Lessons Learned From Limited Overlap of 15 In Vitro COVID-19 Drug Repurposing Screens.

Drug repurposing can quickly and cost-effectively identify medical countermeasures against pathogens with pandemic potential and could be used as a down-selection method for selecting US Food and Drug Administration-approved drugs to test in clinical trials. We compared results from 15 high-throughput in vitro screening efforts that tested approved and clinically evaluated drugs for activity against SARS-CoV-2 replication. From the 15 studies, 304 drugs were identified as displaying the highest level of confidence from the individual screens. Of those 304 drugs, 30 were identified in 2 or more screens, while only 3 drugs (apilimod, tetrandrine, and salinomycin) were identified in 4 screens. The lack of concordance in high-confidence hits and variations in protocols makes it challenging to use the collective data as down-selection criteria for identifying repurposing candidates to move into a clinical trial.

The Mashpee Wampanoag Tribe COVID-19 Pandemic Response: A Case Study.

During the COVID-19 pandemic, the Mashpee Wampanoag Tribe of southeastern Massachusetts requested US federal government assistance. The tribe collaborated successfully with many partners in response to the COVID-19 pandemic. In this case study, the authors describe the tribe's collaboration with a team from the Centers for Disease Control and Prevention who assisted with epidemiology, case investigation and contact tracing, infection prevention and control, community prevention measures, and vaccination. Collaborative efforts resulted in over 200 public service announcements and videos produced, 55 tribal staff trained, 222 people followed up for contact tracing, 80% of tribal members vaccinated, and 5 COVID-19 response plans written. Deployment response teams learned elements essential to partnering with a Native American tribe. This successful partnership during a rapidly evolving pandemic suggests the US federal government and tribal nations can work together effectively to build response capacity for future infectious disease threats.

Examining the Impacts of Title 42 in the Rio Grande Valley, Texas: Perceptions From Stakeholders in Immigrant Health and Wellbeing.

During the initial weeks of the COVID-19 pandemic in the United States, the Department of Health and Human Services implemented a little-known public health law, referred to as "Title 42." The law immediately received criticism from public health professionals and pandemic response experts around the country. Years after its initial implementation, however, the policy has been consistently maintained through numerous court decisions as necessary to prevent COVID-19. This article explores the perceived impact of Title 42 on COVID-19 containment and overall health security in the Rio Grande Valley, Texas, based on interviews conducted with public health professionals, medical professionals, nonprofit staff, and social workers. Our findings show that Title 42 was not perceived to prevent the spread of COVID-19 and likely decreased overall health security in this region.

High potential of technology to face new respiratory viruses: mechanical ventilation devices for effective healthcare to next pandemic emergencies.

Some countries in the presence of unforeseen Coronavirus Disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have experienced lower total deaths, though higher numbers of COVID-19 related infections. Results here suggest that one of the explanations is the critical role of ventilator technology in clinical health environment to cope with the initial stage of COVID-19 pandemic crisis. Statistical evidence shows that a large number of ventilators or breathing devices in countries (26.76 units per 100,000 inhabitants) is associated with a fatality rate of 1.44% (December 2020), whereas a higher fatality rate given by 2.46% is in nations with lower numbers of ventilator devices (10.38 average units per 100,000 people). These findings suggest that a large number of medical ventilators in clinical setting has a high potential for more efficient healthcare and improves the effective preparedness of crisis management to cope with new respiratory pandemic diseases in society. Hence, a forward-thinking and technology-oriented strategy in healthcare sector, based on investments in high-tech ventilator devices and other new medical technologies, can help clinicians deliver effective care and reduce negative effects of present and future respiratory infectious diseases, in particular when new drugs and appropriate treatments are missing in clinical environment to face unknown respiratory viral agents .

The Case for Integrating Health Systems to Manage Noncommunicable and Infectious Diseases in Low- and Middle-Income Countries: Lessons Learned From Zambia.

Noncommunicable diseases (NCDs) are the leading cause of death in the world, and 80% of all NCD deaths occur in low- and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that patients with NCDs are at increased risk of becoming severely ill from the virus. Disproportionate investment in vertical health programs can result in health systems vulnerable to collapse when resources are strained, such as during pandemics. Although NCDs are largely preventable, globally there is underinvestment in efforts to address them. Integrating health systems to collectively address NCDs and infectious diseases through a wide range of services in a comprehensive manner reduces the economic burden of healthcare and strengthens the healthcare system. Health system resiliency is essential for health security. In this article, we provide an economically sound approach to incorporating NCDs into routine healthcare services in LMICs through improved alignment of institutions that support prevention and control of both NCDs and infectious diseases. Examples from Zambia's multisector interventions to develop and support a national NCD action plan can inform and encourage LMIC countries to invest in systems integration to reduce the social and economic burden of NCDs and infectious diseases.

The Impact of COVID-19 on Individuals and Communities Through the Lens of a Kurdish Artist: A Narrative Inquiry Study.

The COVID-19 pandemic affects individuals and society at different levels. For a brief period during the pandemic, the Kurdish government closed all governmental organizations and interconnected routes, except for medical and security settings, and announced a curfew. In this article, we portray the effects of the pandemic on individuals and communities from an artist's view through an art-based narrative inquiry. Narrative analysis is used for analyzing texts or visual data in story form. It describes the life experiences of individuals and the environment in which they reside. Data came from the observations and experiences of the first author during the time he conducted research regarding the impacts of COVID-19 on different aspects of the Kurdish community in the Kurdistan Region through our previous research. The images and stories show that individuals feared COVID-19 and struggled to protect themselves from infection. They faced prolonged social distancing, quarantine, and complete lockdown and lost their family members and loved ones-their relationships with family members and others were disrupted during the pandemic. Additionally, vulnerable groups, such as children and older adults, have been especially affected psychologically during the COVID-19 pandemic. We suggest that the pandemic has affected different groups of people and impacted the health security of Iraqi Kurdistan society. Our findings add a conceptual understanding of the health threat of the pandemic that can be used to implement health services and health policy for individuals and communities in Iraqi Kurdistan.

A Pandemic Treaty: Learning From the Framework Convention on Tobacco Control.

The World Health Organization recently began developing a "pandemic treaty" in response to the perceived failures of the global COVID-19 response. The Framework Convention on Tobacco Control, which obligates members to certain global standards in tobacco control, is an example of a global public health agreement that may be used as a model for the pandemic treaty. Several challenges related to the convention, many from the tobacco industry itself, must be addressed if it is to be used as a prototype for a pandemic agreement. These include harm reduction policies, private-sector involvement, and its impact in low- and middle-income countries. A pandemic treaty may encounter similar challenges faced by the Framework Convention on Tobacco Control, particularly from industry groups with financial interests related to infectious disease control and prevention. Addressing challenges at the outset may facilitate the development and implementation of a more robust international instrument.

A Data-Driven Approach to Allocating Personal Protective Equipment During the COVID-19 Pandemic in King County, Washington.

From the Field is a semiregular column that provides insight into the experiences of local, county, or state health professionals on the frontlines of health emergencies. National Association of County and City Health Officials members share the challenges faced and the solutions developed as they prepared for and responded to disasters, epidemics, and other major health issues. The aim of sharing these practical experiences is to provide other public health champions with the information and tools they need to help keep their communities safe even in extreme situations. The COVID-19 pandemic created an extraordinarily high demand for personal protective equipment (PPE). Acute need and supply chain disruptions made hospitals, emergency medical services, and other critical care agencies particularly vulnerable to PPE shortages. In March 2020, King County, Washington, developed computational tools, operating procedures, and data visualizations to fulfill its responsibilities to prioritize, allocate, and distribute scarce PPE equitably and efficiently during a public health emergency. King County distributed over 1.6 million gowns, 22 million gloves, 3.9 million surgical masks, and 1.5 million N95 respirators (among other items) during its PPE distribution mission. An algorithm processed resource requests from the community, with respect to available inventory, emergency allocation policies, prioritization constraints, estimated PPE use rates, agency-specific needs, and other parameters. With these inputs and constraints, the requests were translated into instructions for fulfillment and delivery and several tabular and graphical data visualizations were produced for quality assurance and transparency. Access to timely, relevant, and stable data was a constant challenge, and constraints invariably changed as the emergency response unfolded. King County's PPE distribution mission provides a useful case study in how to develop a scalable and data-driven approach to resource allocation and distribution under emergency response conditions.

Regional Health System Coordination via a Hospital Association: A Successful Model for Managing Downstate New York's Second COVID-19 Wave.

Based on the experiences and lessons of its first COVID-19 patient surge in spring of 2020 (Wave 1), the New York hospital community recognized the importance of preparation and coordination for the anticipated winter 2020-2021 surge (Wave 2). This case study describes the coordination function of the Greater New York Hospital Association in downstate New York during the second wave, carried out using 4 key elements: enhanced situational awareness coupled with proactive outreach, partnerships between independent hospitals and health systems, frequent coordination meetings with hospitals, and routine coordination meetings with the Governor's Office and the New York State Department of Health. Given the existing relationships, functions, and support structures of hospital associations, this type of collaborative structure between state government and an association can be valuable in any situation that broadly impacts a state's healthcare community.

A COVID-19 Lesson: Better Health Emergency Preparedness Standards Are Needed.

This article reports on an assessment of the value of 4 widely recognized standards of health sector emergency preparedness as predictors of effective preparedness for, and response to, the COVID-19 pandemic in the United States. The standards are sponsored by the National Health Security Preparedness Index (NHSPI), the Trust for America's Health (TFAH), the Emergency Management Accreditation Program (EMAP), and the Public Health Accreditation Board (PHAB). The measure of effectiveness was states' cumulative COVID-19 deaths per 100,000 population, from January 21, 2020, through January 20, 2022. Linear regression analysis found no statistically significant associations when controlling for 3 intervening variables. Cross-tabulation of states' preparedness status with their COVID-19 death rates found that high NHSPI and TFAH preparedness scores were generally, but not uniformly, associated with lower death rates. EMAP and PHAB accreditation had negligible association with low or high death rates. Lack of accreditation was associated with lower death rates. Higher prior state public health spending related to COVID-19 preparedness and higher state household income, an indicator of state economic strength, were associated with lower death rates. States with Democratic control of the legislative and executive branches of government generally had substantially lower death rates than states with Republican control. A science-based, practice-oriented research initiative is recommended to improve the predictive power of health sector preparedness standards and to enhance protection for US residents from large-scale future health threats.

Developing a Rapid Response Single IRB Model for Conducting Research During a Public Health Emergency.

Research is foundational for evidence-based management of patients. Clinical research, however, takes time to plan, conduct, and disseminate-a luxury that is rarely available during a public health emergency. The University of Nebraska Medical Center (UNMC) developed a single institutional review board (IRB), with a vision to establish a rapid review resource for a network focused on clinical research of emerging pathogens in the United States. A core aspect of successful initiation of research during a pandemic or epidemic is the ability to operationalize an approach for rapid ethical review of human subject research and conduct those reviews at multiple sites-without losing any of the substantive aspects of ethics review. This process must be cultivated in anticipation of a public health emergency. US guidance for operationalizing IRB review for multisite research in a public health emergency is not well studied and processes are not well established. UNMC sought to address operational gaps and identify the unique procedural needs of rapid response single IRB (RR-sIRB) review of multisite research by conducting a series of preparedness exercises to develop and test the RR-sIRB model. For decades, emergency responder, healthcare, and public health organizations have conducted emergency preparedness exercises to test requirements for emergency response. In this article, we describe 2 types of simulation exercises conducted by UNMC: workshops and tabletops. This effort represents a unique use of emergency preparedness exercises to develop, refine, and test rapid review functions for an sIRB and to validate readiness of regulatory research processes. Such processes are crucial for conducting rapid, ethical, and sound clinical research in public health emergencies.

The Evolution of the National Special Pathogen System of Care.

Infectious disease outbreaks and pandemics have repeatedly threatened public health and have severely strained healthcare delivery systems throughout the past century. Pathogens causing respiratory illness, such as influenza viruses and coronaviruses, as well as the highly communicable viral hemorrhagic fevers, pose a large threat to the healthcare delivery system in the United States and worldwide. Through the Hospital Preparedness Program, within the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, a nationwide Regional Ebola Treatment Network (RETN) was developed, building upon a state- and jurisdiction-based tiered hospital approach. This network, spearheaded by the National Emerging Special Pathogens Training and Education Center, developed a conceptual framework and plan for the evolution of the RETN into the National Special Pathogen System of Care (NSPS). Building the NSPS strategy involved reviewing the literature and the initial framework used in forming the RETN and conducting an extensive stakeholder engagement process to identify gaps and develop solutions. From this, the NSPS strategy and implementation plan were formed. The resulting NSPS strategy is an ambitious but critical effort that will have impacts on the mitigation efforts of special pathogen threats for years to come.

Lessons Learned From the Public Health Workforce's Experiences With the COVID-19 Response.

Limited research is available on the COVID-19 response experiences of local, state, and federal public health workers in the United States. Although the response to COVID-19 is still presenting challenges to the public health workforce, public health systems must also begin to consider lessons learned that can be applied to future disasters. During July and August 2021, a random sample of participants from a cross-sectional study of the public health workforce was invited to participate in interviews to obtain information on the current state of public health operations, the ongoing response to the COVID-19 crisis, and takeaways for improving future preparedness and response planning. Interviews were transcribed and inductively coded to identify themes. Twenty-four initial interview invitations were sent, and random substitutions were made until thematic saturation was reached when 17 interviews were completed. Four thematic categories were identified, including challenges related to (1) ongoing lack of political support or policy guidance; (2) fluctuations in, and uncertainty about, future funding and associated requirements; (3) job expectations, including remote work and data-sharing capabilities; and (4) the mental health toll of sustained response and related burnout. As the public health response to the COVID-19 pandemic continues in its third year, it is crucial to identify lessons learned that can inform future investment in order to sustain a public health workforce and a public health preparedness and response system that is resilient to future disasters.

Lessons Learned From a Large Cross-Border Field Simulation Exercise to Strengthen Emergency Preparedness in East Africa, 2019.

Field simulation exercises (FSXs) require substantial time, resources, and organizational experience to plan and implement and are less commonly undertaken than drills or tabletop exercises. Despite this, FSXs provide an opportunity to test the full scope of operational capacities, including coordination across sectors. From June 11 to 14, 2019, the East African Community Secretariat conducted a cross-border FSX at the Namanga One Stop Border Post between the Republic of Kenya and the United Republic of Tanzania. The World Health Organization Department of Health Security Preparedness was the technical lead responsible for developing and coordinating the exercise. The purpose of the FSX was to assess and further enhance multisectoral outbreak preparedness and response in the East Africa Region, using a One Health approach. Participants included staff from the transport, police and customs, public health, animal health, and food inspection sectors. This was the first FSX of this scale, magnitude, and complexity to be conducted in East Africa for the purpose of strengthening emergency preparedness capacities. The FSX provided an opportunity for individual learning and national capacity strengthening in emergency management and response coordination. In this article, we describe lessons learned and propose recommendations relevant to FSX design, management, and organization to inform future field exercises.