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The coronavirus disease 2019 (COVID-19) pandemic tested the capacity of local health systems to understand and respond to changing conditions. Although data on new cases of COVID-19 were widely shared in communities, there was less information on the multisector response activities and factors associated with implementation. To address this gap, this empirical case study examined (a) the pattern of implementation of COVID-19 response activities and (b) the factors and critical events associated with both the pattern of new cases and the implementation of the local COVID-19 response. We used a participatory monitoring and evaluation system to capture, code, characterize, and communicate 580 COVID-19 response activities implemented in the city of Lawrence and Douglas County, Kansas. Collaboration across sectors including public health, medical services, city/county government, businesses, social services, public schools, and universities enabled the local public health system’s response effort. Documentation results showed the varying pattern of new COVID-19 cases and response activities over time and the factors identified as enabling or impeding the response and related new cases. Similar participatory monitoring and evaluation methods can be used by local health systems to help understand and respond to the changing conditions of COVID-19 response and recovery.

Are COVID-19 spread and mortality related to different countries’ government mobility restriction policies, democratic institutions, and cultural norms? Leveraging data from 140 countries, we find that policy, institutions, and vulnerabilities interact to determine pandemic spread and mortality. A delay in restricting international mobility increases pandemic mortality. Combining vulnerabilities with a delay in domestic mobility restrictions increases mortality. Democratic countries have faster policy responses and lower pandemic mortality, but they also face more adverse effects from a delay in restricting domestic mobility. More individualistic countries have a higher pandemic spread, and their delay in domestic mobility restrictions is associated with higher pandemic mortality.

Background Over the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon. Objective This paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic. Eligibility criteria We examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest. Source of evidence Google Scholar was the main searching source. Results After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time. Conclusion Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.

Advocate Aurora Health, located in the north‐central United States, is the result of a merger between two large health care organizations in April 2018. The health care system comprises 26 hospitals, offers more than 500 sites of care, and employs 75,000 team members. This article discusses the effects that coronavirus disease 2019 had on the perioperative services departments while directors and site leaders were still managing the complexities of the merger. Included are strategies used to address the challenges created by the pandemic, special considerations based on level‐of‐care capacity, the effect that the hold on elective surgeries had on staffing assignments, the reactivation process when elective surgery resumed, and the importance of keeping the perioperative team members informed and safe. It also illustrates how facing the challenges caused by the pandemic helped to solidify the merger of the two health care organizations.

Like many libraries across Canada, Manitoba public libraries have grappled with the challenges that COVID-19 has presented. Libraries have struggled to remain operational and offer a high level of service to patrons within the constraint of public health orders, all the while ensuring the safety and employment of their staff. Within the ever-changing environment of COVID-19, the Manitoba Library Association recognized the need to gather information from the library community in order to better position themselves to lend support and in an attempt to bridge information gaps. This article describes a study conducted by the Manitoba Library Association whereby fifty-five Manitoba public libraries were surveyed to identify how they were responding to COVID-19 and what their needs might be. The survey questions were divided into 6 sections (facilities, services, communications, staffing, connecting, wrap-up) and the results provide information and insight into how the Manitoba library community has dealt with the pandemic. More importantly, the results can serve to guide other libraries in decision-making and preparation for a pandemic., Comme plusieurs bibliothèques au Canada, les bibliothèques publiques du Manitoba ont dû faire face aux défis présentés par la COVID-19. Les bibliothèques ont tenté de demeurer opérationnelles et d’offrir un niveau élevé de service aux usagers en respectant les contraintes des ordonnances de santé publique tout en assurant la sécurité et les emplois de leur personnel. Compte tenu de la constante évolution de la situation de la COVID-19, la Manitoba Library Association a reconnu le besoin de recueillir de l’information pour la communauté des bibliothèques afin qu’elles puissent mieux se positionner pour offrir du soutien et afin de tenter de combler le manque d’information. Cet article décrit une étude menée par la Manitoba Library Association par laquelle 55 bibliothèques publiques du Manitoba ont été sondées afin d’identifier comment elles ont réagi à la COVID-19 et de connaître leurs besoins. Le sondage comportait six sections (installations, services, communications, personnel, relations, sommaire) et les résultats fournissent des informations et un aperçu sur la façon dont la communauté des bibliothèques du Manitoba a réagi à la pandémie. Plus important encore, les résultats peuvent guider les autres bibliothèques dans la prise de décision et la préparation face à une pandémie.

In March 2020, the outbreak of COVID‐19 was officially declared a global pandemic by the World Health Organization. Given the novelty of the virus, and hence, lack of official guidance on effective containment strategies, individual countries opted for different containment approaches ranging from herd immunity to strict lockdown. The opposing strategies followed by the United Kingdom and its former colony, Malaysia, stand exemplary for this. Real‐time polymerase chain reaction was implemented for testing in both counties. Malaysia acted with strict quarantining rules and infection surveillance. The United Kingdom followed an initially lenient, herd‐immunity approach with strict lockdown only enforced weeks later. Although based on the same health‐care structure historically, Malaysia developed a more unified health system compared with the United Kingdom. We suggest that this more centralized structure could be one possible explanation for why Malaysia was able to react in a more timely and efficient manner, despite its closer geographic proximity to China. We further explore how the differences in testing and quarantining strategy, as well as political situation and societal compliance could account for the discrepancy in the United Kingdom's versus Malaysia's relative success of COVID‐19 containment., Key Points 1.Different countries employed a range of strategies toward the COVID‐19 pandemic, with varying levels of success.2.Malaysia's strict rule enforcement were reflected both in quantitative and qualitative terms.3.Despite the closer geographical proximity to the source of the outbreak, Malaysia fared better than the United Kingdom in its response to the pandemic, suggesting that there are valuable lessons to be learned for the developed from developing, limited‐resource countries.

COVID-19 brought masking, a practice that was largely confined to certain technical occupational settings in the US, into the heart of a national controversy. As with prior emerging infectious diseases (such as HIV, SARS, and Ebola), US public health experts and governmental agencies positioned themselves as authoritative producers of emerging scientific knowledge, including best practices for public masking. US epidemiological outcomes, however, have sorely lagged behind many other countries. The US leads the world in confirmed cases of and deaths from COVID-19, undermining presumed hierarchies in global health authority today. In this essay, I compare US and Taiwanese masking policies, delineating how social relations of care in the US become sites of political conflict within a hierarchical global ecology of scientific knowledge and medical supplies. Drawing upon my experience as an MD/PhD in anthropology trainee studying emerging infectious diseases and as a Taiwanese American immigrant, I explore conflicts over mask acquisition and usage across borders and time, illuminating global inequities of scientific knowledge production and pandemic containment and underscoring racialised disavowals that persist in US public health. These racialised disavowals illustrate the structural limits that circumscribe possibilities of containment during an uncontained pandemic.

The Democratic Republic of Congo (DRC) presents a challenging context in which to respond to public health crises. Its 2018–2020 Ebola outbreak was the second largest in history. Lessons were known from the previous West African outbreak. Chief among these was the recognition that local action and involvement are key to establishing effective epidemic-response. It remains unclear whether and how this was achieved in DRC’s Ebola response. Additionally, there is a lack of scholarship on how to build resilience (the ability to adapt or transform under pressure) in crisis-response. In this article, we critically review literature to examine evidence on whether and how communities were involved, trust built, and resilience strengthened through adaptation or transformation of DRC’s 2018–2020 Ebola response measures. Overall, we found limited evidence that the response adapted to engage and involve local actors and institutions or respond to locally expressed concerns. When adaptations occurred, they were shaped by national and international actors rather than enabling local actors to develop locally trusted initiatives. Communities were “engaged” to understand their perceptions but were not involved in decision-making or shaping responses. Few studies documented how trust was built or analyzed power dynamics between different groups in DRC. Yet, both these elements appear to be critical in building effective, resilient responses. These failures occurred because there was no willingness by the national government or international agencies to concede decision-making power to local people. Emergency humanitarian response is entrenched in highly medicalized, military style command and control approaches which have no space for decentralizing decision-making to “non-experts”. To transform humanitarian responses, international responders can no longer be regarded as “experts” who own the knowledge and control the response. To successfully tackle future humanitarian crises requires a transformation of international humanitarian and emergency response systems such that they are led, or shaped, through inclusive, equitable collaboration with local actors.

Background/Objectives Differences in older adults' worry, attitudes, and mental health between high‐income countries with diverging pandemic responses are largely unknown. We compared COVID‐19 worry, attitudes towards governmental responses, and self‐reported mental health symptoms among adults aged ≥55 in the United States and Canada early in the COVID‐19 pandemic. Design Online cross‐sectional survey administered between April 2nd and May 31st in the United States and between May 1st and June 30th, 2020 in Canada. Setting Nationally in the United States and Canada. Participants Convenience sample of older adults aged ≥55. Measurements Likert‐type scales measured COVID‐19 worry and attitudes towards government support. Three standardized scales assessed mental health symptoms: the eight‐item Center for Epidemiological Studies Depression Scale, the five‐item Beck Anxiety Inventory, and the three‐item UCLA loneliness scale. Results There were 4453 U.S. respondents (71.7% women; mean age 67.5) and 1549 Canadian (67.6% women; mean age 69.3). More U.S. respondents (71%) were moderately or extremely worried about the pandemic, compared to 52% in Canada. Just 20% of U.S. respondents agreed or strongly agreed that the federal government cared about older adults in their COVID‐19 pandemic response, compared to nearly two‐thirds of Canadians (63%). U.S. respondents were more likely to report elevated depressive and anxiety symptoms compared to Canadians; 34.2% (32.8–35.6) versus 25.6% (23.3–27.8) for depressive and 30.8% (29.5–32.2) versus 23.7% (21.6–25.9) for anxiety symptoms. The proportion of United States and Canadian respondents who reported loneliness was similar. A greater proportion of women compared to men reported symptoms of depression and anxiety across all age groups in both countries. Conclusion U.S. older adults felt less supported by their federal government and had elevated depressive and anxiety symptoms compared to older adults in Canada during early months of the COVID‐19 pandemic. Public health messaging from governments should be clear, consistent, and incorporate support for mental health.

Being a small island and low‐middle income country (LMIC) heavily dependent on global markets for sustaining its basic needs and health system, Maldives faced specific challenges during the COVID‐19 pandemic. This was reinforced through tensions between the heavily centralized healthcare delivery and a partially decentralized public health system. Using the pillars of pandemic response proposed by the World Health Organisation, this article explores the planning assumptions, resource estimations and strategies adopted to equip the health system with resources for the pandemic response. The resource need estimates based on projections for COVID‐19 identified a shortfall of medical professionals to care for patients while maintaining 55% of the workforce for regular healthcare across the atolls. The findings show that while the policy of lockdown bought time to increase hospital beds and devices, the country was unable to increase the healthcare workforce. Furthermore, as the lockdown eased, the exponential increase of cases took Maldives to the global one per capita incidence. Despite this, with cautious planning and use of resources, the country has so far managed to maintain low mortality from COVID‐19. The lessons from this experience are paramount in future pandemic response planning, not only for Maldives, but other small island LMICs.

The coronavirus pandemic has shed light on the detrimental impact of neoliberal policies on public health and well-being and as a result, there have been calls for increases in public spending to rectify the lack of public health services. However, neoliberal right-wing parties have dismissed such calls, pointing instead to Asian countries as examples in successfully controlling the pandemic without high public health spending, attributing this to the entrepreneurial orientation of their governments, as opposed to their public services. This article refutes this idea, instead charting the reasons that Asian countries have better controlled the pandemic including prior experience of pandemics, cultural factors, and various successful public health policies. The article concludes by looking at the example of Trump and demonstrating the inadequacies of the business model for dealing with the coronavirus pandemic.

The ongoing COVID-19 pandemic has had widespread social, psychological, and economic impacts. However, these impacts are not distributed equally: already marginalized populations, specifically racial/ethnic minority groups and sexual and gender minority populations, may be more likely to suffer the effects of COVID-19. The COVID-19 Resiliency Survey was conducted by the city of Chicago to assess the impact of COVID-19 on city residents in the wake of Chicago’s initial lockdown, with particular focus on the experiences of minority populations. Chi-square tests of independence were performed to compare COVID-19-related outcomes and impacts on heterosexual vs. sexual minority populations, cisgender vs. gender minority populations, and White vs. racial/ethnic minority subgroups. Marginalized populations experienced significant disparities in COVID-19 exposure, susceptibility, and treatment access, as well as in psychosocial effects of the pandemic. Notably, Black and Latinx populations reported significant difficulties accessing food and supplies (p = 0.002). Healthcare access disparities were also visible, with Black and Latinx respondents reporting significantly lower levels of access to a provider to see if COVID-19 testing would be appropriate (p = 0.013), medical services (p = 0.001), and use of telehealth for mental health services (p = 0.001). Sexual minority respondents reported significantly lower rates of using telehealth for mental health services (p = 0.011), and gender minority respondents reported significantly lower levels of primary care provider access (p = 0.016). There are evident COVID-19 disparities experienced in Chicago especially for Black, Latinx, sexual minority, and gender minority groups. A greater focus must be paid to health equity, including providing increased resources and supplies for affected groups, adapting to inequities in the built environment, and ensuring adequate access to healthcare services to ameliorate the burden of COVID-19 on these marginalized populations. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-020-00497-9.

As the COVID-19 pandemic continues, important discoveries and considerations emerge regarding the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pathogen; its biological and epidemiological characteristics; and the corresponding psychological, societal, and public health (PH) impacts. During the past year, the global community underwent a massive transformation, including the implementation of numerous nonpharmacological interventions; critical diversions or modifications across various spheres of our economic and public domains; and a transition from consumption-driven to conservation-based behaviors. Providing essential necessities such as food, water, health care, financial, and other services has become a formidable challenge, with significant threats to the existing supply chains and the shortage or reduction of workforce across many sectors of the global economy. Food and pharmaceutical supply chains constitute uniquely vulnerable and critically important areas that require high levels of safety and compliance. Many regional health-care systems faced at least one wave of overwhelming COVID-19 case surges, and still face the possibility of a new wave of infections on the horizon, potentially in combination with other endemic diseases such as influenza, dengue, tuberculosis, and malaria. In this context, the need for an effective and scientifically informed leadership to sustain and improve global capacity to ensure international health security is starkly apparent. Public health “blind spotting,” promulgation of pseudoscience, and academic dishonesty emerged as significant threats to population health and stability during the pandemic. The goal of this consensus statement is to provide a focused summary of such “blind spots” identified during an expert group intense analysis of “missed opportunities” during the initial wave of the pandemic.

Background Background The second wave of the COVID-19 pandemic was more aggressive in Brazil compared to other countries around the globe. Considering the Brazilian peculiarities, we analyze the in-hospital mortality concerning socio-epidemiological characteristics of patients and the health system of all states during the first and second waves of COVID-19. Methods We performed a cross-sectional study of hospitalized patients with positive RT-PCR for SARS-CoV-2 in Brazil. Data was obtained from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and comprised the period from February 25, 2020, to April 30, 2021, separated in two waves on November 5, 2020. We performed a descriptive study of patients analyzing socio-demographic characteristics, symptoms, comorbidities, and risk factors stratified by age. In addition, we analyzed in-hospital and intensive care unit (ICU) mortality in both waves and how it varies in each Brazilian state. Findings Between February 25, 2020 and April 30, 2021, 678 235 patients were admitted with a positive RT-PCR for SARS-CoV-2, with 325 903 and 352 332 patients for the first and second wave, respectively. The mean age of patients was 59 · 65 (IQR 48 · 0 - 72 · 0). In total, 379 817 (56 · 00%) patients had a risk factor or comorbidity. In-hospital mortality increased from 34 · 81% in the first to 39 · 30% in the second wave. In the second wave, there were more ICU admissions, use of non-invasive and invasive ventilation, and increased mortality for younger age groups. The southern and southeastern regions of Brazil had the highest hospitalization rates per 100 000 inhabitants. However, the in-hospital mortality rate was higher in the northern and northeastern states of the country. Racial differences were observed in clinical outcomes, with White being the most prevalent hospitalized population, but with Blacks/Browns (Pardos) having higher mortality rates. Younger age groups had more considerable differences in mortality as compared to groups with and without comorbidities in both waves. Interpretation We observed a more considerable burden on the Brazilian hospital system throughout the second wave. Furthermore, the north and northeast of Brazil, which present lower Human Development Indexes, concentrated the worst in-hospital mortality rates. The highest mortality rates are also shown among vulnerable social groups. Finally, we believe that the results can help to understand the behavior of the COVID-19 pandemic in Brazil, helping to define public policies, allocate resources, and improve strategies for vaccination of priority groups. Funding Coordinating Agency for Advanced Training of Graduate Personnel (CAPES) (C.F. 001), and National Council for Scientific and Technological Development (CNPq) (No. 309537/2020-7).

Preparing the world to manage future pandemics must take priority. It is clear that we were not prepared for the COVID‐19 pandemic which continues to cause great suffering around the world. Nurses and other health professionals everywhere must be involved in health policy planning and implementation of public health measures to combat this and future pandemics. Such preparation needs community policy involvement at grassroots levels and needs to be collaboratively instigated at international levels. The death so far of over 2000 nurses is unacceptable in this pandemic, and we need to better protect and sustain the workforce. The International Council of Nurses has been instrumental in data gathering of nurses' experiences during COVID‐19. Key points from analysis of this data have been included in Second Progress Report of the World Health Organization's Independent Panel for Pandemic Preparedness and Response. This paper summarises the key messages from this report, as well as the nursing shortage. The International Council of Nurses resounds the call for massive investment in nursing education, leadership and jobs, as well as protection for our nurses on the frontlines of the pandemic.

Background During March of 2020 the Centers for Disease Control and Prevention (CDC) announced non-pharmaceutical intervention (NPI) guidance as the primary mitigation strategy against growing COVID-19 community spread due to the absence of a vaccine or effective treatment at that time. CDC guidance states that NPIs are most effective when instituted in an early, targeted, and layered fashion. NPIs are effective in slowing spread, and measures should be custom-tailored to each population. This study examines factors associated with implementation and timing of NPI interventions across large public and private U.S. universities at the onset of the COVID-19 pandemic. Methods NPI decisions of interest include when U.S. universities canceled international travel, shifted to online learning, moved faculty/staff to remote work, limited campus housing, and closed campus for all non-essential personnel. Cox proportional hazard analyses of retrospective data were conducted to assess the time to NPI events. Hazard ratios were calculated for university governance, campus setting, religious affiliation, health infrastructure, faculty diversity, and student demographics. The methods control for variance inflation factors, COVID case prevalence, and time varying covariates of spring break and states’ state of emergency (SOE) orders. This study captures NPI decisions at 575 U.S. universities during spring of 2020 which affected the movement of seven million students and two million employees. Results Universities located in districts represented by Democratic party congressional members reported earlier NPI implementation than Republican (Cox proportional hazard ratio (HR) range 0.61–0.80). University religious affiliation was not associated with the timing any of the NPI decisions. Universities with more diverse faculty showed an association with earlier NPI implementation (HR range 0.65–0.76). The existence of university-affiliated health infrastructure was not associated with NPI timing. Conclusion University NPI implementation was largely driven by local COVID-19 epidemiology, culture and political concerns. The timing of university NPI decisions varied by regional politics, faculty demographics, university governance, campus setting, and foreign student prevalence adjusting for COVID-19 state case prevalence and spring break timing. Religious affiliation and presence of university health infrastructure were not associated with timing.

Background The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes. Methods Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers. Results Qualitative content analysis revealed myriad challenges at the individual and interpersonal levels faced by people experiencing homelessness as a result of the pandemic, and multilevel responses for COVID-19 impact mitigation in this community. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that are informing better service delivery moving forward, even beyond the COVID-19 pandemic. Conclusions Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.

In April 2020, the Japanese government declared a state of emergency due to the novel coronavirus disease (COVID-19). Schools were closed and a stay-at-home order was issued in April and May 2020. This before-and-after study aimed to measure the effects of these COVID-19-related restrictions on physical function among Japanese children. The study included children aged 6–7 years, enrolled before and after the emergency declaration. Their body fat percentage, single-leg standing time, Gait Deviation Index score, and history of falls were compared. There were 56 and 54 children in the before and after groups, respectively. Children in the after group had a higher body fat percentage (p = 0.037), shorter single-leg standing time (p = 0.003), and a larger number of falls per month (p &lt, 0.001) than those in the before group. In the logistic regression analysis, children in the after group had a significantly shorter single-leg standing time (odds ratio (OR): 0.985, 95% confidence interval (CI): 0.972−0.997, p = 0.013), a greater number of falls per month (OR: 1.899, 95% CI: 1.123−3.210, p = 0.017), and a higher body fat percentage (OR: 1.111, 95% CI: 1.016−1.215, p = 0.020) than those in the before group. The COVID-19 emergency restrictions had a negative effect on children’s physical function, especially on balance.

OBJECTIVE: Personal protective equipment (PPE) is urgently sought during public health crises. It is necessary for the safety of both the patient and the healthcare professional. Yet during the recent COVID-19 pandemic, PPE scarcity in many countries, including the United States, has impacted the level of care for patients and the safety of healthcare personnel. Additionally, the implementation of mandatory mask mandates for the general public in many countries forced individuals to either reuse PPE, which can contribute to poor hygiene, or buy PPE in bulk and thereby contribute to the scarcity of PPE. In this study, we investigate the possibility of using a cost-effective ozone sterilization unit on contaminated N95 masks as an alternative to current sterilization methods. METHOD: This protocol examined ozone's ability to decontaminate N95 mask fabric that was exposed to a surrogate virus (Escherichia coli bacteriophage MS2). Once the sterilization unit achieves an ozone concentration of ~30 ppm, a 60-minute or 120-minute sterilization cycle commences. Following the sterilization cycle, we investigated the amount of viable virus on the slide using a viral plaque assay and compared it to a non-sterilized, control slide. Furthermore, we carried out trials to investigate the safety of an ozone sterilization device, by measuring the levels of ozone exposure that individuals may experience when operating the sterilization unit post-cycle. RESULTS: We showed that a 120-minute sterilization cycle at ~30 ppm achieves a 3-log reduction in viral activity, thereby complying with industry and U.S. Food and Drug Administration (FDA) standards. Further, we demonstrated that when following our protocol, the ozone exposure levels for a simple sterilization unit to be used at home complied with federal and industry standards. CONCLUSION: Ozone may have the potential to decontaminate masks and other PPE.

Background: This work seeks to better understand the triage strategies employed by head and neck oncologic surgical divisions during the initial phases of the coronavirus 2019 (COVID-19) outbreak. Methods: Thirty-six American head and neck surgical oncology practices responded to questions regarding the triage strategies employed from March to May 2020. Results: Of the programs surveyed, 11 (31%) had official department or hospital-specific guidelines for mitigating care delays and determining which surgical cases could proceed. Seventeen (47%) programs left the decision to proceed with surgery to individual surgeon discretion. Five (14%) programs employed committee review, and 7 (19%) used chairman review systems to grant permission for surgery. Every program surveyed, including multiple in COVID-19 outbreak epicenters, continued to perform complex head and neck cancer resections with free flap reconstruction. Conclusions: During the initial phases of the COVID-19 pandemic experience in the United States, head and neck surgical oncology divisions largely eschewed formal triage policies and favored practices that allowed individual surgeons discretion in the decision whether or not to operate. Better understanding the shortcomings of such an approach could help mitigate care delays and improve oncologic outcomes during future outbreaks of COVID-19 and other resource-limiting events. Level of Evidence: 4.

We introduced the mixed-methods Data-Powered Positive Deviance (DPPD) framework as a potential addition to the set of tools used to search for effective response strategies against the SARS-CoV-2 pandemic. For this purpose, we conducted a DPPD study in the context of the early stages of the German SARS-CoV-2 pandemic. We used a framework of scalable quantitative methods to identify positively deviant German districts that is novel in the scientific literature on DPPD, and subsequently employed qualitative methods to identify factors that might have contributed to their comparatively successful reduction of the forward transmission rate. Our qualitative analysis suggests that quick, proactive, decisive, and flexible/pragmatic actions, the willingness to take risks and deviate from standard procedures, good information flows both in terms of data collection and public communication, alongside the utilization of social network effects were deemed highly important by the interviewed districts. Our study design with its small qualitative sample constitutes an exploratory and illustrative effort and hence does not allow for a clear causal link to be established. Thus, the results cannot necessarily be extrapolated to other districts as is. However, the findings indicate areas for further research to assess these strategies’ effectiveness in a broader study setting. We conclude by stressing DPPD’s strengths regarding replicability, scalability, adaptability, as well as its focus on local solutions, which make it a promising framework to be applied in various contexts, e.g., in the context of the Global South.

Significance It is vital for policymakers to understand how people react during a pandemic. Here, we propose to use domestic electricity-consumption data, which arguably capture peoples’ daily behaviors accurately and dynamically. Considering the city-state of Singapore as a case study, we study over 10,200 individual households’ electricity-consumption patterns to uncover previously unknown behavioral trends during the COVID-19 pandemic. While providing implications for the design of public health interventions during this and other pandemics, our results imply a proactive response from the community, which is surprisingly consistent across all demographics. This cohesive response may have helped the city-state in effectively curtailing the disease, a learning that has direct implications on the pandemic response of other nations as well., Understanding how populations’ daily behaviors change during the COVID-19 pandemic is critical to evaluating and adapting public health interventions. Here, we use residential electricity-consumption data to unravel behavioral changes within peoples’ homes in this period. Based on smart energy-meter data from 10,246 households in Singapore, we find strong positive correlations between the progression of the pandemic in the city-state and the residential electricity consumption. In particular, we find that the daily new COVID-19 cases constitute the most dominant influencing factor on the electricity demand in the early stages of the pandemic, before a lockdown. However, this influence wanes once the lockdown is implemented, signifying that residents have settled into their new lifestyles under lockdown. These observations point to a proactive response from Singaporean residents—who increasingly stayed in or performed more activities at home during the evenings, despite there being no government mandates—a finding that surprisingly extends across all demographics. Overall, our study enables policymakers to close the loop by utilizing residential electricity usage as a measure of community response during unprecedented and disruptive events, such as a pandemic.

In the case of rapid outbreaks of infectious diseases in remote locations, the lack of real-time information from the field and rapid spread of misinformation can be a major issue. To improve situational awareness and decision-making at all levels of operational deployment, there is an urgent need for accurate, reliable, and timely results from patients from the affected area. This requires a robust and fast channel of communication connecting first responders on-site, crisis managers, decision-makers, and the institutions involved in the survey of the crisis at national, regional, and international levels. This has been the rationale sustaining the development of advanced communication tools in the Biological Light Fieldable Laboratory for Emergencies (B-LiFE). The benefit of terrestrial (TETRA, LTE, 5G, and Wi-Fi-Fi) and SatCom communications is illustrated through a series of missions and exercises conducted in the previous five years. These tools were used by B-LiFE operators to provide accurate, comprehensive, timely, and relevant information and services in real time. The focus of this article is to discuss the development and benefits of the integration of multi-mission, multi-user nomadic, rapidly deployable telecommunication nodes for emergency uses (TEN) in the capacity of B-LiFE. Providing reliable communication channels through TEN enables the development and use of an ICT toolbox called MIML_LIMS (multi-institution, multi-mission, multi-laboratory LIMS), a tool which is mandatory for efficient and secure data management and data sharing by a mobile laboratory.

International audience; There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district—community, primary care centers, hospital—including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.

The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers' perspective.This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction. The 33-item web-based questionnaire was developed by a pan-Canadian working group of breast reconstruction experts and disseminated via email to members of the Canadian Society of Plastic Surgery. The questionnaire queried respondents on the impact of the COVID-19 pandemic and associated restrictions on surgeons' breast reconstruction practice patterns and opinions on strategies for resource utilization.Responses were received from 49 surgeons, who reported practicing in 8 of 10 Canadian provinces. Restrictions on the provision of breast reconstructive procedures were most limited during the First Wave of the COVID-19 pandemic, where all respondents reported at least some reduction in capacity and more than a quarter reporting complete cessation. Average reported reduction in capacity ranged from 31% to 78% across all 3 waves. Autologous, delayed, and prophylactic reconstructions were most commonly restricted.This study provides a pan-Canadian impact assessment on breast reconstructive services during the COVID-19 pandemic from the providers' perspective. To uphold the standards of patient-centred care, a unified approach to strategically reorganize health care delivery now and in the future is needed.La pandémie de COVID-19 a donné lieu à des défis et des restrictions sans précédent en matière d’accès aux interventions chirurgicales au Canada, y compris les services de reconstruction mammaire qui font partie intégrante des soins complets du cancer du sein. Les chercheurs ont voulu déterminer le mode de restriction des services de reconstruction mammaire et les stratégies possibles pour en optimiser la prestation grâce à une évaluation pancanadienne du point de vue des chirurgiens.La présente étude transversale a été effectuée auprès de chirurgiens plasticiens et reconstructeurs canadiens qui font de la reconstruction mammaire. Un groupe de travail pancanadien d’experts de la reconstruction mammaire a préparé le questionnaire en ligne en 33 points, lequel a été transmis par courriel aux membres de la Société canadienne de chirurgiens-plasticiens. Le questionnaire portait sur les répercussions de la pandémie de COVID-19 et les restrictions connexes sur les modes de pratique de reconstruction mammaire des chirurgiens, de même que sur leurs avis et stratégies à l’égard de l’utilisation des ressources.Un total de 49 chirurgiens, qui ont déclaré exercer dans huit des dix provinces canadiennes, ont répondu au sondage. Les restrictions imposées aux interventions de reconstruction mammaire ont été plus limitées pendant la première vague de la pandémie COVID-19, puisque tous les répondants ont rendu compte d’au moins une certaine restriction de la capacité et que plus du quart ont fait état de leur arrêt complet. La diminution moyenne de la capacité a varié de 31 % à 78 % dans l’ensemble des trois vagues. Ce sont les reconstructions autologues, tardives et prophylactiques qui ont surtout été touchées.La présente étude fournit une évaluation pancanadienne des incidences de la pandémie de COVID-19 sur les services de reconstruction mammaire du point de vue des chirurgiens. Pour maintenir les normes des soins axés sur les patients, il faudra procéder à une réorganisation stratégique unifiée de la prestation des soins, tant maintenant qu’à l’avenir.