Fear of the unknown keeps WHO infectious diseases team on its toes

Every month, approximately 300 reports cross the desk of Dr Sylvie Briand detailing an outbreak of a disease somewhere in the world.

Often, the report to the director of infectious hazard management for the World Health Organization will be of a localised incident with a limited number of people infected with a virus that is brought under control relatively easily.

On other occasions, however, outbreaks will be far more serious. Ebola, for example, was reported earlier this month in eastern Congo’s North Kivu Province and there are reports that a viral disease that can have a mortality rate of 90 per cent of those infected may have already spread to the city of Butembo, home to approximately 1.2 million people.

At least 211 people have died in what is already the impoverished nation’s worst outbreak of the disease.

And while the Congo case is extremely serious, Dr Briand says, advances in medicine and organised responses to more recent outbreaks have seen mortality rates drop to around 30 per cent.

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Her biggest concern is a previously unknown pathogen emerging and health authorities in a developing country not realising what they are facing.

“If we have a pathogen that is easily transmissible before people begin to show the symptoms it will be too late to isolate patients”, the French doctor told The Telegraph from her offices in Geneva. “Once people show the symptoms, it is too late and already a lot of people have been infected.”

Medical authorities are already aware of a number of such illnesses, such as severe acute respiratory syndrome (Sars), an acute form of pneumonia that was first identified in 2003 and is believed to have originated in Horseshoe bats in China’s Yunnan Province. After crossing the species divide into humans, it spread rapidly and had killed a reported 774 people in 37 countries before the end of the year.

“Nature can be very creative sometimes and in the future there is a high risk from a pathogen that is not visible for a few weeks getting into a highly populated area,” Dr Briand said.

South-East Asia is a likely starting point for such a disease because of the  prevalence of markets that sell live animals for food and humans have no immunity to a newly emerging or evolving illness. Another factor that will aid the spread of the disease is the relatively high population density in the region and, in many places, still rudimentary healthcare facilities.

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Other impacts are not directly a result of people being taken ill as a result of exposure, as the 172-day outbreak of Middle East respiratory syndrome (Mers) in South Korea in 2015 demonstrated.

“Mers originated in camels in Saudi Arabia but was taken to South Korea by a traveller and caused an outbreak”, Dr Briand said. “This was not a major outbreak, there were about 186 cases and 38 deaths, but the issue became the paralysis of the country.

“People stopped going to school, to restaurants or going shopping. People did not know what to do, they panicked and the economic impact was significant.”

Dealing with outbreaks of illnesses has taught the WHO a series of important lessons, Dr Briand said, the first of which is that the response to a major incident must be very swift.

“The WHO has a surveillance system and we try to identify and verify all reports of cases around the world, determine the risk of the illness spreading and help governments to contain the source of the outbreak”, she said.

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The system gathers media and official reports in multiple languages, with the data analysed by specialist teams to determine the potential severity of an outbreak and the possibility of it spreading.

“We need to move very fast,” she told The Telegraph. “If a incubation period of a disease has started then it will spread quickly. Outbreaks in urban areas are even more complicated and in those cases we need to put a major operation into action. And if we are too slow or not efficient, then the disease will spread.”

Dr Briand’s team works closely with the United Nations’ Food and Agriculture Organisation and World Organisation for Animal Health to monitor and assess risks and implement measures to limit the spread of a pathogen, including working with governments and local authorities to educate people in measures to protect their health and stop the outbreak worsening.

“We work closely with NGOs and civil society and we have learned that we need to engage everybody to be effective”, she said. “We have also learned that social media is both an asset and a risk.

“Social media can help us to reach more people, but it also poses a risk because rumours can spread quickly. We need to make sure that the right information gets out so rumours do not take hold.”

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In extreme cases, governments can impose travel bans, but it is important to ensure actions are commensurate with the risk as an over-reaction can mean the public loses trust in the authorities and ignores their warnings.

Dr Briand’s team is presently monitoring an outbreak of the H7N9 avian influenza in China – an illness that has killed at least 615 people globally since it first crossed over into humans in March 2013 – but says our world will never be free of new and mutated diseases.

“We are surrounded by micro-organisms and they will be with us for ever”, she said. “We are continually making advances in medicine and we contain most outbreaks, but our modern way of life does make humans vulnerable to epidemics.

“Currently, the balance is in favour of humans, but we have to make sure that the balance does not tip the other way. We have to be ready.”

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