Rethinking the COVID-19 Pandemic: Back to Public Health

[How much digital public health is in public health degree programs? A systematic analysis of module handbooks in German full-time study programs at public colleges and universities]

BACKGROUND

Professionals, especially in the field of digital public health (DiPH), are crucial for a successful digital transformation in social and health care. However, it is still unclear to what extent academic professionals are taught DiPH-related content in their public health (PH) studies.

METHODS

This study used a systematic module handbook analysis to analyze accredited full-time PH-oriented degree programs at public colleges and universities in Germany for DiPH-related module content. Through the "Hochschulkompass" platform and the member programs of the German Public Health Association (DGPH), 422 programs were identified. Included module handbooks were evaluated by content analysis using MAXQDA.

RESULTS

Only 10 bachelor and 6 master programs contain DiPH. They are heterogeneous in their focus and belong to different subfields of public health ("methods, definition, history, and social medicine" = 5; "health management" = 5; "digital health" = 3; "health services research" = 2; "health communication" = 1). Differences were found between the common understanding of DiPH in academia and the content in the module handbooks. The content identified in the analysis focuses mainly on technical areas. Social and health science content is only marginally present.

DISCUSSION

The heterogeneous study programs with a connection to DiPH allow academic PH specialists to develop specific profiles. To achieve comprehensive competencies in DiPH, there is a need for further development of modules with relevance to the respective degree program. The results could be used for the (further) development of relevant modules and a core curriculum in DiPH.

How do socioeconomic determinants of health affect the likelihood of living with HTLV-1 globally? A systematic review with meta-analysis

Introduction

Human T Lymphotropic Virus type 1 (HTLV-1) is a neglected retrovirus associated with many clinical disorders, most notably Adult T-cell Leukemia/Lymphoma and HTLV-1-Associated Myelopathy (HAM). Found in endemic clusters across the world, high prevalence has been reported in minoritized groups who suffer from health inequities. This study investigates the association between HTLV-1 prevalence and the following socioeconomic determinants of health: education, income, and employment, which are markers of health inequity.

Methods

A systematic review was conducted by searching the following databases: Ovid/Medline, Embase, Global Health Database, Web of Science, LILACS and SciELO. Primary studies in English, Spanish and Portuguese mentioning HTLV-1 and one of education, income and/or employment were included. A random-effects meta-analysis was performed, and odds ratios (OR) were calculated to determine the association between these socioeconomic determinants of health and HTLV-1 prevalence.

Results

42 studies were included. The likelihood of having HTLV-1 was higher in individuals with less than completed primary education compared to those who completed primary education (OR 1.86 [95% CI 1.34-2.57]; p < 0.01). This may be because individuals with low education have reduced access to and understanding of health information, thus increasing the prevalence of risk factors associated with HTLV-1 infection. No other determinants were found to be statistically significant.

Conclusion

Fewer years of schooling are associated with increased likelihood of contracting HTLV-1. Therefore, health promotion materials and public health policies regarding HTLV-1 must consider those with lower educational levels to effectively reduce disease transmission.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335004, identifier (CRD42022335004).

Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study

INTRODUCTION

The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness.

METHODS

Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken.

RESULTS

Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media.

CONCLUSIONS

Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.

Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization

The COVID-19 pandemic, climate change-related events, protracted conflicts, economic stressors and other health challenges, call for strong public health orientation and leadership in health system strengthening and policies. Applying the essential public health functions (EPHFs) represents a holistic operational approach to public health, which is considered to be an integrated, sustainable, and cost-effective means for supporting universal health coverage, health security and improved population health and wellbeing. As a core component of the Primary Health Care (PHC) Operational Framework, EPHFs also support the continuum of health services from health promotion and protection, disease prevention to treatment, rehabilitation, and palliative services. Comprehensive delivery of EPHFs through PHC-oriented health systems with multisectoral participation is therefore vital to meet population health needs, tackle public health threats and build resilience. In this perspective, we present a renewed EPHF list consisting of twelve functions as a reference to foster country-level operationalisation, based on available authoritative lists and global practices. EPHFs are presented as a conceptual bridge between prevailing siloed efforts in health systems and allied sectors. We also highlight key enablers to support effective implementation of EPHFs, including high-level political commitment, clear national structures for institutional stewardship on EPHFs, multisectoral accountability and systematic assessment. As countries seek to transform health systems in the context of recovery from COVID-19 and other public health emergencies, the renewed EPHF list and enablers can inform public health reform, PHC strengthening, and more integrated recovery efforts to build resilient health systems capable of managing complex health challenges for all people.

Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

BACKGROUND

Health challenges like coronavirus disease 2019 (COVID-19) are becoming increasingly complex, transnational, and unpredictable. Studying health system responses to the COVID-19 pandemic is an opportunity to enhance our understanding of health system resilience and establish a clearer link between theoretical concepts and practical ideas on how to build resilience.

METHODS

This narrative literature review aims to address four questions using a health system resilience framework: (i) What do we understand about the dimensions of resilience? (ii) What aspects of the resilience dimensions remain uncertain? (iii) What aspects of the resilience dimensions are missing from the COVID-19 discussions? and (iv) What has COVID-19 taught us about resilience that is missing from the framework? A scientific literature database search was conducted in December 2020 and in April 2022 to identify publications that discussed health system resilience in relation to COVID-19, excluding articles on psychological and other types of resilience. A total of 63 publications were included.

RESULTS

There is good understanding around information sharing, flexibility and good leadership, learning, maintaining essential services, and the need for legitimate, interdependent systems. Decision-making, localized trust, influences on interdependence, and transformation remain uncertain. Vertical interdependence, monitoring risks beyond the health system, and consequences of changes on the system were not discussed. Teamwork, actor legitimacy, values, inclusivity, trans-sectoral resilience, and the role of the private sector are identified as lessons from COVID-19 that should be further explored for health system resilience.

CONCLUSION

Knowledge of health system resilience has continued to cohere following the pandemic. The eventual consequences of system changes and the resilience of subsystems are underexplored. Through governance, the concept of health system resilience can be linked to wider issues raised by the pandemic, like inclusivity. Our findings show the utility of resilience theory for strengthening health systems for crises and the benefit of continuing to refine existing resilience theory.

Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Indonesian Anesthesiologists Preparedness for COVID-19 Surge Capacity in the Early Pandemic

Background: Anesthesiologists play a crucial role in every disaster event, including biological disasters by COVID-19. This medical specialty should be prepared for a surge in patients due to a pandemic. The present study aims to evaluate the preparedness of anesthesiologists in facing the surge in the number of COVID-19 patients at the beginning of the pandemic in Indonesia. Methods: This is a descriptive cross-sectional study using an online survey to Anesthesiologists in Indonesia, with snowballing sampling method. A distribution frequency was used to describe the univariate analysis results of the variables. Pearson correlation was used to test the correlation between perceived resource adequacy/availability and perceived preparedness to face the surge. Results: A total of 141 anesthesiologists participated in our online survey; 47% of responders said they do not have enough staff, while 53% said that their staff did not have sufficient knowledge of handling the critical COVID-19 patients. They also reported limited resources, especially the limited isolation space and N95 masks. The correlation analysis indicated a strong and significant relationship between limited resources and the preparedness of anesthesiologists. Conclusion: At the beginning of the pandemic, Indonesian Anesthesiologists felt that they still had very limited resources, leading to unpreparedness to deal with the surge in the number of COVID-19 patients with critical conditions.

Global Health Strategies in the Face of the COVID-19 Pandemic and Other Unprecedented Threats

Global health is evolving as a discipline aiming at exploring needs and offering equitable health services for all people. Over the past four decades, several global initiatives have been introduced to improve the accessibility of primary health care (PHC) and solve most health issues at this level. Historically, the 1978 Alma-Ata and 2018 Astana Declarations were perhaps the most important documents for a comprehensive approach to PHC services across the world. With the introduction of the United Nations Sustainable Development Goals in 2015, developments in all spheres of human life and multi-sectoral cooperation became the essential action targets that could contribute to improved health, well-being, and safety of all people. Other global initiatives such as the Riyadh Declaration on Digital Health and São Paulo Declaration on Planetary Health called to urgent action to employ advanced digital technologies, improve health data processing, and invest more in research management. All these initiatives are put to the test in the face of the coronavirus disease 2019 (COVID-19) pandemic and other unprecedented threats to humanity.

COVID 19 Pandemic and biomedical waste management practices in healthcare system

The whole world was shaken with the pandemic of Coronavirus Disease (COVID-19) in end of the year 2019. Due to its novel origin, it was required to follow all precautions possible. Dealing with the massive amount of infectious healthcare waste became an enormous challenge. This review identifies the impacts of the pandemic on biomedical waste management. This systematic review was made by using keywords “biomedical waste” and “COVID 19” in open access databases like PubMed, Science Direct, Scopus, Google Scholers etc. 2124 articles downloaded and 765 found duplicate and 634 not related to the topic. after scrutiny with inclusion criteria 102 articles were considered to analyze the practices related to biomedical waste management during pandemic using PRISMA guideline.. The COVID-19 waste segregation, collection, storage, transportation, and disposal are a big challenge with all stakeholders. In order to control the virus spread, strict monitoring of the complete waste management cycle is required. Adoption of appropriate guidelines is paramount to worker safety and containment of infection. Sustainable recycling methods are needed to deal with the ever-increasing plastic waste resulting from mandatory personal protective equipment (PPE) usage. The situation also demands a rethinking of the healthcare system. Overall, there was an increase in BMW generation, and municipal waste had increased globally. Pandemic preparedness requires a global public health strategy and long-term investments. This will be vital for making a robust community capable enough to fight against any public health pressures in the future, as well as the pandemic tremors. Systematized efforts from all stakeholders, at all levels, not only refines epidemic preparation but also helps to attain a sustainable development of health for a healthier future.

Rebuilding to shape a better future: the role of young professionals in the public health workforce

The COVID-19 pandemic has made clear the extreme needs of the public health workforce. As societies discuss how to build up the capacity and infrastructure of their systems, it is crucial that young professionals are involved. Previous attempts to incorporate young professionals into the public health workforce have wrestled with inaccessibility, tokenisation, and a lack of mentorship, leading to a loss of potential workforce members and a non-representative workforce that reinforces systemic societal exclusion of diverse young people. These barriers must be addressed through robust mentorship structures, intentional recruitment and continuous support, as well as genuine recognition of the contributions of young professionals to build the sustainable, interdisciplinary, unified public health that is necessary for the future.

Urban educated group's perceptions of the COVID-19 pandemic management in Bangladesh: a qualitative exploration

Background: Since the emergence of the COVID-19 outbreak, Government of Bangladesh (GoB) has taken various measures to restrict virus transmission and inform the people of the situation. However, the success of such measures largely depends on a positive public perception of the government's ability to act decisively and the transparency of its communication. We explored public perceptions of pandemic management efforts by the Bangladeshi health sector decision-makers in this study. Methods: As this qualitative research was conducted during the COVID-19 pandemic, data was gathered through seven online mixed-gender focus group discussions involving 50 purposively selected clinicians and non-clinicians. Results: The study participants concurred that, from the outset, decision-makers failed to engage the right kind of experts, which resulted in poor pandemic management that included imposing lockdown in periphery areas without arranging patient transport to the center, declaring certain hospitals as COVID-19 dedicated without preparing the facilities or the staff, and engaging private hospitals in care without allowing them to test the patients for COVID-19 infection. Several participants also commented on ineffective actions on behalf of the GoB, such as imposing home quarantine instead of institutional, corruption, miscommunication, and inadequate private sector regulation. The perception of the people regarding service providers is that they lacked responsiveness in providing treatment, with some doctors misleading the public by sharing misinformation. Service providers, on the other hand, observed that decision-makers failed to provide them with proper training, personal protective equipment, and workplace security, which has resulted in a high number of deaths among medical staff. Conclusions: The Bangladeshi health sector decision-makers should learn from their mistakes to prevent further unnecessary loss of life and long-term economic downturn. They should adopt a science-based response to the COVID-19 pandemic in the short term while striving to develop a more resilient health system in the long run.

Public perceptions of the COVID-19 pandemic management in Bangladesh: a qualitative exploration

Background: Since the emergence of the COVID-19 outbreak, Government of Bangladesh (GoB) has taken various measures to restrict virus transmission and inform the people of the situation. However, the success of such measures largely depends on a positive public perception of the government's ability to act decisively and the transparency of its communication. We explored public perceptions of pandemic management efforts by the Bangladeshi health sector decision-makers in this study. Methods: As this qualitative research was conducted during the COVID-19 pandemic, data was gathered through seven online mixed-gender focus group discussions involving 50 purposively selected clinicians and non-clinicians. Results: The study participants concurred that, from the outset, decision-makers failed to engage the right kind of experts, which resulted in poor pandemic management that included imposing lockdown in periphery areas without arranging patient transport to the center, declaring certain hospitals as COVID-19 dedicated without preparing the facilities or the staff, and engaging private hospitals in care without allowing them to test the patients for COVID-19 infection. Several participants also commented on ineffective actions on behalf of the GoB, such as imposing home quarantine instead of institutional, corruption, miscommunication, and inadequate private sector regulation. The perception of the people regarding service providers is that they lacked responsiveness in providing treatment, with some doctors misleading the public by sharing misinformation. Service providers, on the other hand, observed that decision-makers failed to provide them with proper training, personal protective equipment, and workplace security, which has resulted in a high number of deaths among medical staff. Conclusions: The Bangladeshi health sector decision-makers should learn from their mistakes to prevent further unnecessary loss of life and long-term economic downturn. They should adopt a science-based response to the COVID-19 pandemic in the short term while striving to develop a more resilient health system in the long run.