by Craig Klugman, Ph.D.
The last time the United States faced a pandemic on its shores was in 1976, when the threat of the Swine Flu circling the globe led to long lines of adults getting the flu vaccine. I remember going with my parents to my school gymnasium as they wait in a long line for the injection. Because of a strong public health response and the availability of a vaccine, nothing happened—a disaster (high numbers of ill and dying people that overwhelms the health care system) was averted. The last time that a pandemic led to mass deaths and illness in the United States was the 1918 flu, which killed 50 million people worldwide (500,000 in the U.S.). Over three years (1918-1920), 2.7-5.4% of the world population was felled by this flu variant.
Given the long time since we have dealt with these issues, there are many terms and ideas being used in the media and by commentators, public health officials, and elected officials that may not be familiar. Thus, I have assembled this glossary for a pandemic including terms in public health and public health ethics.
Active Monitoring – Public health authorities, medical facilities, or health care professionals have responsibility for communicating daily with people potentially exposed to an infectious agent to check on symptoms.
Altruism – Acting so as to put the needs of others first, above your own. Acting with no expectation of reward.
Autonomy – Self governance; a competent and capacitated patient’s [normal] right to make their own medical decisions. Note: This prima facie duty may be de-emphasized when other values or virtues take priority
Baseline Incidence – “The initial rate within a certain time period of what proportion of a population were getting infected” (Thanks Lara Vaz)
Baseline Prevalence – The amount of a disease that is present in a community at the beginning of a crisis event. Usually written as the number of cases per portion of the population.
Close Contact – Being within 6 feet of another person for an extended period. For COVID-19, 6 feet is about the distance the virus can travel via expectorant or a sneeze.
Compassion – Expressing concern and gratitude for others. Given a high level of anxiety from changes in our daily lives, uncertainty over the trajectory of this infection in our communities, and concerns about our loved ones, it is necessary to display patience with others who may also be panicking and dealing with their own anxiety, as well as looking out for our neighbors. Those at greatest risk in this pandemic (the elderly, immunocompromised) may be the least able to get to stores to stock up on supplies. This means asking to pick up some extra supplies for them when you go shopping. It means checking in on them to make sure they are doing okay or if they have needs you may be able to fulfill (need for human connection and conversation; a meal).
Contagious – When a person is infected with the virus and capable of passing it on to others)
Contagion – The spreading of a disease by close contact.
Containment – A strategy to keep something dangerous under control (i.e. from spreading into the population. According to the Centers for Disease Control & Prevention, containment requires rapid identification, infection control, screenings (testing), coordinated response, and continuing assessment.
Elbow Tap – To avoid close contact, public health specialists recommend against shaking hands or doing a high-5. Instead, many have adopted tapping elbows (which are usually protected by clothing and since most of us cannot touch our elbows to our faces, limits the possibility of spreading viral particles to the face (where we have mucous membranes that are the entryway of the virus into the body).
Epidemic – An infection that is spreading rapidly, causing morbidity and mortality over a significant proportion of the population
Epidemiology – The science of public health that examines the incidence, risk, distribution, and change of time and space of a disease.
Forward Triage – Separating patients suspected of having the virus before evaluating them
Gouging – The illegal act of charging exorbitant prices for goods that people may need in an emergency. For example, in COVID-19, a shortage of hand sanitizer has led some people to re-sell it at 100 times its normal cost.
Hoarding – In an emergency or disaster situation, the act of purchasing mass quantities of supplies (more than a person or a household can reasonably use in the period of time a disaster may lost) that may become limited or unavailable. For example, people purchasing large quantities of toilet paper (and leaving little to none for many others) has been a feature of the reaction to COVID-19.
Incubation Period – The amount of time between exposure and the appearance of symptoms. For COVID-19, the incubation period is 5-12 days.
Infection Rate – The probability of contracting an infection in a given population. Given the lack of testing in the U.S., knowing the risk of being infected cannot be calculated.
Isolation (self-isolation) – A tool where people voluntary separate themselves from the rest of the population. They may have come into contact in the last two weeks with someone who became sick, who have sickness themselves, or who are at high risk for getting sick. They separate themselves not for their benefit, but to benefit everyone else. Note: If people do not choose self-isolation, they may find them subject to forced quarantine. Also, the act of separating people who have been infected with a communicable disease. For COVID-19, the suggest period is 14 days.
Justice – In pandemic (a) distribution of scarce resources; (b) taking care of those who may be vulnerable (socially, economicly, physical). For example, n COVID-19, consider the hourly workers losing wages as a result of the closing of theaters, restaurants, etc.; think about students who are homeless when dorms close and face hunger when school cafeterias close; and consider all of the small businesses and non-profits that may never re-open.
Mitigation – Reducing the severity, danger, pain, damage. To reduce morbidity and mortality.
Morbidity – Injury and illness
Mortality – Death
Mortality (Death) Rate – The number of deaths in a given population over a period of time. The World Health Organization estimates that the COVID-19 morality rate is 3.4% worldwide since January (through March 3). For comparison, the morality rate for flu is 1%.
N95 Respirator Mask – A mask that is specially fitted to a person (to fit closely to the face) and can filter extremely small particles (including many viruses). The “N” means “not resistant to oil). The 95 means it will filter out 95% of particles.
Overflow – In a disaster, when hospital beds (or ICU beds) are full, patients who still need care may be placed in alternative locations such as hospital hallways, tents, schools, hotels, and even stadiums.
Pandemic – A disease epidemic that affects the entire world
Quarantine – A tool of separating from each other the sick, the suspected sick, those who have had contact with someone who was sick, and the uninfected. Quarantine is usually ordered by an authority and enforced by police powers and/or legal penalties. Also, the act of separating people who have been potentially exposed to an infection. For COVID-19, the suggest period is 14 days.
Rationing – When resources and supplies are scarce and one does not know when relief or resupply may come, the choice of restricting use to preserve capacity to assist people at a later time. In terms of people, this can mean calling to duty people who are retired health care professionals or trainees; making sure that these care providers are not overworked and overstretched so that they can “go the distance” of the disaster. In terms of goods, using them sparingly so that they last as long as possible and are available to the people who need them the most. Also, not suing materials when they are ineffective so as not to waste them. For example, in COVID-19, hospital workers should not be taking home scarce hand sanitizer because this is (a) theft and (b) removes a limited from where it is needed the most. At home, soap and water is best.
R (Reproductive) Number (R0) – Approximate number of people that each contagious person passes on the infection to. For COVID-19, the WHO estimates the R0 rate is 2-2.5 meaning that each person with the infection is likely to infect more than 2 other people.
Self-Monitoring – Individuals exposed to, potentially exposed to, or ill from an infectious agent track their symptoms (temperature, cough, quality of breathing). They may report this data to their health care professional or to a public health authority.
Shedding – When a virus replicates in a host (i.e. sick person) cell and then is released out of the cell. Also known as being contagious or infectious.
Shelter in Place – In a crisis, finding a safe place as quickly as possible and staying there until released by authorities.
Social Distancing – The practice of increasing space between people to limit contact and thus reduce the risk of spreading infection. For COVID-19, this practice means limiting close contact (approximately 6 feet).
Solidarity – “As a result of common needs and interests, a community comes together to improve its aggregate health by reducing morbidity and mortality”. To act in support of the population group.
State of Emergency – A declaration by a chief executive (mayor, governor, president) that a situation is a disaster so severe that additional resources may be necessary to combat morbidity, mortality, loss, pain, or hardship. These resources may be financial as well as material, such as accessing federal and state stockpiles, and often easing laws and regulations that may slow down or limit actions necessary to mitigate the disaster.
Strategic National Stockpile – Supply of medications and medical supplies maintained by the federal government (states may have their own) to be available in the case of a national (or state) emergency
Surge Capacity – The ability of a hospital to expand quickly beyond the services it normally offers to meet the increased need of a patient population in the event of a disaster or crisis.
Testing – Providing a biological sample (cheek swab) that can be subjected to a proven laboratory examination (often culturing—growing—the sample and comparing it under magnification to a known agent) that indicates whether is infected with a particular agent
Travel Restriction – In an attempt to slow down the spread of a virus, a ban on people traveling to or from certain areas with a high infection rate, or via means that are more likely to spread the disease faster, or by people who are at higher risk of contracting or spreading the disease.
Triage – a process for determining which patients will receive limited resources in a time of scarcity. The patients who are sickest, have the least chance of recovery, and who require the most resources are often provided with comfort care to easy dying rather than aggressive interventions. Those who are sick but not in emergency need may wait a while to be treated or just sent home. The ones who get resources are those who have a high likelihood of recovery with some intervention in a short time. In COVID-19, triage will determine who gets ICU beds, ventilators, and ECMO. When a vaccine is first created, triage will determine who gets the inoculation first.
This list is not exhaustive and I invite readers to suggest other terms (along with definitions) to add to it.
One of the ironies of our massive public health response right now (canceling public gathers, social distancing, and more) is that we will know these efforts were effective if nothing happens. Or if less happens. Public health works when nothing happens. So, if few people get sick, if few people die, then the efforts work. But people may say “we did all of this and nothing happened.” The nothing is the proof that it worked.