Where are the epidemiologists?

Epidemiologists around the world were trying to push decision-makers to bolster defences against a pandemic which was expected to hit us in the near future. For years we showed photographs of the 1918 pandemic which killed 50-100 million from a population of 1.5 billion. With increased international travel and global connectivity, we knew it would be much more dangerous. For the past few years, I was even raising this issue as a drastic war of survival among species where microorganisms have a clear advantage on us Homo sapiens. But globally, there was a criminal neglect over the preparedness for a major pandemic. And then it hit us worse than our expectations. In three months, it has spread all over the world, infecting millions and killing more than 100,000. The death toll in developed countries is so steep that decision-makers are grasping everything to get out of this situation. However, it’s strange that on the front row we are not seeing epidemiologists, especially those trained to manage outbreaks and pandemics, guide countries out of this grave threat. Even in the US, while the top advisers are top scientists in infectious diseases, they are not field epidemiologists (who specialise in managing outbreaks and pandemics). This is strange as the US has the highest number of the best field epidemiologists trained in CDC Epidemic Intelligence Service. This is also the first time CDC is not at the centre stage of the US Covid-19 control efforts as compared to past pandemics, where CDC was leading the control efforts. Even in the UK, the role of epidemiologists leading the response was taken away by disease modelling scientists. Every leader of every country wanted to know the exact number of casualties in their country. This was the main question in Pakistan too. Disease modelling seems to answer this question. With charts and graphs, it seemed that instead of field epidemiologists, disease modelers are giving a clear picture of the future.

The reason why those with the most experience in outbreak detection and response were shying away from giving a number was due to a lot of unknowns about the virus. We still don’t know about its routes of spread, the immunity it produces, its infectivity and mortality. That is why Imperial College London first projected 500,000 deaths in the UK then reduced it to somewhere between 20,000-500,000. That is a huge range to be a meaningful number. The Institute for Health Metrics and Evaluation (IHME), another well-respected organisation which I follow, projected nearly 100,000-250,000 deaths in the US in a few months, but revised their projections to a lower number within two days.

Few years ago, WHO arranged a top scientific meeting on pandemic predictions. It invited epidemiologists, mathematicians, computer experts, including professionals working on weather modelling. I argued there that the reason weather projections are now better than before is that once a certain level of wind speed, humidity, heat or cold is reached, then by only using mathematics or physics, we could make reasonable predictions. But humans are different and behavioural differences decide which way an outbreak will move. This is as complex as human nature.

That is why developed countries are now struggling with overcoming the expensive lockdowns. A graph or model cannot help them. They need to return to epidemiology to understand that outbreaks could behave differently in different cities of a country. Someone at each location should be paying attention locally and produce a local analysis. Pandemic interventions need a universal approach but need to be modified based on the outbreak’s local analysis. Bring back the epidemiologists to help understand the pandemic.

Published in The Express Tribune, April 19^th, 2020.

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