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.

US adults’ preferences for race-based and place-based prioritisation for COVID-19 vaccines

Implementing equity principles in resource allocation is challenging. In one approach, some US states implemented race-based prioritisation of COVID-19 vaccines in response to vast racial inequities in COVID-19 outcomes, while others used place-based allocation. In a nationally representative survey of n=2067 US residents, fielded in mid-April 2021 (before the entire US population became eligible for vaccines), we explored the public acceptability of race-based prioritisation compared with place-based prioritisation, by offering vaccines to harder hit zip codes before residents of other zip codes. We found that in general, a majority of respondents supported the place-based approach, and a substantial proportion supported the race-based plan. Support was higher among Democrats compared with Republicans. All US residents became eligible for vaccines on 19 April 2021 but as of this writing, equitable uptake of vaccines remains urgent not only for first doses for adults but also for boosters and for children. Our findings also provide a benchmark for future pandemic planning that racial and social justice in vaccine allocation are salient considerations for the public. The findings may furthermore be of interest to policy makers designing vaccine allocation frameworks in countries with comparable health disparities across social, ethnic and racial groups, and more broadly, for those exploring ways of promoting equity in resource allocation outside of a pandemic setting.

Photovoice Exploration of Frontline Nurses’ Experiences During the COVID-19 Pandemic

Background The current COVID-19 global pandemic has had a profound impact on the health care system and on the physical and psychological well-being of nurses. Previous pandemics have led to nurses leaving the profession. Therefore, it is important that we hear the voices of nurses who experienced the pandemic on the frontlines to influence future planning and policy development. Purpose The purpose of this study was to explore frontline nurses’ experiences during the COVID-19 pandemic through photos, narratives, and group discussions. Methods Twelve nurses in two groups shared their lived experiences through Photovoice, a participatory action approach. Photos and narratives were collected over five weeks per group. One group at the beginning of the pandemic and the other group six months later. Focus group discussions were held following each group. Results Five themes emerged from the photovoice data: (1) The work of nursing; (2) Miscommunication; (3) Fatigue; (4) Resilience; and (5) Hope for the future. Various subthemes were noted within each theme to delineate the lived experience of frontlines nurses working in the COVID-19 pandemic. Conclusions The voices of nurses and their experiences on the frontlines of the COVID-19 pandemic need to be considered in pandemic planning and integrated into health care policy, guidelines, and structural changes.

The ‘haves’ and ‘have-nots’ of personal protective equipment during the COVID-19 pandemic: the ethics of emerging inequalities amongst healthcare workers

The COVID-19 pandemic has exacerbated inequalities, including among the healthcare workforce. Based on recent literature and drawing on our experiences of working in operating theatres and critical care in the UK’s National Health Service during the pandemic, we review the role of personal protective equipment and consider the ethical implications of its design, availability and provision at a time of unprecedented demand. Several important inequalities have emerged, driven by factors such as individuals purchasing their own personal protective equipment (either out of choice or to address a lack of provision), inconsistencies between guidelines issued by different agencies and organisations, and the standardised design and procurement of equipment required to protect a diverse healthcare workforce. These, we suggest, have resulted largely because of a lack of appropriate pandemic planning and coordination, as well as insufficient appreciation of the significance of equipment design for the healthcare setting. As with many aspects of the pandemic, personal protective equipment has created and revealed inequalities driven by economics, gender, ethnicity and professional influence, creating a division between the ‘haves’ and ‘have-nots’ of personal protective equipment. As the healthcare workforce continues to cope with ongoing waves of COVID-19, and with the prospect of more pandemics in the future, it is vital that these inequalities are urgently addressed, both through academic analysis and practical action.

Passive immune therapies: another tool against COVID-19

Passive immune therapy consists of several different therapies, convalescent plasma, hyperimmune globulin, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing monoclonal antibodies. Although these treatments were not part of any pandemic planning prior to coronavirus disease 2019 (COVID-19), due to the absence of high-quality evidence demonstrating benefit in other severe respiratory infections, a large amount of research has now been performed to demonstrate their benefit or lack of benefit in different patient groups. This review summarizes the evidence up to July 2021 on their use and also when they should not be used or when additional data are required. Vaccination against SARS-CoV-2 is the most important method of preventing severe and fatal COVID-19 in people who have an intact immune system. Passive immune therapy should only be considered for patients at high risk of severe or fatal COVID-19. The only therapy that has received full regulatory approval is the casirivimab/imdevimab monoclonal cocktail; all other treatments are being used under emergency use authorizations. In Japan, it has been licensed to treat patients with mild to moderate COVID-19, and in the United Kingdom, it has also been licensed to prevent infection.

Nothing about us without us: Canadian vaccine decision making must involve disabled people

Across Canada, national and provincial Covid-19 vaccine prioritization guidance and strategies have failed to appropriately include people with disabilities. Since the early goal of vaccination was to reduce severity, those at higher risk of severe disease if infected were meant to be prioritized early in vaccination campaigns, directly reducing their chance of death due to Covid-19. Older adults and some other higher-risk groups were therefore accorded high priority. However, younger disabled people were not prioritized for vaccines at levels commensurate with their risk of severe Covid-19 outcomes. Consequently, Canadian national policy recommendations have been incongruent with peer countries’ vaccine prioritization, scientific evidence, and priorities expressed by Canadians regarding how we should allocate Covid-19 vaccines. To avoid repeating these mistakes, current and future pandemic planning must include disabled people as full members of decision-making committees, in keeping with the longstanding demand of disabled people: “Nothing about us without us.” (1)

Leveraging Promising Policies to Support Long-Term Care Residents' Quality of Life Post-Pandemic

Long-term care (LTC) is highly regulated and often the policy language is complex and in tension with residents’ quality of life goals. Prior to COVID-19, LTC policy levers prioritized safety over other quality domains such as privacy, dignity, spirituality, and comfort. During the pandemic, this focus on safety regulations, while important, intensified in ways that often negatively impacted residents’ overall quality of life. In this symposium, we share findings from a five- year research project where we conducted a unique and expansive review of regulatory policy across four Canadian jurisdictions. We highlight how 11 different quality of life domains are supported and which texts offering promising policy language to enhance a well-rounded quality of life for residents. These are timely insights to offer as policy-makers look to the future and consider the lessons learned from the pandemic. We contend that creating more LTC policy is not a timely pathway forward to LTC reform. Instead, we suggest that existing policy can be leveraged when applied within a resident-centred quality of life lens. We will guide attendees through examples of existing promising policies highlighting how they might leveraged in planning for a better LTC system. The discussion will be rooted in our unique resident-centred approach to policy analysis using specific domains of quality of life and then applied to four different perspectives: residents, families, staff and volunteers. Our discussant a Ministry of Health decision-maker will address the implications of our research for post-pandemic planning to improve resident quality of life

423. Implementation of a Hierarchy of Controls in a Mobile Health Unit to Safely Care for Inpatients with COVID-19 during Healthcare System Surge

Background In April 2021, Sunnybrook Health Sciences Centre opened a Mobile Health Unit (MHU, i.e. medical tents) under the direction of the Ontario Ministry of Health and Long Term Care in response to a surge in hospitalized patients with COVID-19 during wave three of the pandemic. Providing care to patients in non-conventional spaces is not new, however, experience in safely caring for COVID-19 patients in these settings is lacking. Our aim is to describe the implementation of our MHU and associated outcomes of these COVID-19 patients. Methods A multidisciplinary clinical and operations team was created to plan, execute and operate a safe environment for COVID-19 patients and healthcare workers within the MHU. Patient selection was restricted to patients with COVID-19 who were clinically recovering from severe COVID-19 pneumonia. Ventilation was optimized with air flow directed away from patient areas, velocity reduced to below 0.25 meters per second, and air exchanges of 24-28 per hour. All healthcare workers working in the MHU were offered COVID-19 vaccine and required to complete mandatory education if they declined (vaccination rate of 87% was achieved among dedicated staff). Universal masking and eye protection was used throughout the MHU with designated areas for donning and doffing personal protective equipment. Results In total, 32 patients with COVID-19 were managed in the MHU between 26 April and 21 May, 2021. Table 1 provides the summary of patient characteristics. All patients had a median of one-day of transmission-based precautions remaining in their course and were infected with Alpha variant with exception of one patient with the Gamma variant. Among those patients with genotyping available, all were infected with SARS-CoV-2 carrying the N501Y mutation. Four of the 32 patients required transfer to the main hospital for medical indication while the others were discharged home or to rehabilitation. None of the healthcare workers who worked within the MHU developed COVID-19 infection. Conclusion We safely cared for patients recovering from COVID-19 infection in an MHU to support system healthcare capacity. Our experience, including the specific hierarchy of controls implemented, may be helpful for future pandemic planning. Disclosures All Authors: No reported disclosures

PENYESUAIAN PERENCANAAN AREA KOMPETISI DI STADION SEPAKBOLA UNTUK MENGATASI DAMPAK PANDEMI

The football stadium is a building for soccer sports activities consisting of a field of play, athlete facilities/competition area, grandstand and facilities for spectators, both for match and training activities. With the COVID-19 pandemic, these facilities have to adapt to health protocols to reduce the spreading of the virus. Currently, there are stadiums in Indonesia that have been built and are still in the planning stage, and this study focuses on adjusting the planning of the Competition Area as part of the athlete/player facilities at the Football Stadium. This study tries to explore, interpret, explain and make adjustments to the planning of the Football Stadium Competition Area following the requirements of the pandemic prevention health protocol. As the result of the study, an adjustment plan is needed in the football stadium competition area to overcome the impact of the pandemic. Redesign in the form of adding access screening facilities for personnel entitled to enter by adjusting the detection facilities on access to the competition area corridor and making restrictions through access control, except for evacuation needs and maintenance. Keywords: Football Stadium; Competition Area; Pandemic; Planning Adjustments AbstrakStadion sepakbola adalah bangunan untuk kegiatan olahraga sepakbola yang terdiri dari arena olahraga/permainan, fasilitas atlit/area kompetisi dan fasilitas untuk penonton, baik untuk kegiatan pertandingan maupun latihan. Dengan adanya pandemi COVID-19, fasilitas ini harus menyesuaikan dengan protokol kesehatan agar tidak menjadi sarana penyebaran virusnya. Saat ini, terdapat terdapat stadion-stadion di Indonesia yang sudah terbangun dan yang masih dalam tahap perencanaan, studi ini fokus kepada penyesuaian perencanaan Area Kompetisi sebagai bagian dari fasilitas atlit/pemain di Stadion Sepakbola. Penelitian ini dilakukan secara kualitatif dengan menggunakan metode Studi Kasus, mengeksplorasi dan menyusun penyesuaian perencanaan Area Kompetisi Stadion Sepakbola yang sesuai dengan persyaratan protokol kesehatan pencegahan penyebaran Pandemi. Sebagai hasil penelitian dapat disimpulkan bahwa perbaikan permanen diperlukan sebagai penyesuaian area kompetisi stadion sepakbola untuk mengatasi dampak pandemi yaitu berupa penambahan sarana penyaringan akses bagi personil yang berhak masuk, dengan melakukan penyesuaian fasilitas pendeteksi pada akses masuk ke koridor area kompetisi dan membuat pembatasan melalui kontrol akses, dengan pengecualian untuk kebutuhan evakuasi dan kondisi non match day untuk pemeliharaan.

Program Pendampingan Model Pentahelix dan Pemberian Bantuan Alat Pelindung Diri di Kebon Empring dalam Menghadapi Masa Pandemi (New Normal)

Masa pandemi merubah kebiasaan masyarakat untuk menunjukkan perilaku sehat di lingkungan mereka berada, termasuk kesadaran dan kepedulian dalam berwisata. Menjaga kesehatan diri dan orang sekitar, wisata aman bagi pengelola dan pengunjung dengan penerapan protokol kesehatan harus disiapkan untuk menjaga dan melindungi kegiatan wisata selama pandemi. Program pendampingan dengan mengusung model pentahelix dan pemberian bantuan alat pelindung diri perlu dilakukan di suatu destinasi pariwisata dalam menghadapi masa pandemi. Perencanaan pembangunan dan pengembangan tempat wisata pada masa new normal menciptakan konsep berwisata baru dan berpeluang meningkatkan potensi dalam berkontribusi dari seluruh aspek pendukung sektor pariwisata. Ciri khas yang menjadi daya tarik wisata wajib dimiliki. Keamanan dalam wujud taat pada protokoler kesehatan untuk pencegahan covid-19 di lokasi wisata perlu dikuatkan selama berwisata. Lokasi wisata wajib memiliki karakteristik daya tarik wisata yang perlu dipertahankan The Pentahelix Model Assistance Program and Providing Personal Protective Equipment Assistance at Kebon Empring in Facing the Pandemic Period (New Normal) Pandemic period changes people habits to show healthy behavior in the environment they are in, including awareness and concern in traveling. Maintaining health of yourself and those around you, safe tourism for managers and visitors by implementing health protocols must be prepared to maintain and protect tourism activities during a pandemic. Assistance programs by carrying out the pentahelix model and providing personal protective equipment assistance need to be carried out in a tourism destination in face of a pandemic. Planning for the development and development of tourist attractions during the new normal period creates new tourism concepts and has the opportunity to increase the potential to contribute from all aspects of supporting the tourism sector. Characteristics that are a must-have tourist attraction. Security in form of adhering to health protocols for prevention of Covid-19 at tourist sites needs to be strengthened while traveling. Tourist locations must have tourist attraction characteristics that need to be maintained.