Journal of Public Health and Primary Care

LETTER TO EDITOR
Year
: 2020  |  Volume : 1  |  Issue : 1  |  Page : 43--44

Epidemiology, epidemiologists, and coronavirus disease (COVID-19) - A perspective


Sudip Bhattacharya1, Amarjeet Singh2, Md Mahbub Hossain3,  
1 Department of Community Medicine, Himalayan Institute of Medical Sciences, Dehradun, India
2 Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A and M University, Texas, USA
3 Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India

Correspondence Address:
Dr. Sudip Bhattacharya
Department of Community Medicine, HIMS, Dehradun, Uttarakhand
India




How to cite this article:
Bhattacharya S, Singh A, Hossain MM. Epidemiology, epidemiologists, and coronavirus disease (COVID-19) - A perspective.J Public Health Prim Care 2020;1:43-44


How to cite this URL:
Bhattacharya S, Singh A, Hossain MM. Epidemiology, epidemiologists, and coronavirus disease (COVID-19) - A perspective. J Public Health Prim Care [serial online] 2020 [cited 2021 Mar 1 ];1:43-44
Available from: http://www.jphpc.com/text.asp?2020/1/1/43/305989


Full Text



Dear Editor,

“Epidemiologists of Kolkata, India, are eagerly waiting to help in the corona crisis” we came across this news headline when the whole world is fighting with the deadly coronavirus disease (COVID-19) crisis. Even in few states have constituted task force to combat COVID-19 pandemic, very few of them had any epidemiologist is included in those teams.[1]

This news is really disappointing from a public health perspective, but the problem can be considered as a tip of an iceberg only.

As per World Health Organization (WHO), Epidemiology is defined as “the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.”[2]

An epidemiologist is defined as “a person who studies or is an expert in the branch of medicine which deals with the incidence, distribution, and possible control of diseases.”[2]

To our knowledge, in India there is no dedicated Public Health division/cadre are available within national workforce till date (except in the southern part). However, in each medical college there is a Department of Community Medicine which deals with epidemiological education from decades. In the Community Medicine department a post graduate student learns epidemiology, biostatistics, health promotion, family medicine and become expert after completing Doctor of Medicine (MD) course.[3]

Other than this there are several Schools of Public Health in India (PGI, AIIMS, IIPH etc), which offer Master of Public Health (MPH) and PhD courses. These programmes offer necessary knowledge and skills to assess the severity and magnitude of complex health problems across populations, including key skills in handling an outbreak/epidemic.[4]

Now the moot question is despite of having expert human resources in public health graduating from those institutions, why they are not involved in the task-force teams during pandemic/outbreak situation when their expertise matters the most?

The reasons are multifactorial in nature in our opinion. Epidemiology is a unique science because this requires not only the knowledge of the subject itself but also it requires through insight of how socio-cultural, political, and medical aspects interplay to accumulate and aggravate the disease risk, by which people become sick.[5]

Many researchers/scholars do not consider epidemiology as a science itself. According to their opinion “it is simply a set of tools used by other disciplines, and that its dependence on observational data makes it a form of journalism rather than a science.”[6]

Even during interviews of established epidemiologists, it was perceived by the rest of the scientific community that epidemiology is not considered as a 'true' science, rather it is considered as “soft science.”[6]

The rationale behind framing, epidemiology as 'soft' science, is the biophysical and psychosocial variables used in epidemiology are not simple like mathematics, it is often difficult to quantifiable, (e.g., human behaviours) and interactions within the variables are conventionally been perceived of as less precise than other disciplines like physics or chemistry. But in reality, socioeconomic and lifestyle factors, environmental factors, cultural factors have definite role in health which is evident from people with cardiac[7] and genetic diseases,[8] and simply they cannot be ignored in human health studies.[9] Additionally, we have observed numerous perceptible results from epidemiological research which is beneficial to mankind. It is undeniable that millions of lives have been saved by epidemiology, by preventing from communicable and non-communicable diseases, with the help of evidence based public health research. Even CDC acknowledged that medical epidemiologists has added 25 years to the average life expectancy of people in United States since 1976.[10]

However, if anyone ask a question to us that “what is the exact number of people whose lives have been saved by epidemiological research?” It is nearly impossible to answer, although, its significance in enhancing life quality and endurance cannot be ignored. Interestingly, despite the ambiguity, within the scope of existing and emerging analytical models, epidemiology continues to play the leading role of saving lives today through time trends and forecasting of epidemics and pandemics. It also helps to identify possible diseases outbreaks in the future and implementing appropriate interventions to minimise the death toll.[11],[12] Understanding the effect of environment change on disease burden through multiple factors like humidity, temperature, are also explained by epidemiology only. As an example, it is believed by the researchers that due to climate change, rapid population expansion and urbanisation, Texas in USA has informed amplified transmission or outbreaks of infectious diseases within the last 5 years.[13] Despite of existing problems, increased discrimination, and rapid deforestation, environment change presents a formidable challenge for global health security; in light of these, we believe that epidemiological research will play a vital role in making healthy public health policies in the near future.

From the above discussion it is clear that epidemiology is important now moving to our next question that whether it is a science? Yes, it is. But we should not compare it with mathematics. As an example, during the recent corona pandemic researchers from Cambridge university conducted a research on “age-structured impact of social distancing on the COVID-19 epidemic in India,” in this paper they have also predicted the effect of lockdown and progression of epidemic curve in India. It is mentioned that the flattening of curve on 21 days lockdown vs 28 days vs 18 days lockdowns, they also mentioned the how many lockdowns, in what frequency can be effective to control this corona pandemic.[14] Their mathematical model is excellent and we have no doubt about it. But in the meanwhile, this model failed to consider the unpredicted human behaviours like effects of mass gathering in religious places or mass migration of labourers or the provincial difference like in some province, people are allowed to go to the market from 7-10 am, in some area it is 7am to 1 pm. Now may be the disease pattern and effect of 21 days lockdown in India will not follow the mathematical modelling. In addition to mathematical modelling, prediction in epidemiology requires a multidisciplinary approach because to the study of human health and disease we must follow the scientific method of logical observation, formulation, testing, and modification of hypotheses. Additionally, for any epidemiological forecasting we need to study numerous variables allied with human health and diseases, such as agent, host, and environment which makes it is an overly complex science.

Another important point is that the epidemiological findings obtained for outbreak may not always be replicable, it varies from time place and person for the same disease. Such complexities highlight the critical need for using epidemiology as a key component for managing public health crises.

As an example, the pattern of epidemic curve of COVID-19 in India will be different from Italy, England, and USA for sure. But we should not take it lightly, like non-inclusion of epidemiologist in pandemic management panel, or relax lockdown norms.

We conclude that to tackle special problem we need expert in that particular field. It is the high time that policymakers should appreciate the importance of epidemiology and involve epidemiologist for effectively combatting the global fight against COVID-19 pandemic putting personal agenda aside.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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