CASE 6: A Rapid Risk Assessment Tool: Determining the Risk of New/Emerging/Re-Emerging Infectious Diseases in Canada

The protagonist, Dr. Anna Moreno, is an epidemiologist at the Public Health Agency of Canada (PHAC), where she manages the Public Health Risk Sciences Department. Her role includes managing monthly meetings and advising when it is necessary to use the Rapid Risk Assessment (RRA) tool to conduct an analysis of any emerging infectious disease relevant to Canada. The case presents a fictitious situation in which a series of outbreaks of an influenzalike infectious disease have occurred in certain regions of the Americas. In response to outbreaks of severe respiratory and influenza-like symptoms within the Americas and the more than 100 associated deaths over the past month, the World Health Organization has declared the unknown infectious disease a Public Health Emergency of International Concern (PHEIC). Anna has a meeting that morning, and she will need to prepare an approach to create a working group responsible for conducting an RRA for this unknown disease. Challenges arise because the existing scientific evidence and literature about the disease is limited and Anna will need to defer to the expert knowledge of her team while minimizing expert opinion bias. Given the general standards of RRAs, the assessment should be conducted within the next 24 to 48 hours. Knowing that the outcomes of the risk assessment will set the landscape for the PHAC’s response to the PHEIC, Anna and her team will need to ensure the assessment is conducted in a timely and efficient manner. The results of the RRA will be presented to upper management before being disseminated to the general public. Finally, the case includes a case study, based on true events, of the initial application of the tool to the 2015 Zika virus disease outbreak. Although the initial assessment led to the conclusion that Canadians were at minimal risk, unexpected subsequent Zika outbreaks in 2016 revealed the need to refine and adapt the RRA tool. This case study emphasizes the importance of completing a risk assessment at multiple time points throughout the course of a disease to capture the complexities of evolving information and circumstances. The pedagogical value of presenting this case is rooted in presenting a real-world situation and exposing students to the complexities of translating foundational public health practices to social contexts that do not allow for typical solutions. Although it is necessary to learn concrete knowledge in a classroom environment, this information serves as a foundation to build on through experience within the public health field. Being immersed in real-world situations is imperative for enabling students to visualize how this knowledge may not translate perfectly during a public health event. This case will complement the focus on emergency preparedness and monitoring and managerial control mechanisms emphasized in the course MPH 9010- Managing Health Services. This level of public health response provides direction and recommendations for all sectors in the face of urgent events, such as infectious disease outbreaks

CASE 8: Case Attribution for COVID-19: Who Counts What?

The COVID-19 pandemic has emerged as an important topic of discussion at the Public Health Agency of Canada’s federal, provincial, and territorial tables. Representatives from each Canadian province and territory have come together to discuss the discrepancies noted in the attribution of COVID-19 cases between jurisdictions. Senior epidemiologist, Nina Mendez, is leading a case attribution project to give provinces and territories a forum for discussing any jurisdiction issues they encounter when reporting COVID-19 cases. Nina notices discrepancies in the way provinces and territories are reporting cases, where the majority of jurisdictions have been reporting cases based on official permanent residence, however two jurisdictions have been attributing cases based on location of diagnosis. This discrepancy in attribution leads to a discussion about how different protocols influence the way public health measures are implemented within each jurisdiction. Specifically, in the context of when individuals such as students, commuters, visitors, or long-term temporary workers are away from their permanent residence long enough that the risk of disease transmission no longer applies to their permanent residence jurisdiction

Case 12 : Prioritizing Emerging and Re-Emerging Non-enteric Zoonotic Infectious Diseases: What Should we be Afraid of Next?

As time progresses, new zoonoses make their way to the forefront in the media, in healthcare systems, in government projects, and in the daily lives of Canadians. Prioritization exercises carried out by public health experts can provide an indication for which zoonoses we should be most afraid of next, and ultimately most prepared for, especially in light of impeding changes in climate. Blake O’Neil and Brock Jansen have recently transitioned to new positions with the Health Professionals Guidance Unit at the Centre for Food-borne, Environmental, and Zoonotic Infectious Diseases. Together, they plan to develop health professional guidance documents and tools to aid in the prevention, early diagnosis, and clinical management of various emerging and re-emerging non-enteric zoonotic infectious diseases. To maintain efficiency when creating guidance documents and tools, Blake and Brock have commenced a prioritization exercise to determine which emerging and re-emerging non-enteric zoonotic infectious diseases are of the greatest threat to the health of Canadians as a result of climate change. To date, Blake and Brock have reviewed previously conducted internal and external prioritization exercises; received consultation from the National Microbiology Lab in Winnipeg, Manitoba; undertaken a literature review to explore zoonoses relevant to the Canadian context; and organized an advisory committee composed of external stakeholders from various healthrelated specialties. With the results from the literature review and the input from various stakeholder organizations, Blake and Brock have developed a list of zoonoses to be included in the prioritization exercise. The upcoming federal election tenders a very constrained timeframe for Blake and Brock, specifically for engaging with stakeholders external to the Public Health Agency of Canada. As public servants, Blake and Brock need to ensure government resources are not used for partisan advantage. Therefore, any stakeholder engagement would need to be paused when electoral campaigning begins until a Prime Minister is elected and the Senate and House of Commons resume. Furthermore, prior to the federal election, Blake and Brock must produce a list of priority emerging and re-emerging non-enteric zoonotic infectious diseases so they can begin developing health professional guidance documents and tools. The pair has only been able to identify two prioritization criteria thus far: measuring the number of incident cases within Canada for each zoonosis and measuring the severity of illness associated with each zoonosis. However, because severity of illness is relatively challenging to define, the pair continues to search for a unit of analysis that adequately represents the criterion. In addition, they must tailor the incidence formula to sufficiently capture the status of the zoonoses in Canada. Blake and Brock are now at a standstill in terms of identifying three additional prioritization criteria, defining what each criterion entails, and how each criterion will be measured