According to the WHO, plague can be a very severe disease in people, with a case-fatality ratio of 30%-60% if left untreated. Known as the "Black Death" during the fourteenth century, plague caused an estimated 50 million deaths. Plague arises from the bacteria Yersinia Pestis, usually found in small animals (and their fleas). Plague epidemics have occurred in Africa, Asia, and South America but since the 1990s, most human cases have occurred in Africa. In 2013 there were 783 cases reported worldwide, including 126 deaths.
Reuters has also reported that the U.S. Centers for Disease Control and Prevention stated that the plague was introduced to the United States in 1900 by rat-infested steamships that had sailed from affected areas, mostly in Asia. While plague rarely occurs in the U.S. this, most recent instance serves as an additional reminder of the importance of taking appropriate precautions to mitigate contagion and to be prepared for other types of epidemic and pandemic threats. It also provides an opportunity to reflect that efforts to mitigate infectious disease outbreaks hinge on how well we communicate the right things to the right people at the right time and in the right ways.
Importance of Communication for Epidemic and Pandemic Mitigation
According to the WHO, preventive measures for plague epidemics include effective health communication efforts informing people when zoonotic plague is active in their environment and advising them to take precautions against fleabites. Preventative measures also advise not to handle animal carcasses in plague-endemic areas. People should also avoid direct contact with infected tissues such as suppurating buboes, or exposure to patients with pneumonic plague.
According to the WHO, effective communication is a key aspect in preventing and managing infectious disease outbreaks. This includes plans to inform health workers of the key aspects about where plague is being actively transmitted, what clinical features to look out for and what is the diagnostic plague case definition. Further, effective communication is essential to ensure correct treatment, to verify that patients are being given appropriate antibiotic treatment and that local supplies of antibiotics are adequate. Patient care information must be successfully transmitted, received, understood and verified as implemented. Examples include specific special procedures to isolate patients with pneumonic plague or proper procedures to obtain specimens for laboratory confirmation of the disease. In addition, coordinated successful communication is the key for all comprehensive efforts of surveillance and control. Surveillance and control requires investigating animal sources implicated in the plague cycle in the region and developing environmental management programs to limit spread. Active long-term surveillance of animal foci, coupled with a rapid response during animal outbreaks, has successfully reduced numbers of human plague outbreaks.
Health and risk communication preparedness is an essential component for outbreak mitigation. We have to know what works best, how it should be implemented and what sorts of messages work for which audiences. It is important to have both the tools and techniques of communication ready, tested and validated. Successful communication depends on the technology and channels working so that you can make and receive the calls no matter how dire and fast-moving the health threat is spreading.
It is, however, the application of appropriate knowledge, research and subject matter expertise that helps ensure that one makes the right call at the right time to the right people.
Plague is not the only infection on the list for human history’s top pandemics. As early as 430 BCE, a pandemic emerged from the horn of Africa and eventually devastated the empire of Athens. The infection agent is unknown but may have been typhoid, typhus fever, smallpox or even anthrax. What is known, however, is that the human toll, as well as economic, social and military losses, were staggering. In recent centuries, epidemics and pandemics have recurred on a periodic basis.
During the 1870s and 1880s, the yellow fever pandemic in the Mississippi River Valley in the south central U.S., ranging from New Orleans to Memphis, claimed more than 20,000 victims. Around 1916 and continuing for decades, the polio epidemic killed (as high as a 25 percent fatality rate) or maimed tens of thousands of individuals in the U.S. A smallpox epidemic on the Indian sub-continent killed more than 20,000 during the 1970s. Even in recent years, the threat of pandemic influenza, SARS, MERS, Ebola and other viral infections remains a serious concern. A quick search of headlines regarding epidemic and pandemic threats finds a lengthy list of potential pathogens. To read more about other epidemic and pandemic threats click here.
While many potential pathogens are frequently reported in the mainstream news headlines, many other serious threats are less well known, but potentially just as devastating (or even more so). Most people are aware of the serious threats from diseases like Ebola, Influenza, and HIV/AIDS. However, less well known, are the potential risks from diseases such as cholera and Tuberculosis (TB).
TB – The Underreported Threat
A report, released in late October 2015 by the World Health Organization (WHO), notes that the worldwide tuberculosis (TB) epidemic has affected hundreds of thousands more people than has HIV/AIDS. The WHO report notes that currently more people are dying from the TB epidemic than from HIV/AIDS. The report states that TB killed 1.5 million people during 2014 (in comparison HIV/AIDS claimed 1.2 million lives in the same year).
According to the WHO report, tuberculosis (TB) is a significant fatal infectious disease worldwide. In 2014, 9.6 million people fell ill with TB and 1.5 million died from the disease. Globally in 2014, an estimated 480,000 people developed multidrug-resistant TB (MDR-TB). According to the WHO report, TB is caused by the bacteria “mycobacterium tuberculosis.” TB is thought to spread from person-to-person through the air when people with lung TB cough, sneeze or spit, and subsequently propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected. Tuberculosis is curable and preventable, yet it remains a major infectious epidemic threat.
According to the WHO report, TB occurs in every part of the world. In 2014, the largest number of new TB cases occurred in the South-East Asia and Western Pacific Regions, accounting for 58 percent of new cases globally. However, Africa carried the most severe burden, with 281 cases per 100,000 populations in 2014 (compared with a global average of 133).
The same report does not state that the TB epidemic is expanding but that these surprising statistics are due in part to better monitoring, tracking and reporting of the TB outbreaks. According to the WHO report, in 2014, about 80 percent of reported TB cases occurred in 22 countries. The six countries that stand out as having the largest number of incident cases in 2014 were India, Indonesia, Nigeria, Pakistan, People’s Republic of China and South Africa. Some countries are experiencing a major decline in cases, while in others the numbers are dropping very slowly. Brazil and China, for example, are among the 22 countries with a sustained decline in TB cases over the past 20 years.
Vigilant Due Diligence for Health Risk Communication Effectiveness
TB is just one more example of an infectious disease risk, which threatens people’s health and daily social routines. Behavioral changes can be effective in limiting exposure and promoting quick medical intervention essential to corralling this disease. There are other infectious disease threats that can also be migrated with better health information and behavioral instructions. There is an urgent need to put further emphasis on health communication for disease transmission control and migration precautions to decrease infectious disease risks. Such risk communication efforts should be a priority for both public and private sector entities. This is a pathway to keeping people safe, keeping our schools and businesses operating and helping end widespread human suffering.
Obviously, public agencies and public health officials have communication planning priorities. What may be less obvious is that a pandemic will disrupt supply chains, transportation, infrastructure, business travel and result in high rates of absenteeism and loss of workforce. In some sectors, (e.g. healthcare, education, public events, marketplaces, etc.) the negative effects from a pandemic will be particularly disruptive with surges followed by stagnation periods. The preparation for the coming pandemic includes the critical aspects related to communication planning for pandemics. No matter your business sector, public or private, you need to develop communication plans and capacity to help both your people and your operations survive the coming pandemic.
Luckily, there are a number of resources and options (including comic art) to assist everyone in every situation to be better prepared for the coming pandemic – whatever and whenever it strikes. In doing so, we can hopefully prevent or reduce the number of heartbreaking personal (human health and safety) and business operations losses that inevitably occur with such outbreaks.