Emerging infectious disease and the challenges of social distancing in human and non-human animals.

The 'social distancing' that occurred in response to the COVID-19 pandemic in humans provides a powerful illustration of the intimate relationship between infectious disease and social behaviour in animals. Indeed, directly transmitted pathogens have long been considered a major cost of group living in humans and other social animals, as well as a driver of the evolution of group size and social behaviour. As the risk and frequency of emerging infectious diseases rise, the ability of social taxa to respond appropriately to changing infectious disease pressures could mean the difference between persistence and extinction. Here, we examine changes in the social behaviour of humans and wildlife in response to infectious diseases and compare these responses to theoretical expectations. We consider constraints on altering social behaviour in the face of emerging diseases, including the lack of behavioural plasticity, environmental limitations and conflicting pressures from the many benefits of group living. We also explore the ways that social animals can minimize the costs of disease-induced changes to sociality and the unique advantages that humans may have in maintaining the benefits of sociality despite social distancing.

Factors influencing nurses' intention to care for patients with emerging infectious diseases: Application of the theory of planned behavior.

Emerging infectious diseases have caused many health problems and have been identified as a major health issue worldwide. The aim of this descriptive, cross-sectional survey study was to investigate nursing intention among nurses caring for emerging infectious disease patients in Korea and to describe factors influencing nurses' intention to care by applying the theory of planned behavior. A total of 147 Korean nurses were included and data accrued using an online questionnaire. Among the independent variables, perceived behavioral control, attitudes toward the behavior, and sex significantly influenced nursing intention. These variables explained 55.1% of nursing intention to care for patients with emerging infectious diseases, and perceived behavioral control (confidence or self-efficacy in caring for patients) was the strongest predictor. These findings showed the usefulness of the theory of planned behavior in predicting nurses' intention to care for patients with emerging infectious diseases. Providing an educational program on caring for patients with pandemic diseases would also increase self-confidence and reduce concerns. In addition, institutional support, such as compensation payments and recognition from administrators, would also strengthen positive attitudes among nurses.

Analysis of an Epidemic System with Two Response Delays in Media Impact Function.

A functional differential model of SEIS-M type with two time delays, representing the response time for mass media to cover the current infection and for individuals' behavior changes to media coverage, was proposed to examine the delayed media impact on the transmission dynamics of emergent infectious diseases. The threshold dynamics were established in terms of the basic reproduction number [Formula: see text]. When there are no time delays, we showed that if the media impact is low, the endemic equilibrium is globally asymptotically stable for [Formula: see text], while the endemic equilibrium may become unstable and Hopf bifurcation occurs for some appropriate conditions by taking the level of media impact as bifurcation parameter. With two time delays, we comprehensively investigated the local and global bifurcation by considering the summation of delays as a bifurcation parameter, and theoretically and numerically examined the onset and termination of Hopf bifurcations from the endemic equilibrium. Main results show that either the media described feedback cycle, from infection to the level of mass media and back to disease incidence, or time delays can induce Hopf bifurcation and result in periodic oscillations. The findings indicate that the delayed media impact leads to a richer dynamics that may significantly affect the disease infections.

Impact of individual behaviour change on the spread of emerging infectious diseases.

Human behaviour plays an important role in the spread of emerging infectious diseases, and understanding the influence of behaviour changes on epidemics can be key to improving control efforts. However, how the dynamics of individual behaviour changes affects the development of emerging infectious disease is a key public health issue. To develop different formula for individual behaviour change and introduce how to embed it into a dynamic model of infectious diseases, we choose A/H1N1 and Ebola as typical examples, combined with the epidemic reported cases and media related news reports. Thus, the logistic model with the health belief model is used to determine behaviour decisions through the health belief model constructs. Furthermore, we propose 4 candidate infectious disease models without and with individual behaviour change and use approximate Bayesian computation based on sequential Monte Carlo method for model selection. The main results indicate that the classical compartment model without behaviour change and the model with average rate of behaviour change depicted by an exponential function could fit the observed data best. The results provide a new way on how to choose an infectious disease model to predict the disease prevalence trend or to evaluate the influence of intervention measures on disease control. However, sensitivity analyses indicate that the accumulated number of hospital notifications and deaths could be largely reduced as the rate of behaviour change increases. Therefore, in terms of mitigating emerging infectious diseases, both media publicity focused on how to guide people's behaviour change and positive responses of individuals are critical.

Skepticism toward Emerging Infectious Diseases and Influenza Vaccination Intentions in Nurses.

Nurses generally show low compliance with vaccination recommendations. We assessed whether low vaccine acceptance is due to skeptical attitudes toward emerging infectious diseases (EIDs). Skepticism toward EIDs manifests as doubts about the real threat of emerging diseases and as distrust in the motives and the competence of institutions that fight these diseases. We performed a cross-sectional questionnaire study in 293 Swiss nurses using a newly developed scale to assess skepticism toward EIDs. Skepticism affected nurses' intentions to vaccinate themselves against seasonal influenza and against possible future pandemic influenza. The influence of skepticism persisted after controlling for other factors that are known to determine nurses' vaccination behavior, namely vaccination habits, feeling at risk of catching influenza, and perceiving vaccination as a professional duty. Skeptical attitudes toward EIDs seem to have a unique and hitherto ignored impact on vaccination intentions. Nurses' vaccine acceptance could be increased if vaccination campaigns specifically target skeptical attitudes toward EIDs. These campaigns should address nurses' doubts about the real threat of EIDs and should rebuild their trust in institutions which fight these diseases.

Public apprehension of emerging infectious diseases: are changes afoot?

Using social representations theory this paper casts light on the pattern of content that characterises the public response to emerging and re-emerging infectious diseases (EID). The pattern is: distancing the disease from the self/ one's in-groups; blame of particular entities for the disease's origin and/or spread; and stigmatisation of those who have contracted it and/or who are represented as having intensified its spread. This pattern is not unique to EID but extends to many risks, making EID fruitful events for understanding public apprehension of potential dangers. This process may be driven by worry, fear and anxiety since when levels of these are low, as has arguably been the case with the 2009/10 "Swine Flu" pandemic, the pattern transforms. The distancing-blame-stigma pattern may also be transformed by growing reflexivity, a feature of late modern societies, as well as material features of the epidemic and "EID fatigue".

Initial response of health care institutions to emergence of H1N1 influenza: experiences, obstacles, and perceived future needs.

BACKGROUND: The emergence of H1N1 influenza is cause for great concern. Although one of the most important components of the response to the H1N1 crisis is the work of health care epidemiology professionals, the beliefs and experiences of this community are unknown, and the optimal approach to managing H1N1 in the future has not been delineated. METHODS: To assess attitudes and responses of health care epidemiology professionals to the H1N1 influenza crisis, we conducted a cross-sectional survey of members of the Society for Healthcare Epidemiology of America. We assessed beliefs regarding (1) importance of H1N1, (2) institutional preparedness, (3) time spent on the H1N1 crisis, and (4) the institution's response to H1N1. RESULTS: Of 323 respondents, 195 (60.4%) reported that their hospitals were well prepared for a pandemic. Furthermore, the majority reported that senior administrators provided adequate political support and resources (85.1% and 80.2%, respectively) to respond to H1N1. However, 163 (50.9%) respondents reported that other important infection prevention activities were neglected during the H1N1 crisis. Shortages of antiviral medication were reported by 99 (30.7%) respondents. Furthermore, 126 (39.0%) reported that personal stockpiling of antiviral medications occurred at their institution, and 166 (51.4%) reported that institutional actions were initiated to prevent personal stockpiling. Also, 294 (91.0%) respondents believed that H1N1 influenza would reappear later this year. Vaccine development, health care worker education, and revisions of pandemic influenza plans were identified as the most important future initiatives. Finally, 251 (77.7%) respondents felt that health care workers should be mandated to receive influenza vaccine. CONCLUSIONS: Although generally institutions are well prepared for the H1N1 crisis, substantial revisions of pandemic preparedness plans appear to be necessary. Future efforts to optimize the response to H1N1 should include curtailing personal stockpiling of antivirals and vaccine development with consideration of mandatory vaccination of health care workers.

Emergency nurses' perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency departments.

Purpose: Emerging infectious diseases are considered as a pressing challenge to global public health. Throughout public health response to emerging infectious diseases, emergency nurses are situated at the forefront of the healthcare system. The present study has explored emergency nurses' perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency department context.Methods: The present study used a qualitative descriptive approach. A purposive sampling method was employed to recruit emergency nurses who worked in public hospitals in Hong Kong. Semi-structured interviews were conducted to 24 emergency nurses. The data were interpreted using a thematic analysis strategy.Results: Five overarching themes emerged from the data: (1) the novelty of an emerging infectious disease, (2) the severity of an emerging infectious disease, (3) the proximity to an emerging infectious disease, (4) the complexity of an emerging infectious disease situation, and (5) the response levels towards an emerging infectious disease situation.Conclusion: It is anticipated that the information may help to predict the attitudes and behaviours of emergency nurses in future impending epidemic events, enhancing emergency nurses' preparedness towards in such situations.Abbreviations: EID: Emerging infectious disease; ED: Emergency department; SARS: Severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; WHO: World Health Organization; RN: Registered nurse; APN: Advanced practice nurse; NO: Nursing officer.

Social support and response to AIDS and severe acute respiratory syndrome.

Negative public reactions to emerging infectious diseases can adversely affect population health. We assessed whether social support was associated with knowledge of, worry about, and attitudes towards AIDS and severe acute respiratory syndrome. Our findings suggest that social support may be central to our understanding of public responses to emerging infectious diseases.

The SARS (Severe Acute Respiratory Syndrome) pandemic in Hong Kong: effects on the subjective wellbeing of elderly and younger people.

OBJECTIVES: This study examined the impact of the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong in 2003, on the subjective wellbeing (SWB) of elderly people and a younger comparative sample. The Personal Wellbeing Index (PWI), a contemporary instrument employed to measure SWB, was also examined for its psychometric performance to substantiate its use. METHOD: A total of 302 older adults (age 65 + years) and 158 younger adults (age 35-46 years) were recruited from different districts. Data were collected by individual face-to-face interviews. RESULT: While elderly people living in severely infected districts showed significantly lower levels of SWB, these levels and those of the younger sample were found to remain within the normative range. A major mitigating factor was an increased sense of community-connectedness. Other characteristics linked to low wellbeing levels included chronic illness, female gender, low education and unemployment. The living districts, characterized by varying extents of infection, had stronger associations with SWB than participants' age. The PWI demonstrated good psychometric performance and also more robustness with elderly people, including its sensitivity to the sense of population threat. CONCLUSION: Psychological resilience was identified among both the elderly and younger age-groups in Hong Kong during the SARS pandemic. The PWI is verified as a suitable instrument for SWB measurements.

The psychological effect of severe acute respiratory syndrome on emergency department staff.

BACKGROUND: The severe acute respiratory syndrome (SARS) outbreak in 2003 affected 29 countries. The SARS outbreak was unique in its rapid transmission and it resulted in heavy stress in first-line healthcare workers, particularly in the emergency department. AIM: : To determine the influence of SARS on the psychological status, including post-traumatic stress disorder (PTSD) symptoms, of the staff in the emergency department. METHODS: To investigate whether different working conditions in the hospital led to different psychological effects on healthcare workers, the psychological effect on emergency department staff in the high-risk ward was compared with that on psychiatric ward staff in the medium-risk ward. Davidson Trauma Scale-Chinese version (DTS-C) and Chinese Health Questionnaire-12 (CHQ-12) items were designed to check the psychological status of the staff in the month after the end of the SARS outbreak. RESULTS: 86 of 92 (93.5%) medical staff considered the SARS outbreak to be a traumatic experience. The DTS-C scores of staff in the emergency department and in the psychiatric ward were significantly different (p = 0.04). No significant difference in CHQ score was observed between the two groups. Emergency department staff had more severe PTSD symptoms than staff in the psychiatric ward. CONCLUSION: SARS was a traumatic experience for healthcare providers in Taiwan. Most staff in the emergency department and in the psychiatric ward had PTSD. Emergency department staff had more severe PTSD symptoms than staff in the psychiatric ward.

Understanding an Ebola outbreak: Social representations of emerging infectious diseases.

This study examined the collective image of the 2014-2015 Ebola outbreak, to understand how people incorporate this epidemic in their everyday thinking. A free association exercise elicited by Ebola was answered by 294 people from Spain and the content was analysed using Alceste software. First, results showed that Ebola was represented as inherently African. Second, it was also depicted as a global threat creating fear. People also felt anger, and they blamed political authorities and the mass media for the failure to manage this crisis. Finally, this research underlines the importance of the social representations to understand how current outbreaks are cognitively represented and emotionally faced as a key factor to appropriately manage future epidemics.

Justice Is the Missing Link in One Health: Results of a Mixed Methods Study in an Urban City State.

BACKGROUND: One Health (OH) is an interdisciplinary collaborative approach to human and animal health that aims to break down conventional research and policy 'silos'. OH has been used to develop strategies for zoonotic Emerging Infectious Diseases (EID). However, the ethical case for OH as an alternative to more traditional public health approaches is largely absent from the discourse. To study the ethics of OH, we examined perceptions of the human health and ecological priorities for the management of zoonotic EID in the Southeast Asia country of Singapore. METHODS: We conducted a mixed methods study using a modified Delphi technique with a panel of 32 opinion leaders and 11 semi-structured interviews with a sub-set of those experts in Singapore. Panellists rated concepts of OH and priorities for zoonotic EID preparedness planning using a series of scenarios developed through the study. Interview data were examined qualitatively using thematic analysis. FINDINGS: We found that panellists agreed that OH is a cross-disciplinary collaboration among the veterinary, medical, and ecological sciences, as well as relevant government agencies encompassing animal, human, and environmental health. Although human health was often framed as the most important priority in zoonotic EID planning, our qualitative analysis suggested that consideration of non-human animal health and welfare was also important for an effective and ethical response. The panellists also suggested that effective pandemic planning demands regional leadership and investment from wealthier countries to better enable international cooperation. CONCLUSION: We argue that EID planning under an OH approach would benefit greatly from an ethical ecological framework that accounts for justice in human, animal, and environmental health.

Knowledge, Attitudes and Behaviours of Healthcare Workers in the Kingdom of Saudi Arabia to MERS Coronavirus and Other Emerging Infectious Diseases.

Background: The Kingdom of Saudi Arabia has experienced a prolonged outbreak of Middle East Respiratory Syndrome (MERS) coronavirus since 2012. Healthcare workers (HCWs) form a significant risk group for infection. Objectives: The aim of this survey was to assess the knowledge, attitudes, infection control practices and educational needs of HCWs in the Kingdom of Saudi Arabia to MERS coronavirus and other emerging infectious diseases. Methods: 1500 of HCWs from Saudi Ministry of Health were invited to fill a questionnaire developed to cover the survey objectives from 9 September 2015 to 8 November 2015. The response rate was about 81%. Descriptive statistics was used to summarise the responses. Results: 1216 HCWs were included in this survey. A total of 56.5% were nurses and 22% were physicians. The most common sources of MERS-coronavirus (MERS-CoV) information were the Ministry of Health (MOH) memo (74.3%). Only (47.6%) of the physicians, (30.4%) of the nurses and (29.9%) of the other HCWs were aware that asymptomatic MERS-CoV was described. Around half of respondents who having been investigated for MERS-CoV reported that their work performance decreased while they have suspicion of having MERS-CoV and almost two thirds reported having psychological problems during this period. Almost two thirds of the HCWs (61.2%) reported anxiety about contracting MERS-CoV from patients. Conclusions: The knowledge about emerging infectious diseases was poor and there is need for further education and training programs particularly in the use of personal protective equipment, isolation and infection control measures. The self-reported infection control practices were sub-optimal and seem to be overestimated.

Perception of the Risks of Ebola, Enterovirus-E68 and Influenza Among Emergency Department Patients.

INTRODUCTION: Emerging infectious diseases often create concern and fear among the public. Ebola virus disease (EVD) and enterovirus (EV-68) are uncommon viral illnesses compared to influenza. The objective of this study was to determine risk for these viral diseases and then determine how public perception of influenza severity and risk of infection relate to more publicized but less common emerging infectious diseases such as EVD and EV-68 among a sample of adults seeking care at an emergency department (ED) in the United States. METHODS: We included consenting adults who sought care in two different urban EDs in Seattle, WA in November 2014. Excluded were those who were not fluent in English, in police custody, had decreased level of consciousness, a psychiatric emergency, or required active resuscitation. Patients were approached to participate in an anonymous survey performed on a tablet computer. Information sought included demographics, medical comorbidities, risk factors for EVD and EV-68, and perceptions of disease likelihood, severity and worry for developing EVD, EV-68 or influenza along with subjective estimates of the number of people who have died of each virus over the year in the United States. RESULTS: A total of 262 (88.5% participation rate) patients participated in the survey. Overall, participants identified that they were more likely to get influenza compared to EVD (p<0.001) or EV-68 (p<0.001), but endorsed worry and concern about getting both EVD and EV-68 despite having little or no risk for these viral diseases. Nearly two-thirds (64%) of participants had at-least one risk factor for an influenza-related complication. Most participants (64%) believed they could get influenza in the next 12 months. Only 52% had received a seasonal influenza vaccine. CONCLUSION: Perception of risk for EVD, EV-68 and influenza is discordant with actual risk as well as self-reported use of preventive care. Influenza is a serious public health problem and the ED is an important healthcare location to educate patients.

The impact of community psychological responses on outbreak control for severe acute respiratory syndrome in Hong Kong.

OBJECTIVE: To examine the public's knowledge and perception of SARS and the extent to which various precautionary measures have been adopted. DESIGN: Cross sectional survey. SETTING: General population of Hong Kong at the height of the SARS outbreak (29 March to 6 April 2003). PARTICIPANTS: 1115 ethnic Chinese adults. MAIN RESULTS: Forty per cent did not recognise fomites as a possible mode of transmission whereas 55.1% believed that the infection could be transmitted airborne. A large proportion (30.1%) believed they were very or somewhat likely to contract SARS while only one quarter believed they were very likely to survive if they contracted the disease, benchmarked against an actual case fatality ratio of 2.8% at the time of the survey and 15%-20% according to current best estimates. Precautionary measures directed against person to person droplet spread were generally adopted by most while the prevention of transmission through fomites was not practised as frequently. Respondents with higher risk perceptions and a moderate level of anxiety were most likely to take comprehensive precautionary measures against the infection, as were older, female, more educated people as well as those with a positive contact history and SARS-like symptoms. CONCLUSIONS: The findings demonstrate that the promotion of protective personal health practices to interrupt the self sustaining transmission of the SARS virus in the community must take into account background perceptions of risk and anxiety levels of the public at large. Continuing public education about preventive measures should be targeted at the identified groups with low current uptake of precautions.

Factors governing speed of societal responses to threats: precision of definition of the threat may be more important than its anticipated likely severity.

Responses to two recent international public health threats, AIDS and BSE, both exemplify missed opportunities for early intervention. They are in contrast to the response to the Y2K computer issue, a threat of lesser-anticipated consequence but one that was more precisely defined. Lessons from these experiences should inform the public health response to new threats, such as the emergence of multiple drug resistance in human pathogens.

Impact of attending a health care conference in Toronto during the severe acute respiratory syndrome crisis: survey of delegates.

OBJECTIVE: To describe the impact on delegates of attending the Canadian Pain Society's annual meeting in Toronto during the severe acute respiratory syndrome (SARS) crisis in May 2003. METHODS: A prospective survey design was used. Surveys were sent to all delegates (n=432) who attended the conference, and 294 delegates responded (68% response rate). The survey was developed to determine the level of concern about travelling to Toronto; the adequacy of screening measures; the level of stress about attending; and the occupational consequences of attending. RESULTS: Fifty per cent of the participants were not concerned about travelling to Toronto, while the other 50% expressed some concern ranging from mild to serious. Concerns included being exposed to SARS and fear of transmitting it to others upon return. Reasons for attending the conference despite concern included a desire for continuing education, decrease in the number of reported SARS cases, and perceived minimal risk. Almost one-half (n=140) felt the screening measures at the conference were adequate, while 4% felt they were inadequate and 9% somewhat adequate. Delegates (n=99) suggested that temperature-taking (32.2%), improved screening vigilance (14.4%), SARS screening forms checked daily (9.1%), strictly controlled entry (8.1%) and adopting hospital screening procedures (7.1%) should have been instituted. CONCLUSION: Health care professionals planning conferences in this era of new respiratory diseases can benefit from understanding the responses of delegates who attended conferences during outbreaks. Clear communication about the potential risks and benefits, as well as instituting full screening precautions, will help to allay concerns.