Youth-developed recommendations on public health planning for future pandemics or public health emergencies: a national Delphi study.

Despite difficult challenges during responses to the terrorist attacks of September 11, 2001, Hurricane Katrina, and the 2009 Pandemic Influenza A/H1N1 and severe acute respiratory syndrome outbreaks, no North American emergency to date has overwhelmed intensive care unit (ICU) services on a widespread basis since the modern development of the field of critical care. However, planners have recognized that in a future public health emergency we may not be so fortunate. To deal with very large emergencies involving many patients whose survival depends on immediate access to intensive care, an international Task Force for Mass Critical Care proposed recommendations in January 2007 to extend critical care resources for the adult population, referred to as the Emergency Mass Critical Care (EMCC) approach (1–5). The EMCC approach triples critical care capabilities for a period of up to 10 days in a very large public health emergency by focusing on immediately lifesaving interventions, while delaying or forgoing less urgent care. Crisis standards of care in a large public health emergency would attempt to optimize population outcomes, rather than use unlimited efforts to maximize survival of each individual. Available resources would be substituted or adapted for equivalent or nearly equivalent unavailable resources. Resources would be conserved, reused, and reallocated to those patients most likely to benefit from them. Modest increases in stockpiles and major changes in the organization of care would be essential. While planners in the field acknowledge that mass critical care is a reasonable concept, we lack evidence that such an approach is feasible. However, failure to begin operational planning for mass critical care guarantees a failed response. As public health emergency planners begin to consider the EMCC framework, it is urgent that pediatric implications be detailed for integration into these developing plans. This supplement represents the discussions of a multidisciplinary panel convened by the Oak Ridge Institute for Science and Education (supported financially by the Centers for Disease Control and Prevention), and provides guidance for pediatric EMCC (PEMCC). Work of the PEMCC Task Force was directed by a 17-member Steering Committee selected on the basis of their expertise and experience, and included representatives from the Task Force for Mass Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, American Academy of Pediatrics, American College of Critical Care Medicine, American College of Emergency Medicine, Royal College of Physicians (Canada), and National Commission on Children and Disasters, as well as several unaffiliated disaster preparedness experts. This Steering Committee led development of all manuscripts and selected individuals for the PEMCC Task Force. The full PEMCC Task Force comprised 44 experts from fields including bioethics, pediatric critical care, pediatric trauma and surgery, neonatology, obstetrics, general pediatrics, emergency medicine, pediatric emergency medicine, disaster preparedness and response, emergency medical services (EMS), infectious diseases, toxicology, military medicine, nursing (including critical care nursing), pharmacy, veterinary medicine, information sciences, public health law, maternal and child public health, and local, state, and federal government emergency planning and response agencies. Priority topics were organized on the basis of MEDLINE and Ovid database literature searches, bibliographies, state and federal government planning documents, after-action reports of recent medical responses to catastrophes, and through participation in local, state, and federal government working groups on hospital and disaster preparedness. Where evidence was available, it was utilized in formulating recommendations. Where evidence was lacking, recommendations represent expert opinion. Wherever possible, recommendations are consistent with and easily integrated into prior recommendations of the adult Task Force for Mass Critical Care. The Steering Committee produced draft outlines by synthesizing information obtained in the evidence-gathering process and convened October 6–7, 2009, to review and Vice President, Medical Affairs, British Columbia Children’s Hospital and Sunny Hill Health Centre; BCCH and UBC Global Child Health, Department of Paediatrics and Emergency Medicine, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada. The Pediatric Emergency Mass Critical Care Task Force meeting was supported, in part, by the Centers for Disease Control and Prevention. Disclaimer: The views expressed in this article are those of the authors and do not represent the official position of the Centers for Disease Control and Prevention. The author has not disclosed any potential conflicts of interest. For information regarding this article, E-mail: nkissoon@cw.bc.ca Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses. The lack of a coordinated response added pressure to an already overwhelmed health care system, which was forced to resort to rationing care and personal protective equipment, creating moral distress and trauma for health care workers and their patients. Despite these severe shortcomings, the COVID-19 pandemic also highlighted successful policies and approaches, such as Operation Warp Speed, which led to the fastest development and distribution of a vaccine in history. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. This policy paper builds on various statements produced by ACP throughout the COVID-19 pandemic, including on the ethical distribution of vaccinations and resources, conditions to resume economic and social activity, and efforts to protect the health and well-being of medical professionals, among others.

Nursing perspectives on care delivery during the early stages of the covid-19 pandemic: A qualitative study.

Peer programs, which pair individuals of similar age or life experience, can address complex psychosocial needs, loneliness, and social isolation among diverse older adults. However, these services were heavily disrupted by the COVID-19 pandemic. This study examined which pandemic-era innovations were sustained across six peer programs and identified core features of peer programs relevant to future public health emergency preparedness. In this mixed-methods study, we first thematically analyzed 67 qualitative interviews (August, 2023-April, 2024) with diverse stakeholders, including older adult participants (n = 24), peer specialists (n = 12), program leaders across six peer programs (n = 12), and experts in aging, public health, and peer programs (n = 19) using a rapid assessment process. Qualitative findings were compared with quantitative trajectories of loneliness and depression among peer program participants over 6-month intervals (May 2020-April 2024). Peer programs have been involved in ongoing efforts to help older adults recover from prolonged loneliness and isolation related to pandemic restrictions. Two pandemic-era innovations were sustained: (1) hybrid communication (in-person, virtual, and telephone) that expanded reach, and (2) new partnerships with health and city services. However, "peer drift," where peers roles can become diluted as they are asked to do more, emerged as a challenge, complicating the consistency and effectiveness of programs. Core features of peer programs identified as relevant to future public health emergency preparedness included: (1) fostering trust with marginalized communities, (2) flexibility in responding to urgent public health needs, and (3) complementary expertise to clinical teams. Quantitative data demonstrated diverse trajectories of loneliness and depression for participants over multiple years of the public health emergency, with interviews indicating how peers helped older adults navigate these challenges. Peer programs have continued to leverage hybrid communication and expanded health and city partnerships to meet the needs of socially isolated older adults. Results further suggest their potential to be integrated into future public health emergency responses.

Background: Although significant scholarly assessments have been made regarding the conditions for restricting fundamental rights under extraordinary circumstances and the impact of public health emergencies on the separation of powers, the literature has not yet been able to fully rely on the systematization of the extensive recent constitutional court jurisprudence—particularly in the Central and Eastern European (CEE) region. In recent years, constitutional courts (or supreme courts with constitutional review powers) have addressed many aspects of the COVID-19 pandemic. A thorough examination of this case law can contribute both theoretically and practically to the legal framework governing public health emergencies, the limitations of fundamental rights, the evolution of the separation of powers, and the reinterpretation of the constitutional effects of the global pandemic. Nevertheless, scholars have repeatedly noted the difficulty in accessing relevant materials, which has hindered further research in this field. Methods: The ConstCovid project aims to close this gap by offering systematic access to global constitutional case law related to COVID-19, thereby expanding the potential for comparative research. Several specific examples from the CEE region will be used to demonstrate the regional usefulness of the ConstCovid database. Based on this case law, the regional tendencies and shortcomings of constitutional practice during public health emergencies will be identified. Utilising the ConstCovid database, this study contributes to the broader understanding of the constitutional ramifications of the COVID-19 pandemic and explores its potential implications for managing future public health emergencies in CCE. Results and conclusions: This contribution draws some conclusions from the analysed constitutional case law stemming from ConstCovid, which may be valuable for preparing potential unwanted future public health emergencies. First, it examines strands of case law that applied general constitutional standards to the extraordinary circumstances. Second, it illustrates that these ways of argumentation were combined inconsistently with the elaboration of new frameworks of constitutional interpretation, resulting in meaningful uncertainty across the region. Third, the analysis highlights the absence of constitutional remedies specifically established to address public health challenges.

EDs play a crucial role as frontline health services throughout public health emergencies, including pandemics. The strength of the Australian public health response to coronavirus disease 2019 (COVID‐19) has mitigated the impact of the pandemic on clinical services, but there has still been a substantial impact on EDs and the health system. We revisit major events and lessons from the first wave of COVID‐19 in Australia to consider the implications and avenues for system‐level improvements for future pandemic and public health emergency response for EDs. Notwithstanding, the remarkable efforts of healthcare workers across the health system, COVID‐19 has uncovered structural and planning challenges and highlighted weaknesses and strengths of the Australian federation. In anticipating future pandemics and other public health threats, particularly in the face of climate change, hard‐won lessons from the COVID‐19 response should be incorporated in future planning, policies, practice and advocacy.

BackgroundThe COVID-19 pandemic and subsequent implementation of public health policies exacerbated multiple intersecting systemic inequities, including homelessness. Housing is a key social determinant of health that played a significant part in the front-line defence against COVID-19, posing challenges for service providers working with people experiencing homelessness (PEH). Public health practitioners and not-for-profit organizations (NFPs) had to adapt existing COVID-19 policies and implement novel measures to prevent the spread of disease within congregate settings, including shelters. It is essential to share the perspectives of service providers working with PEH and their experiences implementing policies to prepare for future public health emergencies and prevent service disruptions.MethodsIn this qualitative case study, we explored how service providers in the non-profit sector interpreted, conceptualized, and implemented COVID-19 public health outbreak control policies in Nova Scotia. We interviewed 11 service providers between September and December 2020. Using thematic analysis, we identified patterns and generated themes. Local, provincial, and national policy documents were useful to situate our findings within the first year of the COVID-19 pandemic and contextualize participants’ experiences.ResultsImplementing policies in the context of homelessness was difficult for service providers, leading to creative temporary solutions, including pop-up shelters, a dedicated housing isolation phone line, comfort stations, and harm reduction initiatives, among others. There were distinct rural challenges to navigating the pandemic, which stemmed from technology limitations, lack of public transportation, and service closures. This case study illustrates the importance of flexible and context-specific policies required to support PEH and mitigate the personal and professional impact on service providers amid a public health emergency. Innovative services and public health collaboration also exemplified the ability to enhance housing services beyond the pandemic.ConclusionsThe results of this project may inform context-specific emergency preparedness and response plans for COVID-19, future public health emergencies, and ongoing housing crises.

Background: Uncertainty is inherent in public health emergency management (PHEM) due to the unpredictable nature of emergencies and interplay of public health threats and their drivers. PHEM practitioners must continually develop and adapt methods to manage this uncertainty. General morphological analysis (GMA) is a computer-aided scenario modelling method that effectively addresses issues where uncertainty exists. GMA examines possible components of a complex problem and allows practitioners to consider potential connections and outcomes. Through iterative steps, GMA can generate new knowledge and insights in the development of scenarios to aid in decision-making and planning within PHEM. Method: An environmental scan was designed to identify articles that utilized GMA as one of the primary methodologies across different natural hazards within the context of PHEM. Academic databases included PubMed and Research Gate. A broad search strategy was applied to scan grey literature which included Google Scholar. Results: This environmental scan identified ten examples of GMA employed in PHEM across multiple countries and organizations. Examples in the literature targeted either a specific natural hazard or broadly targeted all known natural hazards. The findings can be divided into three interconnected categories: (a) scenario modelling for managing natural disasters, (b) strategy development and prioritization tools, and (c) decision-making support tools for emergency management teams. Conclusions: GMA is a decision-making and planning tool in PHEM that can be extended beyond scenario modelling to address uncertainties. This modelling method leverages subject matter experts to uncover innovative connections and outcomes when navigating complex problems like those observed within PHEM. Future research can involve applying GMA to PHEM in a Canadian context. Currently, the Public Health Agency of Canada is applying GMA to cyclical events (e.g., wildfires, floods, extreme heat events, and extreme weather events) to create scenarios using a PHEM lens. Future practice should involve integrating GMA with other PHEM methodologies to enhance strategies to prevent, prepare, respond and recover from future public health emergencies.

Rethinking Infection Control: Nursing Home Administrator Experiences during the COVID-19 Pandemic

Accomplishing provider status: Getting pharmacists paid for their patient care services

BackgroundThe transmission of 2019 novel coronavirus (COVID-19) has caused global panic in the past three years. Countries have learned an important lesson in the practice of responding to COVID-19 pandemic: timely and accurate diagnosis is critical. As an important technology of virus diagnosis, nucleic acid testing (NAT) is also widely used in the identification of other infectious diseases. However, geographic factors often constrain the provision of public health services such as NAT services, and the spatial nature of their resource allocation is a significant problem.MethodsWe used OLS, OLS-SAR, GWR, GWR-SAR, MGWR, and MGWR-SAR models to identify the determinants of spatial difference and spatial heterogeneity affecting NAT institutions in China.ResultsFirstly, we identify that the distribution of NAT institutions in China shows a clear spatial agglomeration, with an overall trend of increasing distribution from west to east. There is significant spatial heterogeneity in Chinese NAT institutions. Secondly, the MGWR-SAR model results show that city level, population density, number of tertiary hospitals and number of public health emergency outbreaks are important factors influencing the spatial heterogeneity of NAT institutions in China.ConclusionsTherefore, the government should allocate health resources rationally, optimise the spatial layout of testing facilities, and improve the ability to respond to public health emergencies. Meanwhile, third-party testing facilities need to focus on their role in the public health emergency response system as a market force to alleviate the inequitable allocation of health resources between regions. By taking these measures to prepare adequately for possible future public health emergencies.

BackgroundThe 2009 H1N1 outbreak provides an opportunity to learn about the strengths and weaknesses of current U.S. public health surveillance systems and to identify implications for measuring public health emergency preparedness.Methodology/Principal FindingsWe adopted a “triangulation” approach in which multiple contemporary data sources, each with different expected biases, are compared to identify time patterns that are likely to reflect biases versus those that are more likely to be indicative of actual infection rates. This approach is grounded in the understanding that surveillance data are the result of a series of decisions made by patients, health care providers, and public health professionals about seeking and providing health care and about reporting cases to health authorities. Although limited by the lack of a gold standard, this analysis suggests that children and young adults are over-represented in many pH1N1 surveillance systems, especially in the spring wave. In addition, the nearly two-month delay between the Northeast and the South in the Fall peak in some surveillance data seems to at least partially reflect regional differences in concerns about pH1N1rather than real differences in pH1N1 infection rates.Conclusions/SignificanceAlthough the extent of the biases suggested by this analysis cannot be known precisely, the analysis identifies underlying problems with surveillance systems – in particular their dependence on patient and provider behavior, which is influenced by a changing information environment – that could limit situational awareness in future public health emergencies. To improve situational awareness in future health emergencies, population-based surveillance systems such as telephone surveys of representative population samples and seroprevalence surveys in well-defined population cohorts are needed.

For health educators to successfully meet the challenges of responding to public health emergencies, it is important to establish and understand the role of collaborations with local, state and federal partners in identifying potential public health issues and to develop theory-based models or strategies to address these issues before, during and after an event. This paper presents a case study examining the health education and communication response to Hurricane Katrina in Houston, Texas. CDC's Health Education and Communication Teams and the Harris County Public Health and Environmental Services Division of Health Education worked with identified populations, environmental specialists, epidemiologists and other key partners to identify health education needs and develop appropriate messages and then developed and implemented a broad comprehensive health education and promotion plan. The paper discusses lessons learned and how health educators can use the model developed for this response to plan for future disasters and public health emergencies, including pandemic influenza.

One of the most distressing aspects of the coronavirus disease (COVID-19) pandemic in the U.S. is the lopsided damage that it has triggered to poor communities and communities of color. COVID-19 has emphasized the importance of new approaches to community engagement, community support, and cultural competence related to public health logistics planning, supply chain response, and service of people of color in the U.S. because of past inequities in terms of advance warning, health education, and aid to certain communities. An escape room training experience was used to allow participants from minority communities, emergency response planners, and policy makers to engage each other in a collective learning experience. There was tremendous value for the managers because they were able to engage with culturally diverse participants in a way that allowed them to understand problem-solving from different lenses when they plan and set priorities about community aid and support in future public health emergencies.

Public health emergencies threaten the overall public health security of the country. Based on the need to control the ways of infection, the collection and processing of personal information by the government have become an important part of epidemic prevention and control. However, personal information related to the epidemic is highly sensitive, which contains other personal information and even private information in addition to information on personal health. In the early days of China's response to the public health emergency of COVID-19, a great deal of non-desensitized information was transmitted in an unaccredited manner. With the implementation of epidemic prevention and control measures, the collection and processing of personal information in China have gradually transited from the initial disorder and chaos to the current orderly, legal, and effective situation, continuously optimizing the processing paths of personal information. Serious summary and reflection on the optimization path of China's epidemic-related information collection and processing methods by looking for a border at which the way and scope of personal information disclosure in future major public health emergencies are compatible with its purpose and role may help to improve the development of China's personal information protection legal system from a long-term perspective.