Q&A: ‘Preparedness’ Will Be the Operative Word After COVID-19

What really aggravates Jason Tetro, host of a popular Canadian-based podcast The Super Awesome Science Show, and the author of The Germ Code and The Germ Files, is that the history-altering disruption caused by COVID-19 could have been easily avoided. What’s needed, says Tetro, is a preparedness system that would give an early warning to something like SARS-CoV-2 to hospitals and regional health authorities. The system Tetro imagines would work in tandem with the US Centers for Disease Control and Prevention and the World Health Organization, but would be much more nimble and able to transmit information faster. Tetro recently sat down with Infection Control Today^®to offer some details.  

Infection Control Today^®: How do you think COVID-19 will change the working lives of our readers and viewers? 

Jason Tetro: There's going to be one big change. And it’s something that many of us have been asking for, for a very long time. It’s going to be the addition of a word. You see, back in the good old days before the 1970s, we had infection control. And then sort of as we got into the 1980s, when we started realizing that blood can be very problematic, especially with things like HIV, it eventually became infection prevention and control. And we started getting into precautions and how we can sort of react to the presence of some kind of entity that causes us a concern. And so we’ve developed all sorts of types of testing so that we could essentially find out very, very quickly whether or not a patient could possibly lead to spread. But now in the age of COVID, we have what is known as preparedness. Now this came about back around SARS. We actually started seeing infection prevention control preparedness coming out, but it never took off. And right now, it is more about preparedness than it is about prevention and control. And I think we are finally in the stage now where we can go ahead of the curve, as opposed to trying to deal with it or somehow find a way to control it after it’s already spread. So essentially, think of an infection like COVID-19 SARS-CoV-2 as a brushfire. Imagine if we could figure out where it was going to hit in advance so that we could knock it down before it even starts. That’s the preparedness factor. I think we’re finally at a stage where we’re going to be incorporating that and it’s going to stick around.

ICT^®: What's the difference between prevention and preparedness? 

Tetro: When you’re talking about prevention, you really are talking about your establishment. Your institution. And that’s very, very important because essentially, for health care quality, you have to make sure that your institution is satisfying your patients basically. Now, the problem is that if something happens to come into your environment and you’re not prepared for it, then what happens is that that protection becomes a bit more problematic. And then all of a sudden, your preventative measures are coming in, perhaps, maybe a tick too late. But in many cases, it’s several days too late. All of a sudden, something is showing up. You don’t know what to do. And you’ve got to figure out how to not only develop the control, but then work backwards to prevention. When you have preparedness, what that is essentially saying is you’re looking at your region, and beyond that. And you’re working in a multidisciplinary environment, where you have numerous stakeholders who are providing information. It could be the media, it could be politicians, it could be epidemiologists. They’re all working together to provide that preparedness that eventually gives you and your institution the ability to know what may or may not be coming. But more importantly, when we do see something, as we saw with SARS-CoV-2, you can actually start getting yourself ready. And the funny thing is that those places where there has been preparedness already sort of in the program, they’ve actually done incredibly well not only at what they call flattening the curve, but also making sure that there’s very few to almost no healthcare associated infections in their institutions. Now, again, I’m talking more along the lines of hospitals. But I’m hoping that as we’re moving forward based on what we’ve seen with long-term care facilities, that we can also start incorporating preparedness for them as well.

ICT^®: What would this sort of preparedness look like?

Tetro: What would end up happening is that you have a regional unit, and that region, whether it be run by the local municipality, whether it be something that has been assigned by a larger governmental authority, you have a group of people who are essentially working to find out what is going on outside of your region on a regular basis, and then reporting back to the region about what is happening. Now, here in Canada, we actually had something along those lines called the Global Public Health Intelligence Network. And when that came into play, you started seeing the ability of tracking all sorts of other types of places around Canada without actually worrying about what’s happening inside of Canada. Another good early warning system, which could be part of preparedness, is what is known as the ProMED-Mail.And what this does is it looks at all of the reports that are coming out of anywhere in the world of something that seems infectious, pathogenic, whatever it may be. When you start incorporating that in a framework, that actually is part of your process, whether it be once a month, once a season, whatever it may be. You then get a sense of what’s coming. And then if you have it in place, so that you essentially have breaking news, if you will, then authorities can then notify hospitals and other institutions, that there is this threat, and that they should start putting in their preventative measures to make sure that if it does arrive at their doorstep, they are ready for it.

ICT^®: Isn’t this something that the World Health Organization should be doing?

Tetro: The World Health Organization has a mandate to be able to try and help any kind of healthcare, institution, government, whatever it may be in being prepared. Yes. The problem is that they’re usually second on the list. So normally, what ends up happening is that information comes out and it goes to the regional authority. Especially if it’s a notifiable. If it’s a non-notifiable and unknown, sometimes it just circulates within the institution where everyone’s like, “I don't know what this is.” And then from there, it may go to a national institution. And then it may go to the World Health Organization. What ends up happening is that the information that’s coming to the World Health Organization is coming in later than what you would like in terms of preparedness. Whereas if you have someone who’s in that region, where all of a sudden something comes up, or you have someone who’s in that national institution and something is reported, then you have the ability to share that with everybody in a real-time manner. Before the World Health Organization is even able to put together a statement, or some kind of guidance. Remember, when you’re dealing with the World Health Organization, the first thing that happens is information is developed by the researchers; people who have PhDs. And then what happens is it goes through a vetting process to be absolutely sure that they got it right. And only then will it come through in the public realm and be shared by whichever representative happens to be in charge at that time. It’s a very important process to go through, but it does take time. Whereas if you have that immediate red alert preparedness, then people can start getting ready. And if it happens to be nothing or a false alarm, well, that will happen. But it’s better to be prepared for something that may or may not come, then to be taken off guard by it. I’ll give you one example. Here in Canada a number of years ago, we ended up hearing about a minister who was going to be talking about something that had happened in Canada. We were all kind of wondering what was going on. Even I was sitting down on the couch, looking at the TV going, what happened? Well, it turns out H5N1 had come to Canada. Avian flu. We didn’t know any of the specifics. We just heard H5N1 had come to Canada. My goodness, that was frightening. Now granted, when we finally found out the details, it was one case. Unfortunately, the person had died. There had been no secondary spread. And the institutions had been fully prepared. And so that was great. But we don’t want to be in that situation. We want to be in a place where we’re prepared so that if we all of a sudden hear that H5N1 has come to our shores, we’re ready for it. And I think that’s where COVID-19 has finally given us the ability to harness that, and to take advantage of that and to put the proper resources into it so that we can develop that down the road.

ICT^®: How would that have worked with COVID-19?

Tetro: When COVID-19, SARS-CoV-2, was first detected, and this was at the end of December, there was some information that was being shared and it came through the ProMED-Mail. But there was no real knowledge about what was going on. All we knew was that there was this new novel virus that seems to be causing pneumonia that possibly could be leading to a higher mortality rate. That was it. Now, even with that amount of information, you kind of think, “OK, well, maybe we should have some kind of preparedness.” But then as we found out that there was human-to-human transmission, and that this did have a higher case fatality rate, you started to realize, “OK, well, if this thing starts to spread, and it comes to our shores, then it’s going to be a big problem. And we’re not going to close borders.” I mean, that’s the first thing you have to realize is that you can’t rely on the politicians to do the right thing. What you can do is start saying, “OK, well if this thing is kind of like SARS”-and we knew that as of January 10-"if this thing really is causing the type of pneumonia that we were seeing with SARS….” And people should be very read up about SARS. I mean, we’re hearing about things regarding this virus that we already knew happened with SARS. But for them, it seems to be completely brand new. And we can talk about sort of the short-term memory in a little bit. But I want to point out that if you were to keep that in there, that would be part of your preparedness plan. All of a sudden, now you hear that in this particular area of China, with 11 million people and an international airport, you have a virus that could possibly be as lethal as SARS and showing the same types of symptoms that SARS did, has the same genetic sequence for the most part as SARS: Why not put in a SARS plan? And then that way, if it shows up, you’re already ready for it. And so this this is why you need that multidisciplinary nature and why you need all these different stakeholders. Because when you finally get to that point where everybody’s talking to everybody else and sharing information, you’re going to have much better preparedness at any given time. And we would not be taken to the same extent of lockdowns and other things as we have with this particular virus because we would simply know when it was coming. We’d be able to trace it back very, very quickly and also invoke those proper isolation procedures that are necessary in order to avoid having to go through full lockdown and quarantines.

ICT^®: How would this actually work in the ground?

Tetro: What you want to do is you want to make sure that you have a representative in every healthcare institution. But that representative, essentially is just someone who knows that there’s a phone number that they can call or an email that they can write. If they hear about something, then they would send it off. Most likely, I would say, this would be a nurse manager or one of the infection preventionists. And then they would be able to contact one particular authority that is essentially part of the region. And this could be a governmental role, this could probably be a healthcare role. Maybe one of the infection preventionists at one of the hospitals is responsible for making the call to a larger authority. So basically, what happens is that it works in the form of a pyramid. All you have all the institutions like this here, which have somebody and once someone figures out, sees something, it goes up one step. And then up one step and up one step until finally it reaches the ultimate pinnacle, which probably would be the World Health Organization. But we know that there are other infection prevention and control societies out there, such as APIC [Association for Professionals in Infection Control and Epidemiology]. We have IPAC [Infection Prevention and Control ] here in Canada, and they could also be playing a role. And by the time you get there, it would be relatively quickly, hopefully within a few hours to 24 hours. And then that information would then essentially go from the pinnacle, and then back down to all the different institutions so that they are aware. And in most cases, they probably be like, “OK, that’s very good information but has nothing to do with us” and you move on. There's nothing wrong with that. But what is wrong is all of a sudden, you have heard about something you’re not quite sure what’s happening. And then all of a sudden, in your ICU, you’ve got a number of patients who are showing classical symptoms of pneumonia. And then on top of that, all of a sudden, they’re showing DVT [deep venous thrombosis] and other types of unexpected coagulation. And all of a sudden, you’re like, I don't know what I’m supposed to do here. And then you know, you put them on ventilators and then you realize that oh my goodness, it could be possibly aerosolized and then may have even gone into the ventilation ducts. We went through that with SARS. These are things that happened with SARS. We don’t have to go through that again.

ICT^®: Are you talking about a bridge between healthcare and government? 

Tetro: We have seen something similar. It’s just I haven t seen it formally put into place as a preparedness. Like, I have seen frameworks in the past. And I think the fact is we were going there, especially here in Canada, with SARS. It’s just it never took the hold that it was supposed to take. And while we do have a very good version of that here in Canada, it’s still not perfect. And unfortunately, as a result, we still saw this virus spreading like wildfire in certain parts of our country. I think that that’s preventable. I think that that is preventable, simply as a result of the fact that knowledge can travel incredibly fast. I mean, if everybody happened to be on Slack or something along those lines, the information could travel in a matter of microseconds to absolutely everybody. So we should take advantage of where we are in terms of our ability to share knowledge quickly, rapidly and rely on the people who are properly trained to be able to see the information, vet the information and know whether or not this is something that we should be really focused on. Or whether it’s something that we need to sort of keep in mind, but not necessarily act upon. And then it will essentially look patchwork, when you start seeing maybe one hospital taking some measures, and another one that’s not. Perhaps that hospital that’s taking measures has an international hub that links to the source of the virus, whereas the one that’s not is a complete remote community where there’s almost no travel.

ICT^®: Could this be one of the ways an infection preventionist’s job would change? They’d have to be on the lookout for this sort of thing?  

Tetro: Essentially it would be virtual point prevalence testing. The minute that something comes up, it’s immediately put into the logs, whether it be, you know, an information flow, or something that is immediately shared with everybody else. And we all know what MRSA prevalence testing does, right? It gives us an idea as to what’s the risk if a particular MRSA strain happens to be within our institution. Well, it’s the same idea. It’s just that you’re taking it on a global scale, and it’s essentially any kind of virus that we know could possibly lead to outbreaks, epidemics, and as we saw today, pandemic,

ICT^®: Do you see any other changes in the way infection preventionists might conduct their jobs in the future as a result of COVID-19?

Tetro: Well, I think another thing that we’ve seen, especially with respect to this particular pandemic, is the fact that we have really taken infection prevention for granted in many ways. We know all the processes. We know PPE is necessary, right? But at the end of the day, is there enough of the resources available to us to be able to invoke proper prevention and control procedures. We’ve seen in many places that’s not the case. I think what is going to happen is that infection preventionists are going to have a stronger voice in the larger healthcare community. When healthcare leaders are meeting, I think that they’re going to listen to infection preventionists much more than they have in the past. I think that they’re going to look at how patient satisfaction, quality of care is not just simply a matter of them having a good stay and maybe having some meals that they actually enjoy. But also making sure that not only do they as patients not come down with some kind of infection, but that the institution itself is safe so that they can have visitors. I mean, think about it. How many stories have you heard? And we saw this with SARS. How many stories have you heard where people who are in hospitals in critical care can’t have visitors because of the restrictions that have been put into place. The fact is it’s totally preventable. We know it’s preventable. But in order for us to be able to make sure that this isn’t the case, we have to have that preparedness in place. And the only people who really can give any insight into that are infection preventionists. I think for the next few years, their role is going to be more about being ambassadors of health. When we have an invisible and unknown enemy, then it will be of the day-to-day. And I hope that everybody who is watching, who’s listening, takes up that challenge, if you will, and shows that they are now a representative of a better way of doing healthcare. Of a safer way of doing healthcare. And if that happens, we may never have to worry about what we saw with COVID-19. And instead, we’ll be well prepared for anything that may happen to come into our emergency room doors.

This interview was edited for clarity and length.