Now is not the ideal time to be giving Health Emergency Preparedness and Response its first reading. Co-edited by Chloe Sellwood, NHS England’s National Lead for Pandemic Influenza (for which read: any serious infectious disease), the idea for this book sprang up during the 2009-10 Swine Flu pandemic, and came to fruition following the 2014-15 Ebola outbreak in West Africa. Early chapters, on why it is important to prepare for health emergencies, how to do so, and how to write appropriate plans are last year’s homework, though still provide good blueprints to use if you are playing catch-up.
More relevant now are the later chapters of the book. These deal with how to work in partnership with many different agencies, which may be needed as stretched healthcare systems reach out to volunteer capacity to deal with the surge; the importance of considering the psychological well-being of responders before, during and after the event; and – the chapter for which I was responsible – the importance of communicating with the public, as well as between professional responders, during a health emergency.
The World Health Organization, in its Outbreak Communication Planning Guide, stresses the importance of encouraging the public to adopt protective behaviours. This can have a dramatic impact on the progression of the disease, either reducing the number of cases considerably or by spreading them out over time so that health systems are less likely to be overwhelmed – the message currently being spread through the excellent ‘flatten the curve’ campaign. Ensuring that the public adopt such behaviours is dependent on communicating with them effectively: they must trust the message, receive it early and be confident that the message sender is being transparent. To ensure this, the sender must listen to the public’s concerns so that the messages given out are those that the public need and that enable individuals and communities to prepare their own plans. As I point out in the chapter, the advice from the UK’s Civil Contingencies Secretariat at the time the book was written was: “the more information the public have access to, and the better educated they therefore become before an event, the more open they are likely to be to the warnings and advice they are given at the time of an emergency”. An important factor in building the necessary trust is promoting awareness that plans for dealing with a pandemic of this scale in the UK do exist, and have been in place for years: this book is proof of that.
“Closing borders has minimal effect on disease spread, regular hand washing is more effective”
A good overview of the plans specific to pandemics and other infectious disease emergencies is given in Chapter 14, written around influenza – considered to be the most likely emerging disease to trigger a pandemic – but it is equally applicable to SARS-Cov2. It identifies the need to particularly protect the elderly and those with underlying health conditions. It anticipates the need to consider school closures, potential disruptions to services and supplies, business and travel and discusses ‘layered mitigation’ – how, when no-one is sure which of a potential suite of responses is likely to be most effective, trying more than one in combination may be the best approach. It talks clearly, four years ahead of the current campaign, of the importance of flattening the curve to both reduce cases and buy time (p159) . It also sets out what is known from current academic studies about the effectiveness of mitigation options: closing borders has minimal effect on disease spread, regular hand washing is more effective. The simple measures – as the UK Government has been stressing throughout this pandemic – are the ones that can have the most impact.
It also makes clear – in the Key Answers box on p164 that it is “widely accepted that [a pandemic] cannot be contained at source. The overriding aim is to mitigate impact.” That is the phase we are currently in with COVID19. Mitigating the impact by dusting off – or engaging with for the first time – plans that have been years in the making. You should have read this book already; but if you haven’t, it’s not too late. Need a manual for how to deal with the current situation? Here’s one we made earlier.
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