Preventing Illness in a Pandemic – Lessons Learned

How do you prevent getting sick in general? And during a pandemic? Here I bundle a number of facts and lessons learned.

It is difficult to formulate a general answer to the question of the prevention of diseases. Specific measures may depend on the disease/pandemic. This is being looked at by the authorities. That’s why it’s important to follow government guidelines. And don’t forget to consult your doctor. But give them a rest when they are overworked by the pandemic.

In this post, I give my own opinion, not that of any organization

What are 10 ways to prevent diseases

Wash your hands regularly; eat healthy; get enough sleep; exercise regularly; Relax; Vaccinations;  avoid contact with sick people; cover your mouth and nose when you cough or sneeze; clean your surroundings; Drink plenty of water. Bonus: don’t smoke or drink (too much), prepare the food hygienically, go to the doctor.

How do these controls work?

1. Wash your hands regularly: this is one of the simplest and most effective ways to prevent the spread of germs. Do this at least after going to the toilet and before eating.
2. Eat healthy: maintain a varied diet with a focus on high-fiber foods with some fruits, and plenty of vegetables and whole grains. This food contains vitamins and minerals. They strengthen your immune system.
3. Get enough sleep: sleep is essential for good health.
4. Exercise regularly: exercise strengthens your immune system and reduces stress.
5. Relax: stress weakens your immune system. Practice yoga, meditation, or go for a walk in nature.
6. Vaccinations: find out about the useful vaccinations for your age. Watch out for urban stories or misinformation about them. Vaccinations are a temporary or more permanent way to prevent getting sick. Its usefulness also depends on your general state of health.
7. Avoid contact with sick people around you. Please contact them online.
8. Cover your mouth and nose when you cough or sneeze, for not spreading germs.
9. Keep your environment clean, especially the surfaces you touch frequently such as doorknobs, faucets, and your smartphone and keyboard.
10. Drink plenty of water as it helps your body to function properly and strengthen your immune system.

Bonus: don’t smoke, drink alcohol moderately, prepare your food hygienically and consult your doctor if you have symptoms. The latter may be possible online in the event of a pandemic.

How can you prevent illness during a pandemic?

Follow government guidelines.

1. During the Covid19 pandemic, the ‘golden rules’ applied in Belgium, which were adapted as the pandemic progressed. In addition, there was also a list of FAQs that also depended on the evolution of the pandemic and advancing scientific insight. These served to limit the spread of the virus. Some examples of these guidelines were:
   • Stay home if you’re sick and avoid contact with others.
   • Keep your distance from others (social distancing).
   • Wear a face mask in public areas where it is mandatory.
   • Wash your hands regularly.
   • Get vaccinated if possible.
   • Avoid traveling to high-risk areas.
2. Limit your physical contact with people who are sick. Therefore, avoid large gatherings and crowded places. After all, you don’t know for many people whether they are carriers of the disease and whether they are in a contagious stage.
3. Get tested if you think you may be infected. This way you know that you have to take measures against infecting others.
4. Work from home if possible. As a result, you are less likely to infect others or to become infected yourself.
5. Maintain good hygiene: see above.
6. Stay up to date with the latest information about the pandemic. In Belgium, this could be done by visiting the relevant government website or by following the news. After a while, during corona, the consultative committee regularly shared information.
7. Make sure you have enough supplies of food, medicine, and other necessities at home in case you need to go into quarantine. That’s not a luxury, especially if you have little or no help from third parties or are isolated in a remote place.
8. Be supportive of others by following the tips above. In doing so, you help yourself and others. This will help to limit the spread of the virus. But also help others who are sick or in quarantine. For example, you can do groceries for them, but always while respecting a safe distance.

(See also: World Health Organization (WHO): https://www.who.int/ ; RIVM: https://www.rivm.nl/)

Do the measures during a pandemic depend on the disease itself?

The measures depend in part on the disease itself. Specific features of the disease determine which measures are most effective. Examples include the way it spreads, the severity of symptoms, and the availability of treatments.

Four examples are:

• Respiratory infections: for example, for COVID-19, there were measures in place to limit the spread of aerosols through the respiratory tract, such as masks.
• Foodborne infections: for example, for norovirus, it is important to cook the food properly and avoid contact with other, potentially contaminated, food.
• Vector-borne diseases: for example, for malaria, it is important to use mosquito nets and repellents.
• Ebola is all about preventing contact with contaminated bodily fluids. This can be done in healthcare by wearing protective clothing, using disinfectants and in society by avoiding contact with sick people.

In addition to the disease itself, there are also other factors of the pandemic that are important for the choice of measures, such as:

• In the case of milder symptoms in the pandemic, less drastic measures are needed.
• If the health care system goes down (too many sick people in the corridors of the hospitals or when there is a lot of burnout in healthcare), stricter measures are needed.
• The measures must be proportionate to the social and economic impact they have.
• The way in which the disease is transmitted, because through the air is different from through contact with contaminated surfaces or through bodily fluids. The measures will vary.
• The availability of vaccines or treatments plays an important role in preventing the disease.

What are the measures aimed at?

In general, measures to prevent disease during a pandemic will focus on:

• Reducing exposure to the virus. To this end, the government recommends social distancing, wearing masks and washing hands, and ventilating living spaces and other spaces where people need to gather. Transport by public transport can also be discouraged, or transport in general, to prevent the spread of (variants of) the virus in the country.
• Protecting vulnerable groups. These are people with an underlying health condition or with a mental retardation, people in nursing homes, etc.
• Slowing down the spread of the virus is done by mass testing of people for the virus, contact tracing through surveys and quarantining and checking infected people.

Do the measures have an effect and how do you demonstrate this?

There are several ways to demonstrate that the measures are effective:

1. By monitoring the number of infections: a decrease in the number of infections after the implementation of measures is a strong indicator.
2. By comparing statistics between areas with and without measures. If the relative number of infections with regard to the entire population is lower in areas with measures than in areas without measures, the measures work.
3. By using mathematical models that can predict the spread of diseases. These models are used to simulate possible futures if the measures had not been taken. These models help to choose measures.
4. By reviewing scientific research that has examined the effectiveness of various measures against disease spread. Scientific studies can be carried out to determine the effectiveness of one or more measures.

You can maximize the effectiveness of measures with the following tips:

• Develop the measures in an evidence-based manner.
• A consistent and coherent implementation of the measures.
• Communicate clearly about the measures taken and their importance.
• Enforce compliance where necessary.
• Evaluate the measures and adjust where useful and necessary.

Note that the effectiveness of measures varies according to the (variant of) disease, the (societal, social, economic, political, demographic, technical, environmental) context and the way in which the measures are implemented. This is one of the reasons why it is important to sometimes combine the measures with each other, such as vaccination, communication, financial support, quarantine and good hygiene..

Are the measures sometimes difficult to understand or follow?

The measures are sometimes difficult to understand or follow. There are several possible reasons for this:

1. The complexity of the pandemic is a function of a large number of parameters, such as the nature of the disease, the mechanisms of transmission, the population density and the level of health care. This can make it difficult to select measures.
2. The rapidly changing information as advancing insight into the disease and the context makes it necessary to adjust the measures. This makes it more difficult for the population to be alert to the latest guidelines and recommendations from the government.
3. Conflicting information normally comes from a variety of sources, such as the media, scientific studies, and social media. This can be the result of malice. This makes it hard to know what to believe.
4. The inconsistency of the reporting further leads to misunderstandings. Inconsistency may be due to different experts having different opinions on the measures to be used, or due to incorrect or incomplete presentation of the data. That’s why unity of communication is important. The different parties have to sit together to come out with a single message.
5. The fear and stress of the disease and its consequences make it difficult to make rational decisions. This makes it difficult to understand and apply the measures.
6. The cultural and social factors influence people’s support for taking measures. In some cultures, it is more difficult to practice social distancing.
7. The economic factors influence people’s support for following measures. Not everyone can telework, not every company can (temporarily) close.
8. The political factors influence the implementation of measures. For example, there may be fear of the economic or social consequences.
9. The complexity of the measures can arise from evidence-based scientific reporting, which also evolves according to advancing insight.

To understand the measures and therefore follow them more likely, one must:

• Get information from reliable sources such as The World Health Organization (WHO) and national health authorities.
• Keep up to date with the latest guidelines and recommendations published by the WHO and national health authorities.
• Dare to ask questions to your doctor or in the pharmacy about the measures.
• Be patient because it takes a while for the measures to take effect.
• Discuss the measures with others such as family, friends, colleagues from work or neighbors.

What are reasons why people don’t follow the measures?

The most common reasons why people do not follow the measures are:

• Lack of understanding of the measures and do not seeing the importance. For example, due to a lack of information or disinformation.
• Denial of seriousness because one does not believe that the pandemic is real or deadly.
• Distrust in the government or science that leads people to believe that the measures are unnecessary or harmful.
• Disbelief that the measures are effective. For example, through one or a few personal experiences, through an ideological or religious conviction or by giving credence to conspiracy theories.
• Anxiety and stress can lead to denial.
• Complacency because the measures are unpleasant, so that people do not follow them.
• Individualists sometimes feel that measures limit their individual freedom.
• Sometimes it is difficult to follow the measures due to social, economic or personal circumstances. For example:
  • Poverty can make it difficult to stay at home because one is dependent on third parties.
  • People with a job in healthcare or another essential sector.
  • People with mental illness struggle with the stress and anxiety.
• Political divisions can cause problems with the measures to deal with the pandemic. This leads to skepticism and resistance.
• Confidence in alternative treatments for the disease gnaws at the willingness to follow the measures communicated.
• Frustration and anger due to a major impact of the measures on social and economic life.
• Due to self-interest, some ignore the measures because they consider the health of others less important than their own interests.
• Cultural factors such as religion, norms and values help determine how people experience the measures.
• Political ideology sometimes leads people to believe that the measures are an infringement on their freedom.
• Misinformation and disinformation leads to confusion and fear.
• Conspiracy theories about the pandemic typically incite, directly or indirectly, the ignoring of the measures.
• Lack of access to resources such as soap and water make it impossible to follow the measures.
• Lack of support from family, friends or community makes it difficult to follow the measures or to stick to them.

People can be motivated to follow the measures by:

• Communicating clear and reliable information so that people understand the measures and know why they are important.
• Using multiple, always the same, communication channels, such as social media, traditional media and community organizations.
• Keeping the measures practical and realistically achievable by taking into account people’s needs.
• Creating trust with (leadership of) communities and local leaders, also to combat misinformation.
• Fostering solidarity by working together to fight the pandemic.

Measures will be understood and followed more quickly by:

• Systematically share only reliable information from the best sources, such as the RIVM (The Netherlands), Sciensano (Belgium) or the WHO.
• Showing empathy and treating them with respect, as this will allow us to better understand their perspective and thereby gain their goodwill.
• To offer help to people who are struggling to make sense of it all.
• Emphasizing that the measures are important for everyone.
• Working with government, science, the media and community groups to communicate the measures in appropriate language. If necessary, with drawings.

How can local cultural customs put a brake on measures?

This can be done in several ways:

1. Physical contact by greeting each other with a handshake, hug, or kiss hinders social distancing.
2. Group events, such as festivals, weddings, and funerals, are sometimes common. This increases the risk of contamination.
3. Hygiene practices are different in other cultures. This allows diseases to spread. The cause is sometimes a lower availability of soap and water, or less general knowledge about how germs are transmitted.
4. Sharing meals with others can increase the risk, if people don’t wash their hands before eating.
5. Wrong medicinal herbs are sometimes mistakenly used to treat diseases.
6. Religious beliefs that prevent people from seeking medical attention due to gender differences, or from taking measures against the spread of disease.
7. Stigma and discrimination in some cultures are linked to diseases. One then hides symptoms and avoids testing and treatment.
8. Language barriers if one speaks little or no English. Therefore, in a multicultural environment, a multilingual approach can be needed to make people understand (the need for) the measures.
9. Lack of trust in the government gives rise to erroneous thinking about the severity of the pandemic and the effectiveness of the measures.

That’s why it’s so important to work with local community groups and community leaders to make sure the measures take into account local cultural customs. This can be done by:

• ‘Culturally sensitive messaging‘: The messages take into account local cultural norms and values of the local population, in their own language. They are therefore adapted to the local context.
• ‘Community engagement’: Work with local leaders and organizations to achieve the intended goals.
• ‘Capacity building: Provide training and support. Use local media.
• ‘Empowerment’: The local communities manage the measures themselves, with the necessary resources. Encourage local initiatives.

What are indicators that the measures are working effectively?

There are several possible indicators for this:

• Decrease in the number of new cases: this means that the measures can slow down the spread of the disease.
• Decrease in the number of deaths: this is a stronger indicator of the slowing of the disease.
• Reproduction number (R0): this is the average number of people infected by one infected person. If it drops below 1, the disease decreases statistically.
• Test positivity rate: this is the percentage of tests that are positive for the disease. If this decreases, the measures may be effective.
• Occupancy of ICU beds: if it decreases, the measures may be effective.
• Decrease in the number of hospital admissions and deaths: if it decreases, the measures are very effective.
• Increase in the number of tests: to measure is to know. It provides numbers for other indicators.
• Decrease in viral circulation: this follows from sewage research or by looking at the number of people who have antibodies. If the virus circulates less, there may be a slowdown in the disease.
• High vaccination rates: a high vaccination rate can help to control the pandemic. It is an indicator to measure whether one can get the disease under control.
• Compliance with the measures: if compliance with the measures is high, it is possible that a (combination of a) number of other indicators are (is) useful.
• Population satisfaction: this is an indicator that the measures are accepted and that they are likely to be complied with.
• Population screening: this allows one to check how many people are infected with the disease, whether they have symptoms and whether or not they have been vaccinated. This provides input to indicators, but is not an indicator in itself.
• Modelling: one can mathematically simulate how the disease would spread without measures and with different types of measures.
• Improvement in economic indicators: this may indicate that the measures are getting the pandemic under control and that society is getting back on track.

Remember, no indicator is perfect. Effectiveness is assessed on the basis of a combination of indicators.

Conclusions:

• There are a number of generic tips to prevent illness. But they are not all-encompassing.
• The effectiveness of measures varies depending on the disease and the way in which the measures are implemented within a cultural context.
• It is important to continue to monitor the effects of the measures. Where necessary, the measures will have to be adjusted.
• It is important to communicate with the public about all the useful aspects of the measures, including, first and foremost, effectiveness. The social context is very important for this.
• To measure is to know. One needs appropriate indicators to know details. It is necessary to look at the indicators together in order to draw well-founded conclusions.

Question to readers:

How did you experience the corona pandemic, and what were the obstacles to complying with measures, for yourself or for others?