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The COVID-19 pandemic has shocked health systems worldwide, with visible impacts on intensive care units and emergency departments. The concept of “surge capacity” should be analyzed within this context as this crisis could be seen as an opportunity to improve the knowledge base of intensive care units and emergency departments.We reflected, based on our experience from work at the frontlines, on health service planning and with epidemiological data, about the importance of surging critical care capacity for COVID, now and as lessons for the future. We summarize and relate virus clinical characteristics, epidemiological patterns and critical care surge capacity as important factors to consider for effective health systems response. Some practical aspects are described, but also the role that mathematical models can play to improve intensive care units surge capacity by considering its importance as a predictor of needs according to epidemiological patterns. Also, in the transitional phase, we consider the importance of coexisting COVID-19 and non-covid-19 health care services, and the importance of a new surge capacity for postponed activities. In this new transitional phase, also emergency departments will have to adapt their surge capacity for a rebound effect due to delayed visits from non-COVID-19 health conditions during the pandemic.Health systems and society must remain vigilant for potential resurgence of cases as measures are relaxed to restart the economy and a new normal. Emergency departments and intensive care units have to develop surge strategies to deal together with COVID-19 and non-COVID-19 flow of patients.

Abstract Evidence of use of toxic gas chemical weapons in the Syrian war has been reported by governmental and non-governmental international organizations since the war started in March 2011. To date, the profiles of victims of the largest chemical attacks in Syria remain unknown. In this study, we used descriptive epidemiological analysis to describe demographic characteristics of victims of the largest chemical weapons attacks in the Syrian war. We analysed conflict-related, direct deaths from chemical weapons recorded in non-government-controlled areas by the Violation Documentation Center, occurring from March 18, 2011 to April 10, 2017, with complete information on the victim’s date and place of death, cause and demographic group. ‘Major’ chemical weapons events were defined as events causing ten or more direct deaths. As of April 10, 2017, a total of 1206 direct deaths meeting inclusion criteria were recorded in the dataset from all chemical weapons attacks regardless of size. Five major chemical weapons attacks caused 1084 of these documented deaths. Civilians comprised the majority (n = 1058, 97.6%) of direct deaths from major chemical weapons attacks in Syria and combatants comprised a minority of 2.4% (n = 26). In the first three major chemical weapons attacks, which occurred in 2013, children comprised 13%–14% of direct deaths, ranging in numbers from 2 deaths among 14 to 117 deaths among 923. Children comprised higher proportions of direct deaths in later major chemical weapons attacks, forming 21% (n = 7) of 33 deaths in the 2016 major attack and 34.8% (n = 32) of 92 deaths in the 2017 major attack. Our finding of an extreme disparity in direct deaths from major chemical weapons attacks in Syria, with 97.6% of victims being civilians and only 2.4% being combatants provides evidence that major chemical weapons attacks were indiscriminate or targeted civilians directly; both violations of International Humanitarian Law (IHL). Identifying and quantifying chemical weapons violations requires inter-disciplinary collaboration to inform international policy, humanitarian intervention and legal action.

Introduction To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age.Methods Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015–2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015–2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models.Results Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively.Conclusion This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.