Exploring challenges and opportunities in detecting emerging drug trends: A socio-technical analysis of the Canadian context.

OBJECTIVES: This study aimed to apply a systems thinking approach to explore factors influencing the detection of emerging drug trends in Canada's provinces and territories to better understand how the local context can influence the design and performance of a pan-Canadian (i.e., national) substance use early warning system (EWS). This study also presents a set of actionable recommendations arising from the results. METHODOLOGY AND METHODS: Semi-structured interviews were conducted with 13 purposively recruited Medical Officers of Health and epidemiologists from across Canada working in the field of substance use. Thematic and social network analysis guided by the socio-technical systems framework were subsequently employed. RESULTS: Barriers and facilitators for detecting emerging drug trends in provinces and territories are a product of the collective linkages and interactions between social (objectives, people, culture), technical (tools, practices, infrastructure), and external environmental (financial, regulatory frameworks, stakeholders) factors. Shortcomings in several of these areas shaped the system's behaviour and together contributed to fragmented operations that lacked strategic focus, poorly designed cross-sector partnerships, and unactionable information outputs. Participants' experiences shaped perceptions of a national substance use EWS, with some voicing potential opportunities and others expressing doubts about its effectiveness. CONCLUSION: This study highlights interconnected social, technical, and external environmental considerations for the design and implementation of a national substance use EWS in Canada. It also demonstrates the value of using the socio-technical systems framework to understand a complex public health surveillance issue and how it can be used to inform a path forward.

RéSUMé: OBJECTIFS: Cette étude visait à appliquer une approche de pensée systémique pour explorer les facteurs influençant la détection des tendances émergentes en matière de drogues dans les provinces et territoires (P/T) du Canada afin de mieux comprendre comment le contexte local peut influencer la conception et le rendement d'un système pancanadien (c.-à-d. national) d'alerte précoce (SAP) en matière de consommation de substances. Cette étude présente également un ensemble de recommandations réalisables découlant des résultats. MéTHODOLOGIE ET MéTHODES: Des entrevues semi-structurées ont été menées auprès de 13 médecins hygiénistes et épidémiologistes recrutés dans tout le Canada et travaillant dans le domaine de la toxicomanie. L'analyse des réseaux thématiques et sociaux guidée par le cadre des systèmes socio-techniques (STS) a ensuite été utilisée. RéSULTATS: Les obstacles et les facilitateurs à la détection des tendances émergentes en matière de drogues dans les provinces et les territoires sont le produit des liens et des interactions collectifs entre les facteurs sociaux (objectifs, personnes, culture), techniques (outils, pratiques, infrastructure) et environnementaux externes (cadres financiers, réglementaires, intervenants). Les lacunes dans plusieurs de ces domaines ont façonné le comportement du système et, ensemble, ont contribué à des opérations fragmentées qui manquaient d'orientation stratégique, à des partenariats intersectoriels mal conçus et à de l'information inexploitable. Les expériences des participants ont façonné les perceptions d'un SAP national sur la consommation de substances, certains exprimant des opportunités potentielles et d'autres exprimant des doutes quant à son efficacité. CONCLUSION: Cette étude met en évidence les considérations sociales, techniques et environnementales externes interconnectées pour la conception et la mise en œuvre d'un SAP national sur la consommation de substances au Canada. Il démontre également la valeur de l'utilisation du cadre STS pour comprendre un problème complexe de surveillance de la santé publique et comment il peut être utilisé pour éclairer une voie à suivre.

Iterative data-driven forecasting of the transmission and management of SARS-CoV-2/COVID-19 using social interventions at the county-level.

The control of the initial outbreak and spread of SARS-CoV-2/COVID-19 via the application of population-wide non-pharmaceutical mitigation measures have led to remarkable successes in dampening the pandemic globally. However, with countries beginning to ease or lift these measures fully to restart activities, concern is growing regarding the impacts that such reopening of societies could have on the subsequent transmission of the virus. While mathematical models of COVID-19 transmission have played important roles in evaluating the impacts of these measures for curbing virus transmission, a key need is for models that are able to effectively capture the effects of the spatial and social heterogeneities that drive the epidemic dynamics observed at the local community level. Iterative forecasting that uses new incoming epidemiological and social behavioral data to sequentially update locally-applicable transmission models can overcome this gap, potentially resulting in better predictions and policy actions. Here, we present the development of one such data-driven iterative modelling tool based on publicly available data and an extended SEIR model for forecasting SARS-CoV-2 at the county level in the United States. Using data from the state of Florida, we demonstrate the utility of such a system for exploring the outcomes of the social measures proposed by policy makers for containing the course of the pandemic. We provide comprehensive results showing how the locally identified models could be employed for accessing the impacts and societal tradeoffs of using specific social protective strategies. We conclude that it could have been possible to lift the more disruptive social interventions related to movement restriction/social distancing measures earlier if these were accompanied by widespread testing and contact tracing. These intensified social interventions could have potentially also brought about the control of the epidemic in low- and some medium-incidence county settings first, supporting the development and deployment of a geographically-phased approach to reopening the economy of Florida. We have made our data-driven forecasting system publicly available for policymakers and health officials to use in their own locales, so that a more efficient coordinated strategy for controlling SARS-CoV-2 region-wide can be developed and successfully implemented.