Syndemic analysis of the pandemic Covid-19 crisis: A multidisciplinary “Understand - Anticipate – Propose” meta-method (preprint)

Background. In order to understand the pandemic COVID-19 crisis in a forward-looking way, the French High Council for public health (HCSP) has designed a conceptual scheme for public health planning based on L. Green's model in order to better understand the issues at stake, by identifying dangers and levers for action. The final aim was to establish priorities and guidelines in order to anticipate the collateral consequences of the management of the crisis and be better prepared for the next one. Method. A public health conceptual framework PROCEED-PRECCED adapted to the Covid-19 health crisis was developed using both a graphic (concept map) and analytic (to make the conceptual scheme functional) approaches. Then, a "meta-method" was applied using three distinct cognitive stages: understanding, anticipation and proposals of action.Results. The conceptual framework was broken down into 10 technical sheets covering essential diagnoses and integrating different public health determinants. Each of these was broken down into three cognitive stages, allowing for a diagnosis of understanding, a scenario of anticipation and a strategic analysis of action according to the chronology: understand-anticipate-propose. From these 10 technical sheets, 32 guidelines have been proposed.Conclusion. This work is intended to allow reflections on public health approaches to strengthen and anticipate health crisis management and health planning by politic managers working at national or sub-national level.

Analysis of national and international guidelines on respiratory protection equipment for COVID-19 in healthcare settings. (preprint)

Introduction Consistent guidelines on respiratory protection for healthcare professionals combined with improved global supply chains are critical to protect staff and patients from COVID-19. We summarized and compared the guidelines published by national and international societies/organizations on facemasks and respirators to prevent COVID-19 in healthcare settings. Methods From the 1st January to the 2nd April 2020, guidelines published in four countries (France, Germany, United States, United Kingdom), and two international organizations (US and European Center for Diseases Control, and World Health Organization) were reviewed to analyze the mask and respirators recommended as PPE for the care of patients during the COVID-19 outbreak. Guidelines were eligible for analysis if they (1) included specific guidelines, (2) were written for HCP protection, (3) targeting healthcare settings. The strategy recommended for optimizing supplies and overcoming shortages was collected. Observations The guidelines publication process on respiratory protections varied greatly across countries. Some referred to a unique guide whereas others saw the issue of multiple recommendations by various societies and organization. In term of chronology, most guidelines were published in March with either downgraded (US and European CDC), relatively stable (WHO, Germany, and UK), or a mixing of high and low level equipment (France). The recommendation of respirators was universally recommended for aerosol generating procedures (AGP) across countries, although the type of respirators and what constituted an AGP was variable. Some guidance maintained the use of N95/99 for all contact with confirmed COVID-19 cases (i.e. Germany) whereas others, recommended a surgical mask (i.e. WHO, UK, France). The strategies to overcome shortage of respiratory protection equipment were based on minimizing the need and rationalizing the use, but also prolonging their use, reusing them after cleaning/sterilization, or using cloth masks. Conclusions Stable and consistent guidelines inside and across countries, clearly detailing the respiratory protection type, and the circumstances in which they need to be used may prevent the confusion among frontline staff, and avoid shortage.