Future Pandemics Research Articles

COVID-19 testing and reporting behaviours in England across different sociodemographic groups: a population-based study using testing data and data from community prevalence surveillance surveys

Understanding underlying mechanisms of heterogeneity in test-seeking and reporting behaviour during an infectious disease outbreak can help to protect vulnerable populations and guide equity-driven interventions. The COVID-19 pandemic probably exerted different stresses on individuals in different sociodemographic groups and ensuring fair access to and usage of COVID-19 tests was a crucial element of England's testing programme. We aimed to investigate the relationship between sociodemographic factors and COVID-19 testing behaviours in England during the COVID-19 pandemic. We did a population-based study of COVID-19 testing behaviours with mass COVID-19 testing data for England and data from community prevalence surveillance surveys (REACT-1 and ONS-CIS) from Oct 1, 2020, to March 30, 2022. We used mass testing data for lateral flow device (LFD; data for approximately 290 million tests performed and reported) and PCR (data for approximately 107 million tests performed and returned from the laboratory) tests made available for the general public and provided by date and self-reported age and ethnicity at the lower tier local authority (LTLA) level. We also used publicly available data on mean population size estimates for individual LTLAs, and data on ethnic groups, age groups, and deprivation indices for LTLAs. We did not have access to REACT-1 or ONS-CIS prevalence data disaggregated by sex or gender. Using a mechanistic causal model to debias the PCR testing data, we obtained estimates of weekly SARS-CoV-2 prevalence by both self-reported ethnic groups and age groups for LTLAs in England. This approach to debiasing the PCR (or LFD) testing data also estimated a testing bias parameter defined as the odds of testing in infected versus not infected individuals, which would be close to zero if the likelihood of test seeking (or seeking and reporting) was the same regardless of infection status. With confirmatory PCR data, we estimated false positivity rates, sensitivity, specificity, and the rate of decline in detection probability subsequent to reporting a positive LFD for PCR tests by sociodemographic groups. We also estimated the daily incidence, allowing us to calculate the fraction of cases captured by the testing programme. From March, 2021 onwards, individuals in the most deprived regions reported approximately half as many LFD tests per capita as individuals in the least deprived areas (median ratio 0·50 [IQR 0·44-0·54]). During the period October, 2020, to June, 2021, PCR testing patterns showed the opposite trend, with individuals in the most deprived areas performing almost double the number of PCR tests per capita than those in the least deprived areas (1·8 [1·7-1·9]). Infection prevalences in Asian or Asian British individuals were considerably higher than those of other ethnic groups during the alpha (B.1.1.7) and omicron (B.1.1.529) BA.1 waves. Our estimates indicate that the England Pillar 2 COVID-19 testing programme detected 26-40% of all cases (including asymptomatic cases) over the study period with no consistent differences by deprivation levels or ethnic groups. Testing biases for PCR were generally higher than those for LFDs, in line with the general policy of symptomatic and asymptomatic use of these tests. Deprivation and age were associated with testing biases on average; however, the uncertainty intervals overlapped across deprivation levels, although the age-specific patterns were more distinct. We also found that ethnic minorities and older individuals were less likely to use confirmatory PCR tests through most of the pandemic and that delays in reporting a positive LFD test were possibly longer in populations self-reporting as "Black; African; Black British or Caribbean". Differences in testing behaviours across sociodemographic groups might be reflective of the higher costs of self-isolation to vulnerable populations, differences in test accessibility, differences in digital literacy, and differing perceptions about the utility of tests and risks posed by infection. This study shows how mass testing data can be used in conjunction with surveillance surveys to identify gaps in the uptake of public health interventions both at fine-scale levels and across sociodemographic groups. It provides a framework for monitoring local interventions and yields valuable lessons for policy makers in ensuring an equitable response to future pandemics. UK Health Security Agency.

2.C. Round table: A Pandemic Treaty to deliver global health equity: negotiating under a ticking clock

Abstract Access to medical countermeasures (vaccines, therapeutics, diagnostics), fair resource allocation and a global health framework to counter future pandemics are to be provided for by the Pandemic Treaty, intensely debated in the Intergovernmental Negotiating Body (INB) over the past two years. The final negotiations round began under tremendous pressure (Apr 29, 2024), with dissonance on structural treaty elements and a ticking clock to finalise the text at the World Health Assembly (end of May 2024). At a time of shifting geopolitical powers, in a year of elections across the world, war in Europe and rising defence expenditure, countries are reluctant to commit; the draft postpones key decisions, proposing to establish two intergovernmental working groups for instruments on One Health and prevention, and on a Pathogen Access and Benefits (PABS), with technology transfer and capacity-building remain largely unaddressed, despite COVID-19 lessons. With EU and G7 countries holding to their positions on surveillance, financing, and intellectual property (IP), negotiations will continue. A more critical question remains: will the Treaty’s be adequate and timely enough to meet the challenges of inevitable future pandemics? Will it deliver the global framework of its foundational purpose of equity and justice? This RT aims to inform and involve the European public health community, continuing the series of activities embarked upon at the beginning of the pandemic, empowering its members for evidence-informed advocacy and concerted action. Following a brief presentation on the Treaty’s key provisions, each panel member will deliver a brief (2-3 min) intervention based on core expertise, with two rounds of panel questions/statements to follow, and with an interactive element to prioritise and submit questions. The first elaborating on the current provisions, linking them to the key expertise of panel members, i.e., international and EU law, public health law, One Health and infectious disease control, global health policies, technology transfer, fair pricing and access to countermeasures. The second examining what can be achieved via evidence-informed advocacy, and with a special focus on the role of the European public health community. Has it been well represented so far in negotiations? Should it be more involved? Is it well equipped to provide expert advice to Europe’s policymakers? Is there complementarity in relation to Europe’s Global Health Strategy (GHS) and national global health plans? Finally, the role of WHO will be briefly debated. How can sovereignty be safeguarded without compromising implementation? What is the role of transparency and sound governance to remain in line with national and EU laws and priorities? The last five minutes of this RT will be used to consolidate messages and share plans to inform future formal EUPHA positioning in negotiations. Key messages • Pandemic accord deliberation has have taken place under extreme urgency and geopolitical pressure. The European public health community must be informed and engaged for EU and country-level advocacy. • At a time of permacrisis, the adoption of a global framework for fair resouce allocation, access to medical countermeasures,and to strengthen health systems for future pandemics is urgently needed. Speakers/Panelists Sujitha Subramanian University of Liverpool, Liverpool, UK Dimitra Lingri European Healthcare Fraud and Corruption Network, Brussels, Belgium Debjani Muller HTAi, Edmonton, Canada Ricardo Mexia National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal Bettina Borisch WFPHA, Geneva, Switzerland

Impact of COVID-19 measures on psychosocial outcomes in Austria – a qualitative vignette study

Abstract During the COVID-19 pandemic, Austria implemented frequent and restrictive containment measures. We aimed to explore the perspectives of individuals affected by political and epidemiological decisions in Austria, particularly in Vienna and Lower Austria. A qualitative vignette-based study conducted from July to Oct 2023 utilized two hypothetical future pandemic scenarios to prompt in-depth discussions in semi-structured interviews with Austrian residents about their perspectives, either private or from the fields of healthcare, education, citizen representation, business, research, public health and politics. Interview data was analysed using a thematic analysis approach. To ensure results’ rigor and accuracy, we followed the COREQ guideline and included two citizen research partners. This project is funded by WWTF (Grant ID: LS22071). Preliminary thematic analysis from 28 interviewees (53.6% female) aged 19-77 (mean 53.0 years) shows that the negative effects of school closures was a major concern among participants. Despite diverging points of view on other topics, there was a broad consensus that school closures would have negative consequences, such as unstable educational modalities impairing young people’s individual development, decreasing psychosocial support in their peer groups, leading to long-term educational losses, not only for individuals but also for society as a whole, and having a negative impact on economic growth, social justice and innovation. The participants also described a lack of evidence for the necessity of the frequent school closures during the pandemic as had happened in Austria and suggested a different approach in a future pandemic. Further topics were the deterioration of mental health, incentives instead of mandatory measures, more transparent communication by authorities, agreement between experts and researchers, reducing uncertainties regarding pandemic management, compliance by the general public and democratic social cohesion. Key messages • Addressing the multi-faceted impact of a pandemic requires a comprehensive approach that considers mental health, social justice, communication and social cohesion alongside containment measures. • This work represents a learning from the COVID-19 pandemic. From the conclusions of this study, recommendations can be derived to be better equipped in future pandemics.

Global health resource distribution during COVID-19 and in future pandemics: Here’s what people say

Abstract During the COVID-19 pandemic, countless individuals across the world needed novel and sophisticated health care resources simultaneously, leading to dramatic global shortages. How to distribute resources in such situations? This dilemma is neither new nor understudied: Its complexity is well known to medical ethicists, public health scientists and philosophers. Building on this knowledge, powerful global distribution frameworks were proposed already early into the pandemic. Despite this knowledge, no globally consensual regulations existed (and exist) on the political sphere. Worse still, numerous countries hoarded resources for themselves, increasing global inequalities and prolonging the pandemic for everyone. For future emergencies, it is thus necessary to develop immediately applicable strategies. Because public acceptance is key for such interventions, evidence on the public opinion towards allocation principles is strongly needed. In 2021, we asked representative samples of N = 2694 adults in England and Germany to rate seven COVID-19-specific global allocation principles. In line with literature on justice attitudes in general, extensions of bifactor(S-1) models showed that participants would have preferred a more equity- or equality-based global resource distribution during the pandemic, presenting themselves as more cosmopolitan than global leaders. Trying to understand these attitudes better, we tested preregistered hypotheses on relations with other constructs and found positive associations between equity- and equality-directed preferences and global human identification, among others. To ensure generalisability on future pandemics, we collected data from a second cohort in spring 2024. All results will be presented in detail. With their responses, European citizens call upon the development of fairer and more efficient global distribution mechanisms. This global public health perspective could inform preparations for future global emergencies. Key messages • European citizens would have preferred a more equity- or equality-based global distribution of scarce health care resources during the COVID-19 pandemic than global leaders organised. • Citizens’ global perspective on public health and their strong emphasis on global fairness should inform preparations for future pandemics and other global emergencies.

Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study

Abstract Background The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care. Methods In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses. Results Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021. Conclusions Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics. Key messages • Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care. • This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.

The state of pandemic preparedness in four European countries

Abstract One of the lessons learned from the COVID-19 pandemic is that monitoring determinants and behaviour can improve policy and communication strategies. To improve countries’ capacity to respond in a hot phase of a pandemic and build a resilient society, suitable monitoring in a cold phase of various behaviours and determinants that could become important in future pandemics is key. In March 2024 we launched the first round of the Pandemic Preparedness and Behaviour (PPb) survey in four European member states: Spain, Slovenia, Ireland and The Netherlands (N = ∼1000 per country). In this presentation we start by showing key findings. For example, we found that overall, approximately one third of participants believe their government is prepared if a new pandemic would occur next month. Next, we discuss similarities. For example, we find that in all four countries, perceived preparedness of self is higher than perceived preparedness of one’s government. We also address key differences, such as distinct patterns in perceived risk of a highly contagious outbreak in the next 5 years (whereas in Spain 26% perceives of participants an outbreak as probable, this is 43% in Slovenia) or differences in self-reported adherence to hygiene behaviours (i.e. handwashing after coughing or sneezing in elbow is markedly higher in the Slovenian sample than in the Netherlands). Next, we explore which determinants of these patterns are generalisable, and which are specific to two of the four countries: Spain and Slovenia. We follow up by comparing insights for policy and practice in their given contexts, as well as lessons learned with respect to use and development of the monitor. We conclude that monitoring individual behaviours and its determinants helps to develop joint efforts in developing effective public health policies across Europe regarding pandemic preparedness.

Environment, climate, socio-economics & restrictions impact on COVID-19 in Northen Italy

Abstract Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, and most of them focused on viral spread rather than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (n.68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly. Key messages • Evaluating simultaneously four exposure domains on COVID-19 outcomes informs public health policy for future pandemic management. • The comprehension of risk factors associated with severe outcomes, such as hospitalization and mortality, is pivotal for planning responses to similar health emergencies in the future.

Health and well-being during the pandemic: views and support needs of older adults who lived alone

Abstract Background Physical and social distancing measures during the COVID-19 pandemic had the potential to jeopardize health and well-being of older adults. Especially older adults who lived alone faced challenges due to restrictive COVID-19 measures. In this study, we explored views and support needs to maintain health and well-being of older adults living in a single household during the COVID-19 pandemic. Methods We employed an interpretative phenomenological analysis, including twenty semi-structured interviews with older adults (≥65 years old) living in single households during the pandemic. Interviews were conducted between June and September 2021, audio-recorded and lasted approximately one hour. Data analysis was guided by the heuristic framework of Smith et al. Trustworthiness of the study was enhanced through bracketing and multiple interdisciplinary moments of revision of the data analysis. Results The views and support needs of participants to maintain health and well-being during the pandemic were captured in three overarching themes: ‘A lingering search for connectedness’, ‘Dealing with a discouraging situation to stay well’, and ‘Leaning on lessons learned during life’. Important resources that enabled participants to maintain health and well-being were: experiences of social connectedness, acceptance of the situation, and (re)gaining a sense of control. Participants described how they leaned on lessons learned from life-experiences when facing situations that challenged their health and well-being. Conclusions Our study points out that views and support needs of older adults to maintain health and well-being during the pandemic were diverse and rooted in various coping mechanisms. During future situations similar to the pandemic, public health policies should include strategies to promote social connectedness among older adults who live alone, to prevent adverse health outcomes. Key messages • Experiences of social connectedness, acceptance, and (re)gaining a sense of control were coping mechanisms that enabled older adults to maintain health and well-being during the COVID-19 pandemic. • Public health policies should include strategies to promote social connectedness among older adults who live alone, to prevent adverse health outcomes during future pandemics.

Recent Developments in Infectious Disease Research

The field of infectious disease research is rapidly evolving and advancing, driven by the demand to address both current and emerging threats to global health. The recent COVID-19 pandemic underscored the criticality of infectious disease outbreak preparedness and response, while factors such as climate change, migration, and globalization continue to influence disease transmission dynamics. Innovative approaches to infectious disease research are more essential than ever to prevent future pandemics and the spread of vectorborne diseases. This comprehensive review article investigates some recent pertinent developments in infectious disease research, including the development of a novel serosurveillance platform, modeled after the one designed during the COVID-19 pandemic, aimed at tackling the growing global threat of arboviruses. Also investigated in this article is the repurposing and application of mRNA vaccine technology, initially developed during the pandemic, to address the complex challenge of tick-borne Lyme disease. Finally, we outline several novel and cutting-edge strategies aimed at tackling the ever-mounting crisis of antimicrobial resistance (AMR). Each of these innovations marks a significant step forward in global health security and preparedness, offering promising solutions to the challenges of a rapidly evolving world, while drawing on the lessons learned from past outbreaks and epidemics.

Socioeconomic And Mental Health Challenges: Lessons From The COVID-19 Era

Abstract The relationship between work arrangements, financial difficulties, compliance with COVID-19 sanitary measures, and preexisting mental health issues amidst the ongoing pandemic is multifaceted. By merging data from the TEMPO cohort and other European cohort studies during the RESPOND European project, we seek to provide comprehensive about these dynamics for developing targeted interventions and policies aimed at mitigating the adverse impact of pandemics on mental well-being. Our analyses reveal significant associations between unemployment, financial strain, and elevated levels of symptoms of anxiety and depression during the COVID-19 pandemic. Even after controlling for pre-pandemic socioeconomic and mental health factors, individuals experiencing unemployment or financial difficulties were more likely to report heightened mental distress. Additionally, our findings highlight gender-specific patterns in compliance with COVID-19 sanitary measures, with women exhibiting increased compliance amidst mental health difficulties, while men, particularly those with lower educational attainment, demonstrated decreased compliance. These preliminary results underscore the complex interplay between socioeconomic factors, mental health, and public health behaviours during pandemics. In conclusion, our study underscores the urgent need for targeted interventions and strategies to address the intersecting challenges of mental health, employment, financial strain, and compliance with public health measures during the COVID-19 pandemic. The findings emphasize the importance of considering socioeconomic disparities in designing effective interventions aimed at promoting public well-being and resilience in the face of future pandemics. By leveraging these insights, public health practitioners and policymakers can develop evidence-based approaches to support individuals and communities experiencing heightened vulnerabilities during times of crisis.

An international comparison of Long-term Care Facility outcomes during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic has had huge repercussions for public health internationally and different countries had different outcomes based on preconceived policy interventions. Lessons influencing future policy have been learned, notably how best to manage vulnerable populations, particularly those living in long-term care facilities (LTCFs). In Ireland LTCF residents accounted for 56% of deaths during the first wave of the pandemic and it is imperative to establish the causes of this. International research has highlighted how factors including county incidence rate, facility size, occupancy, LTCF ownership and compliance with health inspection regulations influenced LTCF COVID-19 outcomes. The aim of this research is to explore the impact of these factors in an Irish context and compare to best international standards. Methods The main outcome considered was deaths per 100 beds. Data on crude mortality were available for 580 Irish LTCFs up to 28 May 2020. Data regarding occupancy, ownership, facility size and compliance with regulations were obtained for these LTCFs from a novel dataset of 1130 available LTCF regulatory inspection reports between 2018- 2022. Regression analysis was carried out to show how LTCF mortality was predicted by examined variables. Results The most significant predictor of deaths from COVID-19 in Irish LTCFs resulting from this research was LTCF occupancy (Odds ratio:1.029, significance <0.001). Regional community incidence, in concordance with international literature was also an important factor. Other stated predictors in this model were either non-significant or only marginally significant. These results are analysed in conversation with international research of the same variables. Conclusions To protect LTCF residents for potential future pandemics, attention should be paid to monitoring and suppressing local incidence rates and moves should be implemented towards designing smaller facilities with individual rooms for vulnerable residents. Key messages • Irish long-term care pandemic mortality was predicted by high occupancy of facilities and high regional COVID-19 incidence. • Comparing International COVID-19 outcomes in long-term care facilities can provide guidelines for the future.

11.P. Scientific session: Behavioural Science of Emergency Preparedness across Europe

Abstract The COVID-19 pandemic highlighted the critical role of human behaviour in times of crisis. However, it also revealed that the behavioural sciences were not optimally prepared to provide actionable insights to policy makers to support preventive and coping behaviours in a crisis context. To ensure that the behavioural sciences can provide timely and effective advice to policy makers during future emergencies, it is key to act before a crisis occurs. The current workshop chaired by the Behavioural and Cultural Insights Unit of the WHO, will offer five perspectives to explore how behavioural science as a discipline is being applied to our understanding of pandemic and emergency preparedness and what concrete actions can and are already being taken now. Following five short presentations, a discussion with the panel and the audience will take place. The Dutch National Institute of Public Health and the Environment (RIVM) will start by presenting their approach toward embedding behavioural science of pandemic preparedness: the organisation of a national stakeholder network, the development of a conceptual framework, and3) development of a quantitative survey monitor for individual level behaviour. monitoring pandemic preparedness. f The Spanish Carlos III Health Institute and Slovenian Public Health institute will present insights about operationalising this monitor in their given context. They will present results of the first two rounds of this monitor on behalf of the four European member states, focusing on comparative insights on perceptions and states of preparedness, vaccination, citizen wellbeing and resilience with respect to their context. Next, the Competence Centre on Behavioural Insights of the European Commission will present an experimental approach toward preparedness. They will present results based on a scenario study, focused on understanding behaviours in the broader context of pandemic and disaster preparedness. The last two presentations will reflect on qualitative approaches. The Behavioural and Cultural Insights Unit of the WHO will present their qualitative study on health-service access, needs and behaviours of Ukrainian refugees in neighbouring countries, and reflect on operating under emergency constraints. In the final presentation the RIVM will present their findings of qualitative methods to study perceived emergency readiness. In particular, their study focuses on what citizens understand by pandemic preparedness, and to what extent they perceive their government as prepared for a future pandemic. Overall, the workshop aims to equip participants with a comprehensive understanding of the importance of behavioural science in pandemic and disaster preparedness and inspire collaborative action towards building resilient and effective strategies for future crises. Key messages • The workshop underlines the importance of behavioural science in preventing and responding to infectious disease outbreaks. • Participants learn how behavioural sciences can already be applied now to prepare citizens and organisations for future pandemics and crises.

Integrated sentinel surveillance of influenza, SARS-CoV-2, RSV and respiratory viruses in Serbia

Abstract Introduction Integrated sentinel SARI surveillance of influenza, SARS -CoV-2 and RSV has been established in Serbia since 2021-2022 influenza season. Nine sentinel hospitals in 3 cities participated in the SARI surveillance system. The aim of this study is to provide a review of integrated sentinel surveillance of SARI in Serbia in 2023-2024 influenza season, from October 2023 to April 2024. Methods On a weekly basis, both epidemiological and virological data were collected. Surveillance is be conducted year-round. Specimens were tested for influenza, SARS-CoV-2,RSV and other respiratory viruses. Respiratory disease wards, intensive care units (ICUs) and pediatric wards were all represented. Real time polymerase chain reaction (RT-PCR) was used. Results From October 2023 to April 2024, a total of 1571 SARI cases were reported with 100% recorded age. Of these, 35% were 0-4 years old, 16% were 5-14, 6% were 15-29, 14% were 30-64, 18% were 65-79 and 11% were 80+. Among these cases, 1002 (64%) respiratory specimens were collected. The number of positive samples for influenza was 294 (29%). The positivity rate was 10% for SARS-CoV-2 and 19 % for RSV. The highest proportion of laboratory-confirmed influenza cases was 67% in week 04/2023. Then above 50% in week 05/2023 and 06/2023. Type A viruses was predominated, accounting for 97% of all influenza SARI detections. Activity was dominated by A(H3) with 42% positivity rate. Also, collected swabs were tested for rhinoviruses, positivity rate was 26%, for adenoviruses, 12%, for human metapneumovirus, 7% and for parainfluenza 3 viruses, 4%. Conclusions Sustaining and intensified effective integrated surveillance for influenza, SARS-CoV-2,RSV and other respiratory viruses in Serbia is the priority especially in the frame of International Health Regulations. In this way, we improve national capacity for preparedness and emergency response to national and cross-border public health threats. Key messages • Building and maintaining integrated respiratory surveillance that can rapidly integrate the surveillance of a new viruses is crucial. • Establishing well structured surveillance of severe acute respiratory infections, strengthening and expanding respiratory viral surveillance is one the base pillars preparation for future pandemics.

The impact of the COVID-19 pandemic on physical activity among primary school children in Ireland

Abstract Background The containment measures implemented during COVID-19 to curb the virus’s spread disrupted family life globally and profoundly impacted children’s daily behaviours. A decrease in children’s physical activity during COVID-19 is one such health behaviour change that was observed in many European countries. This study aimed to understand the pandemic’s impact on primary school children’s physical activity in Ireland which is important given the epidemic of childhood obesity and chronic diseases in the long term. Methods All Childhood Obesity Surveillance Initiative (COSI) participating countries (n = 45) could voluntarily implement the COVID study as part of their COSI Round 6 (R6) data collection or separately. The parents of First and Second-class primary school children (n = 2,784) who consented to participate in COSI-Ireland R6 were invited to complete the family survey which included the standardised COVID study. The COVID module assessed children’s lifestyles and health behaviours before and during the pandemic through 12 questions. Consenting parents supplied their email or postal address and completed the survey in hardcopy or electronically using LimeSurvey. Descriptive statistics were then calculated on the cleaned pseudonymised dataset (n = 1,060) using IBM SPSS Statistics 27. Results The time spent playing actively outside school hours remained the same for some children on both weekdays and weekends (24.2% and 37.1%, respectively). An increase rather than a decrease in the time spent in active play was also observed among almost twice as many children across Ireland on both weekdays (47.3% and 24.2% respectively), and weekends (40.10% and 21.80% respectively). Conclusions The positive findings show that the public health messaging from the Irish Government which emphasized the importance of staying active during COVID-19 may have been effective. Further research to assess children’s physical activity during COVID-19 is warranted to inform future pandemics. Key messages • In Ireland, unlike in many European countries, a substantial number of primary school children increased their time spent playing actively during the COVID-19 pandemic. • A unique trend in Irish children’s physical activity levels compared to their European counterparts.

Psychosocial Workloads and Resilience of Heads of Municipal Public Health Authorities in Germany During the COVID-19 Pandemic: Perceptions of Operational Organization, Communication, and Measures

Healthcare professionals are particularly vulnerable to mental health issues during epidemics, as evidenced by the COVID-19 crisis. German public health authorities, crucial for disease prevention, faced significant strain from chronic understaffing and resource limitations exacerbated by the pandemic. The study was designed as a cross-sectional, observational online survey. This study conducted an online needs assessment survey among heads of municipal public health authorities in Thuringia, Saxony, North Rhine-Westphalia, Bavaria, and Berlin between June and November 2023. Of the 191 contacted authorities, 74 responses (38.7%) were analyzed, focusing on professional demands, recognition, stress resilience, general life satisfaction, operational organization, and communication during the pandemic. Validated scales such as ERI, RS-13, L-1, and the COVID-19 add-on module of the COPSOQ were utilized. Statistical tests included descriptive statistics, correlation coefficients, Chi-Square tests, linear regression, T-tests, and ANOVA with a significance level set at p < 0.05. Respondents were mainly from North Rhine-Westphalia (43.3%) and Bavaria (24.3%), predominantly female (54.1%), and had a mean age of 52.7 years. The majority were medical specialists (71.9%). The RS-13 mean score was 72.66 (SD = 12.42), with 58.9% demonstrating high stress resilience. Public health degree holders showed the highest resilience. The ER-ratio indicated high effort versus reward for 96.7% of heads. Larger districts showed lower ER-ratios, suggesting resilient organizational structures. The study highlights high psychosocial workload and resilience among German public health authority heads during COVID-19, suggesting the need for optimized crisis management and scalable staffing for future pandemics and crises.

Excess mortality during COVID-19 pandemic in Bangladesh - evidence from a rural survey.

The coronavirus disease 2019 (COVID-19) had a profound impact worldwide. In Bangladesh, the official number of deaths for COVID-19 was around 29 000. However, many countries including Bangladesh experienced substantial underreporting of COVID-19 deaths due to lack of complete national civil registration system. This study aims to estimate excess mortality in 2020, identify risk factors, and determine leading causes of death in Bangladesh. In February 2021, we conducted a cross-sectional household survey in Sitakunda, a subdistrict of Chattogram, identifying deaths from January 2018 to December 2020. Excess mortality was quantified using the p-score and incidence rate ratio (IRR) utilising Poisson segmented regression. We employed the InterVA-5 algorithm to attribute causes of death. Proportional distribution and cause-specific mortality rates (CSMR) per 100 000 individuals were compared between pre-pandemic and pandemic periods. Among 1748 deaths from 25 669 households, we found 1.4 (95% confidence interval (CI) = 1.2-1.4) times excess mortality in 2020 compared to 2018-2019. Leading causes of death in 2020 included cardiac disease (CSMR = 121.0, CI = 115.8-127.3), stroke (CSMR = 108.0, CI = 102.6-114.0), and acute respiratory infection (CSMR = 61.0, CI = 55.1-66.5), all displaying significantly higher mortality rates than in previous years. Older age (IRR = 1.6), less education (IRR = 1.8), and lower socio-economic groups (IRR = 2.1) had higher mortality rates in 2020 compared to pre-pandemic years. Our study suggests high rural excess mortality during COVID-19 including cardiac disease, stroke and acute respiratory infection as the leading causes of deaths. We require targeted strategies to identify high-risk patients with comorbidity and social vulnerabilities that contribute to mortality to guide the preparedness strategy for future pandemics.

13 Child maltreatment in Canada in the time of COVID-19: Experiences of child protection teams

Abstract Background At the onset of the COVID-19 pandemic, there were many fears regarding the effect on children’s wellbeing – specifically with regards to increased exposure to violence and potential for abuse and neglect within their homes. Early experiences of child protect teams (CPT) in the literature from one Canadian tertiary care center revealed a number of adaptations in their child abuse programs such as a move toward virtual assessments. Objectives Our descriptive study seeks to understand the perspectives, practices, and experiences of child protection teams in Canada during the COVID-19 pandemic with regards to: clinical practice, interactions with child welfare organizations and the justice system, team modes of operating and medical education. These lessons can be applied to child maltreatment and neglect clinical practice in the event of future pandemics, natural disasters, and to provide care to rural areas of Canada. Design/Methods Using a web-based, bilingual, mixed methods survey, we asked both quantitative and open-ended qualitative questions to members of CPTs across Canada. Thematic analysis was completed on qualitative responses. We received a total of 11 responses. Results Respondents unanimously reported a decrease in referrals during the COVID-19 pandemic. 64% endorsed the use of new virtual tools. Virtual tools were used to collaborate amongst members of the CPT as well as with external partners (such as child welfare and justice system). Interestingly, there was minimal adaptation of these tools in patient-facing contexts. 57% of respondents foresee these tools to continue being used in a post-COVID-19 context, and 71% see relevance of these tools for use in rural contexts. Respondents reported that virtual clinical discussions changed the way medical education and case discussion in child maltreatment was delivered. Conclusion These findings describe not only the adaptation of child protection teams to the pandemic, but also robust changes to clinical practice, interactions with partner organizations and the justice system, team modes of operating and medical education in child maltreatment and neglect in Canada.

High-cost users still came to hospitals during the COVID-19 pandemic during first wave data in Thailand: secondary data analysis

BackgroundThe phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system.ObjectivesThis study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU.MethodsThe secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU.ResultsThe characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB).ConclusionThe HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics.

Broad cross neutralizing antibodies against sarbecoviruses generated by SARS-CoV-2 infection and vaccination in humans

The outbreaks of severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2 highlight the need for countermeasures to prevent future coronavirus pandemics. Given the unpredictable nature of spillover events, preparing antibodies with broad coronavirus-neutralizing activity is an ideal proactive strategy. Here, we investigated whether SARS-CoV-2 infection and vaccination could provide cross-neutralizing antibodies (nAbs) against zoonotic sarbecoviruses. We evaluated the cross-neutralizing profiles of plasma and monoclonal antibodies constructed from B cells from coronavirus disease 2019 (COVID-19) convalescents and vaccine recipients; against sarbecoviruses originating from bats, civets, and pangolins; and against SARS-CoV-1 and SARS-CoV-2. We found that the majority of individuals with natural infection and vaccination elicited broad nAb responses to most tested sarbecoviruses, particularly to clade 1b viruses, but exhibited very low cross-neutralization to SARS-CoV-1 in both natural infection and vaccination, and vaccination boosters significantly augmented the magnitude and breadth of nAbs to sarbecoviruses. Of the nAbs, several exhibited neutralization activity against multiple sarbecoviruses by targeting the spike receptor-binding domain (RBD) and competing with angiotensin-converting enzyme 2 (ACE2) binding. SCM12-61 demonstrated exceptional potency, with half-maximal inhibitory concentration (IC50) values of 0.001–0.091 μg/mL against tested sarbecoviruses; while VSM9-12 exhibited remarkable cross-neutralizing breadth against sarbecoviruses and SARS-CoV-2 Omicron subvariants, highlighting the potential of these two nAbs in combating sarbecoviruses and SARS-CoV-2 Omicron subvariants. Collectively, our findings suggest that vaccination with an ancestral SARS-CoV-2 vaccine, in combination with broad nAbs against sarbecoviruses, may provide a countermeasure for preventing further sarbecovirus outbreaks in humans.

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

BackgroundThroughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15–26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.MethodsTo identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.ResultsCategories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.ConclusionsThese results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.