What is the current state of public health system preparedness for infectious disease emergencies? A scoping review (preprint)

Background: The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies. Methods: Using scoping review methodology, a comprehensive search was conducted for indexed and grey literature with a focus on records published from 2017 and 2020 onward, respectively. Records were included if they: a) described PHEP, b) focused on an infectious emergency, and c) were published in an Organization for Economic Co-operation and Development country. An evidence-based all-hazards Resilience Framework for PHEP consisting of 11 elements was used as a reference point to identify additional areas of preparedness that have emerged in recent publications. The findings were summarized thematically. Results: The included publications largely aligned with the all-hazards Resilience Framework for PHEP. In particular, the elements related to collaborative networks, community engagement, risk analysis and communication were frequently observed across the publications included in this review. Emergent themes were identified that expand on the Resilience Framework for PHEP. These were related to mitigating inequities, public health capacities (vaccination, laboratory system capacity, infection prevention and control capacity, financial investment in infrastructure, public health legislation, phases of preparedness), scientific capacities (research and evidence-informed decision making, climate and environmental health), and considerations for health system capacity. Conclusions: The themes from this review contribute to the evolving understanding of critical public health preparedness actions; however, there was a paucity of recent evidence on PHEP indicators. The themes can expand on the 11 elements outlined in the Resilience Framework for PHEP, specifically relevant to infectious disease emergencies and risks. Further research will be important to validate these findings, and expand understanding of how refinements to PHEP frameworks and indicators can support public health practice.

Rising Through the Pandemic: A scoping review of quality improvement in public health during the COVID-19 pandemic (preprint)

Background: The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) has been identified as a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear. Methods: We conducted a scoping review of literature published January 2020 - February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic. The search was conducted on four bibliographic databases, in addition to a supplementary grey literature search using custom Google search engines and targeted website search methods. Of the 1,878 peer-reviewed articles assessed, 15 records met the inclusion criteria. An additional 11 relevant records were identified during the grey literature search, for a total of 26 records included in the scoping review. Results: Records were organized into five topics: 1) collaborative problem solving and analysis with stakeholders; 2) supporting learning and capacity building in QI; 3) learning from past emergencies; 4) implementing QI methods during COVID-19; and 5) evaluating performance using frameworks/indicators. Conclusions: The literature indicates that QI-oriented activities are occurring at the organizational and program levels to enhance COVID-19 response. To optimize the benefits that QI approaches and methodologies may offer, it is important for public health agencies to focus on both widespread integration of QI as part of an organization's management philosophy and culture, as well as project level activities at all stages of the emergency management cycle.