This week’s blog covers the pandemic from a healthcare preparedness perspective; looking at how hospitals and other public health agencies prepare for and respond to events of this nature. Dr Eric Toner, Senior Scholar in the Johns Hopkins Center for Health Security and a Senior Scientist in the Johns Hopkins Bloomberg School of Public Health discusses learnings from previous infectious diseases, pandemic plans and guidance that were in place and the lasting impacts he foresees this pandemic will have on the society.
I study healthcare preparedness, that is to say, how hospitals and other aspects of the health sector prepare for and respond to disasters and epidemics. I have been doing this since 2001. As part of this work, I have studied prior influenza pandemics and other infectious disease crises. For the 3 years prior to the COVID pandemic I organized and conducted the high-level pandemic simulation exercises Event 201 and Clade X which brought attention to the economic, societal and policy consequences of a severe pandemic. The Event 201 exercise that was conducted in October 2019 involved a novel coronavirus emerging from bats. Since early January I have been studying how hospitals and governments have responded to the pandemic and comparing what we see happening compared to what we anticipated would happen based on prior experience.
WHO and the US CDC (Centers for Disease Control and Prevention) as well as many other public health agencies around the world have been developing pandemic guidance for at least 15 years. It was prompted by 2 overlapping events, the huge H5N1 avian influenza outbreak in 2002-2005 and SARS in 2003. Many of us who study emerging infectious diseases thought we would experience a pandemic due to at least one of these. But we got lucky. Guidance was developed for governments, public health authorities, and hospitals from WHO, CDC, and other organizations. Most health departments and hospitals in the US developed pandemic plans at around this time and these were used in the 2009 H1N1 influenza pandemic. Following the experience of 2009 many of these plans were revised and updated. Over the same time period, CDC and state public health departments developed or refined disease surveillance and reporting systems.
I think the planning was pretty thorough, but for the most part it was based on a mild to moderate pandemic scenario rather than the severe pandemic we are now experiencing. A severe pandemic was considered so unlikely that it was not given enough attention.
"...a severe pandemic was considered so unlikely that it was not given enough attention."
I have spent many years studying pandemic health response and now I have the opportunity to study it in real time. My experience and knowledge about past events has helped me in the most important issues we face today. Specifically, hospitals need to know the magnitude of what they must be prepared for which involves understanding both clinical manifestations of the disease and being able to do epidemiological forecasting. Studying past events gives us insights into these issues.
"Hospitals need to know the magnitude of what they must be prepared for which involves understanding both clinical manifestations of the disease and being able to do epidemiological forecasting."
We are actively studying how the US health system innovated and adapted to COVID-19. We are interested in how surge capacity was augmented, how infection control was achieved and how workforce challenges were met.
The research community has responded with remarkable vigour. Papers are coming out at an incredible rate and almost in real-time. Literally, I can not keep up with all the information coming out from all over the world.
We have seen a cavalcade of emerging infectious diseases over the last 40 years and especially in the last 20: HIV, West Nile virus, Ebola, Zika, SARS, MERS, chikungunya, Nipah, H5N1 and the 2009 H1H1 influenza pandemic all taught us useful lessons.
Scientists have done an effective job in communicating facts. Unfortunately, there has also been a lot of disinformation from non-science sources which undermines the messaging. Researchers have a duty to educate the public in times of crisis and that scientists and public health authorities must work even harder to counter the misinformation.
In general scientists need to find a better balance between acknowledging uncertainty and emphatically telling the public the scientific consensus. The public often misinterprets scientific caution as equivocation. The public wants our best judgment not the range of uncertainty.
"The public wants our best judgment not the range of uncertainty."
Various online forums, conference calls, and zoom conferences have enabled very rapid exchange of clinical and epidemiological information. This can happen much more rapidly than even preprint manuscripts and has been immensely helpful.
The rapid rate of change of preliminary information about the virus and the disease is very challenging and hard to keep up with. Many of the unsolved questions just require a lot of time to sort out, careful research takes time but pandemic keeps moving at a fast pace so there is great pressure to work as fast as possible
Yes, I hope so. I expect this pandemic to have lasting impacts on society. In the same way that the Great Depression and World War II defined a generation, I think young people today will be greatly influenced by this pandemic for the rest of their lives. Public policy will need to adapt to these changes in attitude, political outlook, and behaviour that result from the pandemic.
"In the same way that the Great Depression and World War II defined a generation, I think young people today will be greatly influenced by this pandemic for the rest of their lives."
Scientific publishing is an inherently slow process, but we are faced with a fast-moving virus that does not care if reviewers are busy. Publishers need to continue to fast track important research findings and continue to innovate in enabling rapid peer review.
We will have learned a great deal about infection control in healthcare settings, how infectious diseases propagate, and how public health interventions can flatten the epidemiological curve. Our challenge going forward will be to find ways to incorporate these learnings into practice.
All our interviews reflect the views and opinions of the interviewees.
Dr. Eric Toner is a Senior Scholar with the Johns Hopkins Center for Health Security and a Senior Scientist in the Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering. He is an internist and emergency physician. His primary areas of interest are healthcare preparedness for catastrophic events, pandemic influenza, and medical response to bioterrorism. He has been the principal investigator of several US government–funded projects to assess and advance healthcare preparedness. Dr. Toner has served on a number of national working groups and committees, including the Institute of Medicine’s Forum on Medical and Public Health Preparedness for Catastrophic Events. Dr. Toner has been involved in hospital disaster planning since the mid-1980s. Prior to joining the Center, he was Medical Director of Disaster Preparedness at St. Joseph Medical Center in Towson, Maryland, where he practiced emergency medicine for 23 years. In 2003, he spearheaded the creation of a coalition of disaster preparedness personnel from the 5 Baltimore County hospitals, the health department, and the Office of Emergency Management. During this time, he also headed a large emergency medicine group practice and co-founded and managed a large primary care group practice and an independent urgent care center. Dr. Toner received his BA and MD degrees from the University of Virginia. He trained in internal medicine at the Medical College of Virginia.