James Hayslett is a epidemiologist who have been working in U.S. and worldwide for public health and infectious disease disaster counteraction and recovery. He worked at CDC(Centers for Disease Control) in United States Public Health Service and at National Biosurveillance Integration Center in United States Department of Homeland Security.

He served for inhalation anthrax response team in Washington D.C. in 2007,  novel influenza emergency response team in 2009, and was dispatched to Korea for CDC liaison officer in 2014 to 2016. We asked about the countermeasure we are taking action to COVID-19 in Korea. We conducted the email interview with him from Santa Fe in New Mexico, U.S.

What is your opinion of the status of the current COVID-19 outbreak in Korea?

This outbreak, both in Korea and on the international stage, is very dynamic and requires a proactive and nimble response from the government and private sectors.  In Korea specifically, the clinical, public health and diagnostic resources mustered in response to this threat have been impressive. Especially, the ability to ramp up and implement the diagnostic component of this response is impressive.  This timely and transparent characterization of this event will provide much needed information for all aspects of the response but most importantly effective and timely risk communication to the Korean people.  

Is it appropriate to increasing diagnosis while clinical resources such as hospital beds are limited?

Information is truly power in this and all outbreaks, with accurate diagnostics being a key component to help with planning at all levels of the response. Being able to diagnose and characterize the outbreak allows us to provide timely and accurate information to empower the population.  For example, if we know that otherwise healthy individuals are positive for the infection but non or mildly symptomatic, they would be able to self-quarantine and monitor their symptoms as directed. This level of self-management serves not only to empower the person but on the larger scale can reduce the burden on the healthcare6 system that can be caused by the "worried well". 

Is the infection rate in Korea higher than other countries because of the level of diagnostic testing undertaken?

As this outbreak evolves, we are seeing that virus may have been circulating in communities and gone undetected in other countries, whereas in Korea, the more comprehensive testing may be detecting these non and mildly symptomatic individuals. Korea's extensive testing has the potential to be extremely helpful on the international stage to better define mortality and how pervasive the infection is.     

What should be in priority to response to highly contagious like COVID-19? Fast diagnosis or proper treatment?

This is a situation - like most novel infections - where treatment and diagnostics run in parallel. I like to think of it as a railroad track where the rails may be the treatment and diagnostic functions while the ties or cross-members add strength, support and connectivity between the two parallel tracks and serve as feedback mechanisms to increase the overall efficacy of the public health response.

Based on your experience worked as CDC liaison officer in Korea, how do you see current crisis compared to then?

From my vantage point here in the US, I am finding both the efficiency and transparency of the response to COVID-19 to be admirable and an example for other countries.  The professionals at KCDC/KNIH and MOH should be commended for the progress they have made since the MERS outbreak.

How does the severity of COVID-19 compare to previous outbreaks of SARS, MERS and influenza?

The present mortality rate of ~2% is based on limited data that may not adequately represent how pervasive the infection is among populations where the virus is circulating. As the diagnostic capacity increases, a more accurate characterization of the outbreak will allow for a direct comparison of morbidity and mortality.  It can't be stressed enough that while public health officials work to characterize  this outbreak, the standard precautions for respiratory viruses offer the best protection to you, your family and your community.

Due to limitation of clinical resources, many of confirmed cases are quarantined at home or so-called “medical care for mild patients”. What should be cared of to these response?

Home quarantine and isolation are sound public health strategies to limit the spread while prioritizing medical resources. Korea is fortunate to have such an extensive level of connectivity to support this strategy.  As with all health care interactions, communication is key.  To effectively implement this strategy people must feel there is trusted two-way communication that not only supplies them timely and accurate information but allows them access to providers to answer their questions  and allow them access to additional care, if needed. 

How should we cope with this situation?

I think people should be engaged with their trusted local government sources of information, such as KCDC, MOH, to find timely information to allow them to take appropriate precautions while still carrying on as many of their daily activities as possible. 

Unfortunately, our increases in the scientific understanding of this disease does not move at the speed of the 24-hour news cycle, which leave a vacuum for confusing, conflicting, incomplete and sometimes, false information.  It is incumbent on the media and government officials to provide timely and factual information to help the public understand the disease and remain their trusted source for information. 

I will say that the more that public health agencies are integrated with the daily life of citizens, the easier it is to push out factual information that is trusted and minimizes confusion. I found the public service announcements on the subway during MERS to be very well done and helpful.

May COVID-19 be seasonal virus which comes every winter?

There is the possibility that this could become a circulating season virus and the international community has acknowledged this and is moving rapidly in vaccine development that would mitigate its impact in a seasonal setting. 

Beyond a country, how the globe respond to spreading of the contagion outbreaks?

I think your use of the term “global spread” is central to the discussion.  Public health and emergency response professionals have acknowledged we are only one plane flight away from the next outbreak.  To that end, governmental cooperation and scientific transparency are ? and will continue to be ? the pillars that support an effective response to not only COVID-19 but future emerging health threats.
 

translated by Surie Lee
translation supervised by Beckhee Cho