Pandemic Planning Research Articles

Kanta Subbarao—confronting influenza and COVID-19

Kanta Subbarao—confronting influenza and COVID-19

Risk Perception and Health Precautions Towards COVID-19 Among Older Culturally and Linguistically Diverse Adults in South Australia: A Cross-Sectional Survey.

BackgroundRisk perceptions and precaution-taking against COVID-19 are affected by individuals’ health status, psychosocial vulnerabilities and cultural dimensions. This cross-sectional study investigates risk perceptions associated with COVID-19 and specifically the problem- and emotion-focused health precautions of older, culturally and linguistically diverse (CALD) South Australians.MethodsCross-sectional research involving self-administration of an online survey. Participants were CALD adults living in South Australia, aged 60 years and above (n = 155). Multi-indicator surveys were analyzed using Stata/MP version 13.0 and multiple linear regression models fitted to examine associations between risk perceptions and problem- and emotion-focused health precautions.ResultsDread risk returned the highest mean score; COVID-19 was perceived as a catastrophe. Mean scores for fear showed that participants were worried about COVID-19 and scared of becoming infected. Participants followed health advice as they were worried [β 0.15; 95% CI 0.07, 0.23] and realized the effect of COVID-19 on them [β 0.15; 95% CI 0.02, 0.28], or worried and had trust in experts’ knowledge and managing capacity [β 0.17; 95% CI 0.06, 0.28]. Age was negatively associated with sum-score of problem-focused coping: compared to participants aged 60–69 years, 80+ years revealed a decrease in problem-focused health precautions. Variables like education (primary schooling [β 2.80; 95% CI 0.05, 5.55] and bachelor degree [β 3.16; 95% CI 0.07, 6.25] versus no formal education), self-confidence in reducing risk, and fear [β 0.84; 95% CI 0.31, 1.36] significantly affected emotional-focused health precautions.ConclusionThis local study has global implications. It showed that COVID-19 has psychosocial and environmental implications for older CALD adults. When many CALD populations have existing vulnerabilities to intersecting disadvantage, cultural-tailoring of interventions and pandemic response plans may buffer the effects of compounding disaster. Larger studies are needed to compare risk perception and health response patterns across countries and cultural groupings.

Pandemic escape plan: Discontinuing policies that have reached their expiry date

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The COVID-19 pandemic has highlighted the need to invest in care home research infrastructure

The COVID-19 pandemic resulted in catastrophic levels of morbidity and mortality for care home residents. Despite this, research platforms for COVID-19 in care homes arrived late in the pandemic compared with other care settings. The Prophylactic Therapy in Care Homes Trial (PROTECT-CH) was established to provide a platform to deliver multi-centre cluster-randomized clinical trials of investigational medicinal products for COVID-19 prophylaxis in UK care homes. Commencing set-up in January 2021, this involved the design and development of novel infrastructure for contracting and recruitment, remote consent, staff training, research insurance, eligibility screening, prescribing, dispensing, and adverse event reporting; such infrastructure being previously absent. By the time this infrastructure was in place, the widespread uptake of vaccination in care homes had changed the epidemiology of COVID-19 rendering the trial unfeasible. Whilst some of the resources developed through PROTECT-CH will enable the future establishment of care home platform research, the near absence of care home trial infrastructure and nationally-linked databases involving the care home sector will continue to significantly hamper progress. These issues are replicated in most other countries. Beyond COVID-19, there are many other research questions that require addressing to provide better care to people living in care homes. PROTECT-CH has exposed a clear need for research funders to invest in, and legislate for, an effective care home research infrastructure as part of national pandemic preparedness planning. Doing so would also invigorate care home research in the interim, leading to improved healthcare delivery specific to those living in this sector.

Abstract P1-02-12: Genomic testing on breast cancer core biopsy material is feasible and provides useful treatment information

Abstract Background: Genomic profiling assays for invasive breast cancer provide useful predictive and prognostic information and are performed most commonly on surgical resection specimens. Obtaining the molecular profile at the time of initial core needle biopsy is ideal because it could provide information that could significantly alter preoperative decision-making and avoid unnecessary treatments. In January 2020, the breast center began a 3 month pilot program that would reflexively send core biopsy material on all newly diagnosed patients for genomic testing using the MammaPrint (MPT) and BluePrint (BPT) assays regardless of receptor status. The goals were to determine feasibility and examine the impact to patient care. Methods: Breast core biopsy tissue was triaged by an attending pathologist as soon as slides were available. If invasive carcinoma with at least 3 mm in linear extent of tumor with 20% cellularity was identified, materials were immediately sent to Agendia for MPT/BPT testing even before ER/PR/HER2 testing was available to the pathologist. Clinicopathologic information, turn-around time (TAT) and adequacy data were tracked. The impact was discussed regularly at breast tumor board to determine if the results led to altered decision-making that could reduce unnecessary interventions and time to initial treatment. Results: 445 core biopsy specimens were sent for genomic testing. Of those 442, (97%) yielded genomic results with an average TAT from biopsy to genomic result of 11 calendar days. MPT identified 233 (53%) cases that were low risk and 209 (47%) cases that were high risk. BPT showed that 60 (14%) cases were Basal, 18 (4%) cases were HER2, and 364 (82%) cases were Luminal. Further analysis of the Luminal subgroup demonstrated that 154 (42%) were Luminal A low risk, 78 (21%) were Luminal A Ultralow risk and 132 (36%) were Luminal B High Risk. Analysis by race demonstrated a significantly higher percentage of high risk tumors in African-American women including a higher percentage of basal cancers (26%) as compared to Caucasian women (10%). Of note, 51 patients in the pilot study had additional OncotypeDX (ODX) testing on subsequent surgical resection. There was fair correlation between the assays with the majority of the low risk MPT having low risk ODX scores (<=25) and the high risk MPT having high risk ODX scores (>25), though MPT identified more patients as being high risk. The COVID-19 pandemic altered plans to assess time to treat and treatment interventions as initially intended. However, the knowledge of genomic result enhanced the ability to triage patients, allowing those patients with low risk tumors to begin endocrine therapy and delay surgery. Use of preoperative hormone therapy was considered more often in place of neoadjuvant chemotherapy in patients with low genomic risk ER+/HER2- patients. Because of the continued feedback indicating positive impact, the pilot ultimately was extended to 11 months to allow time for formal implementation. Conclusions: Genomic testing using the MPT/BPT assay on core biopsy samples with at least 3 mm yields results 97% of the time with an average TAT of 11 days from biopsy date to result. The genomic information at the time of initial diagnosis impacted patient care most notably in the ER+ setting. The results led to the immediate implementation of direct reflex testing of all newly diagnosed ER+ and HER2- or IHC 2+ cancers by pathology after the initial pilot phase. Citation Format: Hannah Gilmore, Philip Bomeisl, Alberto Montero. Genomic testing on breast cancer core biopsy material is feasible and provides useful treatment information [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-02-12.

Psychotic disorders amid the COVID-19 pandemic: a consideration of risks and impacts.

The COVID-19 pandemic has had a severe and widespread global impact but particularly for those with psychosis. This review summarizes recent evidence on the relationship between the COVID-19 pandemic and psychotic disorders, highlighting the risks faced by these individuals including the negative impacts on treatment services, complications from contracting COVID-19, and the acceptability of digital interventions. Mortality, morbidity, and infection outcomes are among the worst for individuals with psychotic disorders. Presentation rates for psychotic disorders are elevated at emergency departments compared with before the COVID-19 pandemic; demand for inpatient services has increased, and there have been complications in access because of pandemic restrictions. COVID-19 related stressors have led to the exacerbation and incidence of psychotic symptoms among individuals with and without preexisting psychotic diagnoses. Digital interventions may be an acceptable method for maintaining patient contact and treatment during extended isolation. More data is needed on the longitudinal trajectory for psychotic symptoms post-COVID-19 infection and pandemic restrictions to better support individuals with psychotic disorders. Development of a long-term pandemic management plan is needed to monitor and support psychiatric health across the population.

Increases in drug overdose deaths in Norway and the United States during the COVID-19 pandemic.

Little international comparative work exists describing pandemic-related spikes in overdose and related implications for drug and public health policy. We compared increases in overdose deaths during the pandemic in Norway and the United States, two countries in the top 10 for per-capita overdose mortality, yet with very different approaches to the pandemic, healthcare and drug policy. We examined monthly overdoses in 2020 versus baseline rates (the monthly average across 2017-2019). We compared excess overdose mortality to shifts in human mobility and social interaction, measured using cellphone-based mobility data, an indicator of the societal response to the pandemic. Both the US and Norway saw large magnitude exacerbations in overdose mortality during the pandemic-related lockdowns, reaching 46.8% and 57.0% above baseline, respectively. Maximum increases occurred 2-3 months after peak reductions in mobility, suggesting lagged mechanisms. While overdose mortality returned to baseline relatively quickly in Norway, rates remained elevated in the US to the end of 2020. Spikes in overdose mortality in both contexts may relate to disruptions in healthcare access and the drug supply becoming more potent. Norway's quicker return to baseline may reflect more robust access to harm reduction and addiction-related healthcare services. Nevertheless, it is notable that even in Norway - with universal access to high-quality services, low COVID-19 rates, and a highly effective public health infrastructure - a greater than 50% spike in overdose deaths was still seen at the onset of lockdown measures. This may have important implications for future pandemic and disaster planning.

Incorporation of near-real-time hospital occupancy data to improve hospitalization forecast accuracy during the COVID-19 pandemic.

Public health decision makers rely on hospitalization forecasts to inform COVID-19 pandemic planning and resource allocation. Hospitalization forecasts are most relevant when they are accurate, made available quickly, and updated frequently. We rapidly adapted an agent-based model (ABM) to provide weekly 30-day hospitalization forecasts (i.e., demand for intensive care unit [ICU] beds and non-ICU beds) by state and region in North Carolina for public health decision makers. The ABM was based on a synthetic population of North Carolina residents and included movement of agents (i.e., patients) among North Carolina hospitals, nursing homes, and the community. We assigned SARS-CoV-2 infection to agents using county-level compartmental models and determined agents’ COVID-19 severity and probability of hospitalization using synthetic population characteristics (e.g., age, comorbidities). We generated weekly 30-day hospitalization forecasts during May–December 2020 and evaluated the impact of major model updates on statewide forecast accuracy under a SARS-CoV-2 effective reproduction number range of 1.0–1.2. Of the 21 forecasts included in the assessment, the average mean absolute percentage error (MAPE) was 7.8% for non-ICU beds and 23.6% for ICU beds. Among the major model updates, integration of near-real-time hospital occupancy data into the model had the largest impact on improving forecast accuracy, reducing the average MAPE for non-ICU beds from 6.6% to 3.9% and for ICU beds from 33.4% to 6.5%. Our results suggest that future pandemic hospitalization forecasting efforts should prioritize early inclusion of hospital occupancy data to maximize accuracy.

Hospital bed occupancy rate is an independent risk factor for COVID-19 inpatient mortality: a pandemic epicentre cohort study

IntroductionCOVID-19 first struck New York City in the spring of 2020, resulting in an unprecedented strain on our healthcare system and triggering multiple changes in public health policy governing hospital...

Pharmacy practice architecture challenges in handling COVID-19 pandemic - sharing experience from a Kosovo pharmacy practice.

Background:Community pharmacies deliver an essential healthcare service, which is broadly established, encompassing the favored and primary contact for community members. The COVID-19 pandemic is continuing to shift the pharmacy roles and services in order to meet the needs of customers. The important value of community pharmacies was more underlined during the pandemic crisis when they were supposed to undertake abundant precautions to avoid cross-infection among users of the space. Their responsibility is also to create a compatible, efficient, and safe environment inside their premises during this outbreak. The built environment is an important share of pandemic solutions and emergency planning preparations.Objectives:The aim of this paper was to explore the preparedness of community pharmacies in Kosovo for the COVID-19 outbreak in regards to pharmacy design modifications while ensuring adequate medicine management, information, and public health. Consequently, at what stage can the pandemic affect the physical and built environment of pharmacies.Methods:The methods for this study include a cross-sectional survey of 104 community pharmacies operating in seven municipalities in Kosovo during the pandemic. Data collection was conducted from October 1 to October 14, 2021, using self-administered online questionnaires. The questionnaire consisted of a combination of closed and open-ended questions, optional statements, and multiple answers. Data were analyzed in SPSS for Windows version 20 using descriptive statistics.Results:The results show that communities should be prepared ahead in regard to the emergency situations and some of these preparations might be also part of the legislation requirements. Although the pandemic exposed many errors in the Kosovo community pharmacy system, it has also discovered a unique possibility for collaboration and novelty.Conclusions:The study concludes with the recommendation for the architectural design of pharmacies to be positioned as an active mediator in the fight against the COVID 19, with a critical lesson aimed at the flexibility of the space to accommodate emergent situations and create alternative areas for use.

COVID-19 Knowledge, Attitudes, and Preventive Measures of University Students in Bahrain.

The severe, acute respiratory syndrome COVID-19 that was first reported in China in December 2019 quickly became a global pandemic that has resulted in over 100 million infections and more than 2 million deaths. This study aimed to assess the awareness level of university students regarding the possibility of becoming infected with COVID-19. In order to achieve this objective, we assessed the students' knowledge, attitudes, and behaviors using an online survey questionnaire offered to a total of 300 students. A positive response regarding awareness of COVID-19 symptoms was registered by more than 70% of the students, whereas 62% felt that wearing a mask did not give full protection against infection, approximately 30% agreed that antibiotics and antivirals did not treat COVID-19, and 62% agreed that vitamin C was helpful in treating common symptoms of COVID-19. Moreover, around 31% of the students believed that COVID-19 is a man-made virus. Students who had gotten infected with SARS-CoV-2 believed that wearing a mask gives full protection (p=0.018). In response to survey questions related to attitude, 80% of students cancelled and postponed meetings with friends, and 90% agreed that mask-wearing is the most precautionary measure used to prevent the infection. In addition, 82% avoided coughing in public, 82% avoided contact if they felt flu-like symptoms and 80% washed their hands far more often due to the pandemic. Interestingly, 76% carried hand sanitizer, 66.5% avoided shaking hands, and 42.7% were taking vitamin C supplements. This study showed that the participants had a positive awareness of COVID-19 transmission, symptoms, and treatments misconceptions and mistaken beliefs related to treatments and the origin of the virus were also common and should be addressed. This study thus provides a baseline for a population-based surveillance program that could help local authorities to improve pandemic preparation plans, particularly with regard to governmental education and media campaigns.

Respiratory virus detection during the COVID‐19 pandemic in Queensland, Australia

ObjectiveTo determine if non‐pharmaceutical interventions (NPIs) impacted on respiratory virus detections in Queensland, Australia, during the COVID‐19 pandemic year of 2020. MethodsWe analysed weekly counts of influenza, human metapneumovirus, parainfluenza, respiratory syncytial virus, rhinovirus, and adenovirus available from a Queensland laboratory network for the year 2020. These were compared with averaged counts from 2015 to 2019. ResultsOverall, 686,199 tests were performed. The timing of NPI implementation was associated with a sharp and sustained decline in influenza, where during the typical annual influenza season (weeks 23–40) no cases were detected from 163,296 tests compared with an average of 26.1% (11,844/45,396) of tests positive in 2015–2019. Similar results were observed for human metapneumovirus and parainfluenza. Respiratory syncytial virus detections also declined but increased in weeks 48–52 (5.6%; 562/10,078) to exceed the 2015–2019 average (2.9%; 150/5,018). Rhinovirus detections increased after schools reopened, peaking in weeks 23–27 (57.4%; 36,228/63,115), exceeding the 2017–2019 detections during that period (21.9%; 8,365/38,072). ConclusionsNPIs implemented to control COVID‐19 were associated with altered frequency and proportions of respiratory virus detections. Implications for public healthNPIs derived from influenza pandemic plans were associated with profound decreases in influenza detections during 2020.

Understanding and attenuating pandemic-related disruptions: a plan to reduce inequalities in child development

The Secretary General of the United Nations described the impact of COVID-19-related school closures as a “generational catastrophe.” What will be the legacy of the 2020–2021 pandemic-related disruptions in 5, 10, 20 years from now, as regards education and well-being of children and youth? Addressing the disproportionate impact on those growing up in socio-economically disadvantaged areas or on those with pre-existing learning challenges is key to sustainable recovery. This commentary builds on the four literature reviews presented in this Special Section on a Pandemic Recovery Plan for Children and proposes strategies to understand and attenuate the impact of pandemic-related lockdown measures. Importantly, we need a monitoring strategy to assess indicators of child development in three areas of functioning: education and learning, health, and well-being (or mental health). Surveillance needs to begin in the critical prenatal period (with prenatal care to expectant parents), and extend to the end of formal high school/college education. Based on child development indicators, a stepped strategy for intervention, ranging from all-encompassing population-based health and education promotion initiatives to targeted prevention programs and targeted remedial/therapeutic interventions, can be offered. As proposed in the UN plan for recovery, ensuring healthy present and future generations involves a concerted and intensive intersectoral effort from the education, health, psychosocial services, and scientific communities.

At the front of the front-line: Ontario paramedics' experiences of occupational safety, risk and communication during the 2020 COVID-19 pandemic

PurposeThe study aimed to (1) determine on what bases paramedics in this context have defined themselves as feeling safe or at risk while serving on the front lines and (2) develop recommendations to support paramedics in their critical public health emergency response role.Design/methodology/approachThis qualitative study consisted of 21 semi-structured interviews with primary care paramedics (PCPs), advanced care paramedics (ACPs) and critical care paramedics (CCPs) with first-hand experience responding to the COVID-19 pandemic in Ontario. Qualitative research is best suited to the research objectives of gaining detailed and nuanced understandings of paramedics' experiences during this public health emergency, and identifying in paramedics' accounts what changes to policy and practice might strengthen their sense of safety in future infectious disease outbreaks (Bowling, 2002; Chafe, 2017). Data collection occurred over the course of 3.5 months, from June 2020 until September 2020.FindingsParticipants described several factors that heightened their feeling exposed to risk particular to working on the front lines of the COVID-19 public health response. These factors include stress connected to personal protective equipment (PPE) and equipment access, risks of infection to self and family, communications and feelings of being systematically under-considered. Recommendations from this research include, but are not limited to, ensuring a more equitable distribution of protective equipment to paramedics across unevenly funded services, and recognizing paramedics face unique and additional stressors in public health emergencies.Research limitations/implicationsA key limitation of this study was the relatively small sample, with 50% of potential participants deciding not to engage in an interview. The authors suspect this is likely a result of timing, as this was conducting during significant periods of the COVID-19 pandemic in Ontario. The study identifies and begins to shed light on the way in which feelings of compromised safety and specific stressors in a public health emergency context connect to one another and potentially increase risks of burnout for this healthcare provider group. This study's documentation of paramedics feeling uncertainty about their own and their family's safety, combined with feeling occupational pressure, decisional pressure within constrained frameworks of care delivery, a lack of autonomy and a lack of consideration within their healthcare system in general and within its pandemic response in particular, is important in and of itself. These stressors can have serious implications for the ability of paramedics to sustain their integral role in public health emergency response.Practical implicationsA series of pandemic-specific and generalizable recommendations emerged from this research and in collaboration with community-based medical leadership. (1) Consult paramedics on effectiveness of screening questions and equipment. Be sure to illicit and respond to paramedic feedback in a timely manner. (2) Implement operational changes during pandemics in the form of donning and doffing stations, disposable gowns, decontamination teams at hospitals, infectious disease paramedic (IDP) truck, anti-fog sprays for goggles, and safe and controlled areas for eating and taking breaks. (3) Develop an emergency pandemic plan that is resourced and maintained as part of EMS strategic planning. Involve EMS in decisions related to health system emergency planning and sustainability of EMS practice. (4) Establish equitable distribution of resources, such as ensuring PPE is distributed equitably and applying pandemic pay equally to all essential workers. (5) Validate and respect EMS, as they are essential workers. Recognize the expertise of paramedics and community healthcare providers. Finally, an overarching recommendation at the core of this research is the consideration for paramedic knowledge as expertise given their role as critical front line healthcare specialists and the protection of this crucial human resource as it relates to their resilience and mental wellbeing.Social implicationsEvidence-based awareness and improved understanding of paramedic stress during the pandemic is a first step to developing strategies to reduce that stress. This is essential in ensuring access to this essential service during emergencies and the safety of the communities they serve.Originality/valueFindings from this study can inform development of supports to sustain paramedic wellbeing during public health emergencies, during the ongoing pandemic, in Ontario and beyond.

Psychosocial Stressors and Coping Strategies Among African Americans During Early Stages of the COVID-19 Pandemic: a Qualitative Study.

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

How optimal allocation of limited testing capacity changes epidemic dynamics

Insufficient testing capacity has been a critical bottleneck in the worldwide fight against COVID-19. Optimizing the deployment of limited testing resources has therefore emerged as a keystone problem in pandemic response planning. Here, we use a modified SEIR model to optimize testing strategies under a constraint of limited testing capacity. We define pre-symptomatic, asymptomatic, and symptomatic infected classes, and assume that positively tested individuals are immediately moved into quarantine. We further define two types of testing. Clinical testing focuses only on the symptomatic class. Non-clinical testing detects pre- and asymptomatic individuals from the general population, and a concentration parameter governs the degree to which such testing can be focused on high infection risk individuals. We then solve for the optimal mix of clinical and non-clinical testing as a function of both testing capacity and the concentration parameter. We find that purely clinical testing is optimal at very low testing capacities, supporting early guidance to ration tests for the sickest patients. Additionally, we find that a mix of clinical and non-clinical testing becomes optimal as testing capacity increases. At high but empirically observed testing capacities, a mix of clinical testing and non-clinical testing, even if extremely unfocused, becomes optimal. We further highlight the advantages of early implementation of testing programs, and of combining optimized testing with contact reduction interventions such as lockdowns, social distancing, and masking.

Pandemic planning, sustainability practices, and organizational performance: An empirical investigation of global manufacturing firms

Disruption events like pandemic crises and natural disasters are unpredictable and therefore, most organizations are implementing an emergency plan to mitigate the unforeseen risks. This paper presents a research framework based on sustainability theory perspectives (i.e., crisis life cycle and management cycle). To test a research model that defines key variables, we assess and validate the hypothesized relationships using a large-scale survey. The respondents are from global food, pharmaceutical, and medical manufacturing companies (n = 301). We use a polynomial regression method coupled to response surface analysis. Results suggest that in the COVID-19 pandemic context, pandemic emergency planning dimensions are positively related to organizational performance metrics (e.g., sales, net profit, on-time orders, and quality) of the food, medical and pharmaceutical industries. The response surface analysis also shows that prudent firms implement triple sustainability practices--economic improvement practices, socially responsible practices, and environmental practices--to ensure their market competitiveness and corporate reputation during critical times. Theoretical and managerial implications are presented for future studies.

Millions of Bangladeshi Children Missed Their Scheduled Vaccination Amidst COVID-19 Pandemic.

The Government of Bangladesh imposed a movement control order as a mass quarantine strategy to control the outbreak of coronavirus disease 2019 (COVID-19). Adherence to the home quarantine may put children at risk by missing routine vaccination. In this study, we investigated the impact of COVID-19 on child routine immunization in a rural area of Bangladesh and consider the broader implications. Data for this study comes from the Chakaria Health and Demographic Surveillance System (HDSS) of icddr,b with a population of 90,000 people residing in 16,000 households in 49 villages in a rural, coastal area of Southeast Bangladesh. We used an explanatory sequential mixed methods design which involved two phases between March 1, 2020, and May 31, 2020: first, we observed 258 outreach sessions of 86 EPI centers. We calculated the number of Expanded Program on Immunization (EPI) outreach sessions suspended and the number of children who missed their routine vaccination due to the COVID-19. We extrapolated the number of Bangladeshi children who missed their routine vaccination using Chakaria HDSS observations. Secondly, we conducted in-depth interviews to explain the quantitative results. The EPI outreach session (EOS) declined to 74.42% (95% CI 63.97–83.22), 10.45% (95% CI 5.00–18.94), and 3.45% (95% CI 1.00–9.75) from 2019 levels in March, April, and May 2020, respectively. By extrapolation, in Bangladesh, between March and May 2020, 3.2 million children missed their scheduled vaccination compared to 2019. Results from in-depth interviews showed that the unwillingness of villagers to hold EOS and the absenteeism of the vaccinators due to social distancing recommendations and lack of personal safety measures were the main reasons for the discontinuation of the EOS. Resuming EPI outreach sessions and introducing a special catch-up program is essential to prevent future outbreaks and deaths due to vaccine-preventable diseases in Bangladesh and the countries where children missed their routine vaccination due to COVID-19. This health system failure should be considered a factor in all future pandemic preparedness plans.

National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project

BackgroundIn the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON).MethodsMixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified.DiscussionFor a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

Outbreak of NDM-1-Producing Escherichia coli in a Coronavirus Disease 2019 Intensive Care Unit in a Mexican Tertiary Care Center.

ABSTRACTEmergency department areas were repurposed as intensive care units (ICUs) for patients with acute respiratory distress syndrome during the initial months of the coronavirus disease 2019 (COVID-19) pandemic. We describe an outbreak of New Delhi metallo-β-lactamase 1 (NDM-1)-producing Escherichia coli infections in critically ill COVID-19 patients admitted to one of the repurposed units. Seven patients developed infections (6 ventilator-associated pneumonia [VAP] and 1 urinary tract infection [UTI]) due to carbapenem-resistant E. coli, and only two survived. Five of the affected patients and four additional patients had rectal carriage of carbapenem-resistant E. coli. The E. coli strain from the affected patients corresponded to a single sequence type. Rectal screening identified isolates of two other sequence types bearing blaNDM-1. Isolates of all three sequence types harbored an IncFII plasmid. The plasmid was confirmed to carry blaNDM-1 through conjugation. An outbreak of clonal NDM-1-producing E. coli isolates and subsequent dissemination of NDM-1 through mobile elements to other E. coli strains occurred after hospital conversion during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This emphasizes the need for infection control practices in surge scenarios.IMPORTANCE The SARS-CoV-2 pandemic has resulted in a surge of critically ill patients. Hospitals have had to adapt to the demand by repurposing areas as intensive care units. This has resulted in high workload and disruption of usual hospital workflows. Surge capacity guidelines and pandemic response plans do not contemplate how to limit collateral damage from issues like hospital-acquired infections. It is vital to ensure quality of care in surge scenarios.