Research on the collaborative evolution process of information in public health emergencies based on complex adaptive system theory and social network analysis: a case study of the COVID-19 pandemic

Introduction

This review aimed to elucidate the significance of information collaboration in the prevention and control of public health emergencies, and its evolutionary pathway guided by the theory of complex adaptive systems.

Methods

The study employed time-slicing techniques and social network analysis to translate the dynamic evolution of information collaboration into a stage-based static representation. Data were collected from January to April 2020, focusing on the COVID-19 pandemic. Python was used to amass data from diverse sources including government portals, public commentary, social organizations, market updates, and healthcare institutions. Post data collection, the structures, collaboration objectives, and participating entities within each time slice were explored using social network analysis.

Results

The findings suggest that the law of evolution for information collaboration in public health emergencies primarily starts with small-scale collaboration, grows to full-scale in the middle phase, and then reverts to small-scale in the final phase. The network's complexity increases initially and then gradually decreases, mirroring changes in collaboration tasks, objectives, and strategies.

Discussion

The dynamic pattern of information collaboration highlighted in this study offers valuable insights for enhancing emergency management capabilities. Recognizing the evolving nature of information collaboration can significantly improve information processing efficiency during public health crises.

Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone

This paper examines health worker experiences in two areas of post-epidemic preparedness in Sierra Leone - vaccine trials and laboratory strengthening - to reflect on the place of people in current models of epidemic response. Drawing on ethnographic research and interviews with health workers in the aftermath of Ebola, it explores the hopes and expectations that interventions foster for frontline workers in under-resourced health systems, and describes the unseen work involved in sustaining robust response infrastructures. Our analysis focuses on what it means for the people who sustain health systems in an emergency to be 'prepared' for an epidemic. Human preparedness entails more than the presence of a labour force; it involves building and maintaining 'relational infrastructures', often fragile social and moral relationships between health workers, publics, governments, and international organisations. The COVID-19 pandemic has underscored the value of rethinking human resources from an anthropological perspective, and investing in the safety and support of people at the forefront of response. In describing the labour, personal losses, and social risks undertaken by frontline workers for protocols and practicality to meet in an emergency context, we describe the social process of preparedness; that is, the contextual engineering and investment that make response systems work.

Field Epidemiology Training Program Response to COVID-19 During a Conflict: Experience From Yemen

COVID-19 pandemic has underscored the need for a well-trained public health workforce to save lives through timely outbreaks detection and response. In Yemen, a country that is entering its seventh year of a protracted war, the ongoing conflict severely limited the country's capacity to implement effective preparedness and response measures to outbreaks including COVID-19. There are growing concerns that the virus may be circulating within communities undetected and unmitigated especially as underreporting continues in some areas of the country due to a lack of testing facilities, delays in seeking treatment, stigma, difficulty accessing treatment centers, the perceived risks of seeking care or for political issues. The Yemen Field Epidemiology Training Program (FETP) was launched in 2011 to address the shortage of a skilled public health workforce, with the objective of strengthening capacity in field epidemiology. Thus, events of public health importance can be detected and investigated in a timely and effective manner. During the COVID-19 pandemic, the Yemen FETP's response has been instrumental through participating in country-level coordination, planning, monitoring, and developing guidelines/standard operating procedures and strengthening surveillance capacities, outbreak investigations, contact tracing, case management, infection prevention, and control, risk communication, and research. As the third wave is circulating with a steeper upward curve than the previous ones with possible new variants, the country will not be able to deal with a surge of cases as secondary care is extremely crippled. Since COVID-19 prevention and control are the only option available to reduce its grave impact on morbidity and mortality, health partners should support the Yemen FETP to strengthen the health system's response to future epidemics. One important lesson learned from the COVID-19 pandemic, especially in the Yemen context and applicable to developing and war-torn countries, is that access to outside experts becomes limited, therefore, it is crucial to invest in building national expertise to provide timely, cost-effective, and sustainable services that are culturally appropriate. It is also essential to build such expertise at the governorate and district levels, as they are normally the first respondents, and to provide them with the necessary tools for immediate response in order to overcome the disastrous delays.

Public Health Crises In Comparison: China's Epidemic Response Policies From SARS To COVID-19

The rate of infectious disease outbreaks has been accelerating over the past two decades, from the SARS epidemic in 2003 to COVID-19 in 2020. Termed by some as the twenty-first century's first pandemic, SARS originated in China and alerted the country to the importance of public health and epidemic response. After SARS, China improved its health infrastructure and reformed its political and legal health governance system. The emergence of COVID-19 from Wuhan in late 2019 put those reforms to the test. This paper analyses China's public health and epidemic response policies from a historical perspective, tracing the evolution of Chinese public health policies after the SARS outbreak in 2003. This paper assesses China's response to COVID-19 and how post-SARS policy reforms, particularly in epidemic response, played out on the ground in Wuhan. What policies worked well? What were the challenges faced? Based on the policy analysis, this paper presents recommendations for how China can improve its epidemic response through strengthened infectious disease surveillance, more transparent political coordination, and expanded public health infrastructure.

Rapid Reorganization of an Academic Infectious Diseases Program During the Coronavirus Disease 2019 Pandemic in Detroit: A Novel Unit-based Group Rounding Model

The surge of coronavirus disease 2019 (COVID-19) hospitalizations at our 877-bed quaternary care hospital in Detroit led to an emergent demand for Infectious Diseases (ID) consultations. The traditional one-on-one consultation model was untenable. Therefore, we rapidly restructured our ID division to provide effective consultative services. We implemented a novel unit-based group rounds model that focused on delivering key updates to teams and providing unit-wide consultations simultaneously to all team members. Effectiveness of the program was studied using Likert-scale survey data. The survey captured data from the first month of the Detroit COVID-19 pandemic. During this period there were approximately 950 patients hospitalized for treatment of COVID-19. The survey of trainees and faculty reported an overall 95% positive response to delivery of information, new knowledge acquisition, and provider confidence in the care of COVID-19 patients. This showed that the unit-based consult model is a sustainable effort to provide care during epidemics.

The Progression of COVID-19 and the Government Response in China

The ongoing pandemic of COVID-19 (Coronavirus Infectious Disease-2019) was first reported at the end of 2019 in Wuhan, China. On 30 January 2020, the WHO declared a Public Health Emergency for the novel coronavirus. On 11 March 2020, the WHO officially declared the COVID-19 outbreak as a pandemic. Due to the differences in population distribution, economic structure, degree of damage and other factors, the affected countries have introduced policies tailored to local conditions as a response to the pandemic, leading to different economic and social impacts. Considering the highly heterogeneous spreading of COVID-19 across regions, this paper takes a specific country (China) as a case study of the spread of the disease and national intervention models for the COVID-19 pandemic. The research period of this article is from 17 December to 26 April 2020, because this time period basically covered the important time nodes of the epidemic in China from animal-to-human transmission, limited human-to-human transmission, epidemic to gradual control. This study is useful for comparing the effectiveness of different interventions at various stages of epidemic development within the same country and can also promote the comparison of the epidemic response interventions of different countries. Based on the conclusions of the model simulation, this article evaluates the dual impact of the epidemic on people's wellbeing and the economy.

Gendered care at the margins: Ebola, gender, and caregiving practices in Uganda's border districts

In July 2019, Ebola in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern and neighbouring countries were put on high alert. This paper examines the intersections of gender, caregiving, and livelihood practices in Uganda's border districts that emerged as key factors to consider in preparedness and response. This paper is based on an anthropological study of the Ebola context among Bantu cultures. We report on data from focus group discussions and key informant interviews with various sectors of the community. The study identified intersecting themes reported here: (1) women as primary caregivers in this context; and (2) women as providers, often in occupations that increase vulnerability to Ebola. Findings demonstrate the role that women play inside and outside the home as caregivers of the sick and during burials, and intersections with livelihood-seeking strategies. Because women's caregiving is largely unpaid, women face a double burden of work as they seek other livelihood strategies that sometimes increase vulnerability to Ebola. Epidemic response should address these intersections and the context-specific vulnerabilities of caregivers; it should also be localised and community-centred and able to attend to the cultural as well as the economic needs of a community.

Comparing the Scope and Efficacy of COVID-19 Response Strategies in 16 Countries: An Overview

This article synthesizes the results of case studies on the development of the coronavirus disease 2019 (COVID-19) pandemic and control measures by governments in 16 countries. When this work was conducted, only 6 months had passed since the pandemic began, and only 4 months since the first events were recognized outside of China. It was too early to draw firm conclusions about the effectiveness of measures in each of the selected countries; however, the authors present some efforts to identify and classify response and containment measures, country-by-country, for future comparison and analysis. There is a significant variety of policy tools and response measures employed in different countries, and while it is still hard to directly compare the different approaches based on their efficacy, it will definitely provide many inputs for the future data analysis efforts.

Coronavirus disease-2019 epidemic response in Uganda: The need to strengthen and engage primary healthcare

In Uganda, the numbers of new coronavirus disease cases have continued to increase slowly since the first case was confirmed. Given that the disease is likely to be holoendemic, the role of primary care (PC) with its features of comprehensiveness, accessibility, coordination and continuity, functioning at the heart of a primary healthcare (PHC) approach, will be important. The elements of PC are applicable in the epidemic preparation, case finding and management, follow-up and post-epidemic phases of responding to this pandemic. This also presents opportunities and lessons for strengthening PHC as well as for reflections on missed opportunities. The effective use of available resources in response to the epidemic should mainly focus on community mobilisation and PHC teams for the prevention, screening, testing and treatment of mild and moderate cases.

Spatiotemporal Analysis of Serogroup C Meningococcal Meningitis Spread in Niger and Nigeria and Implications for Epidemic Response

BACKGROUND

After the re-emergence of serogroup C meningococcal meningitis (MM) in Nigeria and Niger, we aimed to re-evaluate the vaccination policy used to respond to outbreaks of MM in the African meningitis belt by investigating alternative strategies using a lower incidence threshold and information about neighboring districts.

METHODS

We used data on suspected and laboratory-confirmed cases in Niger and Nigeria from 2013 to 2017. We calculated global and local Moran's I-statistics to identify spatial clustering of districts with high MM incidence. We used a Pinner model to estimate the impact of vaccination campaigns occurring between 2015 and 2017 and to evaluate the impact of 3 alternative district-level vaccination strategies, compared with that currently used.

RESULTS

We found significant clustering of high incidence districts in every year, with local clusters around Tambuwal, Nigeria in 2013 and 2014, Niamey, Niger in 2016, and in Sokoto and Zamfara States in Nigeria in 2017.We estimate that the vaccination campaigns implemented in 2015, 2016, and 2017 prevented 6% of MM cases. Using the current strategy but with high coverage (85%) and timely distribution (4 weeks), these campaigns could have prevented 10% of cases. This strategy required the fewest doses of vaccine to prevent a case. None of the alternative strategies we evaluated were more efficient, but they would have prevented the occurrence of more cases overall.

CONCLUSIONS

Although we observed significant spatial clustering in MM in Nigeria and Niger between 2013 and 2017, there is no strong evidence to support a change in methods for epidemic response in terms of lowering the intervention threshold or targeting neighboring districts for reactive vaccination.

Health Services and Infrastructure Recovery of a Major Public Hospital in Liberia During the 2014-2016 Ebola Epidemic

During the 2014-2016 Ebola outbreak, health services in Liberia collapsed. Health care facilities could not support effective infection prevention and control (IPC) practices to prevent Ebola virus disease (EVD) transmission necessitating their closure. This report describes the process by which health services and infrastructure were recovered in the public hospital in Monrovia, Liberia. The authors conducted an assessment of the existing capacity for health care provision, including qualitative interviews with community members, record reviews in Ebola treatment units, and phone calls to health facilities. Assessment information was used to determine necessary actions to re-establish services, including building and environmental renovations, acquiring IPC supplies, changing health care practices, hiring additional staff, developing and using an EVD screening tool, and implementing psychosocial supports. On-site monitoring was continued for 2 years to assess what changes were sustained. Described in the report are 2 cases that highlight the challenge of safely re-establishing services with only a symptom-based screening tool and no laboratory tests available on-site. Despite fears among the public, health workers, and the international community, the actions taken enabled basic health care services to be provided during EVD transmission and led to sustainable improvements. This experience suggests that providing routine medical needs helps limit the morbidity and mortality during times of disease outbreak. (Disaster Med Public Health Preparedness. 2018;13:767-773).

A framework for capturing the interactions between laypersons' understanding of disease, information gathering behaviors, and actions taken during an epidemic

This paper provides a description of a methodological framework designed to capture the inter-relationships between the lay publics' understanding of health-related processes, information gathering behaviors, and actions taken during an outbreak. We developed and refined our methods during a study involving eight participants living in severe acute respiratory syndrome (SARS)-affected areas (Hong Kong, Taiwan, and Toronto). The framework is an adaptation of narrative analysis, a qualitative method that is used to investigate a phenomenon through interpretation of the stories people tell about their experiences. From our work, several hypotheses emerged that will contribute to future research. For example, our findings showed that many decisions in an epidemic are carefully considered and involve use of significant information gathering. Having a good model of lay actions based on information received and beliefs held will contribute to the development of more effective information support systems in the event of a future epidemic.