Abstract
When asked by the College in late 2018 if I would be willing to be the Guest Editor for a special edition of Healthcare Management Forum on pandemics and other public health emergencies, little did I know that I would be writing this editorial in the midst of the world battling a new coronavirus pandemic (COVID-19).
SARS and the 2009 H1N1 influenza pandemic are still fresh in my mind as I suspect is true for most readers of this journal. Each crisis generates new knowledge, but then every pandemic brings new surprises. As Theresa Tam is known to quip, “Once you’ve seen one pandemic, you have seen one pandemic.” While there may be many characteristics in common, it is the surprises that get us. We need to prepare well for what we might anticipate to allow us to respond more effectively to the unexpected. For example, COVID-19 is unlike other pandemics we have faced so far this century. It is a coronavirus which includes virus strains associated with the common cold, as well the SARS pandemic of 2003. Unlike the SARS virus, while also deadly, those infected are not actually infectious to others until they are quite ill, thus allowing more effective quarantine and personal protection options for caregivers. With COVID-19, we have discovered much like influenza that we can shed the virus a couple days before we have symptoms and we are highly infectious in the early days with minimal symptoms, thus unwittingly exposing others and contaminating commonly touched surfaces.
This edition brings together those with tremendous experience to share in both identifying the challenges in dealing with such crises and the lessons learned that we can apply into the future.
Planning and testing of plans, adaptability, flexibility, responses proportional to the problem, effective communications and collaboration across sectors, different levels of government, and with the public and practitioners is essential. The reader will hopefully come away from reading the articles with a sense that we can not only make a difference but fundamentally change the trajectory and threat of pandemics, protecting lives and reducing social and economic impacts that our ancestors mostly just watched and prayed for deliverance from, but with little serious hope. For example, Canada in the pandemic of 2009 H1N1, through a combination of good planning, a whole of society response, a stockpile of effective antivirals, and sufficient vaccine for the population, effectively stopped the pandemic before Christmas, which few if any other country can claim. In fact, other countries saw the pandemic continue through that winter into spring and return in the next flu season.
However, COVID-19, and the specific virus of the disease referred to by the World Health Organization (WHO) as severe acute respiratory syndrome coronavirus 2 (or SARS-CoV-2) while having elements similar to previous pandemics, displays significant differences. The Canadian response is applying many of the lessons from SARS and H1N1. Since 2014, there has been a reduced capacity and focus on public health. This is not only as it relates to planning for and responding to pandemics or other outbreaks but also for the ongoing work in population health assessment, health promotion, disease and injury prevention, and health protection which addresses the issues that make us ill or kill us on a regular basis. The authors present both lessons learned and suggestions for a better future.
Dr. Craig Stephen, a doctor of veterinary medicine whose speciality is in emerging diseases in wildlife and currently with the University of Saskatchewan, brings a broadened focus on the interplay of animal and human health, the ecosystem, and economics. The concept of One Health is an opportunity to recognize and address the complex intersections that go beyond any sector or jurisdiction to tackle emerging threats in the Anthropocene. Resilience of communities to outbreaks, natural disasters, and other public health emergencies also depends on our abilities to address the underlying determinants of health, as well as minimizing our impact on the natural environment.
Dr. Mauricio Hernandez Avila, a medical doctor with a specialty in epidemiological surveillance of chronic illnesses and Director of the National Institute of Public Health in Mexico, reminds us that one cannot assume where pandemics will emerge, and challenges will exist in spite of having plans in place. Effective responses need to anticipate surge needs. He also notes the importance and value of international cooperation and collaboration across jurisdictions. Shortly after establishing the cause of the serious outbreak in young adults in Mexico, we were finding cases across Canada. It is apparent that not only did the virus originate in North America (not Asia) but it had been circulating for some time before more virulent strains emerged.
Dr. Paul Gully, a senior public health physician with a specialty in communicable diseases who formerly worked at the WHO and is now at the University of British Columbia School of Population and Public Health, offers both a Canadian and international perspective on a range of risks from pandemics to tsunamis. Several multilateral groupings have emerged since the early 2000s, supported by new international health regulations that support improved collaboration, coordination, and cooperation internationally, supplementing the limited recourses and capacity of the WHO.
Dr. Richard Musto, a physician with a specialty in public health and preventative medicine from the O’Brien Institute of Public Health at the University of Calgary, addresses the challenges faced when we hit a crisis in the midst of reorganization. He and his co-authors suggest that it is the proverbial, “trying to build a boat while sailing it,” much like in creating the Public Health Agency and immediately facing different crises, while establishing the structures and new relationships and planning for future risks.
Dr. Theresa Tam, Canada’s Chief Public Health Officer who is a physician with expertise in immunization, infectious disease, emergency preparedness, and global health security, reminds us that the lessons learned from SARS help us to respond to COVID-19. She emphasizes the importance of flexibility and scalability as appropriate, recognizing that the next “Disease X” after COVID-19 will emerge, and the expertise and capacity to deal with it must be in place in advance. She also stresses how important it is to have effective communications in an age of social media and rampant misinformation.
Thilina Bandara, PhD, a Research Officer at the Urban Public Health Network (a network that brings together Medical Officers of Health from Canada’s largest cities) and an Adjunct Professor at the University of Saskatchewan, suggests that in responding to the unique features of a novel pandemic, it is essential to be able to develop practice guidelines and advice quickly to support public health, hospital, and clinical practice. He and his co-authors assert that this requires the best application of science and evidence, plus a measure of adaptability to unique circumstances that may develop in different regions. Bringing together academics and clinicians to discuss what has been learned from intensive care units and new research can help to shorten the length of a virus outbreak before it turns into a pandemic.
There have been several quoted versions along the lines of those who do not remember and learn from the past are condemned to repeat it. As so many people work to reduce the impact of the current pandemic of COVID-19, we have much to learn from the past, not just in specific actions, but in the adaptable approaches necessary whatever may face us. It is a team sport and we all must do our part.
