A COVID-19 Lockdown Tabletop Exercise in New Taipei City, Taiwan

Review of Israel's action and response during the COVID-19 pandemic and tabletop exercise for the evaluation of readiness and resilience-lessons learned 2020-2021

Background

Reevaluating response plans is essential to ensuring consistent readiness and resilience to the COVID-19 pandemic. The "During Action Review" and Tabletop (DART) methodology provides a retrospective and prospective assessment to inform the adaptive response. Israel introduced COVID-19 vaccinations in December 2020 and was the first country to implement booster vaccination to address waning immunity and surges caused by new variants. We assessed Israel's readiness and resilience related to COVID-19 response while capturing the pre-vaccination and vaccination periods.

Methods

A DART analysis was conducted between December 2020 and August 2021 among experts involved in the management of the COVID-19 pandemic in Israel. During the retrospective stage, a role-based questionnaire and discussions were undertaken in a participant-led review of the response, focusing on epidemiology and surveillance, risk communication, and vaccines. The prospective stage included tabletop exercises to evaluate short to long-term simulated scenarios.

Results

Participants emphasized the pivotal role of Israel globally by sharing experiences with the pandemic, and vaccination. Perceived strengths included multi-sectoral collaboration between the Ministry of Health, healthcare providers, academia, military, and others, stretching capacities, expanding laboratory workload, and establishing/maintaining surveillance. The vaccine prioritization plan and strong infrastructure, including computerized databases, enabled real-life assessment of vaccine uptake and impact. Challenges included the need to change case definitions early on and insufficient staffing. Quarantine of patients and contacts was particularly challenging among underprivileged communities. Risk communication approaches need to focus more on creating norms in behavior. Trust issues and limited cooperation were noted, especially among ethnic and religious minorities. To ensure readiness and resiliency, participants recommended establishing a nationally deployed system for bringing in and acting upon feedback from the field, especially concerning risk communication and vaccines.

Conclusion

Our study appraised strengths and weaknesses of the COVID-19 pandemic response in Israel and led to concrete recommendations for adjusting responses and future similar events. An efficient response comprised multi-sectoral collaboration, policy design, infrastructure, care delivery, and mitigation measures, including vaccines, while risk communication, trust issues, and limited cooperation with minority groups were perceived as areas for action and intervention.

Looking Ahead in the Rearview Mirror: During Action Review and Tabletop (DART) to Strengthen Health Emergency Readiness and Resiliency

During health emergencies, such as the COVID-19 pandemic, systematic evaluation of capabilities, and multisector coordination are challenging while operating in triage mode. During Action Review and Tabletop (DART) identifies recommendations for strengthening readiness and resiliency by creating a single methodology integrating retrospective analysis of the response to date with a prospective analysis of future scenarios. DART utilizes a role-based questionnaire and participant-led discussion for retrospective response review and identification of future scenarios of concern. Tabletop exercises exploring those future scenarios are conducted in a multi-role format to assess readiness and resiliency. Participants evaluate findings to determine recommended actions to improve response capabilities. 3 COVID-19 focused DARTs demonstrated the ability of this participant-led approach to systematically assess, not only readiness for today, but also resiliency to future complications. While demonstrating its usefulness during COVID-19, DART's flexible and modular design promises to be an effective for any ongoing health emergency.

The Study of Alternative Fire Commanders' Training Program during the COVID-19 Pandemic Situation in New Taipei City, Taiwan

In Taiwan, firefighters are responsible for transporting confirmed coronavirus cases to hospitals or epidemic prevention hotels. During the epidemic, in order to reduce the chance of cross-infection between the general public and the fire brigade, traditional collective mobilization training was limited. As a solution, this study combines a fire command course (C1) and a VR simulation for training fire station captains (VRST) and then applies the pre- and post-test evaluation approaches and the after-class questionnaire to summarize the learning effectiveness. The results show that, from a total of 244 captains that were trained, the after-training scores are significantly better when compared with the scores before training (p < 0.05, Cohen’s d > 0.8). Additionally, the post-test scores collected during the epidemic (n = 158) have no significant difference compared to the ones taken before the outbreak (2019, n = 86) in terms of sizing up, decision making, and safety management. The training results are still improving. The after-class questionnaire showed that most trainees believed that VRST helped to improve their confidence as incident commanders (ICs) (mean = 4.63, top box = 66.98%), with the novice and suburban groups exhibiting more significant improvements in command ability after the training. After the pandemic, VRST can continue as a regular training method for ICs. Because of the intervention of VRST, the differences in the command experience between different IC groups can be compensated for.