What can lesser known outbreaks teach us about coronavirus surveillance now that we have an unknown origin to consider? The spread of coronavirus bears a strange resemblance to an outbreak that occurred almost ten years ago and resulted in multiple casualties – Klebsiella pneumoniae carbapenemase (KPC). Despite following stringent infection control procedures, one of the most prestigious research hospitals in the country still does not know where this infection originated from and how the drug-resistant disease spread.
The key lesson to learn is that rapid testing and infection control practices alone are not enough, to truly understand the spread of the disease and identify potential patterns, surveillance technologies are critical in connecting the dots for hospitals. These technologies have been slow to deploy but are gaining traction, with hospital networks in the State of New York piloting them for other outbreak risks.
CEO of OpGen, Oliver Schacht draws parallels between the KPC outbreak and the lessons we should take from that in tracking the coronavirus outbreak progression from this new ‘patient zero’.
Digital Journal: Coronavirus is making global headlines. What do we know about the virus?
Oliver Schacht: So far, we know that COVID-19 is a novel coronavirus that has not been previously identified. Coronaviruses are a large family of viruses, each of which will infect either a human or an animal, but very rarely both as it has with this latest outbreak. First detected in Wuhan, China, COVID-19 has been linked to a live animal market there. Taking into account new cases across the globe, it appears that COVID-19 has rapidly become a community spread virus so there is still uncertainty for many regarding how or where new patients became infected according to the CDC.
DJ: The big concern is infection, what is ‘community spread’ and how is this tracked?
Schacht: When a virus is “community spread,” it is unclear where the point of origin came from. The first confirmed case of COVID-19 in the US could be linked to recent travel to Wuhan, China. Patients who have recently traveled to countries where outbreaks are rising rapidly including Italy, Iran, and South Korea can also trace their origins. However, since the identification of the initial coronavirus patient, there have been multiple cases of community spread COVID-19 where a patient did not travel to one of these high-risk countries.
The CDC is currently tracking the COVID-19 outbreak and providing updates daily on new cases and death rates since the virus is spreading quickly and sustainably across the globe.
DJ: What can past outbreaks teach us about infection transmission?
Schacht: Past outbreaks teach us that infection transmission can be complex and difficult to confirm. We’re already aware that the virus appears to spread primarily from one person to another through droplets of mucus or saliva when a person coughs or sneezes, or through contact with contaminated surfaces yet there are still many questions regarding other ways an infected patient may transmit this virus and if transmission can occur when a patient is asymptomatic.
Additionally, previous outbreaks have revealed that reporting transparency and accuracy are crucial to quickly and effectively address novel outbreaks. Information on the number of cases and action taken, while updated regularly, has come under scrutiny for alleged under-reporting in countries like China. When facing a global pandemic, governments, associations and hospitals all need to collaborate and consolidate accurate data on an ongoing basis to best track where infections are coming from and identify how it is being transmitted.
DJ: Are there any notable case studies?
Schacht:The SARS outbreak was among one of the notable case studies where a lack of reporting and data sharing further accelerated the global risk of exposure. In April 2003, the Chinese government admitted to the existence of over 200 undisclosed SARS patients in military hospitals, a jump from the initial 22 reported. Similar to Coronavirus, the SARS outbreak began right before a national holiday, creating international concern about patients travelling.
Another, lesser known superbug outbreak known as Klebsiella pneumoniae carbapenemase, or KPC, also teaches us an important lesson about tracking new outbreaks. In 2014, KPC increased significantly in American hospitals across 44 states.
To this day, no national reporting system to track outbreaks of drug-resistant bacteria at hospitals has been implemented, making it difficult to understand the spread and of drug-resistant superbugs and treatment efficacy.
DJ: How can we take these lessons and develop better surveillance?
Schacht:There are two key takeaways from these case studies. First, there is often a risk of under-reporting, particularly with novel viruses when there is insufficient testing being done. To create a better surveillance program, doctors, hospitals, states and countries need access to accurate information on patients in real-time to better track how they’re being treated, how they contracted the virus, and who they may have spread the virus to. Second, hospitals and healthcare facilities need to share this information with one another as soon and often as possible and eliminate silos, particularly in the wake of a global pandemic. Having access to a broader data pool can help hospitals better treat patients and help organizations like the CDC better understand the evolution of the virus.
DJ: What other public health measures need to be considered?
Schacht:Proper infection control measures and testing protocols, as indicated by the CDC should always be taken by hospitals and healthcare facilities. The CDC is constantly sharing updates to help keep the public aware and safe.
