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 Nigeria’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.
What does your department do at the C.D.C.?
My division and the work that we do focus on working with countries to achieve the goals in the Global Health Security Agenda and keep people safe from outbreaks.
How do you do that?
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.
Are there any examples of that economic fallout?
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.
How many people are involved in containing a disease once we know it’s out there?
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.
People are concerned about the coronavirus. How do decision makers go from one level of seriousness to the next when a virus is spreading?
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 COVID-19 infection. 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.