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Kepp KP, Bardosh K, De Bie T, Emilsson L, Greaves J, Lallukka T, Muka T, Rangel JC, Sandström N, Schippers MC, Schmidt-Chanasit J, Vaillancourt T. Zero-covid advocacy during the COVID-19 pandemic: a case study of views on Twitter/X. Monash Bioeth Rev 2024:10.1007/s40592-024-00205-2. [PMID: 39225854 DOI: 10.1007/s40592-024-00205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
During the COVID-19 pandemic, many advocacy groups and individuals criticized governments on social media for doing either too much or too little to mitigate the pandemic. In this article, we review advocacy for COVID-19 elimination or "zero-covid" on the social media platform X (Twitter). We present a thematic analysis of tweets by 20 influential co-signatories of the World Health Network letter on ten themes, covering six topics of science and mitigation (zero-covid, epidemiological data on variants, long-term post-acute sequelae (Long COVID), vaccines, schools and children, views on monkeypox/Mpox) and four advocacy methods (personal advice and promoting remedies, use of anecdotes, criticism of other scientists, and of authorities). The advocacy, although timely and informative, often appealed to emotions and values using anecdotes and strong criticism of authorities and other scientists. Many tweets received hundreds or thousands of likes. Risks were emphasized about children's vulnerability, Long COVID, variant severity, and Mpox, and via comparisons with human immunodeficiency viruses (HIV). Far-reaching policies and promotion of remedies were advocated without systematic evidence review, or sometimes, core field expertise. We identified potential conflicts of interest connected to private companies. Our study documents a need for public health debates to be less polarizing and judgmental, and more factual. In order to protect public trust in science during a crisis, we suggest the development of mechanisms to ensure ethical guidelines for engagement in "science-based" advocacy, and consideration of cost-benefit analysis of recommendations for public health decision-making.
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Affiliation(s)
| | - Kevin Bardosh
- School of Public Health, University of Washington, Seattle, USA
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Tijl De Bie
- IDLab, Department of Electronics and Information Systems (ELIS), Ghent University, Ghent, Belgium
| | - Louise Emilsson
- General Practice Research Unit (AFE) and Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Varmland, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Justin Greaves
- Department of Politics and International Studies, University of Warwick, Coventry, UK
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | | | - Niclas Sandström
- Faculty of Educational Sciences, Department of Education, University of Helsinki, Helsinki, Finland
| | - Michaéla C Schippers
- Department of Organisation and Personnel Management, Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jonas Schmidt-Chanasit
- Faculty of Mathematics, Informatics and Natural Sciences, Universität Hamburg, Hamburg, Germany
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
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Alcantara DMC, Dos Santos CM, Torres JM, Stutz C, Vieira CA, Moreira RMDS, Rodrigues R, Marcon GEB, Ferreira EDC, Mendes FML, Sarti ECFB, de Oliveira TF, Lemos EF, Andrade UV, Lichs GGDC, Demarchi LHF, Zardin MCSU, Gonçalves CCM, Guilhermino JDF, Fernandez ZDC. Long-term surveillance of SARS-CoV-2 in the school community from Campo Grande, Brazil. BMC Public Health 2024; 24:2057. [PMID: 39085807 PMCID: PMC11290088 DOI: 10.1186/s12889-024-19555-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted education systems worldwide, with Brazil being one of the countries with the longest school closures. Over a million children and teenagers have been affected, leading to increased hunger and nutritional deficiencies. This study aimed to implement long-term surveillance of SARS-CoV-2 infections in public and private schools in Campo Grande, Brazil, after returning to in-person classes. METHODS The study involved testing and genomic surveillance at 23 public and private schools in Campo Grande, Mato Grosso do Sul, Brazil, from October 18, 2021 to November 21, 2022. The participants eligible for enrollment were students aged 6-17 years and staff members from school institutions. At the time of collection, participants were asked if they had symptoms in the last two weeks. Whole-genome sequencing of SARS-CoV-2 was conducted to identify circulating variants and to compare them with those detected in the municipality. The demographic data and clinical history of the participants were described, and a logistic regression model was used to understand how the RT-qPCR results could be related to different characteristics. RESULTS The study included 999 participants, most of whom were women. A total of 85 tests were positive, with an overall positivity rate of 3.2%. The dynamics of case frequency were consistent with those observed in the municipality during the study period. The most common symptoms reported were cough, rhinorrhea, headache, and sore throat. Symptoms were significantly associated with SARS-CoV-2 infection. Eleven lineages were identified in school community samples, with a frequency of occurrence per period similar to that found in the sequences available for the municipality. The most prevalent lineages within the sampling period were BA.2 (59.3%) and BA.5 (29.6%). CONCLUSIONS Our findings demonstrate that schools can play a crucial role in epidemiological surveillance, helping trigger rapid responses to pathogens such as SARS-CoV-2. Long-term surveillance can be used to track outbreaks and assess the role of children and adults in transmission. It can also contribute to pandemic preparedness, enabling a rapid response to emergencies, such as COVID-19.
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Affiliation(s)
| | - Camila Maria Dos Santos
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | - Jaire Marinho Torres
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | - Claudia Stutz
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Camila Aoyama Vieira
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | - Raissa Mariele Dos Santos Moreira
- Instituto Integrado de Saúde (INISA), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Rudielle Rodrigues
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Eduardo de Castro Ferreira
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
- Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina (FAMED), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Flavia Maria Lins Mendes
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Everton Ferreira Lemos
- Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Gislene Garcia de Castro Lichs
- Laboratório Central de Saúde Pública do Estado de Mato Grosso do Sul (LACEN/MS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Luiz Henrique Ferraz Demarchi
- Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina (FAMED), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
- Laboratório Central de Saúde Pública do Estado de Mato Grosso do Sul (LACEN/MS), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Crhistinne Cavalheiro Maymone Gonçalves
- Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina (FAMED), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
- Secretaria de Estado de Saúde de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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Lundberg AL, Wu SA, Soetikno AG, Hawkins C, Murphy RL, Havey RJ, Ozer EA, Moss CB, Welch SB, Mason M, Liu Y, Post LA. Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Europe: Longitudinal Trend Analysis. JMIR Public Health Surveill 2024; 10:e53551. [PMID: 38568186 PMCID: PMC11226935 DOI: 10.2196/53551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND In this study, we built upon our initial research published in 2020 by incorporating an additional 2 years of data for Europe. We assessed whether COVID-19 had shifted from the pandemic to endemic phase in the region when the World Health Organization (WHO) declared the end of the public health emergency of international concern on May 5, 2023. OBJECTIVE We first aimed to measure whether there was an expansion or contraction in the pandemic in Europe at the time of the WHO declaration. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provided the historical context for the course of the pandemic in Europe in terms of policy and disease burden at the country and region levels. METHODS In addition to the updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-tailed t test for whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. RESULTS Speed for the region had remained below the outbreak threshold for 4 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day and 7-day persistence coefficients remained statistically significant, the coefficients were moderate in magnitude (0.404 and 0.547, respectively; P<.001 for both). The shift parameters for the 2 weeks around the WHO declaration were small and insignificant, suggesting little change in the clustering effect of cases on future cases at the time. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became insignificant for the first time in April 2023. CONCLUSIONS While COVID-19 continues to circulate in Europe, the rate of transmission remained below the threshold of an outbreak for 4 months ahead of the WHO declaration. The region had previously been in a nearly continuous state of outbreak. The more recent trend suggested that COVID-19 was endemic in the region and no longer reached the threshold of the pandemic definition. However, several countries remained in a state of outbreak, and the conclusion that COVID-19 was no longer a pandemic in Europe at the time is unclear.
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Affiliation(s)
- Alexander L Lundberg
- Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Scott A Wu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alan G Soetikno
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Claudia Hawkins
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Global Communicable and Emerging Infectious Diseases, Robert J. Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
| | - Robert L Murphy
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert J. Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Robert J Havey
- Robert J. Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Egon A Ozer
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Pathogen Genomics and Microbial Evolution, Robert J. Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
| | - Charles B Moss
- Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, United States
| | - Sarah B Welch
- Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maryann Mason
- Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yingxuan Liu
- Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lori A Post
- Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, Chicago, IL, United States
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Maglietta G, Puntoni M, Caminiti C, Pession A, Lanari M, Caramelli F, Marchetti F, De Fanti A, Iughetti L, Biasucci G, Suppiej A, Miceli A, Ghizzi C, Vergine G, Aricò M, Stella M, Esposito S. Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis. Front Public Health 2024; 12:1393677. [PMID: 38699417 PMCID: PMC11064846 DOI: 10.3389/fpubh.2024.1393677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Background The use of Non-Pharmaceutical Interventions (NPIs), such as lockdowns, social distancing and school closures, against the COVID-19 epidemic is debated, particularly for the possible negative effects on vulnerable populations, including children and adolescents. This study therefore aimed to quantify the impact of NPIs on the trend of pediatric hospitalizations during 2 years of pandemic compared to the previous 3 years, also considering two pandemic phases according to the type of adopted NPIs. Methods This is a multicenter, quasi-experimental before-after study conducted in 12 hospitals of the Emilia-Romagna Region, Northern Italy, with NPI implementation as the intervention event. The 3 years preceding the beginning of NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (up to September 2020) and a subsequent mitigation measures phase with less stringent restrictions. School closure was chosen as delimitation as it particularly concerns young people. Interrupted Time Series (ITS) regression analysis was applied to calculate Hospitalization Rate Ratios (HRR) on the diagnostic categories exhibiting the greatest variation. ITS allows the estimation of changes attributable to an intervention, both in terms of immediate (level change) and sustained (slope change) effects, while accounting for pre-intervention secular trends. Results Overall, in the 60 months of the study there were 84,368 cases. Compared to the pre-pandemic years, statistically significant 35 and 19% decreases in hospitalizations were observed during school closure and in the following mitigation measures phase, respectively. The greatest reduction was recorded for "Respiratory Diseases," whereas the "Mental Disorders" category exhibited a significant increase during mitigation measures. ITS analysis confirms a high reduction of level change during school closure for Respiratory Diseases (HRR 0.19, 95%CI 0.08-0.47) and a similar but smaller significant reduction when mitigation measures were enacted. Level change for Mental Disorders significantly decreased during school closure (HRR 0.50, 95%CI 0.30-0.82) but increased during mitigation measures by 28% (HRR 1.28, 95%CI 0.98-1.69). Conclusion Our findings provide information on the impact of COVID-19 NPIs which may inform public health policies in future health crises, plan effective control and preventative interventions and target resources where needed.
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Affiliation(s)
- Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Matteo Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Caterina Caminiti
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Andrea Pession
- Pediatric Clinic, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Federico Marchetti
- Pediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Pediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Andrea Miceli
- Pediatric Unit, Pavullo Hospital, AUSL Modena, Modena, Italy
| | | | | | - Melodie Aricò
- Pediatric Unit, G.B. Morgagni – L. Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Li N, Yu X. Characteristic analysis of China's actions against the COVID-19 in schools and comparison with other countries. Public Health Nurs 2024; 41:255-263. [PMID: 38111269 DOI: 10.1111/phn.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The outbreak of the COVID-19 poses a great threat to students globally. China has taken steps to keep students from becoming infected for more than 30 months, while other countries have also taken steps. Comparing the intentions, implementation, immediate and long-term effects of these initiatives can shed more light on the care of adolescents in schools. OBJECTIVE The focus of the study is to describe the full range of school prevention measures in China, identifying when they work and when they do not. At the same time, some typical measures taken in other countries' schools are presented and compared to provide a comprehensive discussion. METHODS This study attempted to combine data comparison, information analysis, policy interpretation, and participatory observation to form a comprehensive analytical network. RESULTS China's schools have gone through of lucky periods, safety periods, difficult periods, and crisis periods. These efforts are due to the government's intense control measures, strict accountability of school administrators, frequent nucleic acid testing, widespread vaccination, and widely implemented online learning. In comparison, the measures taken by China are difficult to implement, and the price paid by the government, schools and students needs to be further assessed and reflected upon. CONCLUSIONS The virus is able to destroy the school's defence with ease. There should be a consensus among countries for a permanent virus control strategy, but the severity of the various measures needs to be appropriately determined, strict control measures can also have negative effects.
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Affiliation(s)
- Na Li
- Professor at School of Law, Ningbo University, Ningbo, Zhejiang Province, Peoples Republic of China
| | - Xiang Yu
- Professor at School of Public Affairs, Fujian Jiangxia University, Fuzhou Fujian Province, People's Republic of China
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Branch-Elliman W, Elwy AR, Chambers DA. Embracing dynamic public health policy impacts in infectious diseases responses: leveraging implementation science to improve practice. Front Public Health 2023; 11:1207679. [PMID: 37663826 PMCID: PMC10469790 DOI: 10.3389/fpubh.2023.1207679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Rationale The host-pathogen relationship is inherently dynamic and constantly evolving. Applying an implementation science lens to policy evaluation suggests that policy impacts are variable depending upon key implementation outcomes (feasibility, acceptability, appropriateness costs) and conditions and contexts. COVID-19 case study Experiences with non-pharmaceutical interventions (NPIs) including masking, testing, and social distancing/business and school closures during the COVID-19 pandemic response highlight the importance of considering public health policy impacts through an implementation science lens of constantly evolving contexts, conditions, evidence, and public perceptions. As implementation outcomes (feasibility, acceptability) changed, the effectiveness of these interventions changed thereby altering public health policy impact. Sustainment of behavioral change may be a key factor determining the duration of effectiveness and ultimate impact of pandemic policy recommendations, particularly for interventions that require ongoing compliance at the level of the individual. Practical framework for assessing and evaluating pandemic policy Updating public health policy recommendations as more data and alternative interventions become available is the evidence-based policy approach and grounded in principles of implementation science and dynamic sustainability. Achieving the ideal of real-time policy updates requires improvements in public health data collection and analysis infrastructure and a shift in public health messaging to incorporate uncertainty and the necessity of ongoing changes. In this review, the Dynamic Infectious Diseases Public Health Response Framework is presented as a model with a practical tool for iteratively incorporating implementation outcomes into public health policy design with the aim of sustaining benefits and identifying when policies are no longer functioning as intended and need to be adapted or de-implemented. Conclusions and implications Real-time decision making requires sensitivity to conditions on the ground and adaptation of interventions at all levels. When asking about the public health effectiveness and impact of non-pharmaceutical interventions, the focus should be on when, how, and for how long they can achieve public health impact. In the future, rather than focusing on models of public health intervention effectiveness that assume static impacts, policy impacts should be considered as dynamic with ongoing re-evaluation as conditions change to meet the ongoing needs of the ultimate end-user of the intervention: the public.
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Affiliation(s)
- Westyn Branch-Elliman
- VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, Boston, MA, United States
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - A. Rani Elwy
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - David A. Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
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