Coronavirus shows the urgent need to invest in health infrastructure

by Raywat Deonandan

This article was first published in The Ottawa Citizen on Mar 13, 2020. A longer version is available here.

Bill Gates recently speculated that COVID-19 could be the “once in a century” disease whose severity rivals that of the 1918 Spanish Flu. That disease was so dire that it likely played a role in ending the First World War, having removed so many soldiers from the battlefield.

COVID-19 has already caused profound economic, psychological and even climatic impacts. But with a century of experience since the Spanish Flu, how resilient is our health infrastructure against this and future pandemics?

The 2019 Global Health Security Index ranked 195 countries according to their abilities to prevent, detect and respond to biological threats. Overall, the world scored a disappointing 40.2 out of a possible 100 points, with the United States ranking as the most secure nation with a score of 83, and Canada ranking a respectable fifth with 75.3 points.

Canada’s comparatively high score is based mostly on our detection capability, due in large part to our excellent laboratory facilities and well-trained workforce, both of which received perfect scores. Our ability to respond to an existing epidemic, though, was not as well rated, at 60.7.

The capacity to respond is a systems management issue. During a pandemic, a nation needs a robust health care system that can treat people at scale and quickly isolate carriers. With international coordination, we also need an integrated biopharmaceuticals industry that can rapidly develop, test, manufacture and deploy vaccines and treatments. And this all hangs upon a communications infrastructure for information dissemination and the assuagement of panic.

We should be investing more in disease surveillance. Knowing when and where new cases of diseases occur can inexpensively guide resource allocation. In the era of digital communication and data capacity, getting accurate, real-time information on incident cases should not be as challenging as it is.

And yet, globally, surveillance is fundamentally weak, with many countries having trivial capacity to identify outbreaks. In Canada, though, scores of diseases are monitored by dedicated surveillance programs. We have a good grasp of our influenza burden, for example, because of our national flu surveillance system, FluWatch. The inclusion of COVID-19 in this paradigm would help us track and manage that disease’s spread.

Related data tools help to draw relationships between clusters of cases, making instances of “community transmission” less mysterious. Absent such tools, cases can appear to manifest without a clear transmission route, fomenting panic and confounding containment efforts. Canada has world-class expertise in such analytics. We need the resources and leadership to deploy that capability onto the field at scale.

Scale is the magic word for pandemic response. All nations’ outbreak plans assume relatively low numbers of cases. But if hospitals become overwhelmed, how do we distribute care at a national level? And do we have the legislative power, ethical oversight and political cover to enact more restrictive isolation policies, should that need arise?

The one preparedness category in which Canada received a score of zero was in our failure to exercise our response plans. In the wake of SARS, much thought went into building our Maginot Line against the next viral assault. Yet that bulwark remained truly untested until now.

So even if COVID-19 is not the “once in a century” disease Bill Gates warned us about, we can nevertheless consider it a working test of our pandemic resilience systems, which will no doubt be challenged repeatedly and at greater intensities in decades to come. We can choose to invest in the appropriate infrastructure to keep Canadians safe from pandemic disease, now and in the future.

Dr. Raywat Deonandan is an Associate Professor, Epidemiologist, and Assistant Director of the Interdisciplinary School of Health Sciences, University of Ottawa.