It is very clear that pandemics are a collision of politics, pathogens and people and most commonly the pathogens win, Prof Lucille Blumberg, deputy director of epidemiology and medical consultant at the National Institute of Communicable Diseases (NICD) pronounced during this week’s sixth and final BHF Dialogue Session.
“I am a veteran of more than 200 outbreak response activities,” she noted, “and am afraid with every one that occurs there are always things that get promised, you plan to implement changes and so often this doesn’t happen. So I think we really need to use this pandemic to move forward.”
Critically important in this regard was to have a system that responds quickly: “Decision-making must be nimble and quick and not bogged down by bureaucracy if we want to get ahead of the curve. At the moment the COVID virus is very definitely ahead of us.”
One of the main contributing factors in this regard, Blumberg intimated, were the “much neglected” infection, prevention and control (IPC) measures at the country’s health facilities.
“We don’t respect practitioners in this, everybody has to actually become an IPC practitioner. We need to protect healthcare workers, have quality PPE training, compliance etc. This is an opportunity now to recognise that this is a gap and to move forward on that. Hospital outbreaks, health care worker infections, populations who are afraid to go to hospital because of the risk of COVID is something we can work on. So we must bring IPC to the core of outbreak preparedness and response – in fact not only because there is a pandemic, but that it becomes part of everyday practice.”
Also of critical importance, Blumberg added, was a sound surveillance system on the pretext of “you can only manage what you can measure”. Here she recalled the “shambolic” state in which Italy found itself early in the pandemic when the only “surveillance” was on social media and pictures in the newspapers. There was clearly no surveillance system to report the situation in the many hospital groups which, she said, was “disastrous” and “shameful” at the time.
South Africa, however, was somewhat better prepared, as Blumberg explained: “We introduced a hospital surveillance system that worked very well to show where morbidities, mortalities and the risk groups are.”
The Western Cape in particular, she noted, has an excellent surveillance system which brings together many data bases from the many different health sectors: “They were therefore able to quickly examine what the problems were, where the responses were needed and who the most vulnerable populations were.
Touching on testing, Blumberg made the point that intervention needs to have purpose. Looking back at the strategy of testing in this respect, the basic idea, she said, was to test a lot of people, identify patients, isolate them from others to prevent the spread of disease, and follow up contacts “and quarantine them”.
“I think some of this got lost.”