Urban resilience under the COVID-19 pandemic: A quantitative assessment framework based on system dynamics.

The COVID-19 pandemic, which lasted for three years, has had a great impact on the public health system, society and economy of cities, revealing the insufficiency of urban resilience under large-scale public health events (PHEs). Given that a city is a networked and multidimensional system with complex interactions, it is helpful to improve urban resilience under PHEs based on system thinking. Therefore, this paper proposes a dynamic and systematic urban resilience framework that incorporates four subsystems (governance, infrastructures, socioeconomy and energy-material flows). The composite index, system dynamics and epidemic simulation model are integrated into the framework to show the nonlinear relationships in the urban system and reflect the changing trend of urban resilience under PHEs. Then, urban resilience under different epidemic scenarios and response policy scenarios is calculated and discussed to provide some suggestions for decision-makers when faced with the trade-off between the control of PHEs and the maintenance of city operation. The paper concludes that control policies could be adjusted according to the characteristics of PHEs; strict control policies under a severe epidemic could lead to a significant decrease in urban resilience, while a more flexible control strategy can be adopted under a mild epidemic scenario to ensure the normal operation of urban functions. Moreover, the critical functions and impact factors of each subsystem are identified.

Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone.

This paper examines health worker experiences in two areas of post-epidemic preparedness in Sierra Leone - vaccine trials and laboratory strengthening - to reflect on the place of people in current models of epidemic response. Drawing on ethnographic research and interviews with health workers in the aftermath of Ebola, it explores the hopes and expectations that interventions foster for frontline workers in under-resourced health systems, and describes the unseen work involved in sustaining robust response infrastructures. Our analysis focuses on what it means for the people who sustain health systems in an emergency to be 'prepared' for an epidemic. Human preparedness entails more than the presence of a labour force; it involves building and maintaining 'relational infrastructures', often fragile social and moral relationships between health workers, publics, governments, and international organisations. The COVID-19 pandemic has underscored the value of rethinking human resources from an anthropological perspective, and investing in the safety and support of people at the forefront of response. In describing the labour, personal losses, and social risks undertaken by frontline workers for protocols and practicality to meet in an emergency context, we describe the social process of preparedness; that is, the contextual engineering and investment that make response systems work.

Infectious Diseases Institute at Makerere University College of Health Sciences: a case study of a sustainable capacity building model for health care, research and training.

The Infectious Diseases Institute (IDI), established in 2001, was the first autonomous institution of Makerere University set up as an example of what self-governing institutes can do in transforming the academic environment to become a rapidly progressive University addressing the needs of society This paper describes the success factors and lessons learned in development of sustainable centers of excellence to prepare academic institutions to respond appropriately to current and future challenges to global health. Key success factors included a) strong collaboration by local and international experts to combat the HIV pandemic, along with b) seed funding from Pfizer Inc., c) longstanding collaboration with Accordia Global Health Foundation to create and sustain institutional strengthening programs, d) development of a critical mass of multi-disciplinary research leaders and managers of the center, and e) a series of strong directors who built strong governance structures to execute the vision of the institute, with subsequent transition to local leadership. Conclusion: Twenty years of sustained investment in infrastructure, human capital, leadership, and collaborations present Makerere University and the sub-Saharan Africa region with an agile center of excellence with preparedness to meet the current and future challenges to global health.

A Framework for Social Science in Epidemics

In epidemic preparedness and response, it is now commonly accepted that insights from social science disciplines are important in shaping action. Unfortunately, the role of social science is often confined to risk communication and community engagement (RCCE) efforts. In this article, we propose an analytical framework that would allow researchers and practitioners from different disciplines to employ social science insights to enrich their understanding of epidemics and formulate more effective and sustainable responses. The framework goes beyond simply unpacking social, political, economic and cultural dimensions of context;it situates disease itself - as it is shaped by the contexts in which it circulates - and views it in dynamic relation to response. It also explores how different individuals, social groups and institutions shift their knowledge and practices during an epidemic through power-laden processes of dialogue and learning, or even through silencing and side-lining. It is our hope that this framework will enable responders to engage more deeply and systematically with the contexts of emergencies, so as to ensure activities are more adaptive to local dynamics.

Field Epidemiology Training Program Response to COVID-19 During a Conflict: Experience From Yemen.

COVID-19 pandemic has underscored the need for a well-trained public health workforce to save lives through timely outbreaks detection and response. In Yemen, a country that is entering its seventh year of a protracted war, the ongoing conflict severely limited the country's capacity to implement effective preparedness and response measures to outbreaks including COVID-19. There are growing concerns that the virus may be circulating within communities undetected and unmitigated especially as underreporting continues in some areas of the country due to a lack of testing facilities, delays in seeking treatment, stigma, difficulty accessing treatment centers, the perceived risks of seeking care or for political issues. The Yemen Field Epidemiology Training Program (FETP) was launched in 2011 to address the shortage of a skilled public health workforce, with the objective of strengthening capacity in field epidemiology. Thus, events of public health importance can be detected and investigated in a timely and effective manner. During the COVID-19 pandemic, the Yemen FETP's response has been instrumental through participating in country-level coordination, planning, monitoring, and developing guidelines/standard operating procedures and strengthening surveillance capacities, outbreak investigations, contact tracing, case management, infection prevention, and control, risk communication, and research. As the third wave is circulating with a steeper upward curve than the previous ones with possible new variants, the country will not be able to deal with a surge of cases as secondary care is extremely crippled. Since COVID-19 prevention and control are the only option available to reduce its grave impact on morbidity and mortality, health partners should support the Yemen FETP to strengthen the health system's response to future epidemics. One important lesson learned from the COVID-19 pandemic, especially in the Yemen context and applicable to developing and war-torn countries, is that access to outside experts becomes limited, therefore, it is crucial to invest in building national expertise to provide timely, cost-effective, and sustainable services that are culturally appropriate. It is also essential to build such expertise at the governorate and district levels, as they are normally the first respondents, and to provide them with the necessary tools for immediate response in order to overcome the disastrous delays.

iDMer: an integrative and mechanism-driven response system for identifying compound interventions for sudden virus outbreak.

Emerging viral infections seriously threaten human health globally. Several challenges exist in identifying effective compounds against viral infections: (1) at the initial stage of a new virus outbreak, little information, except for its genome information, may be available; (2) although the identified compounds may be effective, they may be toxic in vivo and (3) cytokine release syndrome (CRS) triggered by viral infections is the primary cause of mortality. Currently, an integrative tool that takes all those aspects into consideration for identifying effective compounds to prevent viral infections is absent. In this study, we developed iDMer, as an integrative and mechanism-driven response system for addressing these challenges during the sudden virus outbreaks. iDMer comprises three mechanism-driven compound identification modules, that is, a virus-host interaction-oriented module, an autophagy-oriented module and a CRS-oriented module. As a one-stop integrative platform, iDMer incorporates compound toxicity evaluation and compound combination identification for virus treatment with clear mechanisms. iDMer was successfully tested on five viruses, including the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our results indicated that, for all five tested viruses, compounds that were reported in the literature or experimentally validated for virus treatment were enriched at the top, demonstrating the generalized effectiveness of iDMer. Finally, we demonstrated that combinations of the individual modules successfully identified combinations of compounds effective for virus intervention with clear mechanisms.

From Ebola to COVID-19: emergency preparedness and response plans and actions in Lagos, Nigeria.

BACKGROUND: Lagos state is the industrial nerve centre of Nigeria and was the epicentre of the 2014 Ebola outbreak in Nigeria as it is now for the current Coronavirus Disease (COVID-19) outbreak. This paper describes how the lessons learned from the Ebola outbreak in 2014 informed the emergency preparedness of the State ahead of the COVID-19 outbreak and guided response. DISCUSSION: Following the Ebola outbreak in 2014, the Lagos State government provided governance by developing a policy on emergency preparedness and biosecurity and provided oversight and coordination of emergency preparedness strategies. Capacities for emergency response were strengthened by training key staff, developing a robust surveillance system, and setting up a Biosafety Level 3 laboratory and biobank. Resource provision, in terms of finances and trained personnel for emergencies was prioritized by the government. With the onset of COVID-19, Lagos state was able to respond promptly to the outbreak using the centralized Incident Command Structure and the key activities of the Emergency Operations Centre. Contributory to effective response were partnerships with the private sectors, community engagement and political commitment. CONCLUSION: Using the lessons learned from the 2014 Ebola outbreak, Lagos State had gradually prepared its healthcare system for a pandemic such as COVID-19. The State needs to continue to expand its preparedness to be more resilient and future proof to respond to disease outbreaks. Looking beyond intra-state gains, lessons and identified best practices from the past and present should be shared with other states and countries.

Public Health Crises In Comparison: China's Epidemic Response Policies From SARS To COVID-19.

The rate of infectious disease outbreaks has been accelerating over the past two decades, from the SARS epidemic in 2003 to COVID-19 in 2020. Termed by some as the twenty-first century's first pandemic, SARS originated in China and alerted the country to the importance of public health and epidemic response. After SARS, China improved its health infrastructure and reformed its political and legal health governance system. The emergence of COVID-19 from Wuhan in late 2019 put those reforms to the test. This paper analyses China's public health and epidemic response policies from a historical perspective, tracing the evolution of Chinese public health policies after the SARS outbreak in 2003. This paper assesses China's response to COVID-19 and how post-SARS policy reforms, particularly in epidemic response, played out on the ground in Wuhan. What policies worked well? What were the challenges faced? Based on the policy analysis, this paper presents recommendations for how China can improve its epidemic response through strengthened infectious disease surveillance, more transparent political coordination, and expanded public health infrastructure.

The Progression of COVID-19 and the Government Response in China.

The ongoing pandemic of COVID-19 (Coronavirus Infectious Disease-2019) was first reported at the end of 2019 in Wuhan, China. On 30 January 2020, the WHO declared a Public Health Emergency for the novel coronavirus. On 11 March 2020, the WHO officially declared the COVID-19 outbreak as a pandemic. Due to the differences in population distribution, economic structure, degree of damage and other factors, the affected countries have introduced policies tailored to local conditions as a response to the pandemic, leading to different economic and social impacts. Considering the highly heterogeneous spreading of COVID-19 across regions, this paper takes a specific country (China) as a case study of the spread of the disease and national intervention models for the COVID-19 pandemic. The research period of this article is from 17 December to 26 April 2020, because this time period basically covered the important time nodes of the epidemic in China from animal-to-human transmission, limited human-to-human transmission, epidemic to gradual control. This study is useful for comparing the effectiveness of different interventions at various stages of epidemic development within the same country and can also promote the comparison of the epidemic response interventions of different countries. Based on the conclusions of the model simulation, this article evaluates the dual impact of the epidemic on people's wellbeing and the economy.

Rapid Reorganization of an Academic Infectious Diseases Program During the Coronavirus Disease 2019 Pandemic in Detroit: A Novel Unit-based Group Rounding Model.

The surge of coronavirus disease 2019 (COVID-19) hospitalizations at our 877-bed quaternary care hospital in Detroit led to an emergent demand for Infectious Diseases (ID) consultations. The traditional 1-on-1 consultation model was untenable. Therefore, we rapidly restructured our ID division to provide effective consultative services. We implemented a novel unit-based group rounds model that focused on delivering key updates to teams and providing unit-wide consultations simultaneously to all team members. Effectiveness of the program was studied using Likert-scale survey data. The survey captured data from the first month of the Detroit COVID-19 pandemic. During this period there were approximately 950 patients hospitalized for treatment of COVID-19. The survey of trainees and faculty reported an overall 95% positive response to delivery of information, new knowledge acquisition, and provider confidence in the care of COVID-19 patients. This showed that the unit-based consult model is a sustainable effort to provide care during epidemics.

Coronavirus disease-2019 epidemic response in Uganda: The need to strengthen and engage primary healthcare.

In Uganda, the numbers of new coronavirus disease cases have continued to increase slowly since the first case was confirmed. Given that the disease is likely to be holoendemic, the role of primary care (PC) with its features of comprehensiveness, accessibility, coordination and continuity, functioning at the heart of a primary healthcare (PHC) approach, will be important. The elements of PC are applicable in the epidemic preparation, case finding and management, follow-up and post-epidemic phases of responding to this pandemic. This also presents opportunities and lessons for strengthening PHC as well as for reflections on missed opportunities. The effective use of available resources in response to the epidemic should mainly focus on community mobilisation and PHC teams for the prevention, screening, testing and treatment of mild and moderate cases.

Impact of climatic, demographic and disease control factors on the transmission dynamics of COVID-19 in large cities worldwide.

Approximately a year into the COVID-19 pandemic caused by the SARS-CoV-2 virus, many countries have seen additional "waves" of infections, especially in the temperate northern hemisphere. Other vulnerable regions, such as South Africa and several parts of South America have also seen cases rise, further impacting local economies and livelihoods. Despite substantial research efforts to date, it remains unresolved as to whether COVID-19 transmission has the same sensitivity to climate observed for other common respiratory viruses such as seasonal influenza. Here, we look for empirical evidence of seasonality using a robust estimation framework. For 359 large cities across the world, we estimated the basic reproduction number (R0) using logistic growth curves fitted to cumulative case data. We then assess evidence for association with climatic variables through ordinary least squares (OLS) regression. We find evidence of seasonality, with lower R0 within cities experiencing greater surface radiation (coefficient = -0.005, p < 0.001), after adjusting for city-level variation in demographic and disease control factors. Additionally, we find association between R0 and temperature during the early phase of the epidemic in China. However, climatic variables had much weaker explanatory power compared to socioeconomic and disease control factors. Rates of transmission and health burden of the continuing pandemic will be ultimately determined by population factors and disease control policies.

Comparing the Scope and Efficacy of COVID-19 Response Strategies in 16 Countries: An Overview.

This article synthesizes the results of case studies on the development of the coronavirus disease 2019 (COVID-19) pandemic and control measures by governments in 16 countries. When this work was conducted, only 6 months had passed since the pandemic began, and only 4 months since the first events were recognized outside of China. It was too early to draw firm conclusions about the effectiveness of measures in each of the selected countries; however, the authors present some efforts to identify and classify response and containment measures, country-by-country, for future comparison and analysis. There is a significant variety of policy tools and response measures employed in different countries, and while it is still hard to directly compare the different approaches based on their efficacy, it will definitely provide many inputs for the future data analysis efforts.

SARS to novel coronavirus - old lessons and new lessons.

The response to the novel coronavirus outbreak in China suggests that many of the lessons from the 2003 SARS epidemic have been implemented and the response improved as a consequence. Nevertheless some questions remain and not all lessons have been successful. The national and international response demonstrates the complex link between public health, science and politics when an outbreak threatens to impact on global economies and reputations. The unprecedented measures implemented in China are a bold attempt to control the outbreak - we need to understand their effectiveness to balance costs and benefits for similar events in the future.