key: cord-313264-3fbikatx
authors: Banerjee, Debanjan; Nair, Vasundharaa S.
title: Handling the COVID-19 Pandemic: Proposing a Community Based Toolkit for Psycho-social Management and Preparedness
date: 2020-05-07
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102152
sha: 
doc_id: 313264
cord_uid: 3fbikatx

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own homes, as a measure to contain the outbreak (WHO Situation report as on 9 April 2020).

As the therapeutic focus is mainly restricted to biological therapies worldwide to develop an effective cure for the virus, the deep-rooted psycho-social repercussions are often neglected (Singhal, 2020) . Research on pandemic protocols in the past have shown the role of psychosocial preparedness in improving the resilience during a 'biological disaster' like such largescale infections. Though there are well-known international guidelines for disaster management in general, specific ones guided to pandemic-preparedness are lacking, though some countries have formulated their own policies (Colizza et al., 2007) . Effectiveness, applicability and feasibility are attributes which indicate that the psychosocial interventions are going to be more appropriate in the community as the knowledge, attitude and practice (KAP) regarding any new infection improves the preparedness in both the health-care professionals and the general public.

Preparedness towards any form of disasters is vital to reduce their impact. As the global situation related to COVID-19 is changing rapidly each day, 'Community Based Disaster Preparedness'(CBDP) is perhaps the method of management. CBDP is a response mechanism in an attempt to save the maximum and effective community triage (Troy et al., 2008) . This leads to multi-pronged but flexible interventions to reduce vulnerability and build a self-reliant and resilient society. It is true that pandemics of such epic proportions cannot be fully controlled by any degree of preparedness but the goal here is more of harm-reduction. Earlier outbreaks have highlighted important areas. During the Zika outbreak in Brazil that eventually spread to North and South America, WHO had declared it too as a public health emergency of international concern, just like COVID-19 (WHO, 2017) . Research had been conducted to J o u r n a l P r e -p r o o f understand the preparedness of community-based psychosocial toolkit for ZIKA virus affected-areas (Nair et.al., 2020) , wherein it was understood that the lack of understanding about a new condition and uncertainty about it has a direct correlation with the preparedness among the healthcare professionals, and thereby implying policy planning and training needs to gear up towards this.

The purpose of this proposed intervention toolkit is to aid facilitators to bring about ownership for sustainability of the process during a pandemic. Better preparedness during an infection leads to better preparedness which in turn helps better intervention planning and community integration ( Figure 1 ). Here we use the model of the Zika virus preparedness toolkit to propose a similar one for the ongoing COVID-19.

A Stepped-approach to Psycho-social interventions J o u r n a l P r e -p r o o f

Step 1: Collection of Basic Information Before planning any intervention, the first step is always gauging the problem statement and understanding the basic attitudes and beliefs of the people towards the crisis. Considering the pandemic as an ongoing process, regular updated data should be collected and assimilated from the global health agencies like WHO, CDC, and regional health ministries (like the ICMR and Ministry of Health and Family Welfare in India, CDC in China, etc.). Collaboration with the media to provide unbiased information will be helpful. As social distancing makes field visit difficult, online surveys or telephonic communication might yield valuable information. The content of queries from the helplines and crisis intervention at the hospital emergency settings will help understand the various types of psycho-social problems. People with pre-existing mental disorders, people in isolation, the elderly and those institutionalized are more vulnerable and thus need to be contacted separately to ensure that their physical and medical needs are met. Liaison with nearby health-care centres and integration of alternative medicine specialists will be helpful.

Step 2: Crisis Management: Knowledge, Attitude and Practices in the advent of a Biological Disaster (TABLE 1) 

Pre-assess Introduction of the Intervention programme Ice Breaking games 

In this section post the interventions, the goals are  To understand that situation, focussing on current 'crisis at hand' and hence survival, protection and sustenance are necessary.

 Minimise the contact, maintain the essential services and to maximise the help to others but maintaining the prevention.

 Immediate ideal response might not be possible but to reduce the infection, exposure needs to be reduced and insight needs to be improved. 

Step 4: Individual  Self-Isolation and restrict travel  Physical but not 'social' distancing  Protection of self (hand and respiratory hygiene)

 Reduce 'digital screen time'

 Address panic, uncertainty and fear: encourage active usage of helplines

Step 5 The steps mentioned above can be organized in the form of pamphlets and other IEC materials to ensure the sustenance and easy dissemination of the module. IT liaison can be sought for to even incorporate them in smart-phone applications and software for easy accessibility. Module training can also be done online for the paramedical personnel and health-care support staff.

Such community based stepped interventions using precautionary and psychological strategies have been used for emergency care workers, health-care staff and quarantined people in Wuhan, China and found to increase the degree of work satisfaction, decrease absenteeism J o u r n a l P r e -p r o o f and increase the compliance to quarantine instructions (Chau et al., 2020) . Earlier studies during the Nipah and Influenza virus outbreaks, also impress upon the need for useful communication techniques, as reaching out to the masses is the key (Kumar and Kumar, 2018) .

Our module proposes to include the same.

The World Health Organization has standard protocols during periods of epidemics and pandemics which work the best in accordance with the set rules of any country, but the focus remains that for a long period of time various administrative agencies have not implemented or modified the strategies to suit the crisis needs (Melnychuk and Kenny, 2006 At times when an unknown infection threatens community transmission in many countries, causing panic and hysteria at the societal level, it is important to have structured psychosocial interventions to improve awareness and ensure that the first level steps taken by the primary health-care workers, can provide some degree of damage control. We expect the proposed toolkit to serve this purpose. Challenges can be its effective implementation, standardisation of the steps, impediment by social distancing as well as comparability in different countries and socio-economic strata. However, as our studies are in progress in India using the tool-kit at the community level, we expect more consistent findings to supplement this literature in the near future.

ETHICAL CONSIDERATIONS: NO SUBJECT HAS BEEN RECRUITED J o u r n a l P r e -p r o o f

SARS epidemic on Chinese health professionals: Implications for epidemics including Ebola

Modelling the worldwide spread of pandemic influenza: baseline case and containment interventions

Deadly Nipah outbreak in Kerala: Lessons learned for the future

Pandemic triage: the ethical challenge

Knowledge Among Nursing Students on Zika Preparedness

Enhancing community-based disaster preparedness with information technology

WHO toolkit for the care and support of people affected by complications associated with Zika virus