Last night some of the world experts on COVID-19 came together: These are their thoughts

Image: Wired

I don’t set my alarm for 0300am for just anyone.

But for this line-up of speakers — it was a no brainer.

An international webinar discussion organised by “DisasterDoc” Mark Keim — one of the most widely recognised disaster medical experts in the world — which brought together four world-renowned disaster experts to provide their point of view on how to tackle the global threat that is the COVID-19 pandemic.

And what a list of speakers it was:

• Dr. Luca Ragazzoni, Scientific Coordinator — CRIMEDIM Research Center in Emergency and Disaster Medicine
• Dr. James Phillips, Section Chief and Fellowship Director — George Washington University, Disaster and Operational Medicine
• Greg Burel, President and Principal Consultant — Hamilton Grace LLC, former Director of the Strategic National Stockpile

and

• My long-time mentor and treasured friend, dearest “Uncle Skip” — Professor Frederick M. Burkle, Jr. Senior Fellow & Scientist — Harvard University and T.H. Chan School of Public Health

Image: Professor Frederick M. Burkle, Jr. Source: Harvard Humanitarian Initiative

Particular issues of concern during the current pandemic

Of perhaps little surprise to anyone working on the frontlines of the pandemic anywhere around the globe, a consistent message from all experts was focused on the universal lack of personal protective equipment (PPE).

Dr. Luca Ragazzoni, sharing a devastating insight from the frontlines of Italy, noted that parts of his country were “at breaking point.”

He told of patients being treated in corridors, healthcare workers treating outside of their fields of expertise, and entire hospitals being dedicated only to COVID-19 patients.

While the Italian intensive care systems were undoubtedly being stressed, he emphasised that not enough attention was being paid to the prehospital and primary health settings.

“Where are the patients going after discharge”? he asked. “What about continuing care”?

Little is known about how long these patients will need assistance— how long they will need home care?

Image: Dr. Luca Ragazzoni. Source: Eusem

Dr. James Phillips — a board certified Emergency Medicine physician and currently an Assistant Professor of Emergency Medicine at George Washington University — agreed that PPE is a critical issue during this pandemic, and not just for places like the United States, Europe and Australia.

He highlighted that for places like Africa and South America — some of this PPE doesn’t even exist.

Dr. Phillips noted the current concerns of frontline healthcare workers wearing PPE in a manner not consistent with existing standards of care — provider protection is suffering.

“Wearing a mask for 8 hours…it’s hard to breath through…it makes you fatigued,” he said.

Seeing an outpouring of concern from the public and people trying to make home-made PPE and cloth face masks for healthcare workers was incredible.

“It’s heart warming. But we cant use them.”

He’s advice — we need to be less worried about the economy in the short term and more worried about cranking out PPE.

“Crank up the curve on PPE, while flattening the curve on the virus.”

Ventilators are obviously a concern.

Rationing — Italy has started that conversation — one hospital in New York had its rationing policy leaked to the media. These are really distressing things we are talking about here, so we need official guidelines, we need the Centers for Disease Control and Prevention (CDC) to weigh in and give us guidelines so that healthcare workers are not making personal decisions.

“We need help so that we are not burdened by making these decisions.”

And we need better crisis leadership.

On that point — all of the experts agreed.

Greg Burel, President and Principal Consultant — Hamilton Grace LLC, and former Director of the Strategic National Stockpile pointed to the misinformation and confusion that has been circulating along with the virus.

“We need our leaders to be credible and trustworthy.”

Calling the shortage of PPE “unconscionable,” Burel described the U.S. medical supply chain as fragile — “people don’t understand that — it’s fragile at all links”.

From the point of dispensing, all the way back to manufacturing, there is never usually more than 30 days of supply available. It’s a cost effective system he pointed out — which is great if you’re in the auto parts industry — not so great for when we need to protect and save lives.

“There is no safety stock, there is no margin for error.”

Professor “Skip” Burkle, Jr. thoughtfully considered how this pandemic is the first time that many of our global healthcare workers have experienced population-based care.

He described a shift in our healthcare system from a narrow model of acute care targeted at the individual patient, to one that focuses on the health and overall wellness of the broader population it serves.

He highlighted a distinct difference in how different countries had managed the outbreak — democratic vs authoritarian — where democratic countries had utilised principles of public health protection while authoritarian regimes had largely compromised public health securities.

What strengths have we seen through this pandemic to date?

For Dr. Ragazzoni, it was clear. It was the sharing of knowledge, of experiences. To be able to share the lessons from Italy with the rest of the world — to teach, to prepare, to forewarn.

And it was the overwhelming willingness of healthcare workers to respond in face of incredible personal risk — “that is spectacular,” he said.

Dr. Phillips echoed this sentiment.

“Frontline providers at the local level are stepping up and showing remarkable courage.”

He said true courage comes from stepping up and working despite being directed to work without appropriate PPE.

“It’s also seeing the strength and resolve of everyday people.”

Image: Dr. James Phillips. Source: Twitter

Greg Burel was impressed with the way that people have been coming together to try to problem-solve.

“More people are trying to follow restrictions than we thought.”

Professor “Skip” Burkle, Jr. acknowledged the difficult decisions that Italian healthcare workers had been compelled to make — the first to start triage at the population level.

“This will not be forgotten,” he said.

“Global public health must now get much needed recognition — we can not turn back.”

If you could change one thing about the pandemic response?

Dr Ragazzoni had a clear message for the world: stronger containment; stronger collaboration; stronger coordination.

“No healthcare system can contain an uncontrolled outbreak.”

All governments must act now. We need isolation, quarantine, containment, social distancing — otherwise we will see collapse of entire healthcare systems and unnecessary loss of life.

Dr. Ragazzoni also highlighted the need for better coordination between primary health — prehospital health — hospital — and care in the home.

We also need better understanding around the difficult decisions regarding population-based triage and ethical dilemmas.

Dr. Phillips reiterated the need for more protection for those on the frontlines.

And from a crisis management standpoint — we need much more effective crisis leadership. Clear and decisive messaging. Leadership that is inspiring and makes those most at risk feel like someone “has their back.”

Greg Burel concurs.

When it comes to crisis communications — be first with the information, and be credible.

Image: Greg Burel. Source: Medium.com

And a final word from the one so many of us regard as a mentor in this field of disaster medicine.

“Uncle Skip” tells us that fragmented approaches to population-based crises wont work.

We need to work collectively — both within our own countries and also globally.

For many of the large number of healthcare providers worldwide, the COVID-19 pandemic is their first experience in population-based care. In past decades, lower population densities, infectious disease outbreaks, epidemics and pandemics were rare and driven almost exclusively by natural disasters, predatory animals, and war.

In the early 1900’s, Sir William Osler first advanced our knowledge of zoonotic diseases that are spread from reservoir animals to human animals.

Once rare, they now make up 71% or more of new diseases.

Because the human population has grown in numbers and density, the spread of these diseases accelerated though rapid unsustainable urbanisation, biodiversity loss, and climate change.

Furthermore, they are exacerbated by an increasing number of vulnerable populations suffering from chronic deficiencies in food, water, and energy.

Skip argues the need for local grassroots coordination, and a bottom-up capability driven by medical, veterinary and public health practitioners. This must include rapid, networked information sharing and the use of multiple expert disciplines to mitigate an outbreak.

Lastly, public health and public health infrastructure and systems in developing countries must be seen as strategic and security issues that deserve international public health resource monitoring.

“There is so much more we need to know!”

Yes, Uncle Skip — indeed there is!

Image: Disasters.org.au