Task 10 - What has been published about information sharing and inter-sectoral collaboration?

Which are the methods for coordinating data-gathering with standardized nomenclature?

Sharing response information among planners, providers, and others

Understanding and mitigating barriers to information-sharing

Modern GIS technologies centre around web - based tools , improved data sharing and real - time information to support critical decision - making . Dashboards exemplify those ideals and have been extremely popular in sharing and understanding the spread of SARS - CoV - 2 coronavirus . Communication through map - based dashboards offers accessible information to people around the world eager to protect themselves and their communities . This tool type improves data transparency and helps authorities disseminate information .

During the prevention of coronavirus disease 2019 ( COVID - 19 ) , epidemiological data is essential for controlling the source of infection , cutting off the route of transmission , and protecting vulnerable populations . Following Law of the People ’ s Republic of China on Prevention and Treatment of Infectious Diseases and other related regulations , medical institutions have been authorized to collect the detailed information of patients , while it is still a formidable task in megacities because of the significant patient mobility and the existing information sharing barrier . As a smart city which strengthens precise epidemic prevention and control , Shanghai has established a multi - department platform named “ one - net management ” on dynamic information monitoring . By sharing epidemiological data with medical institutions under a safe environment , we believe that the ability to prevent and control epidemics among medical institutions will be effectively and comprehensively improved .

The kind of scientific information that has been produced in order to increase the knowledge of others , but is sent to an unrelated audience , is called perplexing information . For example , some high - level scientific information about coronavirus is sent to the general public or adolescents , who do not have enough knowledge and cannot understand it , which can in turn exacerbate their concerns . On the other hand , sometimes some simple content is sent to health professionals , for whom the content is elementary , and this can lead to wasting their time . Most of this content is shared on online social networks .

In addition to informing the general population , use of online media to share data on cases is facilitating rapid efforts at better understanding the epidemiology of the disease and its control . Notably , information from health agencies has guided mathematical modeling efforts to project case counts and assess potential impact of interventions , such as social distancing . 37 - 39 The robustness of modeling efforts to inform decision - making depends on the quality of data used to develop them . Especially at the start of an outbreak , it is important to distinguish between importations and community spread among all recorded cases in order to capture the growth of the epidemic accurately .

COVID - 19 presents a unique challenge to public health . Effective mitigation of the disease will require nontrivial efforts from a significant fraction of the world population , including social distancing and avoiding unnecessary interactions with others . No matter how stringently these measures are recommended , a fraction of people may not believe that they can or should act in ways that will limit the threat . The HBM is a model that has been used to study behaviors related to preventing or mitigating disease . It conceptualizes beliefs about disease as being comprised of the perception of the threat as severe and relevant , the perception of benefits of and barriers to acting , and the perception of one ' s intrinsic ability to act . As trusted , community - facing healthcare professionals , pharmacists are uniquely suited to bring about change in patient behaviors . Community pharmacists using HBM to reinforce COVID - 19 mitigation behaviors should appropriately emphasize the severity and susceptibility of the threat , emphasize barriers to acting , help patients identify ways to overcome barriers to acting , and reinforce self - efficacy beliefs .

How to recruit, support, and coordinate local expertise and capacity relevant to public health emergency response?

The World Health Organization ( WHO ) declared the current COVID - 19 a public health emergency of international concern on January 30 , 2020 . Countries in the Eastern Mediterranean Region ( EMR ) have a high vulnerability and variable capacity to respond to outbreaks . Many of these countries addressed the need for increasing capacity in the areas of surveillance and rapid response to public health threats . Moreover , countries addressed the need for communication strategies that direct the public to actions for self - and community protection . This viewpoint article aims to highlight the contribution of the Global Health Development ( GHD ) / Eastern Mediterranean Public Health Network ( EMPHNET ) and the EMR ’ s Field Epidemiology Training Program ( FETPs ) to prepare for and respond to the current COVID - 19 threat . GHD / EMPHNET has the scientific expertise to contribute to elevating the level of country alert and preparedness in the EMR and to provide technical support through health promotion , training and training materials , guidelines , coordination , and communication . The FETPs are currently actively participating in surveillance and screening at the ports of entry , development of communication materials and guidelines , and sharing information to health professionals and the public . However , some countries remain ill - equipped , have poor diagnostic capacity , and are in need of further capacity development in response to public health threats . It is essential that GHD / EMPHNET and FETPs continue building the capacity to respond to COVID - 19 and intensify support for preparedness and response to public health emergencies .

Objective To explore the main layout and countermeasures of Scientific research projects during the public health emergency of COVID - 19 . Methods Literature investigation method is applied to collect information of scientific research and emergency research projects of COVID - 19 funded since January 20th by different entities including national , provincial and municipal administrative departments , public health agencies , research institutes , universities and industries . Results Along with priorities identified for the emergency response and key research agendas , the national science and technology authorities at all levels and scientific research institutions have deployed a series of new science and technology projects , as well as a number of supporting policies and measures . Conclusions In the campaign of science and technology to deal with COVID - 19 , the leadership of Chinese government and their coordination with local agencies facilitated quick response in both R & amp ; D investment and supporting policies . Periodical achievement is recognized so far , and with the continuous development and in - depth research , the related scientific research results will be gathered into the core force of epidemic prevention . Moreover , it will improve China ' s capacity to deal with health emergencies and the level of medical health innovation , and better protect the health of the people .

In the most affected regions , the National Healthcare Service is close to collapse - the results of years of fragmentation and decades of finance cuts , privatisation , and deprivation of human and technical resources . The National Healthcare Service is regionally based , with local authorities responsible for the organisation and delivery of health services , leaving the Italian Government with a weak strategic leadership . Over the period 2010 - 19 , the National Healthcare Service suffered financial cuts of more than €37 billion , a progressive privatisation of health - care services . Public health expenditure as a proportion of gross domestic product was 6 · 6 % for the years 2018 - 20 and is forecast to fall to 6 · 4 % in 2022 . 2 The Lombardy region has the heaviest burden of the COVID - 19 pandemic , with ( as of March 19 , 2020 ) 19 884 total cases of the disease , 2168 deaths , and 1006 patients requiring advanced respiratory support . At its standard operational level , Lombardy has a capacity of 724 intensive care beds . 3 To tackle the medical equipment shortage , Italian Civil Protection undertook a fast - track public procurement to secure 3800 respiratory ventilators , an additional 30 million protective masks , and 67 000 severe acute respiratory syndrome coronavirus 2 ( SARS - CoV - 2 ) tests . 4 To avert the shortage of health workers produced by decades of inadequate recruitment practices , the Italian Government authorised regions to recruit 20 000 health workers , allocating €660 million for the purpose . 5 There are lessons to be learned from the current COVID - 19 pandemic . First , the Italian decentralisation and fragmentation of health services seems to have restricted timely interventions and effectiveness , and stronger national coordination should be in place . Second , health - care systems capacity and financing need to be more flexible to take into account exceptional emergencies . Third , in response to emergencies , solid partnerships between the private and public sector should be institutionalised . Finally , recruitment of human resources must be planned and financed with a long - term vision . Consistent management choices and a strong political commitment are needed to create a more sustainable system for the long run .

An important need remains for ensuring long - term sustainability of what is being built . Africa needs to continue its upward trajectory of activities so as to align public health resources , scientific expertise and experience , and political commitment so that any future infectious disease outbreaks can be stopped before they become an epidemic in Africa . Africa needs more investments into ONE - HEALTH collaborative activities across the continent in order to meet the challenges of current and future public health threats ( Kock et al . , 2020 ; Petersen et al . , 2019 ; Talisuna et al . , 2020 ; Hui et al . , 2020 ; Zumla et al . , 2016 ) . A whole new young generation of enthusiastic , committed and dedicated African public health workers , epidemiologists , researchers , healthcare workers and laboratory personnel have emerged over the past 5 years , and they need to be supported by security of funding to build their careers and sustain their capabilities to take forward their research and training portfolios . The future of Africa ' s public health security relies on them . Increased governmental and donor investments are required to advance locally led , world - class public health work with surveillance , data and analytics capabilities and further expanding state - of - the - art laboratory capacities with more trained personnel to sustain capacity to rapidly respond to outbreaks at their source . A well - planned long - term strategy from the Africa Union will add major value for consolidating African leadership of public health capacity building , training and research .

Just a few weeks before the first confirmed case of novel coronavirus ( COVID - 19 ) was reported in the United States , the US Centers for Disease Control and Prevention ( CDC ) issued a bold promise to the nation : the agency will use its scientific expertise to bring a new level of preparedness in the United States and global health security against current and growing threats , finally eliminate certain diseases , and bring an end to the devastation of epidemics . ( 1 ) The current outbreak of COVID - 19 reminds us how urgent this promise is and just how critical it is to continue to sustain and strengthen our nation ' s public health infrastructure . The unprecedented pace of the public health response to COVID - 19 has only been possible because of prior investments in public health preparedness . To accelerate our pace and meet the challenges of current and future health threats , we must advance our world - class data and analytics capabilities ; maintain and expand our state - of - the - art public health laboratory capacity ; continue building a workforce of trusted , expert , public health professionals ; sustain our capacity to rapidly respond to outbreaks at their source ; and assure a strong global and domestic preparedness capacity . ( Am J Public Health . Published online ahead of print February 13 , 2020 : e1 - e2 . doi : 10 . 2105 / AJPH . 2020 . 305618 ) .

Integration of federal/state/local public health surveillance systems

With increasing numbers of cases of coronavirus disease 2019 ( COVID - 19 ) globally and in the United States , Health and Human Services ( HHS ) Secretary Alex Azar declared a national public health emergency on January 31 . The emergency declaration of the HHS authorizes additional resources , enhanced federal powers , interjurisdictional coordination , and waivers of specific regulations . State and local public health emergency declarations are also likely . During crises , government has a special responsibility to thoughtfully balance public health protections and civil liberties .

Briefly stated , we need to make concerted efforts to be aware of and remain interested in the afflictions of individuals in remote villages . Global surveillance coupled with a sense of community are the starting points . These concepts need to be embraced and continually articulated by leaders of the Public Health System . These should be supplemented by federal research support for serious illnesses even if the illnesses are thought to belong to " other " people . The fact is that the boundaries between foreign or exotic and what is traditionally referred to as domestic or local have blurred . We in the developed world cannot afford to be disengaged or appear to show indifference to the health challenge of less fortunate populations living in remote sectors of the world . The noted ethicist Peter Singer argues that given the advances in transportation and communication , coupled with the emergence of transnational companies and universal problems , we must transcend national boundaries to embrace a new ethic of one world ( 16 ) . Our ability to care and reach out defines our humanity and importantly may impact the health of our own communities .

NREVSS is a passive surveillance network established by the U . S . Centers for Disease Control and Prevention ( CDC ) in the 1980s that collects specimen test results for several respiratory and enteric viruses from multiple laboratories across the United States [ 7 ] . NREVSS currently collects data from three different sources : directly from clinical , state , and local laboratories ; indirectly from state or local partners on behalf of laboratories within their jurisdictions ; and indirectly through the Public Health Laboratory Interoperability Project ( PHLIP ) .

An outbreak of coronavirus disease 2019 ( COVID - 19 ) caused by the 2019 novel coronavirus ( SARS - CoV - 2 ) began in Wuhan , Hubei Province , China in December 2019 , and has spread throughout China and to 31 other countries and territories , including the United States ( 1 ) . As of February 23 , 2020 , there were 76 , 936 reported cases in mainland China and 1 , 875 cases in locations outside mainland China ( 1 ) . There have been 2 , 462 associated deaths worldwide ; no deaths have been reported in the United States . Fourteen cases have been diagnosed in the United States , and an additional 39 cases have occurred among repatriated persons from high - risk settings , for a current total of 53 cases within the United States . This report summarizes the aggressive measures ( 2 , 3 ) that CDC , state and local health departments , multiple other federal agencies , and other partners are implementing to slow and try to contain transmission of COVID - 19 in the United States . These measures require the identification of cases and contacts of persons with COVID - 19 in the United States and the recommended assessment , monitoring , and care of travelers arriving from areas with substantial COVID - 19 transmission . Although these measures might not prevent widespread transmission of the virus in the United States , they are being implemented to 1 ) slow the spread of illness ; 2 ) provide time to better prepare state and local health departments , health care systems , businesses , educational organizations , and the general public in the event that widespread transmission occurs ; and 3 ) better characterize COVID - 19 to guide public health recommendations and the development and deployment of medical countermeasures , including diagnostics , therapeutics , and vaccines . U . S . public health authorities are monitoring the situation closely , and CDC is coordinating efforts with the World Health Organization ( WHO ) and other global partners . Interim guidance is available at https : / / www . cdc . gov / coronavirus / index . html . As more is learned about this novel virus and this outbreak , CDC will rapidly incorporate new knowledge into guidance for action by CDC , state and local health departments , health care providers , and communities .

The strict control of cross - infection in medical institutions is also key to preventing the further spread of the epidemic . In addition , actively mobilizing the population to participate in epidemic prevention and control is critical , and this can be achieved by accurate information dissemination and ongoing updates . Real - time updating the information of the epidemic situation can help to alleviate panic and reduce societal anxiety . A strong public health surveillance system to guide the response to the outbreak is important in the face of a lack of effective therapeutics or vaccines . Big data and artificial intelligence systems are tools that can be used to fully integrate the information , conduct comprehensive research and analyze public health risks . Last but not least , use of the Internet and the media to conduct health education for the people , publicize the correct knowledge of prevention , and offer online consultation to guide patients to seek medical treatment correctly are additional strategies that can be implemented to achieve viral containment .

Value of investments in baseline public health response infrastructure preparedness

Just a few weeks before the first confirmed case of novel coronavirus ( COVID - 19 ) was reported in the United States , the US Centers for Disease Control and Prevention ( CDC ) issued a bold promise to the nation : the agency will use its scientific expertise to bring a new level of preparedness in the United States and global health security against current and growing threats , finally eliminate certain diseases , and bring an end to the devastation of epidemics . ( 1 ) The current outbreak of COVID - 19 reminds us how urgent this promise is and just how critical it is to continue to sustain and strengthen our nation ' s public health infrastructure . The unprecedented pace of the public health response to COVID - 19 has only been possible because of prior investments in public health preparedness . To accelerate our pace and meet the challenges of current and future health threats , we must advance our world - class data and analytics capabilities ; maintain and expand our state - of - the - art public health laboratory capacity ; continue building a workforce of trusted , expert , public health professionals ; sustain our capacity to rapidly respond to outbreaks at their source ; and assure a strong global and domestic preparedness capacity . ( Am J Public Health . Published online ahead of print February 13 , 2020 : e1 - e2 . doi : 10 . 2105 / AJPH . 2020 . 305618 ) .

The aftermath of recent epidemics and pandemics ( eg , severe acute respiratory syndrome , H1N1 pandemic , Middle East respiratory syndrome , and Ebola ) have highlighted the need to reinforce national public health capabilities and infrastructures , including diseasesurveillance systems and laboratory networks , as well as human capacity ( eg , training in surveillance , epidemic response , and diagnostic testing ) . 27 , 28 National public health capabilities and infrastructures remain at the core of global health security , because they are the first line of defence in infectious disease emergencies . 27 Crisis management plans should be ready in each African country ; involvement of the international community should catalyse such preparedness . Our findings should help to inform urgent prioritisation for intensified support for preparedness and response in specific African countries found to be at moderate to high risk of importation of COVID - 19 and with relatively low capacity to manage the health emergency .

The SARS outbreak in 2002 clearly highlighted the weaknesses of China CDC ’ s system , their premier public health agency . However , once the outbreak ended , the government prioritized the strengthening of the CDC systems , improving public - health surveillance and laboratory systems , as well as the workforce - development program , through the Field Epidemiology Training Program . This investment in core public - health systems and infrastructure will no doubt be critical in the response to the current 2019 - nCoV outbreak . In fact , an evaluation conducted in 2012 showed the remarkable progress that China CDC has made since 2002 , which has resulted in quicker responses to emergent epidemics , with an overall completeness of public - health services significantly increasing from 47 . 4 % to 76 . 6 % ( ref . 9 ) .

Unfortunately , in resource - constrained settings , investment in this critical health protection infrastructure is a low priority compared with other health priorities . Health protection investment is analogous to an insurance policy e in good times when it is infrequently called upon it may be deemed unnecessary by policymakers . But this is a dangerous misperception . Furthermore , compared with other public health interventions , health protection interventions are highly cost - effective . 12 Disinvestment in health protection is risky as it is not easy to build up health protection infrastructure , skills , and workforce rapidly . Consequently , the risk of COVID - 19 is most likely to be greatest in developing countries that are most likely to lack the means and health protection systems to protect themselves . The burden of infection may , therefore , be heaviest in these countries .

A country ' s response capacity depends on the strength of its emergency preparedness and the regular testing and updating of national plans and capacities . 30 An effec tive response to an outbreak depends not only on the availability of adequate human resources and financing , but also on the ability to manage emergency logistics ( including the handling of supply chains for essential products that are required during an emergency ) . Our findings show that many countries need support to achieve these capacities and increased support should be provided as a global priority action to strengthen health security . Our findings on operational readiness capacities and enabling function , which are low in many low - resource countries , underline the importance of increasing investments in scaling up IHR capacities , as described in the 2019 annual report of the Global Preparedness Monitoring Board . 8 Another challenge underpinning low national preparedness capacities is insufficient investment in human capital and poor continuity planning . 18 , 31 , 32 The world needs to increase investment in anthropologists , data scientists , communication specialist , educationists , and economists , who are all essential in providing necessary support for the control of infectious disease outbreaks . 12 , 31 , 32 The important role these specialists play in responding to outbreaks , including Ebola virus , MERS - CoV , cholera , and measles are well documented , and a key lesson from these public health emergencies has been to ensure that these skillsets are developed further . 32 Our data reinforce this notion , given the low capacities that many countries have to prevent and respond to health emergencies and infectious disease outbreaks effectively .

Modes of communicating with target high-risk populations (elderly, health care workers)

Identifying those at high - risk will aid the public health response in controlling the spread of disease . Given the ubiquity of comorbidities in the elderly population , and their increased susceptibility to severe COVID - 19 infection ( 18 ) , knowledge on the differing prevalence and risk of various conditions may help to focus and tailor public health efforts such as the screening of asymptomatic individuals , risk communication , contact tracing , self - isolation and social distancing . For instance , for COPD , which is less common in the general population and very strongly associated with ICU admission , a more targeted and intensive health protection strategy may be warranted , compared to other conditions ( such as hypertension ) that are more difficult to target due to their higher prevalence in the general population .

SARS - CoV has been isolated in sputum samples , nasal secretions , serum specimens , feces samples , and bronchial washings [ 5 , 14 ] . Evidence suggests that SARS - CoV is transmitted by contact and / or droplets [ 6 , 15 ] and that the use of any mask ( surgical or N95 ) significantly decreases the risk of infection [ 16 ] . However , there are cases that defy explanation based on these modes of transmission , suggesting that alternative modes of transmission may also exist [ 13 , 17 ] . SARS - CoV remains viable in feces for days [ 18 ] , and the outbreak at the Amoy Gardens apartments highlights the possibility of a fecal - oral or fecal - droplet mode of transmission [ 19 , 20 ] . A number of cases occurred in health care workers wearing protective equipment following exposure to high - risk aerosol - and droplet - generating procedures , such as airway manipulation , administration of aerosolized medications , noninvasive positive pressure ventilation , and bronchoscopy or intubation [ 17 , 21 , 22 ] . When intubation is necessary , measures should be taken to reduce unnecessary exposure to health care workers , including reducing the number of health care workers present and adequately sedating or paralyzing the patient to reduce cough . Updated infection control precautions for patients who have SARS are available from the Centers for Disease Control and Prevention ( CDC ) at http : / / www . cdc . gov / ncidod / sars / index . htm .

J o u r n a l P r e - p r o o f Physicians can employ virtual communication with patients in the form of telemedicine . 4 Telemedicine allows interactions with patients while adhering to social distancing . Patients at risk , may benefit from staying at home , reducing exposure to others , while receiving medical care . Elderly populations have more medical conditions / comorbidities thus requiring increased doctor visits . With telemedicine , elderly patients can continue their care , lowering their nonemergent office visits . It is essential to employ all modes of reducing transmission and telemedicine allows this without compromising care .

In recent years , Chinese health workers are often confronted with frustrating situations in the health care system including serious workplace violence against clinicians . A meta - analysis found that the overall prevalence of workplace violence was 62 . 4 % among Chinese health workers 9 . Regardless of the unsafe clinical environment , Chinese health workers are always committed to provide timely health services without any hesitation or reservations . For instance , as of February 12 , 2020 , a total of 189 external expert teams comprising 21 , 569 health workers from other regions of China have volunteered to work in Hubei province , disregarding the high risk of contracting the infection and the high mortality rate of the COVID - 19 among health workers 10 .

This was a heroic effort . Health care workers in Hubei province have provided patient care in an overwhelming epidemic while they themselves are one of the highest risk groups for development of disease . As we saw during the 2014 Ebola outbreak in West Africa , obtaining high - quality clinical trial data to guide the care of patients is extremely difficult in the face of an epidemic , and the feasibility of a randomized design has been called into question . 3 Yet Cao ’ s group of determined investigators not only succeeded but ended up enrolling a larger number of patients ( 199 ) than originally targeted .

Risk communication and guidelines that are easy to understand and follow

Abstract Context The COVID - 19 pandemic created a rapid and unprecedented shift in our medical system . Medical providers , teams , and organizations have needed to shift their visits away from face - to - face visits and toward telehealth ( both by phone and through video ) . Palliative care teams who practice in the community setting are faced with a difficult task : How do we actively triage the most urgent visits while keeping our vulnerable patients safe from the pandemic ? Measures The following are recommendations created by the Palo Alto Medical Foundation Palliative Care and Support Services team to help triage and coordinate for timely , safe , and effective palliative care in the community and outpatient setting during the ongoing COVID - 19 pandemic . Patients are initially triaged based on location followed by acuity . Interdisciplinary care is implemented using strict infection control guidelines in the setting of limited personal protective equipment ( PPE ) resources . We implement thorough screening for COVID - 19 symptoms at multiple levels before a patient is seen by a designated provider . Conclusions / Lessons Learned We recommend active triaging , communication , frequent screening for COVID - 19 symptoms for palliative care patients been evaluated in the community setting . An understanding of infection risk , mutual consent between designated providers , patients , and their families are crucial to maintaining safety while delivering community - based palliative care during the COVID - 19 pandemic .

The WHO also issued detailed guidelines on the use of face masks in the community , during care at home , and in the health care settings of COVID - 19 [ 56 ] . In this document , health care workers are recommended to use particulate respirators such as those certified N95 or FFP2 when performing aerosol - generating procedures and to use medical masks while providing any care to suspected or confirmed cases . According to this guideline , individuals with respiratory symptoms are advised to use medical masks both in health care and home care settings properly following the infection prevention guidelines . According to this guideline , an individual without respiratory symptoms is not required to wear a medical mask when in public . Proper use and disposal of masks is important to avoid any increase in risk of transmission [ 56 ] .

Working with journalists and the media to help them understand the science and epidemiology , particularly in a fast moving event , will improve risk communication to the public and reduce inappropriate concerns and panic .

Medical professionals require an up - to - date guideline to follow when an urgent healthcare problem emerging . In response to the requests for reliable advice from frontline clinicians and public healthcare professionals managing 2019 - nCoV pandemics , we developed this rapid advance guideline , involving disease epidemiology , etiology , diagnosis , treatment , nursing , and hospital infection control for clinicians , and also for public health workers and community residents .

The NHC also formulated a community prevention and control program for SARS - CoV - 2 pneumonia to strengthen community - level epidemic prevention measures to control the spread of the outbreak [ 129 ] . All communities screen patients with fever within the community and monitor and report suspected cases with COVID - 19 . Various forms of health education have been carried out in the community to disseminate knowledge of epidemic prevention and control , such as using masks and washing hands correctly . The NHC issued guidelines for the protection of people at different levels of risk for COVID - 19 [ 130 ] .

Communication that indicates potential risk of disease to all population groups

Patients with cancer are known to be at an increased risk for community acquired respiratory viruses , such as influenza , due to their frequently observed immunocompromised state . 5 The spread of SARS - CoV - 2 is of particular concern in this vulnerable population , given the higher case fatality rate seen in Wuhan , and the potentially increased severity of the disease course with COVID - 19 . 4 , 6

The large majority of the deaths in non - elderly individuals occur in patients who have underlying diseases . Based on existing data to - date , 7 - 9 cardiovascular disease , hypertension , chronic obstructive pulmonary disease and severe asthma , diabetes , kidney failure , severe liver disease , immunodeficiency , and malignancy may confer an increased risk of adverse outcome . Individuals with these diseases should consider that their risk may be higher than average and rigorous prognostic models need to be developed to estimate with accuracy the increased risk . In non - elderly populations , the more prevalent of these conditions is cardiovascular disease and hypertension , with prevalence of approximately 10 % in the 20 - 39 age group and 38 % in the 40 - 59 age group in the USA 24 and similarly high percentages in many other countries . Unfortunately , we could not identify data with the prevalence of these conditions specifically among the non - elderly deceased patients with COVID - 19 , and we encourage public health authorities to start reporting systematically data on comorbidities according to age strata . However , some data are available for the prevalence of these conditions across all age groups of COVID - 19 deaths . For example , in the Netherlands , 49 % of individuals dying with COVID - 19 had cardiovascular disease or hypertension , and 27 % had chronic pulmonary disease . Comparing with the prevalence of these diseases in the general population , 25 it is likely that ~ 2 - fold increases in death risk may be reasonable to expect for people with these conditions in the general population . If so , the risk may remain very low , except in a minority of patients with the most severe manifestations of the underlying diseases .

Outbreaks create fear , and fear is a key ingredient for racism and xenophobia to thrive . The coronavirus disease 2019 ( COVID - 19 ) pandemic has uncovered social and political fractures within communities , with racialised and discriminatory responses to fear , disproportionately affecting marginalised groups . Throughout history , infectious diseases have been associated with othering . 1 Following the spread of COVID - 19 from Wuhan , China , discrimination towards Chinese people has increased . This includes individual acts of microaggression or violence , to collective forms , for example Chinese people being barred from establishments . 2 Rather than being an equaliser , given its ability to affect anyone , COVID - 19 policy responses have disproportionately affected people of colour and migrantspeople who are over - represented in lower socioeconomic groups , have limited health - care access , or work in precarious jobs . This is especially so in resource - poor settings that lack forms of social protection . Selfisolation is often not possible , leading to higher risk of viral spread . Ethnic minority groups are also at greater risk because of comorbidities - for example , high rates of hypertension in Black populations 3 and diabetes in south Asians . 4 Furthermore , migrants , particularly those without documents , avoid hospitals for fear of identification and reporting , ultimately presenting late with potentially more advanced disease .

Three out of 2 , 004 persons have confirmed 2019 - nCoV infection in our study , which highlighted the importance of home quarantine . Quarantine is defined as restricting movement of people who have potentially been exposed to infectious diseases , to prevent the transmission 8 , 9 . It has been widely used in response to plague , e . g the ' Black Death " , severe acute respiratory syndrome ( SARS ) , and Ebola outbreaks [ 10 ] [ 11 ] [ 12 ] [ 13 ] . In current COVID - 19 outbreak , the " Three in One " Task Force , composed of community work stations , community health centers and community police , is responsible for home quarantine and medical observation in As of March 31 , 2020 , there was no other case reported in the study population or in close contacts with our study population , there was also no case reported in people who finished home quarantine in Shenzhen . This indicates that although there was case tested positive after 14 days of home quarantine in our study , the risk of second outbreak due to people who complete home quarantine may be low . However , further information and study is required to estimate if asymptomatic patients are highly contagious . 13 The main limitation of this study is that nasopharyngeal swab sample was collected only once .

Africa may be uniquely positioned to have the most severe and under - detected outcomes related to COVID - 19 infection . 7 The continent ' s countries are among those most at - risk of widespread disease threats , per several indices of epidemic preparedness . The World Health Organization ' s ( WHO ) State Party Self - Assessment Annual Reporting ( SPAR ) database assigns scores to countries to assess capacities needed to detect , assess , notify , report , and respond to public health risk and acute events of domestic and international concern . 1 , 8 Similarly , the Infectious Disease Vulnerability Index ( IDVI ) developed by the RAND Corporation and the Global Health Security Index ( GHSI ) by Johns Hopkins University 9 use a variety of healthcare , economic , demographic , and political factors to assess the vulnerability of a country to prevent or contain an infectious disease outbreak . 10 Using such indices , recent work has shown most of Sub - Saharan Africa ( SSA ) to be at risk of COVID - 19 importation and at reduced capacity to contain outbreaks due to lack of economic and medical resources . 1 While it appears that the age groups at highest risk of severe COVID - 19 disease and death ( those > 60 years old ) 6 , 11 may be proportionately less in many SSA countries than in other parts of the world , the populations in many of these countries are at increased risk of having untreated chronic conditions due to weak health systems . 12 As a result , individuals with cardiovascular diseases or diabetes , 13 , 14 sickle - cell disease , or conditions associated with immunosuppression , 15 , 16 which exacerbate the immune response to SARS - CoV2 infection , may contribute to higher - than - expected mortality for younger age groups .

Misunderstanding around containment and mitigation

Action plan to mitigate gaps and problems of inequity in the Nation’s public health capability, capacity, and funding to ensure all citizens in need are supported and can access information, surveillance, and treatment

Several specific actions can mitigate future threats to the health of the global population . First , we need to fully implement the International Health Regulations ( IHR ) in countries of all income levels . Reports from WHO and the Global Preparedness Monitoring Board have shown that responses to urgent crises have improved under the IHR ( 2005 ) , but important deficiencies in coverage still exist . 3 , 4 We must scale up laboratory capacity and other surveillance capabilities , augment the readiness of health systems to care for large numbers of seriously ill patients while safe guarding the health - care workforce , and improve communication and coordination strategies and implementation . 5 Procurement and supply chain management must also be enhanced to ensure adequate stocks of personal protective equipment and essential medications and to enable equitable access to new diagnostics , therapeutics , and vaccines during health emergencies . 6 Second , we need to accelerate progress towards achieving the priorities and targets of the Sendai Framework for Disaster Risk Reduction , 7 which was adopted by UN member nations in 2015 . The Sendai Framework applies an all - hazards approach to increasing international , regional , national , and local resilience to withstand a broad spectrum of disasters , including epidemics , pandemics , and epizootics . Preparedness for emerging infectious diseases requires strengthening health systems and developing response plans that account for the social , environmental , political , and institutional factors that can either support or disrupt emergency management efforts . 8 The Sendai Framework complements the IHR by integrating infrastructure , climate change , and economic considerations into disaster management plans and promoting inclusive policies that protect vulnerable populations during all phases of mitigation , preparedness , response , and recovery . 7 Third , plans for preventing , detecting , and controlling outbreaks of emerging infectious diseases need to be built on a One Health foundation that emphasises the interconnectedness of humans , animals , and ecosystems . 9 Transdisciplinary , multisectoral strategies are necessary when seeking to solve complex problems that threaten global public health and safety . 10 More specifically in relation to diseases such as COVID - 19 , One Health focuses on the danger existing at the human - wildlife interface . The ability to detect viruses in livestock and wildlife is a crucial component of early warning systems for human pandemics . 11

Many countries are struggling to sustain or develop their national preparedness capacities , primarily because of a lack of resources , competing national priorities , and a high turnover of health - care workers . Only half of the countries analysed in this study have the provision for adequate resources for emer gencies , and these countries are mostly either high - income or middle - income countries . Urgent action is needed to ensure that capacities are in place to prevent and manage health emergencies . The outbreak of COVID - 19 is another opportunity to review the preparedness of all countries and apply key recommendations from other major public health emergencies to better protect the world against future health emergencies .

The 2030 Agenda for Sustainable Development explicitly mentions sexual and reproductive health , with Sustainable Development Goal target 3 . 7 stating “ [ b ] y 2030 , ensure universal access to sexual and reproductive health - care services , including for family planning , information and education , and the integration of reproductive health into national strategies and programmes ” [ 13 ] . The WHO and UNFPA have a common objective to achieve this goal and the best way to do so is through the achievement of Universal Health Coverage ( UHC ) , which would allow everyone to obtain the health services they need , when and where they need them , without facing financial hardship . Doing so will require the government to reach all vulnerable populations with a full range of quality services that are based on their needs , such as : contraceptive services ; maternal and newborn care ; prevention and control of sexually transmitted infections ( STIs ) , including HIV ; comprehensive sexuality education ; safe abortion care , including post - abortion care ; prevention , detection , and counselling for gender - based violence ; prevention and treatment of infertility and cervical cancer ; and counselling and care for sexual health and wellbeing [ 14 ] . However , during the global health emergencies , there is a total reversal of priorities and , as a result , the availability , accessibility and affordability of SRHR services may become challenging especially in resource - poor settings . All these global epidemics have been weakening the health care systems and increasing the barriers to access reproductive health services in the LMICs , especially by impacting the economic , social and personal decision - making of women . As highlighted by Ahmed et al . ( 2020 ) , policymakers , providers and advocates must be aware of the broad links between global outbreak response and SRHR in order to prepare mitigation strategies [ 12 ] . In this time of global pandemic of Covid - 19 and the new demand placed on the system to cope with the resulting new demands , Action Canada for Sexual Health and Rights has emphasized in its statement that there are concerns regarding increased wait times to access SRHR services , difficulties in accessing SRHR medications ( including contraceptives , hormone therapy and HIV treatment and increased health risks ) , and increased health risks experienced by pregnant and immune - compromised people . These crisis situations expose the social , economic and health inequalities and emphasize the need for building an equitable world [ 15 ] . The report from African Development confirms the impossibility of building resilience to Ebola and future infectious disease shocks in households and communities without also addressing systemic gender inequality [ 16 ] , national development strategies for EVD response ( or any EID ) , and gender - sensitive recovery that addresses the associated negative impacts on women and girls [ 17 ] .

China ’ s capacity to contain the spread of COVID - 19 hinges on the strength and resilience of its national health system ( NHS ) , disease surveillance system and other systems that address social determinants of health ( SDH ) . The Universal Health Coverage ( UHC ) service coverage index [ 4 ] for China of 76 % implies a gap in coverage of essential health services ( reproductive , maternal , newborn and child health ; infectious diseases ; noncommunicable diseases ( NCD ) ; and service capacity and access ) of 24 % [ 5 ] . The average of 13 international health regulations ( IHR ) core capacities ( i . e . legislation and financing , coordination and national focal point , zoonotic events , and the human - animal interface , food safety , laboratory , surveillance , human resources , national health emergency framework , health service provision , risk communication , points of entry , chemical events , and radiation emergencies ) scores for China is 94 % ; implying gaps in IHR core capacities of 6 % [ 6 ] . Approximately , 92 % of China ’ s population uses safely managed drinking water services , implying a gap of 8 % [ 7 ] . And the population using safely managed sanitation services is 72 % , meaning the existence of a coverage gap of 28 % . Also , nearly 4 . 9 % of adults ( those aged 15 years and above ) are not literate [ 8 ] . The gaps in NHS ( as indicated by coverage of essential health services ) , disease surveillance ( shown in the sub - optimal IHR capacities ) , and systems that tackle SDH ( such as water , sanitation , and education ) might hamper China ’ s efforts expand effective coverage of various preventive interventions against COVID - 19 .

As many PICTs struggle to deliver even the most basic public health services , international assistance to help prepare for and respond to COVID - 19 is essential . Efforts should focus on enhancing capacity to provide care for severely ill cases , including ensuring access to medical oxygen , ventilators and other vital equipment ; ensuring equipment is available ; that protocols are in place to prevent and manage hospital - acquired infections ; and that the workforce is trained and equipped to stay safe ; surveillance is adequate to identify and track cases in the initial stages of an outbreak , and monitor the temporo - spatial distribution and severity of illness if the disease spreads ; that laboratories are resourced to test samples ; that measures are in place at airports to detect and treat ill travellers and that risk communication mechanisms are in place to ensure the public has access to the correct information and advice .

Measures to reach marginalized and disadvantaged populations

One positive step is from the European Central Bank , which announced a no - limits commitment to protect European economies on March 19 , 2020 , by purchasing sovereign and corporate debt , among other measures . 10 Such bold transnational action can be imitated in other areas , including the development of large - scale public investment projects , social cohesion policies , and redistributive measures to reach mostaffected populations . After years of promoting fiscal austerity and economic deregulation , now is the time for European institutions to actively intervene to protect population health and wellbeing . Effective

COVID - 19 , initially observed / detected in Hubei province of China during December 2019 , has since spread to all but a handful countries , causing ( as of the time of writing ) an estimated 855 , 000 infections and 42 , 000 deaths ( [ 8 ] , March 31st ) . COVID - 19 has a basic reproductive number , R 0 , currently estimated in the region of 2 . 5 - 3 [ 5 ] . Social distance and general quarantine measures can reduce R 0 temporarily , but not permanently . For R 0 = 3 , left unchecked COVID - 19 can be expected to infect more than 90 % of our community , with 30 % of the population infected at the epidemic peak . Even with significant quarantine measures in place the population will not reach " herd immunity " to this virus until 2 / 3 of the population has gained resistance - either through vaccination , or infection and subsequent recovery .

Human mobility places scientists at a serious disadvantage in slowing potential epidemics . A person can pick up a virus in one place and share it to another location within hours . Among the jet set , there is potential to become a super spreader [ 23 ] , infecting many people across an expansive geographical area . While vaccine technology has advanced significantly , it still takes a year or more to formulate a vaccine — time enough for the virus to reach every corner of the world .

We made an effort to distribute and reach all sectors of Israel ' s population . The survey is distributed in 5 languages - Hebrew , Arabic , English , Russian , and Amharic to reflect and serve the diverse spoken languages of Israel ' s population . Although at this point we do not see an unbiased representation of the Israeli population in our responses , special efforts to reach underrepresented populations are currently done through several channels : call centers , media appearance and promotion of the survey through Arabic - speaking TV stations to gain interest and compliance in all sectors of the population .

It is worth noting that the Baidu Migration index still has the following disadvantages for estimating real traveler population . 1 ) The mobility behavior of a large number of groups un - connected to Baidu Map and third - party . CC - BY - NC - ND 4 . 0 International license It is made available under a is the author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

Data systems and research priorities and agendas incorporate attention to the needs and circumstances of disadvantaged populations and underrepresented minorities

Mitigating threats to incarcerated people from COVID-19, assuring access to information, prevention, diagnosis, and treatment

COVID - 19 presents a unique challenge to public health . Effective mitigation of the disease will require nontrivial efforts from a significant fraction of the world population , including social distancing and avoiding unnecessary interactions with others . No matter how stringently these measures are recommended , a fraction of people may not believe that they can or should act in ways that will limit the threat . The HBM is a model that has been used to study behaviors related to preventing or mitigating disease . It conceptualizes beliefs about disease as being comprised of the perception of the threat as severe and relevant , the perception of benefits of and barriers to acting , and the perception of one ' s intrinsic ability to act . As trusted , community - facing healthcare professionals , pharmacists are uniquely suited to bring about change in patient behaviors . Community pharmacists using HBM to reinforce COVID - 19 mitigation behaviors should appropriately emphasize the severity and susceptibility of the threat , emphasize barriers to acting , help patients identify ways to overcome barriers to acting , and reinforce self - efficacy beliefs .

Pharmacists are the most accessible healthcare providers , and so understanding the epidemiology of COVID - 19 , its transmission and how to prevent it spreading , and being aware of informative federal resources regarding COVID - 19 strategies are important considerations . All pharmacy professionals should keep up to date , and be familiar , with the latest CoV prevention and treatment guidelines , which are rapidly changing . 1 Several resources are available to help pharmacists worldwide care for individuals and communities , such as the American Pharmacists ' Association ( APhA ) resource centre webpage , which provides the latest information from federal agencies and a decision - tree document that can be used to assist pharmacists in talking to individuals with different levels of COVID - 19 risk . The APhA has also recently issued a tool - - Preparedness and Prevention Guidance during Coronavirus Pandemic - - to help pharmacists be prepared . 3 For preparing clinicians to respond to health threats and emergencies related to disease outbreaks and disasters , the Centres for Disease Control and Prevention ' s ( CDC ' s ) Clinician Outreach and Communication Activity ( COCA ) is a vital information source . 3 In addition , many reference documents are now being made available to pharmacists so they can have access to the latest updates regarding COVID - 19 management . The American Society of Hospital Pharmacists ( ASHP ) has recently initiated a comprehensive online resource that includes most of the COVID - 19 - related pharmacy information and free , 60 - day open access to ASHP drug information . 4 It should be noted that pharmacists should regularly review these pharmaceutical recommendations because changes are expected as information about the virus accumulates . Below are directions to some of these online resources : patients , they need to pay attention to protecting themselves . The World Health Organization ( WHO ) has recommended that healthcare staff wear appropriate eye protection , surgical masks , long - sleeved gowns and gloves when entering a room containing suspected or confirmed COVID - 19 - infected individuals . WHO has also recommended using a particulate respirator that is at least as protective as a US National Institute for Occupational Safety and Health - certified N95 when performing aerosol - generating procedures such as tracheal intubation , non - invasive ventilation , tracheostomy , cardiopulmonary resuscitation or manual ventilation before intubation or bronchoscopy ) . 5 However , self - isolation of pharmacists who have been in contact with suspected COVID - 19 individuals are not obliged to wear these unless otherwise ordered by health protection professionals . 6

As of 24 February 2020 , a total of 79 , 331 confirmed cases of COVID - 19 , including 2618 deaths , were reported in China and 27 other countries , 11 posing a serious threat to global public health and thus calling for the prompt development of specific anti - coronavirus therapeutics and prophylactics for treatment and prevention of COVID - 19 .

Abstract The coronavirus disease - 19 ( COVID - 19 ) is caused by the novel severe acute respiratory syndrome coronavirus that was first detected at the end of December 2019 . The epidemic has affected various regions of China in different degrees . As the situations evolve , the COVID - 19 had been confirmed in many countries , and made a assessment that it can be characterized as a pandemic by the World Health Organization on March 11 , 2020 . Drugs are the main treatment of COVID - 19 patients . Pharmaceutical service offers drug safety ensurance for COVID - 19 patients . According to COVID - 19 prevention and control policy and requirements , combined with series of diagnosis and treatment plans , pharmacists in the first provincial - level COVID - 19 diagnosis and treatment unit in Jilin Province in Northeast China have established the management practices of drug supply and pharmaceutical care from four aspects : personnel , drugs supply management , off - label drug use management and pharmaceutical care . During the outbreak , the pharmaceutical department of THJU completed its assigned workload to ensure drug supply . So far , no nosocomial infections and medication errors have occurred , which has stabilized the mood of the staff and boosted the pharmacists ' confidence in fighting the epidemic . For the treatment of COVID - 19 , pharmacists conducted adverse reaction monitoring and participated in the multidisciplinary consultation of COVID - 19 . Up to now , the COVID - 19 patients admitted to THJU have not shown any new serious adverse reactions and been cured finally . The hospital pharmacy department timely adjusted the work mode , and the formed management practices is a powerful guarantee for the prevention and control of the COVID - 19 epidemic . This paper summarized the details and practices of drug supply and pharmaceutical services management to provide experience for the people who involving in COVID - 19 prevention and contain in other abroad epidemic areas .

Understanding coverage policies (barriers and opportunities) related to testing, treatment, and care

Sample stratification provides another opportunity for realizing efficiency gains . By separating samples from symptomatic individuals from others , we can artificially decrease prevalence in the individuals tested using pooling , which decreases the tests per individual . This makes it easier to find asymptomatic carriers by expanding test coverage , though practical trade - offs between case abundance and overall testing capacity are worthy of consideration .

Any plan for stopping the ongoing 2019 - nCov epidemic must be based on a quantitative understanding of the proportion of the at - risk population that needs to be protected by effective control measures in order for transmission to decline sufficiently and quickly enough for the epidemic to end . Using an SEIR - type transmission model , we contrasted two alternate strategies by modeling the proportion of the population that needs to be protected from infection by one - time vaccination ( assuming 100 % effectiveness ) or by testing with isolation and treatment of individuals within six , 24 , or 48 hours of symptom onset . If R is currently 2 . 2 , vaccination at the herd immunity coverage of 55 % would drive R just below 1 , but transmission could persist for years . Over 80 % of coverage is required to end the epidemic in 6 months with population - wide vaccination . The epidemic could be ended in just under a year if testing with isolation and treatment reached 80 % of symptomatically infected patients within 24 hours of symptom onset ( assuming 10 % asymptomatic transmission ) . The epidemic could be ended in six months if testing with isolation and treatment reached 90 % of symptomatic patients . If 90 % of symptomatic patients could be tested within six hours of symptoms appearing , the epidemic could be ended in under four months .

Every patient who engages with the traditional oncology care delivery system significantly disrupts this social distancing tactic , resulting in innumerable ripple effects . Clinic visits , surgical stays , infusion sessions , radiation planning and treatment appointments , hospital admissions , phlebotomy visits for laboratory tests , and radiographic imaging studies — all often attended with family members in tow — result in a massive number of personal contact points and many potential opportunities for viral transmission .

Telemedicine ( TM ) has the potential to help by permitting mildly ill patients to get the supportive care they need while minimizing their exposure to other acutely ill patients . After all , the only infection that one can catch while using TM is a computer virus . To encourage the TM approach , nearly all health plans and large employers offer some form of coverage for TM services . Although the use of TM has increased over the last 2 to 3 years , rates of TM adoption among allergists are still low . 3 In response to the current COVID - 19 situation , the Centers for Medicare & Medicaid Services and commercial health plans largely have waived co - pays for TM visits as a means to encourage utilization in this time of need , and allergists need to pay attention to this . 4 , 5 A recent survey demonstrated that patients are willing to use telehealth , but barriers still exist , namely : ( 1 ) At a time of need , many people revert to what they are used to doing and the way in which they previously interacted with the health care system . ( 2 ) Patients would prefer that they see their own provider through TM versus someone with whom they do not have a previously established relationship . ( 3 ) Patients may be unaware that they have TM as an option and do not know how to access it . 6 Health plans , employers , hospital systems , and media outlets should work to overcome these barriers by ( 1 ) educating people that TM is an effective alternative and safer under the current circumstances , ( 2 ) expanding network reimbursement coverage for physicians to see their patients through TM , ( 3 ) making people aware that a TM benefit exists , with step - by - step instructions on how it can be accessed , ( 4 ) helping people understand how TM works , and ( 5 ) continuing to reduce cost barriers to accessing TM .

Despite the possible promise of this NPI for both COVID - 19 and influenza , it is unclear if symptom - based isolation would be truly effective in controlling outbreaks because the CDC - recommended one day policy might not be enough to achieve a meaningful reduction in transmission , and a high rate of asymptomatic infections and partial compliance might weaken the ability to implement the policy . When the attack rate is high , transmission might occur regardless of isolation and the policy might merely create a burden on the isolated individuals and their families , without a tangible public health benefit . If the policy is proven effective , it is not known whether the CDC - recommended one day of symptom - based isolation is sufficient , and if not , how many days would be most beneficial . At the outset of our project , we hypothesized that these policies would have a small beneficial effect on reducing attack rate , delay the peak of the outbreak and reduce the height of its peak . We did not expect these policies to reduce the overall incidence because there would be many other opportunities to become infected . Furthermore , practical barriers may reduce the strictness with which the policies are enforced , which would reduce the policies ' effectiveness .