All Hands on Deck: A synchronized whole-of-world approach for COVID-19 mitigation

COVID-19 on the spectrum: a scoping review of hygienic standards

The emergence of COVID-19 in Wuhan, China, rapidly escalated into a worldwide public health crisis. Despite numerous clinical treatment endeavors, initial defenses against the virus primarily relied on hygiene practices like mask-wearing, meticulous hand hygiene (using soap or antiseptic solutions), and maintaining social distancing. Even with the subsequent advent of vaccines and the commencement of mass vaccination campaigns, these hygiene measures persistently remain in effect, aiming to curb virus transmission until the achievement of herd immunity. In this scoping review, we delve into the effectiveness of these measures and the diverse transmission pathways, focusing on the intricate interplay within the food network. Furthermore, we explore the virus's pathophysiology, considering its survival on droplets of varying sizes, each endowed with distinct aerodynamic attributes that influence disease dispersion dynamics. While respiratory transmission remains the predominant route, the potential for oral-fecal transmission should not be disregarded, given the protracted presence of viral RNA in patients' feces after the infection period. Addressing concerns about food as a potential viral vector, uncertainties shroud the virus's survivability and potential to contaminate consumers indirectly. Hence, a meticulous and comprehensive hygienic strategy remains paramount in our collective efforts to combat this pandemic.

Newspaper coverage on solidarity and personal responsibility in the COVID-19 pandemic: A content analysis from Germany and German-speaking Switzerland

Solidarity and personal responsibility have been repeatedly called upon during the COVID-19 pandemic. This study quantifies and contextualizes the use of these terms in newspaper coverage in Germany and German-speaking Switzerland based on n = 640 articles from six functionally equivalent newspapers. The term solidarity in the context of the COVID-19 pandemic was mentioned in 541/640 articles (84.5%) and was primarily used during phases with high death rates and comparatively stringent policies in place, supporting the idea that solidarity was used to explain restrictive measures to the population and motivate people to comply with these measures. German newspapers published more articles on solidarity than Swiss-German newspapers, consistent with more stringent COVID-19 policies in Germany. Personal responsibility was mentioned in 133/640 articles (20.8%), meaning that the term was less frequently discussed than solidarity. Articles covering personal responsibility included more negative evaluations during phases of high infection rates as compared to phases of low infection rates. Findings indicate that the two terms were, at least to some extent, used in newspaper reporting to contextualize and justify COVID-19 policy during phases of high infection rates. Moreover, the term solidarity was used in a high variety of different contexts and the inherent limits of solidarity were rarely mentioned. Policymakers and journalists need to take this into account for future crises to not jeopardize the positive effects of solidarity.

Identifying the value of a clinical information system during the COVID-19 pandemic

The COVID-19 pandemic has significantly augmented the urgency for service providers to identify and develop clinically urgent system alterations into healthcare systems to facilitate antibody testing and treatment interventions. However, it has been difficult to determine how users assess the value of an information system in terms of its functionality and features. Conversely, the system development process to address urgent user requirements, for example, developing new functionality for COVID antibody testing, has been beset by a myriad of difficulties as research to understand the value of specific aspects of clinical information systems has been elusive. This study addresses this knowledge gap by identifying specific aspects of a national clinical information system in Wales, UK. Through a series of semi-structured interviews, a quantitative study of 559 clinical users and a focus group, the study deconstructs system-related value into 14 unique attributes that have been found to vary according to different types of user roles and geographic location.

Attribution theory is identified in this study as a novel and effective way to study this multifaceted concept of system value. The identification of component attributes of the value of a clinical information system provides insights for service users, system developers, and organization managers to prioritize and focus their system development activity by using an importance ranking identified through this study.

Interactions among the human and organizational factors within the public sector regarding epidemic prevention and control

The management of human and organizational factors (HOFs) within the public sector directly concerns the efficacy of epidemic prevention and control (EPC). Insufficient examination of such HOFs has led to defective countermeasures. This study attempts to comprehensively identify the HOFs within the public sector critical to EPC and investigate their interactions with the weighted network theory. A total of 55 HOFs were identified, and their interactions were assessed and visualized in the Chinese context. Then, the established weighted network was analyzed to investigate the interactions and diagnose critical factors and sectors. The analysis shows that there are strong interactions among HOFs, and that the human and organizational risks emerging from administrative departments of public health, centers for disease control and prevention, and medical institutions act as the key risk sources in the complex interconnected EPC system, exacerbating risk and causing a significant domino effect. It is recommended that the authorities devote more resources to the core sectors and endeavor to reinforce those critical HOFs by implementing closer risk communication, collaboration, and response. This study may deepen and broaden the authorities' awareness and understanding of interactions among HOFs regarding epidemic mitigation, and strengthen their capacity to perceive, evaluate, and manage these factors in a proactive and effective way, thereby facilitating the success of EPC.

Hajj 2021: Role of mitigation measures for health security

PURPOSE

After the impressive results of the 2020 Hajj management, Saudi authorities decided to expand the quota to 60,000 pilgrims in 2021, which resulted in a convenient and successful experience.

PATIENTS AND METHODS

This was a retrospective pre and post-study study conducted on all pilgrims attending the 2021 Hajj using the polymerase chain reaction (PCR) test surveillance with paired-swab samples (pre-Hajj and post-Hajj) to evaluate the risk potential of COVID-19 among Hajj pilgrims, the effectiveness of preventive measures and the potential effect of the Hajj ritual as a huge mass gathering on the epidemiological situation of the Saudi Arabian population.

RESULT

Forty-one cases had positive COVID-19 infections out of a total of 58,428 pilgrims who attended the 2021 Hajj season, as detected by nonmandatory pre- and post-Hajj PCR. Notably, the 2021 Hajj season achieved a decreasing leg of the COVID-19 pandemic curve. The adjusted incidence rate in KSA from July 11th to August 7th ranged from 19 to 24 cases per 100,000 population. In contrast, the incidence rate for the same duration in Hajj ranged from 3 to 7 cases per 100,000 pilgrims.

CONCLUSION

The Saudi mitigation plan ensured the safety of pilgrims and healthcare workers for Hajj, successfully limited the risk of COVID-19 transmission inside and contributed to global health security. The success story of Hajj in 2020 and 2021 during the pandemic represents a successful model for planning, achieving and managing future mass gatherings by integrating technology with global and national health policies and public health measures.

Estimating social contacts in mass gatherings for disease outbreak prevention and management: case of Hajj pilgrimage

Background

Most mass gathering events have been suspended due to the SARS-CoV-2 pandemic. However, with vaccination rollout, whether and how to organize some of these mass gathering events arises as part of the pandemic recovery discussions, and this calls for decision support tools. The Hajj, one of the world's largest religious gatherings, was substantively scaled down in 2020 and 2021 and it is still unclear how it will take place in 2022 and subsequent years. Simulating disease transmission dynamics during the Hajj season under different conditions can provide some insights for better decision-making. Most disease risk assessment models require data on the number and nature of possible close contacts between individuals.

Methods

We sought to use integrated agent-based modeling and discrete events simulation techniques to capture risky contacts among the pilgrims and assess different scenarios in one of the Hajj major sites, namely Masjid-Al-Haram.

Results

The simulation results showed that a plethora of risky contacts may occur during the rituals. Also, as the total number of pilgrims increases at each site, the number of risky contacts increases, and physical distancing measures may be challenging to maintain beyond a certain number of pilgrims in the site.

Conclusions

This study presented a simulation tool that can be relevant for the risk assessment of a variety of (respiratory) infectious diseases, in addition to COVID-19 in the Hajj season. This tool can be expanded to include other contributing elements of disease transmission to quantify the risk of the mass gathering events.

Estimating the course of the COVID-19 pandemic in Germany via spline-based hierarchical modelling of death counts

We consider a retrospective modelling approach for estimating effective reproduction numbers based on death counts during the first year of the COVID-19 pandemic in Germany. The proposed Bayesian hierarchical model incorporates splines to estimate reproduction numbers flexibly over time while adjusting for varying effective infection fatality rates. The approach also provides estimates of dark figures regarding undetected infections. Results for Germany illustrate that our estimates based on death counts are often similar to classical estimates based on confirmed cases; however, considering death counts allows to disentangle effects of adapted testing policies from transmission dynamics. In particular, during the second wave of infections, classical estimates suggest a flattening infection curve following the “lockdown light” in November 2020, while our results indicate that infections continued to rise until the “second lockdown” in December 2020. This observation is associated with more stringent testing criteria introduced concurrently with the “lockdown light”, which is reflected in subsequently increasing dark figures of infections estimated by our model. In light of progressive vaccinations, shifting the focus from modelling confirmed cases to reported deaths with the possibility to incorporate effective infection fatality rates might be of increasing relevance for the future surveillance of the pandemic.

Consumers' perceived effectiveness of COVID-19 mitigation strategies in restaurants: What went well and what could we do better?

As restaurants are resuming normal operations, COVID-19 mitigation strategies are still in place. An effective COVID-19 mitigation protocol may facilitate a more successful rebound since consumers may perceive a lowered risk to purchase food from the restaurant with protocols in place. However, little is known regarding how consumers evaluate restaurants' present efforts to contain the transmission of COVID-19. By using a rigorous scale development procedure, this study creates a scale to measure restaurant consumers' perceptions of COVID-19 mitigation strategies (acronym: PHASE): Protective equipment/technology (P); Health and hygiene (H); Access of purchase/serving (A); Safety measure for customers (S); and Employee safety measure (E). The study further identifies the areas that need to be improved by using importance-performance analysis. Findings of this study provide guidelines for restaurant professionals to potentially reallocate their existing resources to refine their COVID-19 mitigation strategies and to better prepare for the future.

CHALLENGES AND DIFFICULTIES IN IMPLEMENTING AND ADOPTING ISOLATION AND QUARANTINE MEASURES AMONG INTERNALLY DISPLACED PEOPLE DURING THE COVID-19 PANDEMIC IN MALI (161/250)

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The lack of facilities for quarantine and isolation in the sites for internally displaced people (IDPs) was found to be a barrier to the adoption of isolation and quarantine measures by IDPs.

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Changes in social behavior and practices to adopt isolation and quarantine were found to be difficult for IDPs.

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Financial vulnerability and fear of stigma were identified as barriers to the adoption of isolation and quarantine measures by IDPs.

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Endogen solutions to adopt isolation and quarantine measures include strengthening IDPs’ awareness on COVID-19 by IDPs.

Introduction

Isolation and quarantine are among the key measures that protect internally displaced people (IDPs) against COVID-19. This study aims to identify the challenges encountered by humanitarian actors, and health, political, and administrative stakeholders in implementing these measures. It also describes the difficulties faced by IDPs when adopting them, and the local initiatives developed to overcome those difficulties.

Method

We conducted a qualitative survey consisting of individual interviews and focus groups among IDPs, humanitarian actors, and health, political, and administrative stakeholders. The data was collected between November and December 2020 in the Bamako and Ségou Regions of Mali. Interviews were recorded with audio recorders, then transcribed and thematically analyzed using the NVivo 13 software.

Findings

The study involved 36 individual interviews and eight focus groups with 68 participants of whom IDPs represented 72.3%. The main challenges reported on IDP sites included difficulties in contacting positive cases, a lack of facilities for quarantine and isolation, a lack of physical space for building new facilities, and a lack of financial resources to support IDPs during isolation and quarantine. The difficulties reported included: changes in social behavior and practices, fear of stigma, a poor level of literacy, and language barriers. To address those difficulties, the local initiatives developed by IDPs included strengthening the awareness of IDPs on COVID-19, early warning of sites’ leaders about positive and suspected cases, and setting up a toll-free number to facilitate access to appropriate information on COVID-19.

Conclusion

The findings of this study could be used as evidence to guide policy, adjust current strategies and take into account with more focus IDPs, a group with increased vulnerability, in COVID-19 response, more precisely during the implementation of isolation and quarantine measures. By doing so, they will help improve the response to COVID-19, IDPs health, and population health.

Iterative data-driven forecasting of the transmission and management of SARS-CoV-2/COVID-19 using social interventions at the county-level

The control of the initial outbreak and spread of SARS-CoV-2/COVID-19 via the application of population-wide non-pharmaceutical mitigation measures have led to remarkable successes in dampening the pandemic globally. However, with countries beginning to ease or lift these measures fully to restart activities, concern is growing regarding the impacts that such reopening of societies could have on the subsequent transmission of the virus. While mathematical models of COVID-19 transmission have played important roles in evaluating the impacts of these measures for curbing virus transmission, a key need is for models that are able to effectively capture the effects of the spatial and social heterogeneities that drive the epidemic dynamics observed at the local community level. Iterative forecasting that uses new incoming epidemiological and social behavioral data to sequentially update locally-applicable transmission models can overcome this gap, potentially resulting in better predictions and policy actions. Here, we present the development of one such data-driven iterative modelling tool based on publicly available data and an extended SEIR model for forecasting SARS-CoV-2 at the county level in the United States. Using data from the state of Florida, we demonstrate the utility of such a system for exploring the outcomes of the social measures proposed by policy makers for containing the course of the pandemic. We provide comprehensive results showing how the locally identified models could be employed for accessing the impacts and societal tradeoffs of using specific social protective strategies. We conclude that it could have been possible to lift the more disruptive social interventions related to movement restriction/social distancing measures earlier if these were accompanied by widespread testing and contact tracing. These intensified social interventions could have potentially also brought about the control of the epidemic in low- and some medium-incidence county settings first, supporting the development and deployment of a geographically-phased approach to reopening the economy of Florida. We have made our data-driven forecasting system publicly available for policymakers and health officials to use in their own locales, so that a more efficient coordinated strategy for controlling SARS-CoV-2 region-wide can be developed and successfully implemented.

Operationalizing Cooperative Research for Infectious Disease Surveillance: Lessons Learned and Ways Forward

The current COVID-19 pandemic demonstrates the need for urgent and on-demand solutions to provide diagnostics, treatment and preventative measures for infectious disease outbreaks. Once solutions are developed, meeting capacities depends on the ability to mitigate technical, logistical and production issues. While it is difficult to predict the next outbreak, augmenting investments in preparedness, such as infectious disease surveillance, is far more effective than mustering last-minute response funds. Bringing research outputs into practice sooner rather than later is part of an agile approach to pivot and deliver solutions. Cooperative multi- country research programs, especially those funded by global biosecurity programs, develop capacity that can be applied to infectious disease surveillance and research that enhances detection, identification, and response to emerging and re-emerging pathogens with epidemic or pandemic potential. Moreover, these programs enhance trust building among partners, which is essential because setting expectation and commitment are required for successful research and training. Measuring research outputs, evaluating outcomes and justifying continual investments are essential but not straightforward. Lessons learned include those related to reducing biological threats and maturing capabilities for national laboratory diagnostics strategy and related health systems. Challenges, such as growing networks, promoting scientific transparency, data and material sharing, sustaining funds and developing research strategies remain to be fully resolved. Here, experiences from several programs highlight successful partnerships that provide ways forward to address the next outbreak.

Academic activism on behalf of children during the COVID-19 pandemic in Israel; beyond public health advocacy

Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC's activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society's vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.

Lessons from countries implementing find, test, trace, isolation and support policies in the rapid response of the COVID-19 pandemic: a systematic review

OBJECTIVE

To systematically learn lessons from the experiences of countries implementing find, test, trace, isolate, support (FTTIS) in the first wave of the COVID-19 pandemic.

DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA

We searched MEDLINE (PubMed), Cochrane Library, SCOPUS and JSTOR, initially between 31 May 2019 and 21 January 2021. Research articles and reviews on the use of contact tracing, testing, self-isolation and quarantine for COVID-19 management were included in the review.

DATA EXTRACTION AND SYNTHESIS

We extracted information including study objective, design, methods, main findings and implications. These were tabulated and a narrative synthesis was undertaken given the diverse research designs, methods and implications.

RESULTS

We identified and included 118 eligible studies. We identified the core elements of an effective find, test, trace, isolate, support (FTTIS) system needed to interrupt the spread of a novel infectious disease, where treatment or vaccination was not yet available, as pertained in the initial stages of the COVID-19 pandemic. We report methods used to shorten case finding time, improve accuracy and efficiency of tests, coordinate stakeholders and actors involved in an FTTIS system, support individuals isolating and make appropriate use of digital tools.

CONCLUSIONS

We identified in our systematic review the key components of an FTTIS system. These include border controls, restricted entry, inbound traveller quarantine and comprehensive case finding; repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances; extended quarantine period and the use of digital tools for contact tracing and self-isolation. Support for mental or physical health and livelihoods is needed for individuals undergoing self-isolation/quarantine. An integrated system with rolling-wave planning can best use effective FTTIS tools to respond to the fast-changing COVID-19 pandemic. Results of the review may inform countries considering implementing these measures.

Estimating effective infection fatality rates during the course of the COVID-19 pandemic in Germany

BACKGROUND

The infection fatality rate (IFR) of the Coronavirus Disease 2019 (COVID-19) is one of the most discussed figures in the context of this pandemic. In contrast to the case fatality rate (CFR), the IFR depends on the total number of infected individuals - not just on the number of confirmed cases. In order to estimate the IFR, several seroprevalence studies have been or are currently conducted.

METHODS

Using German COVID-19 surveillance data and age-group specific IFR estimates from multiple international studies, this work investigates time-dependent variations in effective IFR over the course of the pandemic. Three different methods for estimating (effective) IFRs are presented: (a) population-averaged IFRs based on the assumption that the infection risk is independent of age and time, (b) effective IFRs based on the assumption that the age distribution of confirmed cases approximately reflects the age distribution of infected individuals, and (c) effective IFRs accounting for age- and time-dependent dark figures of infections.

RESULTS

Effective IFRs in Germany are estimated to vary over time, as the age distributions of confirmed cases and estimated infections are changing during the course of the pandemic. In particular during the first and second waves of infections in spring and autumn/winter 2020, there has been a pronounced shift in the age distribution of confirmed cases towards older age groups, resulting in larger effective IFR estimates. The temporary increase in effective IFR during the first wave is estimated to be smaller but still remains when adjusting for age- and time-dependent dark figures. A comparison of effective IFRs with observed CFRs indicates that a substantial fraction of the time-dependent variability in observed mortality can be explained by changes in the age distribution of infections. Furthermore, a vanishing gap between effective IFRs and observed CFRs is apparent after the first infection wave, while an increasing gap can be observed during the second wave.

CONCLUSIONS

The development of estimated effective IFR and observed CFR reflects the changing age distribution of infections over the course of the COVID-19 pandemic in Germany. Further research is warranted to obtain timely age-stratified IFR estimates, particularly in light of new variants of the virus.

Focus on international and domestic travellers are equally important for successful SARS-COV-2 mitigation: ecological comparison of emigrant and migrant travel patterns and COVID-19 trends in Kerala State, India

We posit from our ecological analysis of COVID-19 trends that the focus on returning international emigrants helped the Indian State of Kerala to successfully mitigate transmission from emigrants. However, the state’s failure to prevent SARS-COV-2 seeding by returning domestic migrants from other states of India led to extensive community transmission.

Medical students as the volunteer workforce during the COVID-19 pandemic: Polish experience

In response to the COVID-19 pandemic medical students in different countries were mobilized to support healthcare systems during the emergency. This study presents the experience of 580 students of a single medical university in Poland who served as volunteers at different healthcare units during the first six months of the first case being recorded in the country (March-September 2020). The mean ± SD hours and days spent on volunteering in the studied group were 52 ± 36 h and 144 ± 126 d, respectively, the collective number of worked hours amounted to 83,460 h. Compared to other fields of study students of medicine engaged in volunteering for more hours and for more days. The main tasks performed by the surveyed group included triage, servicing call-centers for patients and working at the admission ward, hospital clinics, emergency departments and diagnostic labs. The level of fear at the beginning of volunteering was relatively low in the studied group and did not increase over the course. The majority of students received positive feedback from families, friends, patients and healthcare workers, revealed a high level of satisfaction from volunteering (also when experiencing COVID-19-related prejudice), while gaining professional experience and a sense of giving real aid were among the most frequently indicated benefits. The results of the present study demonstrate that although medical students are not essential workers in response to the COVID-19 pandemic, they can be of real assistance to healthcare systems during times of emergency, and should be considered as such in the future in case such a need arises again.

Use of masks in public places in Poland during SARS-Cov-2 epidemic: a covert observational study

Background

Face masks have been employed in the COVID-19 pandemic plans as a public and personal health control measure against the spread of SARS-CoV-2. In Poland, obligatory wearing of masks in public spaces was introduced on April 10th, 2020; a relaxation of previous universal measures was announced on May 29th, 2020, limiting use to indoor public places.

Objective

To assess use of masks or other protective devices in public spaces in Poland during the SARS-Cov-2 epidemic.

Methods

A non-participatory covert observational study was conducted on three dates, (10.05/18.05/25.05.2020) at public spaces in 13 regions with different risks. Ten consecutive individuals were observed by each of 82 medical students (n = 2460 observations), using a structured checklist.

Results

Among 2353 observed persons, the female/male ratios were 1.0, 1.1, and 1.0 on the three dates. Almost three quarters - 73.6% (n = 552/750) were using masks on date 1, 66.5% (544/818) on date 2; and 65.7% (516/785) on date 3. Cloth masks predominated on all dates (64.7–62.3%-62.6%), followed by medical (23.4–28.5%-26.9%). Being female (OR = 1.77–1.47-1.53 respectively) and location in a closed space (OR = 2.60–2.59-2.32) were each associated with higher usage. Participants in sports were about two times less likely to use masks (OR = 0.64–0.53-0.53) as compared to other activities. The proportion using masks correctly decreased gradually over time (364/552; 65.9%; 339/544; 62.3% and 304/516; 58.9%). More females wore masks correctly (date 1: 205/294; 69.7% vs 159/258; 61.6%, and date 3: 186/284; 65.5% vs 118/232; 50.9%; p = 0.045; p = 0.0008 respectively). Uncovered noses (47.3–52.7%) and masks around the neck (39.2–42.6%) were the most frequent incorrect practices.

Conclusions

Practices were not in line with official recommendations, especially among males, and deteriorated over time. Cloth masks were predominantly used in public spaces. Health promotion, through utilizing all available communication channels, would be helpful to increase compliance.

Towards Fusion Energy in the Industry 5.0 and Society 5.0 Context: Call for a Global Commission for Urgent Action on Fusion Energy

This article provides a high-level review of the geopolitical status quo of nuclear fusion energy and outlines a vision for the future against the backdrop of Industry 5.0 and Society 5.0. In 2020, the year of the 75th anniversary of Hiroshima and Nagasaki, ITER, the world’s largest fusion experiment, began its machine assembly, and next year, the DEMO (fusion power) stage of ITER planning is formally due to begin. With several countries now engaged in the design of DEMO-phase machines, we stress that a “burning plasma” self-sustaining fusion reaction event will be a critical juncture similar in status to the Trinity Test. In response, urging the need for US geopolitical engagement, we call for a “Global Commission for Urgent Action on Fusion Energy,” to be backed by the International Atomic Energy Agency and International Energy Agency (IEA), along the lines of the existing IEA “Global Commission for Urgent Action on Energy Efficiency.” We see the Commission serving a similar, this time international, role to the 1946 “Acheson-Lilienthal” report for fission and involving a global External Independent Review of the state-of-the art of fusion energy technologies. We suggest major “soft power” co-chairs from the Global West and North and from the Global South, thereby providing a geopolitical pivot which can unlock tens of billions of dollars in funding for multiple technology pathways, create a global regime to safeguard Intellectual Property, accelerate the transition from fossil fuels to a “Future Fusion Economy,” and prevent the geopolitical polarization of fusion energy.

Public health emergencies of international concern: a historic overview

RATIONALE

The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations.

KEY FINDINGS

Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread.

RECOMMENDATIONS

The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.

Call to avert acceleration of COVID-19 from India's Sabarimala pilgrimage of 25 million devotees

India has the third-highest COVID-19 burden. Hosting the Sabarimala pilgrimage of an estimated 25 million can compromise the near-mitigated but fragile COVID-19 status of the host State of Kerala, accelerate the ongoing outbreaks in other states of India, and potentially in multiple countries with emigrants from Kerala.

Reprint of: Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: A narrative review

Air travel during the COVID-19 pandemic is challenging for travellers, airlines, airports, health authorities, and governments. We reviewed multiple aspects of COVID peri-pandemic air travel, including data on traveller numbers, peri-flight prevention, and testing recommendations and in-flight SARS-CoV-2 transmission, photo-epidemiology of mask use, the pausing of air travel to mass gathering events, and quarantine measures and their effectiveness.

Flights are reduced by 43% compared to 2019. Hygiene measures, mask use, and distancing are effective, while temperature screening has been shown to be unreliable. Although the risk of in-flight transmission is considered to be very low, estimated at one case per 27 million travellers, confirmed in-flight cases have been published. Some models exist and predict minimal risk but fail to consider human behavior and airline procedures variations. Despite aircraft high-efficiency filtering, there is some evidence that passengers within two rows of an index case are at higher risk. Air travel to mass gatherings should be avoided. Antigen testing is useful but impaired by time lag to results. Widespread application of solutions such as saliva-based, rapid testing or even detection with the help of “sniffer dogs” might be the way forward. The “traffic light system” for traveling, recently introduced by the Council of the European Union is a first step towards normalization of air travel. Quarantine of travellers may delay introduction or re-introduction of the virus, or may delay the peak of transmission, but the effect is small and there is limited evidence. New protocols detailing on-arrival, rapid testing and tracing are indicated to ensure that restricted movement is pragmatically implemented. Guidelines from airlines are non-transparent. Most airlines disinfect their flights and enforce wearing masks and social distancing to a certain degree. A layered approach of non-pharmaceutical interventions, screening and testing procedures, implementation and adherence to distancing, hygiene measures and mask use at airports, in-flight and throughout the entire journey together with pragmatic post-flight testing and tracing are all effective measures that can be implemented.

Ongoing research and systematic review are indicated to provide evidence on the utility of preventive measures and to help answer the question “is it safe to fly?“.

Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: A narrative review

Air travel during the COVID-19 pandemic is challenging for travellers, airlines, airports, health authorities, and governments. We reviewed multiple aspects of COVID peri-pandemic air travel, including data on traveller numbers, peri-flight prevention, and testing recommendations and in-flight SARS-CoV-2 transmission, photo-epidemiology of mask use, the pausing of air travel to mass gathering events, and quarantine measures and their effectiveness. Flights are reduced by 43% compared to 2019. Hygiene measures, mask use, and distancing are effective, while temperature screening has been shown to be unreliable. Although the risk of in-flight transmission is considered to be very low, estimated at one case per 27 million travellers, confirmed in-flight cases have been published. Some models exist and predict minimal risk but fail to consider human behavior and airline procedures variations. Despite aircraft high-efficiency filtering, there is some evidence that passengers within two rows of an index case are at higher risk. Air travel to mass gatherings should be avoided. Antigen testing is useful but impaired by time lag to results. Widespread application of solutions such as saliva-based, rapid testing or even detection with the help of "sniffer dogs" might be the way forward. The "traffic light system" for traveling, recently introduced by the Council of the European Union is a first step towards normalization of air travel. Quarantine of travellers may delay introduction or re-introduction of the virus, or may delay the peak of transmission, but the effect is small and there is limited evidence. New protocols detailing on-arrival, rapid testing and tracing are indicated to ensure that restricted movement is pragmatically implemented. Guidelines from airlines are non-transparent. Most airlines disinfect their flights and enforce wearing masks and social distancing to a certain degree. A layered approach of non-pharmaceutical interventions, screening and testing procedures, implementation and adherence to distancing, hygiene measures and mask use at airports, in-flight and throughout the entire journey together with pragmatic post-flight testing and tracing are all effective measures that can be implemented. Ongoing research and systematic review are indicated to provide evidence on the utility of preventive measures and to help answer the question "is it safe to fly?".