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Thursday, 21 February 2013

Emerging Coronavirus threat - how should local public health professionals respond.

A new coronavirus has received considerable attention in the past week.   The virus has only been identified in less than 20 people so far, but of the first dozen in Saudi Arabia, half died and the remainder had significant morbidity.  Now a report from the UK highlights relative ease of infection upon exposure UK coronavirus study.

Whether it is the fun or the fear that emerging pathogens represent, they are one of the reasons why public health professionals have an assured degree of employment.  Germs survive by adapting to their environment.   Selective propagation favours those germs that can readily move to new environments and hosts, can thrive and multiply on their hosts, and are less likely to cause the host to die.

Highly mobile hosts facilitate dissemination and spread of such germs.   Humans have modified the natural ecology by condensing global travel times to hours from days and weeks – hence broad dissemination of novel and emerging pathogens becomes a real risk of our technological advances.   (the second of the main reasons why public health has an assured future – new technology).

The major point of this discussion is what are the appropriate actions in preparation?   We have multiple jurisdictions who are redundantly closely observing this and other emerging pathogens.   Their perceptions tend to be comparable, but occasionally interpretations differ and one jurisdictions/organization/society acts autonomously leading to a “spiralling” of responses.   Trimming some of the duplicity might lead to greater efficiency, more focused response and better coordination (contrast the Canadian and American responses to pH1N1 for a study in efficiency, and no, Canada’s performance was not the more stellar)

The augmenting “spiral” response is rather than retaining logical sense based on evidence, global recommendations for something like surgical masks as respiratory protection, become N35 respirators in some centres, and then specific professions adopt even higher protection like self contained breathing apparatus.  Professional demands for equity drive responses to the highest common denominator, not the most efficient.

The lack of evidence often drives up the precautionary response, compounded by the inevitable changing understanding of the science which conveys a message of distrust and fuels public and professional hysteria. 

Let us hope that this coronavirus quietly disperses faster than its cousin that prompted the SARS scare.   Conversely, we need to be prepared to grapple with a range of moderate to severe pathogen outcomes and current public health infrastructure in North America has probably slipped below the needed surge response capacity, in part in an effort to reduce duplicity because we have this tendency to want to do things within jurisdictions and not trust our national or international leadership

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