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6.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 08 03.
Article in English | MEDLINE | ID: covidwho-1501266

ABSTRACT

PURPOSE: In this work, the authors present some of the key results found during early efforts to model the COVID-19 outbreak inside a UK prison. In particular, this study describes outputs from an idealised disease model that simulates the dynamics of a COVID-19 outbreak in a prison setting when varying levels of social interventions are in place, and a Monte Carlo-based model that assesses the reduction in risk of case importation, resulting from a process that requires incoming prisoners to undergo a period of self-isolation prior to admission into the general prison population. DESIGN/METHODOLOGY/APPROACH: Prisons, typically containing large populations confined in a small space with high degrees of mixing, have long been known to be especially susceptible to disease outbreaks. In an attempt to meet rising pressures from the emerging COVID-19 situation in early 2020, modellers for Public Health England's Joint Modelling Cell were asked to produce some rapid response work that sought to inform the approaches that Her Majesty's Prison and Probation Service (HMPPS) might take to reduce the risk of case importation and sustained transmission in prison environments. FINDINGS: Key results show that deploying social interventions has the potential to considerably reduce the total number of infections, while such actions could also reduce the probability that an initial infection will propagate into a prison-wide outbreak. For example, modelling showed that a 50% reduction in the risk of transmission (compared to an unmitigated outbreak) could deliver a 98% decrease in total number of cases, while this reduction could also result in 86.8% of outbreaks subsiding before more than five persons have become infected. Furthermore, this study also found that requiring new arrivals to self-isolate for 10 and 14 days prior to admission could detect up to 98% and 99% of incoming infections, respectively. RESEARCH LIMITATIONS/IMPLICATIONS: In this paper we have presented models which allow for the studying of COVID-19 in a prison scenario, while also allowing for the assessment of proposed social interventions. By publishing these works, the authors hope these methods might aid in the management of prisoners across additional scenarios and even during subsequent disease outbreaks. Such methods as described may also be readily applied use in other closed community settings. ORIGINALITY/VALUE: These works went towards informing HMPPS on the impacts that the described strategies might have during COVID-19 outbreaks inside UK prisons. The works described herein are readily amendable to the study of a range of addition outbreak scenarios. There is also room for these methods to be further developed and built upon which the timeliness of the original project did not permit.


Subject(s)
COVID-19/prevention & control , Disaster Planning/organization & administration , Disease Outbreaks/prevention & control , Prisoners/statistics & numerical data , Prisons/organization & administration , COVID-19/epidemiology , Disease Outbreaks/statistics & numerical data , Forecasting , Health Personnel/education , Humans , United Kingdom
7.
Elife ; 92020 06 08.
Article in English | MEDLINE | ID: covidwho-1497819

ABSTRACT

SARS-CoV-2 presents an unprecedented international challenge, but it will not be the last such threat. Here, we argue that the world needs to be much better prepared to rapidly detect, define and defeat future pandemics. We propose that a Global Immunological Observatory and associated developments in systems immunology, therapeutics and vaccine design should be at the heart of this enterprise.


Subject(s)
Communicable Disease Control/organization & administration , Communicable Diseases, Emerging/prevention & control , Coronavirus Infections/epidemiology , Disaster Planning/organization & administration , Global Health , International Cooperation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Population Surveillance , Animals , Anti-Infective Agents , COVID-19 , Climate Change , Cohort Studies , Communicable Disease Control/methods , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/immunology , Drug Development , Forecasting , Global Health/trends , Humans , Interdisciplinary Communication , Mass Screening/organization & administration , Models, Animal , Population Surveillance/methods , Serologic Tests , Vaccines , Weather , Zoonoses
10.
Acad Med ; 95(11): 1631-1633, 2020 11.
Article in English | MEDLINE | ID: covidwho-1373678

ABSTRACT

COVID-19 has disrupted every aspect of the U.S. health care and health professions education systems, creating anxiety, suffering, and chaos and exposing many of the flaws in the nation's public health, medical education, and political systems. The pandemic has starkly revealed the need for a better public health infrastructure and a health system with incentives for population health and prevention of disease as well as outstanding personalized curative health. It has also provided opportunities for innovations in health care and has inspired courageous actions of residents, who have responded to the needs of their patients despite risk to themselves. In this Invited Commentary, the author shares lessons he learned from 3 earlier disasters and discusses needed changes in medical education, health care, and health policy that the COVID-19 pandemic has revealed. He encourages health professions educators to use the experiences of this pandemic to reexamine the current curricular emphasis on the bioscientific model of health and to broaden the educational approach to incorporate the behavioral, social, and environmental factors that influence health. Surveillance for disease, investment in disease and injury prevention, and disaster planning should be basic elements of health professions education. Incorporating innovations such as telemedicine, used under duress during the pandemic, could alter educational and clinical approaches to create something better for students, residents, and patients. He explains that journals such as Academic Medicine can provide rapid, curated, expert advice that can be an important counterweight to the misinformation that circulates during disasters. Such journals can also inform their readers about new training in skills needed to mitigate the ongoing effects of the disaster and prepare the workforce for future disasters.


Subject(s)
Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Disaster Planning/organization & administration , Education, Medical/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health/education , Public Health/trends , Adult , Betacoronavirus , COVID-19 , Female , Forecasting , Humans , Male , Middle Aged , SARS-CoV-2 , United States
12.
Med Health Care Philos ; 23(4): 589-602, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1340476

ABSTRACT

This paper addresses global bioethical challenges entailed in emerging viral diseases, focussing on their socio-cultural dimension and seeing them as symptomatic of the current era of globalisation. Emerging viral threats exemplify the extent to which humans evolved into a global species, with a pervasive and irreversible impact on the planetary ecosystem. To effectively address these disruptive threats, an attitude of preparedness seems called for, not only on the viroscientific, but also on bioethical, regulatory and governance levels. This paper analyses the global bioethical challenges of emerging viral threats from a dialectical materialist (Marxist) perspective, focussing on three collisions: (1) the collision of expanding networks of globalisation with local husbandry practices; (2) the collision of global networks of mobility with disrupted ecosystems; and (3) the collision of viroscience as a globalised research field with existing regulatory frameworks. These collisions emerge in a force field defined by the simultaneity of the non-simultaneous. Evidence-based health policies invoke discontent as they reflect the normative logic of a globalised knowledge regime. The development of a global bioethics or macro-ethics requires us to envision these collisions not primarily as issues of benefits and risks, but first and foremost as normative tensions closely entangled with broader socio-economic and socio-cultural developments.


Subject(s)
COVID-19/epidemiology , Disaster Planning/organization & administration , Internationality , Philosophy, Medical , Virology/organization & administration , Bioethical Issues , Health Policy , Humans , SARS-CoV-2 , Socioeconomic Factors
13.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 08 03.
Article in English | MEDLINE | ID: covidwho-1337316

ABSTRACT

PURPOSE: In this work, the authors present some of the key results found during early efforts to model the COVID-19 outbreak inside a UK prison. In particular, this study describes outputs from an idealised disease model that simulates the dynamics of a COVID-19 outbreak in a prison setting when varying levels of social interventions are in place, and a Monte Carlo-based model that assesses the reduction in risk of case importation, resulting from a process that requires incoming prisoners to undergo a period of self-isolation prior to admission into the general prison population. DESIGN/METHODOLOGY/APPROACH: Prisons, typically containing large populations confined in a small space with high degrees of mixing, have long been known to be especially susceptible to disease outbreaks. In an attempt to meet rising pressures from the emerging COVID-19 situation in early 2020, modellers for Public Health England's Joint Modelling Cell were asked to produce some rapid response work that sought to inform the approaches that Her Majesty's Prison and Probation Service (HMPPS) might take to reduce the risk of case importation and sustained transmission in prison environments. FINDINGS: Key results show that deploying social interventions has the potential to considerably reduce the total number of infections, while such actions could also reduce the probability that an initial infection will propagate into a prison-wide outbreak. For example, modelling showed that a 50% reduction in the risk of transmission (compared to an unmitigated outbreak) could deliver a 98% decrease in total number of cases, while this reduction could also result in 86.8% of outbreaks subsiding before more than five persons have become infected. Furthermore, this study also found that requiring new arrivals to self-isolate for 10 and 14 days prior to admission could detect up to 98% and 99% of incoming infections, respectively. RESEARCH LIMITATIONS/IMPLICATIONS: In this paper we have presented models which allow for the studying of COVID-19 in a prison scenario, while also allowing for the assessment of proposed social interventions. By publishing these works, the authors hope these methods might aid in the management of prisoners across additional scenarios and even during subsequent disease outbreaks. Such methods as described may also be readily applied use in other closed community settings. ORIGINALITY/VALUE: These works went towards informing HMPPS on the impacts that the described strategies might have during COVID-19 outbreaks inside UK prisons. The works described herein are readily amendable to the study of a range of addition outbreak scenarios. There is also room for these methods to be further developed and built upon which the timeliness of the original project did not permit.


Subject(s)
COVID-19/prevention & control , Disaster Planning/organization & administration , Disease Outbreaks/prevention & control , Prisoners/statistics & numerical data , Prisons/organization & administration , COVID-19/epidemiology , Disease Outbreaks/statistics & numerical data , Forecasting , Health Personnel/education , Humans , United Kingdom
15.
Am J Public Health ; 111(S2): S93-S100, 2021 07.
Article in English | MEDLINE | ID: covidwho-1328024

ABSTRACT

Timely and accurate data on COVID-19 cases and COVID-19‒related deaths are essential for making decisions with significant health, economic, and policy implications. A new report from the National Academies of Sciences, Engineering, and Medicine proposes a uniform national framework for data collection to more accurately quantify disaster-related deaths, injuries, and illnesses. This article describes how following the report's recommendations could help improve the quality and timeliness of public health surveillance data during pandemics, with special attention to addressing gaps in the data necessary to understand pandemic-related health disparities.


Subject(s)
COVID-19/prevention & control , Disaster Planning/organization & administration , Disasters/prevention & control , Disease Outbreaks/prevention & control , Population Surveillance/methods , COVID-19/epidemiology , Communicable Disease Control/organization & administration , Disasters/statistics & numerical data , Disease Outbreaks/statistics & numerical data , Electronic Health Records/statistics & numerical data , Humans
17.
Am J Health Syst Pharm ; 77(19): 1592-1597, 2020 09 18.
Article in English | MEDLINE | ID: covidwho-1317905

ABSTRACT

PURPOSE: Guidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided. SUMMARY: In disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force's alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services. Important pharmacy planning issues include security and storage of drugs, state board of pharmacy and Drug Enforcement Administration licensing considerations, and staff credentialing, education, and training. Key medication management issues to be addressed in alternate site care planning include logistical challenges of supply chain maintenance, optimal workflow for compounded sterile preparations (eg, on-site preparation vs off-site preparation and delivery from a nearby hospital), and infusion pump availability and suitability to patient acuity levels. CONCLUSION: Planning for and operation of alternate care sites in disaster response situations should include involvement of pharmacists in key decision-making processes at the earliest planning stages.


Subject(s)
COVID-19/drug therapy , Decision Making, Organizational , Disaster Planning/organization & administration , Health Facility Planning/organization & administration , Pharmacy Service, Hospital/organization & administration , COVID-19/epidemiology , Emergencies , Health Facility Planning/standards , Health Services Accessibility/organization & administration , Humans , Medication Therapy Management/organization & administration , Models, Organizational , Pandemics/prevention & control , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , Practice Guidelines as Topic , Workflow
18.
Am J Health Syst Pharm ; 77(18): 1510-1515, 2020 09 04.
Article in English | MEDLINE | ID: covidwho-1317902

ABSTRACT

PURPOSE: To describe our hospital pharmacy department's preparation for an influx of critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic and offer guidance on clinical pharmacy services preparedness for similar crisis situations. SUMMARY: Personnel within the department of pharmacy at a medical center at the US epicenter of the COVID-19 pandemic proactively prepared a staffing and pharmacotherapeutic action plan in anticipation of an expected surge in admissions of critically ill patients with COVID-19 and expansion of acute care and intensive care unit (ICU) capacity. Guidance documents focusing on supportive care and pharmacotherapeutic treatment options were developed. Repurposing of non-ICU-trained clinical pharmacotherapy specialists to work collaboratively with clinician teams in ICUs was quickly implemented; staff were prepared for these duties through use of shared tools to facilitate education and practice standardization. CONCLUSION: As challenges were encountered at the initial peak of the pandemic, interdisciplinary collaboration and teamwork was crucial to ensure that all patients were proactively assessed and that their respective pharmacotherapeutic regimens were optimized.


Subject(s)
COVID-19/drug therapy , Medication Therapy Management/standards , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , COVID-19/epidemiology , Critical Care/organization & administration , Critical Care/standards , Critical Illness , Disaster Planning/organization & administration , Disaster Planning/standards , Emergencies , Humans , Intensive Care Units/organization & administration , Intensive Care Units/standards , Medication Therapy Management/organization & administration , Pandemics/prevention & control , Patient Care Team/organization & administration , Patient Care Team/standards , Pharmacy Service, Hospital/organization & administration , Practice Guidelines as Topic , Professional Role , Workforce/organization & administration , Workforce/standards
19.
Int J Technol Assess Health Care ; 37(1): e77, 2021 Jul 16.
Article in English | MEDLINE | ID: covidwho-1315573

ABSTRACT

Emergency preparedness is a continuous quality improvement process through which roles and responsibilities are defined to effectively anticipate, respond to, and recover from the impact of emergencies. This process results in documented plans that provide a backbone structure for developing the core capacities to address health threats. Nevertheless, several barriers can impair an effective preparedness planning, as it needs a 360° perspective to address each component according to the best evidence and practice. Preparedness planning shares common principles with health technology assessment (HTA) as both encompass a multidisciplinary and multistakeholder approach, follow an iterative cycle, adopt a 360° perspective on the impact of intervention measures, and conclude with decision-making support. Our "Perspective" illustrates how each HTA domain can address different component(s) of a preparedness plan that can indeed be seen as a container of multiple HTAs, which can then be used to populate the entire plan itself. This approach can allow one to overcome preparedness barriers, providing an independent, systematic, and robust tool to address the components and ensuring a comprehensive evaluation of their value in the mitigation of the impact of emergencies.


Subject(s)
Civil Defense/organization & administration , Disaster Planning/organization & administration , Technology Assessment, Biomedical/organization & administration , Civil Defense/economics , Civil Defense/standards , Disaster Planning/economics , Disaster Planning/standards , Evidence-Based Practice/standards , Humans
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