Avian Flu Diary: ECDC Guidance: Lessons from the COVID-19 pandemic

#17,433

Between 2006 and 2008 - when H5N1 was simmering in Southeast Asia and making its first forays into Europe and Northern Africa - we saw a global push for pandemic planning. Nearly every nation (and here in the U.S. every state and most branches of the government) held drills and produced their own `pandemic plan' (see here, here, here, and here).

The plans varied greatly in their approach, with some envisioning a repeat of the devastating 1918 pandemic, while others were preparing for a much milder 1957-style influenza outbreak (see A Tale Of Two States).

Even those plans that were based on a moderate-to-severe pandemic often relied on having quantities of `assets' (ventilators, ICU beds, vaccines, PPEs, etc.) that were highly optimistic. No one really knew what a modern severe pandemic would look like, and what challenges would arise.

Dr. Michael Osterholm, director of CIDRAP, came awfully close however in 2005, when he likened a severe pandemic to an 18-month global blizzard, where nearly everything is shut down. Many would be without a paycheck, either due to their refusal to work and risk exposure, or because their jobs are simply no longer available (see Baby, it's Cold Outside).

The avian flu threat began to retreat, and instead we were hit by the 2009 H1N1 pandemic, which was the mildest of the 3 pandemics following 1918 (2009, 1968 and 1957). It ended in 2010, with many convinced that severe pandemics were a thing of the past, and planning was a waste of time and resources.

Over the next decade, despite repeated warnings (see World Bank: World Ill-Prepared For A Pandemic), and dismal report cards on the world's readiness for another pandemic (see WHO: Survey Of Pandemic Preparedness In Member States), there was more talk about preparedness than actual action.

Pandemic drills and simulations (other than a few tabletop exercises) became rare. Pandemic plans gathered dust, and were rarely updated. Our Strategic National Stockpile (SNS) was inadequately replenished after the 2009 pandemic, and little real thought was given to a non-influenza threat.

As a result we entered the 2020 COVID-19 pandemic wholly unprepared for a fast moving, moderately severe pandemic. HCWs (and the public) lacked proper PPEs, ventilators were in short supply, hospitals were overwhelmed, governmental and public health messaging was a mess, and as predicted by Osterholm, the world went into an extended economic (and supply chain) deep freeze.

While the next pandemic may not look anything like COVID-19, it is imperative that we glean what we can from the past 3 years, and use it to help the world prepare for whatever comes next.

To that end the ECDC is conducting an ongoing after-action review of what worked, and what didn't, during the COVID response. Today they have published a guidance document (see summary below) to assist EU member nations in revising their pandemic or emergency preparedness plans.

The actual report is a 27-page PDF file, and is worth reviewing even if you aren't in the EU.

With H5N1 nipping at our heels once again - and an array of other threats in the wings - we can't depend on having another 10 or 20 years before the next global public health crisis.

We can't afford to squander whatever time we have left to prepare.

First the summary, and a brief excerpt, from the report. I'll have a brief postscript after the break.

Lessons from the COVID-19 pandemic - May 2023
Guidance
2 May 2023

This document aims to collate and present the lessons identified from the public health stakeholders who responded to the COVID-19 pandemic. It is intended to serve as input for countries revising their pandemic or emergency preparedness plans.

Executive summary

This document aims to collate and present the lessons identified from the public health stakeholders who responded to the COVID-19 pandemic. It is intended to serve as input for countries revising their pandemic or emergency preparedness plans.

A structured review of the response to a public health threat in order to learn lessons for future response should be built into the continuous preparedness cycle of anticipation, response and recovery from an incident. The COVID-19 pandemic presents a unique example of public health response to a severe incident and lessons should be quickly identified and used for the updating of pandemic preparedness plans. After-Action Reviews (AAR) and In-Action Reviews (IAR), for which ECDC has developed guidance, are valuable tools to assist countries in this process.

During 2021 and 2022, ECDC carried out a number of activities to identify lessons and collect insights from the response to the COVID-19 pandemic. These activities took the form of an internal exercise with ECDC experts; a review of country lessons reports; discussions with the Member States and two consultation sessions: an expert consultation on the evaluation and implementation of non-pharmaceutical interventions (NPIs), and an expert meeting on lessons learned from the COVID-19 pandemic. Lessons from these activities were collected systematically, initially in nine thematic areas. The information was then further collated into four lesson areas, each one representing a critical component of the response to a health threat:

Lesson Area 1: Investment in the public health workforce
Lesson Area 2: Preparing for the next public health crisis
Lesson Area 3: Risk communication and community engagement
Lesson Area 4: Collection and analysis of data and evidence.

This report presents the lessons identified in each of the areas, together with activities and future action where ECDC can contribute. Discussions on the prioritisation of ECDC follow-up actions are ongoing with the countries of the EU/EEA (European Union/European Economic Area) through the ECDC networks and governing bodies.

Lessons from the COVID-19 pandemic - May 2023 - EN - [PDF-1.13 MB]

As mentioned in my introduction, while most countries had a pandemic plan going into the COVID emergency - as the following excerpt addresses - they were outdated, and wholly inadequate for a novel (non-influenza) pathogen.

(EXCERPT)

Several lessons identified through the above activities refer to the existence of an emergency plan. Even though many countries had a pandemic preparedness plan available at the beginning of 2020, these were mostly influenza pandemic plans and, in many cases, they were outdated. According to the discussions with country representatives, the characteristics of an ideal preparedness plan are:
that it includes various scenarios, even worst case scenario(s), and algorithms of response;

that it addresses various pathogens and hazards;

that it is flexible and scalable, depending on severity and duration of the crisis;

that it addresses all-government intersectoral response with clear roles and responsibilities;

that it address surge capacity issues for staffing;

that it is tested through simulation exercises and updated regularly, including sectors beyond health;

• that it addresses risk communication, community engagement and community response extensively (see also lesson area 4).

In addition, one of the conclusions of the ECDC expert consultation on the implementation and evaluation of NPI measures [5], for the updating of the preparedness plans, is that they should account for the implementation of NPIs, based upon factors such as the phase of the pandemic, the expected effectiveness of the NPI in a given socio-economic and political context, behavioural insights, socio-economic impacts, and levels of uncertainty.

(Continue . . . )

While COVID was bad, it was not the absolute worst that nature could serve up. We might get lucky with the next pandemic, but Avian (H5 or H7) flu, Nipah, MERS-CoV, and Virus X could all far exceed SARS-CoV-2's impact.