NEHA May 2020 Journal of Environmental Health

May 2020 • Journal of Environmental Health 29 (WHO, 2020b). The initial human cases of this disease were linked with the Huanan Seafood Wholesale Market where a novel zoonotic coronavirus transmitted from wild animals to humans (CDC, 2020a; Kaplan, 2020). Concepts of global health security and national health security in the U.S., as described by the WHO 2005 International Health Regulations and the Office of the Assistant Secretary for Preparedness and Response (ASPR) 2019–2022 National Health Security Strategy, is protected by powerful enforcement tools that enable the control of infectious disease threats (ASPR, 2019a; WHO, 2008). On January 30, 2020, WHO proclaimed that COVID-19 consti- tuted a Public Health Emergency of Interna- tional Concern (WHO, 2020c). The follow- ing day, the U.S. Department of Health and Human Services (HHS) ASPR declared a pub- lic health emergency in the country (ASPR, 2020b). The U.S. president also declared a nationwide emergency by implementing the Robert T. Stafford Disaster Relief and Emer- gency Assistance Act (Federal Emergency Management Agency, 2020). The WHO’s Public Health Emergency of International Concern is designed to recognize and control public health risks from crossing national borders while enabling a coordi- nated international response (WHO, 2020c). The U.S. public health emergency declaration enables coordination of the Centers for Dis- ease Control and Prevention (CDC), Federal Emergency Management Agency (FEMA), HHS, and other federal partners toward a uni- fied and integrated approach to pandemics, natural disasters, or chemical or radiological threats (CDC, 2018). Specialists in environmental health are specifically designated to assist in the assess- ment of risk among a coordinated partnership between state, local, tribal, and territorial gov- ernmental jurisdictions. From global to local public health, and in particular the practice of environmental health, plurality of govern- ment in the U.S. represents the intention of the constitutional framework and presents chal- lenges to uniformity of service (Gable, 2012). By March 16, 2020, all 50 U.S. states indepen- dently declared public health emergencies. Global Situation The Chinese government locked down the original hot spot of COVID-19 (Wuhan City) to contain the outbreak on January 23, 2020 (Du et al., 2020). In the ocean nearby, on February 1, 2020, an international cruise ship traveling with 3,711 passengers and crew found that an already-disembarked pas- senger tested positive for COVID-19 in Hong Kong (Princess Cruise Lines, 2020). The cruise ship, operated by the world’s largest leisure travel company, Carnival Corpora- tion, arrived at Yokohama, Japan, and iso- lated passengers who tested positive with COVID-19 in Japanese hospitals and quar- antined the rest on the ship on February 3, 2020. The Disaster Infection Control Team under the Japanese Society for Infection Pre- vention and Control intervened to manage/ mitigate infection on the ship until all dis- embarked on March 1, 2020 (Japan Ministry of Health, Labour, and Welfare, 2020a). By March 8, 2020, 696 former passengers and crew tested positive, 357 were discharged, and 7 died (Japan Ministry of Health, Labour, and Welfare, 2020b). Experiencing surging numbers of suspected cases, South Korea conducted drive-thru virus tests that were capable of completion in 10 min (Yonhap, 2020). With an approximate population of 52 million, South Korea counted 7,869 COVID- 19 cases with 66 deaths on March 12, 2020 (Yonhap, 2020). U.S. Situation Human cases of COVID-19 erupted onboard a series of cruise ships that caused the ini- tiation of an unprecedented U.S. repatriation response, the first of which involved careful coordination between HHS/ASPR, CDC, and the U.S. Department of State. Infected Ameri- can citizens were extracted from the Dia- mond Princess, transported in buses to U.S. aircraft in Japan, and flown to U.S. Air Force bases to be medically assessed, quarantined, and processed for their return home (U.S. Department of State, 2020). As the repatri- ated, infected American citizens were seques- tered in quarantine, the first cases of commu- nity-acquired COVID-19 were recorded in the U.S. (, 2020). When asked if the U.S. had already moved from containment to mitigation phases of outbreak response, CDC director Dr. Robert Redfield stated that we are in “a blended con- tainment/mitigation phase” as human cases increased across the U.S. (C-SPAN, 2020). Meanwhile, states and cities individually declared states of emergency, adopting poli- cies and procedure uncoordinated with other states (Government of the District of Colum- bia, 2020). Part 2: Pathogen Transmission Pathways and an All-Hazards Approach Increasing cases demonstrate that the experts have neither fully assessed the virus risk yet, nor is there consensus on the methods to pre- vent its spread. WHO guidelines have no clear definition of a pandemic and its pandemic alert seven-phase descriptions are influenza specific (WHO, 2009). Current biosurveil- lance is inadequate—creating vulnerabilities to future epidemics by novel pathogens—and public health messaging about zoonotic dis- ease reservoirs and modes of transmission is lacking (Eddy, Sase, & Schuster, 2010; Eddy, Stull, & Balster, 2013). An Equivocal Source of a Pandemic The origin of SARS-CoV-2 is still being investigated, including “…wild animals sold illegally in the Huanan Seafood Wholesale Market” (Huang, 2020; Tan et al., 2020). Considering the biological evolution of COVID-19, WHO finds that although the novel pathogen, SARS-CoV-2, moved from animal to human reservoirs, the intermediate host animal has not been identified, stating that it could be “a domestic food animal, a wild animal, or a domesticated wild animal which has not yet been identified” (WHO, 2020d). WHO is investigating the capacity for food to directly, and indirectly through cross-contamination, transmit COVID-19 if mishandled (WHO, 2020d). New research supports the concept of food as a pathogen transmission source (Pung et al., 2020). Pathogen Transmission Pathways SARS-CoV-2 transmission pathways have not been clearly identified, although body fluids are specifically mentioned and the importance of sanitizing services is empha- sized in definitive guidance documents from U.S. agencies (CDC, 2020b; Pung et al., 2020). CDC reports that “like other close-contact environments, ships may facilitate transmission of respiratory viruses from person-to-person through exposure to respiratory droplets or contact with con- taminated surfaces” (CDC, 2020b), which