Accuracy of Case-Based Seroprevalence of SARS-CoV-2 Antibodies in Maricopa County, Arizona.

We conducted a community seroprevalence survey in Arizona, from September 12 to October 1, 2020, to determine the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used the seroprevalence estimate to predict SARS-CoV-2 infections in the jurisdiction by applying the adjusted seroprevalence to the county's population. The estimated community seroprevalence of SARS-CoV-2 infections was 4.3 times greater (95% confidence interval = 2.2, 7.5) than the number of reported cases. Field surveys with representative sampling provide data that may help fill in gaps in traditional public health reporting. (Am J Public Health. 2022;112(1):38-42. https://doi.org/10.2105/AJPH.2021.306568).

Science preparedness and science response: perspectives on the dynamics of preparedness conference.

The ability of the scientific modeling community to meaningfully contribute to postevent response activities during public health emergencies was the direct result of a discrete set of preparedness activities as well as advances in theory and technology. Scientists and decision-makers have recognized the value of developing scientific tools (e.g. models, data sets, communities of practice) to prepare them to be able to respond quickly--in a manner similar to preparedness activities by first-responders and emergency managers. Computational models have matured in their ability to better inform response plans by modeling human behaviors and complex systems. We advocate for further development of science preparedness activities as deliberate actions taken in advance of an unpredicted event (or an event with unknown consequences) to increase the scientific tools and evidence-base available to decision makers and the whole-of-community to limit adverse outcomes.

Serological survey to estimate SARS-CoV-2 infection and antibody seroprevalence at a large public university: A cross-sectional study.

OBJECTIVE: This study investigated the seroprevalence of SARS-CoV-2 antibodies among adults over 18 years. DESIGN: Prospective cohort study. SETTINGS: A large public university. PARTICIPANTS: This study took volunteers over 5 days and recruited 1064 adult participants. PRIMARY OUTCOME MEASURES: Seroprevalence of SARS-CoV-2-specific antibodies due to previous exposure to SARS-CoV-2 and/or vaccination. RESULTS: The seroprevalence of the antireceptor binding domain (RBD) antibody was 90% by a lateral flow assay and 88% by a semiquantitative chemiluminescent immunoassay. The seroprevalence for antinucleocapsid was 20%. In addition, individuals with previous natural COVID-19 infection plus vaccination had higher anti-RBD antibody levels compared with those who had vaccination only or infection only. Individuals who had a breakthrough infection had the highest anti-RBD antibody levels. CONCLUSION: Accurate estimates of the cumulative incidence of SARS-CoV-2 infection can inform the development of university risk mitigation protocols such as encouraging booster shots, extending mask mandates or reverting to online classes. It could help us to have clear guidance to act at the first sign of the next surge as well, especially since there is a surge of COVID-19 subvariant infections.

Community knowledge, risk perception, and preparedness for the 2009 influenza A/H1N1 pandemic.

OBJECTIVE: To examine public knowledge, perceptions, and preparedness for the 2009 influenza A/H1N1 pandemic. DESIGN: We conducted a telephone survey of selected households in Arizona during the month of October 2009. RESULTS: Among the 727 households interviewed, one-third (34%) were not aware that the terms swine flu and H1N1 refer to the same virus. Many believed that it is more difficult to contract 2009 H1N1 (27%) than seasonal influenza (14%). About three-quarters of respondents perceived the H1N1 situation as urgent (76%), but only about one-third of those surveyed believed a family member would get sick with H1N1 within a year (35%). Approximately half (53%) of those surveyed intended to get the H1N1 influenza vaccine. Family doctors, television news, and local public health officials were the most trusted sources for H1N1 information. CONCLUSIONS: The survey highlighted a number of important misconceptions about H1N1 knowledge, treatment options and transmissibility. Increased efforts should be made to understand how messages are transmitted and received in the community during a pandemic to improve risk communication plans moving forward.

COVID-19 healthcare demand projections: Arizona.

Beginning in March 2020, the United States emerged as the global epicenter for COVID-19 cases with little to guide policy response in the absence of extensive data available for reliable epidemiological modeling in the early phases of the pandemic. In the ensuing weeks, American jurisdictions attempted to manage disease spread on a regional basis using non-pharmaceutical interventions (i.e., social distancing), as uneven disease burden across the expansive geography of the United States exerted different implications for policy management in different regions. While Arizona policymakers relied initially on state-by-state national modeling projections from different groups outside of the state, we sought to create a state-specific model using a mathematical framework that ties disease surveillance with the future burden on Arizona's healthcare system. Our framework uses a compartmental system dynamics model using a SEIRD framework that accounts for multiple types of disease manifestations for the COVID-19 infection, as well as the observed time delay in epidemiological findings following public policy enactments. We use a compartment initialization logic coupled with a fitting technique to construct projections for key metrics to guide public health policy, including exposures, infections, hospitalizations, and deaths under a variety of social reopening scenarios. Our approach makes use of X-factor fitting and backcasting methods to construct meaningful and reliable models with minimal available data in order to provide timely policy guidance in the early phases of a pandemic.

Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise.

Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience, and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal, and territorial governments; private sector organizations; academia; industry; international partners; and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a "bottom-up" systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication, and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided.

A new method of exercising pandemic preparedness through an interactive simulation and visualization.

As seen in the spring 2009 A/H1N1 influenza outbreak, influenza pandemics can have profound social, legal and economic effects. This experience has also made the importance of public health preparedness exercises more evident. Universities face unique challenges with respect to pandemic preparedness due to their dense student populations, location within the larger community and frequent student/faculty international travel. Depending on the social structure of the community, different mitigation strategies should be applied for decreasing the severity and transmissibility of the disease. To this end, Arizona State University has developed a simulation model and tabletop exercise that facilitates decision-maker interactions around emergency-response scenarios. This simulation gives policy makers the ability to see the real-time impact of their decisions. Therefore, tabletop exercises with computer simulations are developed to practice these decisions, which can possibly give opportunities for practicing better policy implementations. This paper introduces a new method of designing and performing table-top exercises for pandemic influenza via state-of-the-art technologies including system visualization and group decision making with a supporting simulation model. The presented exercise methodology can increase readiness for a pandemic through the support of computer and information technologies and the survey results that we include in this paper certainly support this result. The video scenarios and the computer simulation model make the exercise appear very compelling and real, which makes this presented method of exercising different than the other table-top exercises in the literature. Finally, designing a pandemic preparedness exercise with supporting technologies can help identifying the communication gaps between responsible authorities and advance the table-top exercising methodology.

Building evidence for legal decision making in real time: legal triage in public health emergencies.

Similar to the triaging of patients by health care workers, legal and public health professionals must prioritize and respond to issues of law and ethics in declared public health emergencies. As revealed by the 2009-2010 H1N1 influenza outbreak and other events, there are considerable inconsistencies among professionals regarding how to best approach these issues during a public health emergency. Our project explores these inconsistencies by attempting to assess how practitioners make legal and ethical decisions in real-time emergencies to further critical public health objectives. Using a fictitious scenario and interactive visualization environment, we observed real-time decision-making processes among knowledgeable participants. Although participants' decisions and perspectives varied, the exercise demonstrated an increase in the perception of the relevance of legal preparedness in multiple aspects of the decision-making process and some key lessons learned for consideration in future repetitions of the exercise and actual, real-time emergency events.