Coronavirus: Infectious Disease Expert Shares Lessons Learned From Other Recent Outbreaks

Virus outbreaks in the recent past have posed challenges, but the novel coronavirus has an uncommon potential to wreak havoc, an infectious disease expert says.

Although there are differences between the novel coronavirus (COVID-19) pandemic and the recent swine flu and Ebola outbreaks, there are valuable lessons from the earlier flareups, an infectious disease expert says.

The swine flu pandemic hit the United States in 2009 and 2010, with about 12,500 deaths and an estimated 60.8 million cases, according to the Centers for Disease Control and Prevention (CDC). During the 2014–2016 Ebola outbreak, 11 people were treated for the viral disease in the United States, with two deaths. Last week, the Imperial College COVID-19 Response Team declared the novel coronavirus is the most serious public health threat from a respiratory virus since the 1918 Spanish flu pandemic.

Last week, HealthLeaders held a discussion with infectious disease expert Charles Ericsson, MD, to compare the COVID-19 pandemic in the United States to the country's experience with the swine flu and Ebola outbreaks and to share lessons learned from each.

Ericsson is a professor of infectious diseases and professor of medicine at McGovern Medical School at UTHealth in Houston. He also is head of clinical infectious diseases in the medical school's department of internal medicine as well as director of the Travel Medicine Clinic and the Infectious Diseases Fellowship program. He earned his medical degree at Harvard Medical School in Boston.

The following is a lightly edited transcript of Ericsson's conversation with HealthLeaders.

HealthLeaders: How does the COVID-19 pandemic compare to the swine flu pandemic?

Ericsson: A major difference is we have had a poor response to COVID-19 testing. We arranged the testing for swine flu efficiently and rapidly, which helped a great deal in keeping it under control and flattening the epidemiologic curve.

For swine flu, we had testing to recognize the disease, we had treatments, and we had testing that was rapidly developed to recognize when the virus was becoming resistant to one reagent so we could switch to another reagent. We have nothing like this now to control the COVID-19 epidemic.

We have no treatment for COVID-19 that is recognized and actively in use. We have an experimental agent, but it is only for hospitalized patients who are in dire need of a rescue medication.

HL: What lessons were learned from the swine flu pandemic that are helpful in the COVID-19 pandemic?

Ericsson: A key lesson from swine flu is that we need to have a plan in place that we can rapidly adapt. A plan must be flexible enough to deal with the new realities of whatever develops. If you stack up all of the challenges of new viruses that we have had in the recent past, there have been many, but none have had the dangerous potential of COVID-19.

We also learned to try to anticipate supply chain issues and to have a national stockpile, which we are going to have to dip into for COVID-19 in short order. It's good that we have national stockpiles because our local institutions are running out of supplies quickly due to fear and hysteria.

One of the things that we should have anticipated for COVID-19 is that we would run out of the vials needed to test specimens, and that has become a supply chain problem. Now, we are rapidly trying to find ways to adapt that do not require the usual vials and solutions needed to collect samples.

HL: How does the COVID-19 pandemic compare to the U.S. Ebola outbreak in 2014?

Ericsson: What's similar is the fear. With Ebola, particularly for healthcare workers, the fear was quite justified because Ebola is a disease where infection protection had to be absolutely rigorous. We had to use expensive equipment to totally isolate healthcare workers from patients because Ebola is highly transmissible through bodily fluids. We had some healthcare workers become ill with Ebola, and it was deadly. We had no treatment for it.

Ebola was different from COVID-19 because of its rarity and unlikelihood to be imported into our country made containment important almost immediately. We were able to find infected patients and isolate them.

Another way Ebola is different than COVID-19 is that it kills quickly. So, it is unlikely that people are going to be traveling out of an area where there is an Ebola outbreak because they die.

With Ebola, it never reached the point of refusing to let anybody fly into the country. It was relatively easy to recognize people coming into the country from one area of the world instead of worrying about hotspots all over the world. It was a fundamentally different approach that lended itself to containment. With Ebola, we recognized that containment was the way to go, and we were quite successful with that approach.

HL: Why was containment successful with Ebola?

Ericsson: You could recognize people who were entering the country who were suspect. Anyone who was a traveler who had Ebola symptoms was jumped on immediately, isolated, and tested.

HL: Are there lessons from the Ebola outbreak that are helpful in the COVID-19 pandemic?

Ericsson: One thing we learned from the Ebola virus is the necessity to quickly develop vaccines, which is currently underway with the novel coronavirus. But it takes time to get a vaccine developed.

We also realized that we had to have plans for off-site assessment of people if we ever had a surge of disease such as Ebola. We certainly would not to be evaluating many people in the hospital, and we are seeing that now with tents being set up outside hospitals. With a disease such as COVID-19, which is not symptomatic in a large segment of the patients, we just send many people home and don't put them in the hospital.

The situation with Ebola was different, but it made us think through the possibility of needing off-site facilities in the event of a pandemic such as COVID-19. Ebola made us think a lot, and we modified our pandemic plans.