Rapid Integrated Healthcare Response for the First US Evacuees from Wuhan, China, During the COVID-19 Pandemic.

On January 29, 2020, a total of 195 US citizens were evacuated from the coronavirus disease 2019 (COVID-19) epidemic in Wuhan, China, to March Air Reserve Base in Riverside, California, and entered the first federally mandated quarantine in over 50 years. With less than 1-d notice, a multi-disciplinary team from Riverside County and Riverside University Health System in conjunction with local and federal agencies established on-site 24-h medical care and behavioral health support. This report details the coordinated efforts by multiple teams that took place to provide care for the passengers and to support the surrounding community.

Modeling and Surveillance of Reporting Delays of Mosquitoes and Humans Infected With West Nile Virus and Associations With Accuracy of West Nile Virus Forecasts.

Importance: West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease. Objective: To develop real-time WNV forecasts of infected mosquitoes and human cases. Design, Setting, and Participants: Real-time forecasts of WNV in 4 geographically dispersed locations in the United States were generated using a WNV model-inference forecasting system previously validated with retrospective data. Analysis was performed to evaluate how observational reporting delays of mosquito WNV assay results and human medical records were associated with real-time forecast accuracy. Exposures: Mosquitoes positive for WNV and human cases. Main Outcomes and Measures: Delays in reporting mosquito WNV assay results and human medical records and the association of these delays with real-time WNV forecast accuracy. Results: Substantial delays in data reporting exist for both infected mosquitoes and human WNV cases. For human cases, confirmed data (n = 37) lagged behind the onset of illness by a mean (SD) of 5.5 (2.3) weeks (range, 2-14 weeks). These human case reporting lags reduced mean forecast accuracy for the total number of human cases over the season in 110 simulated outbreaks for 2 forecasting systems by 26% and 14%, from 2 weeks before to 3 weeks after the predicted peak of infected mosquitoes. This period is the time span during which 47% of human cases are reported. Of 7064 mosquito pools, 500 (7%) tested positive; the reporting lag for these data associated with viral testing at a state laboratory was a mean (SD) of 6.6 (2.6) days (range, 4-11 days). This reporting lag was associated with decreased mean forecast accuracy for the 3 mosquito infection indicators, timing, magnitude, and season, by approximately 5% for both forecasting systems. Conclusions and Relevance: Delays in reporting human WNV disease and infected mosquito information are associated with difficulties in outbreak surveillance and decreased real-time forecast accuracy. Infected mosquito lags were short enough that skillful forecasts could still be generated for mosquito infection indicators, but the human WNV case lags were too great to support accurate forecasting in real time. Forecasting WNV is potentially an important evidence-based decision support tool for public health officials and mosquito abatement districts; however, to operationalize real-time forecasting, more resources are needed to reduce human case reporting lags between illness onset and case confirmation.

Process of Development of a County-wide Crisis Care Plan - Riverside County, California, 2016-7.

INTRODUCTION: Disasters with substantial impacts to the health care and public health systems can have multiple reverberating effects, including the need to alter the medical standard of care as well as centrally control scarce medical resources. A current crisis care plan can help to establish an ethical and operational framework for stakeholders before such a disaster takes place. However, there are few examples of such a plan that cover large areas and health jurisdictions. This article describes the process of developing such a "Crisis Care Plan." METHODS: Plan developers from the Riverside County Department of Public Health and Riverside County Emergency Management Department first developed an ethical framework for decision making, followed by the development of a full operational crisis care plan with conditions for activation, life cycle and deactivation. The plan was then reviewed by major county stakeholders, including local emergency medical services, the county medical association and the hospital association, and additional comments incorporated. Before the final plan is implemented it will be submitted for public review and provider training materials will be developed. RESULTS: The development of a prerequisite ethical framework helped to reduce the risk that the operational plan would cause or exacerbate care disparities by informing a blinded, objective process for evaluating resource requests centrally prior to distribution. The ethical framework served to establish the grounding principle of all lives having an equal claim on value. Stakeholders recognized the need for such a Crisis Care Plan and agreed with the underlying ethical principles. Stakeholders also contributed useful recommendations to enable the plan to operate in as successful a manner as possible under the difficult conditions within which it would exist. DISCUSSION: The development of a clear ethical framework and the early identification and involvement of stakeholders can enable even very large health jurisdictions to construct crisis care plans that enable the best care under difficult circumstances, while protecting individual rights and incorporating the concerns of the public and the health care community.

Rapid large-scale deployment of tuberculosis testing in a high school - Riverside County, California, 2013-2014.

Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), can spread from person to person through the air, which can make contact investigations particularly complex in heavily populated settings such as schools. In November 2013, a student (the index patient) at a southern California high school with approximately 2,000 students and staff members was diagnosed with active pulmonary TB. Because of an unexpectedly high number of positive tuberculin skin test results in the initial contact investigation, testing was extended to the entire school population, which had to be completed before the end of the school term. A total of 1,806 persons were tested in 24 hours. The rapid testing of the entire population of a high school is unusual and led to widespread media attention and community concern, requiring close coordination among branches of the County of Riverside Department of Public Health, local governments, and the school district. The testing resulted in identification of two additional cases of TB; in addition, 72 persons underwent treatment for latent TB infection (LTBI). This incident demonstrates the importance of a coordinated emergency response in a large-scale deployment of rapid testing, including efficiently focused resources, organized testing operations, and effective media relations.