Health Security最新文献

The United States takes a federalist approach to pandemic responses while the bulk of pandemic powers sits at the state level. Thus, comprehensive accounts of how state health officials managed the crisis and how the federal government affected those efforts are needed to better understand the governmental response to the COVID-19 pandemic. This article reports the results of semistructured interviews with 29 state-level policy actors from 16 US states. Interviewees discussed multiple aspects of the US federal COVID-19 response that affected the response in their states, including communications with the public, intergovernmental communications, and federal actions regarding various aspects of health service preparedness including emergency funding, procurement, testing capacity, vaccine development and distribution, and data systems. This research enriches the discussion about US pandemic preparedness and response, and indicates that alignment of public communications across government levels, enhanced intergovernmental communication, inclusion of rural perspectives, and federal investment in and sustainment of health service preparedness are key factors that can improve future US pandemic responses.

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.

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.

The National Disaster Medical System (NDMS) is a US federally coordinated healthcare system that aims to strengthen its capacity for surge management. We conducted a literature review to aid in the development of a research landscape analysis and strategy for the ongoing NDMS Pilot Program. The review was performed to identify surge management literature published from 2001 to spring 2023. Articles were screened using eligibility criteria and selected for analysis based on a consensus process. The search yielded 504 unique articles after deduplications. After abstract screening, 100 articles were screened for relevance. The final sample included 28 articles that were analyzed using themes relevant to the NDMS Pilot Program. This article discusses lessons learned and recommendations for program leadership to optimize outcomes during a surge event. NDMS should consider methods for improving situational awareness during surge events and should include stakeholders in planning and evaluation of the NDMS Pilot Program. Priority recommendations include strengthening operational coordination and leadership, enhancing information-sharing capabilities, and addressing funding and resource allocation. Findings from this review highlight current practices in surge management as well as gaps in current operational research areas. Addressing these gaps has the potential to strengthen the capacity of the NDMS Pilot Program and health system disaster preparedness more broadly across the United States.

The COVID-19 pandemic has revealed the need for nations to prepare more effectively for emerging infectious diseases. Preparing for these threats requires a multifaceted approach that includes assessing pathogen threat, building flexible capabilities for rapid medical countermeasure (MCM) development, and exercising, maintaining, and improving those response capabilities. The Biomedical Advanced Research and Development Authority (BARDA) promotes the advanced development of MCMs in response to natural and manmade threats. In this article, the authors describe a BARDA threat assessment tool that, in conjunction with other factors, facilitates portfolio management and decisionmaking related to the advanced development of MCMs for emerging infectious diseases. The tool was designed to use readily accessible public data and information related to the threat posed by pathogens. It can be adjusted to modify the specific areas of interest (eg, removal/addition of parameters) to facilitate cross-pathogen analysis and can be updated to reflect changes (eg, new outbreak) that may impact the overall threat assessment. Finally, assessment of certain pathogens is included.

Hospital patient boarding in emergency departments has reached unprecedented crisis levels over the past 4 years. Boarding and crowding has been demonstrated by prior literature to have adverse effects on patient care as well as increased associated costs. Importantly, the increase in hospital patient boarding has created critical shortcomings in disaster preparedness by limiting the capacity of emergency departments to respond to mass casualty incidents due to space and staffing constraints. Multiple concurrent threats exacerbate these challenges, including increases in the incidence of both natural and unnatural disasters over the past decade and decreases in the numbers of US hospitals, hospital beds, and employed healthcare staff. "Emergency department boarding" must also be renamed "hospital boarding" given that the fundamental challenge lies with hospital and health system leadership and does not stem from emergency departments. In this commentary, the authors share a call to action to increase support and funding for research to alleviate the demands of hospital boarding, greater recognition among hospital leadership of the threat that hospital boarding poses to disaster scenarios, and widespread development of hospital-based, regional plans for mass casualty incident response that are more effective in the context of excessive boarding.

In early 2020, to halt the spread of SARS-CoV-2, the state government of Rio Grande do Sul in Brazil established a public health assessment and response framework known as a "controlled distancing model." Using this framework, the government divided the state into 21 regions and evaluated them against a composite index of disease transmission and health service capacity. Regions were assessed using a color-coded scale of flags that was updated on a weekly basis and used to guide the adoption of nonpharmaceutical interventions. In this study, we aimed to evaluate the extent to which the controlled distancing model accurately assessed transmission and the effectiveness of its responses throughout 2020. We estimated the weekly effective reproduction number (R_t) of SARS-CoV-2 for each region using a renewal equation-based statistical model of notified COVID-19 deaths. Using R_t estimates, we explored whether flag colors assigned by the controlled distancing model either reflected or affected SARS-CoV-2 transmission. Results showed that flag assignments did reflect variations in R_t to a limited extent, but we found no evidence that they affected R_t in the short term. Medium-term effects were apparent in only 4 regions after 8 or more weeks of red flag assignment. Analysis of Google movement metrics showed no evidence that people moved differently under different flags. The dissociation between flag colors and the propagation of SARS-CoV-2 does not call into question the effectiveness of nonpharmaceutical interventions. Our results show, however, that decisions made under the controlled distancing model framework were ineffective both at influencing the movement of people and halting the spread of the virus.