The "epidemic within the pandemic”: meeting the needs of racially minoritised women experiencing domestic abuse during the Covid-19 pandemic

PurposeIn March 2020, the UK entered its first lockdown responding to the Covid-19 pandemic. In the same month, the Domestic Abuse Bill had its first reading in Parliament. Charities and non-governmental organisations critiqued the Bill for failing to protect migrants from domestic abuse, and not complying with the Istanbul Convention. Drawing on interviews with staff from Southall Black Sisters, this paper aims to foreground the experiences of practitioners within the women's sector to explore the unique experiences and challenges migrant and racially minoritised women encountered when seeking support from domestic abuse during the Covid-19 pandemic. It highlights how the pandemic-related lockdowns created barriers to accessing support services and housing, creating an epidemic within the pandemic, and how minoritised women and the organisations that supported them had to overcome structural barriers and racism.Design/methodology/approachIn-depth semi-structured interviews were conducted with staff from a leading women's organisation that supports migrant and racially minoritised women. Four participants were asked questions within four themes: domestic abuse before and during the pandemic;accessing support from and reporting domestic abuse;accessibility of resources;and post-pandemic challenges. A phenomenological approach was used to analyse the transcribed interviews.FindingsParticipants consistently highlighted the unique threats and barriers migrant and racially minoritised women faced when seeking support. Barriers included racism, language barriers, cultural constraints, the triple threat of destitution, detention, deportation, and political resistance to protect migrant women from destitution/homelessness.Originality/valueThis paper provides a unique insight into the experiences of staff members within a specialist by and for women's support organisation in England and their perspectives on the barriers racially minoritised and migrant women experienced during the Covid-19 pandemic. It offers rare insights into how service users' needs changed during the lockdowns and how the pandemic affected their ability to operate.

Patrolling portals: the regulation of online genetic data sharing

Background/Objectives: Online portals are being increasingly used to disseminate genetics data. While portal-facilitated sharing might have significant scientific value, it is also likely to raise difficult legal and ethical questions. Many of these questions were highlighted during the Covid-19 pandemic, as the urgency of efficient data sharing became apparent. Responding to these emerging concerns, regulators around the world have implemented regimes for 'software used as a medical device.' It is unclear how these regimes affect online portals for genetic data sharing. This study addresses how online data sharing may be shaped by new forms of regulatory oversight. Method(s): We performed an international comparative analysis of advisory documents applicable to software as medical devices prepared by medical regulators in Canada, the United States, France, and the United Kingdom. We selected 20 documents for review. Result(s): We found that regulatory agencies are likely to regulate online tools as medical devices only when they are intended to perform a medical purpose. Online portals for genetic data sharing will not usually meet this threshold. Nevertheless, regulatory guidance provides significant insight into the kinds of issues to which regulators are likely to be attentive in addressing online data sharing. We identify eight normative and logistical issues: efficiency, equity, transparency, confidentiality, communication, empowerment, training, and safety. Conclusion(s): This review clarifies how the regulation of medical software might apply to portals for genetic data sharing. We offer recommendations to portal developers and researchers.

Mental health parameters of adolescents during COVID-19 Pandemic, an era of compulsory online education in India

Background: COVID-19-Pandemic Lockdowns initiated online teaching-learning in India. We aimed to assess mental health (MH) of adolescents studying online for academic milestone of matriculation during these circumstances. Material(s) and Method(s): It was a cross sectional study carried out in Western Maharashtra, during 2021. MH of study subjects was assessed by presence and severity of symptoms of depression, anxiety, stress (DAS) and emotional intelligence (EI). They were measured by DAS Scale-42 (DASS-42) and Schutte's self-report EI test (SET) respectively with collection of socio-demographic information maintaining confidentiality. Data were analysed by SPSS-20 software. MH parameters were compared with pre-pandemic pilot and other studies to study effect of online education and overall COVID-19 Pandemic scenario on MH of study subjects. Result(s): Total 1162 adolescents participated, out of which 59 were omitted from the analysis due to incomplete data. Out of remaining 1103 participants, 43% boys & 57 % girls with the mean age of 14.69 (+0.78) years. Majority of them belonged to middle socio-economic-status. Mean DAS and EI scores denoted mild anxiety with no evidence of depression and stress. Mean EI score was in normal range. Mean DAS scores were significantly lower and mean EI score was significantly higher than reported in -pandemic pilot and other studies. Conclusion(s): MH derangement of matriculating adolescents during COVID-19- Pandemic with online education seemed to be less severe than that was in pre-pandemic times with in-class education. Recommendations: MH support at schools needs to be strengthened. During the post-COVID-19 period, online school education may be continued in LMIC like India on the basis of willingness of students and parents but with caution and understanding of socio-cultural background and support.Copyright © 2022 Pravara Institute of Medical Sciences. All rights reserved.

Fragmented Transparency: The Visibility of Agency Science in European Union Risk Regulation

Responding to mistrust in the European agencies' risk assessments in politically salient cases, the European Union (EU) legislator, the European Food Safety Authority and the European Medicines Agency alike have accelerated their efforts to foster EU regulatory science transparency. These simultaneous endeavours have, however, taken place in a fragmented legislative and administrative context, with each agency operating under a different legal framework. By focusing on authorisation procedures, from registration of studies to authorisation of novel foods, pesticides and human medicines, this article examines the resulting regimes governing the disclosure of scientific data by EU agencies to identify common trends and sectoral specificities. Against the background of an overall shift towards enhanced transparency, we shed light on, first, the circulation of institutional arrangements and practices among agencies and, second, the new dimensions of transparency emerging from these developments. We also highlight the remaining sectoral differences and argue that they could have potentially large impacts on the amount and type of information disclosed and on the level of transparency perceived by stakeholders and citizens. We argue that more coherence across the sectoral transparency regimes is needed, in particular in light of the agencies' contested legitimacy and of their increasing cooperation on cross-cutting issues like antimicrobial resistance and medicine and pesticide residues in food.

Ethics of digital contact tracing wearables.

The success of digital COVID-19 contact tracing requires a strategy that successfully addresses the digital divide-inequitable access to technology such as smartphones. Lack of access both undermines the degree of social benefit achieved by the use of tracing apps, and exacerbates existing social and health inequities because those who lack access are likely to already be disadvantaged. Recently, Singapore has introduced portable tracing wearables (with the same functionality as a contact tracing app) to address the equity gap and promote public health. We argue that governments have an ethical obligation to ensure fair access to the protective benefits of contract tracing during the pandemic and that wearables are an effective way of addressing some important equity issues. The most contentious issues about contact tracing apps have been the potential infringements of privacy and individual liberty, especially where the use of apps or other technology (such as wearables or QR codes) is required for access to certain spaces. Here we argue that wearables, as opposed to apps alone, will make a digital contact tracing mandate more practical and explain some conditions under which such a mandate would be justified. We focus on Singapore as a case study that has recently deployed contact tracing wearables nationally, but also reference debate about wearables in Australia and New Zealand. Our analysis will be relevant to counties trialling similar portable tracing wearables.

Privacy and Security Risk Factors Related to Telehealth Services - A Systematic Review.

The objective of the study is to identify challenges and associated factors for privacy and security related to telehealth visits during the COVID-19 pandemic. The systematic search strategy used the databases of PubMed, ScienceDirect, ProQuest, Embase, CINAHL, and COCHRANE, with the search terms of telehealth/telemedicine, privacy, security, and confidentiality. Reviews included peer-reviewed empirical studies conducted from January 2020 to February 2022. Studies conducted outside of the US, non-empirical, and non-telehealth related were excluded. Eighteen studies were included in the final analysis. Three risk factors associated with privacy and security in telehealth practice included: environmental factors (lack of private space for vulnerable populations, difficulty sharing sensitive health information remotely), technology factors (data security issues, limited access to the internet, and technology), and operational factors (reimbursement, payer denials, technology accessibility, training, and education). Findings from this study can assist governments, policymakers, and healthcare organizations in developing best practices in telehealth privacy and security strategies.

Fanmi: A Randomized Trial of Community Cohort Hiv Care for Adolescent Girls, Haiti

Background: Adolescent girls and young women are the epicenter of the global HIV epidemic and in need of multilevel interventions to improve their health outcomes. Method(s): FANMI, a randomized-controlled trial, evaluated the effectiveness of community-based cohort HIV care versus standard of care (SOC) among adolescent and young adults living with HIV (AYALH) in Haiti. Females, 16-24 years who were newly diagnosed with HIV at clinic or community HIV testing sites, or defaulted >6 months from care, were randomized 1:1 to FANMI vs SOC. FANMI was designed to improve convenience, social support and stigma by grouping AYALH in cohorts of 6-10 peers to attend monthly HIV care sessions in a community center with integrated clinical care, group counseling, and social activities led by the same provider. National guideline changes during the study included switching participants to dolutegravir regimens and expanding SOC visits to 6 months. The primary outcome was 12-month retention defined as any visit 9-15 months from enrollment. Secondary outcomes included viral suppression (< 1000 copies/ml), risk behaviors, and acceptability using interviews. Result(s): 120 AYALH enrolled (60 per arm) between May 2018-January 2021. Median age was 21, 91% were newly diagnosed, and median CD4 count was 591 cells/mm3 (IQR 399-788). A total of 78.3% (47/60) FANMI participants vs 85.0% (51/60) in SOC achieved the primary outcome (unadjusted RR=0.92 95%CI 0.78-1.09, p=0.35). Excluding 9 participants who never attended a FANMI/SOC visit after enrollment, 12-month retention was 88.7% (47/53) in FANMI vs 87.9% (51/58) in SOC (RR =1.01 95%CI 0.88-1.15, p=0.90). Participants who presented for HIV testing vs community testing and achieved the primary outcome: 95% vs 70% (FANMI) and 83% vs 88% (SOC). Viral suppression among those retained at 12 months: 44.6% (21/47) in FANMI and 37.3% (19/51) in SOC (RR 1.20 95% CI 0.74-1.9, p=0.45). There were no differences in pregnancy and risk behaviors. Providers preferred FANMI reporting increased time for counseling and peer support. FANMI participants reported high acceptability, decreased stigma, and increased social support with no confidentiality breaches. Limitations included interrupted study operations during the COVID-19 pandemic. Conclusion(s): FANMI was not more effective for AYALH in Haiti but was preferred by providers and highly acceptable to participants. It offers promise as a complementary program for high-risk AYALH in low-income settings facing barriers to clinic-based care.

Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Pregnant and Postpartum Mothers at a Tertiary Care Hospital in Kashmir: A Cross-sectional Study

Background: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. The virus can spread from an infected person when they cough, sneeze, speak, or breathe through mouth or nose. Majority of the people who get infected with the virus will experience mild to moderate illness. However, some will become severely ill and require medical attention. Pregnancy is associated with increased risk for severe COVID-19. Few studies have examined knowledge, attitudes, and practices (KAP) during the pandemic especially the high-risk groups like pregnancy and post-partum period. Aim(s): To analyze the knowledge, attitude, practice and hospital experience regarding COVID-19 among pregnant and post-partum mothers at a tertiary care hospital in Kashmir. Method(s): A cross-sectional study was conducted among 403 research participants from a tertiary care hospital of Kashmir in year 2020-2021 using a semi-structured questionnaire. The confidentiality and anonymity of respondents was maintained. The data was entered in Microsoft Excel and analysed using Statistical Package for Social Sciences version 25. The findings were presented as percentages (95% confidence intervals;CI), median, means and Standard deviation. Result(s): A total of 403 post-partum women participated in the study. Almost all the participants had heard about COVID-19 (96.6%). A majority of them were aware about how COVID-19 gets transmitted and its preventive measures. Most of the participants (62%) knew that COVID-19 has effects on pregnancy. Almost all of participants (97%) wore mask during hospital stay. All of the women washed their hands with soap water or alcohol based sanitizer. A fewer of the mothers (20%) wore mask while breastfeeding their baby. The results of binary logistic regression analysis found associations between knowledge and marital status (OR = 4.983, 95% CI 1.894-13.107). Correlation analysis found a weak positive correlation between knowledge and practice scores (r = 0.210, p-value = 0.01). Conclusion(s): As the COVID-19 cases are still increasing globally, participants overall had high KAP scores. This study can guide public health strategies regarding pregnant women and COVID-19. We recommend that interventions to improve and attitude and practice scores.

Relationality and online interpersonal research: Ethical, methodological and pragmatic extensions

The availability, affordability and usability of communication technologies have created new ways to conduct interpersonal qualitative research. Access to digital communications remains uneven, but the online environment provides an alternative, and at times a potentially preferable, research space. As Covid-19 has interrupted and disrupted the dominant assumption that qualitative research must be conducted in person, this paper outlines possibilities and reservations of online interpersonal methods. Though the standard ethical considerations of qualitative research hold true, we argue that these are necessary, but often inadequate, in the contexts of conducting online synchronous interpersonal research. Through centring relational and reflexive practice, we consider the associated pragmatic, methodological and ethical domains from feminist and virtual–material positional perspectives. Unpacking the complexities and possibilities of researching digital environments, we present six guiding principles to inform ethically responsive, methodologically robust and pragmatically feasible approaches to conducting online interpersonal qualitative research.

A novel authentication protocol to ensure confidentiality among the Internet of Medical Things in covid-19 and future pandemic scenario.

Diagnosing the patients remotely, controlling the medical equipment, and monitoring the quarantined patients are some of the necessary and frequent activities in COVID-19. Internet of Medical Things (IoMT) makes this works easy and feasible. Sharing information from patients and sensors associated with the patients to doctors is always an integral part of IoMT. Unauthorized access to such information may invite adversaries to disturb patients financially and mentally; furthermore, leaks in its confidentiality will lead to dangerous health concerns for patients. While ensuring authentication and confidentiality, We must focus on the constraints of IoMT, such as low energy consumption, deficient memory, and the dynamic nature of devices. Numerous protocols have been proposed for authentication in healthcare systems such as IoMT and telemedicine. However, many of these protocols were neither computationally efficient nor provided confidentiality, anonymity, and resistance against several attacks. In the proposed protocol, we have considered the most common scenario of IoMT and tried to overcome the limitations of existing works. Describing the system module and security analysis proves it is a panacea for COVID-19 and future pandemics.

Compassionate Care: Perceptions of English-, Spanish-, and Armenian- Speaking Hospitalized Patients using the Compassionate Care Assessment Tool

Background: Compassion remains a value intrinsic to the professional practice of nursing. Much has been published about the provision of this type of care from the nurses perspective, however, there is a paucity of studies querying hospitalized patients about their expectations and experiences with compassionate care. Objective/Aims. The aim of this study was to explore further and compare the importance of 28 elements thought to comprise compassionate nursing care. The CCAT survey was administered in one hospital setting in the primary languages of the patient (i.e., English, Spanish, Armenian). Methodology: This cross-sectional, prospective, quantitative study included an adequately-powered sample of 254 acute-care inpatients responding to the importance and provision of compassionate care. Results: Statistical differences were detected among three primary languages of the survey participants. English speakers rated the delivery of compassionate care higher than how important it was for them to receive that type of care. English speakers emphasized the importance of compassion through a subscale of Caring Attributes, while Armenian-speaking patients valued items within Meaningful Connections and Spanish-speaking patients emphasized the attributes in the Patient Experience subscale. Conclusion: Many elements comprise the construct of compassionate nursing care from the patients vantage point;however, further exploration focusing on preferences guided by individual, cultural, and educational considerations is needed. Responding to the compassionate needs of every patient remains a professional obligation for nurses that is especially relevant in todays era of diversity, equity, and inclusion.

Epidemiological study of major amputations of upper and lower limbs in France

Major amputation procedures are referenced in medical databases. Despite the existence of these data, no epidemiological follow-up for this condition exists. Amputation is the cause of permanent disability. Measuring its evolution and incidence rates could help improve care and outcomes. The objective of this study was to update epidemiological data by determining the evolution and incidence rates of major upper and lower limb amputations from 2011 to 2020, as well as to analyze the average length of stay for hospitalization according to procedures and regions from 2015 to 2019. This work is a retrospective study. It focuses on the analysis of the "Scansante.fr" database. The data were processed by descriptive analysis and statistical analysis. From 2011 to 2020, 1,616 acts of major amputations of the upper limb and 116,866 acts of major amputations of the lower limb were identified. Trans-humeral amputation and trans-tibial amputation were the most common amputations found for the upper limb and lower limb, respectively. New Aquitaine is the region with the highest average number of major amputations of the lower limb. The highest average rate of major amputations of the lower limb was found in the French Overseas Departments. The analysis of major amputations shows a general regressive trend for both the upper and lower limbs. Two main limitations guide the regression trend: the drop in the number of major amputation procedures between 2019 and 2020 corresponds to the health context of the Covid-19 pandemic, and some procedures are potentially underestimated because of the confidentiality criterion. The study of the incidence of amputation procedures is essential to understand and manage prevention and rehabilitation services in the French population. Level of Evidence: 5.Copyright © 2022 Elsevier Masson SAS

PSYCHOLOGICAL DISTRESS AND JOB SATISFACTION AMONG HEALTH CARE PROFESSIONALS IN POST COVID-19 ERA

This aim of this research was twofold: First to examine the role of psychological distress in relation to job satisfaction among health care professionals in post COVIDE-19 era. Second to examine the gender difference on the variables of psychological distress and job satisfaction among health care professionals in post COVID-19 era. A sample of 150 health care providers was chosen from various hospitals of Faisalabad and Toba Tek Singh, Pakistan. Psychological distress, and job satisfaction were measured with the use of the Psychological Distress Scale (Kessler et al., 2003) and the Job Satisfaction Scale (Locke, 1976) respectively. The linear regression analysis reveals a significant predictive association between psychological distress and job satisfaction. The independent t-test reveals an insignificant gender difference on the variables of psychological distress and job satisfaction among health care professionals. The study has significant implications for mental health of health care professionals.

Endpoint Device Risk-Scoring Algorithm Proposal for Zero Trust

The rapid expansion of remote work following the COVID-19 pandemic has necessitated the development of more robust and secure endpoint device security solutions. Companies have begun to adopt the zero trust security concept as an alternative to traditional network boundary security measures, which requires that every device and user be considered untrustworthy until proven otherwise. Despite the potential benefits of implementing zero trust, the stringent security measures can inadvertently lead to low availability by denying access to legitimate users or limiting their ability to access necessary resources. To address this challenge, we propose a risk-scoring algorithm that balances confidentiality and availability by evaluating the user's impact on resources. Our contributions include (1) summarizing the limitations of existing risk scoring systems in companies that implement zero trust, (2) proposing a dynamic importance metric that measures the importance of resources accessible to users within zero trust systems, and (3) introducing a risk-scoring algorithm that employs the dynamic importance metric to enhance both security and availability in zero trust environments. By incorporating the dynamic importance metric, our proposed algorithm provides a more accurate representation of risk, leading to better security decisions and improved resource availability for legitimate users. This proposal aims to help organizations achieve a more balanced approach to endpoint device security, addressing the unique challenges posed by the increasing prevalence of remote work.

Making better IS security investment decisions: discovering the cost of data breach announcements during the COVID-19 pandemic

PurposeStock price reactions have often been used to evaluate the cost of data breaches in the current information systems (IS) security literature. To further this line of research, this study examines the impact of data breaches on stock returns, information asymmetry and unsystematic firm risk in the context of COVID-19.Design/methodology/approachThis paper employs an event study methodology and examines data breach events released in public databases, spanning pre- and post-COVID settings. This study investigated 283 data breaches of the US publicly traded firms, and the economic cost was measured by cumulative abnormal returns (CARs), trading volume, bid-ask spread and unsystematic risk.FindingsThe authors observe that data breaches during the COVID pandemic make investors react more negatively to data breach announcements, as reflected in the significantly negative difference in CARs between breached firms before COVID and those after COVID. The findings also indicate that, after the disclosure of data breach incidents, information asymmetry is reduced to a lesser extent compared with that in the pre-COVID setting. The authors also find that data breach events lead to an increase in the unsystematic risk of breached companies in the pre-COVID era but no change in the post-COVID era.Originality/valueThis study is the first effort to examine the economic consequences of data breaches by investigating the effects in the form of trading activities and risk measurement in the COVID setting.

Telemedical Early Medical Abortion: Notes for a Debate in Italy

The activism of non-profit organizations such as Women on Web has shown that telehealth abortion services represent an important way to access a safe abortion where antiabortion laws are in place. At the same time, this use of telehealth provides an innovative model to rethink abortion services also within a formal healthcare system, as became particularly clear with the start of the COVID-19 pandemic. Drawing on the experience of telehealth services offered by groups such as Women on Web and the recent policy on telemedicine in England, this timely and innovative contribution illustrates how the implementation of telemedicine can improve abortion access in Italy. © Annali dell'Istituto Storico Itali-Germanico in Trento. All rights reserved.

A Rapid Evaluation of Virtual Grief Cafes across Two National Public Health Organisations

Introduction Restrictions during the COVID-19 pandemic adversely impacted bereavement as: visiting the dying, funerals, family meetings, access to bereavement services were disrupted. Pandemic work at Public Health England and Test and Trace was unrelenting. Enforced home working enhanced isolation. Many colleagues experienced difficult bereavements with little access to normal support networks. Aims To further understand how a workplace grassroots virtual grief cafe can support the bereaved. Methods A grassroots group of bereaved staff and/or with bereavement expertise, established virtual bereavement cafes in May 2021, run by staff for staff. MS Teams (video teleconferencing, chat, signposting to resources) provided a safe, supportive meeting space. Facilitated Cafes are held fortnightly, with mental health first aiders present. Ground rules emphasised respect, confidentiality, the validity of all types of grief and all deaths (pre or during the pandemic). Chat and emojis offered support. Post cafe email and phone follow-up was offered. Additional themed cafes supported: Grief Awareness Week, the Queen's death, Pregnancy or Infant loss and bespoke sessions run for teams whose colleague had died. A rapid qualitative thematic evaluation to better understand participants experience of grief and how the cafes have helped was carried out in 2022. Results Between 9-34 staff attend with new participants at each session. All types of grief have been experienced: anticipatory, complicated, cumulative and disenfranchised grief - often in combination. Participants' feedback has been thematically grouped related to their experience of the Grief Cafes, specific workplace challenges, and the impact of the pandemic on grief. Conclusions There is a significant level of unresolved and complex grief following the COVID-19 pandemic in workingage people. Impact Virtual cafes provide critical emotional support in geographically dispersed organisations. They work best linking with and driving compassionate workplace policies.

Privacy in view of telemedicine. Contributions of the philosophy of technology to bioethics

The philosophy of technology is a recent branch of philosophy in general. It can provide tools for problems arising from recent technological applications, such as telemedicine. A problem repeatedly pointed out by bioethics is privacy in general, and the changes that can be introduced by the increasing use of technology. Commenting on proposals from the World Medical Association and contemporary data derived from the COVID-19 pandemic, it can be recognized that privacy is an ethical requirement that requires regulation through its political implementation for its adequate legal protection. © GKA Ediciones, authors.

Views on increased federal access to state and local National Syndromic Surveillance Program data: a nominal group technique study with state and local epidemiologists.

BACKGROUND: US public health authorities use syndromic surveillance to monitor and detect public health threats, conditions, and trends in near real-time. Nearly all US jurisdictions that conduct syndromic surveillance send their data to the National Syndromic Surveillance Program (NSSP), operated by the US. Centers for Disease Control and Prevention. However, current data sharing agreements limit federal access to state and local NSSP data to only multi-state regional aggregations. This limitation was a significant challenge for the national response to COVID-19. This study seeks to understand state and local epidemiologists' views on increased federal access to state NSSP data and identify policy opportunities for public health data modernization. METHODS: In September 2021, we used a virtual, modified nominal group technique with twenty regionally diverse epidemiologists in leadership positions and three individuals representing national public health organizations. Participants individually generated ideas on benefits, concerns, and policy opportunities relating to increased federal access to state and local NSSP data. In small groups, participants clarified and grouped the ideas into broader themes with the assistance of the research team. An web-based survey was used to evaluate and rank the themes using five-point Likert importance questions, top-3 ranking questions, and open-ended response questions. RESULTS: Participants identified five benefit themes for increased federal access to jurisdictional NSSP data, with the most important being improved cross-jurisdiction collaboration (mean Likert = 4.53) and surveillance practice (4.07). Participants identified nine concern themes, with the most important concerns being federal actors using jurisdictional data without notice (4.60) and misinterpretation of data (4.53). Participants identified eleven policy opportunities, with the most important being involving state and local partners in analysis (4.93) and developing communication protocols (4.53). CONCLUSION: These findings identify barriers and opportunities to federal-state-local collaboration critical to current data modernization efforts. Syndromic surveillance considerations warrant data-sharing caution. However, identified policy opportunities share congruence with existing legal agreements, suggesting that syndromic partners are closer to agreement than they might realize. Moreover, several policy opportunities (i.e., including state and local partners in data analysis and developing communication protocols) received consensus support and provide a promising path forward.

Keeping the secrecy aspect in mass e-voting.

Two years of the COVID-19 pandemic have pushed society's digitalization forward like nothing ever before. Activities that weren't achievable without personal contact, became present online. Currently, when the COVID-19 restrictions are being lifted and personal meetings are becoming possible, in some cases, it still appeared to be more convenient to "meet" virtually than physically. Some actions proved to be more effective when performed online. That is why some people didn't want to come back to the previous form of communication anymore. Many decision-makers who see all the advantages of online communication have turned to the new possibilities that are served by Internet systems. Hence, they intend to keep it virtual even now, when pandemic restrictions have been lifted in most cases. This situation implies lots of great ideas for virtualization. One of those is online voting and polling conducted on many voters - groups larger than just board members or delegates. Such balloting could be performed using a voting system. Unfortunately, in the case of the decision-making process, which should be treated as a one-time event, using typical solutions is mostly very ineffective. Observations revealed that e-voting procedures conducted on a large number of electors may be challenging for many, not computer-experienced users. The procedure of authentication has to stay present in order to protect the votings against ballot stuffing. Particularly in secret voting, the problem remains the same: how to verify the user for a secret ballot without revealing his data. In mass voting, additional issues appear such as how to complete the procedure on multiple (often not ICT-experienced) voters and how to make the system accessible and credible at the same time.