By Diane Hayes, Ph.D., Co-founder, and President, InCrowd
In light of the Zika virus epidemic, much has been made about the open letter to the World Health Organization (WHO) from more than 100 respected physicians to move or cancel the Olympics in Rio de Janeiro, which begin tonight. However, the head of the US Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, has said the threat does not warrant halting the Games.
The CDC and Dr. Frieden have made the right decision. It’s not just that it’s winter in Brazil and the mosquitoes are lower in number. Rather, as an epidemiologist, I know that Dr. Frieden and his colleagues are applying a population-based perspective and that this is a critical factor in their decision. I believe their reasoning is widely misunderstood and deserves some explanation.
At times like this, a population-based approach by organizations like the CDC and WHO may seem at odds with the mission of a physician involved in individual patient care. Our traditional approach in medicine has been to focus on the care of the individual, but emphasis is increasing to manage the health of population.
This is population-based medicine, which considers the individual patient within the context of the larger community of both well and sick members. Five principles are relevant in this regard: a community perspective, a clinical-epidemiology perspective, evidence-based practice, an emphasis on outcomes, and an emphasis on prevention.
In other words, when considering the status, treatment, and prevention of an entire population with a given condition, medical teams can begin to identify ways to improve the overall delivery of care, either by establishing new procedures or improving old ones. The goal is better care and better prevention. This may feel like the individual patient’s particular situation is being ignored, when in fact it isn’t and is being placed in the context of the larger group.
Under this rubric, it makes sense that the focus of the WHO and CDC has been to issue important individual advisories, instead of a blanket ban of the Olympics. This can seem counter-intuitive and in contrast to, for example, primary care physicians and OB/GYNs taking care of individual pregnant women. These bigger public health organizations are focused on managing the health of a population, providing explicit individual based guidelines as appropriate and as a way of managing a disease outbreak or epidemic. Given the widespread outbreak and pandemic potential of Zika, these public health bodies, based on sound population-medicine, have published many guidelines to help slow the spread of the disease.
It is now up to individual physicians, OB/GYNs, and elected officials to educate vulnerable individuals about these guidelines, and apply them appropriately. It is also important for pregnant women and those planning to become pregnant to follow the advisories in order to best protect themselves from infection of the virus. Knowledge, not hype, is very powerful in scenarios like these.
In my opinion as an epidemiologist, a population-based perspective is the right one to take as the Olympics begin tonight in Rio. And, individuals (particularly pregnant and planning to become pregnant women) should follow all the preventive guidelines and avoid areas where outbreaks are present.
Read more coverage of our “Tracking Zika” survey series:
Diane Hayes received her Ph.D. in epidemiology from the University of Illinois, and has gone on to positions in academia, statistics and pharmacology. She has worked on large NIH-sponsored clinical trials, and served in several pharmaceutical and market research executive roles.