Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks, resilience indicators, interdependencies and international standards

Concept analysis of health system resilience

BACKGROUND

There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience.

METHODS

We follow Schwarz-Barcott and Kim's hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form.

RESULTS

Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises.

CONCLUSION

A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country's health system resilience performance.

The rise of resilient healthcare research during COVID-19: scoping review of empirical research

BACKGROUND

The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to: identify key areas of research; synthesise findings on capacities that develop RHC across system levels (micro, meso, macro); and identify reported adverse consequences of the effort of maintaining system performance on system agents (healthcare workers, patients).

METHODS

Three academic databases were searched (Medline, EMBASE, Scopus) from 1st January 2020 to 30th August 2022 using keywords pertaining to: systems resilience and related concepts; healthcare and healthcare settings; and COVID-19. Capacities that developed and enhanced systems resilience were synthesised using a hybrid inductive-deductive thematic analysis.

RESULTS

Fifty publications were included in this review. Consistent with previous research, studies from high-income countries and the use of qualitative methods within the context of hospitals, dominated the included studies. However, promising developments have been made, with an emergence of studies conducted at the macro-system level, including the development of quantitative tools and indicator-based modelling approaches, and the increased involvement of low- and middle-income countries in research (LMIC). Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. The need for healthcare workers to constantly learn and make adaptations, however, had potentially adverse physical and emotional consequences for healthcare workers, in addition to adverse effects on routine patient care.

CONCLUSIONS

This review identified an upsurge in new empirical studies on health system resilience associated with COVID-19. The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events.

Relationship between three aspects of resilience-adaptive characteristics, withstanding stress, and bouncing back-in hospital workers exposed to prolonged occupational stress during the COVID-19 pandemic: a longitudinal study

BACKGROUND

The term resilience is used to refer to multiple related phenomena, including: (i) characteristics that promote adaptation to stressful circumstances, (ii) withstanding stress, and (iii) bouncing back quickly. There is little evidence to understand how these components of resilience are related to one another. Skills-based adaptive characteristics that can respond to training (as opposed to personality traits) have been proposed to include living authentically, finding work that aligns with purpose and values, maintaining perspective in the face of adversity, managing stress, interacting cooperatively, staying healthy, and building supportive networks. While these characteristics can be measured at a single time-point, observing responses to stress (withstanding and bouncing back) require multiple, longitudinal observations. This study's aim is to determine the relationship between these three aspects of resilience in hospital workers during the prolonged, severe stress of the COVID-19 pandemic.

METHODS

We conducted a longitudinal survey of a cohort of 538 hospital workers at seven time-points between the fall of 2020 and the spring of 2022. The survey included a baseline measurement of skills-based adaptive characteristics and repeated measures of adverse outcomes (burnout, psychological distress, and posttraumatic symptoms). Mixed effects linear regression assessed the relationship between baseline adaptive characteristics and the subsequent course of adverse outcomes.

RESULTS

The results showed significant main effects of adaptive characteristics and of time on each adverse outcome (all p < .001). The size of the effect of adaptive characteristics on outcomes was clinically significant. There was no significant relationship between adaptive characteristics and the rate of change of adverse outcomes over time (i.e., no contribution of these characteristics to bouncing back).

CONCLUSIONS

We conclude that training aimed at improving adaptive skills may help individuals to withstand prolonged, extreme occupational stress. However, the speed of recovery from the effects of stress depends on other factors, which may be organizational or environmental.

A multi-objective optimization approach for integrated risk-based internal audit planning

Annual audit planning is a multi-criteria decision-making problem faced by internal audit departments of all organizations. Due to the constrained audit resources, the planning process primarily involves the analysis and evaluation of complex factors for selecting auditable units that maximize the full potential of internal audit. Previous research on internal audit planning only focused on the goal of risk minimization and applied ranking methods to prioritize alternatives. In order to enable internal audit activities to add more value to the organization, the integrated risk-based internal audit planning is proposed to assist audit department in achieving multiple objectives in addition to risk management. Meanwhile, a multi-stage framework is proposed to support the development of such value-added internal audit plan. The new framework integrates the risk assessment of auditable units with the selection of audit activities and resource allocation through a combined analytic hierarchy process (AHP), fuzzy comprehensive evaluation (FCE) and weighted multi-choice goal programming (WMCGP) approach. The model considers both qualitative and quantitative decision criteria. A real-life case study of the development of an integrated risk-based annual audit plan is presented, and sensitivity analysis is performed to illustrate the validity of the proposed approach. The results indicate that the proposed framework is a useful tool for internal audit planning and the implications of the study can be extended to various selection and allocation problems.

The impact of medical infrastructure on regional innovation: An empirical analysis of China's prefecture-level cities

Because of public health emergencies, such as the COVID-19 pandemic, having an optimal medical infrastructure is an important way to maintain the normal operation of society and stimulate vitality in regional innovation. Based on the data on 260 cities at the prefecture level and above in China from 2001 to 2018, this paper investigates the characteristics and mechanisms of medical infrastructure on regional innovation. After a series of regressions, we robustly find that medical infrastructure has a significantly positive impact on regional innovation. In addition, based on the mediating effect model, the mechanism test shows that medical infrastructure can promote regional innovation through the channels of the natural population growth rate, educational level, and the environmental greening level. Finally, considering the urban heterogeneity, we find that the positive impact of medical infrastructure on regional innovation is reflected mainly in eastern and central cities, non-sub-provincial cities, and non-resource-based cities. These conclusions not only enrich the theoretical research on regional innovation from the perspective of medical infrastructure but also shed light on how to better promote regional innovation for China or even other countries.

Community resilience to pandemics: An assessment framework developed based on the review of COVID-19 literature

The COVID-19 outbreak in 2019 and the challenges it posed to communities around the world, demonstrated the necessity of enhancing the resilience of communities to pandemics. In this regard, assessment frameworks can play an essential role and guide resilience-building efforts. However, the lack of a comprehensive assessment framework has led to a focus on sectoral evaluation. This study aims to propose an integrated framework for assessing the pandemic resilience of communities. For this purpose, we rely on a systematic review of literature indexed in major academic databases. We have thoroughly analyzed a total number of 115 related documents to extract relevant criteria. Findings show that many criteria and factors affect community resilience to pandemics. By inductive content coding in MAXQDA software, we have categorized these criteria into five dimensions of Institutional, Social, Economic, Infrastructural, and Demographic. Good leadership and management, insurance and governmental support, planning and preparation, expertise and labor, and available equipment and technologies are the most important institutional criteria. Communication and collective identity, mutual support, public safety and protection, public awareness, and social justice are the influential social criteria. Economic sustainability and resource availability are criteria of economic resilience. Sufficiency of services, public spaces, housing tenure, and transportation system are the main criteria related to the built environment and infrastructural dimension. Finally, demographic resilience includes physical health, psychological well-being, life quality, and hygiene. Based on these criteria, this study develops an integrated evaluation framework that researchers can implement along with conventional assessment and ranking methods to determine the level of community resilience to pandemics.

Facilitating Patient-Centric Thinking in Hospital Facility Management: A Case of Pharmaceutical Inventory

Conventional hospital facility management (FM) focuses on reasonably allocating various resources to support core healthcare services from the perspectives of the FM department and hospital. However, since patients are the main service targets of hospitals, the patients’ demographic and hospitalization information can be integrated to support the patient-centric facility management, aiming at a higher level of patient satisfaction with respect to the hospital environment and services. Taking the pharmaceutical services in hospital inpatient departments as the case, forecasting the pharmaceutical demands based on the admitted patients’ information contributes to not only better logistics management and cost containment, but also to securing the medical requirements of individual patients. In patient-centric facility management, the pharmacy inventory is regarded as the combination of medical resources that are reserved and allocated to each admitted patient. Two forecasting models are trained to predict the inpatients’ total medical requirement at the beginning of the hospitalization and rectify the patients’ length of stay after early treatment. Specifically, once a patient is admitted to the hospital, certain amounts of medical resources are reserved, according to the inpatient’s gender, age, diagnosis, and their preliminary expected days in the hospital. The allocated inventory is updated after the early treatment by rectifying the inpatient’s estimated length of stay. The proposed procedure is validated using medical data from eighteen hospitals in a Chinese city. This study facilitates the integration of patient-related information with the conventional FM processes and demonstrates the potential improvement in patients’ satisfaction with better hospital logistics and pharmaceutical services.

A Perspective towards Multi-Hazard Resilient Systems: Natural Hazards and Pandemics

The concept of resilience has been used extensively across the sciences in engineering and the humanities. It is applied to ecology, medicine, economics, and psychology. The novel coronavirus disease (COVID-19) has posed an extraordinary challenge to the resilience of healthcare systems, communities, and nations and has profoundly altered our previous day-to-day operations. This paper presents a discussion of the definitions and characteristics of resilient systems. Scenarios are utilized to qualitatively explore key relationships, responses, and paths for recovery across different system types. The purpose is to develop an integrated approach that can accommodate simultaneous threats to system resilience, in particular, impacts from a natural hazard in conjunction with COVID-19. This manuscript is the first to advocate for more in-depth and quantitative research utilizing transdisciplinary approaches that can accommodate considerations across our built environment and healthcare system infrastructures in pursuit of designing systems that are resilient to both natural hazards and pandemic impacts.

Support the frontliners – good initiatives during the COVID-19 pandemic for healthcare workers across the world: is this what we really need?

Healthcare workers have faced an unprecedented workload in overstretched health facilities during the COVID-19 pandemic, and we describe various initiatives to support them. Psychological, financial and peer support, accommodation and meal services, proper personal protective equipment, applause and gratitude in the community, spiritual and religious life, child care and volunteering were identified. The potential effects of the COVID-19 pandemic – permanent stress, burnout and other mental health problems among healthcare professionals – can be expected to grow. Continued monitoring is essential to bolster resilience among healthcare workers and prevent the possible consequences for their mental health.

Redefining vulnerability and resilience from COVID-19 lens: a case study of COVID-19 management in Bihar, India

The COVID-19 pandemic uncovered hidden vulnerabilities of the globalized world that were never witnessed before in modern history. Globalization once seen as the main driver for economic prosperity and poverty reduction became bane and led to the spread of coronavirus in the entire world. While coronavirus broke all the boundaries and spread to each segment of society, the scientific community thrives their best to unleash possible solutions for the effective management of COVID-19. To contain the spread of the virus and effective management of the pandemic, concerted efforts are applied from each section of the society. This chapter presents some of the key strategic approaches through digital means adopted by the Indian state of Bihar in containing the spread of coronavirus. Despite high population density, the mortality rate and rate of infection remained low in Bihar as compared to several Indian states. The concerted efforts to mitigate the impacts of COVID-19 through the use of technology-driven solutions, efficient management of migrant laborer, tracking of patients, and treatment minimized overall patient load and reduced suffering of people of Bihar. The pandemic has also brought a new dimension to the vulnerability and resilience discourse. This chapter also provides insights into the elements of vulnerabilities and resilience related to COVID-19 and how these elements are reshaped from the lens of COVID-19 management.

International trade resilience and the Covid-19 pandemic

The Covid-19 pandemic represents a low-probability, high-impact systemic risk that has severely disrupted international trade, reshaping the patterns of globalization. Drawing from the concept of supply chain resilience, which involves both the ability of a system to withstand an impact (robustness) and recover from it (responsiveness), we investigate country-level trade resilience during the 1st wave of the pandemic. By employing Fuzzy-set Qualitative Comparative Analysis (fsQCA), we identify configurations of country-level factors, i.e., country profiles, based on their effectiveness in engendering trade resilience. These factors include social and economic globalization, logistics performance, healthcare preparedness, national government response, and income level. The results show how these factors coalesced to strengthen (or weaken) international trade resilience, contributing to a holistic understanding of the impact of the pandemic on international trade. The findings inform the post-Covid-19 debate on international trade, with implications for managers and policymakers.

Why Resilience in Health Care Systems is More than Coping with Disasters: Implications for Health Care Policy

Health care systems need to be resilient to deal with disasters like the global spread of the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) on top of serving the changing needs of a multi-morbid, ageing and often dispersed population. This paper identifies, discusses and augments critical dimensions of resilience retrieved from the academic literature. It pulls together an integrated concept of resilience characterised by organisational capabilities. Our concept does not focus on the micro-level like most resilience literature in health care but addresses the system level with many stakeholders involved. Distinguishing exogenous shocks to the health care system into adverse events and planned innovations provides the basis for our conclusions and insights. It becomes apparent only when dealing with planned interventions that transformative capabilities are indispensable to cope with sudden increases in health care pressures. Due to the current focus on absorptive and adaptive resilience, organisations over-rely on management capabilities that cannot generate a lasting increase in functionality. Therefore, reducing the resilience discussion to bouncing back from adverse events could deceive organisations into cultivating a suboptimal mix of organisational capabilities lacking transformative capabilities, which pave the way for a structural change that aims at a sustainably higher functionality.

Advancing Resilience of Critical Health Infrastructures to Cascading Impacts of Water Supply Outages—Insights from a Systematic Literature Review

The current understanding of critical health infrastructure resilience is still dominated by a technical perspective. Reality however is different, as past events including the COVID-19 pandemic have revealed: emergency situations are only rarely exclusively technical in nature. Instead they are a product of prior circumstances, often linked to natural hazards, technical mishaps, and insufficient social and organizational preparedness structures. However, experiences and lessons learned from past events are still largely overlooked and have not sufficiently found their way into conceptual understandings of critical health infrastructure resilience. This paper addresses this gap by challenging the one-sided and technically oriented understanding of resilience in the context of critical health infrastructure. Based on a systematic literature review, it assesses real-world cases of water supply failures in healthcare facilities, a serious threat largely overlooked in research and policy. The results underscore the need for targeted organizational strategies to deal with cascading impacts. The overall findings show that addressing technical aspects alone is not sufficient to increase the overall resilience of healthcare facilities. Broadening the dominant resilience understanding is hence an important foundation for healthcare infrastructures to improve risk management and emergency preparedness strategies to increase their resilience towards future disruptions.

Analyzing Healthcare Facility Resilience: Scientometric Review and Knowledge Map

In contemporary “high-risk” society, unexpected disasters (epidemics and extreme weather) and chronic pressures (aging problems) put tremendous pressure on healthcare facilities. Enhancing the healthcare facilities' resilience ability to resist, absorb, and respond to disaster disruptions is urgent. This study presents a scientometric review for healthcare facility resilience research. A total of 374 relevant articles published between 2000 and 2020, collected from Web of Science (WoS) core collection database, Scopus database and MEDLINE database were reviewed and analyzed. The results indicated that research on resilience in healthcare facilities went through three development periods, and the research involved countries or institutions that are relatively scattered. The studies have been focused on the subject categories of engineering, public, environmental, and occupational health. The keywords of “resilience,” “hospital,” “disaster,” “healthcare,” and “healthcare facility” had the most frequency. Furthermore, based on the literature co-citation networks and content analysis, the detected seven co-citation clusters were grouped into four knowledge domains: climate change impact, strengthening resilience in response to war and epidemic, resilience assessment of healthcare facility, and the applications of information system. Moreover, the timeline view of literature reflected the evolution of each domain. Finally, a knowledge map for resilience of healthcare facilities was put forward, in which critical research contents, current knowledge gaps, and future research work were discussed. This contribution will promote researchers and practitioners to detect the hot topics, fill the knowledge gaps, and extend the body of research on resilience of healthcare facilities.

Resilience Assessment Frameworks of Critical Infrastructures: State-of-the-Art Review

During the past two decades, critical infrastructures (CIs) faced a growing number of challenges worldwide due to natural disasters and other disruptive events. To respond to and handle these disasters and disruptive events, the concept of resilience was introduced to CIs. Particularly, many institutions and scholars developed various types of frameworks to assess and enhance CI resilience. The purpose of this paper is to review the resilience assessment frameworks of the CIs proposed by quality papers published in the past decade, determine and analyze the common dimensions and the key indicators of resilience assessment frameworks of CIs, and propose possible opportunities for future research. To achieve these goals, a comprehensive literature review was conducted, which identified 24 resilience assessment frameworks from 24 quality papers. This paper contributes to the current body of resilience research by identifying the common dimensions and the key indicators of the resilience assessment frameworks proposed for CIs. In addition, this paper is beneficial to the practice, because it provides a comprehensive view of the resilience assessment frameworks of CIs from the perspective of implementation, and the indicators are pragmatic and actionable in practice.

Resilient and responsive healthcare services and systems: challenges and opportunities in a changing world

Background

Resilient and responsive healthcare systems is on the agenda as ever before. COVID-19, specialization of services, resource demands, and technology development are all examples of aspects leading to adaptations among stakeholders at different system levels whilst also attempting to maintain high service quality and safety. This commentary sets the scene for a journal collection on Resilient and responsive health systems in a changing world. The commentary aims to outline main challenges and opportunities in resilient healthcare theory and practice globally, as a backdrop for contributions to the collection.

Main text

Some of the main challenges in this field relate to a myriad of definitions and approaches to resilience in healthcare, and a lack of studies having multilevel perspectives. Also, the role of patients, families, and the public in resilient and responsive healthcare systems is under researched. By flipping the coin, this illustrates opportunities for research and practice and raise key issues that future resilience research should pay attention to. The potential of combining theoretical lenses from different resilience traditions, involvement of multiple stakeholders in co-creating research and practice improvement, and modelling and visualizing resilient performance are all opportunities to learn more about how healthcare succeeds under stress and normal operations.

Conclusion

A wide understanding of resilience and responsiveness is needed to support planning and preparation for future disasters and for handling the routine small-scale adaptation. This collection welcomes systematic reviews, quantitative, qualitative, and mixed-methods research on the topic of resilience and responsiveness in all areas of the health system.

The ERNCIP survey on COVID-19: Emergency & Business Continuity for fostering resilience in critical infrastructures

Among the many repercussions of the COVID-19 emergency to be assessed, those on critical infrastructures and the associated businesses and professions are certainly important ones. In this paper, we document the conception, implementation and outcome of a survey organized by European Commission's Joint Research Centre and entitled "COVID-19: Emergency & Business Continuity". This was conducted in April-May 2020 with the participation of critical infrastructure experts (including professionals from the academia and research institutions, infrastructure operators and industry representatives, public authorities and members of security agencies), involved as stakeholders in the European Reference Network for Critical Infrastructure Protection (ERNCIP). Themes explored through this study include an assessment of the business continuity status and the evaluation of emergency management and disaster recovery aspects, as experienced from the perspective of different sectors, organization types and personal perceptions of the respondents.

What determines city's resilience against epidemic outbreak: evidence from China's COVID-19 experience

By employing the city-level data from China during the spring of 2020, this study investigates the relationship between city-level resilience against the outbreak of COVID-19 pandemics and its affecting factors, including the inflow risk pressure of COVID-19 virus (population inflow from the epicenter), city agglomeration characteristics (urban population density and city size), healthcare resource adequacy, among others. The results reveal that, while managing COVID-19 inflow risk pressure plays a critical role in the city's pandemic disaster resilience, city agglomeration characteristics also matters. To be exact, we find that large and high-density cities with high inter and intra-city mobility flows have more difficulties in containing the epidemic spread, but improving healthcare infrastructure adequacy and urban governance capacity can increase time efficacy of pandemic control and then improve the city's resilience against pandemic. Although our analysis is based on the performance of Chinese cities in the case of COVID-19, the research framework can be applied in understanding COVID-19 control performance of cities in other countries and the findings can be useful for improving health-related urban resilience and sustainability.

Dealing with COVID‐19 Pandemic in Complex Societal System for Resilience Study: A Systems Approach

The continuing spread of COVID‐19 has triggered a global health crisis with raising a series of problems in healthcare, economics, policymaking and environment, which significantly affected the resilience of the whole societal system. We emphasize the societal system, as an adaptive and complex system, has a fundamental impact on the spread of the virus linked to individual behavior change and disaster governance system. This paper combined system thinking and resilience thinking to visualize the complexity and comprehend the governance system under global pandemic threats towards recovering the resilient society. We underline the societal system can be affected by the pandemic, and in turn, impinge on the individual behaviors and governance with a proposed multi‐stage and multi‐scalar framework dealt with the process from crisis to recovery. Meanwhile, a qualitative system dynamics model is proposed inspired by the general Susceptible‐Infected‐Recovery (SIR) model with multiple interactions and interdependency of intervention policies, human psychological factors and mobility‐related factors to explore the influence on the societal system with time effect. Through this perspective, we should enhance the sense of crisis and integrate resilience thinking into the current hazards and recovery process combined with the interconnectedness among societal system in the future.

Providing care to patients with COVID-19 in a reference hospital: health care staff intentional behavior and factors that affect it

Objective

The investigation of intentional behavior of hospital staff to care for COVID-19 patients and the study of the factors that influences it.

Method

This is a cross-sectional study, of 261 physicians and nurses working in a COVID-19 reference hospital. Data were collected by an anonymous questionnaire including demographic and professional characteristics and a scale measuring behavioral intention based on the Theory of Planned Behavior of Ajzen. Statistical analysis was performed by SPSS 21.

Results

Mean age of participants was 40.8 years old, while most of them were nurses (75.7%). Behavioral intention mean score was 18.2 (5-21), which shows high intention to care for COVID-19 patients. Bivariate analysis between independent variables showed that behavioral intention mean score was higher for those that had cared for COVID-19 patients and those that did not (19.0% vs. 16.7%, p < 0.001). Multivariate linear regression analysis identified that increased subjective norms (the perceived social pressure to perform or not the behavior) score was associated with increased behavioral intention score (p < 0.001). Also, participants that provided care for COVID-19 patients had higher behavioral intention score (p < 0.001).

Conclusion

Healthcare staff, that cared for COVID-19 patients had high behavioral intention to continue caring for them. This finding could be used to inform policies and training for staff that will be employed in COVID-19 units.

[How can an emergency department be strengthened against a pandemic?]

The emergency department (ED) is one of the crucial parts of the hospital infrastructure during all phases of the pandemic. The ED plays an important part in detecting an increasing number of new contagious diseases, which could potentially lead to an epidemic or pandemic.During a pandemic, the ED's main task is to detect infected individuals. These patients then need to be isolated and an adequate treatment is required. The ED must be prepared in order to perform well in such a situation. One major part for readiness is communication in an open manner to all partners within the department, as well as with emergency medical services and other departments of the hospital.The ED must be restructured to withstand the rising number of infected patients. These patients must be separated from other critically ill patients. Strategies for a diagnostic workup depending on the kind of infection have to be put in place. Pathways for the outpatient and inpatient management must be defined to avoid overcrowding in the ED. Depending on the number of patients, escalation and de-escalation strategies have to be set up within the hospital.Over the whole course of the pandemic, all staff members are the key resources for the ED and the entire hospital. The ED can only cope with a pandemic situation if staff are working together as a whole. This implies several important steps to get the staff prepared: Recurring, open conversations about fears, problems, and successes are critical for staff morale. Training must be continually provided, and protection strategies implemented. In the chronic phase of the pandemic the focus should shift more towards strategies on how to create possibilities for recuperation, domestic support measures, and mental health care for staff.

Big data driven COVID-19 pandemic crisis management: potential approach for global health

INTRODUCTION

Information has the power to protect against unexpected events and control any crisis such as the COVID-19 pandemic. Since COVID-19 has already rapidly spread all over the world, only technology-driven data management can provide accurate information to manage the crisis. This study aims to explore the potential of big data technologies for controlling COVID-19 transmission and managing it effectively.

METHODS

A systematic review guided by PRISMA guidelines has been performed to obtain the key elements.

RESULTS

This study identified the thirty-two most relevant documents for qualitative analysis. This study also reveals 10 possible sources and 8 key applications of big data for analyzing the virus infection trend, transmission pattern, virus association, and differences of genetic modifications. It also explores several limitations of big data usage including unethical use, privacy, and exploitative use of data.

CONCLUSIONS

The findings of the study will provide new insight and help policymakers and administrators to develop data-driven initiatives to tackle and manage the COVID-19 crisis.

A Multi-Criteria Approach for Assessing the Economic Resilience of Agriculture: The Case of Lithuania

This study presents an innovative approach to measuring economic resilience at a sectoral level. The notion of economic resilience is explored through the lens of levels of resilience of the main functions of a researched economic sector. The overall level of sectoral economic resilience is seen as a weighted sum of resilience indexes related to its main economic functions. Such a comprehensive approach is universal, as it allows to measure economic resilience of various economic sectors. For the empirical application, the agricultural sector of Lithuania was selected for analysis of resilience. The results revealed that the overall level of resilience declined in Lithuanian agricultural sector during 2012–2019. Such a persistent trend may pose an increasing risk for food security in Lithuania in the future. The most evident negative changes in the economic resilience levels are observed in terms of economic viability of farms. The most robust levels of economic resilience are indicated in the sense of ability to provide local food at affordable prices.

Could amantadine interfere with COVID-19 vaccines based on the LNP-mRNA platform?

INTRODUCTION

Amantadine is a well-known medication with indications in neurology and infectious diseases. It is currently FDA approved for Parkinson's disease, drug-induced extrapyramidal symptoms, and influenza.

METHODS

The article is the author's original research hypothesis.

RESULTS

Because more people are going to be vaccinated and additional similar vaccines are going to be introduced, we should take into consideration the potential of amantadine to interfere with LNP-mRNA COVID-19 vaccine delivery into the target cells.

CONCLUSIONS

A more cautious approach to the patients taking amantadine as far as vaccination utilizing LNP-mRNA platform should be considered.

Applications of GIS and geospatial analyses in COVID-19 research: A systematic review

Background: Geographic information science (GIS) has established itself as a distinct domain and incredibly useful whenever the research is related to geography, space, and other spatio-temporal dimensions. However, the scientific landscape on the integration of GIS in COVID-related studies is largely unknown. In this systematic review, we assessed the current evidence on the implementation of GIS and other geospatial tools in the COVID-19 pandemic. Methods: We systematically retrieved and reviewed 79 research articles that either directly used GIS or other geospatial tools as part of their analysis. We grouped the identified papers under six broader thematic groups based on the objectives and research questions of the study- environmental, socio-economic, and cultural, public health, spatial transmission, computer-aided modeling, and data mining. Results: The interdisciplinary nature of how geographic and spatial analysis was used in COVID-19 research was notable among the reviewed papers. Geospatial techniques, especially WebGIS, have even been widely used to visualize the data on a map and were critical to informing the public regarding the spread of the virus, especially during the early days of the pandemic. This review not only provided an overarching view on how GIS has been used in COVID-19 research so far but also concluded that geospatial analysis and technologies could be used in future public health emergencies along with statistical and other socio-economic modeling techniques. Our review also highlighted how scientific communities and policymakers could leverage GIS to extract useful information to make an informed decision in the future. Conclusions:  Despite the limited applications of GIS in identifying the nature and spatio-temporal pattern of this raging pandemic, there are opportunities to utilize these techniques in handling the pandemic. The use of spatial analysis and GIS could significantly improve how we understand the pandemic as well as address the underserviced demographic groups and communities.

Applications of GIS and geospatial analyses in COVID-19 research: A systematic review

Background: Geographic information science (GIS) has established itself as a distinct domain and incredibly useful whenever the research is related to geography, space, and other spatio-temporal dimensions. However, the scientific landscape on the integration of GIS in COVID-related studies is largely unknown. In this systematic review, we assessed the current evidence on the implementation of GIS and other geospatial tools in the COVID-19 pandemic. Methods: We systematically retrieved and reviewed 79 research articles that either directly used GIS or other geospatial tools as part of their analysis. We grouped the identified papers under six broader thematic groups based on the objectives and research questions of the study- environmental, socio-economic, and cultural, public health, spatial transmission, computer-aided modeling, and data mining. Results: The interdisciplinary nature of how geographic and spatial analysis was used in COVID-19 research was notable among the reviewed papers. Although GIS has substantial potential in planning to slow down the spread, surveillance, contact tracing, and identify the trends and hotspots of breakdowns, it was not employed as much as it could have been. This review not only provided an overarching view on how GIS has been used in COVID-19 research so far but also concluded that this geospatial analysis and technologies could be used in future public health emergencies along with statistical and other socio-economic modeling techniques. Our systematic review also provides how both scientific communities and policymakers could leverage GIS to extract useful information to make an informed decision in the future. Conclusions:  Despite the limited applications of GIS in identifying the nature and spatio-temporal pattern of this raging pandemic, there are opportunities to utilize these techniques in handling the pandemic. The use of spatial analysis and GIS could significantly improve how we understand the pandemic as well as address the underserviced demographic groups and communities.

Modelling, Measuring, and Visualising Community Resilience: A Systematic Review

The concept of community resilience receives much attention in studies and applications due to its ability to provide preparedness against hazards, to protect our life against risks, and to recover to stable living conditions. Nevertheless, community resilience is complex, contextual, multifaceted, and therefore hard to define, recognise, and operationalise. An essential advantage of having a complete process for community resilience is the capacity to be aware of and respond appropriately in times of adversity. A three-step process constituting of modelling, measurement, and visualisation is crucial to determine components, to assess value, and to represent information of community resilience, respectively. The goal of this review is to offer a general overview of multiple perspectives for modelling, measuring, and visualising community resilience derived from related and emerging studies, projects, and tools. By engaging throughout the entire process, which involves three sequential steps as we mentioned above, communities can discover important components of resilience, optimise available local and natural resources, and mitigate the impact of impairments effectively and efficiently. To this end, we conduct a systematic review of 77 different literature records published from 2000 to 2020, concentrating on five research questions. We believe that researchers, practitioners, and policymakers can utilise this paper as a potential reference and a starting point to surpass current hindrances as well as to sharpen their future research directions.

Living in a Multi-Risk Chaotic Condition: Pandemic, Natural Hazards and Complex Emergencies

Humans are living in an uncertain world, with daily risks confronting them from various low to high hazard events, and the COVID-19 pandemic has created its own set of unique risks. Not only has it caused a significant number of fatalities, but in combination with other hazard sources, it may pose a considerably higher multi-risk. In this paper, three hazardous events are studied through the lens of a concurring pandemic. Several low-probability high-risk scenarios are developed by the combination of a pandemic situation with a natural hazard (e.g., earthquakes or floods) or a complex emergency situation (e.g., mass protests or military movements). The hybrid impacts of these multi-hazard situations are then qualitatively studied on the healthcare systems, and their functionality loss. The paper also discusses the impact of pandemic's (long-term) temporal effects on the type and recovery duration from these adverse events. Finally, the concept of escape from a hazard, evacuation, sheltering and their potential conflict during a pandemic and a natural hazard is briefly reviewed. The findings show the cascading effects of these multi-hazard scenarios, which are unseen nearly in all risk legislation. This paper is an attempt to urge funding agencies to provide additional grants for multi-hazard risk research.