On the one hand, the discovery at the single case level of a novel coronavirus among ICU patients in the UK and Saudi Arabia appears to be a success for international public health. Our team was asked today what our global scanning systems portend, in terms of outcomes. We have been busy reminding our clients that, with better diagnostic technology, we place ourselves at risk of the outcomes: in other words ignorance was once bliss. Now, if you breathe the word coronavirus, most people call us in a fit of anxiety. They forget that the coronavirus family contains routine pathogens that are forecastable inside the United States and elsewhere. New technology provides us ever-greater insight now into what kills people around the world- this will not be the only "discovery" of course. This will not be the only time we "discover" a pathogen that has probably been with us for millenia.
So while the Saudi Arabia / UK situation was a success, Irene Lai points out in ProMED that while the world focuses on this current event, they (the international media) apparently blew off what happened in Jordan last April and May. What is clear is the ECDC picked up on media reporting out of Jordan, and both CDC and WHO were aware as early as April 26, 2012, of an unusual outbreak of respiratory disease in an intensive care unit that infected several staff members and killed one of them. Let us say that the event signature pattern of what happened in Jordan should have suggested high placement on the list of any operational biosurveillance analyst at that time.
But the way the event was mentioned in the ECDC report at the time did not suggest any form of prioritization. In other words, when one monitors the world for unusual or suspicious infectious disease events, how does one prioritize which event to expend effort attempting to verify or clarify? What is perhaps disturbing is ProMED did not report this significant thread of reporting out of Jordan at the time. HealthMap did not pick up on it either:
There was no publicly available alert or warning provided by ECDC, WHO, or CDC at the time. There is online evidence that the civilian amateur group known as Flu Trackers were following the thread as it was reported in the media. However, there is no evidence they considered the thread important enough to prioritize as a message of notification to ProMED.
One argument is the pathogen involved was not of public health consequence, or the rumor was disproved. This was the benefit of having the now-defunkt WHO Outbreak Verification List (OVL). The strength of the OVL was to express awareness and status of current / ongoing WHO investigations. In the current regime of outbreak notification per the revised International Health Regulations, we have the appearance of ...silence... when it comes to these internal processes. In other words, a lack of transparency.
Amman, Jordan is connected, by direct non-stop airflight traffic to the following cities:
- Frankfurt, Germany
- Paris, France
- London, UK
- New York City, NY, USA
- Budapest, Hungary
- Addis Ababa, Ethiopia
- Bucharest, Romania
- Kyiv, Ukraine
- Madrid, Spain
- Boston, MA, USA
- Tel Aviv, Israel
... and so on
The evidence suggests the information regarding this event thread was collected by several organizations, however there is no evidence of:
- whether the Jordanians themselves properly notified WHO per the International Health Regulations versus the ECDC picking up on their media reports that then prompted query;
- (despite partial recognition of an "important" event signature) prioritization by public health analysts for the issuance of warning;
- no dissemination of information by public health authorities at all levels to the public regarding an event that may have met mandatory International Health Regulation reporting requirements; and
- no official Health Advisory via the Health Alert Network (HAN) was issued to US physicians at the time... known in law enforcement parlance as a "Be On The Lookout (BOLO)".
In summary, the evidence therefore suggests that what happened in Jordan was recognized by some, but the significance of the signature pattern was not appreciated as a Priority Event. There are a multitude of 'live' infectious disease events worldwide as this post is being typed. The key is picking which ones warrant prioritization for closer scrutiny and communication to others.
As a final re-emphasis, it appears the entire International Health Regulation process, from the international level to the local, failed to provide appropriate notice to physicians in those global cities who would have potentially been the recipients of translocating cases. Namely, those physicians that reside within the United States.