Scenario F

Disaster has struck - hard on the heels of the COVID-19 pandemic, another disease outbreak has hit your fair city, Glenmarigg. Residents are outraged and worried. There have already been 28 deaths.

The cause of the outbreak appears to be Neisseria meningitidis. (Please refer to the CDC Meningococcal Disease Fact Sheet for more information about the disease.)

Photomicrograph of Neisseria meningitidis diplococci. Image credit: [CDC](https://phil.cdc.gov/details.aspx?pid=6423)

Figure 1: Photomicrograph of Neisseria meningitidis diplococci. 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 (Royal Jubilee)
  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 Glenmarigg
  9. Epidemiologist from the local university, an expert on N. meningitidis 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, Glenmarigg. 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 F1

You are the provost of Glenmarigg, elected in 2013.

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

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

The current population of Glenmarigg (as of December 2022) is 153374. The demographic data for the city is shown below.

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

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

You were elected as a member of the popular “Community Change” party and made a number of election promises regarding a “Green New Deal” for Glenmarigg.

Voting intention by Glenmarigg residents (Source: YouGov polling)

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

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

Political Party Number of Seats
Moderate 1
Progress and Peace 11
Community Change 17
Aquamarine 7
Modern Union 1



The overall budget (expenditures) for the 2022-2023 financial year was £410643699. A summary of expenditures by category for this financial year is shown below.

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

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

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

From:
To:
Cc: Subject: This Bloody Pandemic

Dear Provost,

I am devastated to hear about this new pandemic in Glenmarigg. As if COVID wasn’t enough! Has this city not suffered enough, I ask you.

I hope that your office is going to do something about horrible pandemic at once.

Respectfully,
Rodrigo

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

Dear Provost,

This new pandemic in Glenmarigg has the potential to devastate our businesses. I run a cafe on the high street and almost had to close because of all the draconian lockdowns due to COVID.

I hope you realise how much business we have all lost in recent years, and how much businesses in this city are struggling financially.

I wish that your office is going to do something about dreadful state of affairs at once, keeping in mind the economic interests of businesses in our city and the fact that we cannot afford the draconian lockdowns you imposed during COVID.

Yours sincerely,
Alise (Around the Corner, proprietor)

From:
To:
Cc:
Subject: Government Overstep

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. I am sick and tired of government interference with my life, I have the right to go about my life without some do-gooder from a public health agency telling me that I need to wear a mask and can’t visit my grandmother.

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

Kind regards,
Roman (a concerned voter)

From:
To:
Cc:
Subject:

Dear Provost,

I have just learned that my my uncle has passed away due to the new pandemic in Glenmarigg. This is an unspeakable loss.

This is especially terrible coming hard on the heels of all of our losses due to COVID-19.

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

Yours truly,
Anna

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

Information Packet F2

You are a representative from Public Health Scotland, sent to Glenmarigg to help with the Neisseria outbreak.

Your briefing packet includes the following documents:

Information Packet F3

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

A team of scientists working together have in a PHS lab have isolated and cultured Neisseria (following standard procedures) from a number of patient samples taken during this outbreak; isolated 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 Neisseria 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_003496325.1
2 GCA_003977735.1
3 GCA_003496325.1
4 GCA_003496325.1
5 GCA_003496325.1
6 GCA_003496325.1
7 GCA_003496325.1
8 GCA_003496325.1
9 GCA_003977745.1
10 GCA_003496325.1



Your briefing packet also includes the following documents:

  • Neisseria spp. pubMLST

  • Schoen, Christoph et al. “Whole-genome comparison of disease and carriage strains provides insights into virulence evolution in Neisseria meningitidis.” Proceedings of the National Academy of Sciences of the United States of America vol. 105,9 (2008): 3473-8. doi:10.1073/pnas.0800151105

  • Itsko, Mark et al. “Enhancing Meningococcal Genomic Surveillance in the Meningitis Belt Using High-Resolution Culture-Free Whole-Genome Sequencing.” The Journal of infectious diseases vol. 226,4 (2022): 729-737. doi:10.1093/infdis/jiac104

  • de Souza Santos, Debora Ribeiro et al. “High-Resolution Melting (HRM) for rapid MLST analysis of Neisseria meningitidis.” Journal of microbiological methods vol. 200 (2022): 106557. doi:10.1016/j.mimet.2022.106557

Information Packet F4

You are the director of Glenmarigg’s main hospital, the Royal Jubilee, which has 550 beds across 9 different wards and 10 operating theatres.

The Royal Jubilee hospital in Glenmarigg. Image credit: [DALL-E

Figure 6: The Royal Jubilee hospital in Glenmarigg. 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 Royal Jubilee 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 Royal Jubilee in November 2019. Average ICU bed occupancy before and during the COVID-19 pandemic is in the figure below.

ICU bed occupancy for the Glenmarigg Royal Jubilee hospital (Source: NHS Scotland)

Figure 8: ICU bed occupancy for the Glenmarigg Royal Jubilee hospital (Source: NHS Scotland)

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

Admissions to the Glenmarigg Royal Jubilee hospital by category (Source: NHS Scotland)

Figure 9: Admissions to the Glenmarigg Royal Jubilee 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 Glenmarigg Royal Jubilee hospital (Source: NHS Scotland)

Figure 10: ICU waiting times for the Glenmarigg Royal Jubilee hospital (Source: NHS Scotland)

The Royal Jubilee 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 Glenmarigg Royal Jubilee hospital (Source: NHS Scotland)

Figure 11: Key Performance Indicators (KPIs) related to infectious diseases for the Glenmarigg Royal Jubilee hospital (Source: NHS Scotland)

There are currently 148 patients in the Royal Jubilee with confirmed or suspected meningococcal disease, with 17 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 F5

You are a civil servant working in Glenmarigg, 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 Glenmarigg facts and figures at a glance are summarized in the table below.

Community Amenities Details
Schools 7 primary schools, 4 secondary schools, 2 universities
Care Homes 3, each with ~40 bed capacity
Restaurants and Cafes 131
Parks and Playgrounds 9
Economic Indicators Details
GDP/capita £47608
Unemployment Rate 4%
Traffic and Transport Details
Traffic fatalities (average/month) 13



Your briefing packet on Neisseria includes the following information.

Information Packet F6

You are a microbiologist working in the microbiology department at the Greater Glenmarigg 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 process1812 samples monthly.

You are familiar with the culture requirements for growth of Neisseria spp. in culture, and the range of UK Standards for Microbiology Investigations (UK SMI) for Screening for Neisseria.

Neisseria meningitidis colonies on a Blood Agar plate. Image credit: [CDC](https://www.cdc.gov/meningitis/lab-manual/chpt07-id-characterization-nm.html)

Figure 12: Neisseria meningitidis colonies on a Blood Agar plate. Image credit: CDC

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

  • Identification and Characterization of Neisseria meningitidis (CDC)

  • Morsli, Madjid et al. “Real-time metagenomics-based diagnosis of community-acquired meningitis: A prospective series, southern France.” EBioMedicine vol. 84 (2022): 104247.

  • Sharma, Nupur et al. “Clinical use of multiplex-PCR for the diagnosis of acute bacterial meningitis.” Journal of family medicine and primary care vol. 11,2 (2022): 593-598.

Information Packet F7

You are a public communications expert, often employed by the Glenmarigg 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 F8

You are one of the doctors at the largest surgery in Glenmarigg. In the past fortnight, 66 of your patients have recently presented to the surgery with symptoms consistent with meningiditis. You have therefore recently been familiarising yourself with the relevant literature:

Information Packet F9

You are an epidemiologist working at the University of Glenmarigg, and have been studying N. meningitidis transmission dynamics for the past 9 years. As such, you are very familiar with the relevant literature, including papers such as:

  • Taha S, Hong E, Denizon M, et al. The rapid rebound of invasive meningococcal disease in France at the end of 2022. J Infect Public Health. 2023;16(12):1954-1960. doi:10.1016/j.jiph.2023.10.001

  • Clark SA, Campbell H, Ribeiro S, et al. Epidemiological and strain characteristics of invasive meningococcal disease prior to, during and after COVID-19 pandemic restrictions in England. J Infect. 2023;87(5):385-391. doi:10.1016/j.jinf.2023.09.002

  • Eriksson L, Johannesen TB, Stenmark B, et al. Genetic variants linked to the phenotypic outcome of invasive disease and carriage of Neisseria meningitidis. Microb Genom. 2023;9(10):001124. doi:10.1099/mgen.0.001124

  • Yang Z, Guarracino A, Biggs PJ, et al. Pangenome graphs in infectious disease: a comprehensive genetic variation analysis of Neisseria meningitidis leveraging Oxford Nanopore long reads. Front Genet. 2023;14:1225248. Published 2023 Aug 10. doi:10.3389/fgene.2023.1225248

  • Miellet WR, Pluister G, Sikking M, et al. Surveillance of Neisseria meningitidis carriage four years after menACWY vaccine implementation in the Netherlands reveals decline in vaccine-type and rise in genogroup e circulation. Vaccine. 2023;41(34):4927-4932. doi:10.1016/j.vaccine.2023.06.078

  • Madariaga-Troncoso D, Leyton-Carcaman B, Garcia M, Kawai M, Abanto Marin M. Comprehensive Genome Analysis of Neisseria meningitidis from South America Reveals a Distinctive Pathogenicity-Related Prophage Repertoire. Int J Mol Sci. 2022;23(24):15731. Published 2022 Dec 12. doi:10.3390/ijms232415731

  • Itsko M, Topaz N, Ousmane-Traoré S, et al. Enhancing Meningococcal Genomic Surveillance in the Meningitis Belt Using High-Resolution Culture-Free Whole-Genome Sequencing. J Infect Dis. 2022;226(4):729-737. doi:10.1093/infdis/jiac104

  • Earle SG, Lobanovska M, Lavender H, et al. Genome-wide association studies reveal the role of polymorphisms affecting factor H binding protein expression in host invasion by Neisseria meningitidis. PLoS Pathog. 2021;17(10):e1009992. Published 2021 Oct 18. doi:10.1371/journal.ppat.1009992

  • MacLennan JM, Rodrigues CMC, Bratcher HB, et al. Meningococcal carriage in periods of high and low invasive meningococcal disease incidence in the UK: comparison of UKMenCar1-4 cross-sectional survey results [published correction appears in Lancet Infect Dis. 2021 May;21(5):e122] [published correction appears in Lancet Infect Dis. 2021 Jul;21(7):e182]. Lancet Infect Dis. 2021;21(5):677-687. doi:10.1016/S1473-3099(20)30842-2