On Pandemics Being Productive

BackgroundThe COVID-19 pandemic provided a unique opportunity to learn about acute health organisations experiences implementing a pandemic response plan in real-time. This study was conducted to explore organisational leader’s perspectives and experience activating a COVID-19 pandemic response plan in their health service and the impact of this on service provision, clinicians, and consumers.MethodsThis study was conducted at a large metropolitan health service in Australia that provides acute, subacute, and residential aged care services. Semi-structured interviews were conducted with 12 key participants from the COVID-19 leadership team between November-January 2021/2022. A semi-structured interview guide was developed to explore how the health service developed a clinical governance structure, policy and procedures and experience when operationalising each element within the Hierarchy of Controls Framework. Thematic analysis was used to code data and identify themes. A cross-sectional survey of frontline healthcare workers on the impacts and perceptions of infection control practices during the COVID-19 pandemic, was also completed in 2021 with 559 responses.ResultsTwelve organisational leaders completed the semi-structured interviews. Key themes that emerged were: (1) Building the plane while flying it, (2) A unified communications strategy, (3) Clinicians fear ‘my job is going to kill me’, (4) Personal Protective Equipment (PPE) supply and demand, and (5) Maintaining a workforce. When surveyed, front-line healthcare workers responded positively overall about the health services pandemic response, in terms of communication, access to PPE, education, training, and availability of resources to provide a safe environment.ConclusionHealth service organisations were required to respond rapidly to meet service needs, including implementing a pandemic plan, developing a command structure and strategies to communicate and address the workforce needs. This study provides important insights for consideration when health service leaders are responding to future pandemics. Future pandemic plans should include detailed guidance for acute and long-term care providers in relation to organisational responsibilities, supply chain logistics and workforce preparation.

BackgroundAs the first point of contact in health care, primary care providers play an integral role in pandemic response. Despite this, primary care has been overlooked in previous pandemic plans, with a lack of emphasis on ways in which the unique characteristics of family practice could be leveraged to create a more effective response.AimTo explore family physicians’ perceptions of the integration of primary care in the COVID-19 pandemic response.Design and settingDescriptive qualitative approach examining family physician roles during the COVID-19 pandemic across four regions in Canada.MethodSemi-structured qualitative interviews were conducted with family physicians and participants were asked about their roles during each pandemic stage, as well as facilitators and barriers they experienced in performing these roles. Interviews were transcribed and a thematic analysis approach was employed to develop a unified coding template across the four regions and identify recurring themes.ResultsIn total, 68 family physicians completed interviews. Four priorities for integrating primary care in future pandemic planning were identified: 1) improve communication with family physicians; 2) prioritise community-based primary care; 3) leverage the longitudinal relationship between patients and family physicians; and 4) preserve primary care workforce capacity. Across all regions, family physicians felt that primary care was not well incorporated into the COVID-19 pandemic response.ConclusionFuture pandemic plans require greater integration of primary care to ensure the delivery of an effective and coordinated pandemic response. Strengthening pandemic preparedness requires a broader reconsideration and better understanding of the central role of primary care in health system functioning.

IntroductionDuring the COVID-19 pandemic, primary care providers rapidly adapted their practice in response to emerging knowledge of infection risk, resource availability and evolving patient and system needs. Given the previous lack of guidance specific to primary care settings, there is a need to formalise and integrate lessons learnt from these successful adaptations into future pandemic plans. Our project will develop a model for pandemic planning in primary care designed for replication in other Canadian regions and internationally to facilitate the scale and spread of effective primary care pandemic response strategies.Methods and analysisWe will apply a pragmatic approach and a sequential multiple-methods design consisting of three objectives: (1) scoping review, (2) priority setting exercise and (3) plan creation. For objective 1, we will conduct a scoping review to identify the essential supports of a pandemic response plan for primary care at the clinic, community, regional and provincial levels in Canada and comparable countries. We will conduct the review in accordance with the Joanna Briggs Institute methodology (search date July 2025) and synthesise findings based on recurring themes. For objective 2, we will engage primary care providers, public health professionals and health system managers in a priority-setting exercise consisting of deliberative dialogues and a Delphi process. The exercise will involve a presentation and three rounds of online surveys asking participants to rank the importance of various pandemic supports for primary care. We estimate that 100 participants will attend the presentations and 60 will complete all three rounds of the survey. For objective 3, we will co-create clinic-level, community-level and region-level pandemic response plans in Southwestern Ontario through working groups led by primary care providers and public health members of the research team, with an aim to engage approximately 12–24 participants. We will use rapid reviews, stakeholder input and evidence gathered in earlier components of the project to operationalise prioritised supports.Ethics and disseminationWe obtained ethics approval from the Western University Research Ethics Board (project ID: 127132) and will use best practices for promoting consent, confidentiality and data security. We will disseminate findings through regional, national and international conferences, peer-reviewed journal publications and online platforms. Lastly, we will develop and share a toolkit for pandemic planning in primary care to encourage further research and inform future pandemic preparedness efforts.

Future pandemic planning involves analysing past experiences. We compared intensive care unit (ICU) admissions during the SARS-CoV-2 pandemic (2020) with the preceding year. To assess the SARS-CoV-2 pandemic's effect on ICU admissions in a tertiary hospital, examining differences in patient characteristics, organ support requirements, reason for admission, mortality rates and length of ICU stay. This retrospective cohort study compared ICU patient data at a tertiary hospital during the SARS-CoV-2 pandemic (26 March 2020 to 20 September 2020) with the same period in 2019. Patient admissions (p=0.39) and severity of illness (p=0.27 adults; p=0.92 paediatrics) showed no differences across the study period. Similarly, no differences were observed for underlying chronic conditions between the two years. Adult trauma admissions significantly declined, specifically those related to road traffic accidents (RR 0.63). Admissions for acute infectious conditions, including respiratory infections, sepsis, urosepsis, septic arthritis and gastroenteritis significantly declined in both adults (RR 0.50) and paediatric admissions (RR 0.25). During the lockdown period, the length of stay (LOS) decreased for adults, but mortality rates remained unchanged across the study period. The paediatric mortality rate decreased during the lockdown period (p=0.004). There was no reduction in SARS-CoV-2-negative ICU admissions during the 2020 lockdown period compared with the preceding year, likely due to chronic resource limitations. We found a decrease in acute trauma and acute infectious illness admissions, while acute surgical emergency admissions increased. These findings suggest that lockdown orders may have affected admission patterns, aiding in future pandemic planning. The study highlights the chronic shortage of critical care resources in South Africa and aids with future pandemic preparedness and planning in a resource limited setting.

National Surveillance for Health-Related Workplace Absenteeism, United States 2017-18

The terrorist attacks of September 11, 2001, initiated a shift toward a comprehensive, or "all-hazards," framework of emergency preparedness in the United States. Since then, the threat of H5N1 avian influenza, the severe acute respiratory syndrome epidemic, and the 2009 H1N1 influenza pandemic have underscored the importance of considering infectious events within such a framework. Pediatric emergency departments (EDs) were disproportionately burdened by the 2009 H1N1 influenza pandemic and therefore serve as a robust context for evaluation of pandemic preparedness. The objective of this study was to explore pediatric ED leaders' experiences with preparedness, response, and postincident actions related to the H1N1 pandemic to inform future pandemic and all-hazards planning and policy for EDs. The authors selected a qualitative design, well suited for exploring complex, multifaceted organizational processes such as planning for and responding to a pandemic and learning from institutional experiences. Purposeful sampling was used to recruit medical directors or their designated physician respondents from pediatric emergency medicine training institutions representing a range of geographic regions across the United States, hospital types, and annual ED volumes; snowball sampling identified additional information-rich respondents. Recruitment began in May 2011 and continued until thematic saturation was reached in January 2012 (n = 20). Data were collected through in-depth individual phone interviews that were recorded and professionally transcribed. Using a standard interview guide, respondents were asked open-ended questions about pandemic planning, response, and institutional learning related to the H1N1 pandemic. Data analysis was performed by a multidisciplinary team using a grounded theory approach to generate themes inductively from respondents' expressed perspectives. The constant comparative method was used to identify emerging themes. Five common themes characterized respondents' experiences with pandemic planning and response: 1) national pandemic influenza preparedness guidance has not fully penetrated to the level of pediatric emergency physician (EP) leaders, leading to variable states of preparedness; 2) pediatric EDs that maintained strong relationships with local public health and other health care entities found those relationships to be beneficial to pandemic response; 3) pediatric EP leaders reported difficulty reconciling public health guidance with the reality of ED practice; 4) although many anticipated obstacles did not materialize, in some cases pediatric EP leaders experienced unexpected institutional challenges; and 5) pediatric EP leaders described varied experiences with organizational learning following the H1N1 pandemic experience. Despite a decade of investment in hospital preparedness, gaps in pediatric ED pandemic preparedness remain. This work suggests that raising awareness of pandemic planning standards and promoting strategies to overcome barriers to their adoption could enhance ED and hospital preparedness. Helping hospitals better prepare for pandemic events may lead to strengthened all-hazards preparedness.

To describe the reported impact of Pandemic (H(1)N(1) ) 2009 on EDs, so as to inform future pandemic policy, planning and response management. This study comprised an issue and theme analysis of publicly accessible literature, data from jurisdictional health departments, and data obtained from two electronic surveys of ED directors and ED staff. The issues identified formed the basis of policy analysis and evaluation. Pandemic (H(1)N(1) ) 2009 had a significant impact on EDs with presentation for patients with 'influenza-like illness' up to three times that of the same time in previous years. Staff reported a range of issues, including poor awareness of pandemic plans, patient and family aggression, chaotic information flow to themselves and the public, heightened stress related to increased workloads and lower levels of staffing due to illness, family care duties and redeployment of staff to flu clinics. Staff identified considerable discomfort associated with prolonged times wearing personal protective equipment. Staff believed that the care of non-flu patients was compromised during the pandemic as a result of overwork, distraction from core business and the difficulties associated with accommodating infectious patients in an environment that was not conducive. This paper describes the breadth of the impact of pandemics on ED operations. It identifies a need to address a range of industrial, management and procedural issues. In particular, there is a need for a single authoritative source of information, the re-engineering of EDs to accommodate infectious patients and organizational changes to enable rapid deployment of alternative sources of care.

Should public health policy exempt cases with low viral load from isolation during an epidemic?: a modelling study.

Safety and immunogenicity of influenza A(H5N1) vaccine stored up to twelve years in the National Pre-Pandemic Influenza Vaccine Stockpile (NPIVS)

The core values of community health nursing practice are rooted in the social determinants of health, health equity and social justice. Throughout the COVID-19 pandemic, community health nurses (CHNs) witnessed first-hand the impact on individuals in situations of marginalization. This research inquiry explored how health inequities among client populations contributed to experiences of MD among CHNs in Canada during the pandemic. A total of 245 CHNs from across Canada participated in an online survey. Participants reported that during the pandemic individuals living in situations of marginalization were disproportionately impacted. CHNs were unable to provide the necessary health promotion interventions and experienced high levels of moral distress. The negative impact of the pandemic on individuals living in situations of marginalization illuminated the intersecting social and structural inequities that drive negative health outcomes and emphasized the need to adopt an equity focus for current and future pandemic planning, response, and recovery.

Background The COVID-19 pandemic changed the face of modern healthcare, with impacts felt by staff and organisations alike. Globally, hospital-based healthcare workers have identified increased stress, anxiety, insomnia, and reduced wellbeing related to their work roles. Hospitals have been plagued by increased demand, poor staff retention and a reduction in the working hours of remaining staff. This paper sought to explore the unique experiences of frontline healthcare workers (FHWs) with parenting responsibilities working in Australian hospitals during the COVID-19 pandemic. Methods Thirty-nine FHWs with parenting responsibilities from Australian public hospitals were interviewed from October 2020 and February 2021. Reflexive thematic analysis was used to interrogate transcripts arising from extended interviews with participants regarding their experiences with healthcare work and the workplace support they received during the COVID-19 pandemic. Results Key themes indicate that workplace changes during the early stages of the pandemic were rapid and placed significant burden on healthcare staff and leaders, impacting their physical, mental and social health. Support from leaders was seen as protective for staff but placed an additional burden on staff in leadership roles. Additionally, when leaders considered family safety and were flexible when family demands surged, staff reported better wellbeing and feelings of support. While staff felt a sense of pride in their role during this time and were motivated by family members, they reported reduced career enjoyment and were concerned about long-term mental health consequences. Conclusions The challenges and fatigue associated with healthcare work during a pandemic can impact FHWs in varied ways. However, findings during the COVID-19 pandemic sheds light on important areas that can be bolstered and enhanced during pandemic planning that can prevent negative impacts in future pandemics. Key messages • The COVID-19 pandemic has demonstrated how a pandemic significantly impact healthcare roles and the wellbeing of staff, indicating a need for better pandemic planning in the future. • Important factors to consider during future pandemic planning are proper management of workplace changes, managing staff's work life balance and family safety, and enhancing support from leaders.

ObjectivesThe disproportionate impact of coronavirus (COVID-19) on African Americans along with associated inequities in social determinants of health (SDOH) and racism increase their vulnerability to the psychosocial impact of COVID-19. This qualitative study applied the socio-ecological model (SEM) to explore psychosocial stressors, coping styles, and needs to improve psychosocial health among unique subgroups of African Americans in early pandemic stages.MethodsSixty-two African Americans (16 parents, 15 young adults, 16 essential workers, and 15 individuals with underlying medical conditions) participated in qualitative, semi-structured interviews between May and September 2020. Interview data were analyzed based on the SEM using thematic analysis.ResultsThe majority (84%) reported being stressed with parents having the highest level. Four themes emerged : (1) our COVID-19 pandemic state of mind, (2) top stressors in the early stages of the COVID-19 pandemic, (3) coping strategies during COVID-19, and (4) needs during the COVID-19 pandemic to reduce stress. While there were similarities, different stressors were experienced among subgroups, which yielded different coping styles and needs from stakeholders across multi-levels to improve their psychosocial health.ConclusionsFindings suggest current and future pandemic response plans need targeted strategies across multiple levels of influence to address the psychosocial impact of the COVID-19 pandemic on African Americans.

ObjectiveTo describe the disruptions in care experienced by persons with Multiple Sclerosis in Italy due to the COVID-19 pandemic and the self-reported impact on their health and wellbeing.MethodsA cross-sectional online survey was completed by 2722 persons with Multiple Sclerosis, after Italy instituted a national lockdown in response to the pandemic.ResultsPersons with Multiple Sclerosis reported that the pandemic caused broad disruptions to usual health and social care services, which impacted on their health and wellbeing. Disruptions in care were consistently associated with negative self-reported impacts on the expected progression of the disease, on out-of-pocket expenditure and on carer’s stress. Psychological consequences were associated with interruption to usual psychological support, and concerns about the safety of care delivered in person.ConclusionsThe quality of life of persons with Multiple Sclerosis depends greatly on prompt access to a broad range of health and care services. Negative psychological impacts reported by persons with Multiple Sclerosis with less severe disabilities show that accessible integrated services are crucial for maintenance of their wellbeing. Most persons with Multiple Sclerosis with more severe disability experienced negative impacts on perceived health. Their carers compensating for lack of social input resulted in care overburden. As continuity of care is crucial for persons with Multiple Sclerosis, as well as for persons with chronic conditions in general, strategies must be in place to ensure it is included in future pandemic response plans.

RESUMENEn 2009 se vivió la pandemia del H1N1 con una serie de implicaciones éticas que influyeron en el abordaje de la crisis. En el marco de la pandemia por el coronavirus SARS-CoV-2 se han repetido estas cuestiones, y el análisis de lo sucedido en 2009 ha resultado premonitorio. Los principios de justicia, solidaridad, equidad, transparencia y reciprocidad deben ser incluidos en los futuros planes de respuesta ante pandemias, incluyendo las lecciones aprendidas.

COVID-19 pandemic has given rise to unprecedented challenges to global health and mobility. A valuable lesson from this recent pandemic is that migration statistics can be relied on to illuminate the spread of an epidemic and model diffusion patterns once a highly contagious virus is detected in a country. This study reviews literature published between 2020 and 2021, giving insights into the generation and use of migration and mobility data in COVID-19 response in the East Africa Community (EAC). The reviewed studies regarding the EAC Regional COVID-19 Response Plan all point to the need for timely data, but do not specify requirements for mobility and migration statistics. Several studies featured in this review propounded innovative ways to obtain and use the data in COVID-19 modeling. The study concludes that there is potential for use of migration statistics in future pandemic response plans and recommends that the EAC mainstreams migration statistics within the pandemic response processes.