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1.
Acta Virol ; 65(4): 350-364, 2021.
Article in English | MEDLINE | ID: covidwho-1607905

ABSTRACT

Zoonotic transmission of highly pathogenic viruses, are a cause of deadly epidemics around the globe. These are of particular concern as evident from the recent global pandemic due to Coronavirus disease 2019 (COVID-19). The genus Ebolavirus belongs to the Filoviridae family and its members are known to cause the Ebola virus disease (EVD), a highly contagious disease with a mortality rate of approximately 90%. The similarity of the clinical symptoms to those of various tropical ailments poses a high risk of misdiagnosis. Diagnostic strategies currently utilized include real time reverse transcriptase polymerase chain reaction, amongst others. No specific treatment exists at present, and the management of patients is aimed at the treatment of complications augmented with supportive clinical care. The recent outbreak of EVD in West Africa, which began in 2014, led to accelerated development of vaccines and treatment. In this review, we contemplate the origin of the ebolaviruses, discuss the clinical aspects and treatment of the disease, depict the current diagnostic strategies of the virus, as well discuss its pathogenesis. Keywords: Ebolavirus; viral origin; treatment; pathogenicity of Ebola; Ebola virus disease.


Subject(s)
COVID-19 , Ebolavirus , Hemorrhagic Fever, Ebola , Disease Outbreaks , Ebolavirus/genetics , Hemorrhagic Fever, Ebola/diagnosis , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/therapy , Humans , Perception , SARS-CoV-2
2.
Infect Control Hosp Epidemiol ; 42(11): 1307-1312, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574178

ABSTRACT

OBJECTIVE: In response to the 2013-2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). DESIGN: A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. SETTING AND PARTICIPANTS: The questionnaire was sent to 82 ETCs. METHODS: We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. RESULTS: Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. CONCLUSIONS: There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Critical Illness , Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/therapy , Humans , Organizational Policy , SARS-CoV-2
3.
Clin Microbiol Rev ; 34(3)2021 06 16.
Article in English | MEDLINE | ID: covidwho-1501522

ABSTRACT

Public health laboratories (PHLs) continue to face internal and external challenges to their abilities to provide successful, timely responses to public health crises and emerging threats. These laboratories are mandated to maintain the health of their communities by identifying, diagnosing, and warning constituents of potential and real health emergencies. Due to the changing characteristics of public health threats and their cross-jurisdictional nature, laboratories are facing increased pressure to ensure that they respond in a consistent and coordinated manner. Here, the Association of Public Health Laboratories (APHL) Emerging Leader Program Cohort 11 members have compiled stories from subject matter experts (SMEs) at PHLs with direct involvement in crises to determine the characteristics of a successful response. Experts examined a diverse selection of emerging threats from across PHLs, including infectious diseases, opioids, natural disasters, and government shutdowns. While no public health crisis will be identical to another, overarching themes were consistent across subjects. Experiences from SMEs that could improve future responses to emerging threats are highlighted.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Hemorrhagic Fever, Ebola/diagnosis , Measles/diagnosis , Opioid-Related Disorders/diagnosis , Public Health/methods , COVID-19/epidemiology , Clinical Laboratory Techniques , Hemorrhagic Fever, Ebola/epidemiology , Humans , Laboratories , Measles/epidemiology , Opioid-Related Disorders/epidemiology
4.
PLoS One ; 16(10): e0258013, 2021.
Article in English | MEDLINE | ID: covidwho-1480448

ABSTRACT

BACKGROUND: The private versus public contribution to developing new health knowledge and interventions is deeply contentious. Proponents of commercial innovation highlight its role in late-stage clinical trials, regulatory approval, and widespread distribution. Proponents of public innovation point out the role of public institutions in forming the foundational knowledge undergirding downstream innovation. The rapidly evolving COVID-19 situation has brought with it uniquely proactive public involvement to characterize, treat, and prevent this novel health treat. How has this affected the share of research by industry and public institutions, particularly compared to the experience of previous pandemics, Ebola, H1N1 and Zika? METHODS: Using Embase, we categorized all publications for COVID-19, Ebola, H1N1 and Zika as having any author identified as affiliated with industry or not. We placed all disease areas on a common timeline of the number of days since the WHO had declared a Public Health Emergency of International Concern with a six-month lookback window. We plotted the number and proportion of publications over time using a smoothing function and plotted a rolling 30-day cumulative sum to illustrate the variability in publication outputs over time. RESULTS: Industry-affiliated articles represented 2% (1,773 articles) of publications over the 14 months observed for COVID-19, 7% (278 articles) over 7.1 years observed for Ebola, 5% (350 articles) over 12.4 years observed for H1N1, and 3% (160 articles) over the 5.7 years observed for Zika. The proportion of industry-affiliated publications built steadily over the time observed, eventually plateauing around 7.5% for Ebola, 5.5% for H1H1, and 3.5% for Zika. In contrast, COVID-19's proportion oscillated from 1.4% to above 2.7% and then declined again to 1.7%. At this point in the pandemic (i.e., 14 months since the PHEIC), the proportion of industry-affiliated articles had been higher for the other three disease areas; for example, the proportion for H1N1 was twice as high. CONCLUSIONS: While the industry-affiliated contribution to the biomedical literature for COVID is extraordinary in its absolute number, its proportional share is unprecedentedly low currently. Nevertheless, the world has witnessed one of the most remarkable mobilizations of the biomedical innovation ecosystem in history.


Subject(s)
COVID-19/epidemiology , Ebolavirus , Hemorrhagic Fever, Ebola/epidemiology , Influenza A Virus, H1N1 Subtype , Influenza, Human/epidemiology , Periodicals as Topic , SARS-CoV-2 , Zika Virus Infection/epidemiology , Zika Virus , Humans
5.
Ann Glob Health ; 87(1): 101, 2021.
Article in English | MEDLINE | ID: covidwho-1478342

ABSTRACT

The 5-year Resilient and Responsive Health Systems (RRHS)-Liberia Initiative, funded by PEPFAR via HRSA, launched in 2017 and was designed to support the implementation of Liberia's National Health Workforce Program as a means to improving HIV-related health outcomes. The COVID-19 pandemic, arrived in Liberia just five years after Ebola and during RRHS-Liberia's fourth year, impacted educational programs and threatened the project's continued work. This paper presents the challenges that the COVID-19 pandemic posed to the RRHS partners, as well as adaptations they made to maintain progress towards project goals: 1) contributing to Liberia's 95-95-95 HIV targets via direct service delivery, and 2) building a resilient and responsive health workforce in Liberia via instruction and training. Direct health service impacts included decreased patient volumes and understaffing; adaptations included development of and trainings on safety protocols, provision of telehealth services, and community health worker involvement. Instruction and training impacts included suspension of in-person teaching and learning; adaptations included utilization of multiple online learning and virtual conferencing tools, and increasing clinical didactics in lieu of bedside mentorship. The RRHS team recommends that these adaptations be continued with significant investment in technology, IT support, and training, as well as close coordination among partner institutions. Ultimately, the RRHS Liberia consortium and its partners made significant strides in response to ensuring ongoing education during the pandemic, an experience that will inform continued service delivery, teaching, and learning in Liberia.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , Liberia/epidemiology , Pandemics , SARS-CoV-2
6.
BMJ Open ; 11(10): e051645, 2021 10 20.
Article in English | MEDLINE | ID: covidwho-1476606

ABSTRACT

OBJECTIVES: Community health workers (CHWs) played important roles in supplementing scarce healthcare workforce in Sierra Leone during the Ebola outbreak, causing the government to launch the National Community Health Worker Policy 2016-2020. This study evaluated this ambitious policy and examined CHWs' sustainability through their job satisfaction and the underlying factors to inform new policy recommendations, especially the implication for COVID-19 containment. DESIGN: A mixed-methods approach applying structured questionnaires and semistructured interviews. SETTING AND PARTICIPANTS: 188 CHWs in Bombali District (key Ebola-stricken areas) of Sierra Leone, 184 of them participated in follow-up interviews. PRIMARY AND SECONDARY OUTCOME MEASURES: Quantitative and qualitative elements were triangulated to improve robustness of investigation: job satisfaction was measured by the Minnesota Satisfaction Questionnaire (MSQ), and factors associated with job satisfaction were identified through thematic analysis and multivariable logistic regression. RESULTS: The MSQ score of CHWs in Sierra Leone was 65.09, extremely low even among low-income and middle-income countries. Five themes (grouped from 16 subthemes) emerged through the semistructured interviews and were tested quantitatively. Payment was CHWs' top concern. Low stipend and payment tardiness were significantly associated with dissatisfaction. Those with Ebola experience were 5.20 times (95% CI 1.51 to 17.95, p=0.009) more likely to be dissatisfied. This study also found that working conditions, medical material supplies and career development were far from what the CHW policy promised. CHWs' commitment was the only 'positive' theme, and their intrinsic job satisfaction (mean=3.61) was much higher than the extrinsic job satisfaction (mean=2.72). CONCLUSIONS: Some critical components of the 2016 National Community Health Worker Policy, aiming to promote CHWs and strengthen primary healthcare, have severe shortfalls in practice. The Sierra Leone government should address the underlying factors that have impaired CHWs' job satisfaction to ensure sustainability of its CHW network, especially during the combat against COVID-19.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Community Health Workers , Cross-Sectional Studies , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , Job Satisfaction , Qualitative Research , SARS-CoV-2 , Sierra Leone
8.
Rev Sci Tech ; 39(2): 579-590, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-1453423

ABSTRACT

All-hazards preparedness and response planning requires ongoing individual, organisational and multi-jurisdictional learning. Disaster after-action reviews are an established emergency management practice to acquire knowledge through a process of analysing what happened and why, to improve the emergency response before the next crisis. After-action reviews help individuals and organisations learn, and are an essential step in the preparedness cycle. Human and animal health authorities have begun to employ after-action reviews for disaster preparedness and response among public health and Veterinary Services. The World Organisation for Animal Health (OIE) encourages Members to establish after-action reviews and share best practice. The adoption of afteraction review is an essential step for all provincial, national and multinational emergency management authorities to mitigate the impact of disasters on human and animal health. Emerging and re-emerging infectious diseases with pandemic potential pose unique preparedness challenges, requiring high-level policy attention to close long-standing gaps. A review of after-action reports from the 2001 anthrax bioterror attacks and of naturally occurring infectious disease crises, from the 2003 outbreak of severe acute respiratory syndrome (SARS) to the 2014 Ebola epidemic, reveal a similar pattern of repeated weakness and failures. These phenomena are described as 'lessons observed but not lessons learned'. Most infectious disease outbreaks with pandemic potential are zoonotic and require a One Health approach to prevent, prepare for and respond to global health security crises. After-action reviews in a One Health security context are essential to improve the pandemic preparedness of public health and Veterinary Services. After-action reviews can also provide the evidence-based 'feedback loop' needed to galvanise public policy and political will to translate lessons observed into sustained and applied lessons learned.


La planification de la préparation et de la réponse à tous les risques est un processus qui exige un apprentissage permanent tant à l'échelle des individus que des organisations et des différentes autorités compétentes. Les retours d'expérience (ou « revues après action¼) suite à une catastrophe constituent un exercice éprouvé de gestion des urgences visant à acquérir de nouvelles connaissances en procédant à l'analyse de ce qui est arrivé et des raisons pour lesquelles c'est arrivé, dans le but d'améliorer les capacités d'intervention d'urgence avant que ne survienne la prochaine crise. Les individus et les organisations trouvent dans ces retours un cadre pour tirer des enseignements de leur expérience, ce qui constitue une étape essentielle du cycle de préparation. Les autorités en charge de la santé humaine et de la santé animale ont commencé à utiliser les retours d'expérience pour planifier la préparation et la réponse au sein des Services de santé publique et des Services vétérinaires. L'Organisation mondiale de la santé animale (OIE) encourage ses Membres à mettre en place des retours d'expérience et à partager les meilleures pratiques en la matière. L'analyse des retours d'expérience est une étape cruciale pour que les autorités en charge de la gestion des urgences à l'échelle provinciale, nationale et internationale puissent atténuer l'impact des catastrophes sur la santé humaine et animale. Les maladies émergentes et ré-émergentes ayant un potentiel pandémique posent des défis exceptionnels en termes de préparation et exigent des prises de décision de haut niveau afin de pallier des lacunes souvent anciennes. L'examen des retours d'expérience datant des attentats terroristes à l'anthrax de 2001 et des crises sanitaires dues à des maladies infectieuses d'origine naturelle (depuis l'épidémie du syndrome respiratoire aigu sévère [SRAS] en 2003 jusqu'à l'épidémie d'Ebola en 2014) révèle des caractéristiques toujours similaires, avec à chaque fois les mêmes faiblesses et les mêmes écueils. Ce phénomène correspond à ce que l'on peut appeler des « leçons observées mais non apprises ¼. Compte tenu de la nature zoonotique de la plupart des foyers de maladies infectieuses ayant un potentiel pandémique, c'est l'approche Une seule santé qui doit prévaloir en matière de prévention, de préparation et de réponse aux crises de sécurité sanitaire d'envergure mondiale. Les retours d'expérience dans un contexte de sécurité Une seule santé sont essentiels pour améliorer la préparation des Services de santé publique et des Services vétérinaires aux pandémies. En outre, les « boucles de réaction¼ fondées sur des éléments factuels résultant des retours d'expérience apportent un éclairage indispensable pour inciter les pouvoirs publics à élaborer des mesures appropriées et pour créer la volonté politique de traduire les leçons observées en leçons durablement apprises et appliquées.La planificación de las labores de preparación y respuesta ante toda clase de peligros exige un permanente aprendizaje tanto personal como institucional y desde múltiples competencias. El examen de las intervenciones tras un desastre constituye un arraigado proceder de gestión de emergencias que sirve para aprender de la experiencia analizando el cómo y el porqué de lo sucedido y, a partir de ahí, mejorar los procesos de respuesta de emergencia antes de que advenga la siguiente crisis. Estos exámenes posteriores a las intervenciones, que ayudan a las personas y organizaciones a aprender, son una etapa fundamental del ciclo de preparación. Las autoridades sanitarias y zoosanitarias han empezado a utilizarlos en los servicios de salud pública y los Servicios Veterinarios con fines de preparación y respuesta para casos de desastre. La Organización Mundial de Sanidad Animal (OIE) alienta a sus Miembros a que establezcan este tipo de exámenes y pongan en común prácticas óptimas al respecto. La implantación del examen posterior a las intervenciones es un paso esencial para que todas las autoridades provinciales, nacionales e internacionales de gestión de emergencias estén en condiciones de mitigar los efectos sanitarios y zoosanitarios de un desastre. Las enfermedades infecciosas emergentes y reemergentes con potencial pandémico plantean singulares problemas de preparación, que requieren una atención y una labor normativa de alto nivel para solventar carencias históricas. El examen de los informes posteriores a las actuaciones de respuesta a los ataques bioterroristas perpetrados en 2001 con bacterias de carbunco (ántrax) y a crisis infecciosas de origen natural, desde el brote registrado en 2003 de síndrome respiratorio agudo severo (SRAS) hasta la epidemia causada por el virus del Ébola en 2014, revela un parecido patrón de fallos y carencias que se van repitiendo, fenómeno que se describe como «hechos observados sin enseñanzas extraídas¼. La mayoría de los brotes de enfermedades infecciosas con potencial pandémico son zoonóticos y exigen la aplicación de la lógica de Una sola salud para prevenir crisis sanitarias de dimensión mundial, prepararse para ellas y darles respuesta. Los exámenes posteriores a una intervención inscritos en el contexto de seguridad sanitaria de Una sola salud son esenciales para mejorar la preparación de los servicios de salud pública y los Servicios Veterinarios para episodios de pandemia. Estos procesos de examen también pueden alimentar con datos científicos el «ciclo de retroalimentación¼ que se requiere para galvanizar las políticas públicas y la voluntad política de traducir los hechos observados en enseñanzas extraídas que sean duraderas y se apliquen en la práctica.


Subject(s)
Disasters , Hemorrhagic Fever, Ebola , Animals , Disease Outbreaks/prevention & control , Disease Outbreaks/veterinary , Global Health , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/veterinary , Humans , Public Health
9.
BMJ Glob Health ; 6(9)2021 09.
Article in English | MEDLINE | ID: covidwho-1430189

ABSTRACT

INTRODUCTION: COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever) and rVSV-ZEBOV (Ebola virus disease). METHODS: We conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants' experiences. Interview data were analysed thematically according to seven implementation domains. RESULTS: Participants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities. CONCLUSION: As supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns.


Subject(s)
COVID-19 , Ebola Vaccines , Hemorrhagic Fever, Ebola , Meningitis , Yellow Fever , Adult , COVID-19 Vaccines , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , Immunization Programs , SARS-CoV-2 , Yellow Fever/epidemiology , Yellow Fever/prevention & control
10.
BMJ Glob Health ; 6(9)2021 09.
Article in English | MEDLINE | ID: covidwho-1416662

ABSTRACT

BACKGROUND: The WHO's Research and Development Blueprint priority list designates emerging diseases with the potential to generate public health emergencies for which insufficient preventive solutions exist. The list aims to reduce the time to the availability of resources that can avert public health crises. The current SARS-CoV-2 pandemic illustrates that an effective method of mitigating such crises is the pre-emptive prediction of outbreaks. This scoping review thus aimed to map and identify the evidence available to predict future outbreaks of the Blueprint diseases. METHODS: We conducted a scoping review of PubMed, Embase and Web of Science related to the evidence predicting future outbreaks of Ebola and Marburg virus, Zika virus, Lassa fever, Nipah and Henipaviral disease, Rift Valley fever, Crimean-Congo haemorrhagic fever, Severe acute respiratory syndrome, Middle East respiratory syndrome and Disease X. Prediction methods, outbreak features predicted and implementation of predictions were evaluated. We conducted a narrative and quantitative evidence synthesis to highlight prediction methods that could be further investigated for the prevention of Blueprint diseases and COVID-19 outbreaks. RESULTS: Out of 3959 articles identified, we included 58 articles based on inclusion criteria. 5 major prediction methods emerged; the most frequent being spatio-temporal risk maps predicting outbreak risk periods and locations through vector and climate data. Stochastic models were predominant. Rift Valley fever was the most predicted disease. Diseases with complex sociocultural factors such as Ebola were often predicted through multifactorial risk-based estimations. 10% of models were implemented by health authorities. No article predicted Disease X outbreaks. CONCLUSIONS: Spatiotemporal models for diseases with strong climatic and vectorial components, as in River Valley fever prediction, may currently best reduce the time to the availability of resources. A wide literature gap exists in the prediction of zoonoses with complex sociocultural and ecological dynamics such as Ebola, COVID-19 and especially Disease X.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Zika Virus Infection , Zika Virus , Animals , Disease Outbreaks/prevention & control , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , SARS-CoV-2 , World Health Organization
11.
Biomed Res Int ; 2021: 9989478, 2021.
Article in English | MEDLINE | ID: covidwho-1403128

ABSTRACT

Introduction: Recent experiences from global outbreaks have highlighted the severe disruptions in sexual and reproductive health services that expose women and girls to preventable health risks. Yet, to date, there is no review studying the possible impact of outbreaks on sexual and reproductive health (SRH). Methodology. Studies reporting outbreaks impacting sexual and reproductive health and pregnancy outcomes were identified using MEDLINE, Embase, and ISI-WoS. Reported impacts were reviewed at systems, community, and legislative levels. Results: The initial run listed 4423 studies; the 37 studies that met all inclusion criteria were mainly from Latin America and Africa. Studies on outbreaks of diseases like Zika and Ebola have documented declines in facility-based deliveries, contraceptive use, and antenatal and institutional care due to burdened healthcare system. Service usage was also impacted by a lack of trust in the healthcare system and system shocks, including workforce capacity and availability. At the community level, poverty and lack of awareness were critical contributors to poor access to SRH services. Assessing the target population's knowledge, attitude, beliefs, and behavior and using health literacy principles for communication were fundamental for designing service delivery. Online resources for SRH services were an acceptable medium of information among young adults. In outbreak situations, SRH and pregnancy outcomes were improved by implementing laboratory surveillance, free-of-cost contraceptive services, improved screening through professional training, and quality of care. In addition, mobile health clinics were reported to be effective in remote areas. Knowledge Contribution. In outbreaks, the interventions are categorized into preoutbreak, during, and postoutbreak periods. The proposed steps can help to improve and do course correction in emergencies. Though conducted before the COVID-19 crisis, the authors believe that lessons can be drawn from the paper to understand and mitigate the impact of the pandemic on sexual and reproductive health services.


Subject(s)
Disease Outbreaks , Reproductive Health Services , Cholera/epidemiology , Female , Health Knowledge, Attitudes, Practice , Hemorrhagic Fever, Ebola/epidemiology , Humans , Influenza, Human/epidemiology , Male , Pregnancy , Pregnancy Outcome , Zika Virus Infection/epidemiology
12.
J Infect Public Health ; 14(11): 1614-1619, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1401633

ABSTRACT

BACKGROUND: Within a few years, the global community has failed twice in responding to large viral infection outbreaks: the Ebola epidemic in 2014 and the SARS-Cov-2 pandemic in 2020. There is, however, no systematic approach or research available that analyses the repeated failures with regard to an adequate response to an epidemic. METHODS: For a better understanding of failing societal responses, we have analysed the available research literature on societal responses to epidemics and we propose a framework called the 'Epidemic Failure Cycle' (EFC). RESULTS: The EFC consists of four phases: Negligence, Arrogance/Denial, Panic and Analysis/Self-criticism. These phases fit largely with the current World Health Organization pandemic influenza phases: Interpandemic, Alert, Pandemic, Transition. By utilizing the Ebola epidemic and the SARS-Cov-2 pandemic as case studies, we show striking similarities in the response to these outbreaks during both crises. Finally, we suggest three major areas to be of utmost importance for triggering and maintaining the EFC. In terms of ecology, zoonoses, supposed to be the main biological origin for virus epidemics, have been largely neglected by politicians, the media and the scientific community. Socioeconomic and cultural conditions such as harsh living and working conditions as well as conspiracy theories hinder effective preventive and counter measures against epidemics. Lastly, in terms of epistemology, the reliance on knowledge about previous outbreaks has led to slow and inadequate decisions. CONCLUSIONS: We conclude that any current society has to be aware of the risks of repeating responses to epidemics that will fail. Being aware of the societal mechanisms that trigger inadequate responses may help to get to more appropriate decisions in the face of an epidemic.


Subject(s)
COVID-19 , Epidemics , Hemorrhagic Fever, Ebola , Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , Pandemics , SARS-CoV-2
13.
PLoS One ; 16(2): e0246515, 2021.
Article in English | MEDLINE | ID: covidwho-1388899

ABSTRACT

BACKGROUND: During health disaster events such as the current devastating havoc being inflicted on countries globally by the SARS-CoV-19 pandemic, mental health problems among survivors and frontline workers are likely concerns. However, during such health disaster events, stakeholders tend to give more precedence to the socio-economic and biomedical health consequences at the expense of mental health. Meanwhile, studies show that regardless of the kind of disaster/antecedent, all traumatic events trigger similar post-traumatic stress symptoms among survivors, families, and frontline workers. Thus, our study investigated the prevalence of anxiety, depression and insomnia symptoms among survivors of the 2014-2016 Ebola virus disease that plagued the West African sub-region. METHODS: We systematically retrieved peer-reviewed articles published between 1970 and 2019 from seven electronic databases, including Google Scholar, MEDLINE, PsychInfo, PubMed, Scopus, Springer Link, Web of Science on Ebola and post-traumatic stress disorder symptoms. A comprehensive hand search complemented this literature search. Of the 87 articles retrieved, only 13 met the inclusion criteria for this meta-analysis. RESULTS: After heterogeneity, influence, and publication bias analysis, our meta-analysis pooled proportion effects estimates showed a moderate to a high prevalence of anxiety (14%; 99% CI: 0.05-0.30), depression (15%; 99% CI: 0.11-0.21), and insomnia (22%; 99% CI: 0.13-0.36). Effect estimates ranging from (0.13; 99% CI: 0.05, 0.28) through to (0.11; 99% CI: 0.05-0.22), (0.15; 99% CI: 0.09-0.25) through to (0.13; 99% CI: 0.08-0.21) and (0.23; 99% CI: 0.11-0.41) to (0.23; 99% CI: 0.11-0.41) were respectively reported for anxiety, depression and insomnia symptoms. These findings suggest a significant amount of EVD survivors are struggling with anxiety, depression and insomnia symptoms. CONCLUSION: Our study provided the first-ever meta-analysis evidence of anxiety, depression, and insomnia symptoms among EVD survivors, and suggest that the predominant biomedical health response to regional and global health disasters should be complemented with trauma-related mental health services.


Subject(s)
Anxiety/complications , Depression/complications , Hemorrhagic Fever, Ebola/complications , Sleep Initiation and Maintenance Disorders/complications , Africa, Western/epidemiology , Anxiety/epidemiology , Anxiety Disorders/complications , Anxiety Disorders/epidemiology , Depression/epidemiology , Depressive Disorder/complications , Depressive Disorder/epidemiology , Ebolavirus/isolation & purification , Hemorrhagic Fever, Ebola/epidemiology , Humans , Prevalence , Sleep Initiation and Maintenance Disorders/epidemiology , Survivors
17.
BMC Health Serv Res ; 21(1): 831, 2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1362055

ABSTRACT

OBJECTIVE: This study aimed to assess health facilities' readiness to provide safe surgical care during Ebola and COVID-19 era in Uganda and in the Eastern DR Congo. METHODS: A cross-sectional study was conducted in selected national, regional referral and general hospital facilities in Uganda and in the eastern part of DR Congo from 1st August 2020 to 30th October 2020. Data was analysed using Stata version 15. RESULTS: The participation rate was of 37.5 % (72/192) for both countries. None of the hospitals fulfilled the readiness criteria for safe surgical care provision in both countries. The mean bed capacity of participating health facilities (HF) was 184 in Eastern DR Congo and 274 in Uganda with an average surgical ward bed capacity of 22.3 % (41/184) and 20.4 % (56/274) respectively. The mean number of operating rooms was 2 and 3 in Eastern DR Congo and Uganda respectively. Nine hospitals (12.5 %) reported being able to test for Ebola and 25 (34.7 %) being able to test for COVID-19. Postponing of elective surgeries was reported by 10 (13.9) participating hospitals. Only 7 (9.7 %) hospitals reported having a specific operating room for suspect or confirmed cases of Ebola or COVID-19. Appropriate Personal Protection Equipment (PPE) was reported to be available in 60 (83.3 %) hospitals. Most of the staff had appropriate training on donning and doffing of PPE 40 (55.6 %). Specific teams and protocols for safe surgical care provision were reported to be present in 61 (84.7 %) and 56 (77.8 %) respectively in Uganda and Eastern DR Congo participating hospitals. CONCLUSIONS: The lack of readiness to provide safe surgical care during Ebola and COVID-19 era across the participating hospitals in both countries indicate a need for strategies to enhance health facility supplies and readiness for safe surgical provision in resource-limited settings.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Health Facilities , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , SARS-CoV-2 , Uganda/epidemiology
20.
Curr Opin Infect Dis ; 34(5): 401-408, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1337302

ABSTRACT

PURPOSE OF REVIEW: Due to the impact of the COVID-19 pandemic this past year, we have witnessed a significant acceleration in the science, technology, and policy of global health security. This review highlights important progress made toward the mitigation of Zika, Ebola, and COVID-19 outbreaks. These epidemics and their shared features suggest a unified policy and technology agenda that could broadly improve global health security. RECENT FINDINGS: Molecular epidemiology is not yet in widespread use, but shows promise toward informing on-the-ground decision-making during outbreaks. Point-of-care (POC) diagnostics have been achieved for each of these threats; however, deployment of Zika and Ebola diagnostics lags behind those for COVID-19. POC metagenomics offers the possibility of identifying novel viruses. Vaccines have been successfully approved for Ebola and COVID-19, due in large part to public-private partnerships and advance purchase commitments. Therapeutics trials conducted during ongoing epidemics have identified effective antibody therapeutics for Ebola, as well as steroids (both inhaled and oral) and a broad-spectrum antiviral for COVID-19. SUMMARY: Achieving global health security remains a challenge, though headway has been made over the past years. Promising policy and technology strategies that would increase resilience across emerging viral pathogens should be pursued.


Subject(s)
COVID-19/epidemiology , Hemorrhagic Fever, Ebola/epidemiology , Zika Virus Infection/epidemiology , Animals , Disease Outbreaks/prevention & control , Global Health , Humans , Pandemics/prevention & control , SARS-CoV-2/pathogenicity , Zika Virus/pathogenicity
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