CAPE TOWN - In a few years from now, many of us will look back at a time when our epidemic preparedness was truly put to the test as we had to hastily find innovative ways to deal with the Covid-19 pandemic.
The International Day of Epidemic Preparedness was held for the first time on 27 December 2020 to emphasise the importance and need for epidemic preparedness as the world had to deal with the Covid-19 pandemic.
What was first reported as an outbreak of a severe respiratory disease in Wuhan, China, within months, had swept to all corners of the globe. While outbreaks and pandemics are not new and there are systems in place to deal with these, the scale of the current pandemic has been unsurpassed, driven in part by the rapid advance in global transport facilities, which has made the world a much more connected place.
We responded with the traditional public health measures of lockdowns, isolation and quarantine as we learnt about the mode of spread of the disease.
Unfortunately, this also had the unintended consequence of negatively affecting the global economy. Mask wearing, physical distancing and hand washing became the watchwords of daily living.
South Africa has certain endemic diseases such as tuberculosis, diarrhoeal disease, HIV and malaria, and we have developed standard protocols for dealing with these.
However, we are also subject to outbreaks of common infectious diseases such as measles, diphtheria and cholera.
In addition, it is well recognised that new infectious diseases are appearing globally at regular intervals, as was the case with HIV in the 1980s, and more recently Sars (severe acute respiratory syndrome), Zika and Mers (Middle East Respiratory Syndrome), some of which have affected South Africa and others not.
Another major area of concern is the occurrence of well-known diseases where the organisms have mutated to become resistant to current treatments due to the widespread misuse of antibiotics.
We are constantly reminded that epidemic preparedness starts with prevention.
We take many of these for granted, but clean water, proper sewage disposal, regulation of food production, storage and restaurants, and hygienic practices (taught at school) are all very important mechanisms for the prevention of communicable diseases.
Established health system protocols for infection prevention and control are in place in health care settings. A very important prevention tool are vaccination programmes, and many infectious diseases have much-reduced incidence due to comprehensive immunisation schedules – the benefits of vaccination and the millions of lives saved are often not well recognised.
Smallpox was eradicated in 1980, and Africa was declared polio-free in 2020, with South Africa having had its last case of wild polio in 1989 – all due to the success of vaccination programmes.
Secondly, adequate surveillance is needed. In South Africa, as in many countries around the world, there are legislated reporting mechanisms for a defined set of notifiable diseases.
A simple call from a clinician to an appropriate authority about an unusual infectious disease can also generate an outbreak response. Having trained personnel in communicable disease control as part of government authorities is important to manage such surveillance systems, and these personnel should have appropriate epidemiological and public health skills.
Such personnel then bring together relevant experts from fields such as infectious diseases, microbiology, communication, environmental health, public health, as well as clinicians, and those working in laboratories to coordinate outbreak response efforts.
We shouldn’t underestimate public communication as it is crucial that the general public stays informed and participates where necessary in the relevant prevention and control measures.
Thirdly, processes to investigate outbreaks are needed to determine the source and guide appropriate control measures.
There are systematic ways of conducting such investigations, including confirming the diagnosis, having clear case definitions, compiling line lists and collecting data on all affected persons. Clinical staff in the field and environmental health practitioners are key to such investigations.
Lastly, appropriate control measures are put in place, which could involve restriction of movement through isolation and quarantine, screening for new cases, administration of vaccines or medication and appropriate environmental control measures, among others. Such investigations are written up so that they contribute to our organisational memory and act as learning experiences which can be built on for future outbreaks.
It is clear that outbreaks can range from a handful of cases to literally millions.
The Covid-19 pandemic has tested our ability to control infectious diseases. It is clear that many traditional tools such as isolation, quarantine, and mask-wearing require more research and need to be refined further.
Many researchers have already taken the opportunity to do so. The pressure of the pandemic has enabled rapid progress in the field of vaccine development – where vaccines had previously taken 5 to 10 years to develop, a number of efficacious Covid-19 vaccines were developed within a year. This must qualify as one of the greatest scientific achievements of modern times.
Because of the varying scale of epidemics, it is very difficult to be completely prepared for all the possible outbreak scenarios, but having a routine infrastructure and trained personnel in place is essential, and the documenting of outbreak responses and ongoing research is needed to enable the increasingly refined responses required for our modern world.
It is clear too that the response to epidemics and outbreaks is not a health issue but can have profound impacts on our economy. Intersectoral collaboration is essential to tackle particularly large epidemics which can affect large parts of the population.
Professor Mahomed is currently a Public Health Medicine Specialist at the Western Cape Provincial Department of Health and the Division of Health Systems and Public Health in the Department of Global Health at Stellenbosch University.