The Next Pandemic Could Happen Anytime. Are Health Systems Ready?

**Tim Elliott** (0:00)
It's the morning drive at Mira Business FM. Health now, as Ebola cases in the Democratic Republic of Congo continue to rise, global health authorities are again under pressure to strengthen outbreak detection, emergency response, and frontline preparedness as well. But what does this latest Ebola outbreak reveal about how prepared we are globally, and how are healthcare systems adapting? A couple of the questions I'm going to ask Sean Costello. He is from Aspen Medical. He's also a fellow of the Royal Society for Public Health, and he's back again. Good to see you.

**Sean Costello** (0:36)
Thanks for having me back.

**Tim Elliott** (0:38)
You're very welcome.
So Aspen Medical is recognized, I suppose, globally, is fair to say for its work in high-risk infectious disease outbreaks. From where you stand, Sean, how does this specific outbreak in the DRC compare to the logistical, clinical hurdles you've navigated in previous regional crises?

**Sean Costello** (1:03)
Yeah, so I suppose it comes back to the same thing. Viruses don't care about maps, they don't care about lines on paper. They'll travel on their hosts regardless.
What's complex about Ebola, I suppose, is there's probably two parts to it, one being kind of the nature of Ebola and how it spreads. So, you know, there's been reports that it's possibly been undetected for a few weeks before the outbreaks were identified. And that's because the early stages, there's just two phases of Ebola. There's the dry phase and the wet phase. The dry phase symptoms can often show up like flu-like symptoms, and that can be often misdiagnosed or not reported from people. And then there's the wet phase, which people are probably more familiar with, which is the internal and external bleeding, the kind of more things that people are familiar about Ebola. And then the second part is, it's very complex in the region where it's broken out as well. So DRC is quite a complex region. Some of the provinces have, you know, there's a higher chance of arm conflicts, so people are moving around a lot as well. And then, you know, some of the provinces have weaker healthcare capacity as well. So that's all very challenging compared to what you might have in a metro area, in a more developed country.

**Tim Elliott** (2:25)
I mean, your team's working some pretty challenging environments, don't they?
I don't know, Liberia, you've been in DRC in the past for outbreaks. When you get to, is it Hot Zone that they're called?

**Sean Costello** (2:39)
Yeah, so yeah, just a few different terms.

**Tim Elliott** (2:40)
Just a few different terms, but that's the one that I kind of came across.
Like the one in this province, is it Uri province in DRC now? What are the immediate priorities that determine whether a response succeeds or needs a bit more help?

**Sean Costello** (2:58)
Yeah, so it's probably around how quickly you can get the resources there is probably the big one.
And then the second part would be what resources are actually there already. So you're kind of acting on the model of isolate, or identify, isolate and inform. So if you've got the right people to identify the right resources, to identify what strain of Ebola it is, and then you've got the resources, the right healthcare facilities to actually isolate the people and care for them properly so that there's not an outbreak inside the facility as well, because that can end up being that the caregivers then contract Ebola and then that they could end up bringing it home. It's not identified for a few weeks. That kind of all plays a role.

**Tim Elliott** (3:47)
Got you. Okay, I picked up another acronym on the way before I spoke to you, before speaking to you this morning, and that's IPC, which is Infection Prevention and Control, right? Which is, from what I understand, that's kind of, I mean, clearly, it's kind of the base when it comes to containing a virus, particularly when it's a virus that lacks a vaccine, which is the situation here, isn't it? And I'm wondering, how do you train, you're talking about healthcare workers there, how do you train healthcare workers to manage a specific strain like this one?
And what are the biggest barriers to those sort of, I suppose they're protocols, aren't they, when you're in an area that's prone to conflicts, like in DRC?

**Sean Costello** (4:30)
Yeah, good question.

**Tim Elliott** (4:32)
A few prongs in that question.

**Sean Costello** (4:33)
Yeah. So IPC, like that's the foundation of probably healthcare anyway, like when you talk to a first year student nurse, they'll be able to tell you what IPC is straight away.