What Does a Coherent Pandemic Response Look like?

In my last two posts, we talked about there already being a clear framework of principles for conducting an outbreak response (Gregg, 2008). 

• Principle 1: Outbreaks should be led by public health, not by elected officials (Van Bavel et al, 2020). 
• Principle 2: A transparent, inclusive, collaborative outbreak team must be immediately struck to manage all aspects of the outbreak. 

We’ve seen how both of these fundamental principles have been violated in the pandemic response for Canada - a country that is generally viewed as having had one of the better pandemic responses, globally. Here’s the next principle. 

Principle 3:  An effective diagnostic test must be made rapidly and widely available, accompanied by a coherent testing strategy. 

In spite of ample warning and a billion dollar federal  commitment to pandemic preparedness, (CIHR, 2014) a coherent, proactive national process to ensure that an effective test could be made available never emerged. Furthermore, our discussions with public health managers  in both Federal and Provincial governments indicated that even when a test became available, its use was seriously hampered (at least in some provinces) due to still unresolved issues over data confidentiality, turf wars, decision paralysis and a deep rooted government culture of controlling data at the expense of health outcomes. 

We are still unaware of what the national testing strategy consists of  at any reasonable level of detail, despite multiple inquiries at the federal, provincial and local levels. For example, in a  conversation with a Member of Parliament on the Federal COVID Committee, the Honourable Member, to his credit - admitted that he knew essentially nothing about public health or infectious disease and apologized  that he  likely couldn’t provide any useful responses to our questions. 

 Ironically, in early May, the Prime Minister himself announced that a national testing strategy for COVID 19 wouldn’t work (Conolly, 2020) and that the Federal Government would instead support the provinces in their testing strategies. What he was actually describing is in fact a national testing strategy - the very one that has been used for decades by Canada for all nationally notifiable diseases, and the one, presumably,  being used now by the Public Health Agency of Canada for COVID 19 (Government of Canada, 2020).  

 This illustrates another reason why outbreak response, including communications, must be led by public health professionals: messaging by political interests lacking a coherent understanding of the public health process creates confusion and mixed messages and justifiably erodes trust among the public and public health experts (Van Bavel et al, 2020) . 

Questions: in your community, state, province or country, what is the testing strategy for COVID 19? Has it been explained clearly? For example, who is being tested, when, why and how? How are the data being used to reduce the spread and impact of infection? 

References: 

Canadian Institutes of Health Research. Evaluation of the Pandemic Preparedness Strategic Research Initiative Final Report, 2014

Connolly, A. ‘National coronavirus testing strategy wouldn’t work for Canada, Trudeau says’. Global News, 7 May, 2020.

(Government of Canada. Coronavirus disease (COVID-19): Outbreak update,  2020

Gregg, M. Field Epidemiology. New York. Oxford University Press, 2008. Print. 

 Van Bavel, J.J.,  Baicker, K., Willer, R. (2020). Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behaviour, 4, 460–471.