The Role of Borders (or lack thereof) in Pandemic Control and Prevention
Pearson, The London Globalist, 2012 Publication
The meaning, significance and geographical location of international borders have and continue to change over time. Today, more and more nations are establishing strictly governed borders between themselves and their neighbours. However, despite the extremes that some governments go to in order to signify their sovereignty between themselves and their neighbours, some entities, including health pandemics, cannot be controlled by international borders. Health pandemics are able to pass freely across any border, national or international, no matter the relations between the neighbouring countries. When a pandemic arises, all nations are immediately incorporated into a borderless world where the health of their citizens is now dependent upon the actions of their neighbours.
Thus, disease transmission during a pandemic is extremely difficult to control and eliminate. All one has to do is look to 2003 and the SARS pandemic or even look to their own citizens suffering from HIV/AIDS. How did HIV arise in every country around the globe in such a short period of time? It was able to quickly and easily cross every heavily guarded border of our modern society.
No matter how hard countries may try, there is simply no fool- proof way to eliminate the borderless world that is created during health pandemics. However, that does not stop the international community from trying. There are currently a few (good and bad) strategies designed by the international community to control transmission across borders during health pandemics.
Quarantine:
Quarantine methods essentially strive for limited contact between the sick and healthy. This can include anything from school and work closures to complete isolation of the ill. Now, instinctively, quarantines seem to make sense right? Why not isolate the sick to prevent infection of the healthy? Sometimes though, things are not always as effective as we have been lead to believe.
For instance, it has been publicly argued that “early, sustained and layered” non-pharmaceutical quarantine interventions can greatly reduce then transmission of disease during pandemics.[i]These conclusions are the result of the examination of American cities which utilized early quarantines as part of pandemic control and saw significantly lower disease infection and death rates during the Spanish Flu pandemic of 1918.i However, today we live in a completely globalized world. Things are not as simple as they were in 1918; even if we were able to quarantine a city mere hours after infection it is not feasible to assume no one has migrated within that short time period.
Furthermore, influenza viruses (including the Spanish Flu) have a shorter incubation period of typically only 2 days.[ii]Thus, the asymptomatic period for the Spanish flu was relatively low. This shorter incubation period means that infected individuals will seek treatment sooner rather than later after being infected and therefore, not have the time to come in contact with and infect others.
If we were lucky all diseases would possess a short incubation period and could be effectively treated through quarantine. Unfortunately, that is not even close to being the case:
Severe Acute Respiratory Syndrome (SARS), a subtype of the coronavirus, has a much longer incubation period compared to the influenza virus.[iii]With an average incubation period of 5 days (range 2-7 days), individuals remain asymptomatic yet infectious for a greater period of time.iiiOther human coronaviruses have been reported to have even longer incubation periods then the SARS subtype; which poses an even more significant threat to the human population.[iv] This longer incubation period would effectively eliminate quarantine as a feasible preventive option due to the magnitude of individuals that have been in contact and exposed to those infected before they were aware that they were infected.[v]
It is easy to see the appeal of quarantine as an effective measure. However, it must be used in an intelligent manner. It is unproblematic for international leaders to immediately implement quarantine during a health pandemic. Yet, in the majority of cases, quarantine does nothing but offer the public a false sense of hope and security that action is being taken to eliminate the disease threat. In actuality, quarantines are really nothing more than one, giant, societal sugar pill.
Screening
Like with any other issue today, society is looking for a quick-fix solution. The quick-fix currently gaining interest in health pandemic transmission is disease screening at international borders. Similar to most quick-fix solutions, no matter how promising, quick and non-invasive disease screening methods appear to be in theory, the reality of disease screening is that it is neither reliable nor accurate.
The main issue is how screening actually works. Most often screening works by rapidly measuring a person’s skin temperature. Although good in theory, thermal screening poses some significant setbacks. For one, it has been proven that skin temperature is not an adequate indictor of overall body temperature.[vi] The second issue is medications. As a modern society, there is easy access to effective medications that eliminate common cold or flu symptoms- including fever.viThus, a screening system is ineffective if humans are capable of eliminating the symptoms it is trying to detect.
Disease screening is just not an effective measure in transmission control. This was evident during the SARS pandemic of 20003 with Canadian authorities stating, “available screening measures for SARS were limited in their effectiveness in detecting SARS among inbound or outbound passengers from SARS-affected areas.”
In spite of the current complete failure of disease screening, it does possess a possible solution for the future: If the technology can be developed to the point that rapid testing for a disease at international borders is accurate then it could safely be said that disease screening could become an immensely effective tool in transmission control across the world and save many lives.
Passive Surveillance
Passive Surveillance involves maintaining and ensuring public awareness of the disease and its symptoms.[vii]Additionally, passive surveillance involves depending on the informed public to seek medical attention once symptoms arise and delay international travel if ill.vii Essentially, this approach tells leaders to keep their citizens informed and count on them to report their illness. Can we actually count on our fellow citizens to stay informed in this fast-paced, crazy world? It is possible.
Passive surveillance is regulated on a national opposed to an international level,viwhich serves to be the perfect solution in today’s bordered world. Nations are always looking for ways to demonstrate their sovereignty and avoid co-operation with other nations that they may not see eye-to-eye with. During a time where a nation is at the mercy of their neighbours, passive surveillance allows nations to regain some control of the pandemic.
Using passive surveillance, nations are able to inform their public about the pandemic and its symptoms using culturally sensitive and effective methods. These passive surveillance methods may vary greatly or slightly across borders in order to effectively convey the message to the public. By allowing nations to adapt the message in a culturally sensitive manner it can be more effective in reducing transmission.
It is possible passive surveillance will either completely fail or completely succeed during a health pandemic and the only thing responsible for its fate is planning. If society fails to plan how to successfully implement this prevention strategy then passive surveillance is a waste of time and money. Countries need to plan today so that they are prepared for a possible pandemic to arise, months, years or decades from now. Unfortunately, this may not prove to be such a feasible option as governments are not likely to spend part of their budget on something that may not occur within their elected term (no matter how much benefit it may provide for their citizens).
Although much can be controlled across international borders, health pandemics are able to transcend borders despite any cultural or political differences of neighbouring nations. Nonetheless, there is hope. What is clear is that this hope will only become reality with time. The world needs more time; It needs time to develop more accurate technology, time to better understand diseases and how these diseases are spread and, most importantly, time to learn how to better cooperate as a global community. In this time, if we are able to study and learn from our past while preparing for our future we will be able to accurately predict and eliminate health pandemics which will effectively save countless lives across the globe.
[i] H. Markel, et al. “Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic.” JAMA : the journal of the American Medical Association298.6 (2007): 644-54. Web.
[ii] M. B. Rothberg, S. He, and D. N. Rose. “Management of influenza symptoms in healthy adults.” Journal of general internal medicine 18.10 (2003): 808-15. Web.
[iii] M. Varia, et al. “Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada.” CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne 169.4 (2003): 285-92. Web.
[iv] M. Enserink. “Infectious diseases. Searching for a SARS agenda.” Science (New York, N.Y.) 300.5625 (2003): 1487-8. Web.
[v] T. Svoboda, et al. “Public health measures to control the spread of the severe acute respiratory syndrome during the outbreak in Toronto.” The New England journal of medicine350.23 (2004): 2352-61. Web.
[vi] J. B. Nuzzo. “Border Restrictions: Not an Effective Means of Preventing the Spread of Swine Flu.” (2009) Print.
[vii] N. M. Ferguson, et al. “Strategies for mitigating an influenza pandemic.” Nature 442.7101 (2006): 448-52. Web.
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