Pandemic Contingency Research Articles

The clinical observation of a patient with common variable immunodeficiency diagnosed as having coronavirus disease 2019

The clinical observation of a patient with common variable immunodeficiency diagnosed as having coronavirus disease 2019

Changes in medication adherence among patients with asthma and COPD during the COVID-19 pandemic

Changes in medication adherence among patients with asthma and COPD during the COVID-19 pandemic

Contingency Planning for a Pandemic: Be Prepared

Back to table of contents Previous article Next article Ethics CornerFull AccessContingency Planning for a Pandemic: Be PreparedClaire Zilber, M.D.Claire ZilberSearch for more papers by this author, M.D.Published Online:28 Apr 2020https://doi.org/10.1176/appi.pn.2020.5a35In this global moment of anxiety about our health and welfare, contingency planning for you and your practice is required in case of sudden respiratory compromise. I propose three elements to a pandemic contingency plan: a personal health history, a document detailing how to contact patients and manage the practice, and a will.The brief health history should contain only the essentials: medical history and diagnoses, medications and allergies, contact information for your primary care provider, and contact information for your closest family members. My health history fits on a single page so that harried doctors won’t have to wade through excessive details to find what’s truly important. Share this document with whoever is most likely to communicate with hospital personnel. Keep a printed copy somewhere convenient; if you must call 911, grab the health history and bring it with you.Next, create a document with specific and concrete details about your office, whom to notify, to whom to delegate tasks, how to access patients’ contact information, and a sample letter to patients. Ask the colleague who usually covers for you when you’re on vacation (remember vacation?) and/or your peer supervisor for permission to include him or her in this process. Review his or her roles in your contingency plan. Under the current shelter-in-place order, my husband has access to my appointment calendar, patient charts, and patients’ contact information, but he could ask a designated colleague to call my patients. Hopefully, the calls would only be to postpone appointments and attend to immediate needs.Create a sample letter to your patients in case your practice needs to be closed to ensure that they will be communicated in the manner you would want. My letter starts with “I regret to inform you” and describes the arrangements that have been made to facilitate my patients’ transition to a new psychiatrist: Who will provide interim refills, how to find a new psychiatrist, and how to obtain information from their chart. It closes by stating how much I valued working with each of them and how I would have wanted a more gradual transition. I hope that in these last two lines my patients will recognize my voice and feel comforted.The plan I wrote is designed for a private practice; however, psychiatrists working for institutions, where support staff assist patients, may still want a contingency plan. Those of you who work in an academic setting may want to address such questions as who will take over your grant so your project can continue? and how are your grant reports and data accessed? In a community health center, although your patients will be reassigned, wouldn’t it be nice for them to receive a letter that includes your own words rather than an impersonal notice?Even more important than our responsibility to our patients is that to our children. Especially if you have minor children, it is wise to designate who will take care of them in your absence, which may be different if the absence is temporary rather than permanent. If you don’t already have a will, write one now. If you do have one, review it to be sure it still reflects your final wishes.As with all pandemic planning, we hope the precautions we take are excessive, not insufficient. Far better to have too many ventilators than too few. Far better to have wasted some time creating a contingency plan that isn’t used than to have none and need it. ■Claire Zilber, M.D., is a psychiatrist in private practice in Denver and a senior faculty member of the PROBE (Professional Problem Based Ethics) Program. She is also president-elect of the Colorado Psychiatric Society, chair of its Ethics Committee, and co-author of Living in Limbo: Creating Structure and Peace When Someone You Love Is Ill. ISSUES NewArchived

Risk Communication During COVID-19

During the unprecedented times caused by the novel coronavirus disease 2019, there is rapidly evolving information and guidance. However, a focus must also be on proper and effective risk communication. This is especially the case during pandemics that have high rates of infection, significant morbidity, lack of therapeutic measures, and rapid increases in cases, all of which apply to the current coronavirus disease 2019 pandemic. A consequence of poor risk communication and heightened risk perception is hoarding behavior, which can lead to lack of medications and personal protective equipment. One potential way to ensure appropriate risk communication is using social media channels, and ensuring an ongoing consistent media presence. Another important step is to include all stakeholders including members of the allergy community in broader public health messaging. As we continue to face unprecedented times in the allergy community, an understanding and appreciation of risk communication will be essential as we communicate with, and inform, our patients, and our colleagues, moving forward.

How high is a high risk? Prioritising high-risk individuals in an influenza pandemic

Pandemic contingency plans frequently define priority groups that are given preferential access to influenza vaccine. One of the most commonly named groups for prioritisation is that of high-risk individuals. However, current models of categorisation are unsatisfactory in a number of ways. It will be argued that existing vaccination strategies fail to adequately define what kind of risks are being considered and how, as well as on the basis of which information, these risks are calculated. Moreover, it will be suggested that existing vaccination strategies fail to specify of what magnitude a risk has to be, in order to be categorised as ‘high’. Finally, it shall be argued that a mere focus on the size of a risk factor may lead policy makers to overlook underlying concerns of distributive justice.

Investment decisions in influenza pandemic contingency planning: cost-effectiveness of stockpiling antiviral drugs

Background: The threat of an influenza pandemic has led to stockpiling of antiviral drugs in order to mitigate a plausible outbreak. If the stockpile would be used in relation to the recent pandemic alert, an investment decision about renewing the stock for a possible subsequent pandemic is essential. The decision should include cost-effectiveness considerations. Methods: We constructed a cost-effectiveness analysis in the Dutch context, explicitly including risk of an outbreak. Outcomes from a dynamic transmission model, comparing an intervention with a non-intervention scenario, were input in our health economic calculations. Results: Stockpiling was cost-effective from the health-care perspective if the actual risk is 37% for 30 years. If less than 60% of the population would take the antiviral drugs or the attack rate is about 50%, the investment would not be cost-effective from this perspective. Conclusion: Risk perception, realistic coverage among population and size of a pandemic are crucial parameters and highly decisive for the investment decision.

Community Engagement: Leadership Tool for Catastrophic Health Events

Disasters and epidemics are immense and shocking disturbances that require the judgments and efforts of large numbers of people, not simply those who serve in an official capacity. This article reviews the Working Group on Community Engagement in Health Emergency Planning's recommendations to government decision makers on why and how to catalyze the civic infrastructure for an extreme health event. Community engagement--defined here as structured dialogue, joint problem solving, and collaborative action among formal authorities, citizens at-large, and local opinion leaders around a pressing public matter--can augment officials' abilities to govern in a crisis, improve application of communally held resources in a disaster or epidemic, and mitigate community wide losses. The case of limited medical options in an influenza pandemic serves to demonstrate the civic infrastructure's preparedness, response, and recovery capabilities and to illustrate how community engagement can improve pandemic contingency planning.

Modelling the impact of an influenza pandemic on critical care services in England

The UK Influenza Pandemic Contingency Plan does not consider the impact of a pandemic on critical care services. We modelled the demand for critical care beds in England with software developed by the Centers for Disease Control (Flusurge 1.0), using a range of attack rates and pandemic durations. Using inputs that have been employed in UK Department of Health scenarios (25% attack rate and 8-week pandemic duration) resulted in a demand for ventilatory support that exceeded 200% of present capacity. Demand remained unsustainably high even when more favourable scenarios were considered. Current critical care bed capacity in England would be unable to cope with the increased demand provided by an influenza pandemic. Appropriate contingency planning is essential.

Pandemic influenza and health care demand: dynamic modelling

Another influenza pandemic, following those of 1918, 1957, and 1968, is inevitable and could cause substantial social disruption. In order to minimise the effects of a potential pandemic on the population, the Dutch Government has drawn up an influenza pandemic contingency plan. The objective of this study is to simulate the effects of an influenza pandemic in The Netherlands. For simulation, a dynamic model of the spread of pandemic has been developed. As many uncertainties are involved, experts are consulted for their opinions on the underlying model assumptions. The model has been used to simulate the effects of various preventive interventions in terms of avoided hospitalization and mortality. Possible interventions are vaccinations against influenza of certain groups, or the prescription of antiviral medicine (within 48 h after the first symptoms) for each person with an influenza-like illness. The simulation results have been used to support the Dutch Government's decision regarding stockpiling antivirals and securing of pandemic influenza vaccines.