Defining and identifying the critical elements of operational readiness for public health emergency events: a rapid scoping review.

INTRODUCTION: COVID-19 showed that countries must strengthen their operational readiness (OPR) capabilities to respond to an imminent pandemic threat rapidly and proactively. We conducted a rapid scoping evidence review to understand the definition and critical elements of OPR against five core sub-systems of a new framework to strengthen the global architecture for Health Emergency Preparedness Response and Resilience (HEPR). METHODS: We searched MEDLINE, Embase, and Web of Science, targeted repositories, websites, and grey literature databases for publications between 1 January 2010 and 29 September 2021 in English, German, French or Afrikaans. Included sources were of any study design, reporting OPR, defined as immediate actions taken in the presence of an imminent threat, from groups who led or responded to a specified health emergency. We used prespecified and tested methods to screen and select sources, extract data, assess credibility and analyse results against the HEPR framework. RESULTS: Of 7005 sources reviewed, 79 met the eligibility criteria, including 54 peer-reviewed publications. The majority were descriptive reports (28%) and qualitative analyses (30%) from early stages of the COVID-19 pandemic. Definitions of OPR varied while nine articles explicitly used the term 'readiness', others classified OPR as part of preparedness or response. Applying our working OPR definition across all sources, we identified OPR actions within all five HEPR subsystems. These included resource prepositioning for early detection, data sharing, tailored communication and interventions, augmented staffing, timely supply procurement, availability and strategic dissemination of medical countermeasures, leadership, comprehensive risk assessment and resource allocation supported by relevant legislation. We identified gaps related to OPR for research and technology-enabled manufacturing platforms. CONCLUSIONS: OPR is in an early stage of adoption. Establishing a consistent and explicit framework for OPRs within the context of existing global legal and policy frameworks can foster coherence and guide evidence-based policy and practice improvements in health emergency management.

Pipeline emergency preparedness in Nebraska: Identifying interagency preparedness gaps and proposing solutions.

In Nebraska, there are over 28,000 miles of pipelines that carry various materials, which could impact human health and the natural environment in the event of a leak or spill. Nebraska is heavily reliant on its expansive groundwater supply from the large High Plains aquifer system as well as smaller secondary aquifers. Eighty-eight percent of Nebraska's population utilizes groundwater for personal use, and the state's agricultural sector depends on it for irrigation and livestock care. The ongoing challenges facing the implementation of the proposed Keystone XL pipeline system inspired re-searchers to examine the current state of pipeline emergency preparedness in Nebraska. To do this, a pipeline emergency preparedness workshop was held in November 2021 in Norfolk, Nebraska. Conference participants in-cluded county- and regional-level leadership, local public health departments, tribal representatives, and other organizations. Pipeline emergency responders and other stakeholders were invited to listen to plenary presenta-tions about inland oil spill responses and the current state of Nebraska pipelines and to participate in a facilitated discussion identifying pipeline response challenges and potential solutions. Through a facilitated discussion process, participants identified six general response challenge categories and 24 potential solutions. From those 24 solutions, three were selected as easily implementable solutions-increased joint/coordinated planning, increased pipeline emergency exercising, and increased pipeline emergency train-ing/education. Implementing this work will assist in reducing health risks associated with potential spills.

COVID-19 and CBRNE: Effects of the pandemic in the field of CBRNE.

The coronavirus disease 2019 (COVID-19) pandemic has affected our lives in all aspects, including key fields such as social interaction and economic supply chains. The field of chemical, biological, radiological, nuclear, and explosive substances (CBRNE) was already directly affected by the pandemic in that the COVID-19 virus is, in a sense, a biological agent. This paper elaborates on how the field of CBRNE has changed as a result of the COVID-19 pandemic. It does so by drawing on the results of an interview study with CBRNE practitioners (Fire Brigades, Law Enforcement Agencies, etc.) conducted as part of the European Union project PReparedness against CBRNE threats through cOmmon Approaches between security praCTItioners and the VulnerablE civil society, as well as findings from research literature on links between CBRNE and COVID-19. This paper highlights four areas where the influence of the pandemic on the CBRNE field has been evident. The four areas are as follows: preparedness for CBRNE incidents and likelihood of future CBRNE incidents (with a focus on terrorist attacks), CBRNE training and education, increased awareness of CBRNE-related behaviors and measures among the general public, and greater awareness of the needs of vulnerable groups (older people, etc.).

Emergency preparedness in the central sterile supply department: a multicenter cross-sectional survey.

OBJECTIVE: To investigate the current situation of emergency preparation and emergency drill in the CSSD, and analyze its influence on the nurses' emergency attitude and ability. METHODS: This study employed a multicenter stratified sampling method, conducted from January to June 2023 using the online survey, participants completed the general data, emergency preparedness and drill questionnaire, public health emergency response questionnaire and emergency capacity scale. An independent samples t test or Kruskal-Wallis test was used to analyse differences in nurses' emergency capacity and attitudes. RESULTS: The data from 15 provinces 55 hospitals in China. Overall, 77.58% of participants' institutions set up emergency management teams, 85.45% have an emergency plan and revise it regularly. 92.12% store emergency supplies. All survey staff participated in the emergency drill, which predominantly consisted of individual drills (51.52%), with 90.30% being real combat drills, 49.09% of participants engaging in drills every quarter, and 91.52% of the drill's participants exceeding 50%. The respondents' emergency attitude score was (29.346 ± 6.029), their emergency ability score was (63.594 ± 10.413), and those with rescue experience showed a more positive attitude (Z = -2.316, P = 0.021). Different titles, education levels, rescue experience and the frequency of emergency drill affected the emergency rescue ability of the respondents (P < 0.05). CONCLUSIONS: Most medical institutions establish emergency management systems and plans, yet the content lacks geographical specificity.The duration and participation of emergency drills are high, but the effectiveness of the drills needs to be further improved, and the response capacity and attitudes of CSSD nurses are low. It is recommended that agencies develop comprehensive and targeted contingency plans to strengthen the inspection and evaluation of team strength, equipment and safeguards against the contingency plans, so as to ensure that the measures mandated by the contingency plans can be implemented promptly after the emergency response is initiated.

The Lagos State COVID-19 Think-tank, a Potential Framework for Decision-making in a Pandemic Era.

Lagos state remains the epicenter of COVID-19 infection in Nigeria. To facilitate the emergency preparedness and response to COVID-19, the State Governor and Incident Commander constituted a Think Tank comprising 13 experts from various disciplines committed to the health of the public. The Think Tank assisted the government with decision-making strategies and supported the emergency operation centre (EOC) for the COVID-19 response. Their main achievements were developing frameworks for decision-making and strategies for phased easing of the State-wide lockdown. The challenges encountered were that it was often viewed as a parallel structure to the EOC and separated from the traditional civil service structure; causing some reluctance to implement ideas generated by the Think Tank. Nevertheless, the Think Tank played an important role during the COVID-19 pandemic; the lessons learned might help other states and resource-limited countries wishing to adopt this approach to emergency response.

RésuméL'État de Lagos reste l'épicentre de l'infection au COVID-19 au Nigeria. Pour faciliter la préparation et la réponse aux situations d'urgence (EPR) face au COVID-19, le gouverneur de l'État a constitué un groupe de réflexion composé de 13 experts de diverses disciplines. Le concept du groupe de réflexion était d'impliquer le secteur privé et le milieu universitaire dans la réponse COVID de l'État de Lagos, reconnaissant qu'un résultat réussi de l'EPR nécessite une expertise dont certaines n'existaient pas au sein de la fonction publique. Le Think Tank a aidé le gouvernement à élaborer des stratégies de prise de décision et a soutenu le centre des opérations d'urgence (COU) pour la réponse à la COVID-19. Leurs principales réalisations ont été l'élaboration de cadres de prise de décision et de stratégies d'assouplissement progressif du confinement à l'échelle de l'État. Les défis rencontrés étaient qu'il était souvent considéré comme une structure parallèle à l'EOC et séparé de la structure traditionnelle de la fonction publique; provoquant une certaine réticence à mettre en œuvre les idées générées. Le groupe de réflexion de l'État de Lagos a démontré un modèle réussi de partenariat public-privé dans le domaine de la santé mis en œuvre par une diversité d'acteurs dans des secteurs critiques. Cela pourrait être considéré comme un modèle utile pour faire face à une myriade de crises similaires auxquelles le secteur de la santé est souvent confronté. Les enseignements tirés pourraient aider d'autres États et pays aux ressources limitées souhaitant adopter cette approche dans les interventions d'urgence.

HERA-lding More Integration in Health? Examining the Discursive Legitimation of the European Commission's New Health Emergency Preparedness and Response Authority.

CONTEXT: Since COVID-19, the European Commission (EC) has sought to expand its activities in health through the development of a European Health Union and within it the Health Emergencies Preparedness and Response Authority (HERA). METHODS: The authors applied a discourse analysis to documents establishing HERA to investigate how the EC legitimated the creation of this institution. They focused on how it framed health emergencies, how it framed the added value of HERA, and how it linked HERA to existing EU activities and priorities. FINDINGS: Their analysis demonstrates that security-based logics have been central to the EC's legitimation of HERA in alignment with a "securitization of health" occurring worldwide in recent decades. This legitimation can be understood as part of the EC's effort to promote future integration in health in the absence of new competences. CONCLUSIONS: Securitization has helped the EC raise its profile in health politically without additional competences, thereby laying the groundwork for potential future integration. Looking at the discursive legitimation of HERA sheds light not only on whether the EC is expanding its health powers but also how it strategizes to do so. HERA, while constrained, allows the EC to further deepen security-driven integration in health.

Conflict, COVID-19, and crisis response: shifting from 'pivoting' to preparedness.

This paper assesses the extent to which the COVID-19 (Coronavirus disease 2019) pandemic directed the attention and resources of the international community away from peacebuilding, and the potential impact of this on conflict-affected environments. It draws from a global survey, interviews, and conversations with peacebuilding practitioners, publicly available information on peacebuilding funding, and real-time data on conflict events from the Armed Conflict Location & Event Data Project. The paper argues that resources and attention have 'pivoted' away from peacebuilding to tackle the threat presented by COVID-19, and that this can-but does not always-adversely affect conflict dynamics. It contends that this pivoting belies the interconnectedness of crises, leads to 'forgotten crises' and escalating threats, and exposes deficiencies in peacebuilding funding and, more broadly, preparedness and crisis response. Crises do, however, provide opportunities for reflection and change, including how to address these deficiencies and, in so doing, advance more efficient, effective, and ethical practice.

WHO Report: COVID-19 Was a Preventable Disaster.

Failures in preparation and response led to a worsened crisis.

Approaching the COVID-19 Pandemic Response With a Health Equity Lens: A Framework for Academic Health Systems.

Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.

A systematic review of long-term care facility characteristics associated with COVID-19 outcomes.

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. DESIGN: Systematic review. SETTING: Long-term care facilities (nursing homes and assisted living communities). PARTICIPANTS: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. MEASUREMENTS: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. RESULTS: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. CONCLUSION: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers.

Reimagining Construction and Renovation of Health Care Facilities During Emergence from a Pandemic.

The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.

Methodology of emergency medical logistics for multiple epidemic areas in public health emergency.

Coronavirus disease 2019(COVID-19) has brought great disasters to humanity, and its influence continues to intensify. In response to the public health emergencies, prompt relief supplies are key to reduce the damage. This paper presents a method of emergency medical logistics to quick response to emergency epidemics. The methodology includes two recursive mechanisms: (1) the time-varying forecasting of medical relief demand according to a modified susceptible-exposed-infected- Asymptomatic- recovered (SEIAR) epidemic diffusion model, (2) the relief supplies distribution based on a multi-objective dynamic stochastic programming model. Specially, the distribution model addresses a hypothetical network of emergency medical logistics with considering emergency medical reserve centers (EMRCs), epidemic areas and e-commerce warehousing centers as the rescue points. Numerical studies are conducted. The results show that with the cooperation of different epidemic areas and e-commerce warehousing centers, the total cost is 6% lower than without considering cooperation of different epidemic areas, and 9.7% lower than without considering cooperation of e-commerce warehousing centers. Particularly, the total cost is 20% lower than without considering any cooperation. This study demonstrates the importance of cooperation in epidemic prevention, and provides the government with a new idea of emergency relief supplies dispatching, that the rescue efficiency can be improved by mutual rescue between epidemic areas in public health emergency.

The World after COVID-19: Reflections on Global Health and Policy.

COVID-19 has infected hundreds of millions of people across the globe. The pandemic has also inflicted serious damages on global and regional governing political structures to a degree meriting a revisit of their own raison d'etre. The global economic fallout is also unprecedented as the flows of goods and people got severely disrupted while lockdowns hit the transport, services and retail industries, among others. We argue that three realities need to be genuinely addressed for building a post COVID-19 order that has to be amply equipped to deal with the next global crisis, as well as the ones on-going for decades. First, there is need to shelf-away the hitherto practiced doctrine that global crises and problems are confronted through local responses. Second, the COVID-19 pandemic has cautioned us on the need to (re)invest in basic, many may consider naïve and simple, public health functions such as sanitation as well as transparent national and global health monitoring. Third, the pandemic is a clear reprimand to discard the mantra that privatization of healthcare delivery system is the solution in favor of viewing health as a public good that needs to be managed and executed by the state and its public sector, be it national, sub-regional or local. It is critical that we learn from such pandemic and advance our societies to become stronger.