Scenario D

Disaster has struck - hard on the heels of the COVID-19 pandemic, another disease outbreak has hit your fair city, Rosblane. Residents are outraged and worried. There have already been 22 deaths.

The cause of the outbreak appears to be Campylobacter jejuni. (Please refer to the WHO Campylobacter Fact Sheet for more information about the pathogen.)

Scanning electron microscopy (SEM) image of Campylobacter jejuni cells. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=5778)

Figure 1: Scanning electron microscopy (SEM) image of Campylobacter jejuni cells. Image credit: CDC

Each member of your group will play one of the following roles as you attempt to tackle the disease outbreak and save your city:

  1. Provost (head of the city council)
  2. Representative from a national public health org. (Public Health Scotland)
  3. Epidemiologist (on secondment from Public Health Scotland)
  4. Director of the city’s main hospital (North Shore)
  5. City planner/civil servant
  6. Microbiologist (working in one of the NHS Scotland clinical labs)
  7. Public communications expert (past and current sci comm campaigns)
  8. Doctor at a major surgery in Rosblane
  9. Epidemiologist from the local university, an expert on Campylobacter transmission

You must work together, using the information that has been provided for you in the attached information packets, and decide what action(s) should be taken to control the outbreak currently plaguing your city, Rosblane. Your actions should be evidence-based – use the peer-reviewed literature to decide on measures that will stop the pandemic in your scenario.

Your action points may include directives to gather more information (e.g., contact tracing of current cases, microbiological testing of food/water, etc.), or specific directives (e.g. public health measures, non-pharmaceutical interventions, etc.). Use the data/expertise of all group members. Be clear, concise, and specific.

You may choose to include mathematical modeling as part of your decision making (for example, using an epidemic calculator or other models); if you do so, you should provide details of your modelling and predictions when you submit your group’s pro forma.

You should submit 3-5 specific actions to control the pandemic, using the workshop 3 pro forma (also available on MyPlace). Submit this by noon, Friday March 1st, via the submission link on MyPlace.

Information Packet D1

You are the provost of Rosblane, elected in 2020.

Photograph of Rosblane city centre. Image credit: DALL-E

Figure 2: Photograph of Rosblane city centre. Image credit: DALL-E

The current population of Rosblane (as of December 2022) is 155806. The demographic data for the city is shown below.

Rosblane demographics (Source: Office for National Statistics)Rosblane demographics (Source: Office for National Statistics)

Figure 3: Rosblane demographics (Source: Office for National Statistics)

You were elected as a member of the popular “Peace and Prosperity” party and made a number of election promises regarding a “Green New Deal” for Rosblane.

Voting intention by Rosblane residents (Source: YouGov polling)

Figure 4: Voting intention by Rosblane residents (Source: YouGov polling)

There are currently 37 elected councillors, representing the 5 main political parties in Rosblane as follows:

Political Party Number of Seats
New Hope 2
Wind and Solar Power 8
Peace and Prosperity 17
Rational Industry 9
Social Unity 1



The overall budget (expenditures) for the 2022-2023 financial year was £465532761. A summary of expenditures by category for this financial year is shown below.

Public expenditures by category for the 2022-2023 financial year (Source: Rosblane City Council)

Figure 5: Public expenditures by category for the 2022-2023 financial year (Source: Rosblane City Council)

Your office has recently received a great deal of correspondence regarding the pandemic in Rosblane. A representative sample of these e-mails is shown below.

From:
To:
Cc: Subject: This Bloody Pandemic

Dear Provost,

I am upset to hear about this new pandemic in Rosblane. Too many people have died and it is such a tragedy.

I hope very much that your office is going to do something about dreadful state of affairs immediately.

Kind regards,
Siobhan

From:
To:
Cc:
Subject: Pandemic Disaster for Businesses

Dear Provost,

This new pandemic in Rosblane has the potential to devastate our businesses. I run a bookshop on the high street and virtually went bankrupt due to COVID.

You should be ashamed to think of all the businesses that have had to close because of the coronavirus measures this city took, and all of the people who lost their jobs.

I hope that your office is going to do something about all of the poor people dying immediately, keeping in mind the economic interests of businesses in our city and the fact that we cannot afford another lockdown.

Kind regards,
Ailidh (Jewels, proprietor)

From:
To:
Cc:
Subject: Government Overreach

Dear Provost,

I fear that you and your office are going to use this new pandemic as yet another excuse for government overreach into citizens’ lives. The mental health consequences of the last pandemic were underappreciated, but very real - people suffered due to the lockdowns and children’s development was affected by the wearing of face masks and the closing of schools.

Please do not use this disaster as another opportunity for oppressive lockdowns and government control of our lives.

All the best,
Roman (a concerned voter)

From:
To:
Cc:
Subject:

Dear Provost,

I have just learned that my my niece has passed away due to the new pandemic in Rosblane. Words cannot begin to describe our loss.

The family are all devastated as you can surely imagine.

I hope that you will do everything you can to stop this pandemic so that no other families need to suffer this pain.

Best wishes,
Siobhan

As Provost of Rosblane, you are of course familiar with the work of the Standing Committee on Pandemic Preparedness. You are also familiar with:

Information Packet D2

You are a representative from Public Health Scotland, sent to Rosblane to help with the Campylobacter jejuni outbreak.

Your briefing packet includes the following documents:

Information Packet D3

You are an epidemiologist working for Public Health Scotland, sent to Rosblane to help with the Campylobacter outbreak.

A team of scientists working together have in a PHS lab have isolated and cultured Campylobacter jejuni (following standard procedures) from a number of patient samples taken during this outbreak; isolated Campylobacter jejuni DNA from these cultures; sequenced this DNA using an Illumina MiSeq platform; assembled the short paired-end reads; and compared these assemblies to the extant Campylobacter jejuni genome sequences available in the NCBI databases. The results of these experiments are summarised in the table below.

Patient NCBI accession of closest database match
1 GCA_001686905.1
2 GCA_001299565.1
3 GCA_001686905.1
4 GCA_001686905.1
5 GCA_000835285.1
6 GCA_000835285.1
7 GCA_000835285.1
8 GCA_000835285.1
9 GCA_000835285.1
10 GCA_000835285.1



Your briefing packet also includes the following documents:

  • Campylobacter jejuni/coli pubMLST

  • Bessell, Paul R et al. “Using sequence data to identify alternative routes and risk of infection: a case-study of campylobacter in Scotland.” BMC infectious diseases vol. 12 80. 1 Apr. 2012, doi:10.1186/1471-2334-12-80

  • Llarena, Ann-Katrin et al. “Whole-Genome Sequencing in Epidemiology of Campylobacter jejuni Infections.” Journal of clinical microbiology vol. 55,5 (2017): 1269-1275. doi:10.1128/JCM.00017-17

  • Joseph, Lavin A et al. “Comparison of Molecular Subtyping and Antimicrobial Resistance Detection Methods Used in a Large Multistate Outbreak of Extensively Drug-Resistant Campylobacter jejuni Infections Linked to Pet Store Puppies.” Journal of clinical microbiology vol. 58,10 e00771-20. 22 Sep. 2020, doi:10.1128/JCM.00771-20

Information Packet D4

You are the director of Rosblane’s main hospital, the North Shore, which has 550 beds across 9 different wards and 10 operating theatres.

The North Shore hospital in Rosblane. Image credit: [DALL-E

Figure 6: The North Shore hospital in Rosblane. Image credit: [DALL-E

The annual operating budget for financial year 2022-2023 was £1.5 million, and average expenditures are shown by category in the figure below.

Hospital expenditures by category for financial year 2022-2023 (Source: NHS Scotland)

Figure 7: Hospital expenditures by category for financial year 2022-2023 (Source: NHS Scotland)

The North Shore has units specialising in coronary care; maternity care; dermatology; gastroenterology; an ear, nose, and throat clinic; an eye clinic; and an orthopedic unit.

There are currently 25 ICU beds (with ventilators) available, an increase from the 14 ICU beds in the North Shore in November 2019. Average ICU bed occupancy before and during the COVID-19 pandemic is in the figure below.

ICU bed occupancy for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 8: ICU bed occupancy for the Rosblane North Shore hospital (Source: NHS Scotland)

There are approximately 1.3m admissions to the North Shore hospital annually, the majority of these being to the emergency (A&E) department.

Admissions to the Rosblane North Shore hospital by category (Source: NHS Scotland)

Figure 9: Admissions to the Rosblane North Shore hospital by category (Source: NHS Scotland)

A&E waiting times have been called “disastrously high” in recent months, both by the press and by tthe hospital ombudsman.

ICU waiting times for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 10: ICU waiting times for the Rosblane North Shore hospital (Source: NHS Scotland)

The North Shore has been set a goal of 25% reduction in sepsis mortality (compared to past years)and 50% reduction in the nosocomial transmission of superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridiodes difficile (C. diff), and Candida auris (C. auris).

Key Performance Indicators (KPIs) related to infectious diseases for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 11: Key Performance Indicators (KPIs) related to infectious diseases for the Rosblane North Shore hospital (Source: NHS Scotland)

There are currently 172 patients in the North Shore with confirmed or suspected Campylobacter jejuni, with 16 of these patients currently in the ICU.

The hospital follows the guidelines set out in the National Infection Prevention and Control Manual.

As a hospital director, you are familiar with the literature surrounding hospital pandemic preparedness, and regularly read papers such as:

  • Mer, Mervyn et al. “Critical Care Pandemic Preparation: Considerations and Lessons Learned from COVID-19.” Critical care clinics vol. 38,4 (2022): 761-774.

  • Tacconelli, Evelina et al. “Challenges of data sharing in European Covid-19 projects: A learning opportunity for advancing pandemic preparedness and response.” The Lancet regional health. Europe vol. 21 (2022): 100467.

  • Adelaja, I., Sayma, M., Walton, H., McLachlan, G., de Boisanger, J., Bartlett-Pestell, S., Roche, E., Gandhi, V., Wilson, G. J., Brookes, Z., Yeen Fung, C., Macfarlane, H., Navaratnam, A., James, C., Scolding, P., & Sara, H. (2020). A comprehensive hospital agile preparedness (CHAPs) tool for pandemic preparedness, based on the COVID-19 experience. Future healthcare journal, 7(2), 165–168.

Information Packet D5

You are a civil servant working in Rosblane, working closely with the provost, city council and various agencies including the NHS, the UK Health Security Agency (UKHSA), and the Scottish Environment Protection Agency (SEPA).

Some of the key Rosblane facts and figures at a glance are summarized in the table below.

Community Amenities Details
Schools 5 primary schools, 2 secondary schools, 1 university
Care Homes 1, each with ~45 bed capacity
Restaurants and Cafes 92
Parks and Playgrounds 2
Economic Indicators Details
GDP/capita £48869
Unemployment Rate 4%
Traffic and Transport Details
Traffic fatalities (average/month) 15



Your briefing packet on Campylobacter jejuni includes the following information.

Information Packet D6

You are a microbiologist working in the microbiology department at the Greater Rosblane Clinical Laboratory. Your laboratory is equipped to handle a range of culture samples (including anaerobic and microaerobic bacteria, as well as viruses), and you routinely process1811 samples monthly.

You are familiar with the culture requirements for growth of Campylobacter, and the UK Standards for Microbiology Investigations (UK SMI) for Identification of Campylobacter species.

Campylobacter jejuni grown on Skirrow and Butzler growth medium. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=15986)

Figure 12: Campylobacter jejuni grown on Skirrow and Butzler growth medium. Image credit: CDC

You are also familiar with the literature surrounding Campylobacter identification, and often read papers such as:

  • LaGier, Michael J et al. “A real-time multiplexed PCR assay for rapid detection and differentiation of Campylobacter jejuni and Campylobacter coli.” Molecular and cellular probes vol. 18,4 (2004): 275-82.

  • Ferrari, Sevinc et al. “Validation of PCR methods for confirmation and species identification of thermotolerant Campylobacter as part of EN ISO 10272 - Microbiology of the food chain - Horizontal method for detection and enumeration of Campylobacter spp.” International journal of food microbiology vol. 388 (2023): 110064.

  • Ojima-Kato, Teruyo et al. “Proteotyping of Campylobacter jejuni by MALDI-TOF MS and Strain Solution Version 2 Software.” Microorganisms vol. 11,1 202. 12 Jan. 2023, doi:10.3390/microorganisms11010202

  • Hong, Seung-Hwan et al. “Gold Nanoparticle and Polymerase Chain Reaction (PCR)-Based Colorimetric Assay for the Identification of Campylobacter spp. in Chicken Carcass.” Food science of animal resources vol. 43,1 (2023): 73-84. doi:10.5851/kosfa.2022.e59

Information Packet D7

You are a public communications expert, often employed by the Rosblane city council to manage the PR response to different initiatives or crises.

As a public communications expert, you are familiar with the literature surrounding science communication in a pandemic, including papers such as:

  • Matta, G. Science communication as a preventative tool in the COVID19 pandemic. Humanit Soc Sci Commun 7, 159 (2020).

  • Abdool Karim, Salim S. “Public understanding of science: Communicating in the midst of a pandemic.” Public understanding of science (Bristol, England) vol. 31,3 (2022): 282-287.

  • Royan, Regina et al. “Use of Twitter Amplifiers by Medical Professionals to Combat Misinformation During the COVID-19 Pandemic.” Journal of medical Internet research vol. 24,7 e38324. 22 Jul. 2022, doi:10.2196/38324

  • Tait, Margaret E et al. “Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S.” Preventive medicine reports vol. 29 (2022): 101971.

You have assembled the following information/resources for this meeting:

Information Packet D8

You are one of the doctors at the largest surgery in Rosblane. In the past fortnight, 50 of your patients have recently presented to the surgery with symptoms consistent with Campylobacter jejuni. You have therefore recently been familiarising yourself with the relevant literature:

Information Packet D9

You are an epidemiologist working at the University of Rosblane, and have been studying Campylobacter transmission dynamics for the past 3 years. As such, you are very familiar with the relevant literature, including papers such as:

  • Bishop, H et al. “Bacteriological Survey of Fresh Minced Beef on Sale at Retail Outlets in Scotland in 2019: Three Foodborne Pathogens, Hygiene Process Indicators, and Phenotypic Antimicrobial Resistance.” Journal of food protection vol. 85,9 (2022): 1370-1379.

  • Lopes, Bruno S et al. “Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom.” Emerging infectious diseases vol. 25,7 (2019): 1320-1329.

  • Sheppard, Samuel K et al. “Evolution of an agriculture-associated disease causing Campylobacter coli clade: evidence from national surveillance data in Scotland.” PloS one vol. 5,12 e15708. 15 Dec. 2010, doi:10.1371/journal.pone.0015708

  • Sheppard, Samuel K et al. “Campylobacter genotypes from food animals, environmental sources and clinical disease in Scotland 2005/6.” International journal of food microbiology vol. 134,1-2 (2009): 96-103.

  • Dessouky, Yara El et al. “Genomic insights into zoonotic transmission and antimicrobial resistance in Campylobacter jejuni from farm to fork: a one health perspective.” Gut pathogens vol. 14,1 44. 5 Dec. 2022, doi:10.1186/s13099-022-00517-w

  • Hadiyan, Maryam et al. “Prevalence, antimicrobial resistance, virulence gene profile and molecular typing of Campylobacter species isolated from poultry meat samples.” Veterinary medicine and science vol. 8,6 (2022): 2482-2493.

  • Ocejo M, Oporto B, Lavín JL, Hurtado A. Monitoring within-farm transmission dynamics of antimicrobial-resistant Campylobacter in dairy cattle using broth microdilution and long-read whole genome sequencing. Sci Rep. 2023;13(1):12529. Published 2023 Aug 2. doi:10.1038/s41598-023-39588-3

  • Rodrigues JA, Blankenship HM, Cha W, et al. Pangenomic analyses of antibiotic-resistant Campylobacter jejuni reveal unique lineage distributions and epidemiological associations. Microb Genom. 2023;9(8):mgen001073. doi:10.1099/mgen.0.001073

  • Katz A, Porte L, Weitzel T, et al. Whole-genome sequencing reveals changes in genomic diversity and distinctive repertoires of T3SS and T6SS effector candidates in Chilean clinical Campylobacter strains. Front Cell Infect Microbiol. 2023;13:1208825. Published 2023 Jul 13. doi:10.3389/fcimb.2023.1208825