Central and Eastern European migrant worker status, co-living situation and SARS-CoV-2 exposure and transmission risk.

BACKGROUND: Central and Eastern European (CEE) migrant workers in essential industries are at higher risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and transmission. We investigated the relationship of CEE migrant status and co-living situation with indicators of SARS-CoV-2 exposure and transmission risk (ETR), aiming to find entry points for policies to reduce health inequalities for migrant workers. METHODS: We included 563 SARS-CoV-2-positive workers between October 2020 and July 2021. Data on ETR indicators were obtained from source- and contact-tracing interviews via retrospective analysis of medical records. Associations of CEE migrant status and co-living situation with ETR indicators were analyzed using chi-square tests and multivariate logistic regression analyses. RESULTS: CEE migrant status was not associated with occupational ETR but was with higher occupational-domestic exposure [odds ratio (OR) 2.92; P = 0.004], lower domestic exposure (OR 0.25, P < 0.001), lower community exposure (OR 0.41, P = 0.050) and transmission (OR 0.40, P = 0.032) and higher general transmission (OR 1.76, P = 0.004) risk. Co-living was not associated with occupational and community ETR but was with higher occupational-domestic exposure (OR 2.63, P = 0.032), higher domestic transmission (OR 17.12, P < 0.001) and lower general exposure (OR 0.34, P = 0.007) risk. CONCLUSIONS: The workfloor poses an equal SARS-CoV-2 ETR for all workers. CEE migrants encounter less ETR in their community but pose a general risk by delaying testing. When co-living, CEE migrants encounter more domestic ETR. Coronavirus disease preventive policies should aim at occupational safety for essential industry workers, reduction of test delay for CEE migrants and improvement of distancing options when co-living.

Identifying the sectors involved in the European public health emergency preparedness and response: a systematic review.

OBJECTIVES: A systematic review was conducted with the aims of identifying sectors mentioned in the public health emergency preparedness and response (PHEPR) literature and mapping the involvement of those sectors in the seven PHEPR cycle domains. SETTING: A detailed search strategy was conducted in Embase and Scopus, covering the period between 1 January 2005 and 1 January 2020. METHODS: Published articles focusing on preparedness for and/or response to public health emergencies of multiple origins on the European continent were included. The frequency with which predetermined sectors were mentioned when describing collaboration during the preparedness and response cycle was determined. RESULTS: The results show that description of the involvement of sectors in PHEPR in general and collaboration during PHEPR is predominantly confined to a limited number of sectors, namely 'Governmental institutions', 'Human health industry', 'Experts' and 'Civil Society'. Description is also limited to only three domains of the PHEPR cycle, namely 'Risk and crisis management', 'Pre-event preparations and governance' and 'Surveillance'. CONCLUSIONS: Optimal preparedness and response require predefined collaboration with a broader scope of partners than currently seems to be the case based on this literature review. We recommend considering these outcomes when planning multisectoral collaboration during preparedness and response, as well as the need to further operationalise the term 'multisectoral collaboration' during PHEPRs. PROSPERO REGISTRATION NUMBER: PROSPERO with registration number 176 331.

Dutch public health professionals' perspectives and needs regarding citizen involvement in COVID-19 contact tracing through digital support tools: an exploratory qualitative study.

BACKGROUND: Contact tracing (CT) is an important, but resource-intensive tool to control outbreaks of communicable diseases. Under pandemic circumstances, public health services may not have sufficient resources at their disposal to effectively facilitate CT. This may be addressed by giving cases and their contact persons more autonomy and responsibility in the execution of CT by public health professionals, through digital contact tracing support tools (DCTS-tools). However, the application of this approach has not yet been systematically investigated from the perspective of public health practice. Therefore, we investigated public health professionals' perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools. METHODS: Between October 2020 and February 2021, we conducted online semi-structured interviews (N = 17) with Dutch public health professionals to explore their perspectives and needs regarding the involvement of cases and contact persons in CT for COVID-19 through DCTS-tools, in the contact identification, notification, and monitoring stages of the CT-process. Interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. RESULTS: Four main themes related to Dutch public health professionals' perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools emerged from the data: 'Distinct characteristics of CT with DCTS-tools'; 'Anticipated benefits and challenges of CT for COVID-19 with DCTS- tools'; 'Circumstances in CT for COVID-19 that permit or constrain the application of DCTS-tools'; and 'Public health professionals' needs regarding the development and application of DCTS-tools for CT'. Public health professionals seem to have a positive attitude towards involving cases and contact persons through DCTS-tools. Public health professionals' (positive) attitudes seem conditional on the circumstances under which CT is performed, and the fulfilment of their needs in the development and application of DCTS-tools. CONCLUSIONS: Dutch public health professionals seem positive towards involving cases and contact persons in CT for COVID-19 through DCTS-tools. Through adequate implementation of DCTS-tools in the CT-process, anticipated challenges can be overcome. Future research should investigate the perspectives and needs of cases and contact persons regarding DCTS-tools, and the application of DCTS-tools in practice.

Vaccines for older adults' the low-hanging fruit of disease prevention : Manuela Wennekes

Background The COVID-19 pandemic highlighted the significance of vaccination for older adults (OA), however, more health benefits could be gained with vaccination against influenza, pneumococcal disease, herpes zoster and tetanus as their uptake remains rather low. As healthcare professionals (HCP) play an important role in the vaccination decision making of OA, this study identifies obstacles in vaccination communication between HCP and OA. Methods 80 in-depth structured interviews have been conducted with HCPs in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR). Participants were general practitioners, medical specialists, public health physicians, occupational physicians, pharmacists, geriatricians, specialists elderly care and nurses. The interview included questions on HCPs’ perceptions regarding information provision to OA on vaccines. Data were analyzed cross-country, using thematic analysis. Results Preliminary results reveal that a factor hindering HCPs to initiate conversations with OA on vaccines was lack of time (FR, IT, HU, NL). In hospitals this was often due to (acute) clinical problems taking precedence over discussing vaccines (IT, NL). In ambulatory settings the high number of patients waiting to be seen prevented discussing vaccines with OA (HU). Moreover, HCPs sometimes forgot to discuss vaccines with OA (NL, HU, IT). Patient factors hindering the conversation of HCPs on OA vaccines were a negative attitude (IT, HU) and lack of understanding the information provided (IT, HU). Also, misinformation on vaccines (FR, HU), as well as anti-vax beliefs from patients (NL) or their relatives (FR, IT) hampered the conversation on vaccines. HCPs mentioned their need to learn communication skills to convince OA on vaccines (FR, IT, HU). Conclusions HCPs encounter various obstacles in communicating with OA about vaccines. Lack of time and not recognizing the opportunity to discuss vaccines are important barriers for initiating vaccine conversations. Key messages • Providing HCPs with communication strategies is important to support HCPs in discussing vaccines with OA. • Reminder systems are important to help HCPs remember address vaccination.

Public perceptions uncovered: engaging in decision-making regarding non-pharmaceutical interventions : Sophie Kemper

Background To control the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, that heavily impacted the daily lives of citizens. Occasionally, the public expressed discontent about NPIs, as NPIs did not always corresponded with their preferences. The question is if and how public engagement (PE) could aid in development and implementation of NPIs, in order to improve legitimacy, quality and compliance. Methods An online survey was conducted from 27 October to 9 November 2021, with a representative sample of the public in the Netherlands on gender, age, education, place of residency and migration background. In total 4981 respondents participated. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 was collected. Four NPIs were used: Nightly curfew (NC);Digital Covid Certificate (DCC);Closure of schools and daycares (CSD);and 1.5meter social distance. Results Around 25% of respondents expressed a desire to engage in decision-making, as it would increase understanding and quality of NPIs, and their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage, by providing their perspective on certain trade-offs in values in decision-making (e.g. opening up society vs division in society by vaccination status). The public could play a role by giving feedback on bottlenecks during decision-making, however overall responsibility should stay with experts and policy-makers. Desire for engagement was lowest for CSD. Around 50% of the respondents did not want to engage, as they felt they were not knowledgeable enough to do so and did not perceive a need to engage. The other 25% had a neutral disposition. Conclusions Engagement was not self-evident for most respondents, yet the ones willing to engage revealed important possibilities for future outbreaks. Next, a deliberative process for PE in decision-making could be executed, in order to implement our findings in practice. Key messages Although engagement was not self-evident, respondents who were willing to engage revealed important possibilities to shape future public engagement practices in decision-making in COVID-19 control. Respondents were mostly willing to engage in NPIs with no consensus in the trade-offs of relevant values in decision-making, such as the Nightly Curfew and the Digital Covid Certificate.

The impact of the AstraZeneca suspensions on the public’s vaccination intentions and trust : Marion de Vries

Background In spring 2021, several countries, among which the Netherlands, suspended vaccinations against COVID-19 with the Vaxzevria vaccine from AstraZeneca (AZ) after reports of rare but severe adverse events (SAE). We investigated the impact of this news and the suspension on the Dutch public’s COVID-19 vaccination intentions, COVID-19 vaccination perceptions (attitudes and feelings) and their trust in the government’s COVID-19 vaccination campaign. Methods We conducted two surveys (N = 2628), one shortly before the AZ suspension in the Netherlands and one shortly thereafter when all vaccinations were resumed. Chi2 tests were conducted to study changes in COVID-19 vaccination perceptions, intentions and trust before and after the suspension, and differences between perceptions and intentions regarding AZ vaccines compared to COVID-19 vaccines in general. All variables were measured on a 5-point Likert scale. Results No significant changes were observed in COVID-19 vaccination perceptions and intentions, but trust in the campaign declined slightly (mean diff.(ΔM)=-0.2, 95% CI=-0.3/-0.2). In addition, compared to COVID-19 vaccinations in general, respondents were less likely to vaccinate with AZ (ΔM=-0.7, 95% CI=-0.7/-0.7), reported less positive vaccine attitudes (ΔM=-0.7, 95% CI=-0.7/-0.7), and more negative feelings (ΔM=0.5, 95% CI = 0.4/0.5). Conclusions The news on SAE and the AZ suspension might have caused a decline in trust in the government’s COVID-19 vaccination campaign, as well as negatively impacted AZ vaccination perceptions and intentions. These results stress the need to adapt vaccination policies to anticipated public perceptions and responses following a vaccine safety scare, as well as the importance of informing citizens about the possibility of very rare SAE prior to the introduction of novel vaccines. Key messages • Trust in the COVID-19 vaccination campaign declined following the news on rare but severe adverse events (SAE) and the suspension of AstraZeneca vaccines. • While the news on SAE and the vaccination suspension did not seem to impact COVID-19 vaccination intentions in general, intentions to vaccinate with AstraZeneca were considerably lower.

Patient and public engagement in decision-making regarding infectious disease outbreak management: an integrative review.

INTRODUCTION: Worldwide, people experience the effects of infectious disease outbreaks on a regular basis. These effects vary from direct impact of the virus on health, to indirect impact of control measures on day-to-day life. Yet, incorporating the experiences, views and ideas of patients and the public in decision-making in managing outbreaks does not take place on a structural basis. However, this might be beneficial. We examined the current incorporation of patient and public engagement (PPE) in decision-making regarding outbreak management (OM). METHODS: A systematic search was executed in PubMed, Embase, APA PsycInfo, Web of Science, Scopus and other literature sources. Papers describing PPE in decision-making regarding OM on a collective level (group-level) were included. Relevant information about study characteristics, methods, impact and embedment of PPE in decision-making in OM was collected. RESULTS: The search yielded 4186 papers of which 13 were included. The papers varied in study context and design. Remarkably, no substantial patient engagement was identified. Overall, public engagement (PE) in decision-making regarding OM was mostly executed by a mix of methods, for example, workshops, interviews and surveys. Knowledge and idea sharing between the public and experts was deemed beneficial for establishing well-informed discussions. The efforts resulted in either direct implications for practice or recommendations in policy papers. Most papers described their efforts as a first step. No structural embedment of collective PE in decision-making regarding OM was identified. Furthermore, the quality of most papers was low to moderate due to insufficient description. CONCLUSION: Overall, various practices for PE can be potentially valuable, but structural embedment in OM decision-making on a collective level was low. Before PPE can be permanently embedded in OM, more evidence on its impact needs to be collected. Furthermore, reporting on the engagement process and used terminology needs to be harmonised to ensure reproducibility and transparency.

Closing the preparedness-response gap in time: Operational readiness at points of entry in Europe

Background As points of entry (POE) - ports, airports and ground-crossings - are important structures for international travel and trade, their timely activated capacity to respond to infectious disease threats is of utmost importance. How can POE timely adjust their capacity from generic preparedness to specific response? Methods We developed a conceptual framework for public health response at POE, based on a military used model, leading to a step-wise approach from preparedness to response. Subsequently, our framework has been used to analyze interview data of professionals working at European ports (n = 12), airports (n = 15) and ground-crossings (n = 4) in 11 European countries in June - August 2020 covering the activation of the response to COVID-19. Results By integrating the military model, we learned that in preparedness frameworks the pre-defined time expected to activate required capacity is missing. While combining time with capacity creates the possibility of defining a readiness range for different capacity requirements. E.g. information provision to passengers is arranged within hours, while entry-screening may take up to days to be operational. We hypothesized that this readiness range provides the opportunity to split strategic thinking from operational readiness, and may support proactive thinking. The interviews confirmed a very implicit and non-formalized reference to the time needed to activate the response. POE differed highly as regards proactive or reactive response strategies. A much stated problem was fast and often changing strategies on measures, leading to extreme required flexibility and workload in operations. Conclusions Explicitly acknowledging the time needed to activate appropriate capacity during the transition from preparedness to response can contribute to a better definition of the operational consequences of readiness. These findings may also be of added value in other public health area than POE.

A systematic literature review on the use of health care resources during pandemic response

Background The COVID-19 pandemic demonstrated the need for better pandemic preparedness and response, and more international collaboration. The H2020 EU-funded PANDEM-2 project aims to prepare Europe for future pandemics. As part of the project, an European dashboard consisting of epidemiological data and insights on available pandemic health care capacity is developed. To model and map the availability of pandemic resources, data on the use of these resources and interdependencies between resources are needed to parametrize the resource model of the PANDEM-2 dashboard. Methods We conduct a systematic literature review. The database Embase.com was searched on articles that include a model, scenario, or simulation of pandemic resources and/or describe resource parameters, for example PPE usage, length of stay on the ICU, or vaccine efficacy. Our search included data from all continents and focuses on infectious diseases that have been declared a pandemic by the WHO in the last twenty years, which are the H1N1 influenza (2009-2010) and COVID-19 (ongoing). Preliminary results The search query and additional sources resulted in 1215 articles, of which 187 are included for the full text eligibility assessment. We identified several pandemic resources in the field of vaccination (vaccine efficacy), contact tracing (apps), general practitioners, the hospital (staff, PPE, ventilators), and national and regional public health institutes. Furthermore, interdependencies between resources and possible resource gaps were found, for example in hospital staff and PPE. Conclusions To be better prepared and to be able to respond fast to a pandemic outbreak, it is important to have insight in the availability of pandemic resources on a national and regional level, their use and mutual dependencies. This makes it possible to anticipate on fast changes and possible shortages by reallocating resources within and between regions.

The isolation room of the future: changing the perspective on isolated care

Antibiotic resistance is a growing problem worldwide. Several measures are taken when identified carriers of antibiotic resistant bacteria (such as MRSA) are admitted to a hospital: patients stay in an isolation room and healthcare workers have to put on personal protective equipment (PPE) before entering the isolation room. Previous research on experiences of isolated care shows that patients felt lonely, forgotten and stigmatized while healthcare personnel felt guilty for bundling their contact moments. Therefore, an innovation project has been set up to re-design the concept of an isolation room: the isolation room of the future. The isolation room of the future concentrates around providing enhancements for communication and interaction, comfort and accessibility and architecture and interior design, while taking into account the infection prevention regulations for isolation rooms in hospitals. The interior of the isolation room of the future consists of biophilic elements, including photo wallpaper, transparent walls, surfaces that mimic natural materials, and natural and dynamic light;creating a positive healing and working environment for patients, staff and visitors. Transparent walls also allow easy communication between patients and healthcare workers without the need for the PPE. Furthermore, a transfer hatch is installed to easily serve meals and drinks to the patient. A modular furniture set-up will ensure the most optimum use of space in the room. The isolation room of the future does not necessarily need to be built as a whole;specific elements can implemented depending on needs, finances and possibilities. We hope that these practical solutions might inspire healthcare facilities worldwide to re-think the concept of an isolation room to improve the experiences of people involved in isolated care. This approach is useful for a broader range of infections with pathogens that require isolation precautions, among which SARS-CoV-2. Key messages A change on perspective of isolated care is needed. Although based on experiences with resistant bacteria, the isolation room of the future useful for a broader range of infections with pathogens that require isolation precautions.

What is next? Vision statement and reflections for sustaining project outcomes in a possibly post-pandemic era

Introduction The ongoing COVID-19 pandemic has demonstrated the importance in strengthening cooperation and coordinated action of Member States (MS) to improve preparedness and response capacities at points of entry (PoE). This emphasizes the need for perpetuating the work of EU HEALTHY GATEWAYS (EU HG) and the availability of this cross-European network to transfer lessons learned for future public health threats. Methods An interdisciplinary sustainability working group identified options for continuity of activities at EU level and provided a template national sustainability plan to be adapted by MS based on national needs and priorities. Results Since the beginning of the pandemic EU HG provided 37 consultations to MS, developed 15 advice documents, delivered training courses, produced a study on preparedness and response at PoE and developed the EU digital Passenger Locator Form (EUdPLF) system. A European web-based network for PoE was developed including discussion forums, e-learning platform, searchable network of professionals' at PoE registry, bibliographies, web-based training resources and best practice catalogues. Overall, the 533 inspectors in the EU SHIPSAN INFORMATION SYSTEM (EU SIS) recorded 29268 IHR (International Health Regulations) certificates, followed up 69 public health events via the communication network for EU ports, and recorded >4600 hygienic deficiencies. Conclusions EU HG has a holistic approach, supporting operations on local, regional, national and European level and by taking into account all transport sectors. The web-based systems and capacity building activities support EU Decision 1082/2013/EU for serious cross-border health threats and the EUdPLF supports implementing Decision (EU) 2017/253 for the contact tracing of passengers identified through PLFs. Adoption of components of EU SIS will support implementation of Regulation (EU) 2019/1239 which includes the provision of a common ship sanitation database.

Experience with in-action reviewing at points of entry

Background Lessons learned and experiences gained ask for enhancing the response even during a crisis. We present the application of the in-action review (IAR) of Dutch ports and airports, based on methods developed by the World Health Organization (WHO) and the European Centre for Disease Control (ECDC). Methods We performed two separate IARs among Dutch airports (5/5) and ports (15/16) respectively. 1) A questionnaire among participants was used to decide upon most urgent matters to discuss during a 4-hour online meeting. 2) a 4-hour, interactive, online meeting was held among local representatives of points of entry, regional public health professionals, safety professionals, the national institute of public health and the ministry of health. Best practices, lessons, barriers and actions on different topics were first prepared in small groups, and discussed and finalized in plenary sessions. Follow-up of actions was performed during the consecutive 6 weeks at the moment of writing. A questionnaire among participants evaluated satisfaction and impact of the IAR among participants. Results Main items for the online meetings were the implementation of measures, and regional and supra-regional collaboration. Most urgent actions formulated were a better integration of local needs into national policy making, and enhancing contacts among different points of entry. Implemented actions include the integration of local public health authorities involved at airports into an existing meeting structure at the national level;and an inter-port meeting structure that was developed leading to 3-weekly meetings to discuss upcoming challenges and exchange practices and advice. Conclusions This is to our best knowledge the first time that an in-action review has been performed specifically for the point of entry setting. Performing IARs, online with operational partners led to quick wins and a better network during the COVID-19 pandemic.

Public engagement in the management of the COVID-19 pandemic: Views & expectations of the publics

Introduction During an epidemic, like COVID-19, trade-offs have to be made between measures to reduce mortality and morbidity and associated social, economic and political consequences. Traditionally, epidemic management (EM) has been guided by experts and policymakers, and is executed most attentively. It can however still be controversial in the public sphere. The question arises if public engagement (PE) could be a means to improve the quality and effectiveness of EM, as it has proven to be for other domains of healthcare policy. Methods From June to October 2020, seven Deliberative Discussion Focus Groups were executed with 35 Dutch citizens between 19 and 84 years old, to discuss their views on PE in COVID-19 management. Timeline Interviews were conducted to elucidate meaningful experiences during the epidemic. Next, benefits, barriers, timing and possible forms of PE in EM were discussed. Results Almost all participants supported PE in EM, as the integration of experiences and ideas of the public would benefit the quality of EM, and PE would increase awareness and acceptance of measures. Also, participants emphasized the importance of receiving information on the process of EM, to overcome the perceived lack of transparency herein. Consultation was seen as a fitting form for PE since the public could share ideas and feedback on EM, particularly on communication campaigns and control measures, however final authority stayed with experts. PE could be executed after the first acute phase of the epidemic, but also during evaluations. Moreover, barriers for PE were identified such as time constraints and the lack of knowledge of the public. Conclusions A foundation of values and conditions for PE in EM from the perspective of the public was laid. Support for PE was identified and considered valuable for quality and effectiveness of EM. Next, the results should be confirmed within a broader audience and the views of experts and policymakers on PE in EM should be elucidated. Key messages According to participants, public engagement can increase quality and effectiveness of outbreak management, by sharing knowledge, experiences and ideas between the public, experts and policymakers. The focus groups in this study were executed whilst the COVID-19 pandemic unfolded, which yielded very relevant outcomes of current interest.

New from the market? Coronavirus outbreak in Wuhan

China is struggling with the outbreak of a new coronavirus that is not yet under control. What exactly is going on, what do we know and what not, and how should we proceed? This article lists the current state of affairs and discuss the international approach, as well as discussing past outbreaks, what they currently know about COVID-19, and public health preparation to control and prevent transmission of the virus in Netherlands.

Coronavirus disease (COVID-19) outbreak: can HTA improve preparedness and response in emergencies with a high degree of uncertainty?

Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and irrefutable evidence may be lacking. The Coronavirus disease (COVID-19) outbreak is determining a scenario of uncertainty for public health decision-making with fragmented and different responses also within countries (i.e. regional level), which are implemented quickly, sometimes not fully supported by the necessary body of scientific evidence. In such a situation, following a common line and having a shared tool that would allow to include evidence in public health decision-making, would be strategic to strengthen the impact of interventions, enabling stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent. The objective of this presentation is to use the example of the COVID-19 outbreak, in order to explore how HTA can improve preparedness and response in emergencies with a high degree of uncertainty, representing the mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies, addressing the link between scientific evidence and decision-making in public health emergencies, overcoming the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines.