PRINCIPLES OF PANDEMICS Flashcards
DIFFERENCES BETWEEN AN ENDEMIC/OUTBREAK/EPIDEMIC AND PANDEMIC?
ENDEMIC: OBSERVED CASES ARE EXPECTED, A CONDITION HAS A STEADY RATE AMONG A POPULATION
OUTBREAK: INCREASE IN CASES, NOT EXPECTED, USUALLY CONCERNS A SMALL GEOGRAPHICAL AREA
EPIDEMIC: OUTBREAK OVER A LARGER GEOGRAPHICAL AREA
PANDEMIC: AN EPIDEMIC WITH A GLOBAL SPREAD
WHAT WAS THE MOST SEVERE PANDEMIC OF THE 20TH CENTURY?
THE SPANISH FLU
DESCRIBE THE SPANISH FLU PANDEMIC:
- MOST SEVERE IN RECENT HISTORY WITH WORLDWIDE SPREAD IN 1918-1919
- CCA 500 MILLION INFECTED
- CCA 50 MILLION DEATHS
- HIGH PREVALENCE IN <5, 20-40 AND 56+ YEAR OLDS
- INTERVENTIONS: NON PHARMACEUTICAL (ISOLATION, QUARANTINE, HYGIENE, DISINFECTANTS..); NO VACCINE, NO ANTIVIRALS, NO ANTIBIOTICS (ALTHOUGH ANTIBIOTICS CAN’T HELP TREAT THE FLU AS IT IS A VIRAL INFECTION, PEOPLE WITH FLU CAN DEVELOP A BACTERIAL INFECTION BECAUSE OF THEIR COMPROMISED IMMUNE SYSTEM)
NAME THE INFLUENZA PANDEMICS IN THE 20TH AND THE 21ST CENTURY?
SPANISH FLU (1918-1919) ASIAN FLU (1957-1958) HONG KONG FLU (1968) SWINE FLU (2009-2010)
2 INFLUENZA PANDEMICS OF THE 20TH AND THE 21ST CENTURY THAT WERE CAUSED BY THE SAME VIRUS?
SPANISH FLU AND SWINE FLU
WHEN WAS INFLUENZA FIRST ISOLATED AND SHOWN TO BE A VIRUS?
1930
TIMELINE OF THE FLU VACCINATION IN THE UK?
1960s: SEASONAL VACCINE IN UK FOR HIGH RISK GROUPS
2000: SEASONAL VACCINE IN THE UK FOR THE 65+ YEAR OLDS
2013: VACCINE IN THE UK FOR CHILDREN
WHAT DOES THE ‘BLACK DEATH’ REFER TO?
IN THE MIDDLE AGES, ‘BLACK DEATH’ WAS A BUBONIC PLAGUE PANDEMIC FROM 1346 TO 1353 CAUSING OVER 50 MILLION DEATHS
ORIGIN OF THE WORD ‘QUARANTINE’?
- DERIVED FROM THE ITALIAN WORDS ‘QUARANTA GIORNI’ WHICH MEANS 40 DAYS
- DURING BLACK DEATH (BUBONIC PLAGUE PANDEMIC), EUROPE WAS PARTICULARLY AFFECTED, ONE OF THE FIRST COUNTRIES BEING ITALY
- IN 1348, VENICE BECAME THE FIRST CITY TO CLOSE ITS PORTS TO INCOMING VESSELS
- THOSE THAT DID GET ADMITTED WERE SUBJECT TO 30 DAYS ISOLATION, LATER 40 DAYS, AND THAT’S HOW QUARANTINE GOT ITS NAME
IMPACTS OF BLACK DEATH (BUBONIC PLAGUE PANDEMIC IN THE MIDDLE AGES)?
- LARGE SOCIAL AND ECONOMIC EFFECTS
- PSYCHOLOGICAL EFFECTS: FAITH IN RELIGION DECLINES, SOME LIVED WILD, IMMORAL LIVES AS THEY HAD A PERCEPTION OF SOON, UNAVOIDABLE DYING
- PEOPLE BEGAN TO HATE POVERTY AND THEIR ‘BETTERS’
- EXTREME INFLATION
- GOODS IN SHORT SUPPLY
- WORKERS MORE EMPOWERED BECAUSE THE SHORTAGE MADE THEM ABLE TO CHOOSE WHO TO WORK FOR
BLACK DEATH/BUBONIC PLAGUE PANDEMIC WAS CAUSED BY?
BY A BACTERIUM CALLED YERSINIA PESTIS
DESCRIBE THE PATHOGEN: YERSINIA PESTIS?
- BACTERIUM, USUALLY FOUND IN SMALL MAMMALS LIKE RATS AND THEIR FLEAS (VECTOR = RAT FLEA)
- ZOONOTIC; CAN TRANSMIT FROM ANIMALS TO HUMANS BY BITE OF INFECTED FLEAS, DIRECT CONTACT WITH INFECTED TISSUES AND/OR INHALATION OF INFECTED RESPIRATORY DROPLETS
- CAN BE TREATED WITH ANTIBIOTICS
- gram-negative, non-motile, coccobacillus bacterium without spores, facultative anaerobe
2 MAIN CLINICAL FORMS OF PLAGUE CAUSED BY YERSINIA PESTIS AND THEIR FATALITY?
BUBONIC (CHARACTERISED BY BUBOES; SWOLLEN LYMPH NODES) AND PNEUMONIC
- BOTH CAN BE VERY SEVERE
- CASE FATALITY RISK OF 30-60% FOR BUBONIC
- ALWAYS FATAL FOR UNTREATED PNEUMONIC PLAGUE
CRITERIA FOR PRIORITIZATION OF PATHOGENS (IN RESEARCH) WITH PANDEMIC POTENTIAL?
- HUMAN TRANSMISSION
- MEDICAL COUNTERMEASURES
- SEVERITY
- HUMAN/ANIMAL INTERFACE
- PUBLIC HEALTH CONTEXT
- POTENTIAL SOCIETAL IMPACTS
- EVOLUTIONARY POTENTIAL
- OTHER FACTORS
WHAT ARE THE CURRENT WHO PRIORITY DISEASES? (BASED ON THEIR PUBLICH HEALTH RISK DUE TO THEIR EPIDEMIC POTENTIAL)
- COVID 19
- CRIMEAN CONGO HAEMORRHAGIC FEVER
- EBOLA VIRUS DISEASE AND MARBURG VIRUS DISEASE
- LASSA FEVER
- MIDDLE EASTERN RESPIRATORY SYNDROME CORONAVIRUS (MERS Co-V) AND SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
- NIPAH AND HENIPAVIRAL DISEASES
- RIFT VALLEY FEVER
- ZIKA
- DISEASE X
(NOT AN EXHAUSTIVE LIST, DOESN’T INDICATE THE MOST LIKELY CAUSE OF THE NEXT EPIDEMIC, LIST REGULARLY UPDATED)
CONTRIBUTING FACTORS TO INCREASING PANDEMIC RISKS?
- GLOBAL TRAVEL (INTERNATIONAL FLIGHTS MADE DISEASE SPREAD EASY; 4.2 BILLION PEOPLE TRAVELLED BY AIR IN 2018)
- URBANISATION (MORE CROWDING, INCREASING NUMBER OF PEOPLE IN SMALL PLACES, CITIES OVERPOPULATED)
- CLIMATE CHANGE (INCREASES RISK OF EXTREME EVENTS, LIKE FLOODING, WHICH ARE OFTEN ASSOCIATED WITH INFECTIOUS DISEASE AS IT INFLUENCES PATHOGENS AND THEIR VECTORS)
- INCREASED HUMAN-ANIMAL CONTACT (AS PEOPLE MOVE INTO NEW AREAS, AS WELL AS THE NATIONAL AND INTERNATIONAL TRADE IN WILDLIFE)
- HEALTH WORKER SHORTAGES (MAY LEAVE HEALTH SYSTEMS MORE VULNERABLE TO INFECTIOUS DISEASE OUTBREAKS. ESP IN LMIC)
WHICH ANIMAL DID SARS-CoV-2 CAUSING COVID 19 ORIGINATE FROM? HOW HAS THIS BEEN DETERMINED?
FROM BATS (DETERMINED THROUGH GENETIC DATA)
ORIGINS OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS) AND MIDDLE EASTERN RESPIRATORY SYNDROME (MERS)?
SARS: 2002; ORIGINATED FROM BATS, BUT THEN PASSED THROUGH CIVET CATS AND ONTO HUMANS
MERS: 2012; MAY HAVE ORIGINATED FROM BATS, BUT WAS IN DROMEDARY CAMELS FOR A LONG TIME BEFORE IT WAS ABLE TO INFECT HUMANS
WHEN DID CHINA ALERT WHO OF CLUSTER OF CASES OF PNEUMONIA OF UNKNOWN AETIOLOGY IN WUHAN?
31ST DECEMBER 2019
WHEN WAS SARS CoV-2 (A NOVEL CORONAVIRUS) IDENTIFIED AS A SOURCE OF PNEUMONIA CASES ORIGINATING IN WUHAN, CHINA?
7TH JANUARY 2020
WHAT DO REPORTED CASE RATES OF COVID 19 DEPEND ON AND HOW DOES THAT INFLUENCE THE NUMBERS?
DEPEND ON: TESTING CAPACITY, TESTING STRATEGY, TEST SEEKING BEHAVIOUR, TEST SENSITIVITY/SPECIFICITY
- DAILY NUMBER OF CONFIRMED CASES ALWAYS LOWER THAN THE ACTUAL NUMBER
WHAT IS THE NUMBER OF COVID-19 PATIENTS IN HOSPITALS IN DIFFERENT COUNTRIES INFLUENCED BY?
- HOSPITAL ADMISSION THRESHOLDS (WHICH ARE SIMILAR IN COUNTRIES WITH COMPARABLE HEALTHCARE SYSTEMS)
- RISK FACTORS IN THE POPULATIONS (E.G. IS IT A PREDOMINANTLY OLD POPULATION, ARE THERE A LOT OF SMOKERS ETC)
- INCIDENCE OF COVID 19
WHY IS NUMBER OF CONFIRMED DEATHS FROM COVID-19 IN SOME COUNTRIES MUCH LOWER THAN THE TRUE NUMBER?
- LIMITED TESTING FOR COVID
- EXCLUSION OF CERTAIN GROUPS
- CHALLENGES IN DETERMINING EXACT CAUSE OF DEATH ETC
WHAT IS THE AIM OF PANDEMIC RESPONSE?
- LIMIT ONWARD SPREAD TO CONTAIN THE EPIDEMIC AND(OR SLOW ITS PROGRESSION
- ENSURE PROMPT AND APPROPRIATE CLINICAL CARE TO REDUCE MORBIDITY AND MORTALITY
- IDENTIFY KNOWLEDGE GAPS AND DEVELOP TOOLS TO PREVENT DISEASE AND IMPROVE TREATMENTS (DRUGS, VACCINES)
- LIMIT IMPACT IN TERMS OF HEALTH, ECONOMIC AND SOCIAL ASPECTS OF SOCIETY
WHAT ARE THE STAGES OF EMERGENCY RESPONSE?
- PREVENTION + MITIGATION: HEALTH EMERGENCIES PREVENTED OR QUELLED
- PREPAREDNESS: CAPABILITY TO MANAGE EMERGENCY
- RESPONSE: EFFECTIVELY RESPOND TO SAVE LIVES (PANDEMIC PHASE)
- RECOVERY: SUSTAIN EFFORTS (TRANSITION PHASE)
STAGES OF A PANDEMIC?
1) NO KNOWN CASES (FOCUS ON PREPARING, SURVEILLANCE, HEALTH CARE READY TO RESPOND
2) A FEW CASES OR SMALL CLUSTERS (FOCUS ON CONTAINMENT, BREAK TRANSMISSION CHAINS)
3) WIDESPREAD COMMUNITY TRANSMISSION (FOCUS ON SUPPRESSING AND MITIGATION; REDUCING TRANSMISSION, MORBIDITY AND MORTALITY, ENSURE HEALTH SERVICES CAN COPE)
CONTRIBUTORS IN PANDEMIC RESPONSE?
INTERNATIONAL: WHO, UN AND OTHER ORGANISATIONS
NATIONAL: GOVERNMENTS
ORGANISATIONAL: HEALTH CARE, EDUCATION, PUBLIC ORGANISATIONS AND FOUNDATIONS, BUSINESSES
WHO DECIDES AND BASED ON WHAT IF AN INFECTIOUS DISEASE OUTBREAK IS UNEXPECTED AND SPREADING INTERNATIONALLY AND MAY REQUIRE GLOBAL RESPONSE?
- DIRECTOR GENERAL OF WHO
- BASED ON: EPIDEMIOLOGICAL DATA INCLUDING INTERNATIONAL SPREAD, IMPACT ON TRADE AND TRAVEL, MAXIMUM PUBLIC HEATH SAFETY BUT WITH MINIMAL INTERFERENCE WITH TRAVEL AND TRADE
WHAT ARE INTERNATIONAL HEALTH REGULATIONS (IHR)?
- AN INTERNATIONAL LEGAL BINDING INSTRUMENT FOR 194 COUNTRIES ACROSS THE GLOBE, INCLUDING ALL THE MEMBER STATES OF WHO
- ENTERED INTO FORCE ON 15 JUNE 2007
- REQUIRE COUNTRIES TO REPORT CERTAIN DISEASE OUTBREAKS AND PH EVENTS TO WHO
WHAT DOES ‘PHEIC’ STAND FOR?
PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN, DECLARED BY WHO
WHEN WAS COVID 19 DECLARED A PHEIC (PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN) BY THE WHO?
30TH JANUARY 2020
THE TERM PHEIC ORIGINATED FOLLOWING WHAT?
SARS OUTBREAK IN 2003
WHEN DID WHO DECLARE COVID 19 A PANDEMIC?
11 MARCH 2020
WHO IS THE DIRECTOR-GENERAL OF THE WORLD HEALTH ORGANISATION?
DR TEDROS ADHANOM GHEBREYESUS
DESCRIBE THE AIMS OF RESPONSE TO COVID 19?
- CONTAINMENT (AIM TO ELIMINATE COMMUNITY TRANSMISSION)
- SUPPRESSION (MINIMIZE COMMUNITY INFECTIONS)
- MITIGATION (AVOID OVERWHELMING HEALTHCARE)
DESCRIBE THE STRATEGIES OF RESPONSE TO COVID 19?
- CASE BASED INTERVENTIONS (TESTING AND CONTACT TRACING; RAPIDLY DETECT AND ISOLATE CASES, MONITOR CLOSE CONTACTS)
- POPULATION BASED INTERVENTIONS (FACE MASKS, DISTANCING, CLOSURE OF HOSPITALITY, LIMIT GATHERINGS, WORK/STUDY REMOTELY AND FROM HOME)
- BORDER CONTROL MEASURES (TRAVEL RESTRICTIONS, MANDATORY QUARANTINE)
LIST THE ACTIONS FOR EMERGENCY RESPONSE FOR A PANDEMIC?
- PLANNING AND COORDINATION (RESPONSE PLAN, SURVEILLANCE, LEADERSHIP, DIRECT RESEARCH, GIVE RESOURCES..)
- SITUATION MONITORING AND ASSESSMENT (MONITOR TRENDS, ANALYSE DATA, MODEL PROJECTIONS, DEVELOP/TEST NEW TOOLS)
- COMMUNICATION FOR INFORMATION AND INTERVENTIONS (GUIDELINES TO HCPs AND PH WORKERS, COMMUNICATE PLANS)
- REDUCE THE SPREAD OF DISEASE (CONTAINMENT, INDIVIDUAL BEHAVIOURS AND SOCIETAL BEHAVIOURS)
- CONTINUITY OF HEALTHCARE PROVISION (PLANS FOR SCALE UP OF HEALTHCARE, INFECTION PREVENTION AND CONTROL, DELIVERY OF DRUGS AND VACCINES)
STAGES OF VACCINE DEVELOPMENT?
DISCOVERY (DEVELOPMENT OF THE VACCINE)
PHASE 1 (GIVEN TO A SMALL GROUP OF HEALTHY INDIVIDUALS FOR INITIAL SAFETY DATA)
PHASE 2 (DETERMINE SAFETY EFFECTIVENESS)
PHASE 3 (SAFETY AND EFFECTIVENESS, DOSE, SIDE EFFECTS, RCT)
REGULATORY (REVIEW AND APPROVAL)
PHASE 4 (SURVEILLANCE FOR ADVERSE EVENTS, NEW FORMULATIONS)
GIVE SOME EXAMPLES OF DRUGS THAT WERE CONSIDERED AS A POTENTIAL TREATMENT FOR COVID 19?
CHLOROQUINE/HYDROXYCHLOROQUINE: USED IN MALARIA, EARLY SUGGESTIONS OF BENEFIT IN SOME PEOPLE WITH COVID IN CHINA AND FRANCE, BUT NO BENEFIT WITH SUBSEQUENT RCTs
REMDESIVIR: PREVIOUSLY TESTED IN EBOLA, SOME SUGGESTIONS OF BENEFIT FROM RESULTS IN ANIMAL STUDIES FOR MERS-CoV AND SARS, DATA FROM RCTs SHOWED A FASTER TIME TO CLINICAL IMPROVEMENT IN THOSE SEVERELY ILL WITH COVID-19 AND THE DRUG HAS SINCE BEEN APPROVED FOR USE IN COVID 19
GIVE EXAMPLE OF A DRUG THAT HAS BEEN APPROVED FOR USE IN COVID 19?
REMDESIVIR
WHAT IS THE ‘RECOVERY’ CLINICAL TRIAL?
- RANDOMISED EVALUATION OF COVID-19 THERAPY
- AIMING TO ASSESS IMPROVED OUTCOMES
- ENROLLED ADULTS PATIENTS IN HOSPITAL WITH COVID-19 COMPARING STANDARD OF CARE+ONE OF THE 4 TREATMENTS VS STANDARD OF CARE ALONE
- HAS INCLUDED MANY TREATMENTS (E.G. STEROIDS, HIV MEDICATION, CHLOROQUINE, SOME ANTIBIOTICS)
- CURRENTLY TESTING SOME TREATMENTS: HIGH-DOSE VS STANDARD CORTICOSTEROIDS, EMPAGLIFLOZIN (A DRUG FOR DIABETES AND HEART AND KIDNEY DISEASE), SOTROVIMAB (A MONOCLONAL ANTIBODY TREATMENT AGAINST THE SPIKE PROTEIN)
NAME SOME OF THE DRUGS THE ‘RECOVERY’ CLINICAL TRIAL IS CURRENTLY TESTING AS POTENTIAL TREATMENTS FOR COVID 19:
- HIGH-DOSE VS STANDARD CORTICOSTEROIDS
- EMPAGLIFLOZIN (A DRUG FOR DIABETES AND HEART AND KIDNEY DISEASE)
- SOTROVIMAB (A MONOCLONAL ANTIBODY TREATMENT AGAINST THE SPIKE PROTEIN)
EXAMPLES OF COUNTRIES THAT HAVE FOCUSED ON CONTAINMENT (AIM TO ELIMINATE COMMUNITY TRANSMISSION) IN THEIR RESPONSE TO COVID?
ASIAN AND PACIFIC COUNTRIES SUCH AS CHINA, NEW ZEALAND AND SINGAPORE
EXAMPLES OF COUNTRIES THAT HAVE FOCUSED ON SUPPRESSION (MINIMIZE COMMUNITY INFECTIONS) IN THEIR RESPONSE TO COVID 19?
UNITED STATES, ARGENTINA
EXAMPLES OF COUNTRIES THAT HAVE FOCUSED ON MITIGATION (AVOID OVERWHELIMING HEALTHCARE) IN THEIR RESPONSE TO COVID 19?
SWEDEN
FACTORS ENSURING SUCCESSFUL CONTAINMENT OF COVID 19?
- POLITICAL COMMITMENT
- PREPAREDNESS
- SCIENTIFIC INPUTS
- TRUST
- COMMUNITY ENGAGEMENT
- SOCIOECONOMIC SUPPORT
- BORDER CONTROL SUPPORT
- MEASURES TO SURGE CAPACITY
DESCRIBE THE CONSEQUENCES/IMPACTS OF COVID-19?
- ECONOMIC IMPACT (LOSS OF EMPLYMENT IMPACTING MENTAL AND PHYSICAL HEALTH)
- SOCIAL ISOLATION INFLUENCING MENTAL HEALTH + PRACTICAL DIFFICULTIES, RELATIONSHIPS, EXPLOITATION, HEALTH DAMAGING BEHAVIOURS
- DISRUPTION OF ESSENTIAL SERVICES (HEALTHCARE, EDUCATION)
- TRANSPORT
- SOCIAL DISORDER (PEOPLE LOOKING FOR WHO TO BLAME, STIGMA..)
- PSYCHO-SOCIAL IMPACT AND FEAR AND ANXIETY WHICH MIGHT BE BARRIERS TO THE RETURN TO NORMALITY
- SOCIETAL CHANGE
- OPPORTUNITY TO FACE PROBLEMS OF SOCIETY
