Planning for the next pandemic: Reflections on lessons from the uncontained transmission phases of the COVID-19 pandemic and their impacts on emergency departments in Australia

Australia was a world leader in managing the earlier waves of the COVID-19 pandemic. Subsequently, three major turning points changed the trajectory of the pandemic: mass vaccinations, emergence of more transmissible variants and re-opening of Australia's borders. However, there were also concomitant missteps and premature shifts in pandemic response policy that led to mixed messaging, slow initial vaccination uptake and minimal mitigation measures in response to the Omicron variant. The latter marked Australia's entry into a new phase of (or approach to) the pandemic: widespread transmission. This led to an exponential increase in cases and significant impacts on the health system, particularly, EDs. This paper reflects on this phase of the pandemic to urge for system-level changes that instal better safeguards for ED capacity, safety and staff well-being for future pandemics. This is essential to strengthening our health system's resilience and to better protecting our communities against such emergencies.

Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study

BACKGROUND

Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff.

OBJECTIVE

The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective.

METHODS

The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate.

RESULTS

Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use.

CONCLUSIONS

FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales.

Planning for the next pandemic: Reflections on the early phase of the Australian COVID-19 public health response from the emergency department

EDs play a crucial role as frontline health services throughout public health emergencies, including pandemics. The strength of the Australian public health response to coronavirus disease 2019 (COVID‐19) has mitigated the impact of the pandemic on clinical services, but there has still been a substantial impact on EDs and the health system. We revisit major events and lessons from the first wave of COVID‐19 in Australia to consider the implications and avenues for system‐level improvements for future pandemic and public health emergency response for EDs. Notwithstanding, the remarkable efforts of healthcare workers across the health system, COVID‐19 has uncovered structural and planning challenges and highlighted weaknesses and strengths of the Australian federation. In anticipating future pandemics and other public health threats, particularly in the face of climate change, hard‐won lessons from the COVID‐19 response should be incorporated in future planning, policies, practice and advocacy.

Web-Based Apps for Responding to Acute Infectious Disease Outbreaks in the Community: Systematic Review

Background

Web-based technology has dramatically improved our ability to detect communicable disease outbreaks, with the potential to reduce morbidity and mortality because of swift public health action. Apps accessible through the internet and on mobile devices create an opportunity to enhance our traditional indicator-based surveillance systems, which have high specificity but issues with timeliness.

Objective

The aim of this study is to describe the literature on web-based apps for indicator-based surveillance and response to acute communicable disease outbreaks in the community with regard to their design, implementation, and evaluation.

Methods

We conducted a systematic search of the published literature across four databases (MEDLINE via OVID, Web of Science Core Collection, ProQuest Science, and Google Scholar) for peer-reviewed journal papers from January 1998 to October 2019 using a keyword search. Papers with the full text available were extracted for review, and exclusion criteria were applied to identify eligible papers.

Results

Of the 6649 retrieved papers, 23 remained, describing 15 web-based apps. Apps were primarily designed to improve the early detection of disease outbreaks, targeted government settings, and comprised either complex algorithmic or statistical outbreak detection mechanisms or both. We identified a need for these apps to have more features to support secure information exchange and outbreak response actions, with a focus on outbreak verification processes and staff and resources to support app operations. Evaluation studies (6 out of 15 apps) were mostly cross-sectional, with some evidence of reduction in time to notification of outbreak; however, studies lacked user-based needs assessments and evaluation of implementation.

Conclusions

Public health officials designing new or improving existing disease outbreak web-based apps should ensure that outbreak detection is automatic and signals are verified by users, the app is easy to use, and staff and resources are available to support the operations of the app and conduct rigorous and holistic evaluations.

An example of public health training in emergency medicine

There is growing recognition of the vital roles that Emergency Physicians can play in public health. Accordingly, there is a need for emergency medicine trainees to have opportunities to acquire relevant public health skillsets. This article provides an example of such a possibility. It describes the experience of an emergency medicine trainee in undertaking a 6 month training rotation at a Public Health Unit. The example illustrates the feasibility and benefits of a public health rotation for interested trainees, and offers recommendations for establishing such rotations. There are challenges, including eligibility requirements and funding. However, possible approaches exist at the individual and college levels to facilitate such training opportunities so that emergency medicine trainees can acquire necessary and valuable public health skills.

Paediatric driveway run-over injuries: time to redesign?

AIMS

To investigate the demographic, accident, and environmental characteristics associated with driveway run-over injuries in order to identify potentially modifiable factors and prevention strategies

METHODS

Retrospective review of all children less than 15 years old who were hospitalised or killed due to a driveway run-over injury in the Auckland region of New Zealand over the 50-month period, November 2001 to December 2005. Data was collected on the demographics, accident and environmental characteristics, and parental awareness. Data was obtained from clinical records and telephone interviews with parents.

RESULTS

A total of 93 cases were identified, including 9 fatalities. The median age was 2 years with 73% under 5 years old. Children of Pacific Island and Maori ethnicity comprised 43% and 25% of cases respectively. Injuries occurred predominately on the child's home driveway (80% of cases). In 64% the driveway was the usual play area for the child. Only 13% of driveways were fenced. 51% were long driveways extending through the section, and 51% were shared with other properties. 51% of properties were rented and of these 57% were government houses.

CONCLUSION

The absence of physical separation between driveways and children's play and living areas may predispose to driveway injuries. Further research is needed to investigate the ideal way to implement such separation in current properties and future property developments.

The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy

Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who had not received treatment. Parents completed a structured questionnaire assessing change in their child's quality of life (QOL) and OSA symptoms after treatment, or between 6 months ago and the present time for controls. Fifty-one children were eligible, of whom 19 (37%) completed questionnaires: treatment group, n=10 (adenotonsillectomy 7, CPAP 3); and controls, n=9. The treatment group showed an improvement in OSA symptoms compared to controls, especially sleep disturbance (p=0.005), daytime functioning (p=0.03) and caregiver concern (p=0.03). Parental QOL score improved by a mean of 18% in the treatment group (p=0.06 for a difference from controls). Treatment of OSA in children with cerebral palsy leads to significant benefit in some aspects of health and QOL.