Pandemic preparedness and response plan

The next outbreak? We’re not ready. This is the title to one of the most popular TED talks by Bill Gates. In his speech, Gates highlighted that the failure to prepare for the next epidemic could allow the next epidemic to be dramatically more devastating than Ebola. Five years later. This prediction translated into reality when COVID-19 was declared a pandemic. Unfortunately, most of us were not prepared for it.

As a result COVID-19 pandemic had a catastrophic level impact on the human population all around the world. It was officially confirmed that as of 5th May 2020, more than 3.6 million COVID-19 cases were reported across 187 countries and it has resulted in more than 252,000 deaths.

Preparing for a pandemic would require a joint effort that would take several years. This time period could be considerably shortened through the use of a reliable pandemic management system.

Let me ask, what do countries hope to achieve through pandemic preparedness?

Some of they key objectives of a pandemic response plan are as follows:

• Detect, confirm and note cases of infection that have been caused by new viral sub-types for the timely declaration of the outbreak as a pandemic.
• Decrease the transmission risk and limit the morbidity and the mortality resulting from the pandemic.
• Limit the adverse impact of the pandemic on health and social services and ensure the continuation of essential services.
• Guarantee adequate training for the people involved in pandemic response.
• Provide updated and accurate information for decision-makers, health workers, the media and the public.
• Monitor the efficiency of interventions already begun.

Each one of these key objectives perfectly fits into the features of a pandemic management system. A pandemic management system helps both healthcare personnel and governments to prevent the spread of pandemic virus, monitor the infection reach in the economy, analyzing the route map of the infected individuals, helps in effective quarantine of citizens, initiate health card based access at public infrastructures and much more.

Let’s have a look at one of the past pandemic outbreaks in history. The severe acute respiratory syndrome (SARS) pandemic and outbreaks of Asian influenza of the A/H5N1 virus has led many countries to develop pandemic response plans. The WHO pandemic phases were developed to help countries to ensure pandemic preparedness and improve their response plans. The phases are applicable to the entire world and provide a global framework for governments to control the spread of infection.

In Phase 1, there is no instance of viruses circulating among animals that have caused infections in humans.

Phase 2 includes an animal influenza virus circulating among domesticated or wild animals. This virus has led to instances of infection in humans, and has potential to become a pandemic threat.

In Phase 3, an animal or human-animal influenza virus has resulted in scattered cases or small clusters of infection in humans. However, there will not be enough cases of human-to-human transmission to sustain community-level outbreaks.Under some circumstances, there may be an occurrence of limited human-to-human transmission. For example, when there is close interaction between an infected person and an unprotected caregiver. Moreover, very few reported infection cases during such quarantined situations does not prove that the virus has attained the level of transmissibility in a society necessary to be categorized as a pandemic.

The main characteristic of Phase 4 is verified human-to-human transmission of an animal or human-animal influenza reassortant virus. This virus will be able to cause “community-level outbreaks”. This ability to cause sustained disease outbreaks in a community increases the threat of a potential pandemic. Any country that suspects or has verified such an event should immediately notify the WHO so that the event can be assessed further. This phase gives an indication of the threat of a pandemic, but does not guarantee that such an event will come to pass.

Phase 5 categorized by mass level human-to-human spread of the pandemic virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of This phase provides an indication that a pandemic is on the horizon and that there isn’t much time to finalize the organization, communication, and implementation of the planned mitigation measures.

During phase 6 stage, the pandemic spread extends itself to a community level outbreaks into at least one other country in a different WHO region based as per the criteria defined in Phase 5. The pandemic spread rate in this phase will indicate whether a global pandemic is underway or not.

The effective steps involved in a pandemic response involves:

• Setting up of an immediate pandemic response center.
• Evaluating needs of the people, identifying resource availability and creating an action plan for pandemic response.
• Initiate the response.
• Prepare the community for a complete recovery.

Setting up of an immediate pandemic response center

The Immediate Pandemic Response Center (IPRC) is an unavoidable element of pandemic response action plan. The government and health care support staff responsible for the usual, day to day functioning of an economy must strengthen the pandemic response team structure to make them capable of facing a severe pandemic. Coordinating with leaders from the public and private sectors in an economy, could also help us to create an effective IPRC if one is not already present during a pandemic crisis.

The basic function of an IPRC will be to:

• Execute their pandemic response activities from a flexible physical base location.
• Discover and manage the pandemic response volunteers and concerned representatives.
• Accommodate local leaders and pandemic response equipped personnel's into the team to make them more capable.
• It would be a center of information sharing to keep the concerned authorities updated at all times (regarding the number of personnel's at hand, available resources etc).
• Help all those who request for assistance during a pandemic crisis.
• Necessary personal protective equipment (PPE) kits are stocked and distributed to the healthcare support staff.

Evaluating needs of the people, identifying resource availability and creating an action plan for pandemic response.

Here we need to work on spreading the directions and instructions given by the governing authority at the regional/state or district levels and at the national level. Here the pandemic response team needs to focus on achieving two goals simultaneously. The first one would be to considerably reduce the number of deaths in the local governing area to a minimum. Here in order to tackle the situation we should set aside our personal objectives and work towards keeping the people alive during a pandemic crisis. The second goal will be the effective distribution of local resources to the people such as their basis necessities, personal protective equipment's, health care support for the infected ones, medicines for pre-existing disease illness etc

For this, what we need is:

• Plan for a detailed resource list.
• A well managed resource map.
• Discover knowledge gaps and a way to address them.
• Creation & execution of local governance pandemic response plan

Initiate the response plan

Here we must take these six phases into account while preparing a response plan for pandemics.Some of the key aspects in an effective response plan include:

• Approving and verifying the present pandemic preparedness and management plans and regulations.
• Devising the necessary policies and pandemic preparedness processes to support the undergoing pandemic response efforts in each region.
• Devising or integrating plans within an existing overall crisis management structure to encourage fast and proactive decision making at the right levels of the organization.
• Arranging and coordinating all devised pandemic incident response plans, involving business continuity management, handling of immediate emergency response, supply chain, communications, analyzing the impact level of pandemic on humans and many other unseen factors.
• Training human resources to help ensure the seamless execution of the plan as circumstances dictate.

This plan would account for important activities such as detection, assessment, treatment, escalation and recovery. The detection phase will involve gathering intelligence from other affected countries, enhanced surveillance, developing diagnostics that are specific to the new virus, conveying important information about the virus to the public. Assessment section will include the recommendation of community voluntary self-isolation of cases and suspected cases, handling suspected cases or positive infections etc. The treatment phase will consider enhancing public health measures to disrupt local transmission of the virus. Precautionary measures such as closing of schools can be implemented based on public health risk assessment. The escalation phase will focus on maintaining essential services and executing resilience measures. Finally, the recovery phase will involve normalization of services, resuming businesses as usual, planning and preparation for resurgence of COVID-19 etc.

The task of preparing for pandemics falls not only on governments, but on private organizations as well. It is important for companies to prepare for a dip in their sales during such outbreaks. In such a scenario, devising a plan that is meant to ensure business continuity is very important. Apart from businesses, each and every individual needs to take appropriate precautionary measures to curb the spread of the virus as well. People must stay informed about any updates regarding the virus. It is also important to follow public health advisories. Executing an effective response plan will need the cooperation of the community as a whole. Insufficient preparation for a pandemic can prove fatal and result in the deaths of millions of people all around the world

Prepare the community for a complete recovery

A complete community recovery could only be made possible through the effective use of a pandemic management system. A pandemic management system takes into consideration the steps needed for the future recovery of a community who have been infected by a pandemic. At the same time, local and national governing authorities should work towards undertaking measures to reduce fear of citizens (concerning the non-availability of food, of being infected with the COVID-19, of their own death, of crime and violence) and should work to restore their confidence (in government authority, in fellow residents and in their own ability to earn their living).

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