How to prevent future pandemics?
With UK death rates from COVID-19 on track to be the highest in Europe, what can we do to prevent future pandemics?
We can start by learning from countries that have limited pandemic deaths much more successfully – like Taiwan, South Korea, Germany, Denmark and New Zealand. Here are eight lessons we can learn from them:
1. Be Prepared
Not just on paper, in practice. So:
- Make sure we have a Pandemic Plan we’ve tried, tested and learned from (not simply shelved if we didn’t like the results).
- Ensure we’ve got the capacity to respond. In a pandemic, countries all over the world will be competing to source diagnostic tests, PPE (personal protective equipment) and ventilators. This means we need a stockpile of equipment – plus UK based diagnostic and equipment companies, so we can be self-sufficient if we need to.
- Make sure we have enough CPAP (continuous positive airway pressure) masks. They are a lower cost, less invasive aid to breathing compared with ventilators, although ventilators will still be needed for the most serious cases.
- Involve logistic/emergency planning experts (from the military, private sector or disaster relief charities) from day one, to ensure policies are deliverable and to oversee successful implementation - like making sure the right PPE gets to where it is needed, when it is needed.
- Hospital beds probably aren’t an initial priority. That’s because prevention is always better than cure and we now know how to turn exhibition centres into hospitals at short notice if we need to.
- What we can’t do at short notice is turn people into doctors, nurses and public health professionals from scratch. So, we need to start training more health professionals now. Given recent NHS winter crises we’ll probably need them for years ahead anyway.
2. Take Public Health Seriously
What COVID-19 has illustrated is that in pandemics people with underlying health conditions are usually most at risk of dying – and with COVID-19 that includes people who are obese.
A doctor currently working in an ICU unit with COVID-19 patients advises us, ‘Unfortunately COVID patients with obesity don’t usually do well. I’ve personally seen this on multiple occasions. Obesity affects pulmonary function and lowers lung compliance, which negatively affects ventilator management.’
Patients like these are most likely to require weeks of expensive, time consuming intensive care and put huge strain on the NHS and its doctors and nurses. Some health conditions are unavoidable and we don’t want to start victim blaming - but the risk of many health conditions can be reduced by following a healthy lifestyle. Importantly, as we have identified as a health charity, there’s much more governments, businesses and employers can do to make healthy choices the easy choices for people.
If people are healthier this won’t stop pandemic deaths – but it should reduce them.
This means that instead of cutting funding for Public Health, the front line in disease prevention, the government should be investing in prevention.
3. Don’t Waste Time – Respond Quickly
When a new virus emerges there's a chance that its true extent and impact will initially be under-reported in the country of origin, whether to save face politically or because of difficulty diagnosing the virus. That's the first potential delay. Then, there's likely to be a time lag while scientists try to identify the virus, its speed and spread of infection, its effect on health and how best to contain it – and while politicians consider the implications.
However, what we have seen with COVID-19 is that those countries that erred on the side of caution and took early action usually experienced fewest deaths.
Taiwan was probably the quickest to respond, perhaps because of its proximity to China. On December 31, 2019, when the World Health Organization was notified of pneumonia of unknown cause in Wuhan, China, Taiwanese officials began to board planes and assess passengers on direct flights from Wuhan for fever and pneumonia symptoms before passengers could get off the planes. This was the first of a range of actions taken by Taiwan to combat COVID-19. By April 24th, Taiwan had fewer than 500 cases and only 6 people had died.
South Korea was also an early responder. On 16 January, the South Korean biotech executive Chun Jong-yoon saw what was happening in China and directed his lab to work on a response. Within days, his team developed detection kits and South Korea was soon able to begin mass testing, including at drive-through centres. By 3rd May South Korea had fewer than 12,000 cases and only 250 deaths.
New Zealand’s response came later but was still quick enough to significantly limit the pandemic’s spread. On March 14th, when the country had only six cases, it announced that anyone entering the country would need to self-isolate for two weeks. By March 23rd, with 102 cases but no confirmed deaths, a lockdown was announced. By April 27th there had only been 19 COVID-19 deaths in New Zealand. With ‘no widespread undetected community transmission’ their Prime Minister was able to announce an easing of the lockdown.
4. Border Control
Pandemics don’t respect national boundaries. International travel by land, air or sea (including cruise ships) can help the rapid spread of pandemics. So, it makes sense to close borders early (and arrange for returning Brits to go into quarantine).
5. Track, Trace and Isolate
This has been an important reason why countries like Taiwan, South Korea, Germany and New Zealand have experienced relatively low death rates. What tracking, tracing and isolating does is to reduce the number of people each individual can infect, by identifying who is at risk through contact with an infected person and then isolating them for a period of quarantine. That way, if they prove to be infectious they can’t infect anyone else. Without new human hosts to transmit the disease the spread of the virus is dramatically reduced.
For Track, Trace and Isolate to be a rapid, effective option in the UK we need:
- A UK diagnostic industry, as a strategic priority. One of the reasons Germany could mass test so quickly is that it already had a range of diagnostic companies.
- Contingency Plans for widespread testing, at scale – whether through drive through testing centres, home testing kits or other practical testing arrangements.
- Plans for mass tracing – through tracing apps and/or trained tracing teams.
6. Stop Hospitals and Care Homes spreading disease
We know that if doctors, nurses and care home staff don’t have proper PPE they can catch and spread infection, making hospitals and care homes pandemic epicentres. We also know that when hospitals and care homes are under heavy and continuous pressure staff have to work long hours in demanding conditions, weakening their immune systems and making them more vulnerable to infection.
That’s why it is important to Track, Trace and Isolate to slow the spread of infection and reduce the number of people needing hospital treatment, while also, as a contingency plan, ensuring there’s enough PPE for both hospital and care staff.
7. Build and maintain public confidence
This is important if action like nationwide social distancing needs to be introduced and then sustained. Our advice to government is:
- Promise less, deliver more - so you build credibility
- Lead by example - visibly do what you're telling the public to do.
- Ensure you've got the right experts working with you (including logistic experts and experts in the immune system), so you can agree the right policies and then deliver on them.
- Share the advice you're receiving with the public, so they can understand what they are being asked to do and why.
What we have learned from the rapid spread of COVID-19 around the world is that, as in most aspects of health, prevention beats cure. That means:
- Be prepared for a pandemic (in reality not just on paper)
- Take public health seriously – because a healthy population will usually be more resistant to infection
- Don’t waste time – respond quickly, including border controls
- Track, Trace and Isolate – to deprive the virus of the human hosts it needs to spread
- Stop hospitals and care homes spreading infection – by taking the action needed to reduce the number of cases needing medical treatment in the first place while ensuring there’s enough PPE for staff when cases do need treatment.
- Build and maintain public confidence - leading by example and delivering what you promise
Michael Baber May 2020