Pandemics and Best Practices for Containment Strategies

Introduction

Since the earliest moments of civilization, humanity has been plagued by disease. However, it is worth noting that although humans have been afflicted by various diseases, very few outbreaks have achieved pandemic status. Some of the worst pandemics known to history include, but are not limited to, the Black Death (1346–1353), the Plague of Justinian (541–542), Smallpox (1500s), the Antonine Plague (165 AD), the Spanish Flu Pandemic (1918), the Asian Flu (1956–1958), and the Hong Kong Flu Pandemic (1968). Over recent years, the world has been battling the novel coronavirus. So far, COVID-19 has claimed the lives of more than 5 million people worldwide. Given that various jurisdictions continue to struggle with the disease, it is important to highlight some of the best practices for pandemic containment.

Defining Pandemics and Their Global Impact

From the outset, it is worth noting that a pandemic does not have a single standardized definition. Scientists have not assigned one universal meaning to the term. However, several definitions that have been proposed offer useful insight into the nature and properties of a pandemic. According to Grennan (2019), a pandemic can be defined as an epidemic that spreads across the world. To understand what a pandemic is, it is therefore necessary to first define the term "epidemic." In Grennan's (2019) words, "an epidemic is an outbreak that spreads over a larger geographical area" (p. 57). When a disease affecting a small number of persons spreads beyond the area in which it was first reported and affects people across a wider geographical region, it can be described as an epidemic. More recent examples of epidemics include the Ebola outbreak and the Zika virus. In those cases, the diseases impacted larger geographical regions—Latin America and Brazil, respectively—but never spread across the entire world. In contrast, the COVID-19 pandemic, first reported in Wuhan, China, spread across all continents. Another well-known example of a pandemic with truly global reach was the Spanish influenza of 1918, which caused the deaths of close to 50 million people.

The importance of implementing the most effective strategies to contain a pandemic cannot be overstated. The cost that humanity pays following a pandemic is often massive, and can be even greater in terms of fatalities and other impacts if the pandemic is poorly managed or if containment measures are ineffective. Today, the world is more interconnected than at any previous point in history. Modes of transport have become faster and more convenient, meaning an infection that begins in one part of the world could be spread to another within a matter of hours. These considerations underscore the urgent need to embrace best practices for pandemic containment. According to Kucharski (2020), there are numerous lessons that can be learned from the ways in which past pandemics have been managed.

Core Containment Strategies

In basic terms, containment strategies, as Barry (2005) points out, seek to reduce the risk of transmission from infected persons to those who are not yet infected, thereby halting the outbreak.

One of the most viable approaches to pandemic containment is the tracing of persons who may have been exposed to infection. This is among the very first containment measures that should be undertaken. O'Connell and O'Keeffe (2021) indicate that for centuries, contact tracing has been used in response to both epidemics and pandemics. As the authors state, "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 & O'Keeffe, 2021, p. 485). Contact tracing involves identifying and tracking down all persons who were recently in contact with an individual suffering from an infectious illness whose spread authorities are seeking to halt. This is a time-tested approach with a long and well-documented record of effectiveness.

Thanks to contact tracing, those who are likely to be infected can be taken through a diagnostic process to confirm whether they have contracted the illness. If a positive result is returned, the relevant measures can be taken to ensure that those individuals do not further spread the disease. However, it should be noted that contact tracing can, in some instances, be somewhat ineffective. O'Connell and O'Keeffe (2021) point out that some individuals reached by public health officials may suffer from what is known as recall bias—the inability of an infected person to recall all individuals with whom they may have come into contact, particularly those who are largely unknown to them. The authors also note that the urgency and rapidity of contact tracing may interfere with the effective training of contact tracers.

The confinement of infected persons is another effective containment strategy. As Kucharski (2020) notes, available evidence indicates that "if we isolate people who are infected, it shortens the duration they are spreading infection" (p. 37). This view is further supported by Nam et al. (2018), who indicate that when deployed from the onset of an outbreak, isolation can be instrumental in disrupting the spread of a pandemic. The authors demonstrate that this has been clearly evident during the COVID-19 pandemic, and that isolation proved more effective than other containment measures assessed in their study—including closure of cities, closure of public spaces, and closure of schools. However, Nam et al. (2018) are clear that for the approach to be effective, it must be deployed at the moment the very first infection case is detected.

Kucharski (2020) points out that contact tracing and isolation can be effective containment measures on their own. However, if data indicate the continued spread of an infectious disease, a range of additional containment measures should be considered. One such measure is travel restrictions. Because the world is today more interconnected than at any previous time in history, a person infected with a disease can effectively spread it across multiple continents within a single day. For this reason, it makes sense for countries to close their borders and restrict travel to and from affected areas. In cases where diagnostic procedures have already been established, those wishing to travel in and out of certain jurisdictions can be required to obtain clearance confirming they have not been infected. Such measures have proven effective during the present COVID-19 pandemic (Chinazzi et al., 2020). More specifically, Chinazzi et al. (2020) observe that "international travel restrictions did help to slow spread elsewhere in the world" (p. 396).

Large public gatherings have, in past pandemics, been described as "super-spreading occasions" (Barry, 2005). Such gatherings include, but are not limited to, political rallies, funerals, weddings, sporting events, and religious gatherings. In these settings, transmission of infectious illnesses is particularly high due to close contact between individuals. Closed indoor events can also be prohibited, especially given that studies have consistently shown that transmission of airborne diseases is more pronounced in settings with poor ventilation. Indeed, one study found that small gatherings such as birthday parties held in households have the potential to trigger a higher rate of infections (Whaley, Cantor, & Pera, 2021). More specifically, Whaley, Cantor, and Pera (2021) found 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" (p. 1092). In scenarios where mass gatherings cannot be avoided, authorities can issue clear guidelines on social distancing. For instance, in public transport settings, individuals can be directed to maintain a minimum distance of one meter from others. Kucharski (2020) affirms that social distancing is an effective strategy for minimizing transmission opportunities.

Vaccination can also be considered a containment measure, as it prevents the spread of targeted infectious diseases from one person to another. According to Barry (2005), vaccination is a scientific solution to infectious diseases that most industrialized nations invest considerable resources in developing and deploying. This has been evident during the current COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC, 2022) states that vaccines are instrumental in minimizing the chance of a person contracting an infectious disease and in reducing the likelihood that an infected person will spread it to others. On COVID-19 vaccination, the CDC (2022) notes 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 further supports the effectiveness of vaccination: it is widely held that many more lives would have been lost to the Asian flu had a vaccine not been developed in time (Barry, 2005).

Public awareness and education campaigns should be tailored to the nature of the infectious illness—specifically, how it spreads and what symptoms it presents. For example, past influenza viruses have been known to spread primarily via tiny droplets emitted when an infected person talks, sneezes, or coughs. Nearby uninfected individuals who inhale these droplets are likely to contract the illness. Such droplets can also settle on surfaces; an uninfected person who touches a contaminated surface and then touches their eyes, nose, or mouth may also become infected. Once it was established that COVID-19 spread through respiratory droplets containing the virus, wearing face masks became one of the most widely recommended measures to curb further transmission. Members of the public can also be advised to avoid large gatherings and to routinely sanitize their hands. Furthermore, it is important to ensure that the general public is aware of how to recognize the symptoms of an infectious disease, so that those who are infected seek appropriate care promptly and limit further spread.

Conclusion

Going forward, the world is likely to witness many more pandemics as a consequence of the increasing interconnectedness of modern society. With the world having become a global village and modes of transportation continuing to improve, infectious diseases can spread across multiple locations within a matter of hours. As past experience has demonstrated, pandemics often have devastating effects—in addition to loss of life, they trigger massive social and economic disruption. For this reason, familiarity with pandemic containment measures is critically important. However, as this paper has made clear, the effectiveness of any containment strategy depends significantly on surveillance activities, effective communication, and coordinated stakeholder efforts. Authorities must also chart and monitor the unintended downsides of containment measures, so that appropriate support and interventions can be put in place for affected populations.

References

Barry, J. M. (2005). The great influenza: The story of the deadliest pandemic in history. Penguin.

Chinazzi, M., Davis, J. T., Ajelli, M., Gioannini, C., Litvinova, M., Merler, S., … Vespignani, A. (2020). The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science, 368(6489), 395–400.

CDC. (2022). Benefits of getting a COVID-19 vaccine. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html

Grennan, D. (2019). What is a pandemic? JAMA, 321(9), 55–61.

Kucharski, A. (2020). Containing a pandemic, step by step. Science Direct, 246(3287), 36–39.

Nam, N. H., Tien, P. T., Truong, L. V., El-Ramly, T. A., Anh, P. G., Hien, N. T., … Huy, N. T. (2018). Early centralized isolation strategy for all confirmed cases of COVID-19 remains a core intervention to disrupt the pandemic spreading significantly. PLoS ONE, 16(7), 114–119.

O'Connell, J., & O'Keeffe, D. T. (2021). Contact tracing for Covid-19 — A digital inoculation against future pandemics. New England Journal of Medicine, 38, 484–487.

Whaley, C. M., Cantor, J., & Pera, M. (2021). Assessing the association between social gatherings and COVID-19 risk using birthdays. JAMA Internal Medicine, 181(8), 1090–1099.