A Multi-Criteria Framework for Pandemic Response Measures

Pandemic management: Analysis of availability and relevance of surveillance indicators by COVID-Task-Forces in the German federal state of Lower Saxony

Background

Locally, the introduction of measures during times of a pandemic emergency is embodied in a pandemic containment plan created by the Robert Koch Institute in 2017. In addition to central indicators such as incidence rates and number of deaths, various indicators are used at the local level to assess the pandemic situation. So far, there hasn't been analyses of the availability and perceived relevance of the surveillance indicators used to manage the SARS-CoV-2 pandemic by the local German pandemic task forces.

Aim

This study examined whether local decision-makers had access to surveillance-related indicators in a way that they could be used to make informed decisions in response to the pandemic situation.

Methods

A cross sectional study was conducted, using an online questionnaire developed by experts of The Public Health Agency of Lower Saxony and The University Medical Center Göttingen (UMG). All local COVID-19 task forces of the German state of Lower-Saxony were enrolled in the study.

Findings

The surveillance indicators assessed by survey respondents as most available and relevant are included under the German Infection Protection Act (IfSG). In contrast, the indicators that are not bound by the IfSG have a significantly lower availability and an inconsistent assessment of relevance.

Conclusion

Against the background of efficiency, it seems central to be able to reliably provide the highly weighted surveillance indicators. Nevertheless, the relevance assessment gap between the indicators embedded in the IfSG and the ones that are not may be explained by cognitive processes such as anchoring bias. The collection and use of indicators to assess the pandemic situation and to evaluate measures should be the subject of continuous multidisciplinary discussions.

Closing the Gap Between Decision Analysis and Policy Analysts Before the Next Pandemic

Decision analysis (DA) is an explicitly prescriptive discipline that separates beliefs about uncertainties from value preferences in modeling to support decision making. Researchers have been advancing DA tools for the last 60 years to support decision makers handling complex decisions requiring subjective judgments. Recently, some DA researchers and practitioners wondered whether the difficult decisions made during the COVID-19 pandemic regarding testing, masking, closing and reopening businesses, allocating ventilators, and prioritizing vaccines would have been improved with more DA involvement. With its focus on quantifying uncertainties, value trade-offs, and risk attitudes, DA should have been a valuable tool for decision makers during the pandemic. To influence decisions, DA applications require interactions with policymakers and experts to construct formal representations of the decision frame, elicit uncertainties, and assess risk tolerances and trade-offs among competing objectives. Unfortunately, such involvement of decision analysts in the process of decision making and policy setting did not occur during much of the COVID-19 pandemic. This lack of participation may have been partly because many decision makers were unaware of when DA could be valuable in helping with the challenges of the COVID-19 pandemic. In addition, decision analysts were perhaps not sufficiently adept at inserting themselves into the policy process at critical junctures when their expertise could have been helpful.

Funding: This research was partially supported by the U.S. Department of Homeland Security through the Center for Accelerating Operational Efficiency at Arizona State University.

Health effects of shrinking hyper-saline lakes: spatiotemporal modeling of the Lake Urmia drought on the local population, case study of the Shabestar County

Climate change and its respective environmental impacts, such as dying lakes, is widely acknowledged. Studies on the impact of shrinking hyper-saline lakes suggest severe negative consequences for the health of the affected population. The primary aim was to investigate the relationship between changes in the water level of the hyper-saline Lake Urmia, along with the associated salt release, and the prevalence of hypertension and the general state of health of the local population in Shabestar County north of the lake. Moreover, we sought to map the vulnerability of the local population to the health risks associated with salt-dust scatter using multiple environmental and demographic characteristics. We applied a spatiotemporal analysis of the environmental parameters of Lake Urmia and the health of the local population. We analyzed health survey data from local health care centers and a national STEPS study in Shabestar County, Iran. We used a time-series of remote sensing images to monitor the trend of occurrence and extent of salt-dust storms between 2012 and 2020. To evaluate the impacts of lake drought on the health of the residences, we investigated the spatiotemporal correlation of the lake drought and the state of health of local residents. We applied a GIScience multiple decision analysis to identify areas affected by salt-dust particles and related these to the health status of the residents. According to our results, the lake drought has significantly contributed to the increasing cases of hypertension in local patients. The number of hypertensive patients has increased from 2.09% in 2012 to 19.5% in 2019 before decreasing slightly to 16.05% in 2020. Detailed results showed that adults, and particularly females, were affected most by the effects of the salt-dust scatter in the residential areas close to the lake. The results of this study provide critical insights into the environmental impacts of the Lake Urmia drought on the human health of the residents. Based on the results we suggest that detailed socioeconomic studies might be required for a comprehensive analysis of the human health issues in this area. Nonetheless, the proposed methods can be applied to monitor the environmental impacts of climate change on human health.

A risk-based decision framework for policy analysis of societal pandemic effects

Introduction

In this article, we summarize our findings from an EU-supported project for policy analyses applied to pandemics such as Covid-19 (with the potential to be applied as well to other, similar hazards) while considering various mitigation levels and consequence sets under several criteria.

Methods

It is based on our former development for handling imprecise information in risk trees and multi-criteria hierarchies using intervals and qualitative estimates. We shortly present the theoretical background and demonstrate how it can be used for systematic policy analyses. In our model, we use decision trees and multi-criteria hierarchies extended by belief distributions for weights, probabilities and values as well as combination rules to aggregate the background information in an extended expected value model, taking into criteria weights as well as probabilities and outcome values. We used the computer-supported tool DecideIT for the aggregate decision analysis under uncertainty.

Results

The framework has been applied in three countries: Botswana, Romania and Jordan, and extended for scenario-building during the third wave of the pandemic in Sweden, proving its feasibility in real-time policy-making for pandemic mitigation measures.

Discussion

This work resulted in a more fine-grained model for policy decision that is much more aligned to the societal needs in the future, either if the Covid-19 pandemic prevails or for the next pandemic or other society-wide hazardous emergencies.

From federal transfers and local investments to a potential convergence of COVID-19 and climate change: The case study of São Paulo city

This paper is divided into two parts to explore some aspects of municipal development related to national and subnational investments in disaster risk reduction and urban sustainability related to Covid-19 and climate change response. In Part I, a survey on disasters and national transfers to 45 Brazilian municipalities is presented. In Part II, the local-scale approach enabled to compare the areas most affected by COVID-19 with those impacted by climate change. There are large uncertainties around financial support from the federal government and their impact at local scale. São Paulo city was chosen because it reveals some important aspects of spatial structure carried out through local investments. In this sense, updated information on floods and warmer surfaces were updated to provoke a discussion about a potential confluence with the effects of pandemic. The results highlighted the effects of scarce federal transfers and the maps help us to identify the spatial distribution of people at risk, which can be beneficial for municipal decisions as they highlight a significative relationship between pandemic effects and an uneven social structure. In conclusion, the trade-off between this unequal structure and a necessary and effectively sustainable change leads us to reflect on local investment trends.

The SARS-CoV-2 Pandemic in High Income Countries Such as Canada: A Better Way Forward Without Lockdowns

The SARS-CoV-2 pandemic has caused tragic morbidity and mortality. In attempt to reduce this morbidity and mortality, most countries implemented population-wide lockdowns. Here we show that the lockdowns were based on several flawed assumptions, including "no one is protected until everyone is protected," "lockdowns are highly effective to reduce transmission," "lockdowns have a favorable cost-benefit balance," and "lockdowns are the only effective option." Focusing on the latter, we discuss that Emergency Management principles provide a better way forward to manage the public emergency of the pandemic. Specifically, there are three priorities including the following: first, protect those most at risk by separating them from the threat (mitigation); second, ensure critical infrastructure is ready for people who get sick (preparation and response); and third, shift the response from fear to confidence (recovery). We argue that, based on Emergency Management principles, the age-dependent risk from SARS-CoV-2, the minimal (at best) efficacy of lockdowns, and the terrible cost-benefit trade-offs of lockdowns, we need to reset the pandemic response. We can manage risk and save more lives from both COVID-19 and lockdowns, thus achieving far better outcomes in both the short- and long-term.