Are "cases", "waves", "tests" and "modeling" deceiving indicators to describe the COVID-19 pandemic?

This commentary elaborates on different methodological aspects complicating the interpretation of epidemiological data related to the current COVID-19 pandemic, thus preventing reliable within and across-country estimates. Firstly, an inaccuracy of epidemiological data maybe arguably be attributed to passive surveillance, a relatively long incubation period during which infected individuals can still shed high loads of virus into the surrounding environment and the very high proportion of cases not even developing signs and/or symptoms of COVID-19. The latter is also the major reason for the inappropriateness of the abused "wave" wording, which gives the idea that health system starts from scratch to respond between "peaks". Clinical data for case-management on the other hand often requires complex technology in order to merge and clean data from health care facilities. Decision-making is often further derailed by the overuse of epidemiological modeling: precise aspects related to transmissibility, clinical course of COVID-19 and effectiveness of the public health and social measures are heavily influenced by unbeknownst and unpredictable human behaviors and modelers try to overcome missing epidemiological information by relying on poorly precise or questionable assumptions. Therefore the COVID-9 pandemic may provide a valuable opportunity to rethink how we are dealing with the very basic principles of epidemiology as well as risk communication issues related to such an unprecedented emergency situation.

Coordination during Cholera Outbreak Response: Critical Insights from Yemen.

Within the humanitarian arena and since the introduction of the humanitarian reform process in 2005, the cluster approach was introduced to strengthen the cooperation and accountability between agencies working in the same field. Such an integrated approach is particularly needed and relevant in emergencies like cholera, especially in countries undergoing internal conflicts like Yemen. Several areas of concern have been identified during the past field experiences, which include dysfunctional cooperation as a result of different mandates as well as the relationship between nongovernmental organizations and their donors. Control of environmental health services is, for instance, the responsibility of several clusters/agencies and stakeholders, which usually results in a complicated and sometimes confusing approaches to address gaps and barriers. As far as the drinking water quality monitoring and surveillance are concerned, sampling and testing and compilation of data are usually carried out by many agencies included in the health and water sanitation and hygiene (WASH) clusters. We believe that the cluster theoretical approach for emergency response remains a turning point for the humanitarian arena. However, lessons from the recent past, especially in the management of a cholera outbreak in fragile settings, may serve as a serious reflection on roles and dynamics within the blurred border between health and WASH. Specifically, cluster leads in the field have the responsibility for ensuring that humanitarian actors working in their sectors remain actively engaged in addressing crosscutting concerns such as the environment.

The forgotten sub-regional COVID-19 response layer. The case of the WHO Eastern Mediterranean Region.

The response to the COVID-19 pandemic have been driven by epidemiology, health system characteristics and control measures in form of social/physical distancing. Guidance, information and best practices have been characterized by territorial thinking with concentration on national health system and social contexts. Information was to a large extent provided from global entities such as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and others. This bipolar response mechanism came to the detriment of regional and sub-regional levels. The development of the global pandemic was evaluated in terms of the performance of single countries without trying to reflect on possible regional or sub-regional results of similar characteristics in health system and social contexts. To have a clearer view of the issue of sub-regional similarities, we examined the WHO, Eastern Mediterranean Region. When examining the development of confirmed cases for countries in the region, we identified four different sub-groups similar in the development of the pandemic and the social distancing measure implemented. Despite the complicated situation, these groups gave space for thinking outside the box of traditional outbreaks or pandemic response. We think that this sub-regional approach could be very effective in addressing more characteristics and not geographically based analysis. Furthermore, this can be an area of additional conceptual approaches, modelling and concrete platforms for information and lessons learned exchange.

WHO Paradoxes in Emergency Operations: The Dilemma of a UN Specialized Agency.

The past two decades have witnessed a major shift in humanitarian operations to respond to more internal conflicts instead of the traditional cross-border wars. Over the recent years, two major shifts have taken place within the WHO to orient toward response to emergencies, namely the introduction of the Humanitarian Reform and the Cluster Approach in 2005 and the introduction of the Emergency Response Framework (ERF). The financing of the agency in humanitarian operations is adding emerging elements to the WHO operations, especially because of the constantly higher contribution from non-state- and state- funding agencies. Pending issues include aspects like health strategy, conflict analysis, legal issues of aid delivery, impartiality in delivering services, and other aspects and needs.