COVID-19 Preparedness Research Articles

Perception and preparedness of physicians in public-sector hospitals of LMICs during the COVID-19 pandemic: a phenomenology-based qualitative study

Background: Amid such a global chaotic scenario generated by the COVID-19 pandemic, physicians hold a significant frontline position in the health care system. The current study was designed to explore the perception and preparedness of physicians toward the COVID-19 pandemic and their patient assessment and management aspects. Methods: A total of 11 physicians were purposively interviewed. All the interviews were audio-taped, transcribed verbatim, and subjected to thematic content analysis. Results: Thematic content analysis yielded six major themes: familiarity with COVID-19, perceptions and attitudes toward COVID-19, preparedness for safety against COVID-19, case assessment, barriers to lifestyle, and psychological perspectives. Even in resource-limited settings with the scarcity of sufficient protective equipment and first-line medicines, the physicians provided patient care. They demonstrated intact self-esteem and better understanding and preparedness for COVID-19. Conclusions: The findings demand timely and adequate provision of personal protection equipment, availability of first-line medicines, as well as development and implementation of occupational health surveillance measures that ensure mental health well-being.

Are prison settings included in national preparedness plans?

Abstract With the aim to explore the extent to which places of detention are considered in national preparedness planning in the WHO European Region, a desktop review was conducted and combined with responses to the Health in Prisons European Database (HIPED) survey from Member States referring to 2020. In both searches, the aim was to identify the existence of: 1) national pandemic preparedness plans written prior to the COVID-19 pandemic; and 2) national pandemic preparedness and response plans specific to the COVID-19 pandemic. Where prisons were included, all aspects of pandemic preparedness relating to prisons were extracted and collated as per the main domains of the WHO checklist for influenza pandemic preparedness plans. The desktop review found that 30 Member States had pandemic plans accessible online, but only seven included any mention of prisons. Responses to the HIPED survey suggested wide dissemination of a COVID-19 preparedness and/or response plan, but only six out of 36 Member States referred to prisons or the vulnerabilities of people living in places of detention. The combined findings suggest that prisons are rarely considered in national planning and that lessons from previous pandemics have not led to a change in recognizing that prisons are high-risk environments for pathogen transmission and that failing to consider them in national planning may lead to impacts that affect the wider community.

Exploring the effects of COVID-19 outbreak control policies on services offered to people experiencing homelessness

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.

International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

"Surveillance Preparedness for COVID-19 and Other Infectious Diseases in New Zealand: Embracing Digital Health and Telemedicine in Vast and Isolated Territories"

"Surveillance Preparedness for COVID-19 and Other Infectious Diseases in New Zealand: Embracing Digital Health and Telemedicine in Vast and Isolated Territories"

COVID-19 preparedness and response in the Pitcairn Islands: keeping one of the world's smallest and most isolated populations safe in a pandemic.

While the COVID-19 pandemic threatened the entire world, the extremely remote Pitcairn Islands faced unique vulnerabilities. With only a physician and a nurse to care for an ageing population of fewer than 40 residents, and with very limited referral pathways, Pitcairn encountered distinct challenges in preparing for and responding to the COVID-19 pandemic. The Pitcairn Islands is an overseas territory of United Kingdom of Great Britain and Northern Ireland consisting of four islands in the South Pacific: Pitcairn, Henderson, Ducie and Oeno. Pitcairn is the only inhabited island with a local resident population of approximately 31 people, around half of whom were over 60 years old in 2023. The islands are only accessible by sea and are located more than 2000km from the nearest referral hospital in French Polynesia. Pitcairn's Island Council took aggressive action to delay the importation of SARS-CoV-2, vaccinate its small population and prepare for the potential arrival of the virus. As of May 2024, Pitcairn was one of the only jurisdictions in the world not to have had a single COVID-19 hospitalization or death. Nevertheless, the pandemic presented the islands' population with many economic, social and health challenges. Pitcairn's population avoided COVID-19-related hospitalizations and deaths despite its elderly population's vulnerability to COVID-19, a significant level of comorbidities, and limited clinical management capabilities and options for emergency referrals. The pandemic highlighted some of the population's health vulnerabilities while also underscoring some of their innate strengths.

Investigation of the hospital pharmacy profession in Europe

ObjectiveFrom 1995, the European Association of Hospital Pharmacists (EAHP) has regularly investigated the progress of the hospital pharmacy profession in Europe, and identified key barriers and drivers of this. The...

Quantifying holistic capacity response and healthcare resilience in tackling COVID-19: Assessment of country capacity by MCDM.

The resilience of a country during the COVID-19 pandemic was determined based in whether it was holistically prepared and responsive. This resilience can only be identified through systematic data collection and analysis. Historical evidence-based response indicators have been proven to mitigate pandemics like COVID-19. However, most databases are outdated, requiring updating, derivation, and explicit interpretation to gain insight into the impact of COVID-19. Outdated databases do not show a country's true preparedness and response capacity, therefore, it undermines pandemic threat. This study uses up-to-date evidence-based pandemic indictors to run a cross-country comparative analysis of COVID-19 preparedness, response capacity, and healthcare resilience. PROMETHEE-a multicriteria decision making (MCDM) technique-is used to quantify the strengths (positive) and weaknesses (negative) of each country's COVID-19 responses, with full ranking (net) from best to least responsive. From 22 countries, South Korea obtained the highest net outranking value of 0.1945, indicating that it was the most resilient, while Mexico had the lowest (-0.1428). Although countries were underprepared, there was a robust response to the pandemic, especially in developing countries. This study demonstrates the performance and response capacity of 22 key countries to resist COVID-19, from which other countries can compare their statutory capacity ranking in order to learn/adopt the evidence-based responses of better performing countries to improve their resilience.

National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people

IntroductionInfectious disease outbreaks have historically led to widespread disruptions in routine essential health services. Disruptions due to COVID-19 responses led to excess deaths, including among women and children. This review...

Retail operations strategy for improved customer experience: a better response to crises such as COVID-19 pandemic

Purpose Discount grocery stores (DGSs) are attractive food supply chain (FSC) channels because many cost-conscious Indians use them for monthly needs. Despite capacity, DGSs must address customer concerns about store crowd densities and improve their COVID-19 preparedness. The purpose of this study is to learn how retail operations strategies can improve customer experience and how stores can benefit. Design/methodology/approach The study looked at a case study where retail operations are run more efficiently, and the customer experience is enhanced by standardizing and customizing customer transactions. The potential benefits that customers and retailers might anticipate are then statistically verified. Next, the potential benefits were examined to determine which ones from customers’ and retailers’ views should be prioritized to increase satisfaction. Findings The case situation analysis in the study demonstrates how DGSs can improve their retail operations to reduce customer wait times and provide greater convenience. The study also provides practitioners with potential benefits to pursue from the perspectives of retailers, customers and both retailers and customers. Research limitations/implications This study requires many past transactions and can be considered an extension of the current study, so it does not capture floor space and capacity improvements. Practical implications This research can help FSC retailers compete with upstream supply chain partners and customers in omnichannel retailing. By improving DGS retailer capacity and customer experience, this study can benefit all FSC stakeholders. Originality/value Although there are numerous potential benefits that practitioners can pursue, the current study suggests that practitioners focus on those that can improve retailer and customer satisfaction.

Pandemic Preparedness for COVID-19: Research, Healthcare, and Pharmaceutical Perspectives

Abstract: The COVID-19 pandemic has highlighted the critical importance of pandemic preparedness worldwide, following the devastating 1918 pandemic. The rapid spread of COVID-19, originating in China, led to its classification as a global pandemic by the World Health Organization. COVID-19 is a member of the Coronaviridae family, a large family of viruses that have undergone extensive mutation and evolution over time. Among the coronaviruses, SARS-CoV-2, a Betacoronavirus, has emerged as a highly virulent pathogen capable of causing severe illness and fatalities in both humans and animals. Since 1966, various types of coronaviruses have surfaced, each exhibiting distinct mutations and structural characteristics. These genetic changes have contributed to the enhanced potency of the virus, intensifying the global pandemic crisis we face today. In response, the pharmaceutical approach to combat COVID-19 encompasses a multifaceted strategy. This includes the development of novel antiviral drugs specifically targeting the virus, as well as the repurposing of existing medications to evaluate their effectiveness against the virus. Additionally, there is a growing interest in exploring the potential of herbal and traditional medicine in the treatment of COVID-19. Continued research and collaboration among scientists, healthcare professionals, and pharmaceutical companies are crucial in the quest to find effective treatments for COVID-19 and to mitigate the impact of future coronavirus outbreaks. It is imperative to recognize the power and adaptability of microorganisms, emphasizing the need for vigilance and caution in preventing and managing infectious diseases. By investing in robust pandemic preparedness, measures and fostering global cooperation, we can enhance our ability to respond effectively to emerging viral threats and safeguard public health.

Developing COVID-19 Preparedness in a Pediatric Nursing Course: Knowledge, Confidence, Attitudes, and Practice

Developing COVID-19 Preparedness in a Pediatric Nursing Course: Knowledge, Confidence, Attitudes, and Practice

Faradaic Impedimetric Immunosensor for Label-Free Point-of-Care Detection of COVID-19 Antibodies Using Gold-Interdigitated Electrode Array.

Label-free electrochemical biosensors have many desirable characteristics in terms of miniaturization, scalability, digitization, and other attributes associated with point-of-care (POC) applications. In the era of COVID-19 and pandemic preparedness, further development of such biosensors will be immensely beneficial for rapid testing and disease management. Label-free electrochemical biosensors often employ [Fe(CN)6]-3/4 redox probes to detect low-concentration target analytes as they dramatically enhance sensitivity. However, such Faradaic-based sensors are reported to experience baseline signal drift, which compromises the performance of these devices. Here, we describe the use of a mecaptohexanoic (MHA) self-assembled monolayer (SAM) modified Au-interdigitated electrode arrays (IDA) to investigate the origin of the baseline signal drift, developed a protocol to resolve the issue, and presented insights into the underlying mechanism on the working of label-free electrochemical biosensors. Using this protocol, we demonstrate the application of MHA SAM-modified Au-IDA for POC analysis of human serum samples. We describe the use of a label-free electrochemical biosensor based on covalently conjugated SARS-CoV-2 spike protein for POC detection of COVID-19 antibodies. The test requires a short incubation time (10 min), and has a sensitivity of 35.4/decade (35.4%/10 ng mL-1) and LOD of 21 ng/mL. Negligible cross reactivity to seasonal human coronavirus or other endogenous antibodies was observed. Our studies also show that Faradaic biosensors are ~17 times more sensitive than non-Faradaic biosensors. We believe the work presented here contributes to the fundamental understanding of the underlying mechanisms of baseline signal drift and will be applicable to future development of electrochemical biosensors for POC applications.

Hospital-Level COVID-19 Preparedness and Crisis Management in Czechia.

Objectives: The COVID-19 pandemic exposed the inadequacy of pandemic preparedness mechanisms worldwide. This study gathered comprehensive data from Czech hospitals, identified possible weaknesses in important areas of crisis preparedness, and quantified changes performed to enhance crisis resilience of healthcare facilities. Methods: Drawing on literature review on pandemic preparedness and hospital crisis management and detailed interviews with hospital representatives, a questionnaire was designed and distributed by email among quality managers of all Czech hospitals. Statistical analysis of their responses was conducted using EZR software. Fisher's exact test and Kruskal-Wallis test, with post hoc testing, were used to assess statistical significance. Results: Achieving response rate of 31.9%, responses from 65 hospitals were analysed. New crisis management policies were necessary in 72.3% of responding hospitals. Furthermore, a majority of the respondents changes indicated the need for changes in policies on general pandemic, human resources and infrastructure and material preparedness. Conclusion: The COVID-19 crisis required significant alterations to previously established hospital crisis management protocols and establishment of new ones. The absence of a unified system for crisis preparedness was noted at hospital and national levels.

The relationship between health system affiliation and hospital strategies for COVID-19 preparedness

PurposeTo evaluate the association between health system affiliation and hospitals’ reported responses to the COVID-19 pandemic. MethodsBetween September 14, 2020 and November 20, 2020, we conducted a survey of hospital administrators. We linked these survey results to county-level data on COVID-19 incidence and hospital affiliation data from the Agency for Healthcare Research and Quality Compendium on US Health Systems. We analyzed the association between health system affiliation and hospitals’ reported responses to the COVID-19 pandemic. ResultsWe analyzed data from 217 general, short-stay, acute-care hospitals who responded to the survey. Health system affiliated hospitals reported increased adoption of policies to accept fewer patients in transfer (adjusted OR 2.06, 95% CI 1.01 – 4.21, p = 0.047), increased adoption of new ICU telemedicine programs (adjusted OR 4.90, 95% CI 1.09 – 22.1, p = 0.039), and decreased repurposing of medical-surgical units as ICUs (adjusted OR 0.51, 95% CI 0.27 – 0.97, p = 0.041). ConclusionsHospitals affiliated with health systems responded differently to the pandemic than non-system affiliated hospitals, including in ways that may have promoted efficient management of critical care demand and supply across hospitals. These findings suggest interhospital coordination may play an important role in disaster and pandemic preparedness.

Pattern of Public Healthcare Expenditure and Preparedness for COVID-19 in India: An Interstate Analysis

The present study made an attempt to examine the changing pattern of public healthcare expenditure across Indian states for the period 1979–1980 to 2019–2020 and tried to relate this with the spread and mortality of COVID-19 infected cases. An attempt was also made to analyse the responsiveness of per capita public healthcare expenditure (PCPHE) with the change in per capita GSDP (PCGSDP) to a much-disaggregated level. The supply side composite index (SSCI), panel regression and panel generalised method of moments (GMM) was used for analytical purpose. The study found that the greater variation in PCPHE across Indian states start exhibiting since the early years of initiation of NRHM policy and continued till recent years. Unlike the PCPHE, the public healthcare expenditure to GSDP ratio declined for all states in the subsequent time periods. The value of SSCI for both revenue and capital expenditure was low in states having larger populations and geographical areas. The study argued that the average PCPHE across Indian states exhibited irregular pattern of association with the COVID-19 confirmed cases, positivity and death rate. The panel GMM estimate of PCPHE exhibited an inelastic relationship with PCGSDP implying public healthcare is a ‘necessity’ across the Indian states.

COVID-19 preparedness and response in rural and remote areas: A scoping review

This scoping review used the Arksey and O’Malley approach to explore COVID-19 preparedness and response in rural and remote areas to identify lessons to inform future health preparedness and response planning. A search of scientific and grey literature for rural COVID-19 preparedness and responses identified 5 668 articles published between 2019 and early 2022. A total of 293 articles were included, of which 160 (54.5%) were from high income countries and 106 (36.2%) from middle income countries. Studies focused mostly on the Maintenance of Essential Health Services (63; 21.5%), Surveillance, epidemiological investigation, contact tracing and adjustment of public health and social measures (60; 20.5%), Coordination and Planning (32; 10.9%); Case Management (30; 10.2%), Social Determinants of Health (29; 10%) and Risk Communication (22; 7.5%). Rural health systems were less prepared and national COVID-19 responses were often not adequately tailored to rural areas. Promising COVID-19 responses involved local leaders and communities, were collaborative and multisectoral, and engaged local cultures. Non-pharmaceutical interventions were applied less, support for access to water and sanitation at scale was weak, and more targeted approaches to the isolation of cases and quarantine of contacts were preferable to blanket lockdowns. Rural pharmacists, community health workers and agricultural extension workers assisted in overcoming shortages of health professionals. Vaccination coverage was hindered by weaker rural health systems. Digital technology enabled better coordination, communication, and access to health services, yet for some was inaccessible. Rural livelihoods and food security were affected through disruptions to local labour markets, farm produce markets and input supply chains. Important lessons include the need for rural proofing national health preparedness and response and optimizing synergies between top-down planning with localised planning and coordination. Equity-oriented rural health systems strengthening and action on rural social determinants is essential to better prepare for and respond to future outbreaks.

Assessing US Small Animal Veterinary Clinic Adaptations and Their Impacts on Workforce COVID-19 Preparedness and Response.

Veterinary personnel are an essential yet often underappreciated workforce, critical for zoonotic disease prevention and response efforts that impact human health. During the early COVID-19 pandemic, the veterinary workforce supported emergency responses by promoting zoonotic disease risk communication, sharing animal health expertise, and boosting laboratory surge capacity against SARS-CoV-2 in animals and people. However, small animal veterinary workers (SAVWs), similar to healthcare workers, faced organizational challenges in providing clinical care to family pets, including those susceptible to SARS-CoV-2. We analyzed a cross-sectional survey of 1,204 SAVWs in the United States to assess veterinary clinic adaptations and their associations with SAVWs' self-perceived readiness, willingness, and ability to respond to the COVID-19 pandemic as a workforce. SAVWs who worked fewer hours than before the pandemic (ready, OR 0.59; willing, OR 0.66; able, OR 0.52) or used personal protective equipment less frequently for protection in the clinic (ready, OR 0.69; willing, OR 0.69; able, OR 0.64) felt less ready, willing, and able to respond to COVID-19. SAVWs working remotely felt less ready (OR 0.46) but not less willing or able to respond to COVID-19. Lastly, SAVWs with dependents felt less ready (OR 0.67) and able (OR 0.49) to respond to COVID-19 than SAVWs without dependents. Our findings highlight the importance of proactively managing work schedules, having access to personal protective equipment, and addressing caregiving concerns to enhance SAVW preparedness and response outcomes. SAVWs are knowledgeable, motivated personnel who should be integrated into local public health emergency preparedness and response plans, supporting a One Health framework that unites multidisciplinary teams to respond to future zoonotic disease threats.

Introduction and acceptability of the Surveillance Outbreak Response Management and Analysis System (SORMAS) during the COVID-19 pandemic in Côte d’Ivoire

BackgroundThe Surveillance Outbreak Response Management and Analysis System (SORMAS) has been implemented for various infectious diseases since 2015. 2020, at the beginning of the COVID-19 pandemic, SORMAS was adapted to SARS-CoV2.MethodsWe assessed the acceptability and usability of SORMAS and accompanied its implementation in two pilot regions of Côte d’Ivoire (Abidjan 2 and Gbêkê) from July/August 2021 to March 2022. We conducted 136 semi-structured interviews to cover knowledge on COVID-19, information on conventional surveillance systems for disease monitoring including COVID-19, acceptability of SORMAS, and impact of SORMAS on epidemic preparedness and surveillance. Scores before and 6–8 months after implementation were compared.ResultsSORMAS was implemented in two pilot regions in Côte d’Ivoire. The conventional software for the surveillance of the COVID-19 pandemic by the company MAGPI was maintained in parallel; the additional time needs to enter and manage the data in SORMAS were the main concern. SORMAS acceptance and satisfaction scores were high after the user training, which was prior to implementation, and after 6–8 months of use. The ability of SORMAS to improve COVID-19 preparedness and early detection of cases and contacts was widely acknowledged. To keep the understanding and skills of users up-to-date, regular refresher trainings were requested. The expectation to be able to make decisions based on data produced by SORMAS was high at baseline and the perceived experience after several months of use of the software was very positive. Unfortunately, the link with the laboratories could not be established in the pilot regions, but it is an existing feature of SORMAS that many users were asking for. Following the positive experience using SORMAS for COVID-19, the pilot regions expanded its use for monitoring and management of measles, yellow fever, meningitis, and cholera.ConclusionSORMAS was very well accepted by users and decision makers in the two pilot regions of Côte d’Ivoire and its ability to improve epidemic preparedness and surveillance was acknowledged. If the hurdles of maintenance (tablets, server, and maintaining user skills) are handled sustainably, it can serve as a valid tool to identify, surveil and manage future outbreaks of various infectious diseases in Côte d’Ivoire.

Strategic Management of COVID 19 Pandemic; Response and Preparedness in Sri Lanka

Serious pandemic of COVID -19 a highly contagious respiratory disease caused by the Severe Acute Respiratory Syndrome Corona Virus 2, which was first discovered in December 2019 in the city of Wuhan. This highly infective SARS-CoV-2 virus is spreading from person to person through close contact, and the common symptoms include fever, cough and shortness of breath while muscle pains, loss of smell and taste, diarrhea, abdominal pain and throat ache are other symptoms, which have frequently recorded. This serious pandemic of COVID -19 has threatening lives of people and claimed 682,421,707 patients and 6,819,238 deaths worldwide to date of 19th March 2023. The first COVID-19 case in Sri Lanka on 27th January 2020, who was a 44 year old female tourist from Hubei Province China, and the first local case was reported on 11th of March 2020, who was a travel guide. Aim of this article is to describe the effectiveness of COVID-19 response and preparedness especially on patient care management. A descriptive study was conducted through Key Informant Interviews, data gathering through desk review of records and reports published. Multi strategic approach that was used in the Sri Lankan health sector to combat COVID – 19 pandemic. Strategies done were; system development (curative and preventive services), infrastructure development and improvement of facilities, staff wellbeing and protection, continuation of normal patient care services, intersectoral coordination and collaboration, special projects in relation to COVID – 19 pandemic, leadership and governance, supervision and monitoring, and public / community empowerment. These strategies has reflected in managing COVID – 19 pandemic and similar strategies with modification can be implemented in future pandemic situations. Further, it is recommended to do in-depth studies to understand the interventions done in specific areas, effectiveness of interventions, and gaps of intervention done and to mitigate the gaps for better response system in order to build a resilient health system.