Snakebite management is impacted by Covid

The Covid-19 pandemic has spared no one. It has also impacted to varying degrees all economic sectors and especially affected health systems around the world. Worse, the sprawling ramifications of this health crisis extend far beyond what one might imagine. As proof, the study by Health Action International. The organization that conducts research and advocacy to advance policies allowing access to safe, effective, affordable and quality drugs, is behind a survey published in the columns of the journal Toxicon : X. It highlights the serious impact of Covid-19 on the prevention and management of snakebites. A priority disease for the WHO Forty-three informants from 21 countries took part in this study, which provided inspiring results. The subject is far from secondary. Snakebite envenomation is not to be taken lightly. It is even a priority disease in the eyes of the World Health Organization. Yet for many years the disease has been overlooked, resulting in a steadily increasing significant mortality in low- and middle-income countries (LMICs) where snakebites are endemic. Fortunately, in 2017, the global health community finally took note and the World Health Organization (WHO) re-categorized snakebites as a priority neglected tropical disease (NTD). Reflecting its desire to tackle the problem head-on, the WHO had published a comprehensive global strategy and roadmap to reduce snakebite deaths and disabilities by 50% by 2030. Concretely, the effects of this program are not obvious. Certainly, global awareness has increased somewhat, but at the same time, the health systems of many countries, where snakebites are endemic, are still struggling when it comes to the necessary equipment to respond to this scourge adequately. If we are to believe the aforementioned study, this finding would have been accentuated because of the Covid-19 pandemic. A global emergency which has certainly not worked in favor of a greater exposure to snakes in rural agrarian communities, where the incidences are generally the highest, but on the contrary, it has been at the origin of many related difficulties. including access to health care due to overburdened health care systems and providers, and disruptions in the manufacture and supply of antivenom. In short, the effects of the Covid-19 pandemic on the prevention and treatment of snakebites are apparent in more ways than one, especially in remote rural communities, “proof of the need to invest in prevention and community care ”, assure the authors of the study. Overburdened health services It’s hard to deny that a lack of expertise, equipment, and access to medical products, especially effective antivenoms, are common problems in healthcare facilities. But the least we can say is that the problem has taken on a whole new dimension because of Covid-19. Scientists around the world are saying no more. Scientific editorials, brief communications and other in-depth articles tune their pitch when mentioning concerns related to the reassignment of healthcare facilities to care for Covid + patients, leading to risks of limited availability of beds, particularly for patients requiring specialized care in rural areas. Not to mention the lack of personal protective equipment (PPE), problems with continuity of drug manufacturing and supply chains, disruption of research efforts and insufficient health resources for snakebites in particular. . In addition, the health crisis has pushed neglected tropical disease (NTD) control programs and community NTD prevention activities into the background. Worse still, the new coronavirus worsens the damaging effects of snakebites. And for good reason, the potential interaction between the two diseases causes “a respiratory distress, a pro-coagulant state or an inflammatory response”, specify the scientists, before expressing their concern: “Despite the renewed attention and the progress In recent years in snakebite control and management, we are in danger of regressing if the above concerns are not addressed and mitigated. The Covid-19 pandemic may well have a negative impact on all aspects of snakebites, from the number of events to care-seeking behavior, treatment and health outcomes ”. Avoidance of health care The circumstances of the snakebites were also influenced by the pandemic. Informants who participated in this qualitative cross-sectional study, all considered to be key actors whose work contributes to the prevention or treatment of snakebites, explained that “rural agrarian communities, a high risk group, did not not ceased their activities because movement restrictions were often not enforced, allowing rural workers to continue food production and other work activities ”. Results ? These workers had closer contact than before with snake habitats as many of them resorted to agricultural labor to support themselves. In the worst case scenario, namely being the victim of a snake bite, heading to the nearest hospital as quickly as possible is a vital reflex. But strangely, despite the previous finding, the number of hospital admissions had decreased during the first wave of Covid-19. Mainly for two reasons. First, “avoidance of formal healthcare due to fear, uncertainty, rumors and / or stigma surrounding Covid-19 and its care. Secondly, due to transport difficulties, transport systems are affected by regulations and reluctance from service providers, ”says the study. The snakebite treatment machine purrs even more when the victim has the novel coronavirus ”. “We have to sterilize the whole intensive care unit, we have to stop everything. So yes, it was difficult to quickly treat the person bitten in such a situation “, reports an informant. One of the few reasons for satisfaction lies in the availability of antivenoms for the snakes. In shortage, there is none. Except in a few countries in sub-Saharan Africa and Latin America. In contrast, informants from Bangladesh, Brazil, Ghana, India, Malaysia and Morocco found no antivenom stock-out in 2020. Now that the overall picture of the impact of Covid on the management of snakebites has been painted, it is time to move on to recommendations to improve services and care related to snakebites during a pandemic. Starting with the establishment of a strategy for the continuity of care related to snakebites during a health crisis of such magnitude. For the authors of the study, this care must not only to be considered prio rituals but also as a health emergency. “An appropriate referral system and rapid response strategy to access health services should ensure that redesigning hospitals to Covid-19 does not increase travel time to hospitals treating snakebites”, pleads we conclude. The other recommendation, and not the least, takes shape in strong community systems able to strengthen information and awareness systems, surveillance and reporting of snakebites. Goal ? Improve knowledge of the snakebite situation in communities during emergencies. Finally, there is also a question of creating decentralized health services supposed to facilitate access to health services, on the one hand, by strengthening in particular prehospital care, and on the other hand, by decentralizing the supply of antivenom and training community health workers on snakebites. We could not conclude without citing other flagship measures such as transforming ambulance services into mobile emergency clinics, or investing in regional units specializing in snakebites, in drone delivery. In conclusion, it is crucial to highlight the importance of awareness raising through online collaboration with a view to continuing global and national awareness programs on preventive measures, first aid, emergency management. snakebites, policy development and advocacy efforts to achieve WHO’s global goal of reducing death and disability by 50% by 2030. Chady Chaabi Read also the interview with Dr. Naoual Oukkache, head of the venoms and toxins laboratory at the Institut Pasteur: We must set up a management strategy for people who are poisoned in times of pandemics