Coronavirus response guided by earlier outbreaks

Coronavirus response guided by earlier outbreaks
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The coronavirus spreading in the United States and across the world may be new to scientists, but the responses launched by local, state, national and international governing bodies are not.

Around the globe, government agencies are mobilizing operations designed to stop or slow the virus’s spread, and to treat the thousands who have become ill. The practices and procedures have been honed over a series of previous outbreaks, from drug-resistant tuberculosis to the H1N1 influenza and even Ebola.

Each of those outbreaks served as an opportunity to learn something new, said Tom Frieden, director of the Centers for Disease Control and Prevention (CDC) during the Obama administration. Those valuable lessons can be used to save lives and money, he said, if governing bodies take them to heart.

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“Really crucial will be to adapt our response as we learn more. And we are learning more every single day,” said Frieden, who now runs Resolve to Save Lives, a global health nonprofit.

At the heart of any outbreak response, Frieden said, is the ability to gather and analyze data, and to disseminate the resulting information. That worked in the early 1990s when a tuberculosis outbreak hit New York City, where Frieden was working for the CDC’s Epidemic Intelligence Service.

During that crisis, hospitals and health systems often touted the number of patients they had seen or diagnosed. They were less transparent about the number of patients they had actually cured. To improve those outcomes, CDC officials took a much more active approach to tracking down patients and making sure they took their medicine.

“There was a tiny number of people -- 1 or 2 percent of patients -- who just would not take their medicines. They ended up getting drug resistant tuberculosis and infecting other people,” Frieden said. “We would meet them anywhere. We would meet patients on park benches, in workplaces. We did whatever it took to get them cured.”

The coronavirus racing around the globe spreads far more easily than tuberculosis. But the lesson extends beyond one virus: Information about where patients are located helps identify clusters of cases and drives decisions about where to spend limited resources.

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Two decades after the tuberculosis outbreak, when Frieden was leaving his position as New York City’s health commissioner to lead the CDC, the H1N1 pandemic hit.

An initial burst of data from Mexico, where the virus originated, suggested it had the potential to become a severe pandemic. Around a thousand students at a parochial school in Queens, N.Y., came down with the virus after a spring break trip to Mexico.

But none of those patients became severely ill, suggesting it was not as virulent as initially feared. At a White House meeting, Frieden argued against shuttering schools. Instead, the Obama administration bolstered an existing program called Vaccines for Children, which delivers vaccines to about half the nation’s children.

“The systems that were most helpful were systems that were used every day and were robust enough to be scaled up,” Frieden said.

“You don’t have some emergency thing that you break glass, read the manual and then try it in an emergency. That doesn’t work,” he added. “Rather than doing fancy drills and doing table top exercises, use reality.”

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Frieden angered Obama administration officials when he testified before Congress that a manufacturer of the H1N1 vaccines was running behind schedule. But, he said, sharing the relevant information with the public was more important to stopping the outbreak than any political considerations — an echo of the  response, in which some in the White House have vented anger at senior officials sharing scientific data.

“Treat people like adults and share the information when you know it,” said Frieden.

Five years after H1N1, the Ebola virus broke out in a small village in the West African nation of Guinea, before spreading to neighboring Liberia and Sierra Leone — and eventually to Nigeria, Africa’s most populous nation.

There, too, the systems already in place worked while newly designed programs stalled. A CDC team that had been trained to help eradicate polio in Nigeria was repurposed to fight Ebola, and the Nigerian government brought its anti-polio task force back on line, with many of the same staffers who worked on the initial campaign. Meanwhile, the United Nations Mission for Ebola Emergency Response was widely panned for its lack of impact.

“They were able to repurpose that system to stop what could have been an enormous catastrophe,” Frieden said of the Nigerian effort.

At the same time, the Ebola response highlighted the critical role of front-line health care workers, both then and now. More than 3,000 health care workers in China have come down with the coronavirus, and thousands more in West Africa succumbed to Ebola.

Frieden recalled meeting a contact tracer in Guinea, a middle-aged man tasked with tracking down people who might have been exposed to Ebola. Frieden asked the man what he needed to do his job effectively. The man asked to be paid his salary, the equivalent of $4 a day, money he had not seen in four months.

“I was so angry. There are a million meetings and calls to actions and statements and commitments, and here at the front lines you’re not getting what you need,” Frieden said. “He just wanted to get his $4 a day. And we weren’t giving it to him. We, the world.”

Now, as the coronavirus spreads in the United States, some health care workers are sounding the alarm about a lack of support at hospitals that are becoming an epicenter. In an open letter released by the nation’s largest nurses union, an anonymous nurse who treated one of the first U.S. patients accused the CDC of denying a coronavirus test after the nurse began showing symptoms.

“You have to support the front lines, and you have to support action at the front lines,” Frieden said.