For living I work on outbreaks detection and control systems, including pandemic preparedness. Over the years I have taught young public health officers across the globe how to detect outbreaks quickly and contain them locally. Part of our standardized training curriculum is what not to do if there is a major outbreak or a pandemic. In Pakistan everyone has a say on how to best control this pandemic in our country. It does not matter what this person professional background may be. Then there is a political divide on the best approaches to contain the disease. This is a landscape full of landmines because no matter what I say I will be making some friends and colleagues unhappy. So I will try to test each action on the fundamental principle of outbreak control and will try to steer away from subjective conclusion. If you ask any of Pakistan Field Epidemiology and Laboratory Training (FELTP) program graduates they will testify that these are considered must Dos and Don’ts and I am not just making them up to embarrass some.
Let’s test the actions one by one on these principles.
1. There should be one in charge! This is the first thing all teams need to do before attempting to do anything else. Agree on one person who will be the lead of this outbreak control team. Normally this person will be an epidemiologist with actual experience of outbreak control. In my own professional life I have been lead of many outbreak investigations even though I was most junior officer in many instances. Unified leadership is the critical component in any pandemic control strategy as decisions based on evolving data needs to be made on daily basis which requires understanding of epidemiology, data science and outbreak dynamics. It’s just like military operations. There should be a clear authority before you send your troops to an active fight. Everyone should know their role and responsibilities. Any ambiguity in authority cost lives in combat. Responding to a pandemic is no different. I have a simple question: who is the in charge here?
Pandemics are also local. That means pandemics do behave differently in different parts of the same country
2. Decisions should be based on health intelligence. Disease surveillance is not just a daily list of numbers of dead and sick but a step ahead to predict virus next moves based on its observed strengths and weaknesses and understanding of our own vulnerability. No combat leader will rely on computer models but get the real feedback from an ongoing battle and modify his response in real time. COVID19 pandemic is like third World War and this is high stake war of survival of our specie. Our enemy is not Nazi Germany but a microscopic foe which is stealth in infecting and killing us. We are still trying to learn about it so it become very critical that whatever health intelligence we have about SARSCOV2 (the virus which gives us COVID-19) we use it for our greatest advantage. “Are we making or evolving our decisions based on our data”?
3. Decision should be made based on science. That does not mean that political leaders should not be the final authority in the decision making. However they should get the best technical team of disciplines concerned, and listen to them before they make a decision. No doubt we all have technical committees but they don’t sit on the table when the decisions are made. This helps others to ignore their advice. Look around the world and every political leader is flanked by the country top epidemiologists and public health professionals. The technical committees in these countries are not at second or third tier of decision making but have seats in the top decision maker bodies. The simple reason is that our enemy is not a human whose actions and reactions we could predict but a microscopic virus which has evolved our billions of years. Even with top administrative professionals and military genius will need those who understand viruses and know how to manage them in an outbreak setting. “Do we have right technical experts sitting in top decision making bodies?”
4. One of the most important principles of pandemic management is that the government officials should not be seen fighting with each other in public. That confuses public and they ignore important guidelines being issued by the government because they are not sure who is right and who is wrong. “Are our government officials/ministers are being seen in public in conflict in their opinion on how to respond to an outbreak?”
5. Linked with this is the strong strategy of risk communication. Risk communication (how to convey messages to public when there is a major crisis and public life is in danger) is considered one of the critical components for any pandemic response. It is an evolving professional discipline and has nothing to do with advertising of government officials, ministers touring the affected areas or announcing aid packages. Just plastering the news media with one way stream of photographs, videos of leaders expressing their concern is no way close to having a clear risk communication strategy. According to World Health Organization it’s an exchange of advice between experts and public when their life is in danger to take the informed decisions to save their and loved ones lives. Recently I saw news from a top information official that Pakistan public still need to be informed more of what government is doing for them. “Is there a risk communication strategy anywhere which is being practiced?”
6. Pandemics are also local. That means pandemics do behave differently in different parts of the same country. In the US, first outbreak of COVID-19 started in Seattle and it was controlled in a reasonable way. However, another outbreak in New York was many times more devastating and was different from the one in Seattle. In Italy too there was much more devastating outbreak in northern Italy then south of the country. That means we need to study and respond to local outbreaks at local level too with the same concern and expertise as we are looking at national numbers. Just focusing on national numbers hides early indications of local outbreaks and once missed they easily become multi city outbreaks. So we need to empower local public health professionals with resources and authorities to early detect an outbreak in their local areas and have an authority to modify local response if required. “Are we analyzing local data at local level and who is empowered there to make decisions based on this data?”
For today I will stop here. But all of us should ask these questions to ourselves and we will get the true answers. COVID19 is going to stay with us for some time with a real risk of hitting us back again in coming winter months. We need a long term strategy to manage this pandemic. If Pakistan does not have an effective COVID19 practical control strategy (in Pakistan we are very good in making strategies but never act on them) then we all will lose. It will not mean anything that on which side of political divide we are standing, we all will be losers!
The writer is an adjunct Professor of Epidemiology at the University of Nebraska, USA, and has worked at the Stanford University, University of Washington and London College of Tropical Medicine and with the US Center for Disease Control and Prevention (CDC).