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COVID-19. Flu Season. How Are We Responding?

November 18, 2020

Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous episodes here.

As COVID-19 cases spike and the U.S. and other countries brace for flu season, Abt’s Danielle Hunt and James White take a look around the globe to see how we’re preparing. Learn about the groundwork we’ve laid and what it means for future pandemic responses.

For more on this topic, check out Episode 9: Flu. Coronavirus. Data. Could Analytics Change the Trajectory of a Pandemic?

Read the Transcript

Eric Tischler: Hi and welcome to the Intersect. I'm Eric Tischler. Abt Associates tackles complex challenges around the world, ranging from improving health and education to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it would be enlightening and maybe even fun to pair up colleagues from different disciplines so they can share their ideas and perhaps spark new thinking about how we solve these challenges.

Today, I'm joined by two of those colleagues, Danielle Hunt and James White. Danielle's areas of expertise include epidemiology, business development, international health, environmental health, global health security, and clinical research. James' specialties include infectious disease, brokering public private partnerships for national and community level health service delivery, and strengthening the quality of clinical services in public and private health.

Thank you both for joining me.

James White: Thank you.

Danielle Hunt: Thanks for having me.

Eric: When COVID-19 first hit, parallels were drawn between the novel coronavirus and the flu. At that time, in an attempt to provide some context, some people pointed out—correctly—that the flu is dangerous in its own right. Now the U.S. and other countries are navigating the onset of another flu season while dealing with a new spike in COVID-19 cases. So, Danielle you've worked on the flu and COVID-19 with CDC. What challenges are we facing?

Danielle: So, right now as COVID-19 cases are continuing to spike, we're also entering the winter months, which is when we begin seeing influenza as well. And so you have individuals who may experience some general symptoms that would be applicable to both influenza and COVID-19. And so, as those symptoms begin to appear, I think you would expect to see more people getting tested, and then that could potentially increase the resource strain on hospitals and healthcare settings, where they're needing to provide not only more testing, but more treatment of people that are testing positive.

Eric: And James, I know that you're working on health system strengthening and capacity building overseas. You want to talk about how you’re addressing COVID with USAID’s Local Health System Sustainability project?

James: Sure. Thanks very much. Each country from the beginning of this epidemic—which ultimately became a global pandemic—has had their own experience, but many of the needs have been the same internationally. Initially, we were in the same position as most of the rest of the world, trying to understand this novel virus, trying to understand the science of it, trying to implement basic prevention and control measures, and trying to get our hands on flattening the curve and all of these terminologies that people became very familiar with. Over time, that has remained the same as we see waves or phases of the pandemic in different countries, as we see things like flu season emerge in locales, but also the other health system needs that strain—especially in low-resource health systems around the world—on a daily basis.

These things are leading to health system resilience issues. That's what Danielle is describing with the onset of the threat of the pandemic plus flu season. But many of the countries we're working in, in central Asia, in Africa, and in the Caribbean and Latin America are each dealing with their own health system strains. And so we've been working to try to strengthen laboratories, strengthen frontline healthcare workers, strengthen knowledge throughout the health system as health systems really start preparing to deal with this long term.

Eric: Danielle, strengthening laboratories and knowledge is really what we're doing in the U.S., right?

Danielle: So, what we're doing on the domestic side is really working with CDC to develop a research infrastructure. And so what that is, is basically partnering with university and clinical settings throughout the U.S., so that we are able to implement the number of different studies focused on different objectives and different priority populations. For example, for the influenza research, we set up a cohort of clinical sites throughout the U.S. and started preparing protocols and getting IRB approvals and the other necessary resources in place so that if any pandemic were to occur, that we would be ready to quickly implement the research activities rather than having a lag time of getting everything set up.

But what we were not expecting was a novel virus. And so, with COVID-19, we were able to take the infrastructure that we developed for influenza, and then adapt it for COVID-19 and potential other respiratory viruses. Right now, we're working with CDC implementing five different studies among different priority populations, where we are doing active surveillance, COVID-19 testing. We're also implementing influenza testing and have the ability to incorporate other respiratory viruses. As we better understand the relationship between COVID-19 and other diseases, we can be looking across a number of different viruses and health outcomes and try to make those links.

Eric: Great. How about you, James? How have you been leveraging our expertise in flu and infectious diseases as you've tackled COVID?

James: Two important things that Danielle mentioned was that even though this was a novel virus, we did have experience with influenza. We had experience with H1 N1, with SARS, with other pandemic threats similar, but not the same to COVID. And we certainly drew on all of that in the early days. The protocols for infection control from MERS and SARS from the CDC were particularly helpful.

All of the work that Danielle and the influenza global leadership have been pursuing has really been trying to prepare us for a pandemic like COVID. We've certainly seen certain local locations around the world be better than others in being able to use those protocols. Where we're at now is I think the science is certainly there, and we see it emerging toward a vaccine, but everything else from the second point Danielle made, everything else in terms of preparing for other threats, for other pandemics, for preparing for the next emergency remains as important today as it was in February and March of this year and flu is the first test of that, I think, and really how will health systems deal with this especially difficult time with two very challenging viral threats.

Eric: And one more question for both of you. You both talked about how we're sort of building both on Abt's previous work on the flu, and then what we've learned in the past year from COVID. What do you see for us going forward? James, you just mentioned that we need to be prepared for the next pandemic. How well prepared are we now moving forward?

James: So, two things that I would say are that all of the work we've been pursuing or a good portion of it has, from the beginning, tried to keep that in mind. So, while we've certainly invested our technical assistance and financial assistance on things that are needed today for COVID, we've also tried to invest in laboratory machinery, oxygen and intensive care equipment, and other materials that will serve these health systems that we're trying to support longer term and for other threats.

I think that one is keeping that in mind that we can use an emergency as opportunity to prepare ourselves is a point that unfortunately remains a tough sell and that with pandemics in particular with health system threats like this, there is a proven track record of people coming together and addressing these threats in times of emergency. But there's an equally poor track record of doing the same in times of calm or in-between threats.

The second point is that we can't take our eye off of this goal of preparedness and even perhaps once the sort of shocking threat of COVID is over, we keep this in mind as we prepare ourselves for the future.

Eric: Yeah. How about you, Danielle?

Danielle: The resource management that James refers to, I think, can be driven by better understanding the populations most at risk. And so the research that we're doing is geared towards that understanding the risk factors, the preventive factors, what causes somebody to be hospitalized, what causes somebody to respond well to treatment, not well to treatment. And so, with all of that understanding, then you can better prepare for the future and, whether that be better testing, more testing, resources, medications, etc., then the type of research we're doing will hopefully help us better understand the risk factors.

The other thing is with vaccines. So as a vaccine comes available, we are having plans to look into that in our research studies as well. How effective is the vaccine again? Are there certain factors that cause people to be more receptive to the vaccine than others? And so, again with that, we can better gear our prevention and treatment efforts and preparation for responding to any sort of increases in COVID-19 cases and in preparation for future pandemics as well.

James, I'm wondering, given the relationships that we have with different international organizations, are you seeing much of the epi research happening abroad working at the risk factors and protective factors?

James: Certainly that's being discussed more as the pandemic, and the way it's emerged in different populations, is being better understood. I think with, and you've already made this link, but with a lot of the vaccine deployment planning, that I think that's where that issue will really come to the fore.

Danielle: We have done some international studies in the past with influenza and particularly around vaccine effectiveness. We're wrapping up the study right now, looking at flu vaccine among healthcare personnel and in Israel. And we've done some other influenza work throughout the world and low and middle income countries.

With what we're doing right now, COVID-19 vaccine effectiveness is one of our objectives, but it's not the primary objective. So there's a lot that we're learning outside of the vaccine that I'm just wondering if we could do abroad. I mean, right now we're looking at healthcare personnel, first responders, essential workers, middle-aged and older adults, older adults, and community members and households. And so it's a lot of information that we would be gathering from a lot of different—sorry, I forgot, and pregnant women too. So it's a lot of information that we would be getting from these different priority populations that I think would be applicable in other countries, but they may have different, or they do oftentimes have different environmental and social factors that can add to the risk beyond what we experience here in the U.S.

James: So, in the beginning, it's been emergency response mode. So a lot of the focus has been on ensuring the right materials were in place, the right staff was trained, and that we were sufficiently addressing this immediate epidemic phase. But, as I mentioned, certainly our research efforts, our monitoring and learning over the course of the pandemic is all informing us as we move forward to implement new programs in health system resilience and understanding which populations will be most at risk, as Danielle's mentioned, and understanding how other threats like the flu, but also overseas, HIV, TB, malaria, some of these common health system threats need to be accounted for. And we need to understand how all of these populations are affected. We're starting very much to do that now as we have expedited the sort of emergency phase.

Eric: Well, that sounds like a great place to stop: looking forward to what we can do next. Thank you both for joining me.

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