Interventions to Reduce Risk for Pathogen Spillover and Early Disease Spread to Prevent Outbreaks, Epidemics, and Pandemics.

The pathogens that cause most emerging infectious diseases in humans originate in animals, particularly wildlife, and then spill over into humans. The accelerating frequency with which humans and domestic animals encounter wildlife because of activities such as land-use change, animal husbandry, and markets and trade in live wildlife has created growing opportunities for pathogen spillover. The risk of pathogen spillover and early disease spread among domestic animals and humans, however, can be reduced by stopping the clearing and degradation of tropical and subtropical forests, improving health and economic security of communities living in emerging infectious disease hotspots, enhancing biosecurity in animal husbandry, shutting down or strictly regulating wildlife markets and trade, and expanding pathogen surveillance. We summarize expert opinions on how to implement these goals to prevent outbreaks, epidemics, and pandemics.

The changing face of training in light of the COVID-19 pandemic

BackgroundThe Covid-19 pandemic brought many changes to palliative care. Services had to rapidly adapt to provide the structures needed in challenging and evolving conditions. Service workforces contained palliative medicine trainees who, alongside providing clinical care, were also required to fulfil training competencies. This study explored the impact of the pandemic on training (both positive and negative) including the adaptations made and the ongoing legacies.MethodA UK-wide survey was distributed to all palliative medicine trainees through Association of Palliative Medicine regional trainee representatives. Responses were received from over 70% of deaneries. The survey collected qualitative and quantitative data and considered changes to the workplace and training.ResultsAll trainees recognised changes to consultations across all care settings with a particular increase in telephone and video interactions. There were numerous positive work opportunities. Trainees were involved in policy, guideline and educational resource development and complex clinical situations such as the withdrawal of non-invasive ventilation. Education changed. Initially formal education provision was suspended. Subsequently, the shift to virtual platforms had the benefit of reducing travel and increasing flexibility allowing easier access to national speakers and shared resources. Consequently, for many regions it has remained in place. The survey respondents highlighted challenges in assessments particularly Direct Observation of Procedural Skills (DOPS) and Mini-Clinical Examinations (mini-CEX) due to a combination of increased workload, reduced joint reviews and limitations on movement between different clinical areas.ConclusionThe survey showed that there were definite challenges for trainees that arose from the Covid-19 pandemic however there were also positive changes particularly around education. Further work should explore whether there needs to be a greater emphasis on virtual consultation skills in training.