Summary of Lessons Learned from Previous Pandemics and Infectious Disease Tabletop Exercises

(compiled from a variety of sources)

(Authored by Dr. Lu Tang, Associate Professor, Department of Communications & Dr.  Angela Clendenin, Instructional Assistant Professor, Department of Epidemiology & Biostatistics)

Containing and responding to an outbreak is about identifying infected individuals and taking preventive measures such as quarantine, isolation, and social distancing to prevent perpetuating viral transmission. This can involve actual quarantine, medical isolation, self-isolation, curfews, travel bans, or social distancing. Our previous experience with the 2009 Influenza Pandemic and 2014 Ebola Outbreak, as well as numerous high-consequence infectious disease outbreak tabletop exercises, has provided unique insight and opportunities to learn more about our ability and capacity to prepare and respond to such events domestically. In addition, as current coronavirus disease (COVID-19) events are unfolding as a global pandemic, we are able to begin compiling lessons learned from other countries in real-time.

Lessons From History

  • Actions

    • Social distancing, to include closure of schools, cancellation of large events, and providing options to tele-work have been cited in multiple publications as the primary and most successful non-pharmaceutical intervention.
    • Standardized operating procedures need to be in place to define actions such as quarantine, medical isolation, self-isolation, etc.
    • Consistent, clear, and simple messaging will be important especially describing the difference between vaccines, therapeutics, and other public health interventions.
    • The use of Flu Self-Reporting documents was initiated as part of the 2009 Pandemic Influenza outbreak, and it is mentioned how this action could facilitate social distancing and perhaps unburden the healthcare infrastructure in the early period of a pandemic.
    • After-action Review, a post-outbreak review of all actions taken as part of the response effort, of the COVID-19 outbreak will be imperative to enhancing preparedness and response improvements.
  • Considerations

    • It is important to reach rural populations and those who are underinsured or uninsured (limited access to healthcare) for distribution of any sort of medical countermeasures or other public health interventions.
    • State, local, and tribal officials indicated there needed to be more timely communication for non-English speaking (to include visually/hearing impaired populations) - there are multiple populations to consider when implementing public health measures at the community level.
    • Rapid deployment of and accessibility of testing is imperative. Some exercises have promoted and tested the idea of drive-through or externally-based “fever clinics.” These efforts are currently being implemented and tested in the U.S. (Colorado was an issue with people waiting in a car line for two hours only to be turned away based on an inadequate supply of testing kits to meet the demand; no data on the one in San Antonio at this moment; akin to the gas lines in 1976). Read below for South Korea’s experience with this measure.

Lessons from other countries during the current COVID-19 pandemic

  • Multiple Countries

    • Widespread testing and early diagnosis is vital. (S. Korea, Japan, and Taiwan)
    • Contact tracing and quarantine with standard operating procedures (SOPs) ensure consistency in implementation. (S. Korea and Japan)
    • Social distancing is working in many places.
    • Clear and consistent communication from governmental sources fosters compliance. (Singapore and Taiwan)
    • Big data and information technology to track movement and prevent community spread has been used in some places, but brings about ethical and privacy concerns.
  • Taiwan

    • Ensuring the availability of supplies reduces panic.
    • Educating the public empowers them to engage in preventive measures.
  • South Korea

    • Admitting all patients diagnosed with COVID-19 quickly filled up all hospital beds, and critically ill patients had to wait to be admitted.
  • China

    • In-home quarantine for those diagnosed with COVID-19 but who only have mild symptoms has been found to create an in-home danger in some cases, where there was subsequent transmission to family members quarantined in the same dwelling. This is a priority consideration when multiple generations are living in the same household. One suggestion followed in some countries has been to quarantine mild cases at central locations such as makeshift hospitals, hotels or dormitories. Another suggestion is to more explicitly instruct those quarantined in-home to self-isolate from others living in the dwelling as essential to successfully curbing the spread.
    • Mental health and post-traumatic stress disorder (PTSD) - Extended isolation can be detrimental to the public’s mental health, as well as that of healthcare providers and other emergency responders. Contracting the disease and recovering from it, especially for those who were in critical condition, can be traumatic. (We see that in China, but not in the U.S. since we don’t have many of those cases yet.)
  • Europe

    • The public failing to comply with or ignoring the risk from social distancing mandates has enabled the continued spread in some areas leading to stricter enforcement. (France and Italy)