How to respond to a pandemic? | Covid-19 Special


the covid19 pandemic has exposed

weaknesses in the world's ability to


and respond to major infectious disease


the 2014-16 ebola epidemic in west

africa showed up long-standing


in the international health system and

how prepared it was for a major


four years on and even countries thought

to have strong response capabilities

failed to detect the early signs of

coronavirus outbreaks

or respond quickly enough that meant

that community transmission of the virus

was already well established

before governments could react

think tanks and public policy institutes

alike have been pushing for massive

investment in outbreak response and care


pandemic preparedness has been described

as a global public

good and yet globally it's been left

up to national public health systems to

carry the largest burden of cases

and the bulk of the costs

outbreaks and resurgences of coronavirus

cases are stretching public health

systems the world over

local and national governments keep

having to make drastic measures

to prevent services being overwhelmed

they have to act fast

to get ahead of this virus

stagnation in a place where people would

normally be having fun

this is not how over here had imagined


his fare had only just opened when he

had to close it down again because of a

drastic increase in corona numbers in

the westphalian city of ham

we've put our heart and soul into this

weeks of work it's really tough it's


we haven't earned any money all year and

now we're having to write off potential


and all of this because of a single

wedding celebration

where more than 100 people were infected

with the coronavirus

as far as anyone can tell there hasn't

been a single instance anywhere of

numbers going up in any way around a

temporary leisure ground

nonetheless we're the first to feel the

full impact and it's frankly depressing

that we are the ones who always end up

paying the price

the closure of the fun fair was only one

of the measures ordered by mayor thomas

hunstager peterman

in a bid to get infection rates under

control he says he's now looking at how

private festivities can be better


we're keeping 150 as the upper limit in

hand because we don't want anybody to

start canceling a wedding

or a silver wedding anniversary

but up to 25 people these occasions

don't have to be registered

from 25 to 50 there must be advance

notice so that we know what's happening

and where

and from 50 to 150 they are subject to

approval and will be taking a very close


many in ham are asking themselves how

the couple in question

could have been so unreasonable so far

not everybody who was infected has been

tracked down

the mayor is relying on volunteers who

trace possible victims

people like retired doctor peter ruder

it really pushes you to your limits

especially for people working at the

local health offices

who are organizing this whole operation

it's a real pity that it's had to come

to this i personally believe it could

have been avoided

meanwhile fairground operator uvery is

now faced with the dismantling of his


i just hope we can get back to life as

normal that we can take part in fun

fairs and other festivals as we always


and i hope we can help make people a

little bit happy

for now though fun is on hold

we can now speak to dr ezekiel emanuel

who is a professor

of healthcare management at the

university of pennsylvania in the u.s

we're months into this pandemic now

doctor emanuel

and global health systems are they now

in a better position to cope with the

coronavirus outbreaks or have they been


by these months of of sickness

no i think in general uh certainly in

the advanced countries uh they are

better able uh we know how to manage

patients better we know not to intubate

them to give them high flow oxygen

we know how to use anticoagulants we

know to use dexamethasone so we have a


more knowledge about how to manage these

patients and which ones really need

to be in the intensive care unit

nonetheless if you have a large number

of cases

you will can overwhelm the system and i

believe the french are

you know teetering on that uh problem

right now

yeah what do you think i mean are

advanced countries any more ready for a

second wave than they might have been

for the first one particularly we're

seeing that some of these

second occurrences are coming with even

more cases than the first time round

yes that is worrisome uh they

look the systems can be overwhelmed if

you have too many

cases we do i think have again better

management but we

also need to have better surge capacity

the ability to

quickly put up temporary facilities um

in you know mobile units or tents and

that's going to be

necessary we you know we predict that

you're going to have repeated waves here

uh for the you know influenza of 1918


it also extended to 1920 there were you

know four waves

of it um actually more small echoes

of it um so we've got to be prepared for

that to happen

and part of that preparation is surge


during the course of this pandemic have

we seen certain styles of public health

system that are working better than


uh we have i mean systems that

were uh able to quickly implement

uh testing uh contact tracing and


uh they've kept the number of cases uh

very low you can look at taiwan

singapore south korea japan as real

models here germany itself

did a remarkably good job of keeping the

death rate

extremely low so there are

places that have done well but even

places that surge like

italy they were able to put public

health measures in place the social

distancing the

avoiding crowds the face mask wearing

the closing of non-essential businesses

and in eight or ten weeks they were able

to bring the numbers very very low

and that does show you that even without

a vaccine

using public health measures you can

actually bring the case numbers low

and then begin to open up the economy

it's very important you know once you

have the case numbers low

life can uh resume not completely to

normal but

lots of freedoms can be reintroduced uh

under those circumstances

are there health systems on the other

side of that that we've actually seen

performing less well than we

thought they might have under these


yes the united states is a really good

example of that

we've just done a terrible job and in

large measure the terrible job

has been the fact that we've had you

know we're a very big country

uh four times the size of germany for

example and we've had a haphazard

response so some states are doing a very

good job of

closing non-essential businesses wearing

face masks distancing while other

states like georgia and florida just

aren't and

uh once that happens people travel they

bring the virus with them

and it reignites cases so we saw it go

from new york

to the south and the west and then up

the midwest in the united states

and it's raging we're back up to uh

double the number of cases we had in

june because

states like wisconsin and missouri in

the middle of the country are just

having large scale spread because they

ignored the public health measures

it's been very tough for the united

states dr ezekiel emanuel thank you so

much for joining us

thank you now it's time for one of your

questions to our science correspondent

derek williams today comes from someone

calling themselves eric cartman


how do you make a vaccine for something

that mutates

i get asked this a lot to answer

we have to look at the process of

evolution now just

like with living organisms the genetic


that governs how a virus is made changes

from generation to generation sometimes


small ways sometimes in big ones um the


if they survive eventually will become

separate strains that are distinct

from their common ancestor their genetic

code has changed and

and that can change uh how they look uh

their structure

and and also how they interact with

potential hosts

for example whether they can cause more


less severe illness what's key to

creating a vaccine

is the speed at which these changes


in viruses like the ones that cause


for example which have genomes that are

less stable

the rate of change is so rapid and


that we need a new vaccine to fight them

every year

we have to play catch-up with flu bugs

all the time

fortunately due to the way that sars

cove 2

makes copies of itself its genome


relatively stable as far as we can tell

a worldwide there isn't a lot of genetic

variation yet

among all the novel coronaviruses

circulating in different parts of the


and because those groups are so


theoretically a vaccine that can prevent


should be able to prevent them all um

what's interesting

and kind of scary is that is that when

we start to prevent

infections with a vaccine we'll also

start forcing saris cove to to

change in ways that will allow it to get

around the vaccine

but but that's a different question

now let's have a look at how the world

is doing in terms of

coronavirus cases

a look at data from 209 countries and

territories over the past four weeks

tells us the number of new cases

has doubled or worse in 35 countries

they also increased though at a lesser

degree in a further 77

countries six countries have seen case

numbers rising

at around the same rate 61 countries

have seen their new covet 19 positive

cases go down

by anything up to half and 21

have seen them more than half meanwhile

nine countries have reported

no new cases for four weeks in a row

here's that bar graph compared with the

last few weeks

remember the battle is won when that

entire chart is blue

we still have a long way to go