Understanding Risk: Infectious Disease as a Global Disruptor. Mark Keim, MD, MBA DisasterDoc, LLC August 20, 2015

Transcription

1 Understanding Risk: Infectious Disease as a Global Disruptor Mark Keim, MD, MBA DisasterDoc, LLC August 20, 2015

2 Learning Objectives After attending this lecture, participant will be able to: 1. Describe the three factors that contribute to disaster risk, in general 2. Recognize the epidemiologic triad in terms of assessing disaster risk 3. Define emerging and re- emerging infectious diseases 4. Recognize the role of emerging disease as a global business

3 1 2 Which camp is at higher risk for

4 @disasterdr

5 Use of the term disruptor Term popularized by Clayton Christensen, Harvard Business School Uprooting and changing how we do business day- to- day Displaces an existing market, industry, or technology and produces something new and more efficient and worthwhile. Both destructive and

6 Emerging diseases can be global disruptors Examples of business impacted by SARS Estee Lauder Atlanta Scientific FedEx Nortel Las Vegas tourism 50% losses in 2 nd quarter AIG lost 30% of annual

7 Economic impact of SARS, 2003 Impact on airlines $6 billion in Asia Pacific $1 billion in North America Impact on transportation affected oil demand 300,000 barrels/day GDP losses due to SARS Singapore = $400 million Canada = $5 billion Global =$33

8 What is risk? Risk is the probability that an event will occur. In epidemiology (the study of health risk determinants) it s used to express the probability that a particular outcome will occur following a particular Last JM, ed. A dictionary of epidemiology. 4th edition. New York: Oxford University Press, 2001

9 Factors affecting disaster risk Vulner- ability Hazard / Exposure Capacity RISK

10 What is a hazard? Definition of a hazard A dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage UNISDR 2009,

11 Examples of hazards Floods Earthquakes Radiation Typhoons Biologicals Tornadoes

12 What is exposure? Exposure Any condition which provides an opportunity for a hazard to contact the body Links JM, Principles of Exposure, Dose, and Response Johns Hopkins University, 2006

13 What is vulnerability? The characteristics and circumstances of a (person) that make them susceptible to the damaging effect of a hazard UNISDR 2009 Or simply put Likely to incur physical or emotional illness or injury UNISDR 2009,

14 What is capacity? DEFINITION The combination of all the strengths, attributes and resources available within a community, society or organization that can be used to achieve agreed goals WHAT IS THE DIFFERENCE BETWEEN CAPACITY VS. CAPABILITY? Also known as absorptive capacity UNISDR 2009, Sundnes K, Birnbaum M, Birnbaum E, eds. Health Disaster Management Guidelines for Evaluation and Research in the Utstein Style. USA: Prehospital and Disaster Medicine; 2003

15 Epidemiologic triad Host Vulnerability * Age * Health status, immunity, stress * Genetics * Use of medications * Pregnancy, nursing mothers * Nutritional status, bodyweight * Social and behavioral traits Hazard * Virulence (severity) * Infectivity (spread) * Host specificity * Route of entry * Strain variability * Antimicrobial resistance Agent Environment Exposure * Dose (concentration, time) * Physical environment (WASH) * Social environment (living conditions) * Protection (PPE,

16 Patterns of disease occurrence Outbreak Pandemic Epidemic

17 Patterns of disease occurrence Endemic the constant presence of a disease within a given geographic area or population Example: Hepatitis Source CDC

18 Patterns of disease occurrence Outbreak the occurrence of more cases of disease than expected in a given area or among a specific group of persons during a specific period. Examples: Measles Coronavirus MERS CoV SARS Source CDC

19 Patterns of disease occurrence Epidemic the occurrence of more cases of disease than expected in a given area or among a specific group of persons during a particular period. These are distinguished from outbreaks by being less localized Example: Ebola Source CDC

20 Patterns of disease occurrence Pandemic an epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial proportion of the population. Examples of global pandemics HIV/AIDS Influenza Source CDC

21 Current threats Emerging Diseases Re- emerging

22 What are re- emerging infectious diseases? Diseases that have been around for decades or centuries, but have come back in a different form or a different location Example: v Measles v

23 Re- emerging Measles v 183 cases in 24 states v Outbreak likely imported by overseas traveler that visited Disneyland (n=117) v Strain matches 2014 Philippines outbreak

24 Re- emerging Chikungunya v Spread by mosquitoes v 1.2 million cases : v Caribbean islands v Latin America v USA v Canada v 183 confirmed

25 What are emerging infectious diseases? An infectious disease that has newly appeared in a population or that has been known for some time but is rapidly increasing in incidence or geographic range. Examples Ebola 1976 HIV 1983 Influenza H5N Coronavirus SARS 2003 MERS-

26 Global pandemic could trigger a world recession Decrease global economic output by 4.8% Cost > $ 3 trillion Annual seasonal flu losses in the US 111 million lost workdays $7 billion lost productivity World Bank, * Lee B, et al. Vaccine (37):

27 WHO pandemic alert (H1N1) Phases 1-3 Phase 4 Phases 5-6 Post peak Post pandemic Mostly animals Few humans Sustained human- human transmission Pandemic Widespread human infection Possibly recurrent events Disease at seasonal levels Preparedness Mitigation Response

28 LOSSES 34 million birds in 15 states $900 million economic losses in Iowa and Minnesota

29 Distribution of Ebola cases in Africa

30 Economic impact in Ebola- affected nations IMF estimates of 2014 GDP growth 10.0% 0.0% Sierra Leone Liberia Guinea January

31 Factors affecting economic losses Mobility restrictions, trade and transport * Border closures (20-75% of GDP) Agriculture * Disruption of planting season * 150% increase in food prices * Doubling of inflation rate Mining * Scaling down Ore mining: China Union and Arcelor Mittal Petroleum: Canadian Overseas Petroleum Financial sector * Liquidity issues as large depositors withdraw Tourism * 5 airlines ban flights

32 What is really driving the loss? not as a result of the direct costs (i.e. mortality, morbidity, caregiving, and associated losses to working days ) but rather those resulting from aversion behavior driven by fear of contagion World Bank, 2015

33 New (emerging) corona viruses SARS CoV 2003 >8,000 cases 775 deaths, 50% elderly MERS- CoV cases 475 deaths

34 What is MERS? Middle East Respiratory Syndrome A severe form of the disease How does it spread? Inhaled from the air when an infected person coughs or sneezes - or - Touching a contaminated surface and then touching the eyes, nose, or

35 Global MERS: present ,368 cases

36 Korea MERS 36 deaths WHO assistance >2,500 persons quarantined >1,800 schools closed nationwide

37 Korea MERS: First case: 68 yr- old national of the Republic of Korea History of recent travel to 4 countries in the Middle East Other cases Family members Hospital- acquired * Patients * Caregivers Korea reports MERS case #1 Korea reports 9 more cases Korea Stock Exchange (KOSPI) Index

38 Disruptor Dashboard SARS Influenza Measles MERS CoV Chikunguny Ebola

39 Thank You Mark Keim, MD, MBA DisasterDoc, LLC Atlanta, GA