Health Security最新文献

This case study describes findings from an exercise conducted in April 2023 to assess the readiness of the National Quarantine Unit (NQU) and identify opportunities for improvement. The exercise is part of a multiyear effort to assess the readiness of quarantine and transport capabilities at the NQU through annual workshops, discussion-based exercises, and functional and full-scale exercises. The April 2023 exercise tested interagency coordination and decisionmaking, transport of individuals for monitoring, quarantine unit operations, and escalation of care for symptomatic individuals out of quarantine to high-level isolation units in the United States. Findings showed that collaboration and engagement of local, state, and national organizations increases awareness of novel and emerging high-consequence infectious disease pathogens and enhances capabilities and capacity for patient transport. It also improves timely and efficient diagnostic testing and increases the availability of dedicated assets to support activation and mobilization of the NQU, the Regional Emerging Special Pathogen Treatment Center network, and the future national special pathogen system of care. Given the changing landscape of emerging special pathogens, an objective evaluation of the state of readiness is an essential element of preparedness and response.

The COVID-19 pandemic has underscored the importance of the International Health Regulations (IHR) (2005) in addressing global health emergencies. This review aims to improve healthcare system capabilities, future preparedness, and actions in the Eastern Mediterranean Region, particularly in low-resource areas. The IHR, established in 1969, initially focused on 6 diseases but has since expanded to include a wider range of public health threats. These rules establish a globally recognized legal framework that is applicable to all 196 states parties, including all 194 World Health Organization member states. The IHR prioritize the prevention, protection, and control of global disease transmission while minimizing unwarranted disruptions to international travel and commerce. Nonetheless, the response to COVID-19 in the Eastern Mediterranean Region revealed a range of deficiencies despite the regulatory strengths. Some countries encountered challenges in fully complying with their IHR obligations, particularly in terms of preparedness, and occasional geopolitical tensions obstructed international collaboration. The pandemic experience underscores the need for improved trust, resource allocation, and regulatory revisions to address upcoming global health challenges. This case study highlights positive aspects of the pandemic response, including the swift exchange of information and global cooperation, while also recognizing shortcomings, such as delays in reporting and unequal vaccine access. In summary, the COVID-19 pandemic underscores the urgency of subsequent updates to the IHR or comparable accords, such as the IHR amendments and the pandemic treaty, to rectify these deficiencies. Updates should place a greater emphasis on transparency, cultivating trust, enhancing preparedness, and establishing mechanisms that incentivize comprehensive compliance among all participating nations.

High-level isolation units (HLIUs) are facilities strategically outfitted to receive patients with suspected or confirmed high-consequence infectious diseases (HCIDs). Although most HCID outbreaks occur in low- and middle-income countries, global travel and migration and the deployment of healthcare workers to global outbreaks have led to the occurrence of HCIDs in high-income countries that requires the activation of an HLIU. Despite the existence of HLIUs worldwide, there has been little collaboration between units at the international level. This study reviews the results of a descriptive survey of global HLIUs conducted between December 2022 and February 2023. The purpose of the survey was to identify traits and attributes of global HLIU peers to determine commonalities and differences among the units, identify priorities for increased networking, and inform future activities among global partners. Findings from this survey demonstrate the array of similarities and differences among HLIUs across the globe, indicate potential areas of further investigation, and identify areas in which alignment could be improved and global standards could be created.

Emergency department (ED) visit volumes have increased since 2007, with crowding in the United States reaching its highest levels in 2022. During this same period, mass casualty incidents (MCIs) have increased dramatically, both in frequency and severity, across the United States. Resuscitation of trauma patients is a time-sensitive process that requires immediate patient assessment by coordinated clinical teams in order to successfully diagnose and manage life-threatening injuries. To make resuscitation spaces immediately available for incoming patients, typical MCI plans call for rapidly relocating ED patients from their rooms into hallways or transferring them to open inpatient areas. With current levels of crowding, however, such alternate care spaces are often already in use and traditional MCI plans are increasingly unrealistic. With ED crowding worsening and the frequency of MCIs rising, there is a worrisome risk that EDs could fail in their efforts to save patients due to insufficient resources and spaces to meet the demands of critically injured patients. Hospitals must use innovative, novel response strategies to ensure sufficient patient care spaces in a short timeframe to save the most lives possible. In this commentary, we describe the use of buffer zones to help EDs mobilize an effective response to MCIs in the current context of severe hospital crowding.

We led the last large-scale exercise conducted by the Johns Hopkins Center for Health Security before the COVID-19 pandemic. Despite COVID-19, pandemic exercises are more necessary than ever to prevent the loss of hard-fought gains achieved during COVID-19, keep policymakers from assuming all pandemics will be like COVID-19, and encourage continued engagement from policymakers in strengthening health resilience rather than returning to a cycle of panic and neglect. Pandemic exercises can also advance new solutions necessary to effectively meet the challenge of a future pandemic. Over 2 decades, the Johns Hopkins Center for Health Security has developed and conducted 6 large-scale, high-level tabletop pandemic exercises. These exercises and others were designed to increase policy focus on the most critical needs in pandemic preparedness and heighten the urgency for making these changes in the near future. Pandemic experts and policymakers alike have highlighted the importance of exercises to ensure that all key actors involved in pandemic response-including the government, healthcare, public health, emergency response, and private business and industry sectors-understand both the best practices and policies to pursue before a pandemic and what to do once a pandemic occurs. These advance efforts can enhance planning, resource allocation, and coordination ahead of time and identify unique gaps and barriers. This commentary describes the approach we have developed to create and conduct such exercises and highlights key considerations that were important to successful outcomes.