Public Health Fundamentals in the Prevention and Management of a Pandemic (COVID-19)
Preliminary prevention (aims to anticipate, alert, and prevent outbreaks or contain and stop them in the early phase)
Component 1: Preparatory processes - strengthening the public health system, providing pertinent education and training, communicating hazards and risks, building teams and establishing an incident command system, ensuring baseline optimal function and surge capacity, stockpiling key equipment and supplies, and updating alert and response procedures.
Component 2: Epidemiological measures – monitoring, using, and analyzing environmental and demographic data to identify risks and development of potential outbreaks. Conducting investigations and field studies to further evaluate hazards and risks.
Primary prevention- intervening before a pandemic occurs through vaccinations, altering at-risk behaviors, and enact public health laws to ban known associated factors with the viral infection. As of May 2020, eight candidate vaccines are being tested in clinical trials, and, in addition, there are more than 100 research efforts around the world racing to come up with COVID vaccines. As early as April 2020, states have started to reopen and this raises the concerns of whether people and companies will continue to consistently use face masks, practice good hygiene/sanitation and social distancing.
Secondary prevention - screening to identify the disease in the earliest stages, before the onset of signs and symptoms through testing, contact tracing, isolation, and quarantine. Rapid detection of COVID-19 cases requires widely availability and accurate diagnostic tests to control this fast spreading infection; however, the availability and capacity for testing were alarmingly inadequate, especially during the early phases of the pandemic. Having sufficient numbers of contact tracers and support staff is also a significant challenge; digital technologies likely will be needed in some ways given the scale and reach of contact tracing.
Tertiary prevention - managing disease post diagnosis to slow or stop disease progression through measures such as supportive care with oxygen, antithrombotic therapy, antiviral drugs, immune-based therapy, rehabilitation, and screening for complications. Antiviral drug(s) is primary, since they target the source of illness. As of May 2020, Remdesivir is the only approved investigational antiviral drug to be used in treating suspected or laboratory-confirmed, severe, hospitalized COVID-19 patients.
Post-hoc prevention – collecting ongoing information, studies, tests, and then pool all these data together for critiques and analyses to come up with the best evidence-based policies, treatment, and management to support tertiary prevention (slow, stop the disease, and to prevent complications) and to formulate a roadmap to better manage and prevent similar future pandemic.
If we do the preliminary and primary prevention “right”, then we are in good standing and the risk of a deadly pandemic is measurably reduced. If not, then secondary, tertiary, and post-hoc prevention will have to be used, and they are less attractive choices once a viral pandemic is spreading fast and circulating everywhere.