Building a multisystemic understanding of societal resilience to the COVID-19 pandemic

Socio-ecological factors linked with changes in adults' dietary intake in Los Angeles County during the peak of the coronavirus 2019 pandemic

OBJECTIVE

Comprehensive studies examining longitudinal predictors of dietary change during the coronavirus disease 2019 pandemic are lacking. Based on an ecological framework, this study used longitudinal data to test if individual, social and environmental factors predicted change in dietary intake during the peak of the coronavirus 2019 pandemic in Los Angeles County and examined interactions among the multilevel predictors.

DESIGN

We analysed two survey waves (e.g. baseline and follow-up) of the Understanding America Study, administered online to the same participants 3 months apart. The surveys assessed dietary intake and individual, social, and neighbourhood factors potentially associated with diet. Lagged multilevel regression models were used to predict change from baseline to follow-up in daily servings of fruits, vegetables and sugar-sweetened beverages.

SETTING

Data were collected in October 2020 and January 2021, during the peak of the coronavirus disease 2019 pandemic in Los Angeles County.

PARTICIPANTS

903 adults representative of Los Angeles County households.

RESULTS

Individuals who had depression and less education or who identified as non-Hispanic Black or Hispanic reported unhealthy dietary changes over the study period. Individuals with smaller social networks, especially low-income individuals with smaller networks, also reported unhealthy dietary changes. After accounting for individual and social factors, neighbourhood factors were generally not associated with dietary change.

CONCLUSIONS

Given poor diets are a leading cause of death in the USA, addressing ecological risk factors that put some segments of the community at risk for unhealthy dietary changes during a crisis should be a priority for health interventions and policy.

Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern

Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.

Exploring hospital resilience protective or risk factors: lessons for future disaster response efforts

Background

Hospital resilience is essential in responding to disasters, but current research focuses mainly on frameworks and models rather than the protection of resilience and analysis of risk factors during public health emergencies. This study aims to examine the development of resilience in Chinese frontline hospitals during the initial COVID-19 outbreak in 2020, providing insights for future disaster response efforts.

Objectives

We conducted interviews with 26 hospital staff members who were involved in the initial response to the COVID-19 outbreak in China. We used a semi-structured interview approach and employed purposive sampling and snowball sampling techniques. The interview outline was guided by the 'Action Framework' proposed by the World Health Organization (WHO) for responding to infectious disease emergencies. This framework includes dimensions such as command, surveillance, risk communication, medical response, and public health response. We analyzed the collected data using Colaizzi's seven-step data analysis method and the template analysis method.

Results

WHO's 'action framework' effectively highlights the factors that contribute to hospital resilience. While medical response, including the availability of materials and facilities, the use of information technology, and the capacity for infectious disease diagnosis and treatment, remains crucial, other important aspects include awareness and beliefs about infections, treatment experience, interdisciplinary collaboration, and more. Additionally, it is essential to establish an intelligent command system, foster trusting partnerships between teams, improve monitoring capabilities for infectious disease agents, enhance risk communication through information synchronization and transparency, strengthen infection control planning, and improve environmental disinfection capabilities for effective public health emergency response. These contradictions significantly impact the enhancement of hospital resilience in dealing with major infectious disease outbreaks.

Conclusion

In responding to sudden major infectious diseases, hospitals play a vital role within the healthcare system. Enhancing hospital resilience involves more than just improving treatment capabilities. It also requires effective command coordination at the hospital level, infection control planning, and the deployment of intelligent equipment. Additionally, planning for effective communication and coordination between hospitals, communities, and the national healthcare system can further enhance hospital resilience.

Mitigating the impact of COVID-19 on primary healthcare interventions for the reduction of under-5 mortality in Bangladesh: Lessons learned through implementation research

The COVID-19 pandemic posed unprecedented challenges and threats to health systems, particularly affecting delivery of evidence-based interventions (EBIs) to reduce under-5 mortality (U5M) in resource-limited settings such as Bangladesh. We explored the level of disruption of these EBIs, strategies and contextual factors associated with preventing or mitigating service disruptions, and how previous efforts supported the work to maintain EBIs during the pandemic. We utilized a mixed methods implementation science approach, with data from: 1) desk review of available literature; 2) existing District Health Information System 2 (DHIS2) in Bangladesh; and 3) key informant interviews (KIIs), exploring evidence on changes in coverage, implementation strategies, and contextual factors influencing primary healthcare EBI coverage during March-December 2020. We used interrupted time series analysis (timeframe January 2019 to December 2020) using a Poisson regression model to estimate the impact of COVID-19 on DHIS2 indicators. We audio recorded, transcribed, and translated the qualitative data from KIIs. We used thematic analysis of coded interviews to identify emerging patterns and themes using the implementation research framework. Bangladesh had an initial drop in U5M-oriented EBIs during the early phase of the pandemic, which began recovering in June 2020. Barriers such as lockdown and movement restrictions, difficulties accessing medical care, and redirection of the health system's focus to the COVID-19 pandemic, resulted in reduced health-seeking behavior and service utilization. Strategies to prevent and respond to disruptions included data use for decision-making, use of digital platforms, and leveraging community-based healthcare delivery. Transferable lessons included collaboration and coordination of activities and community and civil society engagement, and investing in health system quality. Countries working to increase EBI implementation can learn from the barriers, strategies, and transferable lessons identified in this work in an effort to reduce and respond to health system disruptions in anticipation of future health system shocks.

Inequalities and mental health during the Coronavirus pandemic in the UK: a mixed-methods exploration

BACKGROUND

The World Health Organisation declared the novel Coronavirus disease (COVID-19) a global pandemic on 11th March 2020. Since then, the world has been firmly in its grip. At the time of writing, there were more than 767,972,961 million confirmed cases and over 6,950,655 million deaths. While the main policy focus has been on controlling the virus and ensuring vaccine roll-out and uptake, the population mental health impacts of the pandemic are expected to be long-term, with certain population groups affected more than others.

METHODS

The overall objectives of our 'Coronavirus: Mental Health and the Pandemic' study were to explore UK adults' experiences of the Coronavirus pandemic and to gain insights into the mental health impacts, population-level changes over time, current and future mental health needs, and how these can best be addressed. The wider mixed-methods study consisted of repeated cross-sectional surveys and embedded qualitative sub-studies including in-depth interviews and focus group discussions with the wider UK adult population. For this particular inequalities and mental health sub-study, we used mixed methods data from our cross-sectional surveys and we carried out three Focus Group Discussions with a maximum variation sample from across the UK adult population. The discussions covered the broader topic of 'Inequalities and mental health during the Coronavirus pandemic in the UK' and took place online between April and August 2020. Focus Groups transcripts were analysed using thematic analysis in NVIVO. Cross-sectional survey data were analysed using STATA for descriptive statistics.

RESULTS

Three broad main themes emerged, each supporting a number of sub-themes: (1) Impacts of the pandemic; (2) Moving forward: needs and recommendations; (3) Coping mechanisms and resilience. Findings showed that participants described their experiences of the pandemic in relation to its impact on themselves and on different groups of people. Their experiences illustrated how the pandemic and subsequent measures had exacerbated existing inequalities and created new ones, and triggered various emotional responses. Participants also described their coping strategies and what worked and did not work for them, as well as support needs and recommendations for moving forward through, and out of, the pandemic; all of which are valuable learnings to be considered in policy making for improving mental health and for ensuring future preparedness.

CONCLUSIONS

The pandemic is taking a long-term toll on the nations' mental health which will continue to have impacts for years to come. It is therefore crucial to learn the vital lessons learned from this pandemic. Specific as well as whole-government policies need to respond to this, address inequalities and the different needs across the life-course and across society, and take a holistic approach to mental health improvement across the UK.

Multisystemic resilience to shocks: a temporal analysis of health, fundamental rights and freedoms, and economic resilience during the first wave of the COVID-19 pandemic in 22 European countries

OBJECTIVES

Research on resilience to the COVID-19 pandemic has primarily focused on health system resilience. The purpose of this paper is to: (1) develop a broader understanding of societal resilience to shocks by evaluating resilience in three systems: health, economic and fundamental rights and freedoms and (2) to further operationalise resilience in terms of robustness, resistance and recovery.

SETTINGS

22 European countries were selected based on the availability of data in the health, fundamental rights and freedoms, and economic systems during the first wave of the COVID-19 pandemic in early 2020.

DESIGN

This study uses time series data to assess resilience in health, fundamental rights and freedoms, and economic systems. An overall resilience was estimated, as well as three of its components: robustness, resistance and recovery.

RESULTS

Six countries exhibited an outlier excess mortality peak compared with the prepandemic period (2015-2019). All countries experienced economic repercussions and implemented diverse measures affecting individual rights and freedoms. Three main groups of countries were identified: (1) high health and high or moderate economic and/or fundamental rights and freedoms resilience, (2) moderate health and fundamental rights and freedoms resilience and (3) low resilience in all three systems.

CONCLUSIONS

The classification of countries into three groups provides valuable insights into the multifaceted nature of multisystemic resilience during the first wave of the COVID-19 pandemic. Our study highlights the importance of considering both health and economic factors when assessing resilience to shocks, as well as the necessity of safeguarding individual rights and freedoms during times of crisis. Such insights can inform policy decisions and aid in the development of targeted strategies to enhance resilience in the face of future challenges.

Scope and applicability of social-ecological resilience to antimicrobial resistance

Social-ecological systems conceptualise how social human systems and ecological natural systems are intertwined. In this Personal View, we define the scope and applicability of social-ecological resilience to antimicrobial resistance. Resilience to antimicrobial resistance corresponds to the capacity to maintain the societal benefits of antimicrobial use and One Health systems' performance in the face of the evolutionary behaviour of microorganisms in response to antimicrobial use. Social-ecological resilience provides an appropriate framework to make sense of the disruptive impacts resulting from the emergence and spread of antimicrobial resistance; capture the diversity of strategies needed to tackle antimicrobial resistance and to live with it; understand the conditions that underpin the success or failure of interventions; and appreciate the need for adaptive and coevolutionary governance. Overall, resilience thinking is essential to improve understanding of how human societies dynamically can cope with, adapt, and transform to the growing global challenge of antimicrobial resistance.

Perspective: lessons learned from the COVID-19 pandemic concerning the resilience of the population

BACKGROUND

A vital stakeholder in the successful management of the COVID-19 pandemic is the public. The degree of involvement of the population in managing the pandemic, and the leadership perception of the public, had a direct impact on the resilience of the population and level of adherence to the issued protective measures.

MAIN BODY

Resilience refers to the ability to 'bounce back' or 'bounce forward' following adversity. Resilience facilitates community engagement which is a crucial component of combating the COVID-19 pandemic. The article highlights six insights recognized in studies conducted in Israel during and following the pandemic concerning the resilience of the country's population. (1) Contrary to varied adversities in which the community serves as an important support system to the individuals, this type of support was substantially impaired during the COVID-19 pandemic, due to the need to maintain isolation, social distancing, and lockdowns. (2) Policy-making during the pandemic should be based on evidence-based data, rather than on assumptions made by decision-makers. This gap led the authorities during the pandemic to adopt measures that were ineffective, such as risk communication based on 'scare tactics' concerning the virus, when the highest risk perceived by the public was political instability. (3) Societal resilience is associated with the public's behavior, such as with vaccine hesitancy and uptake. (4) Factors that affect the levels of resilience include, among others, self-efficacy (impacts individual resilience); social, institutional, and economic aspects as well as well-being (impact community resilience); and hope and trust in the leadership (impact societal resilience). (5) The public should be perceived as an asset in managing the pandemic, thus becoming a vital part of the 'solution'. This will lead to a better understanding of the needs and expectations of the population and an applicable 'tailoring' of the messages that address the public. (6) The gap between science and policymaking must be bridged, to achieve optimal management of the pandemic.

CONCLUSIONS

Improving preparedness for future pandemics should be based on a holistic view of all stakeholders, including the public as a valued partner, connectivity between policymakers and scientists, and strengthening the public's resilience, by enhancing trust in authorities.

COVID-19 Outbreak in Daegu City, Korea and Response to COVID-19: How Have We Dealt and What Are the Lessons?

The first coronavirus disease 2019 (COVID-19) outbreak in Daegu city was overcome by efforts, including; 1) prompt isolation and quarantine action by local government with cooperative help from expert groups and the central government, 2) high-intensity social distancing and active cooperation of citizens, 3) admission of asymptomatic and mild patients in 'residential treatment centers', and 4) use of a telephone scoring system for the allocation of patients, with a mortality rate of 2.5%. A continuous suppression policy with test, tracing, and treatment (3 Ts) was implemented as an active response to the initial outbreaks in Korea. With the introduction of vaccines and therapeutic agents, the COVID-19 crisis had improved. Recently, the omicron variant was responsible for most domestic outbreaks, albeit with a low mortality rate (0.1%). Since the omicron outbreak, a damage mitigation policy has been implemented, focusing on protecting vulnerable groups. In the future, preparation including below are needed; 1) improving the national public health emergency response system, 2) strengthening the crisis response capacity of local governments, 3) cooperation between public healthcare and private healthcare, and 4) establishing a resilient medical response system.

The Impact of COVID-19 on Disruptions of HIV-related Services: A Rapid Review

Background: People living with HIV (PLHIV) and those at risk of HIV are marginalized worldwide and need to reach services regularly. The COVID-19 pandemic can disrupt the HIV care continuum. This study aimed to identify the extent to which HIV-related services have been affected by the COVID-19 pandemic and how we can overcome these challenges. Methods: In this rapid review, we systematically searched PubMed and Scopus databases, the references of studies, international agencies, and studies "cited by" feature in google scholar till May 28, 2021, without restrictions to language. Results: Among the total of 1,121 studies, 31 of them were included in the review. The most important HIV-related services affected by the COVID-19 pandemic were; access to anti-retroviral drugs, HIV testing, periodic HIV-related testing in people living with HIV (PLHIV), pre-exposure prophylaxis, post-exposure prophylaxis, harm reduction services, psychological and counseling services. Some factors were introduced to mitigate the effects of these challenges, including increasing the resilience of health, protecting health care workers and their clients against COVID-19 through vaccination, providing HIV-related services through telehealth, and multi-month dispensing (MMD) of medicines. Conclusion: The results of this review study showed that PLHIV had difficulty in accessing follow-up, care and treatment services during the COVID-19 pandemic. Programs such as the MMD or telemedicine can be useful in providing services to PLHIV during the pandemic.

Qualitative analysis of the organisational response of a university hospital during the first wave of the COVID-19 crisis

Background

The COVID-19 pandemic has required urgent organisational and managerial adaptation, with hospital medical and administrative leaders under considerable pressure.

Methods

At a single French university hospital, we performed a sociological analysis of management adaptation by medical and administrative leaders during the first wave of the COVID-19 crisis. Two sociologists performed interviews with representative members of staff from all the structures involved in managing the crisis to analyse adaptation and the solutions found during this period.

Results

The answers collected during interviews were classified into three main topics describing the organisational adaptations of the hospital staff during the COVID-19 crisis: (1) exceptional mobilisation and collaboration; (2) crisis management based primarily on the principle of subsidiarity; and (3) survival of the administrative structure with interventions to support caregivers.

Conclusion

This study, focusing on a single hospital, identified a number of factors associated with successful mobilisation in the very specific conditions of this viral pandemic.

Conceptualising and assessing health system resilience to shocks: a cross-disciplinary view

Health systems worldwide face major challenges in anticipating, planning for and responding to shocks from infectious disease epidemics, armed conflict, climatic and other crises. Although the literature on health system resilience has grown substantially in recent years, major uncertainties remain concerning approaches to resilience conceptualisation and measurement. This narrative review revisits literatures from a range of fields outside health to identify lessons relevant to health systems. Four key insights emerge. Firstly, shocks can only be understood by clarifying how, where and over what timescale they interact with a system of interest, and the dynamic effects they produce within it. Shock effects are contingent on historical path-dependencies, and on the presence of factors or system pathways (e.g. financing models, health workforce capabilities or supply chain designs) that may amplify or dampen impact in unexpected ways. Secondly, shocks often produce cascading effects across multiple scales, whereas the focus of much of the health resilience literature has been on macro-level, national systems. In reality, health systems bring together interconnected sub-systems across sectors and geographies, with different components, behaviours and sometimes even objectives – all influencing how a system responds to a shock. Thirdly, transformability is an integral feature of resilient social systems: cross-scale interactions help explain how systems can show both resilience and transformational capability at the same time. We illustrate these first three findings by extending the socioecological concept of adaptive cycles in social systems to health, using the example of maternal and child health service delivery. Finally, we argue that dynamic modelling approaches, under-utilised in research on health system resilience to date, have significant promise for identification of shock-moderating or shock-amplifying pathways, for understanding effects at multiple levels and ultimately for building resilience.