Planning and preparing for public health threats at airports

Cost effectiveness and decision analysis for national airport screening options to reduce risk of COVID-19 introduction in Uganda, 2020

INTRODUCTION

Early during the COVID-19 outbreak, various approaches were utilized to prevent COVID-19 introductions from incoming airport travellers. However, the costs and effectiveness of airport-specific interventions have not been evaluated.

METHODS

We evaluated policy options for COVID-19-specific interventions at Entebbe International Airport for costs and impact on COVID-19 case counts, we took the government payer perspective. Policy options included; (1)no screening, testing, or mandatory quarantine for any incoming traveller; (2)mandatory symptom screening for all incoming travellers with RT-PCR testing only for the symptomatic and isolation of positives; and (3)mandatory 14-day quarantine and one-time testing for all, with 10-day isolation of persons testing positive. We calculated incremental cost-effectiveness ratios (ICERs) in US$ per additional case averted.

RESULTS

Expected costs per incoming traveller were $0 (Option 1), $19 (Option 2), and $766 (Option 3). ICERs per case averted were $257 for Option 2 (which averted 4,948 cases), and $10,139 for Option 3 (which averted 5,097 cases) compared with Option I. Two-week costs were $0 for Option 1, $1,271,431 Option 2, and $51,684,999 Option 3. The per-case ICER decreased with increase in prevalence. The cost-effectiveness of our interventions was modestly sensitive to the prevalence of COVID-19, diagnostic test sensitivity, and testing costs.

CONCLUSION

Screening all incoming travellers, testing symptomatic persons, and isolating positives (Option 2) was the most cost-effective option. A higher COVID-19 prevalence among incoming travellers increased cost-effectiveness of airport-specific interventions. This model could be used to evaluate prevention options at the airport for COVID-19 and other infectious diseases with similar requirements for control.

Evaluating the Impact of the Pandemic Crisis on the Aviation Industry

This paper investigates the intellectual structure of the literature addressing "epidemic/pandemic" and "aviation industry" through a bibliometric approach to the literature from 1991 to 2021. The final count of 856 publications was collected from Web of Science and analyzed by CiteSpace (version 5.8.R1) and VOS Viewer. Visualization tools are used to perform the co-citation, co-occurrence, and thematic-based cluster analysis. The results highlight the most prominent nodes (articles, authors, journals, countries, and institutions) within the literature on "epidemic/pandemic" and "aviation industry." Furthermore, this study conceptualizes and compares the growth of literature before theCOVID-19 pandemic and during the COVID-19 ("hotspot") era. The conclusion is that the aviation industry is an engine for global economics on the road to recovery from COVID-19, in which soft (human) resources can play an integral part.

Re-Starting the Cruise Sector during the COVID-19 Pandemic in Greece: Assessing Effectiveness of Port Contingency Planning

Coronavirus disease (COVID-19) outbreaks on board cruise ships early in the pandemic highlighted gaps worldwide in public health emergency contingency plans (PHECPs) for responding to unknown threats. To restart cruise operations in 2021 and respond to potential COVID-19 outbreaks, a major tourist-based Greek island port (Port A) developed a COVID-19 PHECP. We assessed plan effectiveness by reviewing epidemiological data and monitoring outcomes, followed by an intra-action review (IAR) analyzing three event responses. From May to December 2021, 118 calls from 23 cruise ships with 119,930 passengers were recorded, with 29 COVID-19 cases in 11 cruises on board 7 ships. No outbreak was recorded during the study period. Strengths of the introduced PHECP included commitment of senior management; a core multi-disciplinary team of local authorities/ship agents involved in design and execution; interoperability agreements for port and ships' PHECPs; cruise industry commitment to compliance; and pre-existing scenarios considering capacity needs. Central government coordination for preparedness planning at local ports is essential for successful responses. Monitoring local and country level response capacities is critical to inform planning, risk assessment, and decision-making. Immediately recording ports' response actions provides the basis to capture lessons and improve contingency plans. To facilitate communication and common response protocols between European and non-European ports, IARs should be conducted between countries.

A landscape planning agenda for global health security: Learning from the history of HIV/AIDS and pandemic influenza

This paper considers the role of landscape planning and design in the context of a growing need for research and policy recommendations associated with Emerging Infectious Diseases (EIDs), of which COVID-19 is the most recent. Beginning with a definition of EIDs and their origins within the context of landscape planning, the paper then argues that planning and design scholars and practitioners should begin by seeing the importance of a "global urban ecosystem" (GUE) comprised of rapidly transforming metropolitan and regional "patches" connected through "corridors" of relatively unregulated global transportation and mobility networks. It then revisits the history of the two prior global pandemics of HIV/AIDS and pandemic influenza to establish the importance of a landscape planning perspective at the intersection of wildlife, livestock, and globally connected human communities. The essay concludes by arguing that this GUE concept can facilitate creative planning and design by adapting concepts established in other patch and corridor networks like urban transit systems to the ongoing risk of future pandemic EIDs.

Development of a competency profile for professionals involved in infectious disease preparedness and response in the air transport public health sector

BACKGROUND

Recent infectious disease outbreaks highlight the importance of competent professionals with expertise on public health preparedness and response at airports. The availability of a competency profile for this workforce supports efficient education and training. Although competency profiles for infectious disease control professionals are available, none addresses the complex airport environment. Therefore, the main aim of this study is to develop a competency profile for professionals involved in infectious disease preparedness and response at airports in order to stimulate and direct further education and training.

METHODS

We developed the competency profile through the following steps: 1) extraction of competencies from relevant literature, 2) assessment of the profile in a national RAND modified Delphi study with an interdisciplinary expert group (n = 9) and 3) assessment of the profile in an international RAND modified Delphi study with an airport infectious disease management panel of ten European countries (n = 10).

RESULTS

We systematically studied two competency profiles on infectious disease control and three air transport guidelines on event management, and extracted 61 relevant competencies for airports. The two RAND modified Delphi procedures further refined the profile, mainly by specifying a competency's target group, the organizational level it should be present on, and the exact actions that should be mastered. The final profile, consisting of 59 competencies, covers the whole process from infectious disease preparedness, through the response phase and the recovery at airports.

CONCLUSION

We designed a profile to support training and exercising the multidisciplinary group of professionals in infectious disease management in the airport setting, and which is ready for use in practice. The many adaptations and adjustments that were needed to develop this profile out of existing profiles and air transport guidelines suggest that other setting-specific profiles in infectious disease control are desirable.