Conversations on Strategy Podcast – Ep 17 – Wuraola Oyewusi – “Medical Resilience and Pandemics” from Countering Terrorism on Tomorrow’s Battlefield CISR (NATO COE-DAT Handbook 2)

Medical resilience is a key critical infrastructure in a nation’s preparedness against vulnerabilities. Pandemics such as COVID-19 are potent disruptors of this infrastructure. Health systems that are considered low-resourced have adapted and deployed seemingly simple but effective methods to survive such disruptions. Read the collaborative study here. Episode Transcript: Medical Resilience in Pandemics Stephanie Crider (Host) The views and opinions expressed in this podcast are those of the authors and are not necessarily those of the Department of the Army, the US Army War College, or any other agency of the US government. You’re listening to Conversations on Strategy. Today, I’m talking with Wuraola Oyewusi, author of “Medical Resilience and Pandemics,” in Countering Terrorism on Tomorrow’s Battlefield: Critical Infrastructure and Resiliency Handbook Two (Countering Terrorism on Tomorrow’s Battlefield: Critical Infrastructure Security and Resiliency Handbook 2). Welcome to Conversations on Strategy. I’m really glad you’re here. Wuraola Oyewusi Thank you, Stephanie. I’m glad I’m here too. Host Your chapter explores medical resilience as a component of critical infrastructure as well as using low-resourced health systems to build resilience. Will you please briefly expand on that? Oyewusi The work on this chapter focuses on a low-resourced health system (that) has managed to build a resilience against a disruption—this time around, a pandemic—uh, specifically, (coronavirus disease 2019 or) COVID-19. We explored Nigeria as a system that . . . it’s definitely not high resourced. The health-delivery system is not high resourced. And we explored some of the things that were done during the COVID-19 pandemic. Host Let’s talk about that in a little bit more detail. Like you said, your case study focused on Nigeria and COVID-19. How did Nigeria handle COVID-19? Oyewusi So, I’m going to give a bit of context. The first COVID-19 case—recorded one, I think we should emphasize that—was in February . . . February 27, 2020. Right when the whole world was finding out, that was when we found out about that in Nigeria, too. Another clear context that we should have as we go into our discussion is that Nigeria’s epidemic response is carried out in the context of a fragile and underresourced, existent health-delivery system. That means that, even before the pandemic, the system was overstretched, there was a lot of people. There were challenging fault lines already, and then we now had the disruption like COVID-19. So to help you understand this use case, one of the indexes that was used to gauge a country’s preparedness during the pandemic was the number of (intensive-care unit or) ICU beds to the population. Germany had about 29 beds to 100,000 people. The US had about 34 to 35 ICU beds to 100,000 people. Turkey had 48 beds to 100,000 people. But in Nigeria, we had about 0.07 beds to 100,000 people. So, I think that would lay down a context for why we are discussing this and how a disruption to critical infrastructure, like a pandemic, was done in Nigeria. Host What are some key lessons learned from Nigeria on managing pandemics? Oyewusi I’m going to discuss that on the three key items. The first one: There was leveraged experience and infrastructure. The second one: There was civilians, data analysis, and public data sharing. And the third one, which is probably one of the most interesting, are the nonpharmacological interventions. We have established that the system is overstressed. And, given the proportion of ICU to 100,000 people, the country knows; the people know. We had a vague idea of what we were in for, and, you know, it is one of the most interesting things that we did. One of the experiences that help us as a country—despite this fragile health system, this low-resourced health system—was we have some experience managing pandemics (for example, the Ebola of 2014 [Ebola outbreak of 2014–16]). So, the preparedness wasn’t just from the side of the health system professionals. The country had an idea. We have experienced with Lassa fever. We have experienced with cholera. So, one of the key things that happened there: There was a coordinated national effort by the national center for disease control, the Federal Ministry of Health, and the state ministry of health. And then, for example, for data collection and analysis, there was a software that was used during Ebola called SORMAS—SORMAS is Surveillance Outbreak Response Management (and Analysis System). A very interconnected system that was used to collect data from smaller places to bigger places and tracked preparedness for things like, you know, we had anticipated that there would probably be no light. There is usually a lot of outages. There is a lot of issues like that. But this system had been tested during Ebola, so it was like the country spun it up again now that we have another pandemic. The third one is nonpharmacological intervention. For example, there were things like hand washing and face mask. Even though I know it’s global, people had hand sanitizers. There was lockdown. There was restrictive public gathering. There was social culture communication. You know, for example, more than 500 languages are spoken. That means that in villages and religious houses, people were talking about COVID-19, “We think we should wear your mask,” through those channels. In public places, you could wash your hands outside. That means if you are going to the bank—it might not be the prettiest setup—but every public place, public parks, there was “You need for you to wash your hands.” And then, like I said, people remembered from Ebola. That means that there was general knowledge about it and (people knew) to prepare hand sanitizers. “We think there is something dangerous out there. We have heard about it and, you know, just like the other times, we should wash our hands often. We should wear our mask.” You know, there were makeshift masks because a mask (availability) hasn’t happened yet, and, you know, some were made from fabric. Some of them were not the prettiest, but people were wearing their mask in many places. The bulk would put a makeshift bucket. You know, in some public places, it would just be a makeshift bucket with a tap, some soap to wash our hands. But this scaled across the country because they were easy to deploy. And then, information through radio. People were hearing about COVID-19. I remember, in the textbook, I put some examples of the flyers that went around that “This is dangerous.” “We are not always confident that you have the support that you need in the health system, but if you can try those things, if you can stay at home more . . .” Of course, there was the economic downside of people staying at home, but if you don’t have to be out . . . Some states were running, “We’re not closing finally, but can you be home by six?” “Clubbing.” “No parties.” Uh . . . “No big church gatherings.” “No big religious gatherings.” “Can you just pray at home?” This may be for people who could read, but then there was the daily updates by the disease control center. You know, you would know the number of people that died, the number of people that were diagnosed. “What should you do if someone is infected?” “If you suspect there is . . .” It was in public places. “Someone has been coughing, sneezing . . .” “We think this person may have this . . .” The nearest health center. So those are some of the nonpharmacological solutions that kind of worked well for us. Host Do you have any final thoughts that you want to share about this before we go? Oyewusi I have experienced working in a low-resourced health system. You know, I have gone on to other things. But I have always been a believer of, uh, in every pandemic—in every disruption, especially—learning from the experience of where we already know that this is low. It’s not bad because there was pandemic; that was all happened . . . Also, there are usually the low-hanging fruits; countries should embrace them. There is also NATO. NATO should embrace them. Tell people on the radio. Help everybody in their language. I understand that—even in countries where people speak the same language—there are regional nuisances. You know, for example, in Nigeria, local leaders were telling their communities about these. I’m not saying that, “Oh, everyone did that,” but it was common . . . So it’s common knowledge that we should do that. In pandemics, everyone is as confused. It’s not like everyone knows what to do. But for every disruption, one of the key learnings from a low-resourced system like that is that there are the low-hanging fruits, and they should be embraced. Host Thank you for being here today and sharing your ideas and your insights. Oyewusi Nice to be here. Host Listeners, find out more about managing pandemics at press.armywarcollege.edu/monographs/957. Read about it in chapter six. If you enjoyed this episode and would like to hear more, you can find us on any major podcast platform. About the author: Wuraola Oyewusi is a Nigerian pharmacist and data scientist with expertise in clinical health care and the application of data-science methods. Her research spans a range of use cases from natural language processing (NLP) to health care and data curation. She lives in the United Kingdom and is the recipient of the Global Talent Visa in AI, Machine Learning, and Data Science.