Exploring the Impacts of the Beginning of the COVID-19 Pandemic on Critical Care Physicians and the Delivery of Patient Care in Seven Countries: A Qualitative Interview-Based Study

Purpose To understand critical care physician experiences across multiple countries with the COVID-19 pandemic to inform future pandemic preparedness planning. Methods In this qualitative study, 16 critical care physicians (from seven countries) identified in convenience, purposive sampling took part in individual semi-structured interviews from April 7, 2020 to August 27, 2020 that captured the first wave of the pandemic. Open coding was conducted by two researchers who facilitated inductive thematic analysis. Results Key themes identified following thematic analysis included: 1) sourcing and implementation of trusted information; 2) health systems-level preparedness with accessible supports; 3) institutional adaptations including changes to patient care; 4) professional safety and occupational wellbeing; 5) triage and restricted visitation policies; and 6) managing personal familial responsibilities. Conclusion Perspectives of critical care physicians are important for ongoing pandemic planning and should be included in future pandemic policy development.

Does Covid Portend a Shocking Future for Nonprofits?

COVID-19 caught many nonprofit leaders by surprise. The impact of the pandemic was unprecedented in recent history. Has this shock provided a wake-up call for nonprofits to better prepare for possible future shocks, notably those related to climate change? This article presents a number of questions that have emerged from the COVID-19 experience, pro- vides several sources of guidance on preparedness planning, and notes the opportunity for new courses to address lead- ership needs for preparedness.

CLIMATE CHANGE ADAPTATION PLAN

Nations across have come with national adaptation plan (NAPs). The inclination towards mitigation i.e.; to reduce emissions have taken a back step and adaptation has come to forefront as even with advanced frameworks, innovation, methodological tool kits, technology and capacity building, we except nations to adapt, acclimatize, adjust and bear the consequences of climate change. Adaptation plans are focused on making the stakeholders including the entities per se to make them used to impacts rather than nudging the ways and means or processes to future proof the entire supply chain and stakeholders day to day living and functioning. Adaptation is a climate intensive attribute for not just 1.5 degrees and or NDCs targets planning, but it’s a preparedness planning fudge function. Why adapt when we can do away with just mitigation? Is what, debate is on with in the scientific think tank.

Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events. Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework. Results A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans. Conclusions The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.

Global event-based surveillance of chemical incidents

Background The number of chemicals in our society and in our daily lives continues to increase. Accompanying this is an increasing risk of human exposure to and injury from hazardous substances. Performing regular, structured surveillance of chemical incidents allows a greater awareness of the types of chemical hazards causing injury and the frequency of their occurrence, as well as providing a better understanding of exposures. Objective The objective of performing event-based surveillance (EBS) and capturing chemical incidents is to use this information to increase the situational awareness of chemical incidents, improve the management of these incidents and to inform measures to protect public health. Methods This paper describes a method for EBS for chemical incidents, including the sources used, storing the gathered information and subsequent analysis of potential trends in the data. Results We describe trends in the type of incidents that have been detected, the chemicals involved in these incidents and the health effects caused, in different geographic regions of the world. Significance The methodology presented here provides a rapid and simple means of identifying chemical incidents that can be set up rapidly and with minimal cost, the outputs of which can be used to identify emerging risks and inform preparedness planning, response and training for chemical incidents.

The Impact of Natural Hazards on Older Adult Health: Lessons Learned From Hurricane Maria in Puerto Rico

Objective: With natural hazards increasing in frequency and severity and global population aging, preparedness efforts must evolve to address older adults’ risks in disasters. This study elucidates potential contributors to the elevated older adult mortality risk following Hurricane Maria in Puerto Rico through an examination of community stakeholder preparedness, response, and recovery experiences. Methods: In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities. Interview transcripts were deductively and inductively coded and analyzed to identify salient topics and themes representing participant response patterns. Results: The hurricane’s detrimental impact on older adult health emerged as a prominent finding. Through 6 months post-hurricane, many older adults experienced unmet needs that contributed to declining physical and emotional health, inadequate non-communicable disease management, social isolation, financial strain, and excess morbidity and mortality. These needs were predominantly consequences of lengthy public service gaps, unsafe living conditions, interrupted health care, and the incongruence between preparedness and event severity. Conclusions: In a landscape of increasing natural hazard frequency and magnitude, a pattern of older adult risk has become increasingly clear. Study findings compel practitioners to engage in natural hazard preparedness planning, research, and policy-making that considers the multiple facets of older adult well-being.

392. 3D-DOSS – Using Digital Twins and Spatiotemporal Data Mapping for Infectious Disease Surveillance and Outbreak Investigations

Background The COVID-19 pandemic has brought to light the importance of contact tracing in outbreak management. Digital technologies have been leveraged to enhance contact tracing in community settings. However, within complex hospital environments, where patient and staff movement and interpersonal interactions are central to care delivery, tools for contact tracing and cluster detection remain limited. We aimed to develop a system to promptly, identify contacts in infectious disease exposures and detect infectious disease clusters. Methods We prototyped a 3D mapping tool 3-Dimensional Disease Outbreak Surveillance System (3D-DOSS), to have a spatial representation of patients in the hospital inpatient locations. Based on the AutoCAD drawings, the hospital physical spaces are built within a game-development software to obtain accurate digital replicas. This concept borrows from the way gamers interact with the virtual world/space, to mimic the interactions in physical space, like the SIMS franchise. Clinical, laboratory and patient movement data is then integrated into the virtual map to develop syndromic and disease surveillance systems. Risk assignment to individuals exposed is through mathematical modeling based on distance coordinates, room type and ventilation parameters and whether the disease is transmitted via contact, droplet or airborne route. Results We have mapped acute respiratory illness (ARI) data for the period September to December 2018. We identified an influenza cluster of 10 patients in November 2018. In a COVID-19 exposure involving a healthcare worker (HCW), we identified 44 primary and 162 secondary contacts who were then managed as per our standard exposure management protocols. MDRO outbreaks could also be mapped. Conclusion Through early identification of at-risk contacts and detection of infectious disease clusters, the system can potentially facilitate interventions to prevent onward transmission. The system can also support security, environmental cleaning, bed assignment and other operational processes. Simulations of novel diseases outbreaks can enhance preparedness planning as health systems that had been better prepared have been more resilient in this current pandemic. Disclosures All Authors: No reported disclosures

Public health preparedness and response synergies between institutional authorities and the community: a qualitative case study of emerging tick-borne diseases in Spain and the Netherlands

Background Communities affected by infectious disease outbreaks are increasingly recognised as partners with a significant role to play during public health emergencies. This paper reports on a qualitative case study of the interactions between affected communities and public health institutions prior to, during, and after two emerging tick-borne disease events in 2016: Crimean-Congo Haemorrhagic Fever in Spain, and Tick-Borne Encephalitis in the Netherlands. The aim of the paper is to identify pre-existing and emergent synergies between communities and authorities, and to highlight areas where synergies could be facilitated and enhanced in future outbreaks. Methods Documentary material provided background for a set of semi-structured interviews with experts working in both health and relevant non-health official institutions (13 and 21 individuals respectively in Spain and the Netherlands), and focus group discussions with representatives of affected communities (15 and 10 individuals respectively). Data from all sources were combined and analysed thematically, initially independently for each country and then for both countries together. Results Strong synergies were identified in tick surveillance activities in both countries, and the value of pre-existing networks of interest groups for preparedness and response activities was recognised. However, authorities also noted that there were hard-to-reach and potentially vulnerable groups, such as hikers, foreign tourists, and volunteers working in green areas. While the general population received preventive information about the two events, risk communication or other community engagement efforts were not seen as necessary specifically for these sub-groups. Post-event evaluations of community engagement activities during the two events were limited, so lessons learned were not well documented. Conclusions A set of good practices emerged from this study, that could be applied in these and other settings. They included the potential value of conducting stakeholder analyses of community actors with a stake in tick-borne or other zoonotic diseases; of utilising pre-existing stakeholder networks for information dissemination; and of monitoring community perceptions of any public health incident, including through social media. Efforts in the two countries to build on the community engagement activities that are already in place could contribute to better preparedness planning and more efficient and timely responses in future outbreaks.

CHILD-SAN: a new disability-inclusive framework for emergency sanitation for children aged five to 11, based on a systematic review of existing guidance

The specific sanitation needs of children aged five to 11 years old—those too old to use small potties, but usually too young to safely and confidently use adult latrines during both the day and night, and including children in this age range with disabilities—have often been overlooked in the provision of emergency sanitation. There are multiple reasons to provide sanitation specifically for this age group. They represent a large number of beneficiaries; legal principles and the moral obligations of humanitarian actors should drive their inclusion. Failure to consider their needs results in increased risk of injuries, abuse and/or exploitation when using unsuitable locations to urinate or defecate, and negative health impacts arising from being unable to manage personal hygiene.We have critically reviewed existing guidance for the provision of emergency sanitation for children aged five to 11 and subsequently presents a new disability-inclusive framework: CHILD-SAN. CHILD-SAN is an acronym representing key factors for the water, sanitation and hygiene (WASH) sector to consider in emergency sanitation programmes: child participation, heights, user-friendly, location, décor, scaled-down, accessibility, and monitoring and evaluation.The CHILD-SAN framework recommends (a) safe and meaningful child participation in emergency WASH preparedness planning and emergency WASH programming as a means to develop contextually-appropriate facilities, (b) specific design considerations for child-friendly toilets (that is, they meet the needs of a child), and (c) the collection of sex-, age- and disability-disaggregated data against contextually appropriate indicators to determine the prevalence of child-friendly facilities and their use. We found few examples of emergency WASH programmes adhering to elements of the CHILD-SAN framework, but the implementation of CHILD-SAN would contribute to the WASH sector’s aims of achieving universal sanitation and maximising opportunities for good health, dignity, comfort and safety for all.

Community social vulnerability and access to medications for opioid use disorder within the continental US: A cross-sectional study

The COVID-19 pandemic, like past natural disasters, was associated with significant disruptions in medications for opioid use disorder services and increased opioid overdose and mortality. We examined the association between community vulnerability to disasters and pandemics and geographic access to each of the three medications for opioid use disorder within the continental US and if this association was impacted by urban, suburban, or rural classification. We found communities with greater vulnerability did not have greater geographic access to medications for opioid use disorder and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access to all three medications regardless of vulnerability. Future disaster preparedness planning should include anticipation of access to medications for opioid use disorder and better match the location of services to communities with greater vulnerability to prevent inequities in opioid overdose deaths.