The torrential rains have caused massive floods across various parts of Nepal whilst damaging various critical infrastructures.

But,beyond that there's a higher risk of outbreak of other infectious diseases in the flood-affected areas  including the transmission of several water-borne ,air-borne,food-borne as well as vector-borne diseases respectively. 

The World Health Organisation (WHO) has enlisted the following diseases in particular that are worth looking out for during and post floods.  

Vector-borne diseases like Dengue,Malaria:

In this type,mosquitoes serve as  pathogens to transmit either malaria or dengue epidemic as the floodwater act as a prime breeding sites for the proliferation of mosquitoes.

Water-borne diseases like Cholera,Typhoid fever,Leptospirosis,Hepatitis A,Jaundice:

image courtesy: Mfine 

Due to lack of access of clean water or through faecal contaminated water,the diarrhoeal epidemics,among others occur as the flood water mixes up with the sewage water and thus becomes polluted.

As we know that, many displaced people are  sheltering into overcrowded camps with limited access to food,safe drinking water facilities or any proper sanitation measures.

This infact can give a rise to another ongoing  problem of "Coronavirus surge" because our country is still baffling with COVID-19 plus with the spread of this deadly virus might pose a threat against keeping people safe in the shelter homes.

Thus,it calls for an immediate establishment of a "Disaster Evacuation shelter" in the light of the pandemic alongside maintaining the health protocols within the confined space. 

WHO has prepared the following guidelines to check on the public health aspects of the natural disaster in the midst of COVID-19. 

https://iris.wpro.who.int/bitstream/handle/10665.1/14603/WPR-DSE-2020-033-eng.pdf

https://apps.who.int/iris/bitstream/handle/10665/332408/WHO-2019-nCoV-Advisory-Preparedness-2020.1-eng.pdf?sequence=1&isAllowed=y

The major highlights from the released report states that,

• To identify and isolate people with suspected,probable or confirmed with coronavirus infection and similarly allocate toilet,sleeping areas for the categorised people as far as possible. 
• To facilitate contact tracing and physical distancing in the temporary homes. 
• To use PPE,masks,dispensable masks and practice hand hygiene.
• To create separate areas within the evacuated centre for the pregnant women,small children,elderly aged 60 above. 

In the context of Nepal,however one can only assume if the above strategies would be applied or not since the country has its limitations owing to financial constraints; inadequacy in stipulating emergency outreach response and lack of skill human resources. 

At the same time,The research led by United Nations University has derived the following clinical phases of the communicable disease transmission on the survivors or the injured ones after the onset of the disaster:

• PHASE 1 or the impact phase which lasts upto 7 days when the victims are extricated and initial treatment of disaster related injury is provided.
• PHASE 2 or post-impact phase which lasts from 4 days till the 4th week when the first wave of infectious disease might emerge with ongoing symptoms like vomiting, nausea , diarrhoea and so on. 
• PHASE 3 or recovery phase after 4 weeks,when the symptoms of the victims who have contracted infections with long incubation period become clinically apparent.

During the last period,the infected disease that are already endemic in the area,as well as newly imported ones among the affected community,may grow into an epidemic.

The following table shows the breakdown of the infectious disease transference.

source: UN University 

Preventive measures 

source : UN University. 

• Treating drinking water with chlorine or boiling. 
• Using mosquito nets while sleeping. 
• Fencing ORS water on a regular basis.
• Facilitating with mobile toilets.
• Timely Supply of medical materials. 
• Discard any food boxes like juice,milk,baby food, etc which have been in contact with flood water as it cannot be sanitized.
• Awareness about hand washing or good hygiene practice. 
• Ensuring safe food preparation technique. 
• Maintaining cleanliness of the evacuating place.

But,in a larger context the government should strengthen the national surveillance system, distribute the emergency relief materials efficiently ,provide adequate safe drinking water, regulate the nutritious food supplies, monitor proper sanitation facility  and recruiting health personnel to meet with the health needs of the vulnerable group.

Meanwhile,The Ministry of Health and Population has already formed Rapid Response Group at all local levels under the Division of Epidemiology and Disease Control to mitigate the possible harms of the communicable disease.