How to Stop a Disease From Crossing Borders


In nearly 20 years with the Centers for Disease Control and Prevention, Rear Adm. Nancy Knight, director of the agency’s global health protection division, has led the development, coordination and implementation of public health policies and programs in countries including Nigeria, Kenya and South Africa. Before joining the C.D.C., Dr. Knight was a Peace Corps volunteer in Lesotho and trained as a family physician.

In 2008, Dr. Knight helped start in Nigeria the C.D.C.’s Field Epidemiology Training Program, training “disease detectives” to identify diseases and how to respond to them. When Ebola came to Lagos, she returned to Nigeria and worked with the government and the “detectives” to deal with the disease.

“Those people we trained were instrumental in fighting Ebola because they were leading the effort on the ground, looking at daily cases and running that response within those communities,” she said.

Dr. Knight talked about the coronavirus, what travelers can do to avoid it and how the C.D.C. works with governments and other groups around the world to help countries stay prepared for the possibility of an outbreak of a contagious disease, and to tackle those diseases when they occur.

My division and the work that we do focus on working with countries to achieve global health security and keep people safe from outbreaks.

  • Updated Feb. 10, 2020

    • What is a Coronavirus?
      It is a novel virus named for the crown-like spikes that protrude from its surface. The coronavirus can infect both animals and people, and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is possibly transmitted through the air. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • How worried should I be?
      While the virus is a serious public health concern, the risk to most people outside China remains very low, and seasonal flu is a more immediate threat.
    • Who is working to contain the virus?
      World Health Organization officials have praised China’s aggressive response to the virus by closing transportation, schools and markets. This week, a team of experts from the W.H.O. arrived in Beijing to offer assistance.
    • What if I’m traveling?
      The United States and Australia are temporarily denying entry to noncitizens who recently traveled to China and several airlines have canceled flights.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.

We do this through collaborations with partners, particularly governments in countries where we are working. We work together to strengthen core public health systems and find ways to prevent and respond when there are outbreaks.

Through the decisions of Global Health Protection and other experts, we work with countries on some critical aspects of their public health systems. The four aspects that we really focus on are: developing strong disease surveillance systems; making sure there are adequate laboratory networks; making sure there are people with expertise in epidemiology — we call them disease detectives; and ensuring that there are strong emergency response structures.

We have such an interconnected world today, and it’s shocking how quickly people and things can move from country to country. In as little as 36 hours an individual can move from a small village on any continent to any country in the world. With that comes a risk of movement of diseases within our borders and across them.

It is. There’s always going to be fear of diseases, especially when it’s a new disease we’ve never heard of before or one we know about, but it helps to be able to detect them quickly. We want to be equipped to know what it is, stop it, mitigate it and keep it from spreading as quickly as possible.

Another thing that can be kind of frightening is not only the health impact and the lives that can be affected or the people who die, but there’s also a big economic concern. These diseases can affect human health, animal heath, economies. They can affect relations with neighboring countries, trade and tourism.

More than 11,000 people died of Ebola — that’s a huge toll on human life, and the cost on the global economy was more than $53 billion. Severe acute respiratory syndrome — SARS — costs countries $40 to 45 billion.

Thousands and thousands. It’s a worldwide issue. After the SARS outbreak in 2003, countries around the world recognized that not everyone was prepared to address an outbreak like that when it occurs, so the World Health Organization and countries in it put into place the international health regulations. But a majority of countries were not prepared to respond. They knew what they agreed to, but they were missing the road map.

The global health agenda was established, so many countries that wanted help figuring out how to know their gaps in an objective way could get that information.

The C.D.C has three levels when a health threat occurs: Watch, alert and warning. Level One is watch. It’s when you should practice usual precautions for this destination, as described in the Travel Health Notice and/or on the destination page. This includes being up-to-date on all recommended vaccines. Level Two is alert, when you should practice enhanced precautions for this destination. Level three is warning, when we say people should avoid nonessential travel to this destination. At Level Three the outbreak is of high risk to travelers and no precautions are available to protect against the identified increased risk.

Travelers should remember that there is limited access to adequate medical care in affected areas, and older adults and people with underlying health conditions may be at increased risk for severe disease. Travelers with an immune-suppressed system should consult with their health care providers for additional guidance before travel.

Currently, there is no vaccine available to protect against 2019-nCoV. There is no specific antiviral treatment recommended for 2019-nCoV infection. People infected should receive supportive care to help relieve symptoms. If you were in Wuhan and feel sick with fever, cough or difficulty breathing within 14 days after you left Wuhan, you should seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.

This interview was edited and condensed for clarity.


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