Five steps to contain the next outbreak
One of the uncertainties in the current environment is how long the COVID-19 restrictions will last. How effective will we be preventing new cases? How long will it take to bring the virus under control? What new behavioural and social interventions will we adopt? Whether months or years, our new “normal” will be different.
Hong Kong offers an example of our future behaviours. Since the 2003 SARS pandemic, when Hong Kong accounted for about 40 per cent (286/700) of global deaths, its new normal has included:
- Promotion of universal medical precautions, including avoiding contact with patients’ bodily fluids by wearing nonporous articles such as medical gloves, goggles and face shields.
- Improved computer applications for contact tracing.
- A “high-alert” system to warn about infectious disease outbreaks.
- Systematic controls to improve hygiene, including disinfecting high-use areas such as elevators every two hours.
- A revised ticketing system in dim sum eateries in which patrons fill out cards beforehand, writing down the quantity of each dish desired. Before SARS, food was served on trolleys that weaved between tables and diners selected dishes as they came to the table.
- The use of two pairs of chop sticks by restaurant patrons – one to take food off the serving plate and the other to eat.
- The closure of workplaces when multiple staff are sick.
- The regular use of hand sanitizers and the wearing of masks when ill, which is done by more than 90 per cent of the population.
In our new normal, five prevention activities we will need support.
1- Education on prevention and containment
Information on the length of voluntarily home quarantines. We will need advice on how and when to avoid possible super-spreader events. When we are out and about in our communities, we will need to know when and how to be physically distant, whether to use facemasks and to adhere to other prevention behaviours.
2- Better access to testing and health care
Immediate identification of COVID-19 cases in communities as well as in hospitals and care homes. Patients must be isolated and their contacts traced using a combination of local health teams and digital tools. We must ensure transmission is suppressed in hospitals, care homes and workplaces through the right equipment, testing, distancing and hygiene.
3 – Legislation and regulation
Public health legislation to empower local public health offices to isolate infected individuals or if exposed to an infected person. In addition, we need to ensure the most vulnerable, socially and medically, are fully protected through simple access to basic incomes, rights for migrants and safety for those affected by domestic violence.
4 – Measurement and feedback
Public health and digital surveillance to identify where the cases are clustering or continuing to spread. This transparency is essential to inform the lifting of lockdowns while shielding people from transmission hotspots. This also informs how to build community resilience to support the vulnerable and the negative impact of control measures.
5 – Role models
Community leaders must be exemplary role models. They must continue to be a positive voice of evidence-based information on social media, be champions of #COVIDkindness by supporting high-risk individuals, family, friends and colleagues to follow advice of public health officials and model healthy behaviours.
We should not get overly obsessed about exposure to the COVID-19 virus. Everything in life is about managing risk. Not crossing a road is less risky than crossing it but this does not mean we never cross a road. There is a balance of risk and reward in everything, including changing our behaviours to avoid infections. Speak to your physician or pharmacist and research COVID-19 online.
In 1150 AD, the visionary female theologian poet and scientist Heldegard of Bingen (Germany) published Causes and Cures, outlining her thinking about medicine and human anatomy. Her recommendation to boil drinking water made a huge contribution to human health. She believed that since God put everything on Earth for humans to use, cures for a wide variety of diseases would be found in the plants and minerals found in nature. In these uncertain COVID-19 times, her statement about life’s mysteries is reassuring: “Humanity, take a good look at yourself. Inside you’ve got Heaven and Earth and all of creation. You are a world – everything is hidden in you.”
Larry W. Chambers has authored articles and books on disease prevention, improvements in long-term care homes and innovative approaches for continuing professional development. He is Research Director of the Niagara Regional Campus, School of Medicine, McMaster University.
Hanna Levy and Eva Liu are medical students at the Niagara Regional Campus of the McMaster University, School of Medicine.