Best Practices for Pandemic Containment

PANDEMIC CONTAINMENT

Pandemics and Best Practices for Containment

Introduction

Since the earliest moments of civilization, humanity has been plagued by disease. However, it would be prudent to note that although man has been afflicted by various diseases, very few disease outbreaks have achieved the pandemic status. Some of the worst pandemics known to man have been inclusive of, but they are not limited to; Black Death (1346-1353), Plague of Justinian (541-442), Smallpox (1500), Antonine Plague (165 AD), Spanish Flu Pandemic (1918), the Asian Flu (1956-1958), Hong Kong Flu Pandemic (1968), etc. Over the last three years, the world has been battling the Novel Coronavirus. So far, COVID-19 has claimed the lives of more than 5 million people across the world. Given that various jurisdictions continue to struggle with the disease, there is need to highlight some of the best practices for pandemic containment.

Discussion

From the onset, it would be prudent to note that a pandemic does not have a standard definition. This is to say that scientists have not assigned a single definition to the term. However, some of the definitions that have been floated in the past could offer great insight into the nature and properties of a pandemic. Thus, a pandemic, according to Grennan (2019) could be defined as an epidemic that ends up spreading across the world. Thus, in seeking to understand what a pandemic is, there is need to first assign meaning to the term ‘epidemic.’ In the words of Grennan (2019), “an epidemic is an outbreak that spreads over a larger geographical area” (57). With this in mind, when a disease affecting a small number of persons ends up spreading beyond the original area in which it was first reported, and affects persons in a wider geographical area, then this could be described as an epidemic. Some of the more recent epidemics which could be highlighted on this front are inclusive of; the Ebola outbreak and the Zika virus. In this case, the diseases impacted larger geographical regions – i.e. the Latin America and Brazil respectively – but never got to spread across the world. In contrast, the present COVID-19 pandemic, which was first report in the Wuhan city of China, has spread across all continents. Yet another famous example of a pandemic that spread across multiple global locations was the Spanish influenza (1918) which caused the death of close to 50 million people.

The relevance of implementing the most effective strategies in efforts to contain a pandemic cannot be overstated. This is more so the case given that cost that humanity pays following a pandemic is often massive. The cost could even be greater or more severe, in terms of fatalities and other associated impacts, if the pandemic is poorly managed or if the response and containment measures are ineffective. Today, the world is more interconnected that it has ever been in the past. This is especially the case given that modes of transport have become even faster and more convenient. Thus, an infection that starts in one corner of the world could be spread to another corner within a couple or hours. All these considerations are crucial indicators of the need to embrace best practices for pandemic containment. According to Kucharski (2020), there are numerous lessons we can learn from the way past pandemics have been contained.

An Assessment of Best Practices for Pandemic Containment

In basic terms, containment strategies, as Barry (2005) points out, seek to reduce transmission risk, i.e. from persons who are infected to those who are not infected. In so doing, the author indicates that the outbreak can be halted.

a) Contract Tracing

One of the most viable approaches when it comes to containment of pandemics is the tracing of persons who may have been infected. This happens to be among the very first containment measures that should be undertaken. O’Connell and O’Keeffe (2021) indicate that for centuries, contact tracing has been utilized in response to both epidemics and pandemics. For instance, in the words of the authors “from the bubonic plague, to smallpox and tuberculosis, to HIV, the fate of public health has relied on our ability to identify people who have been in contact with infected people” (O’Connell and O’Keeffe, 2021, p. 485). It therefore follows that this is a time-tested approach to the containment of pandemics. In basic terms, contact tracing has got to do with the identification and tracking down of all persons that were at some point in the recent past in contact with an individual suffering from an ailment that is infectious, and whose spread authorities are seeking to halt.

It is important to note that thanks to contact tracing, those who are likely to be infected can be taken through a diagnostic process to ascertain whether they were indeed infected. If a positive diagnosis is returned, then the relevant measures can be taken to ensure that the said persons do not further spread the infectious illness. It should, however, be noted that according to O’Connell and O’Keeffe (2021), contract tracing could in some instances be somewhat ineffective. This is especially the case given that some of those individuals that public health officials reach out to could suffer from what is in some quarters referred to as recall bias. This is, in essence, the inability of an infected person to recall individuals he or she could have come into contact with, especially those who are largely unknown to him or her. O’Connell and O’Keeffe (2021) also indicate that contact tracing’s urgency and rapidity may get in the way of effective training of contact tracers.

b) Confinement/Isolation

Confinement of infected persons could be yet another effective containment strategy. Indeed, in the words of Kucharski (2020), available evidence indicates that “if we isolate people who are infected, it shortens the duration they are spreading infection” (37). This is an assertion further advanced by Nam et al. (2018) who indicate that when deployed from the onset, isolation could be instrumental in disrupting the spread of a pandemic. According to the authors, this has been clearly demonstrated in the case of the COVID-19 pandemic. Indeed, this particular strategy, as Nam et al. (2018) further indicate, was more effective than other containment measures deployed by the relevant authorities. Some of the other containment strategies that were assessed by Nam et al. (2018) in this particular study were inclusive of closure of cities, closure of public spaces, as well as closure of schools. However, the authors are categorical that for the approach to be effective, it has to be deployed at the moment the very first infections case is detected.

c) Border Entry and Travel Restrictions

Kurcharski (2020) points out that contact tracing and confinement/isolation could in effect be effective pandemic containment measures on their own. However, if data indicates the continued spread of an infectious disease, a raft of other containment measures should be taken into consideration. One such measure is travel restrictions. Today, the world is more interconnected than it has been at any other point in history. Thus, to a large extent, we are living in a global village. This effectively means that thanks to today’s hugely efficient modes of transport, a person can have breakfast in one continent, lunch in another, and dinner in a third continent. If such a person were to be already infected with a certain infectious illness, he would effectively spread such a disease across three continents within a single day. For this reason, it would make great sense for countries to close their borders and restrict travel to areas that are affected. In those instances where pandemic diagnostic procedures have already been ascertained, then all those wishing to travel in and out of certain jurisdictions could be required to obtain clearance indicating that they have not been infected. Undertakings of this nature have proven successful during the present COVID-19 pandemic (Chinazzi et al., 2020). More specifically, with reference to the COVID-19 pandemic, the authors observe that “international travel restrictions did help to slow spread elsewhere in the world…” (Chinazzi et al., 2020, p. 396).

d) Banning Large Public Gatherings

Large public gatherings have in past pandemics been described as ‘super spreading occasions’ (Barry, 2005). The said gatherings could be inclusive of, but they are not limited to; political rallies, funerals, weddings, sporting events, religious gatherings, etc. In such occasions, transmission of infectious illnesses happens to be rather high as a consequence of close contact between persons – essentially making it easier for an infectious illness to be transmitted from one person to another. Closed door meetings and engagements could also be banned. This is more so the case given that various studies have in the past indicated that transmission of airborne diseases happens to be more pronounced in settings with poor ventilation. Indeed, in one particular study, it was found that small gatherings such as birthday parties held in households had the potential to trigger a higher rate of infections (Whaley, Cantor, and Pera, 2021). More specifically, in relation to the spread of COVID-19, Whaley, Cantor, and Pera (2021) indicate that one crucial finding was that “events that lead to small and informal social gatherings, such as birthdays, and in particular, children’s birthdays, are a potentially important source in SARS-CoV-2 transmission” (1092). In those scenarios whereby mass gatherings cannot be avoided, the relevant authorities can come up with clear guidelines on social distancing. For instance, in public transport settings, persons can be directed to ensure that a certain distance (i.e. 1 meter) is maintained between one person and another. Kucharski (2020) opines that social distancing is an effective strategy in efforts to ensure that transmission opportunities are minimized.

e) Vaccination

Vaccination could also be seen as containment measure given that it prevents the spread of targeted infectious diseases from one person to another. According to Barry (2005), this is a scientific solution to infectious diseases that most industrialized nations apportion a great deal of resources to. This has been all too clear during the current COVID-19 pandemic. Various vaccines have been rolled out in an attempt to contain the virus. The Centers for Disease Control and Prevention – CDC (2022) is categorical that vaccines are instrumental in minimizing the chance of a person contracting an infectious disease or in reducing the chances of an infected person spreading the disease to uninfected persons. In relation to the present COVID-19 diseases vaccination efforts, CDC (2022) makes an observation to the effect that getting “vaccinated against COVID-19 can lower your risk of getting and spreading the virus that causes COVID-19... vaccines can also help prevent serious illness and death.” Historical data also appears to be in support of the effectiveness of vaccines as a viable pandemic containment measure. For instance, many are of the opinion that many more lives would have been lost to the Asian flu had a vaccine not been developed (Barry, 2005).

f) Public Awareness

Public awareness and education efforts should be based on the nature of the infectious illness, i.e. in relation to how it spreads, presenting symptoms etc. For instance, past influenza viruses have been known to spread from one person to another mainly via tiny droplets emitted by an infected person when he or she talks, sneezes, or coughs. When these droplets are inhaled by nearby uninfected persons, such persons are likely to get flu. Also, such droplets could fall on a surface which an uninfected person might touch. Such a person could get the flu if they also touch their eyes, nose, or mouth after touching the said surface. After it was determined that one of the ways in which COVID-19 was spread was via the inhalation of air that has been contaminated with respiratory droplets containing the virus, wearing of face masks became one of the most effective ways to rein in further spread of the virus. Other measures that the public could be advised to undertake so as to minimize their probability of acquiring a flu virus is avoiding public gatherings, ensuring that they routinely sanitize their hands, etc. Further, there is also need to ensure that the general public is aware of how to recognize symptoms of the infectious disease. This is especially important in efforts to see to it that those who are infected seek the relevant interventions so as to limit further spread of the infectious disease.

Complementary Measures

Although the approaches highlighted above would come in handy in efforts to contain a pandemic, there are a wide range of other measures that should be undertaken to further enhance the effectiveness of the strategies highlighted above. These will be briefly highlighted below.

a) Surveillance

In the absence of surveillance, it would be impossible for officials to have actionable data on the spread of the infectious disease. Data on prevalence and incidence is instrumental in the development as well as deployment of viable as well as targeted containment approaches. The said data could be obtained from health institutions, global health bodies, public agencies from various jurisdictions, etc.

b) Effective Communication

Without effective communication, i.e. in relation to the nature and aspect of risk, the containment measures highlighted above cannot be effective. In this case, the public should be informed about key pandemic statistics (i.e. the number of persons infected and fatalities), the containment measures being taken, the stakeholders involved, preventative measures that could be taken at the individual level, etc. To be more specific, Whaley, Cantor, and Pera (2021) are categorical that “communication by authorities to the public should include explicit information about uncertainties associated with risks, events and interventions and indicate what is known and not known at a given time” (1094). There are a wide range of communication mediums that could be used on this front. Although traditional media has been effective in the past, and could be used to reach out to the general public, there would be need to embrace newer and more effective modern communication methods and approaches. These are inclusive of, but they are not limited to social media platforms such as Twitter and Facebook. The last few decades have seen a marked increase in the number of persons who rely on social media for their diverse information needs.