People should be preparing for PANDEMIC
Coronavirus is going global and containment is no longer an option
The coronavirus containment has broken, with cases exploding across the
world. Now experts have revealed what to do to prepare.
Jamie Seidel
news.com.auFebruary 24, 202011:10am
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Coronavirus has broken containment. Itâs exploding across the world,
from Italy to Singapore, South Korea and Japan.
Now Australian medicos are sounding the alarm: we must prepare for this
pandemic to strike home, Soon.
Thereâs been a profound shift in the Covid-19 epidemic.
Health officials are being taken by surprise. New cases of the virus
are appearing seemingly everywhere. And not all of them can be traced
back to travellers.
That means itâs already loose. Deep inside communities, such as Italy
and Japan.
That means itâs entering a new phase.
Last week, the World Health Organisation (WHO) warned that the âwindow
of opportunityâ to contain the disease was narrowing.
But many epidemiologists fear that may have already passed.
Itâs in hospitals. Itâs in prisons. Itâs on cruise ships.
It seems to be spread by carriers long before they show symptoms
themselves.
And that makes the virus almost impossible to contain.
So how bad is it?
University of Queensland associate professor in virology Ian Mackay
yesterday queried a disease risk-assessment think-tank. He wanted to
know the most responsible way to discuss the worsening Covid-19
outbreak.
So, he asked risk communicators Lanard & Sandman about whether it was
time to start using the `P wordâ.
âYes,â came the blunt reply.
âIt is past time to say `pandemicâ.â
The virus is likely to soon be loose in our own country, cities and
towns.
ACTION STATIONS
The Centres for Disease Control (CDC) announced on Saturday it was
initiating preparations for a âlikelyâ spread of Covid-19 in the United
States.
âWe are reviewing all of our pandemic preparedness materials and
adapting them to Covid-19,â an official told media.
On Sunday, Victoriaâs Chief Health Officer Brett Sutton responded in
kind.
âItâs clear that with local transmission in several countries that a
pandemic is very likely, if not inevitable,â his official Twitter
account reads. âWe are working rapidly on planning and surge with our
health sector.â
Our latest analysis support that of @mlipsitch and colleagues: At
least 2/3 of cases in travellers from China to other countries have
likely been missed. Surveillance is never perfect.
https://t.co/NXUHzdJkRz
-- neil_ferguson (@neil_ferguson) February 21, 2020
A new assessment by the Imperial College London warns the outbreak is
likely dramatically worse than believed:
âWe estimated that about two-thirds of Covid-19 cases exported from
mainland China have remained undetected worldwide, potentially
resulting in multiple chains of as yet undetected human-to-human
transmission outside mainland China.â
This is sending shockwaves through international health circles.
In sum, many countries likely be dealing w COVID epidemic soon. They
should be quickly preparing to deal, to do best they can w pt
medical
care, work to blunt overall impact, protect HCWs and keep health
care system functioning safely, communicate clearly to public et al.
16/x
-- Tom Inglesby (@T_Inglesby) February 23, 2020
âIn sum, many countries likely be dealing with a Covid epidemic soon,â
responded the director of the Johns Hopkins Centre for Health Security
in Baltimore, Tom Inglesby. âThey should be quickly preparing to deal,
to do best they can with medical care, work to blunt (its) overall
impact, protect health care workers, keep health care system
functioning safely and communicate clearly to the public.â
Risk group Lanard and Sandman say itâs important to point out that,
while it looks like Covid-19 will go global, we donât yet know how
severe the disease is.
But, they add, the most âcrucial (and overdue) risk communication task
for the next few daysâ is to prepare the public for when the `keeping
it outâ - containment - approach fails.
In other words, get ready for quarantine lockdowns.
`TAKE THE RISK OF SCARING PEOPLEâ
âIn most countries - including our United States and your Australia -
ordinary citizens have not been asked to prepare,â Lanard and Sandman
write. âInstead, they have been led to expect that their governments
will keep the virus from their doors.â
But such expectations are set to backfire.
And the risk assessors warn concerned academics and medicos to stand
resolute in the face of accusations of `fear-mongeringâ.
âTake the risk of scaring people ⊠It is better to get through this
OMG moment now rather than later,â they write.
"Respond that hiding your strong professional opinion about this
pandemic-to-be would be immoral, or not in keeping with your commitment
to transparency, or unforgivably unprofessional, or derelict in your
duty to warn, or whatever feels truest in your heart.
âYouâre only darned if you warn about something that turns out minor,â
Lanard and Sandman write. âBut youâre damned, and rightly so, if you
fail to warn about something that turns out serious.â
Australian National University infectious disease specialist Dr Sanjaya
Senanayake agrees it is time to get prepared. But not to panic.
âEven though we donât know at this point whether or not a pandemic will
occur, governments should be prepared for one and send out reassuring
messages to the public,â he told News Corp last night.
He says indications are it will be a disruptive disease. But not
devastating.
âWhile a lot isnât known about this virus, at this stage it appears to
cause mild illness in the majority of people with a low case fatality
rate. So while it will cause disruption for a time to health services
and economies, they will eventually recover as more and more people
become immune.â
CHANGING TACTICS
The director of the Center for Communicable Disease Dynamics at Harvard
University, Marc Lipsitch, says containment no longer appears to be an
option.
Instead, countermeasures must be identified and implemented.
âMost things we can do to slow the virusâs spread - isolation,
quarantine, social distancing, cancelling public gatherings, treating
cases with antivirals - are temporary,â he wrote. âOnce let up,
transmission can resurge.â
When a disease is established in a community, international travel bans
become pointless. Instead of slowing its spread, it makes it harder to
bring in urgently needed supplies and support.
So, Lanard and Sandman write, public health messages must switch from
stopping them from infecting us' to keeping us from infecting each
otherâ.
That means cancelling mass events, considering school closures - and
preparing for community lockdowns.
âWe are near-certain that the desperate-sounding last-ditch containment
messaging of recent days is contributing to a massive global
misperception about the near-term future,â they write.
To counter this, public health officials should be talking about
slowing the spread of the virus. Not stopping it.
âOne horrible effect of this continued stop the pandemic' daydream masquerading as a policy goal (is that) it is driving counter-productive and outrage-inducing measures by many countries against travellers," they write. "But possibly more horrible: The messaging is driving resources toward stopping,â and away from the
main potential benefit of containment - slowing the spread of the
pandemic and thereby buying a little more time to prepare for whatâs
coming.â
BUYING TIME
Lipsitch says slowing Covid-19âs spread will be difficult. Strict
quarantine measures worked well for SARS in 2003 because isolating sick
individuals prevented the disease from spreading.
Not so now.
âFor Covid-19 it seems clear from individual well-documented cases that
people can transmit before symptoms (become distinctive),â he wrote.
âThe key question - for which we (desperately) need good data - is
whether this is common or rare. Some circumstantial evidence suggests
it could be common.â
This limits the effectiveness of regular medical interventions. So
practices such as social distancing (self-isolation), as well as
âquarantine or lockdownâ must be considered.
Slowing the spread of a virus through the community causes an epidemic
to last longer - but with less `peak strainâ on health facilities.
"That is beneficial because: 1) fewer individuals get infected in
total; 2) the burden on the health system is spread out, with lower
peak demand for scarce resources; 3) we will know more as time goes on
about how to care for patients, so it is better to get it late than
early; 4) if we can spread it out enough there may be new drugs,
vaccines, or other countermeasures to aid in preventing and treating
infection.
âSummary: Delay is good.â
Another essential piece of unknown information is how the virus affects
children.
So far, they seem strangely immune to Covid-19âs symptoms.
But are they innocent carriers?
âIf kids are important for transmission, school closures may help; if
not, less so,â Lipsitch writes.
And the delaying tactics are already producing results.
âAlthough a vaccine program is many months away, there are promising
therapeutic options for treating people with the virus,â Dr Senanayake
says.
BE PREPARED
In China, Covid-19 came from nowhere on January 1 to put the entire
province of Wuhan in lockdown by February. Its rapid rate of spread can
be seen again in Italy and Japan.
Can we cope?
âWeâve provided guidance to practitioners and many communications
materials but are now focused on the models of care that will need to
be in place - clinics, phone triage, home care, right through to ICU
and aged care,â Sutton says.
Without rapid diagnostics ready to go, healthcare infrastructure may
become rapidly inundated, even if cases turn out all negative - an
abundance of caution will require quarantines until test rules out a
case. Any backlog can quickly hamper hospitals. 4/7...
-- Michael Mina (@michaelmina_lab) February 23, 2020
âVictoria and Australia nonetheless remain completely in containment
mode - identifying any possible case; isolating those who are
infectious; and quarantining contacts. Regardless of developments
internationally, this gives all of us time and space to plan and
prepare.â
But the response must be at all levels, Inglesby warns.
âGiven the developments and trends of last few days, itâs clear
governments need to be working intently with hospitals and health care
systems to prepare to take care of Covid patients, possibly in high
numbers,â he says.
Key among concerning Covid-19 developments is the number of cases
appearing in countries outside China. And many of these arenât linked
to travellers ⊠indicating the virus is established in their general
populations.
Inglesby says that, based on Chinaâs experience, preparations should
include:
o Preparing for a substantial increase in the numbers of patients who
need oxygen and mechanical ventilation;
o Getting people with symptoms of Covid-19 diagnosed rapidly and
correctly;
establishing the highest possible infection control procedures;
ensuring health care workers have high-quality personal protection
equipment to keep them from being infected
o Preparing to give those with Covid-19 who are not sick enough to be
in the hospital, instructions for home isolation and self-care, so they
do not pose risks to hospitalised
o Evaluating whether there are public health interventions at community
levels that might slow Covid-19 spread to create fewer numbers of very
sick people all being in hospital at the same time
WHAT TO DO
Lanard and Sandman say preparedness advice must be spread: âHardly any
officials are telling civil society and the general public how to get
ready for this pandemic.â
To allay panic, they say, health officials should be providing
preparedness guidelines. This way worried people wonât be left feeling
helpless. And the more people getting prepared, the more people will
feel their community is ready.
âWe are all stakeholders, and we donât just want to hear what officials
are doing. We want to hear what we can do, too,â they write.
"We want - and need - to hear advice like this:
o Try to get a few extra monthsâ worth of prescription meds, if
possible.
o Donât panic buy. But slowly build up your long-life grocery stocks to
enough for a few weeks.
o Think through now how we will take care of sick family members while
trying not to get infected.
o Cross-train key staff at work, so one personâs absence wonât derail
our organisationâs ability to function.
o Practice touching our faces less. So how about a face-counter app
like the step-counters so many of us use?
o Replace handshakes with elbow-bumps (the âebola handshakeâ).
o Start practicing harm-reduction habits like pushing elevator buttons
with a knuckle instead of a fingertip.
But the impact of a pandemic could also reach deep into businesses,
supply chains and essential services.
âWe have seen almost nothing in mainstream media citing this guidance,
or recommending business continuity strategies like urgent
cross-training so that core functions wonât be derailed because certain
key employees are out sick, for instance.â
I'm speaking to my CHO counterparts daily and briefing the sector -
and indeed all sectors - through our emergency management
arrangements, under @CommissionerEMV. This is critical - pandemics
challenge all sectors with effects on supply, workforce and business
continuity. (4/6)
-- Chief Health Officer, Victoria (@VictorianCHO) February 23, 2020
That message is now starting to get out.
At least at a state level.
âAustralia absolutely has world-class healthcare, but even the best
healthcare in the world is challenged during pandemics,â Sutton says.
âWeâve got some of the brightest minds in the world in our health
services, laboratories, research sector and emergency management
sector. Iâm confident weâre well placed to meet the challenges ahead,
whatever they might be. Hoping for the best and planning for the
worst.â
Dr Senanayake agrees: âAgain, it is important to communicate the
message to the public that a pandemic doesnât always mean a
catastrophic outcome, especially since the majority of cases with this
virus seem to be mild. It will certainly be an imposition, but likely a
temporary one.â
