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DIALOGUE Issue #5 2020
COVID-19, AN UNFINISHED TALE... Dr Henry Dowlen OG 1997 MBE
Dr Dowlen trained in the military, in medicine and in public health. He has worked for the Government, humanitarian organisations, military and the UN in complex emergencies globally, ran the build of one of the Nightingale hospitals and is currently involved in the national COVID-19 response.
T
here are clear reasons why this pandemic is causing such enormous global shockwaves. In comparison to other infectious diseases it occupies a relatively unusual set of behaviours that make it successful in propagating far and wide without being so devastating that it burns out. However, there are many who believe that COVID-19 could be a test-run for something worse; for example, a disease which causes more fatalities or spreads more easily from one person to another. The lessons we learn from this outbreak will shape every aspect of society for generations. Getting on top of an infectious disease outbreak is a collective responsibility, and we must ensure that those lessons are applied by all of us, but we should also not forget the lessons of the past. There exists standard guidance for how to respond to public health threats of national concern, and they work, they have been developed based on evidence and applied in multiple geographic settings over many years.
The standard wisdom about this guidance has been that it mainly applies to lower income countries with fragile socioeconomic systems, but the year 2020 has challenged that assertion. For instance, there have been huge efforts applied to testing and tracing, but contact tracing is a difficult art form, it requires trust at an individual and societal level. It is also vastly time consuming, with even small outbreaks of disease requiring hours of patient investigation to identify a source and those at risk. Command, control, coordination, collaboration and communication are all vital. These are not aspirational throwaway buzzwords but relate clearly to different parts of an infectious disease outbreak response of international concern. Clear structures for rapid communication and decision making are vital, as is cross-border coordination. Borders are often the source of persistent disease transmission towards the end of an outbreak.
