology Super-course as of May 8, 2015. Nepal Earthquake 2015: Epidemiology of Population Health Concerns Dr. Drona Rasali, DVM, PhD, 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

2. #Nepal Earthquake Aftermath: Why is it so deadly? On 1 April, 2014, a M8.2 Earthquake rocked northern Chile. Only six people died; with 2,500 homes damaged and 80,000 people displaced. Just over one year later, a M7.8 earthquake strikes Nepal. Over 7,500 people (and counting) have been 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)

3. #Nepal Earthquake Aftermath: • Impoverished country of 27 million. • About 39 of the country's 75 districts are affected, with at least two million people needing tents, water, food and medicines over the next three months.

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

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

6. Destruction of Kathmandu’s historical monuments

7. Destruction of Kathmandu’s historical monuments

8. Destruction of Kathmandu’s historical monuments

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

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

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

13. #NepalEarthquake: Role of social media • Social media is playing a huge role in making the whole world converged at #NepalEarthquake.

14. Earthquake Disaster: Trimodal Health Phases Adapted from: Epidemiology of Disasters, Accessed at: http://www.mimms.org.au/about-mimms/epidemiology-disasters

15. #NepalEarthquake: Injuries • 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

16. #NepalEarthquake Aftermath: Deaths and Diseases • 7,652 deaths reported as of May 6; the number speculated to reach 10,000. • 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 • 16,362 people reported injured as of May 6, but deemed to be an under-estimate in this disaster • Concerns about epidemics due to the shortage of clean water supply, the makeshift camp living conditions and the general lack of sanitary toilets

17. #NepalEarthquake Aftermath: Emergency Health Services • 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. • 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. • 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

18. #NepalEarthquake Aftermath: People’s lives • Hundreds of people missing; some survivors are still to be found. • 2.8 million momentarily displaced either because their houses have been destroyed or because they are too afraid of aftershocks to remain at home. • Two million children affected in some way by the events of less than two weeks ago • 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. • Almost 24,000 classrooms were damaged or destroyed in the disaster leading; possibly, about a million children not returning to school when reopen. • Tens of thousands girl survivors reportedly preyed upon by human traffickers

19. #NepalEarthquake 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.” • SairaAsher • BBC News

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

21. #NepalEarthquake: Logistic Dilemma • 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) • 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. • 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.

22. #NepalEarthquake: Health Surveillance • Hospital based health and disease surveillance initiated in the fourteen most affected districts. • 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. • This syndromic approach will help detect potential outbreaks. • 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).

23. #NepalEarthquake: Health System Challenges • Nepal’s Health System has a surge of at least 60,000 extra people needing urgent health care. • Hospitals are overloaded • 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. • Lack of transportations to many affected areas is making intervention harder • Most affected people have to live in the open • Clean water and hygienic environment are major concerns.

24. #NepalEarthquake: Surveillance Recommendations • Population based surveillance is not feasible; hospital and pharmacy based syndromic surveillance of injuries and disease outbreaks should be intensified. • 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. • 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. • Surveillance of affected people for any mental health issues will be increasingly important. • All displaced children should be offered full immunizations according to their age and the Nepal's schedule

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