Dr. Abdi Mahamud: Incident Manager for WHO Western Pacific (Raise the Line)
Hi, I'm R. I'm the chief medical officer at osmosis.
And today I'm happy to be joined by Dr Abdi Mahmoud, the incident manager with the World Health Organization Western Pacific region, who's been helping oversee response to the coronavirus pandemic in China and elsewhere, right from the start of the outbreak.
And we're gonna be discussing what happened in that region. What he thinks are lessons to be learned for the rest of the world as we're all continuing to fight this outbreak.
Thanks so much for being with us today, Abdi, thank you for having me. So just to get started, can you tell me a little bit about your role on the wh O team and during outbreaks, wh O established what we call the incident management system that and uh that coordinate a response from technical perspective to the operation, logistic and to all aspects of the outbreak response.
So we established that the leadership role is the incident manager and that we have different pillars that support the response.
And more importantly is the health operation will provide technical to the to the countries and then we provide them with operation, supply logistics and then more importantly is the human resource that will require to respond.
And finally, the financial and the and the other responses and uh more important. And finally, is the partner of coordination in a big response like this, there will be many, many stakeholders involved.
So coordination of that would be very critical and that's one of the uh wh os leading role as the functional secretariat.
So the countries and the region have spent a lot of time in prepare now. So there's a big document called I just want to show this as Pacific emergency.
So this was the kind of that helped this region strategic for emergency diseases uh that uh been implemented. So they went through phases of multiple outbreaks and and that helped this region prepare better.
So there's a lot of investment that happened in terms of the preparedness and it was uh helping them in establishing the system to detect a to respond.
Now, early on in the response, I know there's a lot of concern and question about whether this was spread person to person.
Do you mind just walking me through the thought process that was happening around mid January for the who and, and how it was decided, uh whether or not it was person to person, uh just to take you back in 2003 when we had the SARS outbreak.
Uh it was a lot of lessons were learned and based on the public health measures which was successful contained subsequent to that, the countries of the region have established surveillance or particularly pneumonia of unknown origin and the surveillance for respiratory illness uh for influenza like illness across the almost all the countries.
So one of those surveillance uh surveillance is really well established in China is a surveillance for pneumonia of unknown origin.
So there were clusters of that that was detected early on and towards the last week of uh cases have been reported on. So on 35 we have been alerted 31st December of 2019, we have been allotted, there are clusters of pneumonia of unknown origin like any other disease we have been responding, you do the due diligence, do the investigation and uh try to learn more epidemiology.
So immediately e every day we are allowed the whole world through the system of the I HR system whenever an event happened, uh most people are not aware, but we do have a yellow fever outbreak going on.
There are different outbreaks going around. So as part of the International Health Regulation system, uh when an event like this is reported immediately, it's you confirm, you verify because this is a signal, you get a signal, you do the investigation and once it's confirmed, you allow the rest.
So on 5th January, uh we are immediately it was allotted the while and we started doing the investigation. Uh On 7th January, the virus was isolated and 10th January, the full genome of the SARS two virus was shared with the wild.
So the initial investigation as you know, as an outbreak as an epidemiology yourself, a lot of the unknown animals that we know and the unknown animals.
Uh so finding more information at the alley, you make decision based with the limited and certain data you have. So we have learned a lot from it in the last 100 days.
But the initial phase, there were a lot of things we didn't knew about it. How was it behaving?
Is it behaving like the other Coronavirus that uh that we have been dealing with? Is it gonna be like SARS virus or the?
So there are a lot of no during that time and in hindsight, what information we know right now, we can say, oh, I wish we knew that.
But at that time, a lot of unknown unknowns, of course, we have learned a lot and the world has within 10 days, the full genomic sequencing was shared.
So this was a remarkable progress that was done. And in terms of transparency thanks to the Wuhan Chinese scientists, it gave enough time for the countries of the world to prepare uh should the virus uh come to them.
So uh once it's over, we'll be doing a detail. What happened, what we learn, what do we got like?
But uh I believe in any outbreaks, uh we always look at what we know or we don't know what the unknowns are not. So in.
Yeah, it's 100 days and we have millions of case million or case and more information and uh over 50 candidate in trial.
So that's a lot of remarkable progress. And speaking of progress, one of the things I'm I'm specifically curious to learn about is what were some of the most effective strategies that you saw used by the Western Pacific countries like China, Japan, Singapore, South Korea.
What were they doing that the US can learn from? I think this is the basic public health measures.
This are 19th century, it's not something new, it was used for every other outbreak response. This one is the number one is a strong surveillance system, the early detection that will help you once you detect that case is intensive and aggressive contact tracing and then finally isolating the contacts and quarantining the case.
So these are four basic public health measures that will be helpful, of course, and then adding to other public health measures from a personal universal population measures, hand hygiene, uh cough etiquette.
And then the second layer of that uh when you have the case and you detected case management and then the and then based on risk approach.
So when you, you have to have a risk approach and that countries in the regions have learned a lot of experience, was it cut risk approach rather than treating the whole country as well?
But uh where the risk uh uh we divide into four areas in regions or province where you don't have cases is a different in that you spend prepared, prepare and strengthen your system, surveillance, your laboratory and health system.
And when you have initial cases, the most important is how you deal with it. So a lot of countries have lost that initial time.
And this country of the region related to that for you to have you need to build the system. I mean, recently the core has been in the in the media, a success story but we have to reflect back, core was hit very hard in 2015 with the mass media ves respiratory COVID from that lessons they learned so well.
They build a system, they change the regulations, they build a lack capacity, the surveillance system, the community. So the next time 2018, when they had a repeated uh they were able to contain it only with one case.
If you go back in 2018, uh 15, sorry. Uh they were 186 with around 35 death, 20% case fatality rate.
Based on that lessons Korea learned through the hard way to build a system. So should there be another instance, they have a well functioning public health system, well functioned, surveillance, well functioning uh laboratory system with public and private and then well risk communication.
So it was the tip of ice but it's been seen what Korea was able to achieve. But is the sophistication that was built in since the 2015 that helped them address the 2018 outbreak and successfully managed in uh 2020 outbreak.
So uh preparedness, preparedness, it really help you to that. And it's not only one part, but it is a whole comprehensive approach uh in 2015 to get you back, there was so much hospital infection and right now this outbreak, Korea with despite having so much cases, the infection prevention control has been really well managed.
So same applies to Japan, to Singapore, to Hong Kong and a lot of countries uh they invested so much in preparedness that helped them to respond to this uh COVID-19 pandemic.
What about specifically testing? I know right now in the US.
That's the focal point of conversation. What was the role of testing in Asia?
How important was it? I think testing was part of the comprehensive, what they really invested much is the 19th century public health measures.
Yeah, you test but the contact tracing and then testing of that context and then making sure they're quarantining and then the rapid response like Korea, uh we had one cluster outbreak in one of the church members around 9000, but they expand it to 300,000 members of that.
So that the lab capacity, the capacity to share timely to once you detect. How do you respond, how do you trace those contacts?
How do you make sure the case, uh the contacts that have been identified through the lab have been isolated and followed.
So it really played as additional measure. But what they were able to achieve and what a lot of country in Middle East, in Europe and in the North America were able to do is what do you do with that test?
Yes, you can expand usa major country leading the world. But what do you, what do you do with those results?
It's far more important than the result is very important testing because you are shooting the darkness, it gives you here where the risks are.
So how do you manage that risk? Once you identify the cases?
That was the success of uh of Korea and Japan and some uh Singapore and most of the country and the regions using test for, for information for removing those patients from the general public rather than going through lockdowns.
And then they were able to prevent, did you see in those countries, did you see shortages of ventilators, N95 masks and other supplies like we're seeing in the US?
And if so what was done about it? I mean, like an outbreak is preventing that.
So if you're able to manage the trick of the business is before you reach there, can you contain it uh easily can up the health system.
So two things they were able to do that. Uh One is preventing the overcrowding, what I feel personal.
Of course, we need a lot of evidence. The overcrowding in the hospitals were may have played a big role in a lot of this country.
So we have to making sure to prevent, of course, it can send us a center of amplifier and then subsequently overwhelming health system.
Yes, the planning process, we haven't reached that but a lot of countries, a global shortage. Once you have a pandemic, the need, every country and every state will require its own that uh we will have prevented, have we acted faster, preventing the overwhelming of the health system by doing basic.
Um coming back again and again in the 19th century, stride in every outbreak and it worked very well. And the second part is, uh, the infection prevention control measures, hand washing.
It looks like so mundane. But it was just the 19th century 1840 when the Hungarian physician insisted telling, you know, if you wash hands, you save life and like everyone was making ridiculous self-respecting doctors don't need to wash.
And that was the, but unfortunately, from 1840 well, we are preaching right there is saving life there and can still live save life right now.
And the basic infection prevention control. That's the message that hasn't changed.
Were there shortages of healthcare staff in any of those countries or? It sounds like they were so well prepared that they didn't get to that state?
But did you notice that even early on in China? And if so how do they deal with the shortages of, of uh staff?
Yes. Uh this no one expected.
I think the system will be overwhelmed just to give you an example in Wuhan and Hubei Province. The system overwhelmed very quickly.
It from an initial cluster of 47 cases in 31st December, all of a sudden within two weeks, the whole system. So what China or other country was, were successful able to do was that all government or societal approach?
They deployed 40,000 uh healthcare workers in Wuhan and it really made a lot of difference. And uh uh we have to see this pandemic fight as like war you need to won the battles at that point.
So the strategy, whether in Daegu and Yanbu, in Korea or in Wuhan and Hubei, you need to shut down these epicenters. Of course, you can prevent that.
So they put all the resources to making sure the epicenter was successfully implemented. And yes and no country will be ready.
Even the most rich country or poor country forgot about the low resource countries. And even in this region, we have Lao Cambodia uh which will be struggling but prevention and that solidarity within the country.
It's not unique to even North America. A lot of developed country health system is, is uh a federal system where uh Japan has, has led at the provincial prefecture level.
But should they be? Uh Hokkaido was once a, a big center so the the government was able to support there and they do the basic so state or prefecture or provinces need to build a system.
But once they overwhelm the rest of the national government and the global government, uh the global community need to support that.
And small box. Uh I think you remember uh had a story about house on fire and that's the success.
Uh We, we, we, we used to do this massive lockdowns. It's massive lockdown, but massive vaccination was going on.
And uh a lot of resources have been western on that and a young Indian physician just raised up. It's like in his village when a house is on fire.
You, you don't put water in the neighbor house, should it catch fire? But you spend all the effort in turn uh switching off that fire.
So in that concept, they were able to do isolation and containment. Finally, the cases and then doing containment vaccination around that.
So I'm using that analogy. It really helps every country everyone to see that house on fire where it's Hubei or Wuhan, it's on fire.
We need to come together uh to switch off to, to timely respond to that or is northern Italy, everyone needs to come together and that to respond.
If, if it doesn't, we are in a situation within 100 pandemic uh across affecting. So that concept that help very much in the smallpox eradication is still valid that solidarity and then catching rather than spending, wasting your resources, putting uh water in houses, should it catch fire?
We need to help each other in that house on fire. And that house on fire can be in Wuhan, it can be in New York City, it can be in Seattle or in somewhere in Sub Saharan Africa.
Did you see stories that were inspiring where people were coming together to help each other uh in these early months of this outbreak?
Uh Yes, I think from everywhere that human. So uh solidarity comes very very strongly from the uh the cruise ships, the people helping the crew members to communists coming out.
I think the our normal instinct during the pandemic is to help each other. Uh So it came out very, very strong.
You know, of course, the media brings out the worst in us, but 98 95% people are good and they will go out of their ways.
We have seen right now retired doctors coming back, they were, they know there's risk to them are very, very high coming and losing their lives.
So a lot of dedication, dedication from the front line workers to the retired physicians. I think the human nature pandemic has shown that we are still out there and we will, people are ready to help each other.
Maybe a what do you imagine the next 3 to 6 months is gonna look like in that region. I think with P pandemic, there would be waves of uh outbreaks coming in from different parts of Singapore.
Vam. Almost all this country were able to contain the initial wave from coming from China.
Successful containment was done. Contact tracing once the outbreak pandemic spread to Europe and other countries.
This now dealing with the second wave. Uh it's very easy to handle one country.
You can me out and do travel and see who's coming from that, but it's everywhere. So how without self isolating a country, no country can survive without depend on that.
So the main challenge will be how to handle the second wave and the third wave is gonna happen and then the societal impact that it has people lost jobs.
Uh The economic impact is massive. Uh We have a country with the middle low resource country going out of the way saying yes, we can rebuild the economy but we can bring back lost life.
Uh It takes a lot of sacrifice countries with not a lot of resources to maintain that. Uh Cambodia uh Ventanna, a lot of these countries have gone to the extra mile.
But how long can you maintain that? Preventing the second or the third wave?
Uh So we really require the solidarity in in finding therapeutics, finding vaccines, helping them with the PPE S I think resources will be easily depleted in in even rich or poor countries.
So the challenge will be how to deal with the second wave. A third wave.
And finally, the fatigue imagine for 100 days, countries of region have been prepared and responded. So uh the next 34 months will be continuing and it a toll on people health system.
It takes a toll on the society on the community. And more importantly, the healthcare workers who have been working 24 7, we have a limited shortage of uh this year is the year of NA and midwife, but there is a massive shortage.
So we are using the small existing to go to the extra mile. That's a good segue from my next question, which is around uh healthcare capacity.
We know about flattening the curve. And that phrase has been used a lot.
There's also this idea of raising the line of what the healthcare system can do. And so I'm curious to know what are your thoughts on creative waves for countries that are in the middle of it?
On the first wave or even the 2nd, 3rd and the fatigue wave, what can they do to raise the line? So I think uh countries with a lot of resource will be able to do that.
It's easily for China to build hospital in six days or for New York to combat uh convention hospitals. What what we help in the countries is to, to build the community, the community support.
Uh so it might not apply for countries but even in the the neighborhoods and other parts. So 40% of the cases are mild, 40% are moderate, 15% is what you require.
So how do you find the balance? And uh that requires uh very, very innovative.
We are able to work very closely with the building, the capacity, providing ventilators and basically like P OX in a community and then strengthen the referral system that we are working.
A lot of our support, rich country will take care of themselves. Of course, some of them will mess up through the way that the vulnerable countries, countries with limited resources, how we do as, as a, as a nation, as a global community will determine.
So for us is working with the community to find solutions. Uh We very, very important in the next phase.
And then the referral system, if you're able to manage the 85% the mild and moderate within the community and save the hospitals and the healthcare system to manage the 15 and the 5% will require ICU will that will be the things and then the global solidarity countries will not be able to pull through it.
So it requires expertise from other countries. Once the US or the uh northern Europe finish, Western Europe, finish the outbreak, they need to come and help Sub Saharan Africa and another country in the Southeast Asia uh countries co up with the second wave and the third wave and related to that.
Also one of the things that I know firsthand has made a difference is education. I'd really love to hear examples of what you've seen in terms of public health education, both for families, taking care of the mild or maybe even the moderate cases at home as well as the health care workers that are trying to stay on top of the latest research and information we know about COVID-19.
How does public, you know, public education, like the stuff we do at osmosis? How does that impact?
What happens on the front lines as you've seen it? Absolutely, it has a major, major impact.
And I think uh osmos and other colleagues have been ahead, way ahead of the curve in trying when we have lockdowns. Uh I think you are preparing for pandemic, teaching people we are learning right now how to conduct webinars and to conduct other to train the clinicians.
Uh And that so the osmosis was way way ahead of the games. And I think a lot of lessons, the clinicians and the and the aspect, one thing that I wanna bring about, I think which you are doing is the teaching clinicians, public health patients and ideology.
Uh very easy. I was a kid initial myself.
When you look at treating your individual patients, it's very easy. But pandemic is population based.
So that mindset shift which osmosis can play a very critical role in clinician. Your role very, very important that shift from hospital based.
OK, patient based to population based intervention. So we are learning a lot and uh we really as wh o we had created a lot of platform for clinicians for the infection prevention experts and then sharing experiences.
So we think we have a network of experts of from different areas from the clinical management using the on online platform created uh by Osmos and others.
We were able to spread and it makes a lot of difference. Having the right information at the right time can save life.
Thank you. I think my final remark, I'll just say one final remark, clinicians can play a big role.
Medications, online education plays a very critical role. Yes, we'll go through this pandemic, but we know very well.
We the world is not ready for the next pandemic. So what we do as a society, as global community, as individuals really makes difference.
So that shift that we have been talking about since 1840 the basic hand washing will make lifestyle. So uh we call everyone the hand washing saves life.
We knew it from 1840. Let's continue practicing that and then prepare for the next one.
Failure to prepare is preparing to fail. So just as Ben Benjamin Fran has said, so, preparedness, preparedness, I was the main lesson learned from this region.
It helped them. And uh next that some of the lessons in preparedness.
So thank you. Thank you, Doctor Mahmoud for joining us today and good luck with your very important work.
I'm Doctor Rishi Asai. Thanks for joining us for today's show.
You can join osmosis to raise the line and flatten the curve. Go to osmosis.org/covid-19.
Thanks a lot.
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