In the event of an emergency ...

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.

Anything that is seen as new and different gets an elevated public profile. It might not be all that serious, it’s just different.