#pandemicwatch
The outbreak has grown to 91 cases (64 confirmed), including 50 fatalities.
#13,449
The notion of a nation closing their borders to prevent the entry of a pandemic virus has been raised – and usually dismissed as impractical for most countries – many times (see Why Airport Screening Can’t Stop MERS, Ebola or Avian Flu).
Between porous borders – and the need for most countries to import food, medicines and other important staples – the odds of maintaining an effective quarantine are believed slim.
But there are a few places on earth where such a strategy might work. Island nations – particularly remote, relatively self-sufficient island nations – might be able to cut themselves off from the rest of the world.
During the 1918 pandemic, when international travel was far less common, a few nations managed to block entry of the pandemic virus by imposing a strict quarantine of all arriving passengers (see Protective Effect of Maritime Quarantine in South Pacific Jurisdictions, 1918–19 Influenza Pandemic).
The four successful quarantines during the 1918 pandemic were in American Samoa (5 days’ quarantine) and Continental Australia, Tasmania, and New Caledonia (all 7 days’ quarantine).
Eventually, once the quarantines were lifted, the virus did make it to these isolated regions of the world. But by that time, the virus often appeared to have weakened and its impact was lessened.
While it might still be possible today, such a move would come at a high economic cost, and it still might fail. A less drastic policy – which might involve fever checking and limited quarantines at points of entry – would almost certainly miss a large number of infected travelers.
In 2012, in EID Journal: Airport Screening For Pandemic Flu In New Zealand, we looked at a study that found that the screening methods used at New Zealand’s airport were inadequate to slow the entry of the 2009 pandemic flu into their country, detecting less than 6% of those infected.
Ten years ago, in New Zealand: Testing Pandemic Quarantine Plans, we looked at Exercise Spring Fever – a `war game’ designed to test New Zealand’s ability to cut themselves off from the rest of the world during a pandemic.
While no decision has ever been made regarding the quarantining of New Zealand during a pandemic, the option continues to be discussed.
Which brings us to a new study, published this week in Australia & New Zealand Journal of Public Health, which looks at the economic impact of a 180-day quarantine on the island nation of New Zealand.
Matt Boyd, Osman D. Mansoor, Michael G. Baker, Nick Wilson
First published: 08 August 2018
https://doi.org/10.1111/1753-6405.12818
The authors have stated they have no conflict of interest.
Abstract
Objective: To perform a comprehensive economic evaluation of border closure for an island nation in the face of severe pandemic scenarios.
Methods: The costing tool developed by the New Zealand (NZ) Treasury (CBAx) was used for the analyses. Pandemic scenarios were as per previous work;1 epidemiological data were from past New Zealand influenza pandemics.
Results: The net present value of successful border closure was NZ$7.86 billion for Scenario A (half the mortality rate of the 1918 influenza pandemic) and $144 billion for preventing a more severe pandemic (10 times the mortality of scenario A). Cost–utility analyses found border closure was relatively cost‐effective, at $14,400 per QALY gained in Scenario A, and cost‐saving for Scenario B (taking the societal perspective).Conclusions: This work quantifies the economic benefits and costs from border closure for New Zealand under specific assumptions in a generic but severe pandemic threat (e.g. influenza, synthetic bioweapon). Preparing for such a pandemic response seems wise for an island nation, although successful border closure may only be feasible if planned well ahead.
Implications for public health: Policy makers responsible for generic pandemic planning should explore how border closure could be implemented, including practical and legal frameworks.
The costs and benefits of island nations completely closing their borders to avoid or minimise the impact of a severe pandemic has received little attention in the literature. This omission may be due to doubts about the likely effectiveness of such measures, the substantial costs of implementation, and how countries interpret the International Health Regulations. Previously, we published a simple proof‐of‐concept model that suggested net benefits of border closure for New Zealand (NZ), if a generic pandemic was severe enough.1However, limitations of our earlier approach included: not including a health system perspective; not calculating cost‐effectiveness; a lack of scenario analyses around the 3% discount rate (which is also lower than 6% favoured by the New Zealand Treasury); and only using a limited societal perspective (i.e. exclusion of the pandemic impact on productivity and superannuation payments). Our previous work also used monetised quality‐adjusted life‐year (QALY) values that were less than the values recommended by the New Zealand Treasury.
Therefore, to provide additional information for policy makers, we aimed to conduct a more rigorous cost–benefit analysis (CBA) as well as cost–utility analyses (CUA) using the New Zealand Treasury’s standardised cost–benefit analysis tool ‘CBAx’. CBAx provides a consistent approach so different government interventions can be compared.2
(Continue . . . )
Whether any of this – in our highly mobile and interconnected global society – is remotely practical, is another matter. A quarantine would have to be enacted quickly – before any pandemic threat could make it into the country – and then the quarantine would have to be perfect in nearly every way.
While the odds of success are long, any chance of avoiding the kind of end-game scenario presented last May in the Johns Hopkins Clade X Tabletop Pandemic Exercise, is a pretty good incentive to try.
If you haven’t taken the time to watch the entire 8 hour exercise, I would urge you to view the 5 minute wrap up video. It will give you some idea of the possible impact of a severe – but not necessarily `worst case‘ – pandemic.
As border closing isn’t an option for 99% of the world, we’ll need to find other ways to deal with the next pandemic. For more on the potential impact of a severe pandemic, you may wish to revisit:
FEMA PREPTalks: John M. Barry On `The Next Pandemic: Lessons from History”
In Europe, surveillance indicates that the 2018 West Nile fever transmission season started earlier than in previous years and with a steeper increase of locally-acquired human infections. Between 2014 and 2017, European Union/European Economic Area (EU/EEA) and EU enlargement countries notified five to 25 cases in weeks 25 to 31 compared with 168 cases in 2018. Clinicians and public health authorities should be alerted to ensure timely implementation of prevention measures including blood safety measures.
The Ministry of Health, the Democratic Republic of the Congo has confirmed 4 new cases of an ebolavirus infection in a new loaction of the country. Earlier there had been reports of 26 cases of fever, diarrhoea, vomiting, nasal bleeding and death since May. There have been at least 20 deaths attributed to the outbreak thus far.
Lab results now confirm this as the second geographically discrete outbreak in 2018 for the DRC.
Map of the Democratic Republic of the Congo from the World Food Program via ReliefWeb. North Kivu Provincde is klocated in eth northeeastern region of the DRC, on the eastern border
No details are available on the specific species of ebolavirus so it remains unclear if the Ebola virus (the one specifically deiosgend to pretect ffomr disease due to members of the species Zaire ebolavirus) vaccine can be used. If it can, hopefully, it will be deployed more quickly than in the last outbreak.
The Government of the Democratic Republic of the Congo #DRC
announced today that preliminary lab results indicate a cluster of #Ebola cases in North Kivu province, some 2500 km from Equateur province.
— World Health Organization (WHO) (@WHO) August 1, 2018
Map of the DRC from Congo Initiative.
The suggestion so far is that the outbreak has occurred in the Province of North Kivu in a place called Mangina in the eastern Mabalako health zone, about 30 kilometers (18 miles) west of Beni, a city of more than 230,000 people and that it is a distinct outbreak from the one that occurred about 1,800km (from the city of Mbandaka to that of Butembo according to Google Maps) to the east earlier this year. That will become more clear once some detail becomes available. These would include contact tracing of the earliest cases to see if there is any history of travel from the Equateur province, and also genetic details from sequencing the newly identified ebolavirus strains to look for differences and similarities to those viruses characterised from the western outbreak.
Pinpointing Mangina in the DRC. Map snipped from GeoHack.
This region of the DRC is suffering from conflict (including thousands of cases of sexual violence), food insecurity and the displacement of many people. The Province borders and actively trades with Uganda and Rwanda, with waterways in abundance as this is part of the African Great Lakes region. Mangina seems to be removed from the waterways but we armchair observers await better maps to get an idea of the layout.
It is interesting to see in the map to the left, that the town of Bundibugyo in the self-name district of Uganda, is not too far off. An ebolavirus species, Bundibugyo ebolavirus (BEBOV), was named after a virus isolated from outbreak cases in this region in 2007.
This region will bring a raft of new challenges to the containment of ebolavirus outbreak.
Despite high levels of vigilance for Ebola virus cases on the other side of the country, this outbreak may have been percolating for 2 to 3 months. The harsh reality of how difficut it is to keep on top of emerging virus outbreaks when they occur in relatively remote, under-resourced regions suffering conflict is exemplified by this one.
The post A second outbreak of an ebolavirus in the DRC appeared first on Virology Down Under.
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