Extract – Ready for the next pandemic? | Which virus or bacteria?

Science has long told us that pandemics are predictable. The question is not: will there be another pandemic? The question is: when? And with what virus? Or what bacteria? Yet this pandemic has caught humanity off guard.

I remember, in January 2020, reading with pleasure and apprehension that the virus causing the epidemic that was raging in Wuhan at that time had been sequenced. With pleasure, because this progress was extremely rapid: identifying the causal agent and knowing its genome one month after the appearance of the cases would make it possible to develop diagnostic tools quickly, which is essential for epidemiological surveillance and the diagnosis of cases. Apprehension, because this new coronavirus had the potential to become pandemic and awakened memories of SARS (acute respiratory syndrome) of 2003.

From that moment, all scientists, governments, public health authorities, international organizations like the World Health Organization (WHO) should have been on high alert. This involves updating pandemic preparedness plans, ensuring the purchase of personal protective equipment, developing the capacity to carry out the tests, assessing the capacity to do the tracing contacts, gauge the reception capacity of health systems, etc. This response has been uneven and delayed in several countries. The WHO may have sounded the alarm and summoned regional representatives, but it was not until March 13 that it officially declared a state of global pandemic. However, in the event of a pandemic, everything depends on the time/response equation. The retrospectoscope tells us that this response time is too long to deal effectively with a pandemic. Meanwhile, the epidemic had already spread to more than 122 countries on five continents, and was already decimating homes for the aged.

This state of affairs was confirmed during the spread of the epidemic in Italy, which experienced a very high mortality rate as soon as the virus was introduced into this country. In reality, this high mortality rate was associated with the fact that the population affected by the virus was particularly old. I was worried. This situation should have alerted us to the fate of our own seniors, particularly those living in closed settings, who were more at risk.

If that weren’t enough to alarm us, the first outbreaks affecting North America that occurred in homes for the aged, particularly that of the Life Care Center in Kirkland, Washington in the United States United, in February 2020, decimating 39 of its residents and several of its employees, should have convinced us.

However, centers for seniors, whether residential and long-term care centers (CHSLD), private residences for seniors (RPA), nursing homes or others, were not specifically planned at the start of the pandemic. In addition, these establishments were already struggling with a shortage of staff and dilapidated facilities in the majority of cases. While acute care facilities were being prepared to receive COVID-19 patients, which was a great thing, little attention was being paid to preparing long-term care facilities. We all know the disastrous consequences of the arrival of the virus in these places.

Of course, it is difficult to predict in pandemic preparedness plans which population will be most affected. It all depends on the pathogen, its mode of transmission, its virulence factors. Thus, our plans are generally designed for an even distribution of disease in the population and do not prepare us for more specific scenarios. However, the need to consider and prepare for various scenarios was a clear lesson learned in the Canadian government’s H1N1 pandemic report.^⁠1.

Imagine that the tropism of a new virulent and pandemic virus is to attack school-aged children in particular: how would we deploy our public health efforts? Schools would be affected, as would parents caring for young children, as they would no longer be able to go to work. The health system needs more pediatric resources. However, the number of children’s hospitals is limited. Could they cope with the situation?

Plans cannot foresee everything, but they must at least consider several scenarios and contingency plans for each of them. And when the pandemic strikes, authorities must quickly determine what scenario they face and who are most at risk, in order to deploy resources appropriately.

1. Public Health Agency of Canada, Lessons to be learned. Public Health Agency of Canada and Health Canada response to H1N1 flu

Ready for a next pandemic?

D^D Cecile Tremblay

Editions La Presse, April 2022

208 pages