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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Why Are We More at Risk Than Ever for a Global Pandemic?

APR 28, 2017 | SASKIA V. POPESCU
CNN recently aired their film, Unseen Enemies, which took the viewer through the journeys and challenges of infectious disease experts and the growing risk of a pandemic from an unknown organism. Following this, they wrote about the seven reasons we are more at risk than ever for a global pandemic. The authors drew from the realities that the next outbreak will most likely be a surprise, the truth that disease knows no boundaries, and that we are only as prepared as the weakest public health system within a country. The seven reasons they noted were:

1.      Growing populations and urbanization,
2.      Encroaching into new environments,
3.      Climate change,
4.      Global travel,
5.      Civil conflict,
6.      Fewer doctors and nurses in outbreak regions, and
7.      Faster information.
 
These are all logical and well-supported reasons; however, I would like to add two more.
 
The first addition I would make to this list is attitude. The current attitude towards infectious diseases puts us more at risk. Ebola brought the realities of borderless outbreaks to the forefront, especially with availability of faster information. Industrialized countries view diseases—emerging infectious diseases, in particular—differently than developing countries. In the United States, we relish our vaccine availability enough that we refuse it and often see emerging diseases as third world problems. Ebola showed us two things; the unfounded and irrational fear that occurred in the United States, and the lack of preparedness or acknowledgement that a disease in West Africa could venture across the pond. In an age of globalization and rapid information sharing, it is tragically ignorant to think we are immune to diseases in foreign countries. This archaic mentality only hurts preparedness efforts at home and foreign aid abroad.
 
We tend to focus on chronic diseases and forget the growing threat of infectious diseases. Sadly, if we think about it, this usually leads to a dangerous and debilitating fear. Outbreaks of novel or emerging infectious diseases often create ethical dilemmas for healthcare workers. The HIV/AIDS epidemic saw healthcare workers refuse to treat patients with AIDS and Ebola was no different. Hospitals are not immune to fear and that trickles down to those caring for patients. This was prevalent in every country, but the cases in Dallas, Texas raised several questions when healthcare professionals refused to care for potential patients as their hospitals prepared.
 
Not only does this viewpoint of emerging infectious diseases as “third world country problems” damage response efforts, it frankly undermines prevention strategies. Programs such as the Global Health Security Agenda seek to change this view and are making great strides; however, it leaves many to wonder if it will take a disease springing up in our own backyards to have a cultural shift.
 
A second addition to this list would be the role of healthcare infrastructure. As Gates emphasized, those countries most likely to experience an outbreak typically have the most underfunded and understaffed healthcare infrastructure. Physicians and nurses alike are desperately needed in developing countries; however, it is important to include another role that is often forgotten: infection control and prevention. Although there are fewer doctors and nurses in outbreak regions, there is also something to be said about the grossly underfunded and underutilized role of infection control as a preparedness and response tool.

Whether it is in the United States or in a developing country, infection prevention and control programs are vital for both patient and employee safety, frequently understaffed, and economically strained. Healthcare is a booming business across the world and people often use hospitals as their primary care source. As public health funding may potentially take a big hit with President Trump’s proposed budget, front-line surveillance and outbreak control will be ever more dependent upon infection control programs within hospitals. Rapid isolation, testing, personal protection equipment (PPE) use, hand hygiene, and communication with public health departments are just a few of the current responsibilities of infection control programs, but these will grow and become even more vital in the future.
 
Although the US public health and healthcare systems rallied to prepare against Ebola, little has been done to maintain hospital preparedness against special pathogens or train workers against potentially unknown or emerging diseases. If we fail to utilize this resource and let the focus of infection control program fall solely on healthcare-associated infections and federal reporting for Centers for Medicare & Medicaid Services (CMS) reimbursement, hospitals will become increasingly vulnerable to failures when dealing with organisms of pandemic potential.
 
It is not surprising that the initial Ebola case in Dallas, Texas was overlooked, but it is nothing short of a miracle that more cases did not come out of the infected patient’s emergency department visit. The United States struggles with infection prevention efforts, whether it be hand hygiene or PPE use, and sadly, we are not alone as most countries face the same challenges. Perhaps the most frustrating part is that infection control programs serve a vast spectrum of roles—healthcare associated infections, antimicrobial resistance, diseases surveillance, etc. Not only do infection prevention programs strengthen hospital preparedness for known pathogens, but well-supported programs can also educate and train healthcare workers to utilize precautions against an unknown organism. Healthcare workers already struggle to use PPE during flu season—this will only get worse during a mass influx of patients and strained resources. Strengthening the support for infection control programs allows for training to ensure staff have the education, supplies, and critical skills to rapidly isolate a patient who appears to have a disease of infectious etiology. Whether it is working with an obvious diagnosis or one that requires additional testing, giving healthcare workers the education and training that makes isolation and PPE-use second nature will prevent a multitude of infectious diseases emergencies.
 
Overall, the way we look at emerging infectious diseases, our role in preventing and responding to them, and how we utilize (or fail to utilize) healthcare have created a substantial vulnerability for future public health threats. We have more than enough proof to show how vulnerable we all are to infectious diseases and how vital hospital infection control is to not only internal infections, but also preventing the spread from the community. Now is the time to truly utilize a holistic approach—including infection control programs, public education and cultural awareness, and more—to prevent the next pandemic. 
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