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Asthana S, Mukherjee S, Phelan AL, Woo J, Standley CJ. Singapore's COVID-19 crisis decision-making through centralization, legitimacy, and agility: an empirical analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 49:101137. [PMID: 39071811 PMCID: PMC11279669 DOI: 10.1016/j.lanwpc.2024.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024]
Abstract
Background Decision-making during health crises differs from routine decision-making and is constrained by ambiguity about evolving epidemiological situations, urgency of response, lack of evidence, and fear. Recent analyses of governance and decision-making during COVID-19, focusing on leadership qualities, involvement of specific stakeholders, and effective resource management, do not adequately address a persisting gap in understanding the determinants of decision-making during health crises at the national level. Methods We undertook a study to understand the processes and characteristics of decision-making during the COVID-19 pandemic in Singapore. We used a case study approach and collected empirical evidence about public health decision-making, using a combination of key informant interviews and focus group discussions with stakeholders from government, academia and civil society organizations. Findings We argue that administrative centralization and political legitimacy played important roles in agile governance and decision-making during the pandemic in Singapore. We demonstrate the role of the Singapore government's centralization in creating a unified and coherent governance model for emergency response and the People's Action Party's (PAP) legitimacy in facilitating people's trust in the government. Health system resilience and financial reserves further facilitated an agile response, yet community participation and prioritization of vulnerable migrant populations were insufficient in the governance processes. Interpretation Our analysis contributes to the theory and practice of crisis decision-making by highlighting the role of political and administrative determinants in agile crisis decision-making. Funding This study is funded by the U.S. Centers for Disease Control and Prevention through a Cooperative Research Agreement (NU2HGH2020000037).
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Affiliation(s)
- Sumegha Asthana
- Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Sanjana Mukherjee
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Alexandra L. Phelan
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J.J. Woo
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - Claire J. Standley
- Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Meyer C, Crayton E, Wright A, Spyer M, Vora N, Houlihan C, Walker NF, Nastouli E, Michie S, Lorencatto F. Factors influencing uptake of protective behaviours by healthcare workers in England during the COVID-19 pandemic: A theory-based mixed-methods study. PLoS One 2024; 19:e0299823. [PMID: 38722954 PMCID: PMC11081271 DOI: 10.1371/journal.pone.0299823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/15/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Hospital infection control policies protect patients and healthcare workers (HCWs) and limit the spread of pathogens, but adherence to COVID-19 guidance varies. We examined hospital HCWs' enactment of social distancing and use of personal protective equipment (PPE) during the COVID-19 pandemic, factors influencing these behaviours, and acceptability and feasibility of strategies to increase social distancing. METHODS An online, cross-sectional survey (n = 86) and semi-structured interviews (n = 22) with HCWs in two English hospitals during the first wave of the COVID-19 pandemic (May-December 2020). The Capability, Opportunity, Motivation (COM-B) model of behaviour change underpinned survey and topic guide questions. Spearman Rho correlations examined associations between COM-B domains and behaviours. Interviews were analysed using inductive and deductive thematic analysis. Potential strategies to improve social distancing were selected using the Behaviour Change Wheel and discussed in a stakeholder workshop (n = 8 participants). RESULTS Social distancing enactment was low, with 85% of participants reporting very frequently or always being in close contact with others in communal areas. PPE use was high (88% very frequently or always using PPE in typical working day). Social distancing was associated with Physical Opportunity (e.g., size of physical space), Psychological Capability (e.g., clarity of guidance), and Social Opportunity (e.g., support from managers). Use of PPE was associated with Psychological Capability (e.g., training), Physical Opportunity (e.g., availability), Social Opportunity (e.g., impact on interactions with patients), and Reflective Motivation (e.g., beliefs that PPE is effective). Local champions and team competition were viewed as feasible strategies to improve social distancing. CONCLUSIONS It is valuable to understand and compare the drivers of individual protective behaviours; when faced with the same level of perceived threat, PPE use was high whereas social distancing was rarely enacted. Identified influences represent targets for intervention strategies in response to future infectious disease outbreaks.
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Affiliation(s)
- Carly Meyer
- Centre for Behaviour Change, University College London, London, United Kingdom
- NIHR Policy Research Unit in Behavioural Science, University College London, London, United Kingdom
| | - Elise Crayton
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Abigail Wright
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Moira Spyer
- Department of Infection, Immunity and Inflammation, UCL GOS Institute of Child Health, London, United Kingdom
| | - Nina Vora
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom
| | - Catherine Houlihan
- Department of Clinical Virology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Naomi F. Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Eleni Nastouli
- Department of Infection, Immunity and Inflammation, UCL GOS Institute of Child Health, London, United Kingdom
- Department of Clinical Virology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, United Kingdom
- NIHR Policy Research Unit in Behavioural Science, University College London, London, United Kingdom
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
- NIHR Policy Research Unit in Behavioural Science, University College London, London, United Kingdom
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Jafarlou M. Unveiling the menace: a thorough review of potential pandemic fungal disease. FRONTIERS IN FUNGAL BIOLOGY 2024; 5:1338726. [PMID: 38711422 PMCID: PMC11071163 DOI: 10.3389/ffunb.2024.1338726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/04/2024] [Indexed: 05/08/2024]
Abstract
Fungal diseases have emerged as a significant global health threat, with the potential to cause widespread outbreaks and significant morbidity and mortality. Anticipating future pandemic fungal diseases is essential for effective preparedness and response strategies. This comprehensive literature review aims to provide a comprehensive analysis of the existing research on this topic. Through an extensive examination of scholarly articles, this review identifies potential fungal pathogens that have the potential to become pandemics in the future. It explores the factors contributing to the emergence and spread of these fungal diseases, including climate change, globalization, and antimicrobial resistance. The review also discusses the challenges in diagnosing and treating these diseases, including limited access to diagnostic tools and antifungal therapies. Furthermore, it examines the strategies and interventions that can be employed to mitigate the impact of future pandemic fungal diseases, such as improved surveillance systems, public health education, and research advancements. The findings of this literature review contribute to our understanding of the potential risks posed by fungal diseases and provide valuable insights for public health professionals and policymakers in effectively preparing for and responding to future pandemic outbreaks. Overall, this review emphasizes the importance of proactive measures and collaborative efforts to anticipate and mitigate the impact of future pandemic fungal diseases.
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Thompson RR, Jones NM, Garfin DR, Holman EA, Silver RC. Contrasting Objective and Perceived Risk: Predicting COVID-19 Health Behaviors in a Nationally Representative U.S. Sample. Ann Behav Med 2024; 58:242-252. [PMID: 38413045 DOI: 10.1093/abm/kaad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Individuals confronting health threats may display an optimistic bias such that judgments of their risk for illness or death are unrealistically positive given their objective circumstances. PURPOSE We explored optimistic bias for health risks using k-means clustering in the context of COVID-19. We identified risk profiles using subjective and objective indicators of severity and susceptibility risk for COVID-19. METHODS Between 3/18/2020-4/18/2020, a national probability sample of 6,514 U.S. residents reported both their subjective risk perceptions (e.g., perceived likelihood of illness or death) and objective risk indices (e.g., age, weight, pre-existing conditions) of COVID-19-related susceptibility and severity, alongside other pandemic-related experiences. Six months later, a subsample (N = 5,661) completed a follow-up survey with questions about their frequency of engagement in recommended health protective behaviors (social distancing, mask wearing, risk behaviors, vaccination intentions). RESULTS The k-means clustering procedure identified five risk profiles in the Wave 1 sample; two of these demonstrated aspects of optimistic bias, representing almost 44% of the sample. In OLS regression models predicting health protective behavior adoption at Wave 2, clusters representing individuals with high perceived severity risk were most likely to report engagement in social distancing, but many individuals who were objectively at high risk for illness and death did not report engaging in self-protective behaviors. CONCLUSIONS Objective risk of disease severity only inconsistently predicted health protective behavior. Risk profiles may help identify groups that need more targeted interventions to increase their support for public health policy and health enhancing recommendations more broadly.
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Affiliation(s)
- Rebecca R Thompson
- Department of Psychological Science, University of California, Irvine, USA
| | - Nickolas M Jones
- Department of Psychological Science, University of California, Irvine, USA
| | - Dana Rose Garfin
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, USA
| | - E Alison Holman
- Department of Psychological Science, University of California, Irvine, USA
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Roxane Cohen Silver
- Department of Psychological Science, University of California, Irvine, USA
- Program in Public Health and Department of Medicine, University of California, Irvine, USA
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Chen H, Xu T, Mitchell R, Yang H, Zhou Z, Wei X, Wang W. The organization-level and physician-level factors associated with primary care physicians' confidence in pandemic response: A multilevel study in China. PLoS One 2024; 19:e0295570. [PMID: 38421982 PMCID: PMC10903868 DOI: 10.1371/journal.pone.0295570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/23/2023] [Indexed: 03/02/2024] Open
Abstract
Primary care physicians (PCPs) suffered from heavy workloads and health problems during COVID-19 pandemics, and building their confidence in pandemic response has great potential to improve their well-being and work performance. We identified the organizational factors associated with their confidence in pandemic response and proposed potential management levers to guide primary care response for the pandemic. We conducted a cross-sectional survey with 224 PCPs working in 38 community health centers in China. Guided by self-efficacy theory, organization-level factors (organizational structure and organizational culture) and physician-level factors (job skill variety, perceived organizational support, work-family conflict, and professional fulfillment) were selected, and two-level ordinal logit models were built to examine their association with PCPs' confidence in pandemic response. We found that hierarchical culture (OR = 3.51, P<0.05), perceived organizational support (OR = 2.36, P<0.05), job skill variety (OR = 1.86, P<0.05), and professional fulfillment (OR = 2.26, P<0.05) were positively associated with PCPs' confidence in pandemic response. However, the influence of organization structure and work-family conflict seemed limited. The study not only increases our understanding of the influence of organizational context on PCPs' pandemic response confidence, but also points out potential management levers for front-line primary care managers to enhance primary care pandemic response capacity.
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Affiliation(s)
- Haiming Chen
- Zhangjiagang Center for Disease Control and Prevention, Zhangjiagang, Suzhou, China
| | - Tiange Xu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Rebecca Mitchell
- Health and Wellbeing Research Unit (HoWRU), Macquarie Business School, Macquarie University, Sydney, Australia
| | - Huiyun Yang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Wenhua Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Asthana S, Mukherjee S, Phelan AL, Standley CJ. Governance and Public Health Decision-Making During the COVID-19 Pandemic: A Scoping Review. Public Health Rev 2024; 45:1606095. [PMID: 38434539 PMCID: PMC10904583 DOI: 10.3389/phrs.2024.1606095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Objective: We provide an in-depth understanding of how governance and decision-making during the COVID-19 pandemic has been empirically characterized in the literature to identify gaps in research and highlight areas that require further inquiry. Methods: We searched peer-reviewed publications using empirical data published between Jan 1, 2020 and Jan 31, 2022 in three electronic databases to examine the process of governance and decision-making during the COVID-19 pandemic. Two authors independently screened the records and 24 publications were extracted for the review. Results: Governance is analyzed by its level at national, sub-national, community and by its aspects of process, determinants and performance. While different methodological approaches are used, governance is conceptualized in four ways 1) characteristics and elements, 2) leadership, 3) application of power and 4) models or arrangements of governance. Conclusion: For future pandemic preparedness, there is a need for more empirical research using a unified conceptual approach to governance, which integrates decision-making processes and can guide governance structures and mechanisms across different countries and contexts. We call for more inclusivity in who performs the research on governance and where.
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Affiliation(s)
- Sumegha Asthana
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | - Sanjana Mukherjee
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | - Alexandra L. Phelan
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | - Claire J. Standley
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Young JJ, Mutch H, Rose AMC, Evans JMM. Enhanced surveillance of hospitalized COVID-19 patients in Europe: an evaluation of the I-MOVE-COVID-19 surveillance network. Eur J Public Health 2024; 34:181-189. [PMID: 37889597 PMCID: PMC10843949 DOI: 10.1093/eurpub/ckad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND A pre-existing, well-established European influenza surveillance network known as I-MOVE enabled the rapid implementation of a European multi-country COVID-19 hospital surveillance network for surveillance of hospitalized COVID-19 cases in early 2020. This network included 257 hospitals in 11 surveillance sites across nine countries. We aimed to identify whether the surveillance objectives were relevant to public health actions, whether the surveillance system met its objectives, where and how shortcomings could be improved, and whether the system was sustainable. METHODS We identified six key attributes (meeting objectives, usefulness, timeliness, data quality, simplicity and sustainability) to assess, using Centers for Disease Control and Prevention's evaluation framework. We analyzed pooled datasets, held interviews and group discussions with 10 participating and coordinating sites and gathered feedback through web surveys. RESULTS There was overall agreement that the surveillance objectives had been met and being involved in a network of European partners had additional important benefits for stakeholders. While the publication of the outputs was not always sufficiently timely, data submission processes were considered straightforward and the key surveillance variables (age, sex, hospital admission and mortality data) were complete. The main challenges were identified as the collection of the large number of variables, limited available human resources and information governance and data protection laws. CONCLUSIONS I-MOVE-COVID-19 delivered relevant and accurate data supporting the development and implementation of COVID-19 surveillance. Recommendations presented here identify learning opportunities to support preparedness and surveillance response for future pandemics. The applied evaluation framework in this study can be adapted for other European surveillance system evaluations.
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Affiliation(s)
- Johanna J Young
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Heather Mutch
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | | | - Josie M M Evans
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
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Unlu A, Truong S, Tammi T, Lohiniva AL. Exploring Political Mistrust in Pandemic Risk Communication: Mixed-Method Study Using Social Media Data Analysis. J Med Internet Res 2023; 25:e50199. [PMID: 37862088 PMCID: PMC10625074 DOI: 10.2196/50199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND This research extends prior studies by the Finnish Institute for Health and Welfare on pandemic-related risk perception, concentrating on the role of trust in health authorities and its impact on public health outcomes. OBJECTIVE The paper aims to investigate variations in trust levels over time and across social media platforms, as well as to further explore 12 subcategories of political mistrust. It seeks to understand the dynamics of political trust, including mistrust accumulation, fluctuations over time, and changes in topic relevance. Additionally, the study aims to compare qualitative research findings with those obtained through computational methods. METHODS Data were gathered from a large-scale data set consisting of 13,629 Twitter and Facebook posts from 2020 to 2023 related to COVID-19. For analysis, a fine-tuned FinBERT model with an 80% accuracy rate was used for predicting political mistrust. The BERTopic model was also used for superior topic modeling performance. RESULTS Our preliminary analysis identifies 43 mistrust-related topics categorized into 9 major themes. The most salient topics include COVID-19 mortality, coping strategies, polymerase chain reaction testing, and vaccine efficacy. Discourse related to mistrust in authority is associated with perceptions of disease severity, willingness to adopt health measures, and information-seeking behavior. Our findings highlight that the distinct user engagement mechanisms and platform features of Facebook and Twitter contributed to varying patterns of mistrust and susceptibility to misinformation during the pandemic. CONCLUSIONS The study highlights the effectiveness of computational methods like natural language processing in managing large-scale engagement and misinformation. It underscores the critical role of trust in health authorities for effective risk communication and public compliance. The findings also emphasize the necessity for transparent communication from authorities, concluding that a holistic approach to public health communication is integral for managing health crises effectively.
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Affiliation(s)
- Ali Unlu
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Sophie Truong
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Tuukka Tammi
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Haltaufderheide J, Viero D, Krämer D. Cultural Implications Regarding Privacy in Digital Contact Tracing Algorithms: Method Development and Empirical Ethics Analysis of a German and a Japanese Approach to Contact Tracing. J Med Internet Res 2023; 25:e45112. [PMID: 37379062 PMCID: PMC10365635 DOI: 10.2196/45112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Digital contact tracing algorithms (DCTAs) have emerged as a means of supporting pandemic containment strategies and protecting populations from the adverse effects of COVID-19. However, the impact of DCTAs on users' privacy and autonomy has been heavily debated. Although privacy is often viewed as the ability to control access to information, recent approaches consider it as a norm that structures social life. In this regard, cultural factors are crucial in evaluating the appropriateness of information flows in DCTAs. Hence, an important part of ethical evaluations of DCTAs is to develop an understanding of their information flow and their contextual situatedness to be able to adequately evaluate questions about privacy. However, only limited studies and conceptual approaches are currently available in this regard. OBJECTIVE This study aimed to develop a case study methodology to include contextual cultural factors in ethical analysis and present exemplary results of a subsequent analysis of 2 different DCTAs following this approach. METHODS We conducted a comparative qualitative case study of the algorithm of the Google Apple Exposure Notification Framework as exemplified in the German Corona Warn App and the Japanese approach of Computation of Infection Risk via Confidential Locational Entries (CIRCLE) method. The methodology was based on a postphenomenological perspective, combined with empirical investigations of the technological artifacts within their context of use. An ethics of disclosure approach was used to focus on the social ontologies created by the algorithms and highlight their connection to the question about privacy. RESULTS Both algorithms use the idea of representing a social encounter of 2 subjects. These subjects gain significance in terms of risk against the background of a representation of their temporal and spatial properties. However, the comparative analysis reveals 2 major differences. Google Apple Exposure Notification Framework prioritizes temporality over spatiality. In contrast, the representation of spatiality is reduced to distance without any direction or orientation. However, the CIRCLE framework prioritizes spatiality over temporality. These different concepts and prioritizations can be seen to align with important cultural differences in considering basic concepts such as subject, time, and space in Eastern and Western thought. CONCLUSIONS The differences noted in this study essentially lead to 2 different ethical questions about privacy that are raised against the respective backgrounds. These findings have important implications for the ethical evaluation of DCTAs, suggesting that a culture-sensitive assessment is required to ensure that technologies fit into their context and create less concern regarding their ethical acceptability. Methodologically, our study provides a basis for an intercultural approach to the ethics of disclosure, allowing for cross-cultural dialogue that can overcome mutual implicit biases and blind spots based on cultural differences.
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Affiliation(s)
- Joschka Haltaufderheide
- Medical Ethics With Focus on Digitization, Joint Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Davide Viero
- Faculty of Educational Sciences, University of Duisburg-Essen, Essen, Germany
| | - Dennis Krämer
- Faculty of Social Sciences, Georg-August-University Göttingen, Göttingen, Germany
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de Carvalho PVR, Bellas H, Viana J, de Castro Nunes P, Arcuri R, da Silva Fonseca V, Carneiro APM, Jatobá A. Transformative dimensions of resilience and brittleness during health systems' collapse: a case study in Brazil using the Functional Resonance Analysis Method. BMC Health Serv Res 2023; 23:349. [PMID: 37032325 PMCID: PMC10084590 DOI: 10.1186/s12913-023-09301-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/17/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic. In January 2021, the Amazonas state's health system collapsed, especially in the city of Manaus, where acute Covid-19 patients died due to scarcity of medical supplies for respiratory therapy. METHODS This paper explores the case of the health system's collapse in Manaus to uncover the elements that prevented the system from performing resiliently to the pandemic, by carrying out a grounded-based systems analysis of the performance of health authorities in Brazil using the Functional Resonance Analysis Method. The major source of information for this study was the reports from the congressional investigation carried out to unveil the Brazilian response to the pandemic. RESULTS Poor cohesion between the different levels of government disrupted essential functions for managing the pandemic. Moreover, the political agenda interfered in the abilities of the system to monitor, respond, anticipate, and learn, essential aspects of resilient performance. CONCLUSIONS Through a systems analysis approach, this study describes the implicit strategy of "living with Covid-19", and an in-depth view of the measures that hampered the resilience of the Brazilian health system to the spread of Covid-19.
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Affiliation(s)
| | - Hugo Bellas
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jaqueline Viana
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula de Castro Nunes
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Arcuri
- Programa de Pós-Graduação Em Engenharia de Produção (TPP), Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Valéria da Silva Fonseca
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Alessandro Jatobá
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Engebretsen E, Baker M. Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness. Int J Health Policy Manag 2023; 12:7532. [PMID: 37579420 PMCID: PMC10461864 DOI: 10.34172/ijhpm.2023.7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/06/2023] [Indexed: 08/16/2023] Open
Abstract
This conceptual paper argues the need for narrative preparedness, understood as the ability to engage and empathize with peoples' stories and the values they encode, assess them based on the universe in which people live, and acknowledge the narrative rationality of each story - even when it conflicts with the rationality of science. Expanding 'health preparedness' to encompass 'narrative preparedness' complements the ideals of patient centeredness, which are sometimes betrayed when implemented into concrete decisions because the rationality of science that underpins medical practice fails to make sense of patients' stories. We outline the central tenets of narrative preparedness and demonstrate its relevance by discussing various responses to mainstream discourses on COVID-19 as a case in point. We discuss and further develop Fisher's narrative paradigm, which provides a model that complements traditional, scientific rationality with attention to narrative rationality and a radical democratic ground for health political critique. Applying the narrative paradigm to authentic examples of vaccine hesitancy and anti-vaccination demonstrates how closer attention to the way narratives are assessed by different constituencies might help us mitigate some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Health authorities must acknowledge and engage with the stories people believe in and their reasons for doing so. The crucial question for the success of health policy interventions is not only 'what are the facts' but 'how do these facts make sense to people, and why.' To be prepared for the next pandemic, health professionals must learn to engage with people's stories and the processes by which they come to be understood and assessed differently by various constituencies.
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Affiliation(s)
- Eivind Engebretsen
- Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway
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Bhatia D, Allin S, Di Ruggiero E. Mobilization of science advice by the Canadian federal government to support the COVID-19 pandemic response. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:19. [PMID: 36687774 PMCID: PMC9844194 DOI: 10.1057/s41599-023-01501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
The procurement and provision of expert-driven, evidence-informed, and independent science advice is integral to timely decision-making during public health emergencies. The 2019 coronavirus disease (COVID-19) pandemic has underscored the need for sound evidence in public health policy and exposed the challenges facing government science advisory mechanisms. This paper is a jurisdictional case study describing (i) the federal science advice bodies and mechanisms for public health in Canada (i.e., the federal science advice "ecosystem"); and (ii) how these bodies and mechanisms have mobilized and evolved to procure expertise and evidence to inform decisions during the first two years of the COVID-19 pandemic. We reviewed publicly accessible Government of Canada documents, technical reports, and peer-reviewed articles available up to December 2021. Canada's federal landscape of science advisory bodies for public health within the Health Portfolio was largely shaped by Canada's experiences with the 2003 severe acute respiratory syndrome and 2009 H1N1 outbreaks. In parallel, Canada has a designated science advisory apparatus that has seen frequent reforms since the early 2000s, with the current Office of the Chief Science Advisor created within the Science Portfolio in 2018. The COVID-19 pandemic has further complicated Canada's science advice ecosystem, with involvement from departments, expert advisory groups, and partnerships within both the federal Health and Science Portfolios. Although the engagement of federal departments outside the health sector is promising, the COVID-19 experience in Canada supports the need to institutionalize science advisory bodies for public health to improve pandemic preparedness and ensure rapid mobilization of well-coordinated and independent advice in future emergencies. This review also identified pressing areas for further inquiry to strengthen science advice for public health in Canada, including to assess the independence of science advisory actors and the interaction between federal and subnational authorities.
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Affiliation(s)
- Dominika Bhatia
- North American Observatory on Health Systems and Policies, Toronto, ON Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Sara Allin
- North American Observatory on Health Systems and Policies, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Erica Di Ruggiero
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Grant D, McLane I, Rennoll V, West J. Considerations and Challenges for Real-World Deployment of an Acoustic-Based COVID-19 Screening System. SENSORS (BASEL, SWITZERLAND) 2022; 22:9530. [PMID: 36502232 PMCID: PMC9739601 DOI: 10.3390/s22239530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has led to countless deaths and widespread global disruptions. Acoustic-based artificial intelligence (AI) tools could provide a simple, scalable, and prompt method to screen for COVID-19 using easily acquirable physiological sounds. These systems have been demonstrated previously and have shown promise but lack robust analysis of their deployment in real-world settings when faced with diverse recording equipment, noise environments, and test subjects. The primary aim of this work is to begin to understand the impacts of these real-world deployment challenges on the system performance. Using Mel-Frequency Cepstral Coefficients (MFCC) and RelAtive SpecTrAl-Perceptual Linear Prediction (RASTA-PLP) features extracted from cough, speech, and breathing sounds in a crowdsourced dataset, we present a baseline classification system that obtains an average receiver operating characteristic area under the curve (AUC-ROC) of 0.77 when discriminating between COVID-19 and non-COVID subjects. The classifier performance is then evaluated on four additional datasets, resulting in performance variations between 0.64 and 0.87 AUC-ROC, depending on the sound type. By analyzing subsets of the available recordings, it is noted that the system performance degrades with certain recording devices, noise contamination, and with symptom status. Furthermore, performance degrades when a uniform classification threshold from the training data is subsequently used across all datasets. However, the system performance is robust to confounding factors, such as gender, age group, and the presence of other respiratory conditions. Finally, when analyzing multiple speech recordings from the same subjects, the system achieves promising performance with an AUC-ROC of 0.78, though the classification does appear to be impacted by natural speech variations. Overall, the proposed system, and by extension other acoustic-based diagnostic aids in the literature, could provide comparable accuracy to rapid antigen testing but significant deployment challenges need to be understood and addressed prior to clinical use.
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Maziar P, Maher A, Alimohammadzadeh K, Jafari M, Hosseini SM. Identifying the preparedness components in COVID-19: Systematic literature review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:385. [PMID: 36618467 PMCID: PMC9818771 DOI: 10.4103/jehp.jehp_28_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/03/2022] [Indexed: 06/17/2023]
Abstract
In 2019, the COVID-19 pandemic posed a major challenge to the world. Since the world is constantly exposed to communicable diseases, comprehensive preparedness of countries is required. Therefore, the present systematic review is aimed at identifying the preparedness components in COVID-19. In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Science Direct, Iran Medex, Magiran, and Scientific Information Database were searched from 2019 to 2021 to identify preparedness components in COVID-19. Thematic content analysis method was employed for data analysis. Out of 11,126 journals retrieved from searches, 45 studies were included for data analysis. Based on the findings, the components of COVID-19 preparedness were identified and discussed in three categories: governance with three subcategories of characteristics, responsibilities, and rules and regulations; society with two subcategories of culture and resilience; and services with three subcategories of managed services, advanced technology, and prepared health services. Among these, the governance and its subcategories had the highest frequency in studies. Considering the need to prepare for the next pandemic, countries should create clear and coherent structures and responsibilities for crisis preparedness through legal mechanisms, strengthening the infrastructure of the health system, coordination between organizations through analysis and identification of stakeholders, culture building and attracting social participation, and service management for an effective response.
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Affiliation(s)
- Pooneh Maziar
- Ph.D. Student of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ali Maher
- Department of Health Policy, Economics and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khalil Alimohammadzadeh
- Department of Health Services Management, North Tehran Branch, Health Economics Policy Research Center, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Mehrnoosh Jafari
- Department of Health Services Management, School of Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
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“Local cooperation has been the cornerstone”: facilitators and barriers to resilience in a decentralized health system during COVID-19 in Finland. J Health Organ Manag 2022; ahead-of-print. [DOI: 10.1108/jhom-02-2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PurposeThe purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland.Design/methodology/approachThe authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis.FindingsThe findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions.Originality/valueFactors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.
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Chen Q, Zhang J, Wang P, Zhang Z. The mechanisms of immune response and evasion by the main SARS-CoV-2 variants. iScience 2022; 25:105044. [PMID: 36068846 PMCID: PMC9436868 DOI: 10.1016/j.isci.2022.105044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. SARS-CoV-2 carries a unique group of mutations, and the transmission of the virus has led to the emergence of other mutants such as Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Kappa (B.1.617.1), Delta (B.1.617.2) and Omicron (B.1.1.529). The advent of a vaccine has raised hopes of ending the pandemic. However, the mutation variants of SARS-CoV-2 have raised concerns about the effectiveness of vaccines because the data showed that the vaccine was less effective against mutation variants compared to the previous variants. Mutation variants could easily mutate the N-segment structure and receptor domain of its spike glycoprotein (S) protein to escape antibody recognition. Therefore, it is vital to understand the potential immune response and evasion mechanism of SARS-CoV-2 variants. In this review, immune response and evasion mechanisms of several SARS-CoV-2 variants are described, which could provide some helpful advice for future vaccines.
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Affiliation(s)
- Qiuli Chen
- Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, Zhejiang 310018, China
| | - Jiawei Zhang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Peter Wang
- Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, Zhejiang 310018, China
| | - Zuyong Zhang
- The Affiliated Hangzhou Xixi Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310023, China
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Meddeb K, Toumi R, Boussarsar M. Lessons learned from the COVID-19 pandemic in a North African country (Tunisia). LA TUNISIE MEDICALE 2022; 100:568-571. [PMID: 36571723 PMCID: PMC9743016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Khaoula Meddeb
- Faculty of Medicine of Sousse, Farhat HACHED University Hospital, University of SousseSousse, 4000Tunisia
| | - Radhouane Toumi
- Faculty of Medicine of Sousse, Farhat HACHED University Hospital, University of SousseSousse, 4000Tunisia
| | - Mohamed Boussarsar
- Faculty of Medicine of Sousse, Farhat HACHED University Hospital, University of SousseSousse, 4000Tunisia
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Parry AE, Kirk MD, Colquhoun S, Durrheim DN, Housen T. Leadership, politics, and communication: challenges of the epidemiology workforce during emergency response. HUMAN RESOURCES FOR HEALTH 2022; 20:33. [PMID: 35410336 PMCID: PMC8995686 DOI: 10.1186/s12960-022-00727-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/25/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Improving the epidemiological response to emergencies requires an understanding of who the responders are, their role and skills, and the challenges they face during responses. In this paper, we explore the role of the epidemiologist and identify challenges they face during emergency response. METHODS We conducted a cross-sectional survey to learn more about epidemiologists who respond to public health emergencies. The online survey included open and closed-ended questions on challenges faced while responding, the roles of epidemiology responders, self-rating of skills, and support needed and received. We used purposive sampling to identify participants and a snowballing approach thereafter. We compared data by a number of characteristics, including national or international responder on their last response prior to the survey. We analysed the data using descriptive, content, and exploratory factor analysis. RESULTS We received 166 responses from individuals with experience in emergency response. The most frequently reported challenge was navigating the political dynamics of a response, which was more common for international responders than national. National responders experienced fewer challenges related to culture, language, and communication. Epidemiology responders reported a lack of response role clarity, limited knowledge sharing, and communication issues during emergency response. Sixty-seven percent of participants reported they needed support to do their job well; males who requested support were statistically more likely to receive it than females who asked. CONCLUSIONS Our study identified that national responders have additional strengths, such as better understanding of the local political environment, language, and culture, which may in turn support identification of local needs and priorities. Although this research was conducted prior to the COVID-19 pandemic, the results are even more relevant now. This research builds on emerging evidence on how to strengthen public health emergency response and provides a platform to begin a global conversation to address operational issues and the role of the international epidemiology responder.
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Affiliation(s)
- Amy Elizabeth Parry
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
| | - Martyn D. Kirk
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
| | - Samantha Colquhoun
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
| | | | - Tambri Housen
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
- University of Newcastle, Newcastle, NSW Australia
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