Photograph Source: 7C0 – CC BY 2.0
Rosenberg: As the former chief of communicable disease epidemiology at the New Hampshire Division of Public Health and deputy public health director in Manchester, NH, you wrote an oped a few months ago that compared COVID-19 with previous pandemics. Can you elaborate?
Dipentima: With smallpox, the only reservoir was humans and thus after the last human case the virus in the wild was eradicated. Diseases like COVID-19, influenza and many others have multiple primary and secondary reservoirs causing the viruses to live, multiply and spread to other animals even when the hosts do not become ill. In some cases, various strains of a virus can mix within a single reservoir and exchange genetic material, creating a novel virus.
Rosenberg: Are these risks growing and if so, what are the factors?
Dipentima: The risk of the emergence of novel viruses is growing due to greater encroachment of humans into animal habitats, climate change and increased population growth. There are particular species like bats and migratory birds that are reservoirs for viruses because of their frequent and easy contact with domestic animals such as poultry, swine and others.
This has been a particular concern in the “wet markets” in China and elsewhere where multiple species of wild and domestic animals have close contact and sanitary conditions are poor. There is a vital need to identify and quickly respond to the development of any novel virus especially in these settings where various viruses can infect a common host and share genetic material.
Rosenberg: Aren’t international health groups doing this?
Dipentima The global surveillance program conducted through the WHO should be greatly expanded, with teams of scientists spread around the globe to monitor unusual deaths in wild or domestic animals and surveillance of unusual cases of human disease presenting to local hospitals. Laboratory capacity must be expanded and easily available. High risk areas such as the “wet markets” must be better controlled and sampling of various species should be conducted to identify any emerging pathogen.
The WHO should hold monthly conference grand rounds with global surveillance teams to share information and establish a rapid alert system when any unusual event is taking place. A central database for all animal and human sampling, similar to the CDC’s PulseNet, should be established to identify any common links between samples taken from around the globe. International treaties and agreements should be in place to allow for a swift international response to a possible emerging pandemic anywhere in the world. Greater international funding and cooperation is needed in the areas of vaccine and antiviral drug research and development.
Rosenberg: As a public health official, you addressed hazardous waste, water contamination/pathogens, radon, rabies, salmonella, swine flu, Legionnaires Disease, Lyme Disease, antibiotic-resistant TB and AIDS. Which challenges have relevance to COVID-19?
Dipentima: For different reasons, different diseases that I have dealt with have relevance to the COVID-19 pandemic. Obviously HIV/AIDS is at the head of the list because it is a pandemic caused by a novel virus. The big difference is that HIV is not easily spread from person to person like influenza or COVID-19. In the very early phase of the HIV/AIDS pandemic there was a great deal of fear about how it was spread, discrimination against high-risk groups and politicization of the disease.
The SARS outbreak in 2003 is also very relevant to COVID-19 since both are coronaviruses with similar epidemiological characteristics. The reservoir in SARS was bats, with a secondary reservoir, civet cats, the source of the initial human infections. While with COVID-19, it is suspected that bats are also the reservoir, but no secondary reservoir has yet to be identified.
Lastly, the 1976 swine flu is relevant. Concerns were related to the possibility of a novel virus, like the 1918 “Spanish Flu.” While the pandemic never took place, the public health response of vaccine development and distribution was very applicable to COVID-19.
Rosenberg: You were a New Hampshire state representative for four years. What are the COVID-19 lessons for lawmakers?
Dipentima: First, all elected officials must understand that the most important function of government at all levels is to protect the safety and wellbeing of its citizen and to, first, “do no harm” as is said with physicians. One of the most damaging effects of the current COVID-19 pandemic has been its politicization –– the spreading of fear, doubt and lack of respect for science and public health officials. This needs to stop.
Beyond that, especially at the state level, elected officials have a duty and a responsibility to carefully weigh the balance between public health and personal freedoms. When individual personal freedom interferes with the health and safety of the entire community, there must be reasonable accommodations made to protect the public. This has always been the case during times of crisis like during WW II or after 9/11. The use of a pandemic or any crisis to further any political goals or objectives, either personal or broader, should be rejected.
Rosenberg: Did public health officials “drop the ball” with COVID-19?
Dipentima: The current pandemic has demonstrated all too vividly how weak our public health surveillance, epidemiological, and laboratory capacity is in the U.S. It also demonstrated how ill prepared we were to quickly provide the necessary PPE to health care workers and the general public. Public health messaging was also very inconsistent and much more attention must be given to preparing public health professionals to communicate risks during a crisis.
The leadership of CDC during the current pandemic was a disaster. The director of the CDC is now a political appointee and the system should be changed back to the way it was prior to 1982, when the director was appointed based on public health qualifications and experience. It is inevitable that another novel virus or other pathogen will emerge sometime in the future and the sooner such a pathogen can be identified, the better the chance to stop it before it becomes a global pandemic.