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COVID-19 has highlighted the dynamic relationship between pandemic threats and global food systems. Despite important connections, research and policy-making on food systems and pandemics largely operate in silos. We propose a framework that integrates food systems and pandemic planning and response, exploring the role of the food system in shaping pandemics and, consequently, the role of pandemics in disrupting a now global food system. This framework highlights important connections between food production, distribution, and consumption at each stage of the pandemic cycle: preven­tion, response, and recovery. We use recent experiences with COVID-19 to illustrate vulnerabilities in systems interaction during the prevention and response phases. Over the long term, in the recovery phase, food systems must transform, adopting an enhanced level of functioning to improve resilience. To reduce population health risks and promote sustainable food systems, we call for implementation of surveillance systems for both emerging infections and food systems functioning in order to strengthen global food supply chains, create stakeholder resource coordination mechanisms, and address underlying socioeconomic vulnerabilities. Multidisciplinary global actors should draw on lessons from the COVID-19 pandemic to prevent the inevitable next one.

BackgroundHealthcare-associated infections (HAIs) constitute a significant financial strain on healthcare systems across the world, with surgical site infections (SSIs) being the costliest form. Despite the existence of diverse sources of infection in the operating room (OR), current literature focuses on human and procedural sources of contamination that could lead to an infection. Comparatively, the OR built environment is understudied as a potential disease transmission interface between the environment, patients, and surgical staff. This systematic literature review aims to investigate how the physical characteristics and components of the built environment impact airflow, infection risk, aerosols, particle counts, contamination, and pathogens in operating rooms.Methods and FindingsLiterature searches were conducted in the PubMed and Web of Science Core Collection databases on December 21, 2020, ultimately retrieving 2,965 articles after duplicates were removed. During abstract screening, all abstracts were independently reviewed by two authors and conflicts were resolved by a third author. All articles published since January 1, 2010, that reported primary data investigating an aspect of the built environment inside an OR in relation to airflow, contamination, and/or infection for which the full text in English was available were included. This resulted in the inclusion of 138 articles, which includes studies conducted in ORs during active surgeries, computer modeling studies, and simulations in which a real OR was used for a mock surgical procedure. Six major built environment categories were identified based on the collected literature: OR layout, disinfection systems, surgical lights, doors, ventilation, and portable airflow devices. A survey created on Qualtrics software was used to record the aspect of the built environment and the outcome of each study, as well as the relationship between the two.ConclusionsWhile OR ventilation has been studied extensively, the OR built environment as a whole is understudied in relation to airflow, contamination, and infection. The current literature is inconsistent in both its findings and subsequent recommendations, making it difficult to inform hospital design in the context of SSIs. No articles were identified that discussed respiratory infection transmission in the OR, and very few addressed healthcare worker (HCW) safety in relation to the OR built environment. The significant discrepancies in the literature identified in this review highlight the need for future studies that assess the quality and bias of these studies before firm recommendations can be made. Future work should also focus on addressing the lack information regarding respiratory infection transmission in the OR, especially in the context of HCW safety.

Background Current mitigation strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on the population-wide adoption of nonpharmaceutical interventions (NPIs). Monitoring the adoption of NPIs and their associations with SARS-CoV-2 infection history can provide key information for public health. Methods We sampled 1030 individuals in Maryland from 17–28 June 2020 to capture sociodemographically and geographically resolved information about NPI adoption and access to SARS-CoV-2 testing, and examine associations with self-reported SARS-CoV-2 positivity. Results Overall, 92% reported traveling for essential services and 66% visited friends/family. Use of public transport was reported by 18%. In total, 68% reported strict social distancing indoors and 53% reported strict masking indoors; indoor social distancing was significantly associated with age, and race/ethnicity and income were associated with masking. Overall, 55 participants (5.3%) self-reported ever testing positive for SARS-CoV-2, with strong dose-response relationships between several forms of movement frequency and SARS-CoV-2 positivity. In a multivariable analysis, a history of SARS-CoV-2 infection was negatively associated with strict social distancing (adjusted odds ratio [aOR] for outdoor social distancing, 0.10; 95% confidence interval, .03–.33). Only public transport use (aOR for >7 times vs never, 4.3) and visiting a place of worship (aOR for ≥3 times vs never, 16.0) remained significantly associated with SARS-CoV-2 infection after adjusting for strict social distancing and demographics. Conclusions These results support public health messaging that strict social distancing during most activities can reduce SARS-CoV-2 transmission. Additional considerations are needed for indoor activities with large numbers of persons (places of worship and public transportation), where even NPIs may not be possible or sufficient.

Genomic surveillance is a critical tool for tracking emerging variants of SARS-CoV-2 (the virus that causes COVID-19), which can exhibit characteristics that potentially affect public health and clinical interventions, including increased transmissibility, illness severity, and capacity for immune escape. During June 2021-January 2022, CDC expanded genomic surveillance data sources to incorporate sequence data from public repositories to produce weighted estimates of variant proportions at the jurisdiction level and refined analytic methods to enhance the timeliness and accuracy of national and regional variant proportion estimates. These changes also allowed for more comprehensive variant proportion estimation at the jurisdictional level (i.e., U.S. state, district, territory, and freely associated state). The data in this report are a summary of findings of recent proportions of circulating variants that are updated weekly on CDC's COVID Data Tracker website to enable timely public health action.

Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.

Infectious disease surveillance systems support early warning, promote preparedness, and inform public health response. Pathogens that have human, animal, and environmental reservoirs should be monitored through systems that incorporate a One Health approach. In 2016, Thailand's federal government piloted an avian influenza (AI) surveillance system that integrates stakeholders from human, animal, and environmental sectors, at the central level and in four provinces to monitor influenza A viruses within human, waterfowl, and poultry populations. This research aims to describe and evaluate Thailand's piloted AI surveillance system to inform strategies for strengthening and building surveillance systems relevant to One Health. We assessed this surveillance system using the United States Centers for Disease Control and Prevention's (U.S. CDC) "Guidelines for Evaluating Public Health Surveillance Systems" and added three novel metrics: transparency, interoperability, and security. In-depth key informant interviews were conducted with representatives among six Thai federal agencies and departments, the One Health coordinating unit, a corporate poultry producer, and the Thai Ministry of Public Health-U.S. CDC Collaborating Unit. Thailand's AI surveillance system demonstrated strengths in acceptability, simplicity, representativeness, and flexibility, and exhibited challenges in data quality, stability, security, interoperability, and transparency. System efforts may be strengthened through increasing laboratory integration, improving pathogen detection capabilities, implementing interoperable systems, and incorporating sustainable capacity building mechanisms. This innovative piloted surveillance system provides a strategic framework that can be used to develop, integrate, and bolster One Health surveillance approaches to combat emerging global pathogen threats and enhance global health security.

ObjectiveThe COVID-19 pandemic has significantly stressed healthcare systems. The addition of monoclonal antibody (mAb) infusions, which prevent severe disease and reduce hospitalizations, to the repertoire of COVID-19 countermeasures offers the opportunity to reduce system stress but requires strategic planning and use of novel approaches. Our objective was to develop a web-based decision-support tool to help existing and future mAb infusion facilities make better and more informed staffing and capacity decisions.Materials and MethodsUsing real-world observations from three medical centers operating with federal field team support, we developed a discrete-event simulation model and performed simulation experiments to assess performance of mAb infusion sites under different conditions.Results162,000 scenarios were evaluated by simulations. Our analyses revealed that it was more effective to add check-in staff than to add additional nurses for middle-to-large size sites with ≥ 2 infusion nurses; that scheduled appointments performed better than walk-ins when patient load was not high; and that reducing infusion time was particularly impactful when load on resources was only slightly above manageable levels.DiscussionPhysical capacity, check-in staff, and infusion time were as important as nurses for mAb sites. Health systems can effectively operate an infusion center under different conditions to provide mAb therapeutics even with relatively low investments in physical resources and staff.ConclusionSimulations of mAb infusion sites were used to create a capacity planning tool to optimize resource utility and allocation in constrained pandemic conditions, and more efficiently treat COVID-19 patients at existing and future mAb infusion sites.

BackgroundMonoclonal antibodies (mAbs) against SARS-CoV-2 are a promising treatment for limiting the progression of COVID-19 and decreasing strain on hospitals. Their use, however, remains limited, particularly in disadvantaged populations.MethodsElectronic health records were reviewed from SARS-CoV-2 patients at a single medical center in the United States that initiated mAb infusions in January 2021 with the support of the U.S. Department of Health and Human Services’ National Disaster Medical System. Patients who received mAbs were compared to untreated patients from the time period before mAb availability who met eligibility criteria for mAb treatment. We used logistic regression to measure the effect of mAb treatment on the risk of hospitalization or emergency department (E.D.) visit within 30 days of laboratory-confirmed COVID-19.ResultsOf 598 COVID-19 patients, 270 (45%) received bamlanivimab and 328 (55%) were untreated. Two hundred and thirty-one patients (39%) were Hispanic. Among treated patients, 5/270 (1.9%) presented to the E.D. or required hospitalization within 30 days of a positive SARS-CoV-2 test, compared to 39/328 (12%) untreated patients (pConclusionsIn this diverse, real-world COVID-19 patient population, mAb treatment significantly decreased the risk of subsequent E.D. visit or hospitalization. Broader treatment with mAbs, including in disadvantaged patient populations, can decrease the burden on hospitals and should be facilitated in all populations in the United States to ensure health equity.SummaryIn a diverse, real-world COVID-19 patient population, treatment with monoclonal antibodies significantly decreased the risk of subsequent emergency department visit or hospitalization within 30 days of a positive SARS-CoV-2 viral test.

BackgroundThe COVID-19 pandemic caught the globe unprepared without targeted medical countermeasures, such as therapeutics, to target the emerging SARS-CoV-2 virus. However, in recent months multiple monoclonal antibody therapeutics to treat COVID-19 have been authorized by the U.S. Food and Drug Administration (FDA) under Emergency Use Authorization (EUA). Despite these authorizations and promising clinical trial efficacy results, monoclonal antibody therapies are currently underutilized as a treatment for COVID-19 across the U.S. Many barriers exist when deploying a new infused therapeutic during an ongoing pandemic with limited resources and staffing, and it is critical to better understand the process and site requirements of incorporating monoclonal antibody infusions into pandemic response activities.MethodsWe examined the monoclonal antibody infusion site process components, resources, and requirements during the COVID-19 pandemic using data from three initial infusion sites at medical centers in the U.S. supported by the National Disaster Medical System. A descriptive analysis was conducted using process assessment metrics to inform recommendations to strengthen monoclonal antibody infusion site implementation.ResultsThe monoclonal antibody infusion sites varied in physical environment and staffing models due to state polices, infection control mechanisms, and underlying medical system structure, but exhibited a common process workflow. Sites operationalized an infusion process staffing model with at least two nurses per ten infusion patients. Monoclonal antibody implementation success factors included tailoring the infusion process to the patient community, strong engagement with local medical providers, batch preparing the therapy before patient arrival, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges stemmed from confirming patient SARS-CoV-2 positivity, strained staff, scheduling needs, and coordination with the pharmacy for therapy preparation.ConclusionsInfusion site processes are most effective when integrated into the pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources. As the pandemic and policy tools such as EUAs evolve, monoclonal antibody infusion processes must also remain adaptable, as practice changes directly affect resources, staffing, timing, and workflows. Future use may be aided by incorporating innovative emergency deployment techniques, such as vehicle and home-based therapy administration, and by developing drug delivery mechanisms that alleviate the need for observed intravenous infusions by medically-accredited staff.

In an outpatient cohort in Maryland, clustering of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity within households was high, with 76% of 74 households reporting at least 1 other symptomatic person and 66% reporting another person who tested SARS-CoV-2 positive. SARS-CoV-2 positivity among household members was associated with larger household size and bedroom sharing.

Avian influenza (AI) is a global health obstacle of critical concern as novel viruses are capable of initiating a pandemic. Recent spillover events of AI into human populations have occurred at human-poultry food system interfaces. As Nepal's poultry sector transitions to more intensified commercial production systems, it is important to examine the epidemiology of AI and the knowledge, attitudes and practices (KAP) of poultry sector workers. We conducted a cross-sectional KAP study utilizing a structured survey to interview 150 commercial poultry farmers in Chitwan District, Nepal. All commercial poultry farmers had knowledge of AI previous to the study and the majority farmers were able to identify farm-farm and poultry-human transmission mechanisms of AI. Farmers had more knowledge surrounding poultry AI symptoms as compared to human AI symptoms. Most farmers believe that AI is serious, contagious and a threat to everyone, yet only half believe it can be prevented. Individual-level personal protective equipment (PPE) uptake, such as facemask, glove and boot usage, on the enrolled farms was low and farm-level biosecurity practices varied greatly. Nine commercial poultry farms (6%) self-reported having an HPAI outbreak and 60 farms (40%) self-reported having an LPAI outbreak in the past 5 years. Layer farms had higher odds (OR: 5.4, 95% CI: 2.3–12.8) of self-reported LPAI as compared broiler farms. Poultry sector farmers face multiple obstacles when attempting to report AI to government authorities such as the fear of flock culling and the perceived lack of monetary compensation for culling. Our study provides updated KAP surrounding AI of farmers and self-reported AI farm-level epidemiology in Nepal's highest density commercial poultry production district. Commercial poultry farmers are fairly knowledgeable on AI, but do not take further protective practice efforts to implement their knowledge and prevent AI. Due to the potential role that human-poultry interfaces may play in AI emergence, it is critical to collaborate with the commercial poultry industry when planning and conducting AI pandemic preparedness mechanisms., Highlights • Farmers had more knowledge surrounding poultry avian influenza symptoms as compared to human avian influenza symptoms. • Farmer personal protective equipment (PPE) uptake, such as facemask, glove and boot usage, was low. • 6% of poultry farms self-reported having an HPAI outbreak and 40% self-reported having an LPAI outbreak in the past 5 years. • Layer farms had higher odds of self-reported LPAI as compared broiler farms. • Poultry farmers fear potential flock culling and lack of monetary compensation for culling when reporting avian influenza.

BackgroundCurrent mitigation strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on population-wide adoption of non-pharmaceutical interventions (NPIs). Collecting demographically and geographically resolved data on NPIs and their association with SARS-CoV-2 infection history can provide critical information related to reopening geographies.MethodsWe sampled 1,030 individuals in Maryland from June 17 – June 28, 2020 to capture socio-demographically and geographically resolved information about NPI adoption, access to SARS-CoV-2 testing, and examine associations with self-reported SARS-CoV-2 positivity.ResultsMedian age of the sample was 43 years and 45% were men; Whites and Blacks/African Americans represented 60% and 23%, respectively. Overall, 96% of the sample reported traveling outside their home for non-employment related services: most commonly cited reasons were essential services (92%) and visiting friends/family (66%). Use of public transport was reported by 18% of respondents. 68% reported always social distancing indoors and 53% always wearing masks indoors; indoor social distancing was significantly less common among younger vs. older individuals, and race/ethnicity and income were significantly associated with mask use (pConclusionsUsing a rapid cost-efficient approach, we highlight the role of movement and social distancing on SARS-CoV-2 transmission risk. Continued monitoring of NPI uptake, access to testing, and the subsequent impact on SARS-CoV-2 transmission will be critical for pandemic control and decisions about reopening geographies.Key PointsWhat we didWe utilized an online survey approach to sample residents of Maryland consistent with the distributions of age, gender, race/ethnicity, and income in the state.We asked questions about places (and the frequency) visited for essential and nonessential services in the prior 2 weeks, practice of non-pharmaceutical interventions (NPIs) while visiting various places, and access to SARS-CoV-2 testing.We characterized how movement and adoption of NPIs differed by key demographics (age, race, gender, income) and how these were associated with self-reported SARS-CoV-2 positivity.What we found96% of the sample reported traveling for either essential or non-essential services in the prior 2 weeks; 82% reported traveling for non-essential services.The adoption of NPIs varied by age, race/ethnicity, and income.Self-reported SARS-CoV-2 positivity was highest among Latinos followed by Blacks/African Americans and then Whites.The more frequently a person traveled/visited places for non-essential services, the more likely they were to report ever having tested positive for SARS-CoV-2.The strict practice of social distancing was associated with a lower likelihood of ever having tested positive for SARS-CoV-2; moreover, strict social distancing attenuated the association between most forms of movement and SARS CoV-2 positivityUsing public transport and attending places of worship remained associated with a higher likelihood of having tested positive for SARS-CoV-2 even when practicing social distancing.About 70% of people who wanted a SARS-CoV-2 test were able to get a test but there were delays of a week or more from wanting a test to getting a result among the majority of the sample.What it meansThe more people move the more likely they are to test positive for SARS-CoV-2; if you must travel, practice social distancing as it reduces the likelihood of testing positive.Avoid public transport to the extent possible.Strategies to reduce time from wanting a test to getting a result are critical to enhance early case detection and isolation to curb transmission.

Background Current mitigation strategies for SARS-CoV-2 rely on population-wide adoption of non-pharmaceutical interventions (NPIs). Monitoring NPI adoption, mobility patterns and their association with SARS-CoV-2 infection can provide key information for public health agencies and be used to calibrate transmission models. Methods We used an online panel to accrue representative samples from Florida, Illinois, and Maryland (n=3,009, approximately 1,000 per state) from July 15–31, 2020 and capture socio-demographically and geographically resolved information about NPI adoption and mobility in the prior 2 weeks. Logistic regression was used to identify correlates of self-reported SARS-CoV-2 infection in the prior 2 weeks. Results Overall, 96% reported traveling outside their home in the prior 2 weeks, the most common reason being to visit a grocery store/pharmacy (92%), followed by visiting friends/family (61%), and visiting a place of worship (23%); 22% reporting public transportation use. In total, 44% of respondents reported always practicing social distancing and 40% reported always using a mask indoors and outdoors. Overall, 74 (2.5%) reported testing positive for SARS-CoV-2 in the prior 2 weeks, with strong dose-response relationships between several forms of movement frequency and SARS-CoV-2 positivity. Variables capturing mobility were all highly correlated with one another, suggesting there are clusters of individuals who engage in multiple activities (Figure); 41% of positive cases engaged in all forms of mobility captured compared to 1% of those who did not test positive within the prior 2 weeks. Patterns of mobility and NPI uptake did not significantly differ by state; however, there were significant relationships with age, race/ethnicity, and gender. In multivariable models including adjustment for NPIs, significant relationships remained with public transportation, visiting a place of worship, and participating in outdoor group fitness activities. Figure. Heatmap depicting pairwise Spearman correlation coefficients between survey responses. Pairwise correlation coefficients are displayed in the boxes at intersection of any two variables. Questions were asked with respect activities in the prior 2 weeks. Conclusion NPI adoption and mobility did not vary across these three states with variable policies and SARS-CoV-2 positivity rates. Rather, associations with recent positivity appear to be driven largely by mobility patterns and engagement in activities where NPI use may be challenging or inconsistent. Disclosures Shruti Mehta, PhD, MPH, Gilead Sciences (Other Financial or Material Support, Speaker) Sunil Solomon, MD, PhD, MPH, Abbott Diagnostics (Grant/Research Support)Gilead Sciences (Grant/Research Support, Advisor or Review Panel member)