Strengthening global health security by improving disease surveillance in remote rural areas of low-income and middle-income countries.

The COVID-19 pandemic has underscored the need to strengthen national surveillance systems to protect a globally connected world. In low-income and middle-income countries, zoonotic disease surveillance has advanced considerably in the past two decades. However, surveillance efforts often prioritise urban and adjacent rural communities. Communities in remote rural areas have had far less support despite having routine exposure to zoonotic diseases due to frequent contact with domestic and wild animals, and restricted access to health care. Limited disease surveillance in remote rural areas is a crucial gap in global health security. Although this point has been made in the past, practical solutions on how to implement surveillance efficiently in these resource-limited and logistically challenging settings have yet to be discussed. We highlight why investing in disease surveillance in remote rural areas of low-income and middle-income countries will benefit the global community and review current approaches. Using semi-arid regions in Kenya as a case study, we provide a practical approach by which surveillance in remote rural areas can be strengthened and integrated into existing systems. This Viewpoint represents a transition from simply highlighting the need for a more holistic approach to disease surveillance to a solid plan for how this outcome might be achieved.

COVID-19 Awareness and Preparedness of Minnesota and Wisconsin Dairy Farms.

Dairy farms that had participated in previous and ongoing projects with the National Farm Medicine Center (NFMC), Migrant Clinicians Network (MCN), and Upper Midwest Agricultural Safety and Health Center (UMASH) were asked to participate in a 17-question survey by phone or email to investigate biosecurity principles on Minnesota and Wisconsin dairy farms in response to COVID-19 and the effects of the pandemic on the dairy industry. Three additional farms were recruited via a press release published in agricultural newsletters. Of 76 farms contacted, 37 chose to participate in this study from June to July 2020. In response to the COVID-19 pandemic, dairies have implemented or increased biosecurity measures and COVID-19 precautions. Dairies reported adequate personal protective equipment for their workers, though face masks were not required on most dairies (n = 32, 86%). Producers were concerned about the safety of their families, maintaining a healthy workforce, and keeping their farms profitable. Access to healthcare was not perceived to be an issue for their workers. One-quarter of dairies reported COVID-19 infections on their farms. Even though the majority had an isolation protocol in place if someone on the farm were to become ill, less than half of respondents felt their farm was protected against COVID-19. Two-thirds of producers have not had to decrease production, and a majority of operations have not furloughed or terminated employees due to COVID-19. Our data suggest that dairy farms in Minnesota and Wisconsin have implemented biosecurity and safety measures in response to COVID-19. These measures can be improved. Farms would benefit from additional guidance and education on implementation of personal protective measures and disease prevention strategies to keep workers employed and safe.