Large-scale Public Health Emergencies Research Articles

Decision fatigue experience of front-line nurses in the context of public health emergency: an interpretative phenomenological analysis

BackgroundDecision fatigue is a new concept in the field of psychology and refers to a state of fatigue alongside impaired cognitive processing and emotional regulation ability. Previous studies have confirmed that nurses are prone to decision fatigue, and nurses who experience decision fatigue may implement nursing measures that are inconsistent with clinical evidence, thus affecting patients’ benefits. COVID-19, as a large-scale global public health emergency, increased the workload and burden of nurses and aggravated decision fatigue. However, the factors leading to decision fatigue among nurses have not yet been identified.MethodsThis study is guided by interpretative phenomenology. During the epidemic period of COVID-19: From November 2022 to February 2023, a one-to-one, semi-structured in-depth interview was conducted among nurses with decision fatigue experience who were participating in front-line work in Jilin Province using homogenous sampling. The interview recordings and related data were transcribed into text within 24 h, and data analysis was assisted by NVivo 12.0 software.ResultsAfter a total of 14 front-line nurses were analyzed in this study, The thematic level reaches saturation, the findings present a persuasive and coherent narrative, and the study is terminated, and finally extracted and formed three core themes: “Cognition, influence and attitude of decision fatigue”, “Approaching factors of decision fatigue” and “Avoidant factors of decision fatigue”.ConclusionThis study confirmed that decision fatigue was widespread in the work of front-line nurses, affecting the physical and psychological health of nurses, the quality of nursing work, the degree of benefit of patients and the clinical outcome. However, nursing staff do not know enough about decision fatigue, so the popularization and research of decision fatigue should be strengthened. Improve the attention of medical institutions, nursing managers and nursing staff.Some suggestions are put forward for the intervention of decision fatigue through personnel, task, tool and technology, organization and environment.

Emergency resource allocation considering the heterogeneity of affected areas during the COVID-19 pandemic in China

The scientific allocation of emergency resources is crucial to ensure the success of COVID-19 relief operations. However, the heterogeneity of epidemic areas has an important impact on the allocation of emergency resources. Although it is a crucial topic, there has been limited research that considers the heterogeneity of affected areas in the emergency resource allocation. To bridge the gap, this study proposes a multi-period optimal allocation model of emergency resources considering the heterogeneity of affected areas, which aims to make the allocation of resources more equitable, efficient and economical. Then, a typical and representative case of emergency medical resource allocation in Hubei Province, China (where the epidemic occurred earlier and was seriously affected by COVID-19), was selected for a simulation study to verify the effectiveness and feasibility of the proposed model and method. The study finds that considering the heterogeneity such as disaster coefficient and demand urgency in different disaster stricken areas in emergency resource allocation can minimize the negative impact of resource shortfalls, especially in the early period of relief operations with insufficient resource supply. In addition, the proposed model can optimize multi-period emergency resource allocation by simultaneously considering time (efficiency criterion), cost (economic criterion), and loss(equity criterion), which is in line with the actual needs of emergency rescue to the COVID-19 epidemic. The results of this study can be effectively applied to the multi-period optimal allocation of emergency resources for large-scale public health emergencies, and providing insights for the government and relevant management departments to formulate emergency resource allocation policies and plans.

The hidden factor in COVID-19 rehabilitation: how does the microenvironment in mobile cabin hospitals impact patient recovery? An observational study

Backgrounds: Existing studies on the treatment of emergency infectious diseases have primarily focused on the pathogen and the human immune system. However, human health is intricately connected to environmental factors, and this interaction becomes particularly during large-scale public health emergencies. Few studies have examined the impact of spatial differences in the microenvironment on the rehabilitation rate of patients with the Omicron variant infection. Objective: This study employs causal inference statistical methods and spatial analysis to investigate how the hospital microenvironment affects the rehabilitation of COVID-19 patients in a mobile cabin hospital, so as to provide a scientific basis for the spatial arrangement of patients in mobile cabin hospitals. Design: Observational study. Methods: This study used the clinical information of 6291 patients admitted in a mobile cabin hospital in Shanghai, from April 9 to May 9, 2022, during the pandemic. Exploratory spatial data analysis and fixed-effects regression analysis were conducted to understand whether the microenvironment around the patients’ beds in the cabin impacted their rehabilitation. Results: The results indicate that the rehabilitation condition of patients is affected by spatial differences of microenvironment. Both the mean and minimum CT values of the surrounding patients show a significant positive correlation with the rehabilitation of patients. The further the distance from the vent is, the more the rehabilitation speed of the patients is affected by the CT values of the surrounding patients. Conclusion: These findings offer valuable insights for bed allocation, patients’ stratification and management, and ventilation management in the mobile cabin hospitals during public health emergencies.

Identifying Barriers to Basic Needs, Academic Success, and the Vaccination Pattern among College Students during the COVID-19 Pandemic.

College students face significant challenges during large-scale disease outbreaks that potentially compromise their basic needs, vaccine confidence, and academic success. Using a cross-sectional design and convenience sampling, we examined the impact of COVID-19 among college students (N = 828). The survey was administered using the Qualtrics survey platform to collect data on multiple demographic and health behaviors of students in the summer semester (2021). Our study demonstrated that the most common financial shock experienced by the study participants was job loss, with less remarkable changes in food and housing insecurities. Academically, students had the most difficulty learning online compared to other modalities (face-to-face, Hyflex, etc.) and struggled with staying motivated. They also struggled with group work and finding appropriate learning spaces. However, many did not use university support systems such as career and tutoring services. Exploring the COVID-19 vaccination attitudes, we found that only age, ethnicity, classification, and health insurance status were associated with getting vaccinated (p < 0.05). When the learning environment was assessed for various modalities, only college attendance was significantly associated (p < 0.05) with the accessible platforms (online, Hyflex, face-to-face, and others); however, nearly 40% of students reported difficulty learning on an online learning platform compared other categories that had much lower proportions. Our findings underscore an immediate need for universities to take measures to improve their preparedness and response strategies to mitigate the negative effects of future large-scale public health emergencies among students.

Impact of COVID-19 on investor sentiment in China's stock markets

Large-scale public health emergencies may exert significant adverse effects on market sentiment. This study utilizes interrupted time series analysis (ITSA) to explore the shift in Chinese investors' sentiment in response to the uncertainties due to the outbreak of the COVID-19 pandemic. The empirical findings demonstrate that COVID-19 had a notable impact on investor sentiment within China's stock markets. Before the outbreak of COVID-19, investor sentiment had been on an upward trend. However, since the onset of the pandemic, there has been a sustained decline in investor sentiment, aligning with the downward trend observed in China's stock markets. Interestingly, the immediate effect of the COVID-19 intervention was positive, briefly boosting investor sentiment. As of 2023, with the conclusion of the pandemic and the Chinese government's decision to end the zero COVID-19 policy, we anticipate resurgence in investor sentiment within China's stock markets.

Challenges of instruments that should tackle multi-hazard and multi-risk situations: an assessment of the recent reforms of the European Solidarity Fund and the Solidarity and Emergency Aid Reserve

The European Union has some dedicated tools and mechanisms available to respond to natural hazard events including the European Union Solidarity Fund (EUSF). It follows the objective of granting financial assistance to Member States in the event of a major disaster with serious consequences. In the latest EU long-term budget plan—the Multiannual Financial Framework 2021–2027—the EUSF was merged with the Emergency Aid Reserve (EAR) to form the new Solidarity and Emergency Aid Reserve (SEAR). One additional significant change was made in 2020 which saw an extension of the scope of the EUSF. This extension allowed the EUSF to cover losses incurred due to major public health emergencies such as the COVID-19 pandemic. It is therefore now a multi-hazard and multi-risk financing instrument designed to financially assist during the emergency phase in case of an emergency event. We assess the consequences of these changes in the light of potential advantages as well as disadvantages compared to the prior EUSF structure. The results will be used to provide some policy recommendations as to how to move forward with the identified challenges. We especially recommend separating the EUSF from the coverage of large-scale public health emergencies and the emergencies covered by the EAR. Instead, we suggest establishing a new flexibility instrument that covers emergencies such as public health related ones as well as the ones within the EAR. The analysis gives some important insights, scientific as well as policy wise, about advantages as well as limitations of financial instruments that simultaneously should tackle different types of hazards and risks.

Civilian Medical Responder Perspectives to a Federal Military Medical Deployment in New York City during the COVID-19 Pandemic

Objectives This study aims to describe the civilian experience and perceptions of the patient coordination and management at the interface of the New York City (NYC) civilian and the military health systems during a large-scale public health emergency. Methods A qualitative study design was implemented with interviews conducted using a basic descriptive approach. Purposive sampling was used to recruit participants with experience working during the first wave of COVID-19 in NYC. Inclusion criteria were civilians who worked at the Javits Center, the USNS Comfort, or NYC hospitals, who interfaced with patient transfer and military personnel during the city-wide medical response to COVID-19. Semi-structured video interviews were conducted between July 20, 2021 and March 11, 2022. Results Civilian responders working in the clinical and transfer operations of patients to military facilities in NYC during March and April of 2020 described initial confusion, as well as logistical (patient selection, transfer logistics, patient tracking), communication, and leadership challenges. While the military deployment was felt to be necessary to address the surge capacity in hospitals, the lack of clarity about military medical resources and frameworks for response resulted in confusion about what was being offered by the military deployment. This was balanced by the positive impression of working with military members and the resources that they brought to the response more generally. The need for future trainings and exercises were highlighted. Conclusions Initial challenges with civilian-military roles and responsibilities, regional needs assessment, patient selection, and logistics were ultimately resolved through adaptation of civilian and military leadership. Improvements in patient tracking, medical records, and standard hospital admission and discharge functions for patients in military alternative care facilities were identified as areas for improvement. Civilian government, health care, and military leaders should consider these ideas when planning for future military deployments in support of a domestic medical response.

The role of international support programmes in global health security capacity building: A scoping review.

Large scale public health emergencies such as COVID-19 demonstrate the importance of Global Health Security (GHS) and highlight the necessity of resilient public health systems capable of preparing for, detecting, managing, and recovering from such emergencies. Many international programmes support low- and middle-income countries (LMICs) to strengthen public health capabilities for compliance with the International Health Regulations (IHR). This narrative review seeks to identify key characteristics and factors necessary for effective and sustainable IHR core capacity development, establishing roles for international support and some principles of good practice. We reflect on the "what" and the "how" of international support approaches, highlighting the importance of equitable partnerships and bi-directional learning, and inviting global introspection and re-framing of what capable and developed public health systems look like.

Mental Health Conditions– and Substance Use—Associated Emergency Department Visits during the COVID-19 Pandemic in Nevada, USA

Background-Mental health conditions and substance use are linked. During the COVID-19 pandemic, mental health conditions and substance use increased, while emergency department (ED) visits decreased in the U.S. There is limited information regarding how the pandemic has affected ED visits for patients with mental health conditions and substance use. Objectives-This study examined the changes in ED visits associated with more common and serious mental health conditions (suicidal ideation, suicide attempts, and schizophrenia) and more commonly used substances (opioids, cannabis, alcohol, and cigarettes) in Nevada during the COVID-19 pandemic in 2020 and 2021 compared with the pre-pandemic period. Methods-The Nevada State ED database from 2018 to 2021 was used (n = 4,185,416 ED visits). The 10th Revision of the International Classification of Diseases identified suicidal ideation, suicide attempts, schizophrenia, and the use of opioids, cannabis, alcohol, and cigarette smoking. Seven multivariable logistic regression models were developed for each of the conditions after adjusting for age, gender, race/ethnicity, and payer source. The reference year was set as 2018. Results-During both of the pandemic years (2020 and 2021), particularly in 2020, the odds of ED visits associated with suicidal ideation, suicide attempts, schizophrenia, cigarette smoking, and alcohol use were all significantly higher than those in 2018. Conclusions-Our findings indicate the impact of the pandemic on mental health- and substance use-associated ED visits and provide empirical evidence for policymakers to direct and develop decisive public health initiatives aimed at addressing mental health and substance use-associated health service utilization, especially during the early stages of large-scale public health emergencies, such as the COVID-19 pandemic.

Toward a sustained recovery of the lodging sector: a management path to lessen the Corona Variants upshots

The lodging industry is an important source of national income being a main ingredient for tourism, also, as it contributes to solving the problem of unemployment. Predominantly, the lodging sector supports the balance of payments. At this place, a reading to “Alpha”; “Beta”; “Gamma”; “Delta”; and “Omicron”—Corona Variants reflects significant implications. On the one hand, there exists a challenge to Egypt’s hotel industry following the pandemic attack; on the other hand, and by considering the case of relaxing the international restrictions, the international tourism is expected to recoup. Egypt has relatively benefited in the first half of 2021 when many Europeans escaped the lower temperature in winter in their homelands opting warm holiday destinations. The primary readings also expect the continuity in this increase. The macro-trend right here considers the shift in favor of a thoroughly managed risk with enhanced pliability, adopting a view of creating value, and increasing trust, while the micro-management considerations signify enhancing the sustainability of the sector performance by means of raising lodging hygienic attributes and approving innovative approaches. Luxury hotel, led by their executives, can significantly contribute and steer this trend mainly for cost tolerance estimates and for the potentiality of cost recovery. This study addresses the ways with which “Alpha”; “Beta”; “Gamma”; “Delta”; and “Omicron” Corona variants necessitate more sustained hotel management practices and helps to establish knowledge and techniques that assist the lodging sector in Egypt. A further goal of this study is to endorse the hotel managers’ impact on counteracting the upshots of Variants’ progressions. The study is multifaceted in “scale” and “scope,” since it is based on an investigation of the effects of large-scale public health emergencies in the lodging sector. A qualitative methodology is set via conducting online and offline surveys to examine how the pandemic affect lodging sector operations, and how far Egypt’s luxury hotel managers tolerate both burdens of managing the emergency and creating sustained plans for recovery. Henceforward, the study constructs a frame for sustained lodging sector recovery. The paper’s scientific value is that it functionalizes a broad inductive method of qualitative research in which a merge of the interpretation of management enabling factors and health enabling trends in the lodging sector and luxury hotel managers’ responses obtained through exploratory qualitative research is utilized to cluster the managers’ responses and thus generalize the information in the setting of a Framework for Health Crisis Management in the lodging sector. The Framework for Health Crisis Management also adds value as it amalgamates a combination of input factors of management and health enablers; a transformation via the change actions; an output of containing the effect of the pandemic through the enhanced managers’ capabilities and hotels’ health hygiene readiness; and an outcome implication of medium-term stabilizing effects that leads to an impact effect of sustained lodging sector recovery. This configures an input, transform (actions), output, outcome, and impact result chain. The study reaches the findings that sustainable recovery in the lodging sector—being sensitive to the uncertainty that the Virus “Variants” create—necessitates the merge between managing the emergency, adopting pliable approaches, alongside with the enhancement of the managers’ (hoteliers) role as a supporting premise.

Study of COVID-19’s influence on Wuhan’s economy

At the beginning of 2020, COVID-19 came unexpectedly, which has brought incalculable losses to China, especially Wuhan. As the core area of the outbreak of the COVID-19, it is of great significance to study the economic development of Wuhan under the impact of the epidemic and the response strategies of Wuhan municipal government to deal with such large-scale public health emergencies. Taking the changes in important economic indexes of Wuhan in 2020 as the starting point, the following paper will present a study of the impact of COVID-19 on the economic development of Wuhan. After that, the effect of the main treatments taken by Wuhan’s government in order to revive the economy will be evaluated, and policy suggestions will be given according to the evaluation results.

A Qualitative Study on Knowledge, Attitude, and Practice of Nursing Students in the Early Stage of the COVID-19 Epidemic and Inspiration for Nursing Education in Mainland China.

Background:At the beginning of the COVID-19 outbreak, there was a lack of sufficient nursing experience for pneumonia caused by COVID-19. All nursing decisions had to be innovatively made and measures taken by nurses using their existing knowledge and skills. This required nurses to have a solid theoretical understanding of infectious diseases and epidemiology, evidence-based solid practice skills, and problem-solving skills. The COVID outbreak reminded undergraduates to master relevant knowledge and abilities during school study.MethodsQualitative research on knowledge, attitude, and practice (KAP) of the COVID-19 epidemic was conducted using semi-structured interviews among sophomore nursing students in the university. Based on the characteristics of the KAP of nursing students, we analyzed the deficiencies of the knowledge and ability to deal with large-scale public health emergencies in the second-year nursing education.ResultsA total of 12 subject headings and 41 sublevel headings were identified from three aspects of KAP. The subject headings included knowledge aspect (the origin of the disease, the route of transmission, main symptoms, the epidemiological characteristics of the disease, scientific cognition of information sources), attitude aspect (different emotional experiences, a certain degree of influence, different views on the development trend of the epidemic, support the government's prevention and control strategies), and behavior aspect (do an excellent job in self-protection, help family members to protect, and participate in social anti-epidemic actions). According to this analysis, second-year nursing students have three deficiencies in dealing with large-scale public health emergencies: knowledge of infectious diseases and epidemiology, evidence-based practice skills, and problem- solving ability.ConclusionWhen students start nursing professional courses, the knowledge of infectious diseases and epidemiology, training of evidence-based practice skills, and problem-solving ability should be strengthened to improve the ability of nursing undergraduates to respond to large-scale public health emergencies after entering the workplace.

Impact of the COVID-19 pandemic on career intention amongst undergraduate medical students: a single-centre cross-sectional study conducted in Hubei Province

BackgroundUndergraduate medical (UM) students faced the difficulties inherent in medical careers due to the coronavirus (COVID-19) outbreak. Thus, imperative containment measures might affect UM students’ career intentions. Information on the factors that may be associated with these students’ career change intentions is limited.MethodsWe conducted a cross-sectional survey in August 2020 to investigate the impact of the COVID-19 pandemic on career intention and the associated factors in UM students. Univariate analyses and logistic regression analysis were performed to identify said factors.ResultsA total of 2040 medical students from the Hubei University of Medicine were surveyed. Univariate analyses showed that grade, attitude towards healthcare, and the degree of the COVID-19 pandemic’s impact on the students’ lives were associated with changes in career choice (P<0.05). Logistic regression analysis showed that Grade 2, Grade 5, attitude towards a medical career, and having relatives with a medical background were associated with changes in career choice. The degree of the COVID-19 pandemic’s impact was a common and significant factor associated with career preference, career perspective, and ideal workplace.ConclusionsChanges in career intentions were particularly influenced by grade, attitude towards being a health worker, and the degree of COVID-19’s impact on the participants’ lives. Treating large-scale public health emergencies rationally, setting up correct views of occupation choice, and building reasonable career planning may reduce the loss of medical talent.

An Old Puzzle and Unprecedented Challenges: Coordination in Response to the COVID-19 Pandemic in the US

Major emergencies and crises require action from all levels of government and the involvement of numerous organizations from the private and nonprofit sectors. Thus, interorganizational coordination is a crucial element of emergency and crisis management. This study first addresses how interagency coordination is structured in American policies and frameworks within the context of public health emergencies. Then, the significant coordination-related challenges that exist at the federal level are discussed, as well as how such challenges manifested in a severe shortage of critical medical resources at the outset of the pandemic. A series of government reports are then reviewed to further explore these coordination failures. Finally, recommendations are offered regarding ways to integrate network governance into the hierarchical governance structure for better crisis coordination. This research contributes to a broader understanding of interagency coordination in response to large-scale public health emergencies.

How community medical facilities can promote resilient community constructions under the background of pandemics.

Nowadays, urban and community resilience have become the core issues of urban theoretical research and construction practices. While there are many studies on climate change, natural hazards and environmental pollution, relatively less attention has been paid to public and human health. However, the current COVID-19 pandemic, which is a major global public health crisis, is posing severe challenges to the resilience of cities and communities in the context of high-mobility, high-density and high-intensity, as well as expands the connotation of community resilience to public health. To compensate for the lack of current research, this study examined the characteristics of community medical facilities in response to pandemics at urban, community and individual multi-spatial scales based on a thorough review of current research and relevant practice. It also emphasized the significant role played by community medical facilities in improving resilient community constructions in the face of large-scale public health emergencies. These characteristics were fully utilized to explore ways to build and govern the ‘resilience' of communities in the future, help people to survive better as well as develop in complex and changeable external environments.

Walking distance for vulnerable populations to public health emergency response points of dispensing in New York City.

During certain public health emergencies, points of dispensing (PODs) may be used to rapidly distribute medical countermeasures such as antibiotics to the general public to prevent disease. Jurisdictions across the country have identified sites for PODs in preparation for such an emergency; in New York City (NYC), the sites are identified based largely on population density. Vulnerable populations, defined for this analysis as persons with income below the federal poverty level, persons with less than a high school diploma, foreign-born persons, persons of color, persons aged ≥65 years, physically disabled persons, and unemployed persons, often experience a wide range of health inequities. In NYC, these populations are often concentrated in certain geographic areas and rely heavily on public transportation. Because public transportation will almost certainly be affected during large-scale public health emergencies that would require the rapid mass dispensing of medical countermeasures, we evaluated walking distances to PODs. We used an ordinary least squares (OLS) model and a geographically weighted regression (GWR) model to determine if certain characteristics that increase health inequities in the population are associated with longer distances to the nearest POD relative to the general NYC population. Our OLS model identified shorter walking distances to PODs in neighborhoods with a higher percentage of persons with income below the federal poverty level, higher percentage of foreign-born persons, or higher percentage of persons of color, and identified longer walking distances to PODs in neighborhoods with a higher percentage of persons with less than a high school diploma. Our GWR model confirmed the findings from the OLS model and further illustrated these patterns by certain neighborhoods. Our analysis shows that currently identified locations for PODs in NYC are generally serving vulnerable populations equitably-particularly those defined by race or income status-at least in terms of walking distance.

Public Health Workforce Burnout in the COVID-19 Response in the U.S.

While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1–4 vs. <1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08−3.36; 5–9 vs. <1 years: PR = 1.89, CI = 1.07−3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08–1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce’s future when many challenges related to the ongoing COVID-19 response remain unaddressed.

Changes in Care Provision During COVID-19 Impact Patient Well-Being.

The fast onset and extensive impact of COVID-19 necessitated strict public health measures and temporary diversion of personnel and resources from other types of medical care. This study examined the prevalence of such disruptions and their impacts on patient-perceived well-being using an untargeted survey. The majority of surveyed patients experienced changes in their routine medical care. Of those whose appointments were postponed or canceled, most patients indicated an overall negative impact on their emotional and physical well-being. We highlighted the impact of disruptions in nonurgent medical care during a large-scale public health emergency.

Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study

ObjectiveThe COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep disturbances during the early phase of COVID-19 pandemic. MethodsThis web-based cross-sectional study recruited 1138 Hong Kong adults using convenience sampling over a two-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. The Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census. ResultsThe weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3%, 29.8%, and 29.1%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR = 1.57, 1.72, 1.99, and 1.96 respectively, all p < 0.05). ConclusionA high proportion of people in Hong Kong felt that their sleep had worsened since the COVID-19 outbreak. Insufficient stock of masks was one of the risk factors that were associated with sleep disturbances. Adequate and stable supply of masks may play an important role to maintain the sleep health in the Hong Kong general population during a pandemic outbreak.

Current State of (Dis)Integration: Public Health and Fusion Centers

Abstract Objective Responding to large-scale public health emergencies relies heavily on planning and collaboration between law enforcement and public health officials. This study examines the current level of information sharing and integration between these domains by measuring the inclusion of public health in the law enforcement functions of fusion centers. Methods Survey of all fusion centers, with a 29.9% response rate. Results Only one of the 23 responding fusion centers had true public health inclusion, a decrease from research conducted in 2007. Information sharing is primarily limited to information flowing out of the fusion center, with little public health information coming in. Most of the collaboration is done on a personal, informal, ad-hoc basis. There remains a large misunderstanding of roles, capabilities, and regulations by all parties (fusion centers and public health). The majority of the parties appear to be willing to work together, but there but there is no forward momentum to make these desires a reality. Funding and staffing issues seem to be the limiting factor for integration. Conclusion These problems need to be urgently addressed to increase public health preparedness and enable a decisive and beneficial response to public health emergencies involving a homeland security response.