Nearly five years have passed since the start of the COVID-19 pandemic, and at this point, there are plenty of data points surrounding which approaches worked and which may need tweaking should another pandemic come around.
The current outbreak of avian influenza in the U.S. has raised alarm bells and thrown into sharper focus the need for strong preparedness measures in the event of another pandemic-level event. At the point of this writing, the CDC continues to maintain that the risk to the general public is low, but there is still something alarming about the rising case numbers with memories of the beginning of the COVID pandemic so close at hand.
An article published in the New England Journal of Medicine on December 31, 2024, entitled “Highly Pathogenic Avian Influenza A(H5N1) Virus Infections in Humans” and written by Shikha Garg, et al, sought to describe characteristics of the human cases of avian influenza, or H5N1, that have spread throughout the country thus far. There have been 46 patients to date, and all but one of them were definitively exposed to infected poultry or infected or presumably infected dairy cows. The one who did not have an identified exposure “was hospitalized with nonrespiratory symptoms, and A(H5N1) virus infection was detected through routine surveillance.” However, among the 45 patients with animal exposures, “the median age was 34 years, and all had mild A(H5N1) illness; none were hospitalized, and none died.” The authors of the article concluded that “A(H5N1) viruses generally caused mild illness, mostly conjunctivitis, of short duration, predominantly in U.S. adults exposed to infected animals; most patients received prompt antiviral treatment. No evidence of human-to-human A(H5N1) transmission was identified. PPE use among occupationally exposed persons was suboptimal, which suggests that additional strategies are needed to reduce exposure risk.”
The article also makes the case that there are so many factors still unknown regarding H5N1 viruses currently circulating in dairy cows. Because of these uncertainties, “how long workers should be monitored is unclear.” High levels of the virus are also being found in “unpasteurized raw milk, which is probably an important source of transmission from cows to dairy workers.” Plus, looking at human cases across the globe reveals a “wide spectrum of clinical disease severity, ranging from asymptomatic illness, conjunctivitis, and mild upper respiratory tract symptoms to lower respiratory tract disease and critical illness, including death. Why recent U.S. cases have generally been clinically mild remains unclear; early detection and initiation of antiviral treatment may play a role.”
The amount that remains unknown about what a larger outbreak of bird flu would look like provides a useful opportunity to look at pandemic preparedness writ large to attempt to determine broadly what needs to be done to minimize adverse outcomes. The past several years of COVID provide plenty of data, both promising and not, about attempts to stop the spread of a respiratory pathogen. An article, called “Positive and negative aspects of the COVID-19 pandemic among a diverse sample of US adults: an exploratory mixed-methods analysis of online survey data” and written by Stephanie A. Ponce, et al, published in BMC Public Health at the beginning of 2024, provided research and data surrounding both positive and negative experiences during the COVID-19 pandemic across “race-ethnicity, gender, and age.” The researchers used results from a survey of about 5,500 racially diverse adults living in the U.S. Most of the data surrounded social effects of the pandemic, but researchers did record “differences across age, gender, and race-ethnicity,” which lends further credence to the notion that recovery strategies need to be “tailored to community needs” if they wish to address inequities. Responses to any future pandemics or outbreaks, then, must attempt to account for “variation in access to economic and social resources” across different groups of people. The authors of the study conclude that having a “more nuanced understanding of such variation in the perceived positive and negative effects of pandemics can inform tailored public health efforts to mitigate potentially harmful factors.”
Healthcare Purchasing News was able to speak with Isis Lamphier, MPH, MHA, CIC, and the manager of Infection Prevention at Moffitt Cancer Center, about hospitals’ responses both to COVID-19 and to any future outbreaks. She also speaks to the possibility of a bird flu epidemic.
Are there any important lessons infection preventionists (IP) learned from the COVID pandemic?
Important lessons learned include the importance of standard precautions, early detection and response including screening protocols, preparedness, and risk management, and how misinformation can be an obstacle IPs face in their work.
What went well and what was lacking during the initial response to COVID?
The things that went well include rapid scientific advancements including testing, vaccine development, and innovations in treatment. Also, organizations quickly adapted to remote platforms to provide telemedicine and conduct meetings. In addition, there was an increase in public awareness of standard precautions such as hand hygiene and mask usage, which helped to drive down infections.
Some of the ways in which the response to COVID was lacking include unexpected supply chain failures and shortages of medical supplies, the spread of misinformation, and increased healthcare worker burnout.
As bird flu cases continue to grow in number, what do you think of the possibility that it could eventually reach epidemic levels?
I think bird flu is unlikely to reach epidemic levels in humans because historically there has been limited human-to-human transmission. After all, bird flu is a zoonotic disease that primarily spreads through humans coming into contact with infected animals or other animal-related contamination. We also have stringent monitoring and control measures in place to detect influenza outbreaks early, quarantine infected poultry, and vaccinate poultry.
What should hospitals and IP departments be doing now to gear up for the next pandemic?
As always, hospitals and IP departments should be informed of emerging pathogens by staying up-to-date with information from local health departments and organizations such as the CDC. Organizations should also have an established policy that discusses epidemics and pandemics.
IP departments should run through possible scenarios, discuss the chain of command for emergency response, and have established plans to address issues such as PPE shortages, whether will they take or send patients to other hospitals, and quarantine measures.=
What measures are hospitals already taking to prepare?
The majority of hospitals already have established policies detailing emergency response and epidemic/pandemic preparedness.
What can everyday people keep in mind for how to behave when a new pandemic strikes?
Stay at home and avoid others if you feel sick, limit non-essential travel, take standard precaution measures, reinforce hand hygiene, and potentially use surgical masks depending on the organism causing the pandemic to limit transmission.
How do you feel generally about the U.S.'s preparedness for another pandemic?
We still have significant room for growth and much to learn from the COVID-19 pandemic. It is crucial to prioritize and reinforce the role of healthcare experts in providing accurate information and actively involving them in decision-making and policy development. To move forward effectively, we must shift attention away from the misinformation prevalent on social media and certain news outlets, focusing instead on the trusted expertise of public health officials.
Matt MacKenzie | Associate Editor
Matt is Associate Editor for Healthcare Purchasing News.
