#14,497
The prospects for having a safe and effective vaccine in any meaningful quantity during the opening months of the next influenza pandemic are undeniably slim (see WHO: Influenza Vaccine Response During The Start Of A Pandemic), and are likely even bleaker for a non-influenza pandemic (see The JHCHS #Event201 (Fictional) CAPS Pandemic Scenario).
While we may have access to some (finite) quantity of antivirals, they are likely to become in short supply early on. And for many countries around the world, even antivirals may be difficult or impossible to obtain.The bottom line is, we will all have to depend primarily upon NPIs - or Non-Pharmaceutical Interventions - to slow the spread, or blunt the impact, of the next pandemic. The CDC’s Nonpharmaceutical Interventions (NPIs) webpage defines NPIs as:
Nonpharmaceutical interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu). NPIs are also known as community mitigation strategies.Social distancing, staying home when sick, hand and respiratory hygiene, avoiding crowds, even the closure of schools or other public venues are all potential NPIs. And are all topics we've covered extensively over the years (see here, here, here, here, and here).
NPIs won't stop a pandemic, but their use could slow its spread, and potentially give more time for the development or deployment of a vaccine or other countermeasures.
Even though the number of infections and deaths would likely be the same, a sharp, steep epi curve (shaded purple above) would be far worse for society than a longer, albeit less intense pandemic wave (grey hatched).
The rub being that there is a paucity of quality evidence on - and little agreement over - the merits, the potential downsides, and the proper timing of many of these measures.When do you close schools? And for how long? What advice should be given to the general public about social distancing, or the use of face masks in public, or traveling during a pandemic? What measures should employers use to reduce viral spread in the workplace?
Addressing these questions - even while acknowledging that often the evidence for their effectiveness is slight or of low quality - the World Health Organization has recently published a 91-page NPI Guidance document.
Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza
Authors:
World Health Organization
Publication details
Number of pages: 91
Publication date: October 2019
Languages: English
ISBN: 978-92-4-151683-9
Downloads
Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza guidance PDF, 1MB
Annex: Report of systematic literature reviews
PDF, 3MB
I've just received the link to these document yesterday, and haven't had time to fully digest their contents, and so I'll probably have an update in the next couple of days. But I wanted my readers to have access to it as soon as possible.
This report does differentiate between pandemics (or seasonal epidemics) of varying intensity, and allows for more aggressive recommendations as the severity increases (see chart below), despite the low quality of evidence for some of their effectiveness.
It remains to be seen how well - or widely - these recommendations will be followed during a crisis. At first glance, I can see some areas where opinions are likely to differ, particularly over the timing of school closures, face mask recommendations, and the screening of travelers.
I'll be posting one or more follow ups on this guidance after I've had time to read it in its entirety.
