ECDC experts Dr Agoritsa Baka and Dr Diamantis Plachouras tell HEQ about public health planning infection control policy during the COVID-19 pandemic.
The European Centre for Disease Prevention and Control (ECDC) is an EU agency aimed at strengthening Europe’s defences against the spread of infectious disease through surveillance and data gathering; public health training and communication; strategic partnerships with policymakers and stakeholders; and preparedness activities.
HEQ speaks to Dr Agoritsa Baka, the ECDC’s expert in emergency preparedness and response, and Dr Diamantis Plachouras, expert in antimicrobial resistance and healthcare-associated infections, about infection control and COVID-19.
Before the spread of COVID-19, what measures did the ECDC have in place in preparation for an international pandemic?
AB: The EU’s Decision 1082/2013, which covers serious cross-border threats to health, provides a legal framework for the Health Security Committee, a co-ordinating body which is made up of high-level representatives from the EU Member States’ ministries of health and the European Commission. There is also Article 4, which came into effect in 2009 and requires Member States to complete a regular survey on their preparedness: the results of the survey are confidential; the data is passed on to us at the ECDC to analyse and propose improvements. This has helped significantly in the last 10 years.
The ECDC does not have a mandate to control preparedness in the EU Member States, but what we could do is organise workshops for Member States to share their preparedness plans with each other, and their lessons learned from different crises, so we have been doing that with different key topics. We have analysed issues in the different Member States including imported cases of non-native diseases, such as Middle East Respiratory Syndrome (MERS), and newly emerging cases like vector-borne diseases; we assess how the Member States responded to those issues and try to identify lessons for the others to follow.
Before the COVID-19 pandemic began, the ECDC organised a series of workshops where we had representatives from Member States work with each other to identify what the cross-border issues would be in case of a new pandemic. All the participants indicated that their 2009 pandemic influenza plans were in review; that they had to deal with all the other sectors and this was difficult; and that they did not have many resources on this issue. Resource availability and allocation, particularly in terms of the resources devoted to planning, is a perennial issue within public health.
Is there a risk that patients who may be seriously ill with conditions other than COVID-19 – such as heart attacks – will deliberately avoid or delay going to the hospital for fear of catching the virus?
DP: This is probably one of the biggest concerns surrounding COVID-19; and its impact has been really underestimated as public health issue. There have been several reports from countries around the world highlighting decreasing numbers of non-COVID cases: for example, the number of cases treated for acute myocardial infarction fell by roughly 50% during the pandemic. Similar decreases in diagnosis of the most common types of cancer have been observed. Meanwhile, there has been a reported increase in incidents of cardiac arrest out of hospital, which may be related to suboptimal treatment for acute heart conditions.
It cannot be the case that actual incidences of heart disease and cancer have decreased because of the pandemic: the most likely reason is that patients are still getting ill, but they have avoided or delayed seeking medical care because of fear of getting infected. Another probable factor is that during the peak of the pandemic, especially where lockdown measures were in place, patients were actively discouraged from seeking care for health issues that were not urgent – because, of course, not only are there concerns about the spread of infection, but also it had a huge impact on the availability of hospital beds and other resources in healthcare. However, it is now of paramount importance to ensure that all essential health care can continue and that the population has access to the necessary services to avoid an epidemic of other diseases in addition to COVID-19.
Is misinformation a concern in addressing the spread of COVID-19?
AB: There is a new term for this: the ‘infodemic’. In 2009, during the most recent influenza pandemic, there were some damaging rumours which has an impact on vaccine uptake. This time the public health organisations have tried to be much more active on social media, but now everybody else is also on social media and there are many more forms of media around, so that situation is even tougher for us. The ECDC has developed different solutions to this: we have question-and-answer sessions on all the issues; we have been answering questions on social media; and we reach out to different outlets to correct or clarify inaccurate reporting. We collaborate closely with social media platforms – all the big platforms like Facebook or Twitter have verified our documents as truthful and have been referring people searching for COVID-19 information to our website – and we issue official statements if they are needed to prevent key issues from being misunderstood.
We also have to acknowledge what is called COVID fatigue. We’re already in month 10 of responding to this pandemic and we have to acknowledge that a degree of fatigue on the part of the public is to be expected and should be targeted. We still have work to do with younger people, who can see that the risk that they have is much lower than older people, so it’s extremely difficult to persuade them to put their lives on hold.
What actions can the public take to support healthcare staff, other than by observing government and medical guidelines on social distancing and self-isolation?
DP: The most important thing for the public is to follow the recommendations to help control the pandemic and minimise its impact. In Spring, during the peak of the pandemic, we saw demonstrations of support for healthcare providers by the public: they were quite moving and I suppose they are welcome, but the most important thing is that the public follows the guidance. Another very important point is that the public needs to be informed. There needs to be risk communication; and there always needs to be clear guidance from the authorities about the role of the healthcare system, as well as the roles and work of healthcare providers, so that there will not be any misconceptions or about healthcare providers as carriers of the disease. It is the responsibility of the authorities to ensure that the public is not misinformed in this respect.
What can be done to minimise the risk of infection in nursing homes and care facilities?
DP: COVID-19 has had an enormous impact on long-term care facilities, especially nursing homes. In some countries, close to half of the reported deaths have been nursing home residents, so it is of utmost importance to shield this population. The ECDC, along with national health authorities, has published its guidance on this front: the most important actions are firstly, to ensure awareness of the problem; and secondly, to make sure that there are appropriate infection control measures in place such as social distancing, hand hygiene and wearing a face mask.
What is also important is establishing policies for safe visits, which are very important for the residents of nursing homes. We must not overlook the social needs of these people; and this means we must find ways to balance the risk of infection with the risk of social isolation. We have seen many situations where these people are isolated and their mental health suffers very badly. The success of these measures is largely dependent on collaboration with public health authorities, and necessitates very clear risk communication and training.
Has the COVID-19 pandemic played a role in accelerating the development and uptake of new innovations and technologies within the field of infection control?
AB: Some of the largest breakthroughs have been in vaccine production – we are probably going to have vaccines which are completely new and which have been developed and produced using new technologies to enable faster production – and we have seen a lot of innovation within contact tracing. Within infection prevention and control specifically, we are revisiting guidance that had previously been considered standard, because some of that guidance comes from as far back as the early 1900s.
DP: We are seeing enormous amounts of new research and a lot of new findings; there have been innovations resulting from research related to COVID-19. The most important measures for preventing disease transmission are largely already known, but we do still need to improve our approach and integrate any new findings into our infection prevention measures. There have also been technologies that were already available but which are now being improved or repurposed – these commonly have to do with ventilation, environmental cleaning or air filtration – but of course we still need to see more robust evidence for the antimicrobial benefits of these devices before we can recommend widespread adoption.
Of course, there have been huge leaps in new technologies for the development of vaccines. What we are seeing now is unprecedented. We didn’t know the existence of this virus 10 months ago; and now we are very close to having a vaccine – and it has not been an easy challenge, because there had not been any vaccines for coronaviruses before. There have also been a great many developments around the apps and mobile technologies needed for contact tracing programmes. This has been moving forward very fast, but we do always need to keep in mind the issues which have to do with personal data protection. We need to make sure that people’s data security is taken into account.
Dr Agoritsa Baka
European Centre for Disease Prevention and Control