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2.
Br J Anaesth ; 128(2): e100-e103, 2022 02.
Article in English | MEDLINE | ID: covidwho-1439905

ABSTRACT

Efficiency is an essential part of sustainable healthcare, especially in emergency and acute care (including surgical) settings. Waste minimisation, streamlined processes, and lean principles are all important for responsible stewardship of finite health resources. However, the promotion of efficiency above all else has effectively subordinated preparedness as a form of waste. Investment in preparedness is an essential part of resilient healthcare. The ongoing COVID-19 pandemic has exposed the gap between efficient processes and resilient systems in many health settings. In anticipation of future pandemics, natural disasters, and mass casualty incidents, health systems, and individual healthcare workers, must prioritise preparedness to be ready for the unexpected or for crises. This requires a reframing of priorities to view preparedness as crucial insurance against system failure during disasters, by taking advantage of lessons learnt preparing for war and mass casualty incidents.


Subject(s)
COVID-19/therapy , Civil Defense/methods , Delivery of Health Care/methods , Health Personnel , Mass Casualty Incidents/prevention & control , COVID-19/epidemiology , Civil Defense/trends , Delivery of Health Care/trends , Health Personnel/trends , Humans
3.
J Cardiovasc Med (Hagerstown) ; 22(9): 701-705, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1339452

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has thoroughly and deeply affected the provision of healthcare services worldwide. In order to limit the in-hospital infections and to redistribute the healthcare professionals, cardiac percutaneous intervention in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergency ones. The aim of this article is to describe the impact of the COVID-19 pandemic on Pediatric and ACHD cath laboratory activity during the so-called 'hard lockdown' in Italy. Eleven out of 12 Italian institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated in the survey. The interventional cardiology activity was reduced by more than 50% in 6 out of 11 centers. Adolescent and ACHD patients suffered the highest rate of reduction. There was an evident discrepancy in the management of the hard lockdown, irrespective of the number of COVID-19 positive cases registered, with a higher reduction in Southern Italy compared with the most affected regions (Lombardy, Piedmont, Veneto and Emilia Romagna). Although the pandemic was brilliantly addressed in most cases, we recognize the necessity for planning new, and hopefully homogeneous, strategies in order to be prepared for an upcoming new outbreak.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Emergency Medical Services , Heart Defects, Congenital , Infection Control , Risk Management/methods , Adolescent , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Civil Defense/methods , Civil Defense/trends , Disease Transmission, Infectious/prevention & control , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Organizational Innovation , SARS-CoV-2
4.
Health Secur ; 18(6): 473-482, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1217794

ABSTRACT

Mass vaccination is a crucial public health intervention during outbreaks or pandemics for which vaccines are available. The US government has sponsored the development of medical countermeasures, including vaccines, for public health emergencies; however, federally supported programs, including the Public Health and Emergency Preparedness program and Cities Readiness Initiative, have historically emphasized antibiotic pill dispensing over mass vaccination. While mass vaccination and pill dispensing programs share similarities, they also have fundamental differences that require dedicated preparedness efforts to address. To date, only a limited number of public assessments of local mass vaccination operational capabilities have been conducted. To fill this gap, we interviewed 37 public health and preparedness officials representing 33 jurisdictions across the United States. We aimed to characterize their existing mass vaccination operational capacities and identify challenges and lessons learned in order to support the efforts of other jurisdictions to improve mass vaccination preparedness. We found that most jurisdictions were not capable of or had not planned for rapidly vaccinating their populations within a short period of time (eg, 1 to 2 weeks). Many also noted that their focus on pill dispensing was driven largely by federal funding requirements and that preparedness efforts for mass vaccination were often self-motivated. Barriers to implementing rapid mass vaccination operations included insufficient personnel qualified to administer vaccinations, increased patient load compared to pill-dispensing modalities, logistical challenges to maintaining cold chain, and operational challenges addressing high-risk populations, including children, pregnant women, and non-English-speaking populations. Considering the expected availability of a severe acute respiratory syndrome coronavirus 2 vaccine for distribution and dispensing to the public, our findings highlight critical considerations for planning possible future mass vaccination events, including during the novel coronavirus disease 2019 pandemic.


Subject(s)
COVID-19 , Civil Defense/trends , Mass Vaccination/trends , Medical Countermeasures , Public Health , Vulnerable Populations/ethnology , Disaster Planning/trends , Humans , Mass Vaccination/organization & administration , Vaccination
8.
Value Health ; 24(5): 625-631, 2021 05.
Article in English | MEDLINE | ID: covidwho-1087117

ABSTRACT

The potential health and economic value of a vaccine for coronavirus disease (COVID-19) is self-evident given nearly 2 million deaths, "collateral" loss of life as other conditions go untreated, and massive economic damage. Results from the first licensed products are very encouraging; however, there are important reasons why we will likely need second and third generation vaccines. Dedicated incentives and funding focused explicitly on nurturing and advancing competing second and third generation vaccines are essential. This article proposes a collaborative, market-based financing mechanism for the world to incentivize and pay for the development of, and provide equitable access to, second and third generation COVID-19 vaccines. Specifically, we propose consideration of a Benefit-Based Advance Market Commitment (BBAMC). The BBAMC uses health technology assessment to determine value-based prices to guarantee overall market revenues, not revenue for any specific product or company. The poorest countries would not pay a value-based price but a discounted "tail-price." Innovators must agree to supply them at this tail price or to facilitate technology transfer to local licensees at low or zero cost to enable them to supply at this price. We expect these purchases to be paid for in full or large part by global donors. The BBAMC therefore sets prices in relation to value, protects intellectual property rights, encourages competition, and ensures all populations get access to vaccines, subject to agreed priority allocation rules.


Subject(s)
COVID-19/prevention & control , Global Health/economics , Immunization Programs/economics , COVID-19/drug therapy , COVID-19/economics , COVID-19 Vaccines/economics , COVID-19 Vaccines/therapeutic use , Civil Defense/methods , Civil Defense/trends , Economic Competition/standards , Economic Competition/trends , Global Health/trends , Humans , Immunization Programs/methods
9.
Nurs Forum ; 56(2): 439-443, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1066744

ABSTRACT

COVID-19 emerged in Wuhan, China, and began its worldwide journey. As the severity of the virus became known, the Chinese National Government mobilized resources, and their centralized management was critical to the containment of the epidemic. Healthcare agencies and providers were overwhelmed with patients, many of whom were critically ill and died. Nurses adapted to the work using personal protective equipment, but its initial scarcity contributed to stressful working conditions. Nurses in the United States can take several lessons from the experiences of their Chinese nurse colleagues, including the benefit of centralized management of the epidemic, the need for specialized treatment facilities, and the importance of a national stockpile of critical equipment and supplies. A fully funded United States Department of Health and Human Services Office of Pandemics and Emerging Threats is necessary. A nursing department within the office and a national mobilization plan to send nurses to support local efforts during a pandemic or other threat are likewise essential. Continuous training for nurses, especially caring for patients with infectious diseases in intensive care units, stress management, and how to comfort the dying, are also useful lessons.


Subject(s)
COVID-19/nursing , Education, Nursing/methods , China , Civil Defense/methods , Civil Defense/trends , Education, Nursing/trends , Humans , Pandemics/prevention & control , Personal Protective Equipment/standards , Personal Protective Equipment/supply & distribution , United States
11.
Disaster Med Public Health Prep ; 14(3): 377-383, 2020 06.
Article in English | MEDLINE | ID: covidwho-1041493

ABSTRACT

Disasters such as an earthquake, a flood, and an epidemic usually lead to large numbers of casualties accompanied by disruption of the functioning of local medical institutions. A rapid response of medical assistance and support is required. Mobile hospitals have been deployed by national and international organizations at disaster situations in the past decades, which play an important role in saving casualties and alleviating the shortage of medical resources. In this paper, we briefly introduce the types and characteristics of mobile hospitals used by medical teams in disaster rescue, including the aspects of structural form, organizational form, and mobile transportation. We also review the practices of mobile hospitals in disaster response and summarize the problems and needs of mobile hospitals in disaster rescue. Finally, we propose the development direction of mobile hospitals, especially on the development of intelligence, rapid deployment capabilities, and modularization, which provide suggestions for further research and development of mobile hospitals in the future.


Subject(s)
Civil Defense/instrumentation , Disasters , Mobile Health Units/trends , Civil Defense/methods , Civil Defense/trends , Humans
12.
Disaster Med Public Health Prep ; 14(3): 372-376, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1028605

ABSTRACT

The novel coronavirus (COVID-19) began in China in early December 2019 and rapidly has spread to many countries around the globe, with the number of confirmed cases increasing every day. An epidemic has been recorded since February 20 in a middle province in Northern Italy (Lodi province, in the low Po Valley). The first line hospital had to redesign its logistical and departmental structure to respond to the influx of COVID-19-positive patients who needed hospitalization. Logistical and structural strategies were guided by the crisis unit, managing in 8 days from the beginning of the epidemic to prepare the hospital to be ready to welcome more than 200 COVID-19-positive patients with different ventilatory requirements, keeping clean emergency access lines, and restoring surgical interventions and deferred urgent, routine activity.


Subject(s)
Coronavirus Infections/complications , Organization and Administration/standards , Pandemics/statistics & numerical data , Pneumonia, Viral/complications , COVID-19 , Civil Defense/methods , Civil Defense/trends , Coronavirus Infections/epidemiology , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Hospitalization/statistics & numerical data , Hospitals/statistics & numerical data , Humans , Italy/epidemiology , Organization and Administration/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/epidemiology
14.
J Pharmacol Exp Ther ; 376(1): 12-20, 2021 01.
Article in English | MEDLINE | ID: covidwho-966521

ABSTRACT

Faced with the health and economic consequences of the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the biomedical community came together to identify, diagnose, prevent, and treat the novel disease at breathtaking speeds. The field advanced from a publicly available viral genome to a commercialized globally scalable diagnostic biomarker test in less than 2 months, and first-in-human dosing with vaccines and repurposed antivirals followed shortly thereafter. This unprecedented efficiency was driven by three key factors: 1) international multistakeholder collaborations, 2) widespread data sharing, and 3) flexible regulatory standards tailored to meet the urgency of the situation. Learning from the remarkable success achieved during this public health crisis, we are proposing a biomarker-centric approach throughout the drug development pipeline. Although all therapeutic areas would benefit from end-to-end biomarker science, efforts should be prioritized to areas with the greatest unmet medical needs, including neurodegenerative diseases, chronic lower respiratory diseases, metabolic disorders, and malignant neoplasms. SIGNIFICANCE STATEMENT: Faced with the unprecedented threat of the severe acute respiratory syndrome coronavirus 2 pandemic, the biomedical community collaborated to develop a globally scalable diagnostic biomarker (viral DNA) that catalyzed therapeutic development at breathtaking speeds. Learning from this remarkable efficiency, we propose a multistakeholder biomarker-centric approach to drug development across therapeutic areas with unmet medical needs.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/epidemiology , Civil Defense/trends , Drug Development/trends , Drug Discovery/trends , Animals , Biomarkers/analysis , COVID-19/drug therapy , COVID-19/genetics , Civil Defense/methods , Drug Development/methods , Drug Discovery/methods , Genetic Markers/genetics , Humans , Pandemics
20.
Disaster Med Public Health Prep ; 14(3): e46-e48, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-646635

ABSTRACT

The prolongation of the Ebola epidemic may have allowed some countries to prepare and respond to the coronavirus disease (COVID-19) outbreak. In Uganda, the surveillance structure built for Ebola virus disease (EVD) has become a pillar in the COVID-19 response. This testing and tracing apparatus has limited disease spread to clusters with zero mortality compared with the neighboring East African countries. As more sub-Saharan countries implement social distancing to contain the outbreak, the interventions should be phased and balanced with health risk and socioeconomic situation. However, having a decision-making matrix would better guide the response team. These initial lessons from EVD-experienced Uganda may be helpful to other countries in the region.


Subject(s)
Civil Defense/standards , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Population Surveillance/methods , COVID-19 , Civil Defense/methods , Civil Defense/trends , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Uganda/epidemiology
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