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Public Health

How to prevent the next global pandemic

This year marks the 100th anniversary of the 1918–1919 global influenza pandemic

500 million cases and 50 million deaths.

Since 1918, there have been further pandemics and today influenza remains a global threat. It is number one on the national risk register, way in advance of terrorism, even Novichoc. It will happen it till be a BIG deal. See here from the Lancet for a neat info graphic

In spring I had to do a keynote on preventing the next pandemic for an excellent SsHARR conference. The subtext was on the importance of a multidisciplinary approach.

These are the key points

Introduction

  • You cant prevent it. Can’t stop a pandemic. Can only be as prepared as possible
  • We WILL have one
  • Likely flu. May not be
  • Likely emerge from SE Asia – probably birds
  • Likely 2-3 weeks before first U.K. cases. Impossible to tell how quick take off, but will be days to weeks not months
  • It will affect a lot of people – wider economic impact, impact on care system will be massive.  Even the football will be cancelled
  • No 1 on risk register- Killed more people than anything else, including both world wars. Some reasonably conservative predictions of a mid severity pandemic – 800k die. 43m infected before vaccine available
  • In swine flu – which remember was mild, the NHS nearly ground to a halt
  • there is much to learn from other places that have done a lot of this
  • make sure you Exercise – Prepare AND response AND recovery
  • there may be quirky stuff. Unintended and unanticipated consequences – Mexico flu vs swine flu, impact on pork production and sales, impact on Mexico tourism.
  • Burial practices may be an issue – ebola and cultural preferences around burial.
  • Intelligence will be sketchy in the first few weeks. there will be significant time delays between the source of an outbreak and collective action. Delays have been extended by insufficient surveillance capacity and time-consuming efforts to mobilize action. H1N1,Ebola,andZika. Deferred global mobilization is a greater source of delay than is poor surveillance capacity
  • we see quicker responses for novel diseases when outbreaks do not coincide with holidays and when US citizens are infected.
  • There is No evidence that quicker responses for more severe outbreaks or those that threaten larger numbers of people.

there is a lot to be learned from the telly. Watch “contagion” – a useful bit of CPD and a massively important social experiment. The model it’s based on is here

Modelling and it’s uses

  • Modelling helps – can be done years in advance. Who  needs to be involved – Mathematically modellers, IT, Tec companies,  Sociology,  Increase the number and diversity of brain power focused on the problem
  • But real life data can’t be done in advance. In Swine flu Our early modelling was way out. Needed real life data to change the response
  • Key metrics – Infectious propensity R0, movements and contacts – smartphones? Calculation of R0 can only be done with real time data when the live outbreak is on us.
  • Smartening the validity of assumptions with real data on how people move. Age, gender, employment, who people interact with
  • How infectious / How long is asymptomatic / When infectious, how long is asx infectious period
  • consider Social super spreaders – If vaccine is in short supply…….vaccinate supersoreaders first. Limit infection Targeting super spreaders could reduce infection by 40%. Are some people biological super spreaders = A genetic issue that predisposes some people to be super spreaders regardless of their employment or social contact profile
  • But basic choice of whether to target vaccination in order to save most lives of those most vulnerable or focused to limit spread and thus do less net harm

Problems to address in real life

  • If and when to close schools
  • If and when to close employment
  • The challenges and trade offs – economic pressure to keep places open
  • Is it a zero sum game in long term
  • Is aim to spread out the distribution of infection over long persiod and thus reduce impact on social protection services

Interventions

  • Treatment – prophylactic and symotomatic
  • Good quality health care
  • Vaccination
  • Infection control – SOAP IS THE MOST IMPORTANT INTERVENTION. Soap may be the most impactful intervention – modelled as, by far, the most important intervention. Reduction of impact of spread by a quarter (13m cases averted and lives saved), spread over longer period (lessen spiky impact on services)
  • Serious suggestion – stop smoking. Smokers are five times more likely to get microbiologically confirmed

Critical worries

  • Swabbing and early surveillance, getting as much intel as possible
  • Business continuity – How would your business cope if reduced by 10, 20, 40% over long period. Adult social care, primary care especially
  • Bodies – Mortuary capacity Body bags
  • Surveillance Early data gives critical information on planning
  • Hospital bed capacity, esp ICU
  • How or whether to use antiviral prophylaxis
  • Need a shared understanding of what IS and ISN’T mission critical across all organisations

Summary

  • It will happen
  • Prepare. Exercises. Prep, response, recovery
  • Multiple scenarios.
  • Prep is no substitute for being fleet of foot in real life
  • SOAP and vaccines. SOAP and dull infection control is more important
  • Business continuity

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