Public health and social measures during health emergencies such as the COVID-19 pandemic: An initial framework to conceptualize and classify measures

Background

Public health and social measures (PHSM) intend to reduce the transmission of infectious diseases and to reduce the burden on health systems, economies and societies. During the COVID-19 pandemic, PHSM have been selected, combined and implemented in a variable manner and inconsistently categorized in policy trackers. This paper presents an initial conceptual framework depicting how PHSM operate in a complex system, enabling a wide-reaching description of these measures and their intended and unintended outcomes.

Methods

In a multi-stage development process, we combined (i) a complexity perspective and systems thinking; (ii) literature on existing COVID-19 PHSM frameworks, taxonomies and policy trackers; (iii) expert input and (iv) application to school and international travel measures.

Results

The initial framework reflects our current understanding of how PHSM are intended to achieve transmission-related outcomes in a complex system, offering visualizations, definitions and worked examples. First, PHSM operate through two basic mechanisms, that is, reducing contacts and/or making contacts safer. Second, PHSM are defined not only by the measures themselves but by their stringency and application to specific populations and settings. Third, PHSM are critically influenced by contextual factors. The framework provides a tool for structured thinking and further development, rather than a ready-to-use tool for practice.

Conclusions

This conceptual framework seeks to facilitate coordinated, interdisciplinary research on PHSM effectiveness, impact and implementation; enable consistent, coherent PHSM monitoring and evaluation; and contribute to evidence-informed decision-making on PHSM implementation, adaptation and de-implementation. We expect this framework to be modified and refined over time.

Ten principles for generating accessible and useable COVID-19 environmental science and a fit-for-purpose evidence base

1. The 'anthropause', a period of unusually reduced human activity and mobility due to COVID-19 restrictions, has serendipitously opened up unique opportunities for research on how human activities impact the environment. 2. In the field of health, COVID-19 research has led to concerns about the quality of research papers and the underlying research and publication processes due to accelerated peer review and publication schedules, increases in pre-prints and retractions. 3. In the field of environmental science, framing the pandemic and associated global lockdowns as an unplanned global human confinement experiment with urgency should raise the same concerns about the rigorousness and integrity of the scientific process. Furthermore, the recognition of an 'infodemic', an unprecedented explosion of research, risks research waste and duplication of effort, although how information is used is as important as the quality of evidence. This highlights the need for an evidence base that is easy to find and use - that is discoverable, curated, synthesizable, synthesized. 4. We put forward a list of 10 key principles to support the establishment of a reproducible, replicable, robust, rigorous, timely and synthesizable COVID-19 environmental evidence base that avoids research waste and is resilient to the pressures to publish urgently. These principles focus on engaging relevant actors (e.g. local communities, rightsholders) in research design and production, statistical power, collaborations, evidence synthesis, research registries and protocols, open science and transparency, data hygiene (cleanliness) and integrity, peer review transparency, standardized keywords and controlled vocabularies.

Swiss Learning Health System: A national initiative to establish learning cycles for continuous health system improvement

The health system in Switzerland is considered as one of the best in the world. Nevertheless, to effectively and efficiently meet current and future challenges, an infrastructure and culture are needed where the best evidence is systematically made available and used, and the system evolves on the basis of a constant exchange between research, policy, and practice. The Swiss Learning Health System institutionalizes this idea as a multistakeholder national initiative to ensure continuous improvement through ongoing research and implementation. This article presents the objectives and mechanisms of the Swiss Learning Health System in the context of international initiatives to strengthen health systems and improve population health through learning cycles.