Blog Series Featuring Christopher Eddy Aveska Scientific Medical Editor and Writer

An all-hazards approach to crisis within a pandemic: an emphasis on pathogen transmission pathways

June 4, 2020

By: Christopher Eddy, Aveshka Scientific Medical Editor and Writer

As of May 31, 2020, my home, Washington, DC and neighboring communities have become the national hotspot for COVID-19 cases in the midst of reopening plans and social distancing strategies largely ignored by thousands during the heated public protests surrounding the death of George Floyd. However, throughout the nation, the response to COVID-19 is now split between the pandemic and civil unrest response, significantly weakening pandemic prevention strategies.

As I read the news, it is clear the risk from a sprawling pandemic is exponentially increased due to recent events such as social justice marches being organized across the nation that congregate massive crowds, and the onset of hurricane season bringing the first serious tropical storm, Cristobol, that currently threatens Louisiana with heavy rainfall and flash flooding. With these potential crises in mind, it is critical to consider the many layers of risk that we face and the prevention opportunity that can be applied. Experts have feared that the second COVID-19 wave will be worse than the first, and this was predicted without the added scenarios of protests and natural disasters.

I can say for certain that we are at a crucial juncture in the fight against COVID-19. Our research and current events warrant heightened public health focus—a full court press to expand upon published research and provide a path toward mitigation…

Working at Aveshka, I am deeply embedded in a hands-on, response-driven corporate culture that employs an all-hazards approach to the unique challenges we face today. Our workforce is actively supporting the nation’s COVID-19 response. Having expertise in two of Aveshka’s various mission areas—Public Health and Emergency Management—I can say for certain that we are at a crucial juncture in the fight against COVID-19. Our research and current events warrant heightened public health focus—a full-court press to expand upon published research and provide a path toward mitigation in lieu of perfect information regarding the nature of existential Pandemic COVID-19.

INITIAL RESEARCH ON TRANSMISSION PATHWAYS

Since my recent publication in the National Environmental Health Association’s Journal of Environmental Health (JEH), An All-Hazards Approach to Pandemic COVID-19: Clarifying Pathogen Transmission Pathways Toward the Public Health Response, we have seen the initial focus on at-risk populations, i.e., elderly and individuals with pre-existing conditions, change to an expanding range of age groups and vulnerabilities as the pandemic cascades across the United States.

In the JEH editorial, my co-authors and I followed the all-hazards focus and applied our knowledge and lessons learned of other pathogens to determine a comprehensive approach to understanding coronavirus transmission pathways. This allowed us to develop legitimate public health COVID-19 prevention strategies. We referred to all-hazards vulnerability assessment models established through our previous publications on Pandemic H1N1 2009, Norovirus, the 2014 Ebola Crisis, the 2011 Fukushima Japan Nuclear Disaster, and most recently, our 2020 Zika papers currently under peer review. With this knowledge, we established a new model that depicts potential COVID-19 transmission pathways as shown below.

Pandemic potential pathogen transmission pathway model

Eddy, Christopher. Pandemic Coronavirus Disease 2019 (COVID-19) Potential Pathogen Transmission Pathway Model
https://www.neha.org/sites/default/files/flipping_book/jeh-may-2020/30/index.html

These identified transmission pathways simply reinforce that we should operate under a “worst-case scenario” basis until we have perfect information about COVID-19. In other words, we should regard the COVID-19 pathogen as though it is like the norovirus, influenza, and SARS or MERS combined.

FUTURE RESEARCH FOCUS

Roughly six months into COVID-19, we are still in the early event stages and are learning about this complex virus and how it is transmitted. We have seen that Sweden’s experiment to refuse social distancing and other preventative strategies adopted by most nations, resulting in a higher level of deaths than surrounding countries. South Korea also experienced relapses in previous prevention successes, resulting in renewed school closures due to a lack of social distancing in a single nightclub. Afghanistan is suffering from large increases in COVID-19 deaths spurring discussion of ceasefires. These examples are part of the lessons learned that may be applicable to the U.S.

We have recently seen food supply chain integrity (e.g., meatpacking and slaughtering facilities, non-meat food processing plants, grain mills) compromised and massive COVID-19 outbreaks occurring in places such as assisted living facilities and jails and prisons. Every day, almost everywhere, new opportunities for infection continue to occur around the world. When the pandemic inevitably wanes, future research on transmission pathways must focus on areas such as:

  • What aspects of meat processing factories were involved in transmission?
  • Were fomites/contaminated environmental services extensively involved in disease transmission?
  • What is the true significance of “person-to-person,” “close contact,” and community transmission?
  • What impact do multiple mutations of COVID-19 have on pathogen ecology, severity of consequences, epidemiology, and future vaccine development?
  • Is animal transmission of a zoonotic-origin (shared between humans and animals) a major concern? — UPDATE: The USDA recently announced that the first dog in the US is COVID-19 positive.
  • What is the effectiveness of social distancing processes and other prevention systems in place?

MOVING FORWARD

“We must all start to think about our individual roles in reducing risk towards prevention, mitigation, and recovery.”

In lieu of complete characterization of COVID-19 pathogen ecology and epidemiology, an escalating risk landscape is developing: heightened protests; hurricane season; the re-opening of states and communities without a standard or consistent approach to risk assessment, and a national election. We must all start to think about our individual roles in reducing risk towards prevention, mitigation, and recovery.

Our research has forced our eyes wide open to COVID-19. Following our knowledge of transmission pathways, we must adjust our daily habits while perfect risk information is unavailable. I suggest that you follow our transmission model and be creative, not paranoid, about your approach to avoiding infection and preventing disease. After reading my paper, I suggest adopting and/or continuing the following behaviors:

Graphic outlining wear protective masks wash your hands and social distance

Most importantly, if you do not practice these disciplines for yourself, please do it for your family, friends, loved ones, co-workers, and even me.