Two decades of infectious disease warnings show the discrepancy of the criteria and the weight of the human factor

Two decades of infectious disease warnings show the discrepancy of the criteria and the weight of the human factor

Until now, an official pandemic model has not been successful in capturing the health alerts being reported around the world every day, sometimes tens of thousands a day. The Covid pandemic accelerated an agreement process that had been going on for years but was still to be developed. Today, a group of scientists is releasing an unprecedented record of official World Health Organization (WHO) warnings, enabling any doctor to report potential health threats from around the world. In addition, it provides a detailed overview of the epidemic outbreaks over the past two decades, just up to months before the outbreak of the Covid pandemic.

The authors point out that their work with the historical record allows us to observe recurring global threats such as influenza or cholera and ongoing epidemics such as Ebola virus disease in Africa or MERS-CoV in the Middle East. Another piece of information is the persistent disparity between countries, not just between North and South, when it comes to disease reporting. “Egypt ranks fifth in terms of the number of reports and close surveillance for yellow fever with 115 health warnings, while neighboring Libya has never reported anything reflecting the collapse of its health system, which was once very effective. , after two civil wars,” laments Rebecca Katz, director of the Center for Global Health Sciences and Security at Georgetown University Medical Center (Washington, USA) and lead author of this study, which covers the period 1996-2019.

Among the information collected, China stands out with the highest number of health warnings (262), in its case the majority related to different types of flu. Katz celebrates the consistency between the information gathered and the accuracy with which epidemics were recorded, as there has not been a phantom pandemic “unreported” despite “the lost logs”, the redundant information or the problems when the categories don’t match. .

Professor Rebecca Katz, director of the Georgetown University Health Center (Washington, USA) and lead author of this publication, advised President Joe Biden on the 2019 coronavirus task force.Professor Rebecca Katz, director of the Georgetown University Health Center (Washington, USA) and lead author of this publication, advised President Joe Biden on the 2019 coronavirus task force.

“The WHO site is the main source of health information,” says Katz, “so we believe the official record needs to be approved.” The researcher explains how specialists “every day have to monitor tens of thousands of signs that can represent a serious global health problem, all the while clarifying what is relevant and what is not”. Therefore, the lead author believes it is imperative to design a model like hers that unifies the criteria for health warnings throughout history. The synthesis presented by the Georgetown team will be available online for everyone.

The criteria of the experts

Epidemiologist Susana Monge Corella, who was not involved in this investigation, highlights another key that draws attention after analyzing the work: the human role in deciding the severity of an outbreak. In these moments, experience is a yardstick for the expert: “You filter thanks to the knowledge you have gathered, but there is no expert panel in which health warnings are decided, in which there has been no discussion despite decades of knowledge.” “Due to the complexity of decision-making, the human factor is difficult to replace,” concludes the person who was part of the Department of Health’s Health Alerts and Emergencies Coordination Center during the Covid crisis.

Monge of the Carlos III Health Institute National Epidemiology Center points out that there are other infections where the decision to report is made based on the unexpected or virulent nature of the event. “A family intoxicated by botulism from a homemade jam is a concrete problem; but if a child is poisoned with botulism by a commercial milk formula that has been sold throughout Spain, then the same disease has a completely different risk, a different dimension, and if the brand of milk is foreign, this is already an international problem,” summarizes the together epidemiologist.

The Center for the Coordination of Health Alerts and Emergencies (CCAES) in full during the assessment of Ebola protocols on July 19, 2019.The Center for the Coordination of Health Alerts and Emergencies (CCAES) in full during the assessment of Ebola protocols on July 19, 2019.

A case of avian influenza has “priority one, every event is reportable” and is “closely monitored over the years, hence its prevalence in the study,” stresses Monge. Hence the alarm triggered by the outbreak among mink, which occurred in Galicia and which, although it has not reached humans, has put virologists on alert around the world.

Dangerous influenza outbreaks are the most frequently reported disease in these 26 years with 776 reports. For example, on January 18, 2023, the last recorded outbreak was that of bird flu in a 9-year-old girl in Ecuador. Because of its decades-long prevalence and severity, Georgetown scientists highlight in the new paper that they have unified the different subtypes of influenza, given the WHO’s obligation to report the new variants under the International Health Regulations. In an attached comment, they describe that the number of flu cases has increased worldwide, but that the pandemic is causing fewer reports and that certain parameters are being skewed. The authors are aware of the thousands of people infected in Iran and India with influenza A or other minor cases in Canada or the Netherlands over the past decade, but that only China has reported them.

Georgetown researchers reviewed 2,789 WHO news reports on disease outbreaks from 1996 to December 2019, just before the current Covid crisis. These online documents contain the relevant information on unexpected outbreaks of epidemics, such as the 2014-2016 Ebola virus in West Africa or the 2011 Cholera virus in the Democratic Republic of the Congo, and they contain the “decision level” that regulates the exchange of information during a public health emergency,” the researchers explain in the paper. For this reason, Katz concludes that more information transparency and “the introduction of standardized formats for sharing epidemiological data” would contribute to their dissemination and the usefulness of the reports to other specialists. Despite this, the author acknowledges a noticeable improvement in the WHO health alert registry due to the new normal imposed by the pandemic.

Monge believes WHO’s role is “sensitive because it has to be very careful in alerting about outbreaks” as it has to “coordinate communications” and mediate between different organizations and countries. For the researcher, while it should rank better in search engines or have more accurate labels, she believes “there’s no point asking about the same type of writing because it influences who writes this report for decades to come.”

There is no expert panel that decides on health warnings where, despite decades of knowledge, no discussion has taken place, due to the complexity of decision-making, the human factor is difficult to replace

Susana Monge Corella of the Carlos III Health Institute National Epidemiology Center

All healthcare professionals must report a possible outbreak of infection and report it urgently even if there is a mere suspicion. A warning of an outbreak of an epidemic is anything that “might pose a risk to public health,” summarizes preventive medicine and public health specialist José María Arteagoitia Axpe. The speed of transmission of information is “essential”, affirms the expert, since the aim of the epidemiological surveillance system is “to detect and combat communicable diseases”.

The professional points out that to support the surveillance of infectious diseases, there are “protocols for more than 60 reportable diseases” such as “whooping cough, hepatitis A, tuberculosis or meningococcal disease”, others that are less common in our environment, such as measles and other emerging diseases such as “whooping cough”, “hepatitis A”, “tuberculosis” or “meningococci”. such as the West Nile Virus or Ebola,” as described by the Basque Country Health Department. Arteagoitia, head of service emeritus at the Basque Government’s Department of Health, points out that the surveillance process for diseases, outbreaks and health alerts is “legally logged and regulated”, although he admits that “it is true that at the moment it is not complete automated, steps are taken in this direction, e.g. B. the data that goes directly from the health system to public health,” he points out.

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