Coronavirus care planning is more important than containment

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Although quarantines and the number of affected people dominate the headlines on the coronavirus, emergency preparedness, not containment of COVID-19, is the most appropriate response, said Amesh Adalja, MD, an infectious disease specialist at the Johns Hopkins Center for Health Safety in Baltimore
"We are seeing an exaggerated reaction in the form of quarantines," he told Medscape Medical News. "But that is not the full picture of the virus."

The first very aggressive actions taken in China set the tone for the world, Adalja explained. "It will take time to adjust the response. We need to get away from focusing on containment and understanding how it affects humans."
Adalja will attempt to unravel the mystique around the new coronavirus, with updated information on the error, during a panel discussion on global threats to health security at the 2020 Critical Care Congress of the Critical Medicine Society (SCCM) in Orlando

In general, our health systems may be more prepared than in the past, but making the right decisions remains a challenge, he explained.

More than 80% of affected people have a mild form of COVID-19. "This is not SARS," he said. Although the respiratory transmission of COVID-19 makes its spread very efficient, the disease caused is milder than what was observed during the SARS outbreak.
Given the current information, Adalja said he believes that the severity of COVID-19 is somewhere between a coronavirus acquired in the community, such as OC43, HKU1 or NL63, and SARS. It is likely to evolve similarly to H1N1, from a new strain of pandemic coronavirus to a seasonal endemic strain that causes about a quarter of the common cold cases, he said.
Still, there will be an impact on the ICU.

ICU impact
"Like any respiratory disease, the elderly and those with other medical conditions are the most affected. That's where it is grouped, so hospitals must be prepared for a wave of patients," he warned.
Because this is the first year of the virus, it is likely to hit it hard this year, "but it will be a mild pandemic," he predicted. "We now know that it is not like SARS; it is not so fatal. That is a relief."
An influenza pandemic caused by viruses in the air is inevitable, according to a 2019 report on health emergencies from the Global Preparedness Monitoring Board, the World Health Organization and the World Bank. And the current preparation is "extremely insufficient."

A fast-moving pathogen has the potential to kill tens of millions of people, disrupt economies and destabilize national security, the report warns.

COVID-19 is unlikely to cause the massive disturbance described in this report, but experts continue to press for better preparation.

Hospitals in the USA UU. They have done some preparation. Providers of the Centers for Medicare and Medicaid Services have been required to have some level of emergency planning established since a final rule was published in 2016.

But the strength of those plans differs. "The emergency committees vary; some simply mark the required check boxes and others are more emboldened and look for threats," Adalja explained.

When an epidemic arises, it is important to have contingency plans. "You don't want to be answering on the go," he said.

The key is to understand the epidemiology of a new infection. "In the early days, you get data that is very asymmetrical; first you hear about gravity, about ICUs and deaths," he said. Quick action is required, but with epidemiological understanding.

This is a point of view of others, including psychiatrist Dinah Miller, MD, who recently wrote about public anxiety out of proportion to the threat posed by COVID-19 in a Medscape comment.

Still, COVID-19 will be detrimental to hospital operations, Adalja said. "It will be something that hospitals will have to deal with, and most are functioning at full capacity now. ICUs are critical for the part of the population that will get a serious illness, and they have to be prepared. Do they have enough beds? insulation? Fans? There may be a demand for extracorporeal membrane oxygenation. All this can be a challenge, "he said.

Although the ICUs are much more prepared for a pandemic than ever before, "we need to practice good judgment," said Adalja. "It's about knowing when to apply emergency measures."

Travel bans and quarantines increase panic, he said, and "do not reflect the mostly mild individual risk."

The movement restriction is "one of those things that will be controversial from a medical point of view," said Anand Kumar, MD, of the University of Manitoba in Winnipeg, Canada, who will discuss preparation at the next SCCM meeting.

But at this time, it makes no sense to issue travel bans, he said.

"We need to stay focused on rising seas and not get too distracted by tsunamis," Kumar said. "Of course, tsunamis have more journalistic interest," he acknowledged, but "antimicrobial resistance is the rising sea in the area of ​​infectious diseases. It is rapidly becoming a big problem."

Blood tests are being developed that quickly identify pathogens and can measure drug resistance. Short-cycle antimicrobial therapy, which has proven effective for intra-abdominal infection, should be investigated further. The administration of antimicrobials is increasingly important in the fight against antimicrobial resistance. "Genetic testing techniques are also improving," Kumar said, providing doctors with more narrow-spectrum therapies to offer.

But the most desperate is the need for new antimicrobials. "They have not been a high priority for pharmaceutical companies because they are not profitable," Kumar said.

"We need to get inland enough to keep dry of both antimicrobial resistance and tsunamis, because either can flood you," he added.

Society for Critical Care Medicine (SCCM) Critical Care Congress 2020: Session 1351. It will be presented on February 16, 2020.

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