Preparedness for Future Pandemics: Threats and Challenges 9819932009, 9789819932009

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Preparedness for Future Pandemics Threats and Challenges Rajeev Varshney Iti Garg Swati Srivastava Editors

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Preparedness for Future Pandemics

Rajeev Varshney • Iti Garg • Swati Srivastava Editors

Preparedness for Future Pandemics Threats and Challenges

Editors Rajeev Varshney Defence Institutute of Physiology and Allied Sciences (DIPAS) Defence Research & Development Organisation (DRDO) New Delhi, India

Iti Garg Defence Institutute of Physiology and Allied Sciences (DIPAS) Defence Research & Development Organisation (DRDO) New Delhi, India

Swati Srivastava Defence Institutute of Physiology and Allied Sciences (DIPAS) Defence Research & Development Organisation (DRDO) New Delhi, India

ISBN 978-981-99-3200-9    ISBN 978-981-99-3201-6 (eBook) https://doi.org/10.1007/978-981-99-3201-6 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Paper in this product is recyclable.

Foreword

I am extremely delighted to write this Foreword for the book entitled Preparedness for Future Pandemics: Threats and Challenges being compiled and edited by Dr Rajeev Varshney, Dr Iti Garg, and Dr Swati Srivastava. This book is coming out soon after India and the world at large are recovering from the catastrophic effects of the COVID-19 pandemic. This pandemic was second in one decade—Swine flu followed by COVID-19 within 10 years. The COVID-19 pandemic has resulted in high morbidity and mortality. This has also disrupted the economies and lives of people all over the world. Air travel by millions of people across continents rapidly resulted in the spread and deeper impact of such epidemics/pandemics. By the time we developed tools and strategies, the damage is already done. This book has quite informative chapters on the historical aspects of pandemics, origins/relationships with ethnicity, pandemics in the modern context, after-effects, host parasite aspects of respiratory infections, multi-omic approaches, medical strategies, development of vaccines and drugs, need of psychological preparedness, financial impacts, industrial perspective of diagnostics, importance of appropriate laboratory networks, access to services, and lessons learnt from the COVID-19 pandemic. The rapid spread of the COVID-19 pandemic was equally matched by the rapid emergence of several hundred thousands of publications on it. Most difficult was to find out what to pick up and what to give lower priority! Fortunately, history has lessons and knowledge that is lasting. I am optimistic that this book will provide readers a filtered knowledge which they can use to think and act for preparation for future pandemics. All the editors and contributing authors are very distinguished experienced colleagues with original contributions to their credit. This is reflected by their insight in defining the themes, issues, technologies, and highlighting their importance in the context of remaining prepared for pandemics all the time so as to minimize their impacts.

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Foreword

I compliment the authors as well as editors for this excellent effort. I am optimistic that this book will be useful to policy makers, biomedical scientists/teachers, healthcare professionals, and healthcare industries involved in developing tools/ strategies to fight infectious diseases in general and pandemics in particular. I also feel that this book will be liked by students belonging to diverse disciplines with interest in different aspects relevant to prevent and fight future pandemics. V. M. Katoch JIPMER Puducherry, India Lepra Society Hyderabad, India Tuberculosis Association of India New Delhi, India Department of Health Research, Govt of India New Delhi, India Indian Council of Medical Research New Delhi, India AIIMS Madurai, India Rajasthan University of Health Sciences (RUHS) Jaipur, India

Preface

The year 2020 witnessed the outbreak of the COVID-19 pandemic, which led to widespread suffering, loss of human lives, social unrest, and also had huge financial impact on industries globally. Various countries across the globe had their own challenges and limitations to deal with the pandemic depending upon their economic conditions, medical facilities, workforce, and population density. In an attempt to restrict the spread of coronavirus, several countries imposed localized lockdowns for varying periods, which not only impacted small industries and its workers financially but also put unprecedented psychological impact on both adults and children due to social isolation. The profound impact of the COVID-19 pandemic instigated several research projects in universities, government sectors, and private industries. Researchers all over the world are struggling to understand the causes of its outbreak and spread of virus, identifying biomarkers for its early detection as well as severity prediction along with scheming novel therapeutic modalities for its effective treatment. The COVID-19 pandemic, which began to spread in early 2020 and continued in its most severe form for over two years, has challenged existing public health systems and has raised serious concerns regarding our preparedness for such outbreaks in future. In fact, the world has experienced other massive viral outbreaks in the past two decades which led to massive loss of lives and economic disruption. As human civilization expands causing climatic change and over-exploitation of natural resources, such viral outbreaks shaping into global pandemics are likely to surface time and again. With huge human inference on natural ecosystems, we are living on the edge where mankind can be placed in a state of emergency anytime due to the outbreak of pandemics. The repercussions caused by the COVID-19 pandemic gave a food for thought for composing a book which should enlighten the world regarding the risks of such future outbreaks and preparedness to counter them. This book deals with wide aspects of pandemics that have erupted in the past, their epidemiology, genetic susceptibility of an individual towards infections along with changes in the lifestyle required to mitigate the effect of viral infections. It also talks about challenges faced during clinical management of the COVID-19 pandemic, its socio-­ economic and psychological impact. The contents of the book elaborate etiology,

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epidemiology, pathophysiology, clinical features, medical and financial management strategies for COVID-19. The book focuses on current challenges, lessons learnt from the current pandemic, and future perspectives to prevent and regulate similar situations. New Delhi, India New Delhi, India  New Delhi, India 

Rajeev Varshney Iti Garg Swati Srivastava

Acknowledgments

The editors of this book would like to express their profound gratitude to all the authors from different parts of the country and abroad, including scientists, clinicians, researchers, and other contributors who devoted their precious time in summarizing the research and writing their point of views on various topics covered under Preparedness for Future Pandemics: Threats and Challenges. The editors are extremely thankful to all the Lab Directors and Departmental Heads for permitting their Scientists and staff to undertake the task of book chapter writings. The proofreading, editing, and compilation of the contents of this book were extensively supported by project coordinator and handling editor(s) from Springer Nature. We commend the proactive participation from all the authors and quick response from the publisher, which has helped in framing the contents of the book focusing on public health imperative ensuring measures for future risks. This book is dedicated to all the doctors, medical staff, and front-line workers who worked tirelessly during the difficult COVID times and saved millions of lives, serving mankind with great humility and strength. We owe an extraordinary debt to these corona warriors.

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Contents

1 History  of Pandemics? How the World Dealt with It? ��������������������������   1 Richa Rathor and Geetha Suryakumar 2 Ethnicity  and COVID-19: Are They Related?����������������������������������������  17 Shuchi Bhagi and Sudhir Chandna 3 Pandemics  in Modern Era: Impact of Geographical Landscapes on Disease Risk������������������������������������������������������������������������������������������  31 Swati and Shweta Saxena 4 Host–Virus-Bacterial  Cross Talk in the Respiratory Tract Microenvironment: Implications for Understanding the Disease Severity of Respiratory Viruses����������������������������������������������������������������  45 Hirawati Deval, Rohit Beniwal, Neha Srivastava, Niraj Kumar, Brij Ranjan Misra, and Rajni Kant 5 Relevance  of Multi-Omics Approach for Future Pandemic Preparedness and Response����������������������������������������������������������������������  53 Apeksha Rana, Manish Sharma, and Gaurav Kumar 6 Surviving  COVID-19 is Half the Battle Won: Long-Term Effects��������  65 Suman Dhankher, Paban Kumar Dash, and Manmohan Parida 7 Lifestyle  Changes Required to Mitigate Effects of Infectious Diseases ������������������������������������������������������������������������������������������������������  77 Samir Samadarshi, Rohit Vashisht, and Uday Yanamandra 8 Medical  Strategies for Current Pandemic: Pros and Cons��������������������  93 Ratnesh Singh Kanwar, Shivi Uppal, and Reena Wilfred 9 Need  for Quicker Systems for Development and Evaluation of Vaccines and Drugs�������������������������������������������������������������������������������� 105 Satyendra Singh, Abhishek Rao, and Shailendra Kumar Verma 10 Infectious  Diseases and Pandemics: Need for Psychological Preparedness and Resilient Response������������������������������������������������������ 121 Swati Mukherjee

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11 COVID-19  Pandemic: Leveraging the Learnings—An Indian Diagnostics Industry Perspective�������������������������������������������������������������� 131 Veena Kohli 12 Financial  Impact of Pandemic on Society������������������������������������������������ 145 Agyeya Trippathi and Pratibha Gupta 13 Strengthening  and Expanding Laboratories for Aetiological Diagnosis in Pandemics: Lessons from the Indian SARS-CoV-2 Experience�������������������������������������������������������������������������������������������������� 163 Lalit Dar, Aashish Choudhary, and Megha Brijwal 14 Investing  in Integrated and Equitable Public Health Systems: The Only Way to Handle Future Pandemics������������������������������������������ 175 Rashmi Aggarwal 15 Two  Years of COVID-19 Pandemic: Lessons Learnt and Way Forward������������������������������������������������������������������������������������������������������ 183 Neeti Jain, T. Seenivasagan, and A. S. B. Bhaskar

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History of Pandemics? How the World Dealt with It? Richa Rathor and Geetha Suryakumar

1.1 Introduction 1.1.1 Outbreaks, Epidemic and Pandemics Outbreaks, epidemics, and pandemics are closely related terms that depend on the occurrence of a health condition and its spread in geographic areas [1, 2]. Outbreak is a condition in which an illness occurs in unexpectedly high numbers. It can stay at one area or it could also spread widely. An epidemic is a situation in which an infectious disease spreads very rapidy that affects a large population. A pandemic is basically an outbreak of infectious disease that not only spreads in one or more area but also spreads across countries and continents. It also sacrifices more lives of people than an epidemic. The mortality rate of a population during a pandemic depends on the infection type, severity of virus virulence, vulnerability of the group of people, and the efforts made to prevent the same. A pandemic alert system is provided by the WHO ranging from Phase 1 (a low risk) to Phase 6 (a full pandemic) as per their severity level (Fig. 1.1). The development of WHO pandemic phases was done in 1999 which was further revised in 2005. The entire world accepted these phases and the vision for pandemic preparedness and timely response against the adverse condition.

R. Rathor (*) · G. Suryakumar Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation (DRDO), New Delhi, India e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 R. Varshney et al. (eds.), Preparedness for Future Pandemics, https://doi.org/10.1007/978-981-99-3201-6_1

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Fig. 1.1  A pandemic alert system developed by WHO [3]

1.2 Brief History of Pandemics (Pandemics Throughout History) Infectious diseases always threaten human health because of their ability to spread rapidly. To cope up with the situation, global surveillance programs play a responsible role in identifying pathogens in animals and humans that further regulates water-borne pathogens and vector-borne diseases. Further, pharmacological and nonpharmacological measures also play a significant role in the prevention and control of infectious diseases and hence limit the spread in human population. To date,

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1  History of Pandemics? How the World Dealt with It? Table 1.1  A glimpse of pandemics with their details Year 541–543

Pathogens Yersinia pestis

Number of deaths 15–100 million

1347–1351

Yersinia pestis

75–200 million

Yersinia pestis Vibrio cholerae Vibrio cholerae Vibrio cholerae Vibrio cholera Vibrio cholerae Vibrio cholerae Vibrio cholerae

12–15 million 100,000+ 100,000+ 1 million+ 600,000 298,600 800,000+ Unknown

Russian flu

1885–ongoing 1817–1824 1827–1835 1839–1856 1863–1875 1881–1886 1899–1923 1961–1975/ ongoing 1889–1893

1 million

Spanish flu

1918–1919

Asian flu

1957–1959

Hong Kong flu

1968–1970

Swine flu

2009–2010

SARS pandemic Middle East respiratory syndrome (MERS) COVID-19

2002–2003 2015–ongoing

Influenza A/ H3N8? Influenza A/ H1N1 Influenza A/ H2N2 Influenza A/ H3N2 Influenza A/ H1N1 SARS-CoV MERS-CoV

2019–ongoing

SARS-CoV2

6,381,643 (till July 2022)

Pandemic First plague pandemic (Plague of Justinian) Second plague pandemic (the Black Death) Third plague pandemic First cholera pandemic Second cholera pandemic Third cholera pandemic Fourth cholera pandemic Fifth cholera pandemic Sixth cholera pandemic Seventh cholera pandemic

17–100 million 1–4 million 1–4 million 151,700–575,400 774 885

numerous pandemics, including plague, cholera, influenza, coronavirus diseases, etc., caused huge problems to humankind throughout history. Evidence depicts that all the pandemics originated due to Zoonosis or zoonotic diseases (cross-species transmission of microorganisms/pathogens from animals to humans) [4] (Table 1.1).

1.3 The Plague of Justinian (541–549) The plague of Justinian is the first known incident of plague. It occurred in Egypt and spread throughout the Eastern Roman Empire and its neighbors [5]. Justinian I, the Byzantine emperor, first suffered with the above disease. Hence, the disease is named after him. This disease spread to humans by the flea-borne bacteria Yersinia pestis (Y. pestis) and rodents acted as carriers. Yersinia pestis is a gram-negative, rod-shaped, coccobacillus and anaerobic bacteria which is transmitted via fleas with rodents and other mammalian hosts [6]. Plagues can be divided into three types according to the route of infection: (1)

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Bubonic, (2) Septicemic, and (3) pneumonic [7]. The most common plague, bubonic plague, is caused by the bite of an infected flea with clinical manifestations of flu-­ like symptoms such as headache, fever, body pains, chills, vomiting, nausea, and weakness with painful swollen lymph nodes. The bubonic plague can be fatal (50–90% cases). Septicemic plague is a progressive bloodstream infection in the absence of lymphadenopathy, and this plague is very rare (10–25% cases). However, the mortality rate is higher in septicemic plague compared with bubonic plague. Pneumonic plague arises if the bacteria infect the lungs, and this type of plague is quickly fatal if left untreated. After the primary pandemic, intermittent plague outbreaks happened in every 8–10 years for the next two centuries. After that, it disappeared, and the reason is still unknown.

1.3.1 Precautionary Measures/Govt Efforts Individuals protected themselves by avoiding contact with infected body fluid, tissues, and animal carcasses. Surveillance and control programs for fleas and animals were also started to regulate the life cycle of Y. pestis. The early isolation of patients on the basis of rapid detection was performed [8]. Standard treatment for plague comprises streptomycin and doxycycline while alternative treatment included gentamicin and fluoroquinolones [7, 9]. The USA approved the whole Y. pestis killed with formalin as a vaccine. However, this vaccine is effective against bubonic plague but not against the pneumonic form of the disease. The WHO recommended vaccination to only healthcare workers and laboratory personnel, highly exposed to the pathogens.

1.4 The Black Death (1346–1353) The second plague pandemic, the Black Death, is considered as the deadliest disease outbreak recorded in history. It devastated between 75 million and 200 million people in Europe, Africa, and Asia [10]. Like the Plague of Justinian, it is carried by rats infected with Yersinia pestis bacteria. The disease is spread between continents via rats that were travelling in ships. The name of Black Death is given as black spots used to form on the skin of the infected person. Suddenly, the bacteria disappeared from Europe, possibly related to the extinction of local rodent reservoirs [11]. That time no treatment was available for plague. Hence, isolation was maintained between healthy and infected persons. Ships with suspicion of plague were put under quarantine and retained for 40 days.

1.4.1 Precautionary Measures/Govt Efforts There was no efficient treatment available for plague. However few precautions were taken to control black death [12]. Infected people were isolated in camps and

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then in permanent plague hospitals (called lazarettos) so that spread could be monitored. The arrival of ships was also stopped in port cities.

1.5 Cholera (1817–Ongoing) Cholera is an acute gastrointestinal tract disease caused by Vibrio cholerae, and it is too fatal that a person can die within hours if untreated [13]. Vibrio cholera is a gram-negative, coma shaped, flagellum type, anaerobic bacteria which colonizes the small intestine and produces cholera toxin. The clinical manifestations include rapid and massive loss of body fluids leading to dehydration, hypovolemic shock, and death. As Vibrio cholera is a water-borne pathogen, humans are infected with cholera via contaminated water used for drinking and cooking. As per WHO, seven cholera epidemics were observed and the third cholera pandemic is considered to have been the deadliest in 1852. Basically, it commenced in India and then spread to rest of Asia and parts of Europe, North America, and Africa. In late 1992, the fear of eighth cholera pandemic outbreak was raised in Bangladesh and neighboring countries [14].

1.5.1 Precautionary Measures/Govt Efforts Poor living conditions such as deprivation of safe drinking water, crowded houses, improper sanitation, and inefficient sewage systems are the primary causes of the insistence of cholera. Considering these causes, implementation of public health measures for adequate sanitation and safe water supply could prevent the cholera outbreak [15]. Millennium Development Goals and sustainable Development Goals were started to maintain the above aspects [16]. After that, the WHO also launched Water, Sanitation and Hygiene (WASH) program to counter cholera transmission [17]. Most of the infected cholera patients were treated with the administration of oral dehydration solution (ORS), while severe cases were managed via rapid administration of antibiotics and intravenous fluids. Doxycycline is considered as the prime drug while other alternatives are tetracycline, ciprofloxacin, and azithromycin [18].

1.6 Influenza The exact time at which influenza began to cause pandemic cannot be determined. However, few historians reported that first influenza might have been detected in 1510 [19]. The first Russian flu pandemic was likely to be declared in between 1889 and 1893 [20]. Based on serologic and epidemiologic data, an A/H3N8 virus was found responsible for influenza pandemic [21, 22]. Further, it is also observed that

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the pandemic virus used to reappear in every 3 years and caused approx. 1 million deaths worldwide. After 25 years, the Spanish flu occurred due to A/H1N1 virus [23]. Unfortunately, the virus spread all over world so silently that its origin could not be detected. The pandemic spread in 3 distinct waves of 9 months interval period around 1918–1919. As per record, the first wave occurred in spring-summer 1918 with low mortality and high morbidity. The second and third waves occurred in summer-fall 1918 and winter 1918–1919 with high mortality [24]. In the first wave, high mortality was observed in very young (65 years). However, 1918–1919 pandemic showed high mortality cases in very young, elderly population, and healthy young adults of aged 20–40 years [25]. The first clinical manifestations of the influenza pandemic consisted of hemorrhages, epithelial necrosis, edema, microvasculitis/vascular necrosis, and severe tissue damage to the lungs [26]. After that, the second clinical manifestation comprised an acute respiratory distress syndrome (ARDS) associated with severe facial cyanosis, noted in 10–15% of cases [27]. After the onset of symptoms, most deaths happened from several days to weeks (median 7–10 days) [28]. In 1957, a new A/H3N2 virus replaced A/H2N2 virus and circulated in human population very rapidly. After that the Hong Kong flu was observed in 1968–1970 with a mortality rate of 0.5–2 million [29]. The mainly affected population met with death was in the age range of 62–65 years. In North America, the first pandemic was severe while the opposite was observed in Europe and Asia [30]. In 2009, A/H1N1 pandemic was transmitted from pigs to humans. The A/H1N1 pandemic (Spine flu) was a triple reassortant comprised of human A/H3N2 (PB1 polymerase gene segment), avian (PB2 polymerase and PA polymerase gene segments), and North American (H1, nucleoprotein, and nonstructural proteins gene segments) and Eurasian (N1 and matrix proteins gene segments) [31]. The 2009 influenza virus simultaneously outbreak occurred in Mexico and in Southern United States which was further spread globally in the next 6 weeks [32]. This virus had less impact on old population and severe disease developed in healthy adults. Clinical manifestations included mild respiratory irritations and severe pneumonia associated with ARDS [33]. Approximately 148,000 and 249,000 mortality cases were estimated due to respiratory diseases in several countries [34].

1.6.1 Precautionary Measures/Govt Efforts The prime precautionary measure includes yearly vaccination which reduced the risk of influenza by 60%. Nonpharmaceutical measures have taken place to reduce live bird market so that humans could not come to contact with birds, thereby

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reducing zoonotic influenza virus infections. Animal facilities were disinfected on a regular basis and the employees, exposed to birds, took all the preventive measures. However, pharmaceutical measures include administration of vaccine and antiviral agents like the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and polymerase inhibitors (baloxavir, marboxil, and favipiravir) [35]. As of now, vaccines are also available for H5, H7, and H9 influenza viruses [36]. Other precautionary measures implemented were to cover the mouth and nose, avoid touching your face, wash the hands with soap or sanitize the same, eat healthy, and exercise regularly. Most importantly be at home until fever is gone without using fever-reducing medicines (Fig. 1.2). Fig. 1.2  Timeline of influenza virus

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