Rural Home Care Nursing During COVID-19

BACKGROUND

The SARS-CoV-2 (COVID-19) pandemic continues to be a challenging time for the nursing profession globally. Research indicates that the care of patients with COVID-19 has caused significant psychological stress for nurses. Although much of the world's attention has been on nurses working in emergency departments and intensive care units, the pandemic also posed significant challenges for nurses providing home care services in rural communities.

PURPOSE

The purpose of this work was to describe the experiences of rural Canadian home care nurses during the early stages of the COVID-19 pandemic.

METHODS

The data for this analysis was derived from a study that explored the continuing education needs of rural home care nurses. Since the data collection for the primary objective occurred in the early stages of the COVID-19 pandemic, COVID-19 related themes were created using interpretive description methodology. Snowball and purposive sampling were used to recruit rural home care registered nurses who were employed in the central and southern areas of a western Canadian province.

RESULTS

Six themes were constructed from the data including: Nurses Must Work, Constant State of Flux, Threatened Safety, Loss of Learning Opportunities, Fearing the Unknown, and Hindsight is Easy.

CONCLUSION

The experiences of rural home care nurses during COVID-19 reflects the chaos, uncertainty, and fear that was felt globally. Based on the findings of this study, recommendations for future pandemic planning are suggested.

A systematic review of fear, stigma, and mental health outcomes of pandemics

BACKGROUND

The COVID-19 pandemic has negatively affected the mental health of people globally. Despite substantial research on the short-term psychological impact of COVID-19, its long-term consequences on mental health remain relatively unexplored.

AIMS

We aimed to examine mental health literature on prior outbreaks to provide recommendations for developing effective strategies to mitigate the short- and long-term psychological impact of the current pandemic.

METHODS

We conducted a narrative review of 41 studies to analyze the adverse impact of the following epidemics and pandemics on the mental health of individuals, groups, and communities: Middle East Respiratory Syndrome, Severe Acute Respiratory Syndrome, Influenza A/H1N1, and Ebola Virus Disease.

RESULTS

We noted that these past epidemics and pandemics escalated stress, distress, anxiety, fear, and stigma that persisted in countries and communities. We also identified the role of misinformation in propagating discrimination and prejudice towards certain groups.

CONCLUSIONS

We discuss how the mental health outcomes of previous pandemics differed from the COVID-19 outbreak. We believe that strategies that reduce misinformation, educational initiatives, and mental health programs when introduced at the individual and community level have the potential to effectively diminish the negative psychological impact of COVID-19.

PRISMA

This study followed the PRISMA guidance and was not registered in PROSPERO. This is a narrative review that used qualitative thematic analysis. Publishing a protocol on a protocol repository for such reviews is not the standard of practice.

Palliative Care and Hospice in the Pandemic: A Review of State Planning and Lessons Not Yet Learned

CONTEXT

Written Crisis Standards of Care guidelines have been published federally in the United States for several decades to assisted in planning for a variety of disasters, and planning documents exist in most states. Federal and state crisis planning guidelines, both before and during the early COVID pandemic, focused on saving the most lives. Palliative care (PC) and hospice shortages were exacerbated by the COVID pandemic but recognized late and incompletely.

OBJECTIVES

1) Quantify the number of state crisis standard planning documents that include recognition of potential PC and hospice crisis needs in a pandemic. 2) Assess the range of practical plans in existing state Crisis Standards of Care plans. 3) Outline elements of recommendations from existing guidelines and literature.

METHODS

Internet searches for state-based "crisis standards of care" completed and results categorized regarding PC and hospice planning as: 1) absent, 2) mentioned only in relation to critical care triage, 3) described only in general principles, 4) describing potential concrete plans to address PC and hospice needs.

RESULTS

Of the 50 states and Washington, DC, 45 states have electronically available "crisis standards of care" or emergency preparedness documents; 35 of these were written or updated since 2020. Only 20 states mention any concrete aspects of planning for potential palliative care or hospice service shortages. Guidelines most often involved alternate care sites, protective equipment, and specialist resources. Visitation policy was rarely mentioned.

CONCLUSIONS

Concrete planning for PC and hospice needs in state crisis planning occurs in less than half of state documents, even three years after the start of this pandemic. Failure to address these needs will result in avoidable suffering for patients in a wide range of settings. It is important to identify and address gaps before the next disaster.

Differences in Palliative Care Provision by Primary and Specialist Providers Supporting Patients With COVID-19: A Qualitative Study

Objectives: To describe the delivery of palliative care by primary providers (PP) and specialist providers (SP) to hospitalized patients with COVID-19. Methods: PP and SP completed interviews about their experiences providing palliative care. Results were analyzed using thematic analysis. Results: Twenty-one physicians (11 SP, 10 PP) were interviewed. Six thematic categories emerged. Care provision: PP and SP described their support of care discussions, symptom management, managing end of life, and care withdrawal. Patients provided care: PP described patients at end of life, with comfort-focused goals; SP included patients seeking life-prolonging treatments. Approach to symptom management: SP described comfort, and PP discomfort in providing opioids with survival-focused goals. Goals of care: SP felt these conversations were code status-focused. Supporting family: both groups indicated difficulties engaging families due to visitor restrictions; SP also outlined challenges in managing family grief and need to advocate for family at the bedside. Care coordination: internist PP and SP described difficulties supporting those leaving the hospital. Conclusion: PP and SP may have a different approach to care, which may affect consistency and quality of care.

Mental health outcomes in health care providers during the COVID-19 pandemic: an umbrella review

As we head into the third year of the COVID-19 pandemic, there is an increasing need to consider the long-term mental health outcomes of health care workers (HCWs) who have experienced overwhelming work pressure, economic and social deprivation, burnout, and post-traumatic stress disorder (PTSD). This scoping umbrella review summarizes the mental health outcomes of published evidence syntheses on HCWs worldwide. We analyzed 39 evidence syntheses representing the findings from 1297 primary studies. We found several persistent fears and concerns (job-related fears, fear of stigmatization, worries about the pandemic, and infection-related fears) that shaped HCW experiences in delivering health care. We also describe several risk factors (job-related, social factors, poor physical and mental health, and inadequate coping strategies) and protective factors (individual and external factors). This is the first scoping umbrella review comprehensively documenting the various risk and protective factors that HCWs have faced during the COVID-19 pandemic. HCWs continue to fear the risk that they may infect their family and friends since they regularly interact with COVID-19 patients. This places HCWs in a precarious situation requiring them to balance risk to their family and friends and potential social deprivation from isolation.

Crowdsourcing homemade facemasks: 772 U.S. health facilities' responses to personal protective equipment shortages in the first half of 2020

Purpose

We examined 772 U.S. health facilities' responses to Personal Protective Equipment (PPE) shortages in the first half of 2020, as they crowdsourced face coverings from volunteer makers to be used as respiratory protection during crisis surge capacity. The purpose was to examine facemask specification requests from health facilities and develop a framework for crowdsourcing last resort PPE.

Design/methodology/approach

Homemade facemask donation requests from health facilities in 47 states systematically recorded in a public database maintained by public health graduate students at a major U.S. university were analysed. Open coding was used to content analyse facemask types and specifications, intended uses, delivery logistics and donation management strategies.

Findings

Our analysis revealed information gaps: Science‐based information was scarce in 2020, leading to improvised specifications for facemask materials and designs. It also revealed the emergence of a crowdsourcing structure: Task specifications for volunteer facemasks makers, delivery logistics, and practical management of donations within the pandemic context. In anticipation of future pandemics and localised PPE shortages, we build on this empirical evidence to propose a framework for crowdsourcing science‐informed facemasks from volunteers. Categorised within (a) logistics and workflow management, (b) task specifications and management, and (c) practical management of contributions functional areas, the framework outlines the required tasks and specifications for crowdsourcing.

Originality

A novel empirically derived framework for crowdsourcing homemade facemasks is proposed, based on empirical analysis and crowdsourcing system design strategies. Our findings and the framework may be used for refining crisis capacity guidelines, as part of strategic planning and preparation for future pandemics that disrupt supply chains and cause shortages in protective equipment.

At least 772 health facilities in 47 U.S. states experienced Personal Protective Equipment (PPE) shortages in 2020.

During crisis surge capacity, they crowdsourced homemade masks from volunteers.

The database shows information gaps and an emerging crowdsourcing structure.

A crowdsourcing framework is essential for effective sourcing of homemade face coverings from volunteer makers during pandemics and surge capacity.

The Impact of Public Health Restrictions in Residential Aged Care on Residents, Families, and Staff During COVID-19: Getting the Balance Right

Outbreaks of COVID-19 in a small number of aged care facilities in Australia had devastating mortality ratios. Strict infection control measures were implemented with little time to adapt. This study explored the views and experiences of residents, families, and care providers about the preparation for COVID-19 and identified areas for improvement. Twenty-one individual interviews were conducted. Using interpretative phenomenological analysis, we found rapid changes to visiting and activities, with physical and emotional impact. Some participants coped using personal resources. Family and residents valued the empathy and quality care provided, despite the overburdened workforce. Good leadership supported implementation of public health advice, but the severity of measures should be proportionate to local risk. Better pandemic planning that includes clear responsibilities, training, and evaluation is important. Consultation with residents, family, and health workers throughout a pandemic will help identify those most at risk of social isolation and physical decline and develop strategies to minimize their impact. The rights and welfare of residents must be respected at all times.

Identifying barriers and facilitators to palliative care integration in the management of hospitalized patients with COVID-19: A qualitative study

BACKGROUND

Palliative care is well suited to support patients hospitalized with COVID-19, but integration into care has been variable and generally poor.

AIM

To understand barriers and facilitators of palliative care integration for hospitalized patients with COVID-19.

METHODS

Internists, Intensivists and palliative care physicians completed semi-structured interviews about their experiences providing care to patients with COVID-19. Results were analysed using thematic analysis.

RESULTS

Twenty-three physicians (13 specialist palliative care, five intensivists, five general internists) were interviewed; mean ± SD age was 42 ± 11 years and 61% were female. Six thematic categories were described including: patient and family factors, palliative care knowledge, primary provider factors, COVID-19 specific factors, palliative care service factors, and leadership and culture factors. Patient and family factors included patient prognosis, characteristics that implied prognosis (i.e., age, etc.), and goals of care. Palliative care knowledge included confidence in primary palliative care skills, misperception that COVID-19 is not a 'palliative diagnosis', and the need to choose quantity or quality of life in COVID-19 management. Primary provider factors included available time, attitude, and reimbursement. COVID-19 specific factors were COVID-19 as an impetus to act, uncertain illness trajectory, treatments and outcomes, and infection control measures. Palliative care service factors were accessibility, adaptability, and previous successful relationships. Leadership and culture factors included government-mandated support, presence at COVID planning tables, and institutional and unit culture.

CONCLUSION

The study findings highlight the need for leadership support for formal integrated models of palliative care for patients with COVID-19, a palliative care role in pandemic planning, and educational initiatives with primary palliative care providers.

COVID-19 vaccine hesitancy and acceptance: a comprehensive scoping review of global literature

As countries continue the third year of the pandemic, we believe that there has been unfair attention to COVID-19 vaccine efficacy and safety, while tacitly ignoring serious challenges with vaccine uptake, without which vaccination may not be effective against the spread of COVID-19. While several studies have been published on COVID-19 vaccine hesitancy, there remains a need to conduct a comprehensive global analysis of vaccine hesitancy. We conducted a scoping review of 60 studies published globally on vaccine hesitancy and acceptance. We conducted a qualitative analysis to identify motivators and barriers to vaccination across several cultural and demographic contexts. We found the following factors to be relevant in any discussion about addressing or minimizing vaccine hesitancy: risk perceptions, trust in health care systems, solidarity, previous experiences with vaccines, misinformation, concerns about vaccine side effects and political ideology. We combine our insights from this comprehensive review of global literature to offer an important and practical discussion about two strategies that have been used to improve vaccine uptake: (i) communication and education and (ii) vaccine rollout and logistics.

Human-Infrastructure Interactions during the COVID-19 Pandemic: Understanding Water and Electricity Demand Profiles at the Building Level

When engineers design and manage a building's water and electricity utilities, they must make assumptions about resource use. These assumptions are often challenged when unexpected changes in demand occur, such as the spatial and temporal changes observed during the coronavirus (COVID-19) pandemic. Social distancing policies (SDPs) enacted led many universities to close their campuses and implement remote learning, impacting utility consumption patterns. Yet, little is known about how consumption changed at the building level. Here, we aim to understand how water and electricity consumption changed during the pandemic by identifying characteristic weekly demand profiles and understanding how these changes were related to regulatory and social systems. We performed k-means clustering on utility demand data measured before and as the pandemic evolved from five buildings of different types at the University of Texas at Austin. As expected, after SDPs were enacted both water and electricity use shifted, with most buildings seeing a sharp initial decline that remained low until the university partially reopened. In contrast to electricity use, we found that water use was tightly coupled with SDPs. Our study provides actionable information for managers to mitigate negative impacts (e.g., water stagnation) and capitalize on opportunities to minimize resource use.

A framework to support the integration of priority setting in the preparedness, alert, control and evaluation stages of a disease pandemic

The COVID-19 pandemic, where the need-resource gap has necessitated decision makers in some contexts to ration access to life-saving interventions, has demonstrated the critical need for systematic and fair priority setting and resource allocation mechanisms. Disease outbreaks are becoming increasingly common and priority setting lessons from previous disease outbreaks could be better harnessed to inform decision making and planning for future disease outbreaks. The purpose of this paper is to discuss how priority setting and resource allocation could, ideally, be integrated into the WHO pandemic planning and preparedness framework and used to inform the COVID-19 pandemic recovery plans and plans for future outbreaks. Priority setting and resource allocation during disease outbreaks tend to evoke a process similar to the 'rule of rescue'. This results in inefficient and unfair resource allocation, negative effects on health and non-health programs and increased health inequities. Integrating priority setting and resource allocation activities throughout the four phases of the WHO emergency preparedness framework could ensure that priority setting during health emergencies is systematic, evidence informed and fair.

A Systematic Map of Non-Clinical Evidence Syntheses Published Globally on COVID-19

STUDY OBJECTIVE

Evidence syntheses perform rigorous investigations of the primary literature and they have played a vital role in generating evidence-based recommendations for governments worldwide during the Covid-19 pandemic. However, there has not yet been an attempt to organize them by topic and other characteristics. This study performed a systematic mapping exercise of non-clinical evidence syntheses pertaining to Covid-19.

METHODS

This study conducted a systematic search on December 5, 2020 across 10 databases and servers: CINAHL (EBSCO Information Services, Ipswich, Massachusetts, United States), Embase (Elsevier, Aalborg, Denmark), Global Health (EBSCO Information Services, Ipswich, Massachusetts, United States), Healthstar (NICHSR and AHA, Bethesda, United States), MEDLINE (NLM, Bethesda, United States), PsychINFO (APA, Washington, DC, United States), Web of Science (Clarivate Analytics, London, UK), Research Square (Research Square, Durham, North Carolina), MEDRxiv (Cold Spring Harbor Laboratory, New York, United States), and PROSPERO (NIHR, York, United Kingdom). Only full evidence syntheses published in a peer-reviewed journal or preprint server were included.

RESULTS

This study classified all evidence syntheses in the following topics: health service delivery (n = 280), prevention and behavior (n = 201), mental health (n = 140), social epidemiology (n = 31), economy (n = 22), and environment (n = 19). This study provides a comprehensive resource of all evidence syntheses categorized according to topic.

CONCLUSIONS

This study proposes the following research priorities: governance, the impact of Covid-19 on different populations, the effectiveness of prevention and control methods across contexts, mental health, and vaccine hesitancy.

Colorado Palliative Care and Hospice Crisis Standards: Moving Beyond Critical Care Planning

Palliative care (PC) and hospice services have experienced shortages before 2020, and during the initial phases of the current pandemic, more critical gaps are expected with future surges, much as scarcity in intensive care unit services may recur during the COVID-19 pandemic. Although ethical allocation of ventilators and intensive care unit care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care and ration these essential services to our communities.

Implications of Social Distancing Policies on Drinking Water Infrastructure: An Overview of the Challenges to and Responses of U.S. Utilities during the COVID-19 Pandemic

Social distancing policies (SDPs) implemented throughout the United States in response to COVID-19 have led to spatial and temporal shifts in drinking water demand and, for water utilities, created sociotechnical challenges. During this unique period, many water utilities have been forced to operate outside of design conditions with reduced workforce and financial capacities. Few studies have examined how water utilities respond to a pandemic; such methods are even absent from many emergency response plans. Here, we documented how utilities have been impacted by the COVID-19 pandemic. We conducted a qualitative analysis of 30 interviews with 53 practitioners spanning 28 U.S. water utilities. Our aim was to, first, understand the challenges experienced by utilities and changes to operations (e.g., demand and deficit accounts) and, second, to document utilities' responses. Results showed that to maintain service continuity and implement SDPs, utilities had to overcome various challenges. These include supply chain issues, spatiotemporal changes in demand, and financial losses, and these challenges were largely dependent on the type of customers served (e.g., commercial or residential). Examples of utilities' responses include proactively ordering extra supplies and postponing capital projects. Although utilities' adaptations ensured the immediate provision of water services, their responses might have negative repercussions in the future (e.g., delayed projects contributing to aging infrastructure).

Incorporating Stakeholder Perspectives on Scarce Resource Allocation: Lessons Learned from Policymaking in a Time of Crisis

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work.

Intensive care digital health response to emerging infectious disease outbreaks such as COVID-19

The COVID-19 pandemic has required intensive care units to rapidly adjust and adapt their existing practices. Although there has a focus on expanding critical care infrastructure, equipment and workforce, plans have not emphasised the need to increase digital capabilities. The objective of this report was to recognise key areas of digital health related to the COVID-19 response. We identified and explored six focus areas relevant to intensive care, including using digital solutions to increase critical care capacity, developing surge capacity within an electronic health record, maintenance and downtime planning, training considerations and the role of data analytics. This article forms the basis of a framework for the intensive care digital health response to COVID-19 and other emerging infectious disease outbreaks.

System impacts of the COVID-19 pandemic on New York City's emergency medical services

OBJECTIVES

To describe the impact of the COVID-19 pandemic on New York City's (NYC) 9-1-1 emergency medical services (EMS) system and assess the efficacy of pandemic planning to meet increased demands.

METHODS

Longitudinal analysis of NYC 9-1-1 EMS system call volumes, call-types, and response times during the COVID-19 peak-period (March 16-April 15, 2020) and post-surge period (April 16-May 31, 2020) compared with the same 2019 periods.

RESULTS

EMS system received 30,469 more calls from March 16-April 15, 2020 compared with March 16-April 15, 2019 (161,815 vs 127,962; P < 0.001). On March 30, 2020, call volume increased 60% compared with the same 2019 date. The majority were for respiratory (relative risk [RR] = 2.50; 95% confidence interval [CI] = 2.44-2.56) and cardiovascular (RR = 1.85; 95% CI = 1.82-1.89) call-types. The proportion of high-acuity, life-threatening call-types increased compared with 2019 (42.3% vs 36.4%). Planned interventions to prioritize high-acuity calls resulted in the average response time increasing by 3 minutes compared with an 11-minute increase for low low-acuity calls. Post-surge, EMS system received fewer calls compared with 2019 (154,310 vs 193,786; P < 0.001).

CONCLUSIONS

COVID-19-associated NYC 9-1-1 EMS volume surge was primarily due to respiratory and cardiovascular call-types. As the pandemic stabilized, call volume declined to below pre-pandemic levels. Our results highlight the importance of EMS system-wide pandemic crisis planning.

A real-time policy dashboard can aid global transparency in the response to coronavirus disease 2019

There has been great provision of open data across the coronavirus disease 2019 (COVID-19) pandemic response, with, for example, dashboards presenting real-time descriptions of new daily cases and risk factors. Transparency has been an important discussion point and there have been concerns and criticisms of governments for not publishing the evidence base that is informing their decision-making. A ‘policy dashboard’ could act as a hub to show the localised reasoning behind COVID-19 policy decisions and allow the global health community to provide further support to governments and international stakeholders.

Pandemic planning: plotting a course through the coronawars

The biological motor behind the current coronavirus pandemic has placed microbiology on a global stage, and given its practitioners a role among the architects of recovery. Planning for a return to normality or the new normal is a complex, multi-agency task for which healthcare scientists may not be prepared. This paper introduces a widely used military planning framework known as the Joint Military Appreciation Process, and outlines how it can be applied to deal with the next phase of the COVID-19 pandemic. Recognition of SARS-CoV-2's critical attributes, targetable vulnerabilities, and its most likely and most dangerous effects is a necessary precursor to scoping, framing and mission analysis. From this flows course of action development, analysis, concept of operations development, and an eventual decision to act on the plan. The same planning technique is applicable to the larger scale task of setting a microbiology-centric plan in the broader context of social and economic recovery.

Public health nurses' experiences during the H1N1/09 response

OBJECTIVE

H1N1/09 was the first pandemic flu ever responded to with mass vaccinations. Public health nurses (PHNs) were pivotal in implementing the H1N1/09 vaccination clinics. With the ongoing threat of pandemic influenza and other viral outbreaks, much can be learned from these PHNs' H1N1/09 experiences. This study's purpose was to explore PHNs' experiences in the H1N1/09 mass vaccination clinics.

DESIGN AND SAMPLE

In a qualitative interpretive description, 23 PHNs (16 immunizers, seven supervisors) who worked in a large Canadian municipal public health agency, participated in semistructured interviews.

RESULTS

Three overarching themes were identified. 'Anticipating an Emergency' discusses participants' experiences learning about the pandemic response and their role preparation. 'Surviving the Chaos' reflects the challenges of the clinics, particularly during the first few hectic weeks of the response. 'Persevering Over Time' encompasses participants' experiences as they became familiar with clinics' operations and their own responsibilities.

CONCLUSIONS

Participants' experiences have implications for future public health pandemic planning and research. Key recommendations include to communicate with PHNs in a timely manner about their clinic roles, and to provide PHNs with appropriate training to optimize clinics' operations. This will help support PHNs in their roles to protect the public and provide quality population care.

Whose crisis? Pandemic flu, 'communication disasters' and the struggle for hegemony

Public health authorities in Germany regard communication as a crucial part of infectious disease prevention and control strategies. Communication becomes even more important during public health crises such as pandemics. Drawing on Briggs and Hallin’s concept of biocommunicability, we analysed the German National Pandemic Plan and key informant interviews with public health experts, critical infrastructure providers and ambulance services. We examined the projected expectations towards the behaviour of the audiences and the projected ways of information circulation informing public health communication strategies during a pandemic. Participants shared the expectation that the population would react towards an influenza pandemic with panic and fear due to a lack of information or a sensationalist media coverage. They associated the information uptake of their target audience with trust in their expertise. While our informants from public health conceptualised trust in terms of a face-to-face interaction, they sought to gain trust through transparency in their respective institutional settings. Our analysis suggests that this moved health information into a political register where their medical authority was open to debate. In response to this, they perceived the field of communication as a struggle for hegemony.

Mapping of the US Domestic Influenza Virologic Surveillance Landscape

Influenza virologic surveillance is critical each season for tracking influenza circulation, following trends in antiviral drug resistance, detecting novel influenza infections in humans, and selecting viruses for use in annual seasonal vaccine production. We developed a framework and process map for characterizing the landscape of US influenza virologic surveillance into 5 tiers of influenza testing: outpatient settings (tier 1), inpatient settings and commercial laboratories (tier 2), state public health laboratories (tier 3), National Influenza Reference Center laboratories (tier 4), and Centers for Disease Control and Prevention laboratories (tier 5). During the 2015–16 season, the numbers of influenza tests directly contributing to virologic surveillance were 804,000 in tiers 1 and 2; 78,000 in tier 3; 2,800 in tier 4; and 3,400 in tier 5. With the release of the 2017 US Pandemic Influenza Plan, the proposed framework will support public health officials in modeling, surveillance, and pandemic planning and response.

Evaluation of Unintended Social and Economic Consequences of an Unplanned School Closure in Rural Illinois

BACKGROUND

School closure is one of the primary measures considered during severe influenza pandemics and other emergencies. However, prolonged school closures may cause unintended adverse consequences to schools, students, and their families. A better understanding of these consequences will inform prepandemic planning, and help public health and education authorities in making informed decisions when considering school closures.

METHODS

We conducted a household survey and interviewed school officials following an 8-day long closure of a school district in rural Illinois. We described household responses regarding difficulties of school closure, and summarized main themes from school official interviews.

RESULTS

A total of 208 (27%) household surveys were completed and returned. This school closure caused difficulties to 36 (17%) households; uncertain duration of closure, childcare arrangements, and lost pay were the most often reported difficulties. Having 1 adult in the household losing pay and household income below $25,000 were significantly associated with overall difficulty during this school closure. Concern about student health and safety was the most frequent theme in school administrator interviews.

CONCLUSIONS

Whereas the majority of responding households did not report difficulties during this school closure, households with 1 adult losing pay during the closure reported incurring additional expenses for childcare.

Global Mortality Impact of the 1957-1959 Influenza Pandemic

BACKGROUND

Quantitative estimates of the global burden of the 1957 influenza pandemic are lacking. Here we fill this gap by modeling historical mortality statistics.

METHODS

We used annual rates of age- and cause-specific deaths to estimate pandemic-related mortality in excess of background levels in 39 countries in Europe, the Asia-Pacific region, and the Americas. We modeled the relationship between excess mortality and development indicators to extrapolate the global burden of the pandemic.

RESULTS

The pandemic-associated excess respiratory mortality rate was 1.9/10,000 population (95% confidence interval [CI], 1.2-2.6 cases/10,000 population) on average during 1957-1959. Excess mortality rates varied 70-fold across countries; Europe and Latin America experienced the lowest and highest rates, respectively. Excess mortality was delayed by 1-2 years in 18 countries (46%). Increases in the mortality rate relative to baseline were greatest in school-aged children and young adults, with no evidence that elderly population was spared from excess mortality. Development indicators were moderate predictors of excess mortality, explaining 35%-77% of the variance. Overall, we attribute 1.1 million excess deaths (95% CI, .7 million-1.5 million excess deaths) globally to the 1957-1959 pandemic.

CONCLUSIONS

The global mortality rate of the 1957-1959 influenza pandemic was moderate relative to that of the 1918 pandemic but was approximately 10-fold greater than that of the 2009 pandemic. The impact of the pandemic on mortality was delayed in several countries, pointing to a window of opportunity for vaccination in a future pandemic.

Introducing One Health to the Ethical Debate About Zoonotic Diseases in Southeast Asia

Pandemic plans recommend phases of response to an emergent infectious disease (EID) outbreak, and are primarily aimed at preventing and mitigating human-to-human transmission. These plans carry presumptive weight and are increasingly being operationalized at the national, regional and international level with the support of the World Health Organization (WHO). The conventional focus of pandemic preparedness for EIDs of zoonotic origin has been on public health and human welfare. However, this focus on human populations has resulted in strategically important disciplinary silos. As the risks of zoonotic diseases have implications that reach across many domains outside traditional public health, including anthropological, environmental, and veterinary fora, a more inclusive ecological perspective is paramount for an effective response to future outbreaks.

Pandemic influenza planning, United States, 1978-2008

During the past century, 4 influenza pandemics occurred. After the emergence of a novel influenza virus of swine origin in 1976, national, state, and local US public health authorities began planning efforts to respond to future pandemics. Several events have since stimulated progress in public health emergency planning: the 1997 avian influenza A(H5N1) outbreak in Hong Kong, China; the 2001 anthrax attacks in the United States; the 2003 outbreak of severe acute respiratory syndrome; and the 2003 reemergence of influenza A(H5N1) virus infection in humans. We outline the evolution of US pandemic planning since the late 1970s, summarize planning accomplishments, and explain their ongoing importance. The public health community's response to the 2009 influenza A(H1N1)pdm09 pandemic demonstrated the value of planning and provided insights into improving future plans and response efforts. Preparedness planning will enhance the collective, multilevel response to future public health crises.

WHO knows best? National and international responses to pandemic threats and the "lessons" of 1976

The discovery of a novel influenza strain at Fort Dix, New Jersey, in 1976-dubbed Swine Flu-prompted differing responses from national and international health organizations. The United States crafted a vaccination campaign to inoculate every citizen; conversely, the World Health Organization (WHO) recommended a 'wait and see' policy. An examination of the WHO conference that issued the influenza policy reveals the decision was driven by the limits of its member states' ability to produce inactivated vaccine and concern over the premature use of unstable live-virus vaccines. The WHO recommendation's reliance upon an uneven surveillance system would have replicated the 1957 and 1968 vaccination failures if a pandemic had appeared.

Paediatric pandemic planning: children's perspectives and recommendations

Children, as major stakeholders in paediatric hospitals, have remained absent from discussions on important healthcare issues. One critical area where children's voices have been minimised is in the planning for future pandemics. This paper presents a subset of data from a programme of research which examined various stakeholder experiences of the severe acute respiratory syndrome (SARS) outbreaks of 2003. These data also generated recommendations for future pandemic planning. Specifically, this paper will examine the perspectives and recommendations of children hospitalised during SARS in a large paediatric hospital in Canada. Twenty-one (n = 21) child and adolescent participants were interviewed from a variety of medical areas including cardiac (n = 2), critical care (n = 2), organ transplant (n = 4), respiratory medicine (n = 8) and infectious diseases (patients diagnosed with suspected or probable SARS; n = 5). Data analyses exposed a range of children's experiences associated with the outbreaks as well as recommendations for future pandemic planning. Key recommendations included specific policies and guidelines concerning psychosocial care, infection control, communication strategies and the management of various resources. This paper is guided by a conceptual framework comprised of theories from child development and literature on children's rights. The authors call for greater youth participation in healthcare decision-making and pandemic planning.

Review of aerosol transmission of influenza A virus

In theory, influenza viruses can be transmitted through aerosols, large droplets, or direct contact with secretions (or fomites). These 3 modes are not mutually exclusive. Published findings that support the occurrence of aerosol transmission were reviewed to assess the importance of this mode of transmission. Published evidence indicates that aerosol transmission of influenza can be an important mode of transmission, which has obvious implications for pandemic influenza planning and in particular for recommendations about the use of N95 respirators as part of personal protective equipment.