Community spread meaning, strategy and principles to prevent COVID-19 

“Can we stop Covid-19, yes we can!”

Community spread meaning can be prevent through awareness and prevention methods which is an important strategy for managing COVID-19, for which it is necessary to strengthen Frontline worker preparedness. It is essential to address this health emergency to reach the population in remote and rural areas of India.

The literature on the management of previous infectious-diseases suggests that the Frontline worker embedded health care system in society may be supported in implementing prevention strategies of community spread and contact tracing and isolation of potential cases that has been widely used to control the Ebola virus in West Africa.

In India, Frontline worker are currently required to conduct (i) Information, Education and Communication (IEC) efforts at the community level and (ii) identify potential COVID-19 cases. Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANM), Anganwadi Workers (AWW), and Community Mobilizers to present community spread through existing guidelines. Protocols and their implementation to identify gaps and opportunities that support the health system response to COVID-19 can prevent community spread.

Community spread meaning

Community spreads specifically about the spread of an infectious disease in the community: cases of contagion to people in a particular geographical area, people who have no contact with other infected people, or those who have not recently traveled to any documented area of the disease

How it spreads?

Between individuals who are near or close to one another. Through respiratory droplets produced by the infected person when coughing, sneezing or talking. These droplets can enter the mouth or nose of close people or be inhaled into the lungs. Some ongoing studies have proposed that COVID-19 might be spread by individuals who do not have symptoms

What is community mitigation?

Community mitigation includes activities /actions to be prepared for people and communities that can slow the  spread of infectious diseases, including COVID-19. Community mitigation is important before a vaccine or drug becomes widely available. Since COVID-19 is highly contagious and spreads to people who do not know, they have the disease, it is difficult to determine the risk of infection in the community.

Until broad-based testing is widely implemented or we have a more comprehensive and accurate measure of the disease burden, states and communities should assume that there is some community spread.

Goal of community mitigation

Goal is to slow down the community spread of COVID-19 transmission and protect all individuals, especially those with serious illness, minimizing the negative effects of strategies. Strategies are used to reduce morbidity and mortality of COVID-19 in social sectors such as schools, offices and health care organizations.

Principle guidelines

1. Community mitigation efforts reduce the rate of infection in person or reduce the likelihood of infection if in contact. The more a person communicates and interacts with different people, the greater the risk of community spread of COVID-19.
2. Each community is unique. There should be appropriate mitigation strategies based on the best data available. Decision making varies based on community transmission level and local conditions.
3. Characteristics of the community and its population, health system and public health capacity local ability to implement strategies are important when determining community reduction strategies.
4. As communities adjust to mitigation strategies, they must ensure that the health care system does not exceed capacity. Care must be taken to protect health care professionals and other critical infrastructure workers.
5. Must ensure that health care systems have adequate staff, inpatient and ICU bed surpluses and critical medical equipment and supplies such as PPE.
6. Make sure the efficacy of the public health system depends on identifying, testing, contact tracing and isolating those who are ill or those who have been exposed to suspect or suspected COVID-19 cases.
7. Care should be taken of people who are seriously ill when deciding and adjusting community mitigation strategies.
8. There is a high risk of certain settings and vulnerable population transmission in the particular setting. It is not limited to compound settings such as nursing homes and other long-term care facilities, correctional facilities and the homeless population.
9. Mitigation strategies can be measured practically and legally within the jurisdiction, depending on the local situation and where possible.
10. Any signs of a new case cluster or the reemergence initiation of a broader community transmission will require a re-evaluation of community mitigation strategies and a decision on whether and how mitigation is needed.
11. Promoting spread-preventing behaviors, maintenance healthy environments, maintain healthy activities, and preparing when someone is ill.
12. Community mitigation strategies should overlap and be used at the same time with multi-layered security measures to reduce the spread of disease and reduce the risk of another spike in cases and deaths as one strategy alone isn't sufficient
13. Use range of implementation options when setting or adjusting community mitigation plans. These options provide different levels of protection from community transmission risk.
14. Determine acceptable risk levels and select information about the implementation of mitigation plans accordingly.
15. Make choices about following recommended behavioral patterns. Compliance with community mitigation decisions also affects the prevalence of COVID-19.
16. Develop specific strategies for a various sectors, including businesses, schools, higher education institutions, parks and recreational facilities and other locations.
17. Travel policies within and outside the jurisdiction affect efforts to reduce community spread. Coordination within the state and local jurisdictions is very important, especially between jurisdictions with different levels of community transmission.

Implementation of mitigation strategies

Mitigation strategies should be feasible, practical and acceptable. They must meet the needs of each community and be implemented in a manner that minimizes both morbidity and mortality from COVID-19 and does not create or exacerbate health inequalities.

The choice and implementation of these measures should be guided by the extent of the spread of the disease. Demographics and other community characteristics, as well as the efficiency of the public health and health care system, can lead to decision-making on mitigation. Finally, a set of cross-cutting mitigation strategies to be considered for communities is outlined under following 3 Levels

The level of social transmission and the level of mitigation/reduction through social characteristics

Community transmission level	Community characteristics and description	level of mitigation /reduced
Substantial, unrestricted transmission	Large-scale, unrestricted community transmission, including various settings (e.g., schools, offices)	Shelter in place
Substantial, restricted transmission	Large-scale, controlled community transmission various settings (e.g., schools, offices)	Significant mitigation
Minimum to moderate community transmission	High probability or sustained transmission moderate relief with verified exposure and rapid increase in cases	Moderate mitigation
Minimum Community Transmission	No evidence of isolated cases or limited community transmission, case investigations are underway, no evidence that it was revealed in the context of large setting	Low mitigation

Factors to consider in determining mitigation strategies

Epidemiology community

1. More extensive relief/ mitigation is needed when there is more community transmission
2. Not limited to specific settings or nursing homes and other long-term care facilities, correctional facilities, including meat and poultry processing plants, and homeless populations, but the number and type of population that may be affected by specific settings
3. Community transmission level impact and any spread on healthcare or other critical infrastructure or services distribution

Community characteristics

1. Community size and population density
2. Community engagement and support level
3. The size and characteristics of the vulnerable population
4. Access to health care
5. Transport infrastructure (e.g., mass transport availability and use)
6. Type of business or industry
7. Meeting settings (e.g., correctional facilities, homeless shelters)
8. Plan large events / meetings such as event sports events
9. The relationship of the community with other communities (e.g., transportation, tourist destination, traffic volume and other characteristics)

Health care capacity

1. Healthcare Workforce
2. Number of health care facilities (including auxiliary health care facilities)
3. Test activity
4. Intensive care capacity
5. Availability of Personal Protective Equipment (PPE)

Public health capacity

1. Availability of public health workforce and resources to implement health strategies (e.g., resources to identify, test, track and isolate cases)
2. Support available from other state / local government agencies and partner organizations

Overview of mitigation strategies to be considered in communities with local COVID-19 transmission in settings and fields

Encourage behaviors that prevent the spread

1. Educate people to stay home when they are sick or in contact with someone with COVID-19
2. Teach and strengthen hand hygiene and respiratory etiquette
3. Teach and strengthen the use of cloth face shields to protect others
4. Make sure for access to adequate supplies (e.g., soap, at least 60% alcohol, hand sanitizer with paper towels) to promote healthy hygienic behavior.
5. Post Sign signs or posters and promote messages about anti-spread behaviors
6. Educate people to stay home when they are sick or in contact with someone with COVID-19
7. Teach and strengthen hand hygiene and respiratory etiquette
8. Teach and strengthen the use of cloth face shields to protect others
9. Make sure for access to adequate supplies (e.g., soap, at least 60% alcohol, hand sanitizer with paper towels) to promote healthy hygienic behavior.
10. Post Sign signs or posters and promote messages about anti-spread behaviors

Maintain a healthy environment

1. Intensify frequent cleaning and disinfection of frequently touched surfaces
2. Make sure ventilation systems are working properly and increase outdoor air circulation
3. Make sure all water systems are safe
4. Modify layouts to promote at least 6 feet of social distance between people especially for people who do not live together
5. Install physical barriers and guidelines to support social distance
6. Close religious places, or clean and disinfect between inconsistent uses
7. Restrict sharing of objects or clean and disinfect between uses

Perform healthy practices

1. Protect people at high risk of serious illness from COVID-19
2. Encourage people to deal with stress, take a break from the news, take care of their bodies, take time to break and connect with others, especially when they have concerns
3. Raise awareness on local or state regulations
4. Create consistent groups or "coordinates" of stat people and avoid mixing between groups
5. Manage social distance at any individual events and limit group size as much as possible
6. Limit activities with unwanted visitors, volunteers and outdoor groups or organizations, especially those in the local area
7. Encourage work from home and virtual meetings
8. Consider options for unnecessary travel in accordance with state and local regulations
9. Safety Train staff on all safety protocols
10. Consider performing daily health checks, such as a temperature test or a symptomatic check
11. Encourage those facilities to adhere to mitigation strategies
12. Self-report for COVID-19 symptoms, positive test for COVID-19, or exposure to COVID-19
13. Informing local health authorities of COVID-19 cases
14. Notify individuals (employees, customers, students, etc.) exposure to COVID-19 while maintaining confidentiality in accordance with privacy laws.
15. Facility informing individuals (e.g., employees, customers, students) about the closure of any facility

Be prepared when someone gets sick

1. Prepare to transport sick people to their home or health care center alone and safely
2. Encourage sick people to follow government guidelines for caring for themselves and those who are sick
3. Inform local health authorities about any case of COVID-19 while maintaining confidentiality in accordance with CO regulations.
4. Inform those who have close contact with a person suffering from COVID-19 and advise them to stay at home and self-monitor for symptoms and follow government guidelines if symptoms develop
5. Advice sick people when it is safe to return based on government guidelines to stop being home alone

What are the universal safety measures?

Individuals should adopt healthy hygiene practices, stay indoors when sick, practice physical distance to reduce the risk of disease transmission, and use face masks in community settings when physical distance cannot be maintained. These universal precautions are appropriate as to how much relief is needed.

Wash your hands regularly

Wash your hands with soap and water for in any event at least 20 seconds, especially after you are out in the open or sniffing, coughing or sneezing.

Washing is very important:

1. Before eating or preparing food
2. Before Your Touches you’re Face
3. After using The Restroom
4. After leaving the open space
5. After coughing or sneezing
6. After performing your mask
7. After changing the diaper
8. After caring for the sick
9. After touching animals or pets
10. In the event that soap and water are not accessible, utilize a hand sanitizer that contains at least 60% alcohol. Spread all the surfaces of your hands and rub them until they look dry.
11. Avoid from contacting or touching your eyes, nose, and mouth with unwashed hands.

Avoid close contact

1. Inside your home: Avoid close contact with sick people. Keep 6 feet distance between the sick person and other household members.
2. Outside your home: Keep a distance of 6 feet between you and people who do not live in your home.
   
   
   
3. Keep in mind that some people who do not have symptoms can spread the virus.
4. Stay at least 6 feet (2 arms away approximately) from other people.
5. It is important for those at risk of falling ill to stay away from others.
6. Use mask to cover your mouth and nose when others are around you
7. You can transmit infection to other people even if you don't feel sick.
8. Everyone should wear a mask in public settings and around people who do not live in your home
9. Continue keeping yourself 6 feet between yourself and others.

Cover cough and sneeze

1. When you cough or sneeze or use the inside of your elbow cover your mouth and nose with tissue and do not spit.
2. Dispose of used tissue.
3. Wash your hand immediately for 20 seconds with soap and water, In the event that soap and water are not accessible, utilize a hand sanitizer that contains at least 60% alcohol.

Clean and disinfect

1. Disinfect and clean frequently touched surfaces. These include door handles, light switches, ledges, handles, work areas, tables, telephones, consoles, latrines, spigots and.
2. If the surface surfaces are dirty, clean them. Utilise detergent or soap and water before disinfection.
3. Then use family unit disinfectant.

Monitor your health on a daily basis

1. Be alert for symptoms. Look for fever, cough, shortness of breath or other symptoms of COVID-19.
2. This is especially important if you are running important tasks, when going to the office or workplace and in settings where keeping a physical distance of 6 feet is difficult.
   
   
   
3. If symptoms appear then take the temperature.
4. It’s recommended that temperature should not be taken within 30 minutes of exercising or after taking medications (such as acetaminophen) that can lower your temperature.

About Author

Staying up to date on nursing topics is an important task to keep in mind. Prof. R. P. Saxena founder of www.communityhealthnursing.guru has created this site during COVID-19 Pandemic for all Nursing students, Professional Nurses and Public to keep in touch with current trend in the subject of nursing to excel in their careers. I hope this site will be very useful to all.

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