Geography, global pandemics & air travel: Faster, fuller, further & more frequent

Identifying essential resource parameters for pandemic preparedness and response: an international Delphi study within the EU PANDEM-2 project

OBJECTIVE

The COVID-19 pandemic highlighted the crucial role of healthcare and public health resource management, where scarcity impairs pandemic response resulting in increased disease transmission, delayed patient care and poorer health outcomes. In the EU PANDEM-2 project, we aimed to identify essential resource parameters for pandemic preparedness and response in the context of an emerging viral respiratory illness.

DESIGN

After performing a systematic literature review, we conducted a Delphi study consisting of a structured questionnaire and consensus round with two separate panels of European public health experts (PHEs) and clinicians, respectively. Resources were categorised as material (n=23), human (n=18) or pharmaceutical (n=12). Data were analysed descriptively for both panels.

RESULTS

Participants were 17 PHEs and 16 clinicians from nine countries. Consensus between the two panels was found on 40 resource parameters (17 material, 14 human, 9 pharmaceutical; 33 accepted and 7 rejected). Notably, clinicians selected three home care resources while PHEs did not, and PHEs selected two pharmaceutical resources which clinicians did not. No consensus was observed on 13 resources. Eleven additional resources were suggested and included (five for PHE and six for clinicians) among which were personal protective equipment for mobile teams, resources for primary care and resources related to mechanical ventilation.

CONCLUSIONS

The high level of consensus between the two expert panels indicates common goals in pandemic resource planning. The disagreement on 13 resource parameters reflects the different priorities between PHEs and clinicians in pandemic planning. This study has demonstrated the core components of resource modelling required for pandemic preparedness planning and shows the importance of consulting experts with both public health and clinical backgrounds. Including our proposed resources in pandemic models allows for more enhanced planning and training activities for future pandemics.

Pandemics and the Impact on Physician Mental Health: A Systematic Review

Physician mental health is a major area of concern with physician burnout on the rise, while at the same time pandemics are becoming more frequent and serious in nature. This combination of physician burnout and pandemics has the potential for serious negative implications for physicians, patients, and health care organizations. Thus, we conduct a systematic review that examines the effect of pandemics on physician mental health using the burnout cascade as a framework. We identified 30 quantitative studies for inclusion. We find that Stages 4 and 5 of the burnout cascade are particularly troublesome with physicians experiencing high levels of anxiety and depression. Furthermore, we find in the degradation phase that physicians experience stigma which may intensify other negative effects. Physicians who are women, younger, and have less training are more susceptible to the negative effects of pandemics. We discuss overall implications and recommendations for future research.

Drivers of the summer influenza epidemic in New South Wales, 2018-19

OBJECTIVES

To assess the extent to which the 2018-19 New South Wales summer influenza epidemic was associated with overseas or domestic travel and with seasonal influenza vaccination status.

DESIGN, SETTING

Unmatched case-control study, based on an online survey distributed from the NSW Notifiable Conditions Information Management System (NCIMS) to people for whom mobile phone numbers were available.

PARTICIPANTS

A case was defined as a person with notified laboratory-confirmed influenza with onset of illness between 1 December 2018 and 21 March 2019. People with notified pertussis infections (confirmed or probable) were selected as controls.

MAIN OUTCOME MEASURES

Notified influenza infection, by travel and contact with unwell overseas travellers in the week before onset of illness and seasonal influenza vaccination status (as the primary exposures).

RESULTS

Valid survey responses were provided by 648 of 2806 invited people with notified influenza (23%) and 257 of 796 invited people with notified pertussis (32%). The demographic characteristics of the respondents were similar to those of the source population (7251 cases, 2254 controls). During the first two months of the summer of 2018-19, notified influenza was more likely for people who had travelled overseas or had contact with an ill overseas traveller in the week before symptom onset (adjusted OR [aOR], 6.99; 95% CI, 3.59-13.6), but not during the second two months (aOR, 1.63; 95% CI, 0.79-3.35). Influenza vaccination status was not associated with the likelihood of notified influenza.

CONCLUSIONS

Travel-related factors were early drivers of the 2018-19 NSW summer influenza epidemic; local transmission sustained the outbreak despite unfavourable conditions later in summer. Our findings prompted re-evaluation of recommendations for pre-travel vaccination in NSW. The role of travel in out-of-season influenza outbreaks should be considered in other temperate zones.