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: We applied a discourse analysis on documents establishing HERA to investigate how the creation of this institution was legitimated by the EC. We 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: Our 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 competencies. CONCLUSIONS: Securitization has helped the EC raise its profile in health politically, without additional competencies, 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.

Kenya's Experience: Factors Enabling and Impeding the COVID-19 Response.

This case study describes the country-level response to the COVID-19 pandemic in Kenya between February 2020 and May 2021. We organize the presentation of COVID-19 response strategies across the five stages of (a) engagement, (b) assessment, (c) planning, (d) action/implementation, and (e) evaluation. We describe the participatory monitoring and evaluation (M&E) process implemented in collaboration with the WHO Regional Office for Africa Monitoring and Evaluation Team. The M&E system was used to organize and make sense of emerging data regarding specific response activities and changing COVID incidence. We share the results of that collaborative sensemaking, with particular attention to our analysis of the factors that facilitated and those that impeded our pandemic response. We conclude with lessons learned and practical implications from Kenya's experience to help guide future country-level responses to rapidly changing public health crises.

Epidemiological intelligence community network intervention: a community response for COVID-19 community transmission.

BACKGROUND: Expanding and providing access to early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through testing community-based strategies among socially vulnerable communities (SVC) are critical to reducing health disparities. The Epidemiological Intelligence Community Network (EpI-Net) community-based intervention sought to increase coronavirus 2019 (COVID-19) testing uptake and prevention practices among SVC in Puerto Rico (PR). We evaluated EpI-Net's community leaders' capacity-building component by assessing pre-post COVID-19 public health workshops' tests' score changes and satisfaction among trained community leaders. METHODS: A total of 24 community leaders from SVC in PR have completed four community workshops. Pre- and post-assessments were completed as part of the health promotors training program to evaluate participants' tests score changes and satisfaction outcomes. RESULTS: Preliminary results showed: (1) high intervention retention levels of community leaders (85.7% acceptance rate); (2) change in post-test scores for community engagement strategies (p = 0.012); (3) change in post-test educational scores in COVID-19 prevention practices (p = 0.014); and (4) a change in scores in public health emergency management strategies (p < 0.001). CONCLUSIONS: The overall workshop satisfaction was 99.6%. Community leaders have shown the importance of community capacity building as a key component for intervention feasibility and impact. TRIAL REGISTRATION: Our study was retrospectively registered under the ClinicalTrial.gov ID NCT04910542.

COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

INTRODUCTION: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

Participatory Monitoring and Evaluation of the COVID-19 Response in the Africa Region.

As the COVID-19 pandemic swept throughout the world, it created a demand for information to help understand the public health response and its effects. Limited capacity to see and interpret data-"sensemaking" with measures of progress-affects the use of data for quality improvement. The World Health Organization Regional Office for Africa (WHO AFRO) supported partners from the Member States in using a participatory monitoring and evaluation system to document and systematically reflect on the COVID-19 response at the country level. The WHO AFRO's COVID-19 Response Monitoring and Evaluation (M&E) team captured and communicated response activities based on available reports from 35 of the 47 member countries. By reviewing reports and communications, the M&E team documented nearly 8,000 COVID-19 response activities during the study period (January 2020 through July 2021). A "sensemaking" protocol was used to support country partners in identifying factors associated with increases or decreases in both new cases and response activities. This report describes this participatory M&E approach and process of shared sensemaking. We illustrate with a country-level case study of the COVID-19 response in the Africa Region.

COVID-19 Health Education Activities: An Analysis of a National Sample of Certified Health Education Specialists (CHES®/MCHES®) in Response to the Global Pandemic.

The National Commission of Health Education Credentialing, Inc. (NCHEC) created the Category 1 COVID-19 Claim Form Opportunity to document how Certified Health Education Specialists (CHES®) and Master Certified Health Education Specialists (MCHES®) assisted communities during the COVID-19 pandemic. Using data submitted by CHES®/MCHES® (n = 3,098 claim forms), the purpose of this study was to (a) describe the settings where CHES® and MCHES® completed their pandemic work and (b) assess differences in the type of pandemic work completed by CHES® compared with MCHES® based on specific Areas of Responsibility (AOR) for Health Education Specialists. Findings showed that CHES® and MCHES® engaged in seven AOR during the pandemic, with the largest proportion of CHES® (n = 859; 33%) and MCHES® (n = 105; 21.9%, documenting COVID-19-related activities in health departments. CHES® reported higher engagement than MCHES® in activities such as COVID-19 reporting/tracking, χ2 (1, N = 3,098) = 27.3, p < .001; outbreak response, χ2 (1, N = 3,098) = 4.3, p = .039; and vaccination, χ2 (1, N = 3,098) = 5.2, p = .023. Conversely, MCHES® reported higher participation than CHES® in screening/testing, χ2 (1, N = 3,098) = 174.2, p < .001; administration of budgets/operations, χ2 (1, N = 3,098) = 30.1, p < .001; and adapting educational activities at college/universities, χ2 (1, N = 3,098) = 46.1, p < .001. CHES® were more likely than MCHES® to indicate working in all AOR except for Area 2-Plan Health Education/Promotion. Results support that employer-verified health education skills in all AOR were transferable during COVID-19, especially for CHES® employed within state/county health departments.

Continuing Contributions of Field Epidemiology Training Programs to Global COVID-19 Response.

We documented the contributions of Field Epidemiology Training Program (FETP) trainees and graduates to global COVID-19 preparedness and response efforts. During February-July 2021, we conducted surveys designed in accordance with the World Health Organization's COVID-19 Strategic Preparedness and Response Plan. We quantified trainee and graduate engagement in responses and identified themes through qualitative analysis of activity descriptions. Thirty-two programs with 2,300 trainees and 7,372 graduates reported near-universal engagement across response activities, particularly those aligned with the FETP curriculum. Graduates were more frequently engaged than were trainees in pandemic response activities. Common themes in the activity descriptions were epidemiology and surveillance, leading risk communication, monitoring and assessment, managing logistics and operations, training and capacity building, and developing guidelines and protocols. We describe continued FETP contributions to the response. Findings indicate the wide-ranging utility of FETPs to strengthen countries' emergency response capacity, furthering global health security.

From the Operating Room to Online: Medical Student Surgery Education in the Time of COVID-19.

BACKGROUND: On March 17, 2020 the Association of American Medical Colleges recommended dismissal of medical students from clinical settings due to the COVID-19 pandemic. Third-year (M3) and fourth-year (M4) medical students were at home, M4s were interested in teaching, and residents and faculty had fewer clinical responsibilities due to elective surgery cancellations. To continue M3 access to education, we created a virtual surgery elective (VSE) that aimed to broaden students' exposure to, and elicit interest in, general surgery (GS). METHODS: Faculty, surgical residents, and M4s collaborated to create a 2-wk VSE focusing on self-directed learning and direct interactions with surgery faculty. Each day was dedicated to a specific pathology commonly encountered in GS. A variety of teaching methods were employed including self-directed readings and videos, M4 peer lectures, case-based learning and operative video review with surgery faculty, and weekly surgical conferences. A VSE skills lab was also conducted to teach basic suturing and knot-tying. All lectures and skills labs were via Zoom videoconference (Zoom Video Communications Inc). A post-course anonymous survey sent to all participants assessed changes in their understanding of GS and their interest in GS and surgery overall. RESULTS: Fourteen M3s participated in this elective over two consecutive iterations. The survey response rate was 79%. Ninety-one percent of students believed the course met its learning objectives "well" or "very well." Prior to the course, 27% reported a "good understanding" and 0% a "very good" understanding of GS. Post-course, 100% reported a "good" or "very good" understanding of GS, a statistically significant increase (P = 0.0003). Eighty-two percent reported increased interest in GS and 64% reported an increase in pursuing GS as a career. CONCLUSIONS: As proof of concept, this online course successfully demonstrated virtual medical student education can increase student understanding of GS topics, increase interest in GS, and increase interest in careers in surgery. To broaden student exposure to GS, we plan to integrate archived portions of this course into the regular third-year surgery clerkship and these can also be used to introduce GS in the preclinical years.

A medical student-led model for telephone-based opioid overdose education and naloxone distribution during the COVID-19 pandemic.

Background: The co-occurrence of the COVID-19 pandemic and opioid epidemic has increased the risk of overdose and death for patients with opioid use disorder (OUD). COVID-19 has also exacerbated already limited access to opioid overdose education and naloxone distribution (OEND). In this context, we aim to increase access to OEND for patients at risk for opioid overdose. Methods: Medical student volunteers were trained to conduct telephone-based OEND, and subsequently contacted all patients at a NYC primary care clinic for people who use drugs as well as those presenting to the hospital with OUD or a history of opioid overdose. Interested patients who completed the training received naloxone kits via mail or at hospital discharge. Results: OEND provision was converted to a remote-only model from May to June 2020. During this time, eight pre-clinical medical students called a total of 503 high-risk patients. Of these patients, 165 were reached, with 90 (55%) accepting telephone-based OEND. Comparing across populations, 51% of primary care patients versus 76% of ED/hospitalized patients accepted opioid overdose education. Eighty-four total patients received naloxone. Conclusions: We have outlined a scalable, adaptable model by which clinics and hospitals with affiliated medical schools can provide OEND by telephone. Medical student-driven, telephone-based OEND efforts can effectively reach at-risk patients and increase naloxone access.

Fishing safely during COVID-19 in Newfoundland and Labrador, Canada: Making it happen.

Globally, fisheries have been the site of multiple documented outbreaks of COVID-19. Existing studies point to the threat posed by the pandemic to livelihoods and health among migrant industrial fishery workers, small-scale fish harvesters, and fishing communities. They show the pandemic enhanced safety, economic, social and political layers of vulnerability in fisheries, while also showcasing examples of resilience. Case studies of COVID-19 response provide an opportunity to explore how existing organizational structures, leadership and networks in fisheries can enable the rapid co-development of customized strategies for fishing safely during large-scale global disruptions such as pandemics. This article contributes to our understanding of governance and fishing safety in small-scale fisheries during the early pandemic, examining the response of small-scale fisheries in the Canadian province of Newfoundland and Labrador. These seasonal fisheries successfully opened with regulator approval after a short delay and operated without documented COVID-19 outbreaks during 2020. Findings draw from key informant interviews with a safety sector association and union leader, complemented with insights from an anonymous online survey of small-scale harvesters. Interviews capture the organizational processes and resources mobilized to rapidly co-develop the COVID-19 Safe Work Practice Guideline. Online survey findings indicate that fifty-nine percent of respondents (crew and skippers) had no COVID-19-related concerns while fishing in 2020; older harvesters and owner-operators were significantly more likely to indicate concerns. When asked about the relative practicality of listed COVID-19 precautions, respondents commonly identified sanitization, reduced interactions with shore workers, social distancing, protection equipment, modifications to eating/rest areas, and reduced crew as impractical. These assessments are generally consistent with those of the interviewed leaders and the Guideline approach. This suggests the co-developed Guideline provided tailored and practical COVID-19 prevention strategies. Pre-existing governance structures and networks can help address small-scale fisheries vulnerabilities to pandemics by supporting co-development of organizational resources and evidence-informed prevention strategies.

Response to a crisis and applicant attraction: Signaling employer brand personality and organizational trust through warm and competent COVID-19 responses.

This paper investigates how organizations' response to a crisis such as the COVID-19 pandemic affects their employer attractiveness. Based on signaling theory, we argue that a COVID-19 response can signal an organization's employer brand personality, positively affecting applicant attraction. We conducted two experimental studies with employed and unemployed UK participants through Prolific Academic. Both studies indicate that a warm COVID-19 response leads to the highest employer attractiveness and job pursuit intentions, although a competent response was still more attractive than no response. Moreover, applicants use the warm and competent responses as signals of organizational warmth and competence respectively, building higher organizational trust. Limited support for the moderating role of applicants' personality was found. Implications during and beyond COVID-19 are discussed.

Leading with local solutions to keep Yarrabah safe: a grounded theory study of an Aboriginal community-controlled health organisation's response to COVID-19.

BACKGROUND: Pandemics such as COVID-19 are a serious public health risk for Australian Aboriginal and Torres Strait Islander communities, yet primary healthcare systems are not well resourced to respond to such urgent events. At the start of the COVID-19 pandemic, a federal government advisory group recommended a rapid, tailored Indigenous response to prevent predicted high morbidity and mortality rates. This paper examines the efforts of one ACCHO, which in the absence of dedicated funding, pivoted its operations in response to COVID-19. Gurriny Yealamucka Health Service (Gurriny) is the only primary healthcare service in the discrete Indigenous community of Yarrabah, Far North Queensland. METHODS: The research was conducted at the request of the Chief Executive Officer of Gurriny. Using grounded theory methods, thirteen Gurriny staff and five Yarrabah and government leaders and community members were interviewed, transcripts of these interviews and 59 documents were imported into NVIVO-12 and coded, and key concepts were compared, organised into higher order constructs, then structured into a theoretical framework. RESULTS: Gurriny responded to COVID-19 by leading with local solutions to keep Yarrabah safe. Four key strategies were implemented: managing the health service operations, realigning services, educating and supporting community, and working across agencies. These strategies were enabled or hindered by five conditions: the governance and leadership capacity of Gurriny, relying on the health taskforce, locking the door, "copping it", and (not) having resources. A year after the first case was experienced in Australia and on the eve of vaccine rollout to Indigenous communities, there have been no COVID-19 cases in Yarrabah. DISCUSSION: The success of the locally led, holistic, comprehensive and culturally safe response of Gurriny suggests that such tailored place-based approaches to pandemics (and other health issues) are appropriate, but require dedicated resourcing. Key challenges were the fragmented and rapidly changing government processes, poorly coordinated communication and resource allocation channels, and bottlenecks in hierarchical funding approval processes. CONCLUSIONS: The COVID-19 response in Yarrabah demonstrates the need for governance reform towards greater resourcing and support for local decision making by Aboriginal community-controlled health organisations.

Genetic counseling research and COVID-19: A lesson in resiliency.

GenCOUNSEL is the largest genetic counseling research grant awarded to date and brings together experts in genetic counseling, genomics, law and policy, health services implementation, and health economics research. It is the first project of its kind to examine the genetic counseling issues associated with the clinical implementation of genome-wide sequencing (exome and genome sequencing). GenCOUNSEL is a Canadian-based, multi-method research study that takes place over a variety of sites, including non-clinical, clinical, and laboratory research sites and includes the training of undergraduate and graduate students. The COVID-19 pandemic will likely have a lasting impact on genetic counseling service delivery, research, and training. Almost every aspect of the GenCOUNSEL research project has been impacted by the COVID-19 pandemic. Here we describe how our research recruitment strategies, methods, resource allocation, and training capacity have been affected. We discuss ways that we have adapted to the pandemic including revision of our research methods and work to understand the barriers in order to optimize opportunities. We finish with take-home messages to fellow researchers highlighting the importance of resiliency in genetic counseling research.

A study on factors affecting privacy risk tolerance to prevent the spread of COVID-19 in South Korea.

South Korea has been evaluated as a country that is responding well to COVID-19. The Government of the Republic of Korea discloses where, when, and by which means of transportation people confirmed to have the virus have visited. Although disclosure of movement has contributed to flattening the curve and providing timely medical service, concerns about privacy infringement have also been raised. This article determines what factors influence privacy risk tolerance, looking specifically at threat severity, vulnerability, response efficacy, and response cost. We also provide implications for the preparation of better countermeasures for the government to implement.

Disparate on-site access to water, sanitation, and food storage heighten the risk of COVID-19 spread in Sub-Saharan Africa.

COVID-19 is an active pandemic that likely poses an existential threat to humanity. Frequent handwashing, social distancing, and partial or total lockdowns are among the suite of measures prescribed by the World Health Organization (WHO) and being implemented across the world to contain the pandemic. However, existing inequalities in access to certain basic necessities of life (water, sanitation facility, and food storage) create layered vulnerabilities to COVID-19 and can render the preventive measures ineffective or simply counterproductive. We hypothesized that individuals in households without any of the named basic necessities of life are more likely to violate the preventive (especially lockdown) measures and thereby increase the risk of infection or aid the spread of COVID-19. Based on nationally-representative data for 25 sub-Saharan African (SSA) countries, multivariate statistical and geospatial analyses were used to investigate whether, and to what extent, household family structure is associated with in-house access to basic needs which, in turn, could reflect on a higher risk of COVID-19 infection. The results indicate that approximately 46% of the sampled households in these countries (except South Africa) did not have in-house access to any of the three basic needs and about 8% had access to all the three basic needs. Five countries had less than 2% of their households with in-house access to all three basic needs. Ten countries had over 50% of their households with no in-house access to all the three basic needs. There is a social gradient in in-house access between the rich and the poor, urban and rural richest, male- and female-headed households, among others. We conclude that SSA governments would need to infuse innovative gender- and age-sensitive support services (such as water supply, portable sanitation) to augment the preventive measures prescribed by the WHO. Short-, medium- and long-term interventions within and across countries should necessarily address the upstream, midstream and downstream determinants of in-house access and the full spectrum of layers of inequalities including individual, interpersonal, institutional, and population levels.

Fast-track Innovation: Area Agencies on Aging Respond to the COVID-19 Pandemic.

Millions of older Americans depend on services provided by Area Agencies on Aging to support their nutritional, social, and health needs. Social distancing requirements and the closure of congregate activities due to COVID-19 resulted in a rapid and dramatic shift in service delivery modes. Area Agencies on Aging were able to quickly pivot due to their long-standing expertise in community needs assessment and cross-sectoral partnerships. The federal Coronavirus relief measures also infused one billion dollars into the Aging Network. As the pandemic response evolves, Area Agencies on Aging are poised to be key partners in a transformed health system.

The armed forces medical services response to COVID-19.

The Indian Armed Forces have always responded to the Nation's call and the COVID-19 pandemic response has been no different. On instructions from the Government of India, the Armed Forces Medical Services (AFMS) pitched in right from the initial stages of the epidemic in India as part of a coordinated national response. Be it the execution of medical quarantine for Indian citizens evacuated from China and other COVID affected countries or establishing dedicated and mixed COVID hospitals for its own clientele as well as civilian patients, the AFMS worked in tandem with the national policies. The Armed Forces ensured force preservation and protection of its own troops and families by timely implementation of public health measures, even as it played its designated role in the national strategy. With vision, understanding and clarity, the AFMS continue to lend shoulder to India's response to this global public health challenge.

Ku Like Kakou: Utilizing a Community-led Model of Collaboration to Respond to the COVID-19 Pandemic.

The outbreak of COVID-19 in 2020 brought significant challenges for Native Hawaiians (NH), Pacific Islanders (PI), and other communities of color worldwide. Rapidly increasing rates of infection and transmission of the virus in Native Hawaiian and Pacific Islander (NHPI) communities and incomplete or unavailable data signaled to Hawai'i's leaders that advocacy and action needed to take place to minimize the impact of COVID-19. The Native Hawaiian and Pacific Islander Response, Recovery, and Resilience team (NHPI 3R Team) emerged from an effort to lead and fill gaps in response to COVID-19. Through the swift, intentional, and collaborative work of the team and its partners, NHPI communities and the entities that serve them were better equipped to navigate the pandemic, improve health outcomes, and contribute to a reduction in the number of infections, a rise in vaccination uptake, and an increase in NH and PI representation on various levels of government agencies. As the world shifts its focus from COVID-19 to broader health topics, the NHPI 3R Team will continue to serve as a hub for the exchange of resources and a model of community-led work that can be used to tackle issues like COVID-19 and beyond.

Use of a toll-free call center for COVID-19 response and continuity of essential services during the lockdown, Greater Kampala, Uganda, 2020: a descriptive study.

Introduction: on March 21, 2020, the first case of COVID-19 was confirmed in Uganda. A total lockdown was initiated on March 30 which was gradually lifted May 5-June 30. On March 25, a toll-free call center was organized at the Kampala Capital City Authority to respond to public concerns about COVID-19 and the lockdown. We documented the set-up and use of the call center and analyzed key concerns raised by the public. Methods: two hotlines were established and disseminated through media platforms in Greater Kampala. The call center was open 24 hours a day and 7 days a week. We abstracted data on incoming calls from March 25 to June 30, 2020. We summarized call data into categories and conducted descriptive analyses of public concerns raised during the lockdown. Results: among 10,167 calls, two-thirds (6,578; 64.7%) involved access to health services, 1,565 (15.4%) were about social services, and 1,375 (13.5%) involved COVID-19-related issues. Approximately one-third (2,152; 32.7%) of calls about access to health services were requests for ambulances for patients with non-COVID-19-related emergencies. About three-quarters of calls about social services were requests for food and relief items (1,184; 75.7%). Half of the calls about COVID-19 (730; 53.1%) sought disease-related information. Conclusion: the toll-free call center was used by the public during the COVID-19 lockdown in Kampala. Callers were more concerned about access to essential health services, non-related to COVID-19 disease. It is important to plan for continuity of essential services before a public health emergency-related lockdown.