Outbreak response: Clinician

In Step 1.12, Soka Moses (Liberia Ministry of Health) outlined the role of clinicians in outbreak preparedness and response. In this step, he will further outline the specific interventions clinicians use to respond to outbreaks. He will cover the key tools used by clinicians; their main collaborators; and the main challenges faced during an outbreak response.

1) What key outbreak interventions involve clinicians?

During an outbreak, there are four key interventions involving clinicians:

1. Medical interventions: screening, isolation, and treatment of sick people to prevent disability and death. They also ensure continuity of other routine health care services.

2. Vaccination and prophylaxis to protect healthy and exposed persons.

3. Epidemic surveillance: Clinicians are vital in collecting and reporting data to define the descriptive epidemiology of the disease, develop clinical case definitions, and implement response.

4. Infection prevention and control (IPC) interventions.

2) What are the key tools clinicians use in outbreak control?

1. Outbreak assessment and diagnostic tools such as appropriate clinical case definitions, point-of-need diagnostic tools, and reference laboratories to identify unknown pathogens.

2. Essential medical supplies, therapeutics, and vaccines.

3. IPC tools such as appropriate personal protective equipment and procedural guidance.

4. Ambulances and other essential transport services for patients and supplies.

5. Communication tools.

3) Who are the clinicians’ main counterparts and collaborators?

Effective response to outbreaks require a multidisciplinary team, including:

1. Epidemic surveillance team involved in outbreak investigation and contact tracing.

2. Laboratory team – collaborations with laboratories enables timely testing and reporting to confirm an outbreak; provides appropriate care to sick persons; and prevents exposure of individuals without the disease.

3. Social mobilisation and communication teams to disseminate accurate information about the outbreak; prevent, investigate and respond to rumors; and investigate and address the cultural influencers of the outbreaks. This can promote community support for the response.

4. Other health teams including, IPC staff, water and sanitation (WASH) teams, and burial teams, as well as routine health service providers and community health workers to ensure access to routine care.

5. Logisticians, accountants and outbreak managers for effective distribution and management of supplies and resources to support an effective response.

6. Close collaboration with security services is essential to protect response teams and patients.

7. Local community.

4) What are the main challenges for clinicians during an outbreak response?

1. Weak local response capacity. In the case of emerging diseases, clinicians often have limited information and expertise.

2. Inadequate diagnostic capacity.

3. Shortage of appropriate personal protective equipment.

4. Lack of effective vaccines and/or treatment.

5. Lack of effective surveillance and standardisation in data collection creates challenges in reporting and understanding regional trends.

6. Implementation of critical research integrated in the outbreak response.

7. Occupational hazards and managing convalescence complications after outbreaks.

8. Local context such as language and cultural barriers negatively affect outbreak control.

9. Insecurity, especially in conflict regions, and community resistance can delay or prevent response activities. This can be potentiated by the lack of trust in the response by affected communities.