Pandemics at Work: Convergence of Epidemiology and Ethics

2021 ◽  
pp. 1-34
Author(s):  
Michele Thornton ◽  
William “Marty” Martin
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Disease Outbreaks ◽  
Control Measures ◽  
Ethical Framework ◽  
Workplace Intervention ◽  
Ethical Challenges ◽  
Infectious Disease Outbreaks ◽  
Disease Causation ◽  
Workplace Setting

Like COVID-19, new infectious disease outbreaks emerge almost annually, and studies predict that this trend will continue due to a variety of factors, including an aging population, ease of travel, and globalization of the economy. In response to episodic public health crises, governments and organizations develop, implement, and enforce policies, procedures, protocols, and programs. The epidemiological triad is both a model of disease causation and fundamentally used to design and deploy such control measures. Here we adapt this model to the workplace setting and use the epidemiological triad to characterize the related ethical challenges in implementing the control measures employers face as a guide for a workplace intervention framework. Through this approach, our aim is to show how an integrated ethical framework, grounded in epidemiological principles, has important implications for how we categorize, understand, and resolve the difficult decisions that emerge in the workplace under pandemic conditions.

scholarly journals Ethics of emerging infectious disease outbreak responses: Using Ebola virus disease as a case study of limited resource allocation

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246320
Author(s):  
Ariadne A. Nichol ◽  
Annick Antierens
Keyword(s):  
Infectious Disease ◽  
Ebola Virus ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Emerging Infectious Disease ◽  
Ethical Framework ◽  
Experimental Therapeutics ◽  
Ethical Challenges ◽  
Outbreak Response ◽  
Infectious Disease Outbreaks

Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013–2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013–2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers’ access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants’ insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.

scholarly journals What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer B. Nuzzo ◽  
Diane Meyer ◽  
Michael Snyder ◽  
Sanjana J. Ravi ◽  
Ana Lapascu ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Scoping Review ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

scholarly journals Ethics of instantaneous contact tracing using mobile phone apps in the control of the COVID-19 pandemic

2020 ◽  
Vol 46 (7) ◽  
pp. 427-431 ◽  
Author(s):  
Michael J Parker ◽  
Christophe Fraser ◽  
Lucie Abeler-Dörner ◽  
David Bonsall
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Mobile Phone ◽  
Public Health Practice ◽  
Disease Outbreaks ◽  
Contact Tracing ◽  
Mobile Phone Data ◽  
Public Health Response ◽  
Infectious Disease Outbreaks ◽  
Ethical Implications

In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deployed or are developing mobile phone apps capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions. In our paper, we outline some ethical considerations that need to be addressed in any deployment of this kind of approach as part of a multidimensional public health response. We also, briefly, explore the implications for its use in future infectious disease outbreaks.

scholarly journals Facemask shortage and the coronavirus disease (COVID-19) outbreak: Reflection on public health measures

2020 ◽  
Author(s):  
Huailiang Wu ◽  
Jian Huang ◽  
Casper J. P. Zhang ◽  
Zonglin He ◽  
Wai-Kit Ming
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Disease Outbreaks ◽  
Wuhan City ◽  
Medical Resources ◽  
Infectious Disease Outbreaks ◽  
Health Measures ◽  
Global Pandemic ◽  
Novel Coronavirus ◽  
Effective Public Health

AbstractBackgroundA novel coronavirus disease (COVID-19) outbreak due to SARS-CoV-2 infection occurred in China in late-December 2019. Facemask wearing is considered as one of the most cost-effective and important measures to prevent the transmission of SARS-CoV-2, but it became a social concern due to the recent global facemask shortage. China is the major facemask producer in the world, contributing to 50% of global production. However, even full productivity (20 million facemasks per day) does not seem to meet the need of a population of 1.4 billion in China.MethodsPolicy review using government websites and shortage analysis using mathematical modelling based on data obtained from the National Health Commission (NHC), the Ministry of Industry and Information Technology (MIIT), the Center for Disease Control and Prevention (CDC) of the People’s Republic of China, and Wuhan Bureau of Statistics.FindingsSupplies of facemasks in the whole of China would have been sufficient for both healthcare workers and the general population if the COVID-19 outbreak only occurred in Wuhan city or Hubei province. However, if the outbreak occurred in the whole of China, facemask supplies in China could last for 5 days if under the existing public health measures and a shortage of 853 million facemasks is expected by 30 Apr 2020. Assuming a gradually decreased import volume, we estimated that dramatic increase in productivity (42.7 times of the usual level) is needed to mitigate the facemask crisis by the end of April.InterpretationIn light of the COVID-19 outbreak in China, a shortage of facemasks and other medical resources can considerably compromise the efficacy of public health measures. Effective public health measures should also consider the adequacy and affordability of medical resources. Global collaboration should be strengthened to prevent the development of a global pandemic from a regional epidemic via easing the medical resources crisis in the affected countries.Research in contextEvidence before this studyWe searched PubMed and Web of Science for articles in English, between 1 Jan 1980, and 1 Jan 2020, using the search terms 1) (infection OR infectious disease* OR outbreaks) AND (modelling); and 2) (mask* OR facemask* OR medical resource*) AND (infection OR infectious disease* OR outbreaks). Most relevant studies identified were performed to predict diseases spread and to determine the original infection source of previous epidemics like SARS and H7N9. However, few studies focused on the medical resources crisis during the outbreaks.Added value of this studyTo the best of our knowledge, this is the first study to investigate the facemask shortage during the novel coronavirus pneumonia (COVID-19) outbreak in China. We have summarized in detail the management strategies implemented by the Chinese governments during the outbreaks. By considering three scenarios for the outbreak development, we simulated the facemasks availability from late-December 2019 to late-April 2020 and estimated the duration of sufficient facemask supplies. Our findings showed that if the COVID-19 outbreak occurred only in Wuhan city or Hubei province, facemask shortage would not appear with the existing public health measures. However, if the outbreak occurred in the whole of China, a shortage of facemask could be substantial assuming no alternative public health measures.Implications of all the available evidenceOur findings provide insight into the public health measures to confront medical resources crisis during infectious disease outbreaks. Effective public health measures should consider the adequacy and affordability of existing medical resources. Governments across the world should revisit their emergency plans for controlling infectious disease outbreaks by taking into account the supply of and demand for the medical resource. Global collaboration should be strengthened to prevent the development of a global pandemic from a regional epidemic via easing the medical resources crisis in the affected countries.

scholarly journals If long-term suppression is not possible, how do we minimize mortality for COVID-19 and other emerging infectious disease outbreaks?

2020 ◽  
Author(s):  
Andreas Handel ◽  
Joel C. Miller ◽  
Yang Ge ◽  
Isaac Chun-Hai Fung
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health Care ◽  
Health Care System ◽  
Disease Outbreaks ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Infectious Disease Outbreaks ◽  
Long Time

As COVID-19 continues to spread, public health interventions are crucial to minimize its impact. The most desirable goal is to drive the pathogen quickly to extinction. This generally involves applying interventions as strongly as possible, which worked for SARS, but so far has failed for COVID-19. If fast eradication is not achievable, the next best goal is to delay the spread and minimize cases and burden on the health care system until suitable drugs or vaccines are available. This suppression approach also calls for strong interventions, potentially applied for a long time.

scholarly journals To what extent does evidence support decision making during infectious disease outbreaks? A scoping literature review

2020 ◽  
Vol 16 (3) ◽  
pp. 453-475 ◽  
Author(s):  
Andreea Salajan ◽  
Svetla Tsolova ◽  
Massimo Ciotti ◽  
Jonathan E. Suk
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Decision Making ◽  
Disease Outbreaks ◽  
Decision Makers ◽  
Expert Advice ◽  
Scientific Uncertainty ◽  
Infectious Disease Outbreaks ◽  
Decision Making Processes

Background:Infectious disease outbreaks require decision makers to make rapid decisions under time pressure and situations of scientific uncertainty, and yet the role of evidence usage in these contexts is poorly understood. Aims and objectives:To define and contextualise the role of scientific evidence in the governance of infectious disease outbreaks and to identify recommendations for overcoming common barriers to evidence-informed decision making. Methods:A scoping review and an expert workshop to provide additional input into recommendations on enhancing evidence uptake during infectious disease outbreaks taking place in European settings. Findings:Forty-nine records reporting on multiple decision-making processes during infectious disease outbreaks of the past ten years were included in the study. Decision makers prioritise expert advice, epidemiological data and mathematical modelling data for risk characterisation and management, but tend to be challenged by scientific uncertainties, which allow for conflicting interpretations of evidence and for public criticism and contestation of decision-making processes. There are concrete opportunities for optimising evidence usage to improve public health policy and practice through investment in decision-making competencies, relationship building, and promoting transparent decision-making processes. Discussion and conclusions:It is not necessarily a disregard of evidence that puts a strain on decision making in health crises, but rather competing interests and the lack of clear, unambiguous and rapidly available evidence for risk characterisation and effectiveness of response measures.The relationship between science and public health decision making is relatively understudied but is deserving of greater attention, so as to ensure that the pursuit of evidence for decision making does not challenge timely and effective crisis management.

scholarly journals Perfect counterfactuals for epidemic simulations

2019 ◽  
Vol 374 (1776) ◽  
pp. 20180279 ◽  
Author(s):  
Joshua Kaminsky ◽  
Lindsay T. Keegan ◽  
C. Jessica E. Metcalf ◽  
Justin Lessler
Keyword(s):  
Infectious Disease ◽  
Disease Outbreaks ◽  
Computation Time ◽  
Control Measures ◽  
Mathematical Representation ◽  
Theme Issue ◽  
Stochastic Variation ◽  
Infectious Disease Outbreaks ◽  
Negative Effect ◽  
And Control

Simulation studies are often used to predict the expected impact of control measures in infectious disease outbreaks. Typically, two independent sets of simulations are conducted, one with the intervention, and one without, and epidemic sizes (or some related metric) are compared to estimate the effect of the intervention. Since it is possible that controlled epidemics are larger than uncontrolled ones if there is substantial stochastic variation between epidemics, uncertainty intervals from this approach can include a negative effect even for an effective intervention. To more precisely estimate the number of cases an intervention will prevent within a single epidemic, here we develop a ‘single-world’ approach to matching simulations of controlled epidemics to their exact uncontrolled counterfactual. Our method borrows concepts from percolation approaches, prunes out possible epidemic histories and creates potential epidemic graphs (i.e. a mathematical representation of all consistent epidemics) that can be ‘realized’ to create perfectly matched controlled and uncontrolled epidemics. We present an implementation of this method for a common class of compartmental models (e.g. SIR models), and its application in a simple SIR model. Results illustrate how, at the cost of some computation time, this method substantially narrows confidence intervals and avoids nonsensical inferences. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’. This theme issue is linked with the earlier issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’.

Use and effectiveness of mHealth technologies in tracking the spread of infectious disease outbreaks and their implications for the COVID-19 pandemic: a systematic review protocol (Preprint)

2020 ◽  
Author(s):  
Madison Milne-Ives ◽  
Simon Rowland ◽  
Alison McGregor ◽  
J Edward Fitzgerald ◽  
Edward Meinert
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Systematic Review ◽  
Public Health Practice ◽  
Disease Outbreaks ◽  
Digital Technologies ◽  
World Health ◽  
Health Practice ◽  
Public Health Response ◽  
Infectious Disease Outbreaks

BACKGROUND The World Health Organisation (WHO) defines mHealth as medical and public health practice supported by mobile devices. A number of mHealth devices, primarily apps designed to support contact tracing, have been utilised as part of the public health response to the Covid-19 pandemic. The value of mHealth devices in augmenting public health practice is however yet to be defined. OBJECTIVE The study aims to address three research questions: (1) What digital technologies are being used to track the symptoms and spread of infectious disease outbreaks and what strategies do they use to do so? (2) How effective and cost-effective are digital technologies at tracking the spread of infectious disease outbreaks and what are their strengths and limitations? (3) What are the user perspectives on the usability and effectiveness of these technologies? METHODS The PICOS template and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) will be followed for this systematic review. The review will be composed of a literature search, article selection, data extraction, quality appraisal, data analysis, and a discussion of the implications of the data for the current COVID-19 pandemic. RESULTS N/A CONCLUSIONS This systematic review will summarise the available evidence for use of mHealth devices for tracking the spread of infectious disease outbreaks. These results are potentially valuable for informing public health policy during infectious disease outbreaks such as the current Covid-19 pandemic.

scholarly journals Examining the application of behaviour change theories in the context of infectious disease outbreaks and emergency response: a review of reviews

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dale Weston ◽  
Athena Ip ◽  
Richard Amlôt
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Behaviour Change ◽  
Emergency Response ◽  
Critical Role ◽  
Disease Outbreaks ◽  
Theoretical Models ◽  
Public Health Emergency ◽  
Change Models ◽  
Infectious Disease Outbreaks

Abstract Background Behavioural science can play a critical role in combatting the effects of an infectious disease outbreak or public health emergency, such as the COVID-19 pandemic. The current paper presents a synthesis of review literature discussing the application of behaviour change theories within an infectious disease and emergency response context, with a view to informing infectious disease modelling, research and public health practice. Methods A scoping review procedure was adopted for the searches. Searches were run on PubMed, PsychInfo and Medline with search terms covering four major categories: behaviour, emergency response (e.g., infectious disease, preparedness, mass emergency), theoretical models, and reviews. Three further top-up reviews was also conducted using Google Scholar. Papers were included if they presented a review of theoretical models as applied to understanding preventative health behaviours in the context of emergency preparedness and response, and/or infectious disease outbreaks. Results Thirteen papers were included in the final synthesis. Across the reviews, several theories of behaviour change were identified as more commonly cited within this context, specifically, Health Belief Model, Theory of Planned Behaviour, and Protection Motivation Theory, with support (although not universal) for their effectiveness in this context. Furthermore, the application of these theories in previous primary research within this context was found to be patchy, and so further work is required to systematically incorporate and test behaviour change models within public health emergency research and interventions. Conclusion Overall, this review identifies a range of more commonly applied theories with broad support for their use within an infectious disease and emergency response context. The Discussion section details several key recommendations to help researchers, practitioners, and infectious disease modellers to incorporate these theories into their work. Specifically, researchers and practitioners should base future research and practice on a systematic application of theories, beginning with those reported herein. Furthermore, infectious disease modellers should consult the theories reported herein to ensure that the full range of relevant constructs (cognitive, emotional and social) are incorporated into their models. In all cases, consultation with behavioural scientists throughout these processes is strongly recommended to ensure the appropriate application of theory.

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