Pandemic Response Research Articles

"I Didn't Know Him Before the Pandemic… Now He's on My Speed Dial": Strengthening Collaboration Between Infectious Diseases Physicians and State and Local Public Health for Future Public Health Emergencies.

Infectious diseases (ID) physicians play a crucial role in public health emergencies. Effective collaboration between public health agencies and healthcare providers is essential for a coordinated response. However, there is limited information on how ID physicians and health departments collaborate and which areas need to be improved. Here, we identify ways to enhance public health preparedness through increased collaboration between ID physicians and state, tribal, local, and territorial health departments. We performed a secondary qualitative analysis of 37 telephone interviews conducted using a semistructured discussion guide. Interviews were conducted from July 2023 through September 2023 as part of a pandemic preparedness needs assessment by the Infectious Diseases Society of America's COVID-19 Real-Time Learning Network. Participants included ID physicians (n = 13), public health workers (n = 7), healthcare facility-based pandemic leaders (n = 7), and national stakeholders (n = 10). While some jurisdictions had robust connections between ID physicians and public health staff, lack of coordination in other areas led to duplication of efforts, confusion, and underutilization of resources. Respondents indicated that collaboration can be strengthened over time. Recommendations included better data systems, standardized reporting procedures, early dissemination of updates, and training of ID physicians in the incident command structure and media communication. The opportunity to build on institutional knowledge from the coronavirus disease 2019 pandemic will be lost without a commitment of time, resources, and planning. Public health officials can use this experience as a catalyst for building strong collaborative relationships between ID physicians and public health practitioners, a cornerstone of future pandemic response.

The crucial role the field epidemiology training program played in preparedness and response to the COVID-19 pandemic in Sierra Leone, January 2020 to August 2022

BackgroundOn January 30, 2020, the World Health Organization declared COVID-19 a Public Health Emergency of International Concern (PHIEC). On March 11, 2020, it was characterized as a pandemic, prompting the Government of Sierra Leone to implement response plans. The first case in the country was reported on March 31, 2020. To build resilient public health systems after the Ebola crisis, the Sierra Leone Field Epidemiology Training Program (SLFETP) was launched in 2016 with funding from the U.S. CDC in collaboration with the Ministry of Health and the African Field Epidemiology Network (AFENET). The program started at the FETP Frontline level, a 3-month in-service training program, followed by the FETP Intermediate, a 9-month in-service training program launched in 2017. Both levels adopted the CDC curriculum to the local context. The curriculum consists of classroom modules focusing on surveillance, outbreak investigation, and field projects. The SLFETP graduates and trainees were deployed to assist in COVID-19 response efforts. While reports indicate the SLFETP's contributions to COVID-19 preparedness and response, the specific roles of its graduates and trainees remain undocumented. This paper outlines their crucial involvement during the pandemic in Sierra Leone.MethodsWe reviewed 12 documents from the SLFETP, including work plans, outbreak investigation reports, and success stories, to assess the FETP's contributions during the COVID-19 pandemic. We interviewed graduates and trainees about their roles and conducted discussions with stakeholders and FETP staff to explore the FETP's role during the pandemic's preparedness and response phases. A thematic analysis was performed.ResultsThe SLFETP played a critical role during the preparedness and response phase of the COVID-19 pandemic. The trainees and graduates enhanced the surveillance system and led key response pillars, such as coordination, surveillance, and quarantine. SLFETP supported districts by building their capacity, especially in the district surveillance pillar, to conduct case investigations, contact tracing, quarantine monitoring, and data management.ConclusionsThe graduates and trainees reportedly played critical roles in key response pillars across the country in the preparedness and response phase of the COVID-19 pandemic. These gains should be maintained and scaled up to build a strong and resilient public health workforce in Sierra Leone, which is crucial for preparedness and response to future outbreaks.

Community Health Centers' Response to COVID-19 and Serving the Community: This Feeling of Never Being Enough and Never Doing Enough.

Community health centers (CHCs) are a vital safety net for under-resourced and medically underserved patients. As few studies have explored how they implemented broad-based organizational changes throughout the COVID-19 pandemic, we aimed to qualitatively examine CHCs' longitudinal, comprehensive pandemic response through the perspectives of staff, administrators, and researchers working in CHCs. 25 clinic leaders, staff, and researchers from three CHC networks and two academic medical centers in Northern California and the Central Valley of California participated in 18 focus groups and interviews between April and October 2022. We used thematic content analysis to identify key themes. Key themes emerged for three pandemic phases: shutdown, pivot, and recovery. During the shutdown, CHCs paused non-urgent services and in-person outreach while facing increased strain on staff capacity. Although CHCs were traditionally siloed, the pivot phase yielded efforts to build trust through information dissemination, partnerships with other health care organizations, and unprecedented innovations in care delivery. During recovery, CHCs re-prioritized preventive care but continued to face poor access to specialty care and socioeconomic resources for their patients. The COVID-19 pandemic magnified extant barriers within CHCs, including limitations in funding, staff capacity, and infrastructure for collaboration. CHC constituents highlight lessons learned through organization-wide adaptations and opportunities for the continuation and expansion of pandemic-related changes (e.g., investments in CHCs' workforce, care delivery infrastructure, and avenues for multidisciplinary collaboration) to better serve their communities in the post-COVID era.

Gender equity and COVID-19 vaccine policies for pregnant people: a global analysis

BackgroundDespite increasing vaccine availability and evidence and expert recommendations to support administration, some countries maintained restrictive policies regarding COVID-19 vaccination in pregnancy throughout the pandemic. This global analysis explores the role of gender equity, country income level, and vaccine availability in predicting national policies on COVID-19 vaccine administration in pregnancy.MethodsPolicies were collected from May 2021 to January 2023 from 224 countries/territories using publicly available information posted on national public health authority web pages. Policies were categorized into 6 types, representing different levels of permissiveness, from recommended for some or all to not recommended, and changes in national policies were captured over time. Outcomes were defined as: 1) prevalence of restrictive policies at a specific time point; 2) country-level change from restrictive policy/no position at an earlier time point to a permissive policy at a later timepoint. Simple and multivariable logistic regressions were performed to explore the association between the outcomes and potential policy predictors, including income level, mRNA vaccine availability, and the Global Gender Gap Index (GGGI).ResultsComplete cross-sectional data were available for 114 countries as of June 2021, 137 countries as of October 2021, and 142 countries as of March 2022. The number of maternal immunization policies increased and became steadily more permissive between 2021 and 2022. Availability of mRNA vaccines and higher income level were associated with reduced odds of a restrictive policy at the 2021 timepoints, and higher GGGI scores were associated with reduced odds of restrictive policies at all timepoints. After adjusting for income level and mRNA vaccine availability, higher GGGI scores reduced the relative odds of a restrictive COVID-19 vaccine policy by 10% (aOR: 0.90, 95CI: 0.81, 0.99) in October 2021 and 14% (aOR: 0.86, 95%CI: 0.76, 0.97) in March 2021. Higher GGGI scores were also associated with increased odds of a policy switch from restrictive/no position in June 2021 to permissive in October 2021 (aOR: 1.12, 95%CI: 1.00, 1.24).ConclusionsGender inequity was associated with greater odds of a restrictive policy for use of COVID-19 vaccines in pregnancy, suggesting that gender biases may influence fair policymaking for pregnant people in pandemic preparedness and response.

Under-Funded and Under-Pressure: State Epidemiologists During the COVID-19 Response.

We conducted interviews with state epidemiologists involved in the state-level COVID-19 response to understand the challenges and opportunities that state epidemiologists and state health departments faced during COVID-19 and consider the implications for future pandemic responses. As part of a broader study on policymaking during COVID-19, we analyzed 12 qualitative interviews with state-epidemiologists from 11 US states regarding the challenges and opportunities they experienced during the COVID-19 response. Interviewees described the unprecedented demands COVID-19 placed on them, including increased workloads as well as political and public scrutiny. Decades of under-funding and constraints posed particular challenges for meeting these demands and compromised state responses. Emergency funding contributed to ameliorating some challenges. However, state health departments were unable to absorb the funds quickly, which created added pressure for employees. The emergency funding also did not resolve longstanding resource deficits. State health departments were not equipped to meet the demands of a comprehensive COVID-19 response, and increased funding failed to address shortfalls. Effective future pandemic responses will require sustained investment and adequate support to manage on-going and surge capacity needs. Increased public interest and skepticism complicated the COVID-19 response, and additional measures are needed to address these factors.

Experiences of U.S. frontline physicians during the COVID-19 pandemic: a qualitative study

BackgroundThe COVID-19 pandemic caused profound and rapid changes in patient care and healthcare system organization. There is a compelling need for insight into the challenges that confronted physicians during the early phase of the pandemic to identify successful adaptations and strategies that minimize disruption to patient care and protect clinician wellbeing. The purpose of this study was to understand physicians’ lived experiences of providing patient care during the early COVID-19 pandemic.MethodsThis qualitative, descriptive study used a thematic analysis approach. The sample included 17 physicians from five specialties with direct care experience of COVID-19 patients (infectious disease, primary care, emergency medicine, critical care, and hospitalists). Participants were identified through snowball sampling. Data were collected through focus groups and interviews in May and June 2020 and analyzed with an inductive and deductive approach using thematic analysis.ResultsThree overarching themes relating to patient care delivery during the ongoing COVID-19 pandemic were identified: facilitators, barriers, and acute stressors. Facilitator subthemes included: organizational logistical and operational support, organizational support for self-care and wellness, and peer and family support/debriefing. Barrier subthemes included: lack of clear and consistent governmental guidelines and organizational support, uncertainty resulting from poor communication or lack of information, and interpersonal barriers to physician self-care and wellbeing. Stressor subthemes included: concern about exposure, feeling unprepared, and anticipating the worst.ConclusionsPhysicians reported that both patient care and their own wellbeing were greatly impacted by organizational and systems level facilitators and barriers. Findings from this study can inform the creation of best practices, tools, and strategies that can assist with future emergency preparedness and pandemic response planning efforts.

Screening the Pandemic Response Box identifies novel ligands of the Staphylococcus aureus protein arginine kinase, McsB

BackgroundThe protein arginine kinase, McsB, plays a pivotal role in the stress-response mechanism of gram-positive bacteria and represents a potential target to combat gram-positive pathogens. There are currently no recorded ligands or inhibitors reported for bacterial McsB.Methods and resultsWe sought to identify novel ligands for the Staphylococcus aureus McsB by screening the Pandemic Response Box using thermal shift and cellular thermal shift assays. Six compounds were identified as McsB ligands, inducing positive shifts in the melting and aggregating temperature of the protein. Compounds MMV1593539 and MMV1782355 imparted the greatest stability to McsB across both assays. While none of the six McsB-targeting ligands yielded anti-bacterial effect against S. aureus under standard or heat stress conditions, MMV1634391, MMV1633968 and MMV1782213 effectively potentiated the activity of ciprofloxacin. Molecular docking and dynamic studies predict the ATP pocket of McsB as the likely binding site for MMV1593539 and MMV1782355.ConclusionsCompounds MMV1593539 and MMV1782355 stabilised McsB in two thermal stability assays while returning the most favourable docking scores and retaining protein-ligand stability in molecular dynamics. These ligands signify promising candidates for future drug discovery efforts aimed at inhibiting or exploiting the protein arginine kinase, McsB.

COVID-19 vaccination access, acceptability, and pandemic recovery in American Indian communities.

The present study explored perspectives on COVID-19 vaccine acceptability, access, and strategies for pandemic recovery among rural and urban/suburban American Indian (AI) community leaders and members in California. The qualitative study was initiated by a community-academic partnership with a large AI health organization and two universities and included virtual focus groups focused on COVID-19 vaccine acceptability (concerns, risks, benefits), initial vaccine rollout accessibility (vaccination site preferences, accessibility, strategies for improving vaccination), and recommendations for pandemic recovery. Reflexive thematic analysis was used to generate themes. In Fall 2021, three urban/suburban (n = 9) and three rural (n = 9) AI focus groups in California were held virtually. A majority of participants were Tribal or community leaders (n = 12). Participants in both urban/suburban and rural settings reported preferences for Tribal or Indian Health Service clinics for vaccination and recommended culturally tailored COVID-19 educational materials, health services, and community events to promote pandemic recovery. Participants in rural groups provided examples of tailored community-led pandemic care but illustrated how health care access limited vaccination, how basic needs affected vaccine prioritization, and how gaps in data on AI communities limited local informed decision-making. Findings demonstrate differences in the COVID-19 experience among AI adults living in urban/suburban and rural regions, including vaccine access and basic needs concerns. Findings also highlight local preferences in the pandemic community response and recommendations for culturally tailored health information, health services, and gatherings. Public health campaigns may require additional resources for AI communities to improve equitable distribution and uptake. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Ethnic equity in Aotearoa New Zealand's COVID-19 response: A descriptive epidemiological study.

Ethnic equity in Aotearoa New Zealand's COVID-19 response: A descriptive epidemiological study.

Effectiveness of digital contact tracing interventions for COVID-19: A systematic scoping review.

Digital contact tracing (DCT) interventions have been deployed at unprecedented scale during COVID-19. However, no comprehensive appraisal of the evidence exists to date regarding their effectiveness. We aimed to systematically review the global literature for a holistic understanding of DCT effectiveness during COVID-19, and to identify factors that enabled or hindered its effectiveness. Systematic scoping review. We searched six databases for peer-reviewed literature relevant to the evaluation of DCT interventions during COVID-19 (January 2024) (CRD42021268586). We compiled implemented DCT interventions from grey literature. Effectiveness appraisals, different operationalizations, measurements, and definitions of DCT effectiveness, as well as associated factors were synthesized qualitatively. Study quality was assessed using the Mixed Methods Appraisal Tool. We followed Cochrane and PRISMA guidance. We identified 133 studies evaluating 121 different DCT implementations. Seventy-three (60%) studies found DCT to be effective, mostly when evaluating epidemiological impact metrics. Public trust emerged as crucial for DCT to be effective, which requires high and enforceable data safety and privacy standards, clear and transparent communication, high accuracy and reliability of the intervention, and an acceptance-enhancing implementation approach of other pandemic response measures by public health authorities more broadly. Most evaluations took place in high rather than low-resource settings. While technical performance matters, DCT effectiveness primarily depends on a relatively small number of non-technical drivers centred around public trust. DCT should only be implemented as integrated part of a broader public health framework. Our findings hold important insights for the design, implementation, and evaluation of other digital technology for pandemic response.

Assessing Thailand’s Debt Ceiling—Room for Recalibration?

The pandemic responses and subsequent fiscal stimulus measures have eroded Thailand’s fiscal space, pushing its public debt close to the ceiling of 70 percent of GDP. While this situation generally calls for fiscal prudence to reduce debt levels, it also raises questions about the adequacy of the current debt ceiling. This paper uses various approaches to assess Thailand’s public debt threshold, beyond which debt could become unsustainable or negatively impact growth. Stochastic simulations are used to account for potential impact of macroeconomic and fiscal shocks in calibrating an appropriate debt ceiling for Thailand.

"A word that describes it well is 'lonely'" - Experiencing preterm birth during the first COVID-19 lockdown in Germany: A qualitative study.

"A word that describes it well is 'lonely'" - Experiencing preterm birth during the first COVID-19 lockdown in Germany: A qualitative study.

Intensive care unit nurses' redeployment experiences during the COVID-19 pandemic: A qualitative study.

Intensive care unit nurses' redeployment experiences during the COVID-19 pandemic: A qualitative study.

COVID-19 impacts on decarceration for Indigenous, Black, and other racialized people in Ontario, Canada: an interrupted time series study.

COVID-19 impacts on decarceration for Indigenous, Black, and other racialized people in Ontario, Canada: an interrupted time series study.

Applying an after-action review process to examine a complex public health response in New South Wales (NSW), Australia: lessons for reflective practice

Objective After-action reviews (AARs) are used to systematically examine the functions, capabilities and barriers impacting effective pandemic responses. This paper describes the methods used for and the lessons learnt from undertaking the first formal state-wide AAR of the public health response to COVID-19 in New South Wales (NSW), Australia. Type of program A state-wide AAR was applied to examine the public health response to COVID-19 conducted by Health from January 2020 until May 2022. Methods The AAR was conducted between March and November 2022. The World Health Organization ARR approach was used and involved six stages including: (1) AAR design, (2) AAR planning, (3) team debriefs, (4) workshop preparation, (5) consensus workshop and (6) AAR report review and finalisation. Results The AAR process involved over 100 people across the NSW network through surveys, team debriefs and workshops. The stepped process used to complete the review, with standardised templates, was found to be acceptable and feasible. The preparatory stage elicited important insights, provided an opportunity for structured reflection and helped identify themes for discussion in the workshop. Feedback methods included two participant satisfaction surveys and one post-implementation review session, which identified strengths in the process and areas that could be modified for future iterations of other public health reviews in NSW. Lessons learnt The AAR process successfully engaged multi-disciplinary pandemic response staff in a systematic reflection process. The process was perceived by most participants as a highly valuable opportunity to reflect and it led to important findings to improve public health emergency responses. It is important that the scope of the AAR is well understood by participants and that the psychological needs of the workforce are considered in the AAR process. There is merit in applying such reviews as standard practice in future public health emergencies.

“No one ever comes back and asks us how could we do it better”: findings from First Nations community panels about ways to keep First Nations peoples safe from COVID-19

Equity in pandemic planning and response for First Nations peoples in Australia requires a deeper understanding of sociocultural realities to determine appropriate public health actions. First Nations community panels were held in three locations across Australia between September 2020 to December 2020 to make decisions on how government authorities should help First Nations peoples keep safe from COVID-19. Twenty-two First Nations peoples participated in online panels. Panels heard from public health experts, examined the evidence and deliberated on the issues. All panels highlighted that embedding First Nations worldviews into health policy was important. First Nations peoples must be supported and resourced to enable self-determination in preparation for future infectious disease emergencies, otherwise their health could be negatively impacted if they are not intentionally considered or actively engaged.

Convergence and diversity: how collective risk perception shapes public compliance behaviour – a case study of China’s Covid-19 response

This study investigates the influence of collective risk perception on public compliance behaviour, aiming to elucidate why cities exhibit significant disparities in pandemic response effectiveness and compliance levels despite implementing similar containment policies. Drawing on the perspectives of power and knowledge, we first construct an explanatory framework for collective risk perception, and employ the most similar systems design (MSSD) to examine the contrasting Covid-19 responses in Wuhan and Shanghai, China. The findings indicate that during the early stages of the Wuhan outbreak, collective risk perception exhibited a high degree of convergence, shaped by unknow knowledge, stringent government interventions, pessimistic expert evaluations, negative societal opinions and the alarming global pandemic trajectory, thereby fostering strong public compliance. Conversely, during the Shanghai outbreak, collective risk perception became highly diversified owing to the proliferation of scientific knowledge, divergence in expert opinions, dramatic shifts in government containment strategies, polarization of social opinion and the availability of alternative international response models, collectively undermining public consensus on governmental measures and attenuating compliance. On the basis of these insights, this study develops a theoretical framework delineating the interaction between collective risk perception and public compliance behaviour, positing that the degree of convergence or diversity in collective risk perception serves as a critical determinant of compliance levels. A convergent risk perception fosters high compliance, whereas a diversified perception engenders behavioural inconsistencies and lower adherence. By advancing the understanding of risk perception dynamics in public crisis governance, this study offers policy implications for future public health emergencies, emphasizing the necessity for governments to strategically construct collective risk perception through continuous and transparent crisis communication, coordinating expert consensus and guiding social discourse to enhance public adherence and optimize crisis governance outcomes.

"You Start With the Community": The Value of Community-Based Approaches to COVID-19 in Sri Lanka.

Background: Despite the previous success of a universal health care system, Sri Lanka is facing novel challenges including non-communicable diseases such as diabetes and cancer, an aging population, and most recently, the COVID-19 pandemic. Previous pandemic and disaster responses worldwide have centered local community approaches as crucial for effective solutions. However, there is a gap in the literature surrounding the role of community organizations in Sri Lanka's public health response. Purpose: This study investigates the role of community-based responses during the COVID-19 pandemic in Sri Lanka through the perspective of public health professionals and nongovernmental organization (NGO) affiliates. Research Design: The study is based on qualitative interviews and the antecedent literature review, used to triangulate the collected qualitative data.Study Sample: Ten interviews were conducted to gain an understanding of the role of community organizations in Sri Lanka's COVID-19 pandemic response from both those who work within the public health sector as well as community organizations that assisted with public health efforts. Results: Findings demonstrate that community organizations aided in the COVID-19 response through various forms of hands-on support, most commonly including fundraising and the provision of resources, food, safety equipment, and educational materials. In addition, community organizations' were most successful in navigating the pandemic climate when they communicated closely with communities, engaged in ongoing collaboration with the government, and used innovative strategies. Conclusion: We see this work as exploratory and important for informing future research on the Sri Lankan public health context. Our findings suggest that community organizations should not be overlooked in global public health contexts as they are often well positioned to combat arising public health issues through their unique networks and potential for new and creative solutions.

Assessing the global implications of the COVID-19 pandemic on the cervical cancer elimination initiative.

The COVID-19 pandemic disrupted many public health programs; understanding these disruptions is critical for directing future resources. In a project studying the implementation of human papillomavirus (HPV) testing-based cervical cancer screening, we queried about the impact of the pandemic on screening programs globally. In consultation with World Health Organization's Regional Advisors, program managers, government officials, and clinicians involved in the implementation of HPV testing-based cervical cancer screening programs were invited to participate in semi-structured, in-depth, interviews. Interview notes and transcripts were used for inductive analysis, focusing on responses to the impact of COVID-19 pandemic on screening programs. Thirty-two interviews were conducted with participants between the age of 29 and 61 years, representing programs from 25 countries. Six key themes were noted. Regarding disruptions, (1) the entire cancer continuum was affected, leading to delays or, in some cases even cessation of vaccination, screening, and treatment programs; and (2) a heightened sense of fear around contracting and transmitting COVID-19 shifted government priorities and impacted healthcare delivery. Nonetheless, participants noted constructive ways in which programs leveraged the impact of the pandemic: (1) at the community level, participants were able to leverage an increased understanding and acceptance surrounding the importance of preventive health behaviors; (2) for HPV-testing: molecular laboratories became well-equipped with better technician training, increasing overall HPV-testing capacities; (3) the pandemic promoted virtual healthcare systems; and (4) for planning: shutdowns allowed time to plan for program scale-up. In many ways, the pandemic response provided evidence supporting countries' abilities to mobilize resources. While disruptions were noted, the pandemic provided implementers with opportunities to strengthen screening programs, which should be further assessed in future sustainability research on cervical cancer prevention and control.

Learning from COVID-19: A Systematic Review of the IHR-SPAR Framework’s Role in the Pandemic Response

The International Health Regulations (IHR) provide a global framework for health security, requiring annual reporting on 35 indicators across 15 core capacities via the State Parties Annual Reporting (SPAR) tool. The COVID-19 pandemic exposed gaps in the IHR framework and monitoring systems, prompting calls for reform. This systematic review analyzed the correlations between IHR-SPAR scores and pandemic outcomes across nine studies (2020–2024), selected using the PRISMA guidelines. The study quality was assessed using the Joanna Briggs Institute’s tool for cross-sectional studies. Of 1019 screened studies, nine met the inclusion criteria. Higher SPAR scores generally correlated with lower COVID-19 incidence and mortality, although some high-scoring countries experienced severe outbreaks. Middle-income countries showed the greatest improvement, particularly in risk communication and emergency response, while zoonotic disease capacities saw little progress. While the SPAR tool aids monitoring, it requires revisions to better reflect real-world pandemic responses. High SPAR scores do not always indicate effective crisis management. This study recommends integrating more dynamic, operational, and context-sensitive indicators to enhance the global preparedness for future health emergencies.