Quantifying optimal resource allocation strategies for controlling epidemics.

Frequent emergence of communicable diseases is a major concern worldwide. Lack of sufficient resources to mitigate the disease burden makes the situation even more challenging for lower-income countries. Hence, strategy development for disease eradication and optimal management of the social and economic burden has garnered a lot of attention in recent years. In this context, we quantify the optimal fraction of resources that can be allocated to two major intervention measures, namely reduction of disease transmission and improvement of healthcare infrastructure. Our results demonstrate that the effectiveness of each of the interventions has a significant impact on the optimal resource allocation in both long-term disease dynamics and outbreak scenarios. The optimal allocation strategy for long-term dynamics exhibits non-monotonic behaviour with respect to the effectiveness of interventions, which differs from the more intuitive strategy recommended in the case of outbreaks. Further, our results indicate that the relationship between investment in interventions and the corresponding increase in patient recovery rate or decrease in disease transmission rate plays a decisive role in determining optimal strategies. Intervention programmes with decreasing returns promote the necessity for resource sharing. Our study provides fundamental insights into determining the best response strategy when controlling epidemics in resource-constrained situations.

The impact of resource allocation during the COVID-19 pandemic on cardiac surgical practice and patient outcomes: a systematic review.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has shaken the world and placed enormous strain on healthcare systems globally. In this systematic review, we investigate the effect of resource allocation on cardiac surgery programs and the impact on patients awaiting elective cardiac surgery. METHODS: PubMed and Embase were systematically searched for articles published from 1 January 2019 to 30 August 2022. This systematic review included studies investigating the impact of the COVID-19 pandemic on resource allocation and the subsequent influence on cardiac surgery outcomes. A total of 1676 abstracts and titles were reviewed and 20 studies were included in this review. RESULTS: During the COVID-19 pandemic, resources were allocated away from elective cardiac surgery to help support the pandemic response. This resulted in increased wait times for elective patients, increased rates of urgent or emergent surgical intervention and increased rates of mortality or complications for patients awaiting or undergoing cardiac surgery during the pandemic. CONCLUSIONS: While the finite resources available during the pandemic were often insufficient to meet the needs of all patients as well as the influx of new COVID-19 patients, resource allocation away from elective cardiac surgery resulted in prolonged wait times, more frequent urgent or emergent surgeries and negative impacts on patient outcomes. Understanding the impacts of delayed access to care with regards to urgency of care, increased morbidity and mortality and increased utilization of resources per indexed case needs to be considered to navigate through pandemics to minimize the lingering effects that continue to negatively impact patient outcomes.

Optimizing two-dose vaccine resource allocation to combat a pandemic in the context of limited supply: The case of COVID-19.

The adequate vaccination is a promising solution to mitigate the enormous socio-economic costs of the ongoing COVID-19 pandemic and allow us to return to normal pre-pandemic activity patterns. However, the vaccine supply shortage will be inevitable during the early stage of the vaccine rollout. Public health authorities face a crucial challenge in allocating scarce vaccines to maximize the benefits of vaccination. In this paper, we study a multi-period two-dose vaccine allocation problem when the vaccine supply is highly limited. To address this problem, we constructed a novel age-structured compartmental model to capture COVID-19 transmission and formulated as a nonlinear programming (NLP) model to minimize the total number of deaths in the population. In the NLP model, we explicitly take into account the two-dose vaccination procedure and several important epidemiologic features of COVID-19, such as pre-symptomatic and asymptomatic transmission, as well as group heterogeneity in susceptibility, symptom rates, severity, etc. We validated the applicability of the proposed model using a real case of the 2021 COVID-19 vaccination campaign in the Midlands of England. We conducted comparative studies to demonstrate the superiority of our method. Our numerical results show that prioritizing the allocation of vaccine resources to older age groups is a robust strategy to prevent more subsequent deaths. In addition, we show that releasing more vaccine doses for first-dose recipients could lead to a greater vaccination benefit than holding back second doses. We also find that it is necessary to maintain appropriate non-pharmaceutical interventions (NPIs) during the vaccination rollout, especially in low-resource settings. Furthermore, our analysis indicates that starting vaccination as soon as possible is able to markedly alleviate the epidemic impact when the vaccine resources are limited but are currently available. Our model provides an effective tool to assist policymakers in developing adaptive COVID-19 likewise vaccination strategies for better preparedness against future pandemic threats.

OPTN/SRTR 2021 Annual Data Report: Lung.

The number of lung transplants has continued to decline since 2020, a period that coincides with the onset of the COVID-19 pandemic. Lung allocation policy continues to undergo considerable change in preparation for adoption of the Composite Allocation Score system in 2023, beginning with multiple adaptations to the calculation of the Lung Allocation Score that occurred in 2021. The number of candidates added to the waiting list increased after a decline in 2020, while waitlist mortality has increased slightly with a decreased number of transplants. Time to transplant continues to improve, with 38.0% of candidates waiting fewer than 90 days for a transplant. Posttransplant survival remains stable, with 85.3% of transplant recipients surviving to 1 year; 67%, to 3 years; and 54.3%, to 5 years.

Influencing factors of health resource allocation and utilisation before and after COVID-19 based on RIF-I-OLS decomposition method: a longitudinal retrospective study in Guangdong Province, China.

OBJECTIVES: To explore factors that influenced the health resource allocation and utilisation before and after COVID-19, and subsequently offer sensible recommendations for advancing the scientific distribution of health resources. DESIGN: A longitudinal survey using 2017-2020 data, which were collected for analysis. SETTING: The study was conducted based on data collected from the Health Commission of Guangdong Province's website. OUTCOME MEASURES: Eight health resource indicators and four health resource utilisation indicators were included in the factor analysis. Four indices were calculated to measure the inequality in health resource allocation and utilisation. We analysed factors for the inequality indices using the recentred influence function index ordinary least squares decomposition method. RESULTS: The health resource inequality indices peaked in 2020 (Gini coefficient (Gini): 0.578, Absolute Gini coefficient (AGini): 1.136, Concentration Index (CI): 0.417, Absolute CI (ACI): 0.821), whereas the health resource utilisation inequality indices declined year by year, thus reaching their lowest point in that same year. The majority of inequality indices in the annual change of health resource allocation were at their lowest in 2020 (Gini: -1.672, AGini: 0.046, CI: -0.189, ACI: 0.005), while the use of health resources declined dramatically, showing a negative growth trend. The inequality indices of health resource allocation and utilisation in 2020 were affected by a number of variables, including the COVID-19 level, (p<0.05), while the proportion of expenditure on public health was the most significant one. CONCLUSIONS: Guangdong Province's health resource allocation and utilisation were still concentrated in economically developed regions from 2017 to 2020. The health resource allocation inequality indices increased, especially under COVID-19, but the health resource utilisation inequality indices decreased. Measures should be taken to adjust the health resource allocation scientifically, which will fulfil the changing needs and the use of resources more efficiently. One effective measure is reasonably increasing the proportion of expenditure on public health.

The Ethics of Implementing Emergency Resource Allocation Protocols.

AbstractWe explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention.

Resource allocation.

PURPOSE OF REVIEW: The coronavirus disease 2019 pandemic and recent global recessions have brought to the forefront of the medical-political discussion the fact that medical resources are finite and have focused a spotlight on fair allocation and prioritization of healthcare resources describe why this review is timely and relevant. RECENT FINDINGS: This review presents past and present concepts related to the ethics of resource allocation. Included are discussions regarding the topics of who should determine resource allocation, what types of research require allocation, methods currently in use to determine what resources are appropriate and which should be prioritized.describe the main themes in the literature covered by the article. SUMMARY: Models for resource allocation must differentiate between different types of resources, some of which may require early preparation or distribution. Local availability of specific resources, supplies and infrastructure must be taken into consideration during preparation. When planning for long durations of limited resource availability, the limitations of human resilience must also be considered. Preparation also requires information regarding the needs of the specific population at hand (e.g. age distributions, disease prevalence) and societal preferences must be acknowledged within possible limits.

Effects of Vertical Fiscal Imbalance on Fiscal Health Expenditure Efficiency-Evidence from China.

Improving fiscal health expenditure efficiency is an inherent requirement of the strategy of "healthy China" and "high-quality development". The outbreak of COVID-19 has highlighted the importance of efficient health system. First, this paper systematically sorts out the multiple theoretical mechanisms of the positive and negative relationship between vertical fiscal imbalance and fiscal health expenditure efficiency. Secondly, a comprehensive index system, including the quantity and quality of medical services, is constructed, and the super-efficiency DEA model is used to measure fiscal health expenditure efficiency. There are obvious differences between eastern and western regions. Finally, the fixed effect model is constructed to carry out empirical research and it is found that the vertical fiscal imbalance in China has an overall positive and significant impact on the fiscal health expenditure efficiency, which is mainly achieved by optimizing the resources allocation between primary medical institutions and hospitals. Heterogeneity analysis shows that transfer payment scale has a corrective effect on the vertical fiscal imbalance's effect. The result of quantile regression shows that the impact of vertical fiscal imbalance is not constant, and it gradually turns from positive to negative along with the improvement of fiscal health expenditure efficiency.

A novel Energy Resources Allocation Management model for air pollution reduction.

Although air pollution has been reduced in various industrial and crowded cities during the COVID-19 pandemic, curbing the high concentration of the crisis of air pollution in the megacity of Tehran is still a challenging issue. Thus, identifying the major factors that play significant roles in increasing contaminant concentration is vital. This study aimed to propose a mathematical model to reduce air pollution in a way that does not require citizen participation, limitation on energy usage, alternative energies, any policies on fuel-burn style, extra cost, or time to ensure that consumers have access to energy adequately. In this study, we proposed a novel framework, denoted as the Energy Resources Allocation Management (ERAM) model, to reduce air pollution. The ERAM is designed to optimize the allocation of various energies to the recipients. To do so, the ERAM model is simulated based on the magnitude of fuel demand consumption, the rate of air pollution emission generated by each energy per unit per consumer, and the air pollution contribution produced by each user. To evaluate the reflectiveness and illustrate the feasibility of the model, a real-world case study, i.e., Tehran, was employed. The air pollution emission factors in Tehran territory were identified by considering both mobile sources, e.g., motorcycles, cars, and heavy-duty vehicles, and stationary sources, e.g., energy conversion stations, industries, and household and commercial sectors, which are the main contributors to particulate matter and nitrogen dioxide. An elaborate view of the results indicates that the ERAM model on fuel distribution could remarkably reduce Tehran's air pollution concentration by up to 14%.

Does the Digital Economy Increase Green TFP in Cities?

COVID-19 accelerated the growth of the digital economy and digital transformation across the globe. Meanwhile, it also created a higher demand for productivity in the real economy. Hence, the correlation between the digital economy and green productivity is worth studying as COVID-19 prevention becomes the norm. The digital economy overcomes the limitations imposed by traditional factors of production on economic growth and empowers innovative R&D and resource allocation in all aspects. This study delved into the digital economy by focusing on its green value at different levels of development. The study gathered the green-productivity indices and the principal components of the digital economy for each prefecture-level city in China from 2011 to 2019 and meticulously portrayed their trends in spatial and temporal figures. Meanwhile, regression models were used to verify the mechanism through which digital-economy development influences the changes in green productivity. The results showed that: (1) a higher level of digital economy helps to increase urban green total-factor productivity (GTFP) and that the conclusions of this paper still held after potential endogeneity problems were solved through the instrumental-variables approach; (2) the digital economy will drive an increase in urban GTFP by upgrading firms' production technologies and that digital-economy development encourages green patent applications from firms; and (3) as the digital economy develops, it will also drive urban GTFP increases by removing polluting enterprises from the market and that the higher the level of digital-economy development, the greater the number and probability of polluting enterprises exiting the market. In view of this study's results, the government should increase the importance of the digital economy, strengthen the role of the digital economy in promoting urban green development, and provide more guidance on regional green development with the help of the digital economy.

The harm in and of COVID-19.

Coronavirus-19 (COVID-19) is a trending topic that is currently engaging the attention of scholars all over the globe. Much has been said and written about it in terms of its nature, mode of infection, the ethics, the harm and, of course, the best resource allocation and triaging paradigm. While offering theoretical explanation of why we need to make a distinction between harms in and of COVID-19, this paper, at the same time, exposes the harms in and of COVID-19, as well as offer examples of where both forms could be seen, using three spheres of reality, namely economy, education, and reproductive rights (abortion). Whereas it notes that harms in COVID-19 are those harms that are inherent in it and are direct vis-à-vis its victims, the paper observes that harms of COVID-19 are those harms that are causally, but only indirectly related to COVID-19. It concludes that knowledge of the distinction between harms in and of COVID-19 will be of use to the masses across the globe in checkmating the antics of those state actors in their respective jurisdictions who may wish to hide under the guise of combating the spread and menace of COVID-19 to carry out some hidden, selfish and vindictive agenda.

Trends in the disparities and equity of the distribution of traditional Chinese medicine health resources in China from 2010 to 2020.

BACKGROUND: At present, improving the accessibility to traditional Chinese medicine (TCM) health resources is an important component of China's health policy. This study evaluated the trends in the disparities and equity of TCM health resource allocation from 2010 to 2020 to inform optimal future local health planning and policy. METHOD: The data for this study were extracted from the China Health Statistical Yearbook (2011-2021) and China Urban Statistical Yearbook (2020). The equity and rationality of the allocation of TCM health resources at the national and provincial levels were evaluated using the Gini coefficient and the health resource aggregation degree, respectively. RESULT: The number of TCM-related institutions, beds, health staff, outpatients and admissions increased by 1.97, 2.61, 2.35, 1.72 and 2.41 times, respectively, between 2010 and 2020. The population-based Gini coefficients for health staff, beds and institutions were 0.12, 0.23 and 0.13, respectively, indicating acceptable equity, while the geographical area-based Gini index for health staff, beds and institutions were 0.65, 0.62 and 0.62, respectively, indicating serious inequity. The agglomeration degree as a function of geographical area was as follows: eastern region > central region > western region. Moreover, the institutional and health staff gaps between the geographical areas increased from 2012 to 2020. In addition, there was a relatively balanced agglomeration degree based on the population in these three regions and an increasingly equitable allocation of institutions and health staff. CONCLUSION: In recent years, China's TCM health resources and services have increased rapidly, but their proportions within the overall health system remain low. The equity and rationality of TCM health allocated by the population was better than that by the geographic area. Regional differences and inequalities, especially for institutions, still exist. A series of policies to promote the balanced development of TCM need to be implemented.

Children as an afterthought during COVID-19: defining a child-inclusive ethical framework for pandemic policymaking.

BACKGROUND: Following the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics-one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this framework from young people's perspectives, informed by advances in childhood ethics and children's rights. MAIN BODY: In this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted-aligned with the approach used by Thompson and colleagues-to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health. CONCLUSION: Efforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts.

An epidemic context elicits more prosocial decision-making in an intergroup social dilemma.

Societal challenges such as the COVID-19 pandemic have the quality of a social dilemma, in that they compel people to choose between acting in their own interests or the interests of a larger collective. Empirical evidence shows that the choices people make in a social dilemma are influenced by how this decision is framed. In four studies, we examined how context of an epidemic influences resource allocation decisions in a nested social dilemma task, where participants share resources between themselves, their subgroup, and a larger collective. Participants consistently allocated more resources to the collective in the context of the Ebola epidemic than in the context of a neighborhood improvement project, and these choices were strongly associated with prescriptive social norms. Together, the findings provide an experimental demonstration that the context of a quickly spreading disease encourages people to act more prosocially.

Avoiding Crisis Conditions in the Healthcare Infrastructure: 2 Case Studies in Statewide Collaboration.

In fall 2020, COVID-19 infections accelerated across the United States. For many states, a surge in COVID-19 cases meant planning for the allocation of scarce resources. Crisis standards of care planning focuses on maintaining high-quality clinical care amid extreme operating conditions. One of the primary goals of crisis standards of care planning is to use all preventive measures available to avoid reaching crisis conditions and the complex triage decisionmaking involved therein. Strategies to stay out of crisis must respond to the actual experience of people on the frontlines, or the "ground truth," to ensure efforts to increase critical care bed numbers and augment staff, equipment, supplies, and medications to provide an effective response to a public health emergency. Successful management of a surge event where healthcare needs exceed capacity requires coordinated strategies for scarce resource allocation. In this article, we examine the ground truth challenges encountered in response efforts during the fall surge of 2020 for 2 states-Nebraska and California-and the strategies each state used to enable healthcare facilities to stay out of crisis standards of care. Through these 2 cases, we identify key tools deployed to reduce surge and barriers to coordinated statewide support of the healthcare infrastructure. Finally, we offer considerations for operationalizing key tools to alleviate surge and recommendations for stronger statewide coordination in future public health emergencies.