By BOB JOHANNESSEN | Bureau
of Community Preparedness Communications Consultant, LDH Office of Public
Health
As COVID-19, a relatively new coronavirus,
spreads throughout China, it has the attention of world, U.S. and local health
officials, as well as around-the-clock news coverage. We recently sat down with
Dr. Frank Welch, medical director for emergency preparedness at the Louisiana
Department of Health, who directs and coordinates all aspects of infectious
disease planning and response activities for Louisiana.
We asked Dr. Welch about the
planning and response to COVID-19 at a
time when Dr. Welch’s team was also responding to five concurrent outbreaks of
infectious diseases: seasonal flu, hepatitis A, mumps, norovirus and chicken
pox.
Is it unusual to have so many
outbreaks under investigation at the same time?
 |
| Dr. Frank Welch |
It’s not unusual to have outbreaks and there is no relation between the
ones Louisiana is experiencing. The fact they are all occurring at once is
coincidental. Interestingly, though, several of the outbreaks we are seeing
today have unique features.
Hepatitis A,
for example, is a disease that that we usually only see a few cases of a year,
typically confined to specific people or to food. It is uncommon that we have
been seeing so many cases for more than a year,
reaching epidemic proportions in a very specific population. For context, over
the past 10 years, an average of nine cases are reported each year. Today’s
ongoing outbreak is almost 800 cases.
With mumps, the
vaccine is about 90% effective, so we typically see only a case or two a year.
In the past, outbreaks have been rare, but today, we are regularly seeing mumps
outbreaks on college campuses.
Norovirus behaves like other new and unique outbreaks like SARS and
N1H1 (swine flu). For these outbreaks, anytime there are a lot of people in
close spaces, and someone is sick, an infectious disease can spread pretty
quickly.
From a preparedness standpoint,
can the Department devote, or have enough resources to adequately address all
of these outbreaks at one time?
Yes, and no.
Yes, we have been preparing for about 20 years to be ready to respond
to many hazards and emergencies, not just for infectious diseases. Over this
time, we have built a strong emergency
response infrastructure. This means that when it comes to a new disease
such as COVID-19, we are not starting from scratch. Instead, we only have to
build upon the existing structure for the new, specific issue.
No, because building upon the existing structure can sometimes be
challenging because it requires human resources and additional funding. There
is a limit to what we can do ourselves, but the federal government has always
been there to assist. In the past, the feds have recognized there is additional
work and added costs, and they have provided us and other states more money for
the response.
How do you prioritize resources?
Within the Office of Public Health, we have a continuity of operations
plan that lets us identify essential, critical operations that we need to do,
and the responsibilities that we can put off or place to the side for a while.
For this planning, we follow the federal guidelines for continuity of
operations. This is important to our ability to respond to an emergency,
recover afterwards and then catch up when the crisis is over.
Of the recent outbreaks, which
one should we be most worried about? And, why?
We should be most
worried about the flu. This really is the severe, contagious illness that
needs to be taken seriously. Millions of people get the flu every year — about
20% of the population.
According to the CDC, the flu has already caused more than 2,000 deaths
this season, and Louisiana has seen heightened flu activity every week since
flu season started last fall. But, the flu is vaccine-preventable, vaccine-mutable.
From my perspective, we need to focus on the diseases that are most serious,
while still having the ability to respond to other concerns like COVID-19.
How dangerous is COVID-19 compared
to the flu or to other viruses?
We aren’t yet sure how quickly COVID-19 can spread. However, it appears
that for every person who becomes infected, they can spread it to three other
people. For comparison, every person who gets norovirus can spread it to 9 to
10 other people. By this measure, norovirus spreads three times as much as COVID-19.
My prediction for COVID-19 is that it will mutate itself out, or fail to
adapt to new environments, like SARS,
an earlier coronavirus. Or, it might eventually slowly spread throughout
the global populations. The strategy of health officials is to slow the time it
takes for the virus to enter the U.S., allowing time for effective treatments
and vaccines — in other words, allowing time for more tools to be developed to
fight it.
As an example, H1N1
started in the U.S., migrated globally, but is now part of the common flu.
How worried should the general
public be about COVID-19?
If and when the virus gets to the U.S., the best strategy to keep from
getting sick are the same strategies to prevent getting the flu: wash your
hands frequently and keep your distance from others.
Given how rapidly norovirus recently
spread through Southwest Louisiana, can we expect the same from COVID-19?
This depends on several things. First, the ability of the virus to
spread. Remember, it appears that one-person sick with COVID-19 can spread it
to three other people.
The second thing is the sick person must be in close proximity to
someone else.
In China, the city of Wuhan is small in area but has 11 million people.
There are a lot of people living and working very close to one another. This
has allowed the virus to spread rapidly. You should also remember that it
started during the Chinese New Year when there were large crowds of people.
This is probably why it spread so quickly.
It is different in Louisiana where we are not nearly so crowded. We
have lots of wide open spaces, and to find a crowd of people, you have to
actively seek out the crowd. This makes it unlikely that we’d see the same rate
of transmission in Louisiana as we’re seeing in Wuhan.
If you could advise the general
public to do only one thing to protect themselves, what would that be?
As I said earlier, you need to keep your hands clean and keep your
distance from others. Infectious diseases such as the flu, norovirus and COVID-19
all spread person to person. So, the best things to do are to stay away from
sick people, cover your mouth, wash your hands and stay home if you are sick. This is
the best prevention for any infectious disease. You should also call your
doctor if you are sick and follow your doctor’s advice.
Why do some people seem to worry
about COVID-19 more than they worry
about the flu?
Anything that is new and different captures media attention, as well as
the attention of the CDC and the world health organizations. All of this
attention elevates the idea that this is something new and different and more
dangerous.
In fact, a recent article in the New York Times said this illustrates
an unconscious bias in how humans think about risk … we are conditioned to
focus heavily on new threats, looking for any cause for alarm. We might obsess
over the scariest reports and worst-case scenarios, making the danger seem bigger
than it actually is. Where COVID-19 is new and different, the flu, in
comparison, is seen as old and somewhat boring. It doesn’t capture the 24-hour
news cycle, and, therefore, it is not as glamorous.
