Module 5B- DISASTER EVENTS ( Part-2)

            This module aims to identify the nature, characteristics and accompanying related hazards brought
about by each of the different disaster events impacting the country. This will provide opportunities for the
students to explore the specific tasks to do from preparation and prevention of disaster events up to the
activities to be done during recovery phase of disaster response management. An opportunity to
synthesized all these responsibilities will be given to students through developing a well-structured work
plan starting from risk-hazard mapping up to the creation of information education leaning materials that
will be beneficial to educational community as well as to their own family.

Lesson 1                                                        BIOLOGICAL HAZARDS

What is Biological Hazard?

            Biological Hazard or biohazard is a biological substance that poses a threat to the health of living
organisms, primarily humans. This could include a sample of a microorganism, virus or toxin that can
adversely affect human health. A biohazard could also be a substance harmful to other animals.

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            Sources of biological hazards may include bacteria, viruses, insects, plants, birds,

animals, and humans. These sources can cause a variety of health effects ranging from skin irritation
and allergies to infections (e.g., tuberculosis, AIDS), cancer and so on.

What are Biological Weapons?

            According to WHO Journal on Biological Weapon Issue (2002) Biological weapons are
microorganisms like virus, bacteria, fungi, or other toxins that are produced and released deliberately to
cause disease and death in humans, animals or plants. 

            Biological agents, like anthrax, botulinum toxin and plague can pose a difficult public health

challenge causing large numbers of deaths in a short amount of time while being difficult to contain.
Bioterrorism attacks could also result in an epidemic, for example if Ebola or Lassa viruses were used as
the biological agents. 
            Biological weapons are a subset of a larger class of weapons referred to as weapons of mass
destruction, which also includes chemical, nuclear and radiological weapons. The use of biological agents
is a serious problem, and the risk of using these agents in a bioterrorist attack is increasing. 

            The focus of our discussion will be on the common Biological agents being used as Biological
weapon to cause harm to large number of population and will put a greater risk to the socio-economic
condition of the community.

1. Anthrax  

            Anthrax is an infectious disease that can affect the skin, the lungs, as well as the mouth, throat
and gastrointestinal tract. The infection sometimes can spread to other parts of the body, especially if
treatment is not started early. For example, anthrax could, very rarely, lead to inflammation of the
meninges (meningitis).
            Anthrax is caused by a bacterium called Bacillus anthracis. The bacteria occur in living tissue of
infected animals. The bacteria can form spores under certain conditions when, for example, body fluids
infected with the bacteria are exposed to the air. The bacteria cannot live for long outside an animal. On
the other hand, the spores can survive in soil and some other materials for decades.  (Source: Canadian
Center for Occupational Health and Safety Fact Sheets)

Is ANTHRAX a Biological Concern in Disaster Situation?

            Human anthrax is unusual in North American. The center for Disease Control in British Columbia
reports that a case in BC was seen in 2001, and 2 people were infected in 2006 in Saskatchewan (during
an outbreak among animals (mainly cattle)). All these people developed skin infections and recovered.
Human cases of digestive and lung anthrax have never been reported in Canada. Anthrax can be an
occupational hazard for workers who process hides, hair, bone and bone products and wool. Animal
breeders, slaughterhouse workers, trappers and hunters, fur industry workers, tanning and leather
industry workers, veterinarians, or wildlife, agricultural, and laboratory workers who handle infected
animals or animal products can also be at risk for the infection. (Source: Canadian Center for
Occupational Health and Safety Fact Sheets) .

Transmission

            To multiply, Bacillus anthracis produces small spores. When these spores enter a cut or
abrasion on the skin they start a skin infection usually called cutaneous anthrax. If the spores are inhaled,
they are small enough that they enter the lungs and cause inhalation anthrax. Eating contaminated,
undercooked meat can cause oropharyngeal (mouth and throat) and gastrointestinal anthrax.

Signs and Symptoms

            Symptoms of the disease vary depending on how the disease was contracted. Symptoms usually
occur within 7 days of exposure, but usually between 2 to 5 days. The skin infection begins with itchy
bumps that resemble insect bites. Skin bumps develop into painless black blisters.

If the Bacillus anthracis spores are inhaled, the initial signs of disease are usually flu-like symptoms
including fever, sore throat, feeling unwell, body aches, fatigue, cough and chest discomfort. The
symptoms may progress to severe breathing problems.

In the case of intestinal anthrax symptoms usually begin a few days after ingestion of the contaminated
meat. The symptoms include:

·         fever, chills,

·         swelling of neck or neck glands,

·         abdominal pain,

·         fever, nausea,

·         loss of appetite,

·         vomiting and diarrhea.

How to recognize ANTHRAX?

            Confirmation of anthrax diagnosis requires laboratory examinations which identify Bacillus

anthracis in the blood, skin lesions or respiratory secretions. Laboratory blood tests can also detect
whether the amount of certain specific protein (i.e. antibodies) has increased in the blood. An increase
indicates infection by Bacillus anthracis. Antibodies are produced by special cells of the body's infection
defense system to reduce or neutralize the effect of invading microorganisms. Tests may also be done
using skin lesion swabs, spinal fluid or respiratory secretions.

Treatment

            Anthrax can be controlled with antibiotics. To be effective, treatment should start early after
exposure. If left untreated or if treatment starts too late, anthrax can be fatal.

How can we prevent Anthrax from infecting us?

            Workplaces which process animal products should have adequate ventilation systems including
local exhaust system to reduce dust levels. Clean the workspace with a high-efficiency
particulate (HEPA) air vacuum just like what other countries are doing now to lessen possible spread
of corona virus (COVID 19). Workers who handle raw animal materials should be informed about modes
of transmission. Avoid shaking or beating hides, dry sweeping or using compressed air (for cleaning).
Workers should follow good personal hygiene practices including care of skin abrasions. Workers should
use adequate protective clothing (such as a properly fitted face mask or respirator (N-95), eye protection
and protective gloves) and facilities for washing and changing clothes after work.

2. Botulinum Toxins

            Botulinum toxins pose a major threat as biological weapons because they are extremely potent
and lethal; some of the toxins are relatively easy to produce and transport; and people with botulism
require prolonged intensive hospital care. (Bossi, 2004)

            Botulism is a serious, but rare, paralytic illness caused by neurotoxins (botulinum toxin) produced
by the common bacterium, Clostridium botulinum, which is found throughout the world in soil and ocean
sediment. Normally, the bacterium exists in the environment as a dormant spore; however, in low oxygen
(anaerobic) environments such as in canned foods, deep wounds, or the intestinal tract, the spores
germinate into active bacteria, multiply, and produce toxin. C. botulinum produces 8 types of toxin (A
through H), which are among the most potent toxins known. A dilute formulation of botulinum toxin A is
used clinically under the name Botox®, and a dilute formulation of botulinum toxin B is used clinically under
the name Myobloc®. (Bossi, 2004)

Transmission

Botulism is not transmitted from person to person.

            There are 3 types of naturally occurring botulism; each results from absorption of botulinum toxin
into the bloodstream:

 Foodborne botulism is caused by ingestion of food or drink containing botulinum toxin. Often this
occurs when canned foods that are contaminated with C. botulinum are not adequately sterilized.
The bacteria produce toxin while growing in the anaerobic interior of the can. Foodborne botulism
could also result from intentional contamination of the food supply.
 Wound botulism is the result of a deep, contaminated wound. C. botulinum can multiply and
produce botulinum toxin in the anaerobic center of the wound, which is then absorbed into the
bloodstream. Wound botulism has become more prevalent in recent years among intravenous drug
users.
 Infant/Intestinal botulism is the result of eating food contaminated with C. botulinum spores that
then go on to produce botulinum toxin in the intestine. Intestinal botulism primarily affects infants. A
healthy adult can consume a small number of C. botulinum spores without becoming sick. Because
honey can contain C. botulinum spores, it should be avoided for children younger than 12 months
of age.

            Inhalational botulism is a form of disease that results from inhaling aerosolized botulinum toxin. It
could only result from an intentional aerosol release or a laboratory/industrial accident.

Is Botulinum Toxin a Biological Concern in Disaster Situation?

            Botulinum toxins pose a major threat as biological weapons:

·                     They are extremely potent and lethal.

·                     Some of the toxins are relatively easy to produce and transport.

·                     People with botulism require prolonged intensive hospital care.

            A deliberate release of botulinum toxin could be in the form of an aerosolized weapon or
contamination of the food or water supply with C. botulinum or botulinum toxin. Several countries
developed botulinum toxin as aerosol weapons in the past. Animal models suggest that inhaling 0.7-0.9
µg of aerosolized botulinum toxin would be enough to kill a standard weight person (70 kg or 154 lbs).
(Bossi, 2004)

            A release of aerosolized botulinum toxin would likely result in an outbreak of acute flaccid
paralysis (sudden, profound muscle weakness) among persons in the same geographic area who have
had no obvious common dietary exposure.

            Bioterrorism involving deliberate contamination of food with botulinum toxin would produce

similar symptoms, but there would be a connection to a common food source. There would be few initial
clues to help distinguish between an intentional and a naturally occurring foodborne botulism
outbreak (See "Botulism”, a short video from the CDC.)

Infection Control Measure

            No special precautions are needed for botulism patients in the hospital; as with all
patients, standard precautions should be followed. (See- CDC Isolation Precautions Guidelines.)

Signs and Symptoms of Botulism

            Symptoms of botulism are caused not by the C. botulinum bacteria, but by the toxin it produces.
The initial diagnosis of botulism is based on clinical signs and symptoms. Confirmatory testing is available
at the CDC and some local and state laboratories, but the specialized tests needed to confirm a diagnosis
of botulism can take days to complete. In the case of a bioterrorist attack with botulinum toxin, clinical
diagnosis will be the basis for medical response, and treatment should be started without waiting for
laboratory confirmation of disease.

            Symptoms are similar for all types of botulism, but the severity of illness and the time it takes for
symptoms to appear can vary widely, in part depending on the amount and type of toxin absorbed.
Symptoms of foodborne botulism usually appear within 12 to 72 hours after ingestion, but may begin
anywhere from 2 hours to 8 days after eating contaminated food. The 3 known cases of inhalational
botulism, which occurred after a laboratory accident, caused symptoms approximately 72 hours after
exposure. The amount of aerosolized toxin inhaled in these cases is unknown.

            Botulism causes flaccid paralysis, which begins in the muscles of the head and neck and
progresses to the muscles of the trunk and extremities. Initial symptoms of botulism poisoning include
difficulty seeing, speaking, and/or swallowing. Sagging eyelids, double vision, and blurred vision are
common. Botulism is frequently misdiagnosed as Guillain-Barré syndrome, stroke, or other diseases of
the central nervous system. Difficulty swallowing, loss of the protective gag reflex, and paralysis of the
respiratory muscles may require endotracheal intubation for airway protection and mechanical ventilation.
Botulism poisoning does not cause fever. Patients typically are fully alert and aware of their situation.
Although the patient's muscles may be paralyzed, they can still feel pain, temperature, and touch. Without
treatment, death results from airway obstruction (paralysis of pharyngeal and upper airway muscles) and
respiratory failure (paralysis of diaphragm and accessory breathing muscles).

            Recovery from paralysis due to botulism requires the re-growth of motor nerve endings and can
take weeks to months. Muscle fatigue and shortness of breath can persist for years.

Treatment

            There is no post-exposure prophylaxis available for persons exposed to botulinum toxin. A toxoid
vaccine against the toxin exists but takes too long to induce immunity to be useful after exposure.

            For symptomatic individuals, botulinum antitoxin is available in limited supply (see below). Such
patients should be treated as quickly as possible. Timely administration of antitoxin minimizes further
nerve damage by the toxin, but it cannot reverse paralysis that has already occurred. Antibiotics are of no
use, except in the case of wound botulism and then only as an adjunct to surgical wound care.

            Botulism patients require supportive therapy, which may include mechanical ventilation,
administration of nutrition via feeding tube, and treatment of secondary infections.  (Source: John
Hopkins University -UPMC Center for Health Security, 2014)

3. Yersinia Pestis (Plague)

            Plague is an infectious disease caused by Yersinia pestis, a naturally occurring bacterium found
primarily in wild rodents. Plague has been the cause of 3 of the great pandemics of the modern era-in the
mid-6th century, the mid-14th century (known as the Black Death), and the early 20th century.

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            Three forms of naturally occurring plague infection exist:

 Pneumonic plague is the result of Y. pestis infection of the lungs. Primary pneumonic plague
results from inhalation of Y. pestis bacteria and would be the expected form of disease following an
 aerosol attack with Y. pestis. Secondary pneumonic plague can occur if bubonic or septicemic
plague goes untreated and the plague bacteria are allowed to spread to the lungs.
 Bubonic plague is the most common form of naturally occurring plague and is typically acquired
through the bite of an infected flea. Bubonic plague is characterized primarily by swollen, tender
lymph nodes (called buboes).
 Septicemic plague is the result of plague bacteria multiplying in the blood and disseminating
throughout the body. Septicemic plague usually occurs as a result of untreated bubonic or
pneumonic plague.

Is PLAGUE a Biological Concern in Disaster Situation?

            Plague is currently considered to be one of the most serious bioterrorism threats. Y. pestis was
developed as an aerosol weapon by several countries in the past. Aerosol dissemination of bacteria would
cause primary pneumonic plague in the exposed population, an otherwise uncommon, highly lethal, and
contagious form of plague.

Source: CDC, Division of Vector-Borne Infectious Diseases, Fort Collins, Colo.

            A number of factors contribute to concern over the use of plague as a biological weapon:

·         There is widespread availability of Y. pestis in microbe banks around the world.

·         There is widespread natural availability of the Y. pestis bacteria in endemic areas

·         Reports indicate that techniques for mass production and aerosol dissemination of Y. pestis have
been developed.

·         The fatality rate of pneumonic plague in untreated cases is extremely high.

·         Plague has the potential for secondary spread from person to person following an attack.

·         Y. pestis can be disseminated in aerosol form.

·         Plague has a low infectious dose.

·         Antibiotic resistant strains of Y. pestis exist in nature.

Signs and Symptoms

            Diagnosis of plague is based on clinical presentation of symptoms and confirmed by laboratory
testing, which usually takes 24 to 48 hours. There are no widely available rapid diagnostic tests for
plague. The first sign of a bioterrorist attack with plague would most likely be a sudden surge of patients
presenting at hospitals and doctors' offices with symptoms of severe pneumonia and sepsis.

Transmission

            Fleas are natural vectors (carriers) of Y. pestis, and the bacteria are typically transmitted to and
among rodents via flea bite. Humans may contract plague through a flea bite or by handling an infected
animal or breathing in an aerosolized form of the bacteria.

            Neither bubonic nor septicemic plague is known to spread directly from person to person.
However, pneumonic plague does spread from person to person through respiratory droplets over short
distances.

Infection Control Measures

            The Center for Disease Control (CDC) recommends that individuals suspected of having

pneumonic plague be placed in isolation, with respiratory droplet precautions, and monitored for
symptoms for the first 48 hours of antibiotic treatment. Those with confirmed pneumonic plague should
remain in isolation under droplet precautions until all laboratory cultures are negative, indicating that
disease has run its course. Standard respiratory droplet precautions should also be taken by individuals in
close contact with patients with confirmed or suspected pneumonic plague. Contacts of patients with
plague should be identified for surveillance purposes, and any contacts who develop plague should be
placed in isolation.

Treatment

            Early antibiotic therapy is recommended for persons deemed exposed to or infected with plague.
Tetracyclines (eg, doxycycline), fluoroquinolones (eg, ciprofloxacin), and aminoglycosides (eg,
streptomycin, although not widely available, and gentamicin) are all antibiotics that have been used for
post-exposure prophylaxis and treatment of plague. Specific treatment recommendations following a
biological attack with plague will depend on several factors, including antibiotic susceptibility of the strain.

            Antibiotic treatment should be initiated within 24 hours for patients showing symptoms of
pneumonic infection, and should be continued for 10 days. Prophylactic antibiotics may be administered to
protect people who have had known direct contact with infected patients, and should be continued for 7
days. People with suspected exposure to pneumonic plague should be placed under surveillance and
monitored for symptoms. If symptoms develop, antibiotic therapy should be initiated immediately and
continued for 10 days. In addition to antibiotic prophylaxis, people with established on-going exposure to a
patient with pneumonic plague should use standard respiratory droplet precautions.

4. COVID 19 –Corona Virus

            Coronaviruses are a family of RNA viruses that typically cause mild respiratory disease in
humans. A novel coronavirus (COVID-19) was identified in December 2019.

            Coronaviruses (CoVs) are a family of RNA viruses that typically cause mild respiratory disease in
humans. However, the 2003 emergence of the severe acute respiratory syndrome
coronavirus (SARS-CoV) demonstrated that CoVs are also capable of causing outbreaks of severe
infections in humans.  A second severe CoV, Middle East Respiratory Syndrome coronavirus (MERS-
CoV), emerged in 2012 in Saudi Arabia. The third severe CoV, severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), was identified in Wuhan, China, in December 2019 and has driven this
current pandemic.4 The emergence of human coronaviruses, including MERS-CoV and SARS-CoV, is
thought to be driven by the spill over of bat-adapted CoVs into an intermediate host. For SARS-CoV, this
intermediate host is believed to have been palm civets, while camels play that role for  MERS-CoV.
Genetic analyses of SARS-CoV-2 suggest that the virus likely originated from a bat reservoir. There are a
number of theories regarding the presence of an intermediary animal host for the origins of SARS-CoV-2,

THE EMERGING OF SARS-CoV-2 now known as COVID-19

            SARS-CoV-2 the scientific community is still working to define the precise clinical and
epidemiological characteristics of SARS-CoV-2. As of April 8, there have been 1,353,361
confirmed COVID-19 cases and 79,235 deaths linked to the disease.9 These case numbers do not
represent the full number of SARS-CoV-2 infections, which often manifests as mild symptoms in infected
individuals. Initial evidence suggests that SARS-CoV-2 passes from one host to another via droplets
produced while coughing, breathing, talking, or singing.10 Other methods of transmission have been
explored, including the ability for the virus to persist on surfaces and fecal-oral transmission. The most
common symptoms of COVID-19 are fever and cough.11 Studies suggest that these symptoms usually
present roughly 5 days after exposure, but can show up as early as 2 days and as long as 14 days after
exposure.12 Preliminary data suggest a majority of COVID-19 cases will not require advanced medical
attention. Severe COVID-19 cases typically progress to viral pneumonia and often require mechanical
ventilation to aid in breathing.10 While the scientific community is still collecting data as the outbreak
grows, initial estimates of case fatality ratio with treatment range from 1.4% to 4.7%.13 Diagnosis and
Treatment Laboratory diagnosis of coronavirus infections relies on nucleic acid–based testing early in the
clinical course and serology later on. It is possible to isolate SARS-CoV, MERS-CoV, and other
coronaviruses from respiratory secretions, blood, urine, and fecal samples for diagnostic testing. Clinically,
coronavirus infections (except SARS-CoV-2) can be diagnosed with respiratory viral panels that are
commercially available. The development of SARS-CoV-2 diagnostics has advanced rapidly in the
months since the virus’s emergence. Most countries are relying on nucleic acid–based testing, although
there are several variations of these tests currently in circulation.

            There is an on-going effort to develop serological testing. Care for most coronavirus patients is
home-based and supportive with fever reduction and oral hydration. This is also true for most  COVID-
19 patients. For a minority of patients, especially the elderly and infirm and those infected with  SARS-
CoV, MERs-CoV, and SARS-CoV-2, hospitalization may be needed for supplemental oxygen and fluid
administration. Some of these patients will become critically ill and require intensive care, including
invasive or non-invasive mechanical ventilation.

Infection Control Measures

            Hospitals have amplified both SARS-CoV and MERS-CoV outbreaks, and super spreading events

have been noted. Consequently, stringent infection control is critical to preventing transmission to
healthcare workers and other patients. Droplet precautions (eg, surgical or procedure mask, gown, and
gloves) are indicated during the treatment of all coronavirus patients, and such protocols for droplet-
spread respiratory viruses are part of hospital infection control practices. Additional respiratory
precautions may also be appropriate during aerosol-generating procedures. SARS-CoV-2 has shown high
transmissibility both inside and outside of healthcare settings. WHO has developed infection control
technical guidance for various groups, including health workers. This guidance also provides insights on
best practices for personal protective equipment.

COVID-19 Planning Guide and Self-Assessment for Higher Education

(SOURCE: Johns Hopkins Center for Health Security, the Council for Higher Education Accreditation
(CHEA), and Tuscany Strategy Consulting –TSC) June, 2020.

Introduction

            Globally, institutions of higher education are facing unprecedented challenges related to
Coronavirus Disease (COVID-19). The resulting academic, financial, ethical, and operational questions
are complex and high-stakes. The COVID-19 pandemic may represent an inflection point, fundamentally
altering how we work, socialize, and learn. The authors of this toolkit collectively believe that our
institutions need near-term tools to ensure continuity through this pandemic as well as methods for
rethinking the basic assumptions and values of their institutions.

            This guide and accompanying risk assessment are designed to provide practical planning
resources to help institutions gauge how effectively they are addressing a range of COVID- 19 scenarios.
It is intended to accommodate a wide range of institutions: public, private, large, small, comprehensive,
specialized, urban, and rural. Each institution will need to develop and implement its own tailored
approach to reopening in-person instruction.

            Retooling for the future, with urgency, involves a significant planning effort to manage the present
environment as well as the opportunity to envision new ways to fulfil institutional missions. Plans need to
address the safety of students, faculty, and staff, the financing of our colleges and universities, and
preservation of equity and diversity. They will also need to address short- and long-term investment in
academic tools that will be essential for education in the period of COVID-19 – adding instructional and
enterprise technologies, expanding the range of capabilities of faculty, improving the nature of the
curriculum, and strengthening the network of student support. We encourage leadership and planning
committees to use this opportunity to set their institutions on new pathways supporting academic
excellence, health, and equity. This process begins with Four Guiding Principles.

 To successfully address the challenge of the COVID-19 pandemic, the first opportunity is to
acknowledge that all major dimensions of higher education will benefit from being
reimagined to address the impact of the COVID-19 pandemic and beyond.
 
  The health and safety of all members of the community are paramount. Special care and
attention must be given to the needs of vulnerable populations.
 
 The commitment to academic excellence must not wavier under these challenging
circumstances. This commitment crosses all instructional modalities in-person, online, and
hybrid instructional modes.
 
 Equity and inclusion are critical components of institutional responses. The economic,
health, academic, and operational challenges are immense. It is incumbent upon
institutions to engineer responses that serve and support the entire community.

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