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The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacitybuilding measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country. [ABSTRACT FROM AUTHOR]

Background: Developing public health educational programs that provide workers prepared to adequately respond to health system challenges is an historical dilemma. In India, the focus on public health education has been mounting in recent years. The COVID-19 pandemic is a harbinger of the increasing complexities surrounding public health challenges and the overdue need to progress public health education around the world. This paper aims to explore strengths and challenges of public health educational institutions in India, and elucidate unique opportunities to emerge as a global leader in reform.Methods: To capture the landscape of public health training in India, we initiated a web-based desk review of available offerings and categorized by key descriptors and program qualities. We then undertook a series of in-depth interviews with representatives from a purposively sample of institutions and performed a qualitative SWOT analysis.Results: We found that public health education exists in many formats in India. Although Master of Public Health (MPH) and similar programs are still the most common type of public health training outside of community medicine programs, other postgraduate pathways exist including diplomas, PhDs, certificates and executive trainings. The strengths of public health education institutions include research capacities, financial accessibility, and innovation, yet there is a need to improve collaborations and harmonize training with well-defined career pathways. Growing attention to the sector, improved technologies and community engagement all hold exciting potential for public health education, while externally held misconceptions can threaten institutional efficacy and potential.Conclusions: The timely need for and attention to public health education in India present a critical juncture for meaningful reform. India may also be well-situated to contextualize and scale the types of trainings needed to address complex challenges and serve as a model for other countries and the world. [ABSTRACT FROM AUTHOR]

Background: This update outlines amendments to the CHAMPION2/STRIPES2 cluster randomised trial protocol primarily made due to the COVID-19 pandemic and nationwide lockdown in India in 2020. These amendments were in line with national guidelines for health research during the COVID-19 pandemic. Methods: We did not change the original trial design, eligibility, and outcomes. Amendments were introduced to minimise the risk of COVID-19 transmission and ensure safety and wellbeing of trial staff, participants, and other villagers. CHAMPION2 intervention: participatory learning and action (PLA) and fixed day service (FDS) meeting were revised to incorporate social distancing and hygiene precautions. During the COVID-19 pandemic, PLA participation was limited to pregnant women and birthing partners. STRIPES2 intervention: before/after-school classes were halted for a period and then modified temporarily (reducing class sizes, and/or changing meeting places) with hygiene and safe distancing practices introduced. Data collection: The research team gathered as much information as possible from participants by telephone. If the participant had no telephone or could not be contacted by telephone, data were collected in person. COVID-19 precautions: trial teams were trained on COVID-19 precautions and used personal protective equipment whilst in the villages for trial-related activities. After restarting the trial between June and September 2020 in a phased manner, some trial activities were suspended again in all the trial villages from April to June 2021 due to the second wave of COVID-19 cases and lockdown imposed in Satna, Madhya Pradesh. Trial timelines were also revised, with outcomes measured later than originally planned. Trial registration: Clinical Trial Registry of India CTRI/2019/05/019296. Registered 23 May 2019. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MzExOTg=&Enc=&userName=champion2. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has become a global pandemic, prompting lockdowns in practically every country. To prevent the spread of the disease, India has enforced a rigorous nationwide lockdown that commenced in March 2020. The lockdown imposed amid the pandemic ensured that most commercial activities and vehicle transportation ceased, resulting in a significant reduction in air pollution levels. Material and Methods: The value of air pollutants PM10, PM2.5, NO2, and SO2 from January to May 2020 was obtained from the Indian Central Pollution Control Board. Before lockdown and during lockdown, relative fluctuations in ambient concentrations of four air contaminants were investigated. The Box-Jenkins approach was used to estimate future air pollution data points using time series data analysis. Results: The PM10 level reduced by 61%, 30%, 68%, 37%, and 43% in the selected cities, respectively. Comparison of other pollutant concentrations before and after the lockdown also found a reduction in ambient pollutant concentrations, resulting in improved air quality. Inference of predicted model values to observed values revealed a significant increase in the concentrations of all pollutants. The percentage increases in AQImean from predicted to observed values were 206% in Ghaziabad, 148% in Delhi, 59% in Hyderabad, and 160% in Cochin. Conclusion: The strict lockdown has resulted in a significant drop in air pollutant levels. Upgrading present technologies could help keep pollution to a minimum of 37% under control. The findings would prompt the government to consider how to strictly reduce vehicle and industrial pollution to improve air quality and maintain improved public health. [ABSTRACT FROM AUTHOR]

Introduction: Maharashtra, India, remained a hotspot during the COVID-19 pandemic. After the initial complete lockdown, the state slowly relaxed restrictions. We aim to estimate the lockdown's impact on COVID-19 cases and associated healthcare costs. Methods: Using daily case data for 84 days (9 March–31 May 2020), we modeled the epidemic's trajectory and predicted new cases for different phases of lockdown. We fitted log-linear models to estimate the growth rate, basic (R0), daily reproduction number (Re), and case doubling time. Based on pre-restriction and Phase 1 R0, we predicted new cases for the rest of the restriction phases, and we compared them with the actual number of cases during each phase. Furthermore, using the published and gray literature, we estimated the costs and savings of implementing these restrictions for the projected period, and we performed a sensitivity analysis. Results: The estimated median R0 during the different phases was 1.14 (95% CI: 0.85, 1.45) for pre-lockdown, 1.67 (95% CI: 1.50, 1.82) for phase 1 (strict mobility restrictions), 1.24 (95% CI: 1.12, 1.35) for phase 2 (extension of phase 1 with no restrictions on agricultural and essential services), 1.12 (95% CI: 1.01, 1.23) for phase 3 (extension of phase 2 with mobility relaxations in areas with few infections), and 1.05 (95% CI: 0.99, 1.123) for phase 4 (implementation of localized lockdowns in high-case-load areas with fewer restrictions on other areas), respectively. The corresponding doubling time rate for cases (in days) was 17.78 (95% CI: 5.61, −15.19), 3.87 (95% CI: 3.15, 5.00), 10.37 (95% CI: 7.10, 19.30), 20.31 (95% CI: 10.70, 212.50), and 45.56 (95% CI: 20.50, –204.52). For the projected period, the cases could have reached 631,819 without the lockdown, as the actual reported number of cases was 64,975. From a healthcare perspective, the estimated total value of averted cases was INR 194.73 billion (USD 2.60 billion), resulting in net cost savings of 84.05%. The Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Year (QALY) for implementing the lockdown, rather than observing the natural course of the pandemic, was INR 33,812.15 (USD 450.83). Conclusion: Maharashtra's early public health response delayed the pandemic and averted new cases and deaths during the first wave of the pandemic. However, we recommend that such restrictions be carefully used while considering the local socio-economic realities in countries like India. [ABSTRACT FROM AUTHOR]

Mucormycosis emerged as a major public health challenge during the second wave of the COVID-19 pandemic in India in mid-2021. The disease, colloquially known as the Black fungus, was declared epidemic by the government. This review describes the epidemiological pattern and the determinants of mucormycosis. The review also proposes evidence based public health strategies for the prevention and control of mucormycosis. The rationale use of steroids in clinical management, formulation of evidence-based standard treatment guidelines and adherence to those guidelines by physicians, the strengthening of primary healthcare services to facilitate early care; compliance with infection prevention and control measures at all the health facilities; and early diagnosis and case management are the key strategies to prevent future emergence of mucormycosis. The article concludes that it is not enough that we tackle a health challenge at hand, in crisis mode. It is equally important that we derive learnings and take measures prevent any future. Effective control of mucormycosis and prevention of future outbreaks of disease is possible through coordinated actions of health policy makers, public health experts and clinicians. The entire episode is also a reminder for strengthening India's health systems at all levels – primary, secondary and tertiary – as well as in both public and private sector. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, which is known for the multiple mutations and forms that have rapidly spread across the world. With the imminent challenges faced by low- and middle-income countries in curbing the public health fallbacks due to limited resources, mucormycosis emerged as a fungal infection associated with high mortality. In this rapid review, we explored MEDLINE, Cochrane, Web of Science, WHO Global Database, and the search engine—Google Scholar for articles listed until July 2021 and presented a narrative synthesis of findings from 39 articles. The epidemiology, causative factors, incidence parameters, pharmacological treatment, and recommendations for low- and middle-income countries are enlisted. This study concludes that a majority of the globally reported COVID-19 associated mucormycosis cases stemmed from India. Individuals receiving systemic corticosteroids or who have a history of diabetes mellitus are more prone to contracting the disease. Public health authorities in LMIC are recommended to strengthen antifungal therapies for COVID-19 associated mucormycosis and to strategize reduction in diabetes mellitus prevalence. [ABSTRACT FROM AUTHOR]

aimed to make a comparative analysis of the public health containment measures between China and India, explore the causes of the serious COVID-19 epidemic in India, and eventually to improve global infectious disease control. Methods: We extracted publicly available data from official websites, summarized the containment measures implemented in China and India, and assessed their effectiveness. Results: China has responded to the COVID-19 outbreak with strict public health containment measures, including lockdown of Wuhan city, active case tracing, and large-scale testing, ultimately preventing a large increase in daily new cases and maintaining a low mortality rate per million population (as of May 5, 2021, daily new cases were 11 and mortality rate per million population was 3.37). India, although imposing a national lockdown to control the pandemic, has not implemented strict testing, tracking, and quarantine measures due to the overburdened healthcare system. Combined with massive lockdown, it has accelerated human mobility and exacerbated the epidemic, resulting in a rapid increase in daily new cases and a high mortality rate per million population (as of May 5, 2021, daily new cases were 412,431 and mortality rate per million population was 166.79). Conclusion: China and India implemented public health containment measures to contain the spread of the COVID-19 pandemic based on their national situations. Meanwhile, daily new cases and mortality of COVID-19 also were affected by environmental and socioeconomic. Countries make a comprehensive strategy not only in terms of the biological, pharmaceutical, health, and sanitation sectors but also based on sustainability science and environmental science. [ABSTRACT FROM AUTHOR]