Undergraduate Teaching During COVID-19.

Background:Migrant and seasonal farmworkers face enormous barriers to health and have been a particularly vulnerable population during the COVID-19 pandemic, but their pandemic experiences and potential inequities have not been well studied.Objectives:We aimed to assess the impact of COVID-19 in Immokalee, Florida, a community with a significant population of migrant and seasonal farmworkers. We evaluated for differences in pandemic experience by language, a known barrier to healthcare, to inform and strengthen future public health efforts.Methods:First, to estimate the burden of COVID in the area, we conducted a descriptive analysis of data on COVID-19 deaths for Collier County from May-August 2020. We then surveyed a cross-sectional, randomized representative sample of 318 adults living in Immokalee from March-November 2020 to assess socio-demographics, workplace conditions, sources of information, ability to follow guidelines, and experiences with testing and contact tracing programs. Results were compared across language groups.Findings:Average excess mortality in Collier County was 108%. The majority surveyed in Immokalee had socio-demographic factors associated with higher COVID risk. Non-English speakers had higher workplace risk due to less ability to work from home. Haitian Creole speakers were less likely to be tested, though all participants were willing to get symptomatic testing and quarantine. Those participants who tested positive or had COVID-19 exposures had low engagement with the contact tracing program, and Spanish-speakers reported lower quality of contact tracing than English speakers.Conclusions:The community of Immokalee, FL is a vulnerable population that suffered disproportionate deaths from COVID-19. This study reveals language inequities in COVID testing and contact tracing that should be targeted in future pandemic response in Immokalee and other migrant farmworker communities.

During the COVID-19 pandemic, Türkiye implemented strict measures like curfews, school closures, and isolation rules, which also affected religious practices. The Presidency of Religious Affairs (PRA) suspended congregational prayers, leading to imam-hatips being exempt from their mosque duties and redeployed to assist with contact tracing. Unlike many countries, Türkiye implemented home-based contact tracing, where health professionals monitored infected individuals and their contacts. Imam-hatips supported these efforts by calling patients, delivering masks and sanitizers, and ensuring isolation compliance. They also participated in Vefa Social Support Groups to provide socioeconomic aid. Despite their significant roles, the experience of imam-hatips, particularly in contact tracing, has been understudied. This research, based on interviews with imam-hatips in Istanbul and Balıkesir, explores their experiences. Findings reveal that while imam-hatips faced challenges balancing their religious duties with new responsibilities, many found purpose and satisfaction in contributing to their communities. Though missing their traditional roles, imam-hatips embraced their expanded duties, motivated by a sense of religious and moral obligation. This study sheds light on imam-hatips' unique contributions and the challenges they faced during Türkiye's pandemic response.

Since the outbreak of COVID-19, the process of considering a treaty for pandemic prevention, preparedness, and response has been entirely led by World Health Organization (WHO) member states. To overcome the fundamental limitations of the International Health Regulations (2005) (IHR 2005) system, it is possible to consider a more comprehensive revision of the IHR, perhaps even more drastic than the 2005 revision. Alternatively, a new fundamental and comprehensive treaty for pandemic response could be considered, independent of any revision of the IHR. The WHO and its member states have chosen the latter option and are now pursuing a two-track legislative process to adopt a new pandemic treaty in parallel with some revisions to the IHR.
 This article examines the international community's efforts to improve international health law for pandemic prevention, preparedness, and response in the wake of the COVID-19 pandemic. To do so, it first examines the failures of international health rules and lessons learned from COVID-19, and then analyzes the progress of the WHO's Member States in revising IHR and negotiating a draft pandemic treaty, as well as the differences in legal basis articles under the WHO’s Constitution. The IHR have not responded effectively to the COVID-19 pandemic, and as Report of the Review Committee on the Functioning of the IHR during the COVID-19 response, revision of the Regulations seems inevitable. However, IHR revision alone are not enought to address the problems that have arisen during the pandemic. While a major revision of the IHR could be considered, it would be more difficult to incorporate new legislation into the existing framework of the IHR to create a harmonized and unified normative framework than to create a new treaty. Furthermore, maintaining the form of the Rules in Article 21 is not the best option, despite the fact that the WHO’s Constitution authorizes the Organization to enter into “conventions or agreements” under Article 19. In this regard, amending the International Health Regulations and creating a new pandemic treaty at the same time is the most effective legislative approach in the current context to prevent, prepare for, and respond to diseases that could cause an international health crisis.
 This article reviews the highlights of ｢the Zero Draft of the WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (“WHO CA+”)｣, published in February 2023, for consideration by the Intergovernmental Negotiating Body (INB). The Zero Draft provides a framework for legal regulation at all levels of the pandemic response and is extensive in its substantive content. The Zero Draft emphasizes equity at all levels and provides concrete measures to achieve it. It covers and documents many issues relevant to pandemic governance, from crisis-resilient health systems and a strong health workforce to measures related to one health and antibiotic resistance, health literacy, and even social determinants of health. The Zero Draft is completely open-ended, meaning that it could change over the course of future negotiations, but it is unlikely to change much in terms of the main content that will be included in a pandemic treaty.

Self-directed learning: Alternative for traditional classroom learning in undergraduate ophthalmic education during the COVID-19 pandemic in China

Control of epidemics by jails: lessons for COVID-19 from HIV

PurposeThe purpose of this paper is to examine the effect of hotel safety leadership on employee safety behavior during the COVID-19 pandemic, and the mediation role of belief restoration and the moderation role of perceived risk between safety leadership and behavior were also investigated.Design/methodology/approachThe COVID-19 outbreak served as the background for a questionnaire survey of 23 hotels in China with 1,594 valid responses being received. The statistical analysis techniques used were exploratory and confirmatory factor analysis, correlation analysis, structural equation modeling and hierarchical regression.FindingsThe results showed that: hotel safety leadership positively affected employee safety behavior (compliance, participation and adaptation); belief restoration partially mediated the influence of safety leadership on safety behavior; and perceived risk negatively moderated the direct effect and the mediation effect of “safety leadership – belief restoration – safety behavior.”Research limitations/implicationsThe main limitation was that the questionnaires were collected with the same measurement system within a certain period of time (cross-sectional design). Then, future research should test and expand this conceptual model in different crises, business fields, theoretical orientation and cultural backgrounds.Practical implicationsHotels should develop management strategies based on safety leadership and motivate and promote employee safety behavior from the four aspects of safety coaching, care, motivation and control.Originality/valueThis investigation expanded the research on the effectiveness of safety leadership and especially with respect to safety in the hospitality industry during a major global crisis. Also, the research conceptual model and variables contained therein are original contributions to the hospitality research literature.

The 2020 SARS-CoV-2 pandemic created a unique opportunity for Public Health/General Preventive Medicine (PH/GPM) and Occupational and Environmental Medicine (OM) residents to contribute to pandemic public health response activities. We surveyed all 18 Health Resources and Services Administration (HRSA)-funded PH/GPM and OM residency program directors to evaluate program and resident involvement in pandemic response activities from January 1 through June 30, 2020. Of 116 residents, 110 (95%) participated at some level in the response activities including screening/testing, contact tracing, surveillance, data analysis, incident command, provider support, reopening, direct patient care, education, and risk communication. Residents' response activities were in multiple settings, such as state, local, and federal health agencies; hospital systems; long-term care facilities; academic centers; local businesses and labor unions; Federally Qualified Health Centers; homeless shelters; and clinics. Residents' participation was facilitated by their training in public health, epidemiology, the care of patients and populations, and emergency preparedness. Programs should continue to promote these experiences and key roles that PH/GPM and OM residents can play, as this leadership is a necessity for the successful navigation of future major public health events. As the pandemic continues, evaluation of residents' experiences will help guide longer-term changes to program curriculum and partnerships. Many trainees' contributions and expertise met both educational and service goals and therefore should be integrated into ongoing pandemic response work in PH/GPM and OM programs.

The COVID-19 pandemic has highlighted how society is naturally reactive to issues that could have been prevented or minimized in hindsight. Environmental public health professionals (EPHPs) take a proactive approach to health and safety to prevent the occurrence of adverse events that can negatively impact the health of individuals. The Canadian healthcare system largely invests in hospitals and acute care compared to public health. EPHPs have been actively mobilized to assist with the pandemic response and have demonstrated their versatility in skillset—EPHPs have performed a variety of activities, such as enforcement action, education, and contact tracing. Despite EPHPs proving to be a valuable resource during the pandemic, there remains a sense of under-recognition and underappreciation for the work being done. Indeed, the nature of public health work relies on efforts occurring behind-the-scenes—trends over time will reveal the outcomes of health initiatives. Although it is challenging to obtain timely health evidence to justify investment into public health, a continued passive approach to prevention will be harmful to society. Greater acknowledgement and investment of resources into the health protection field can help establish a proactive attitude to thereby lessen the economic and health burdens our communities may face in the future.

Outbreaks of communicable diseases such as COVID-19 can significantly threaten individual wellbeing and societal functioning. To contain such outbreaks, public health services (PHS) implement contact tracing (CT). In this process, a public health professional (PHP) interviews an infected individual (‘case’) to identify people they were in contact with during their infectious period (‘contacts’) and informs them about the necessary measures to prevent further transmission of the pathogen. However, CT can be challenging during large outbreaks due to the high numbers of cases and contacts, time and resource demands, and limited cooperation. In this thesis, we investigated whether and how CT can be improved by more actively involving cases and contacts in tasks typically performed by PHPs, supported by digital tools. We refer to this approach as ‘self-led’ CT. In part one of this thesis, we examined the use of web-based respondent-driven sampling (webRDS) in public health. A scoping review showed that webRDS has been successfully used to recruit participants for research on various topics, deliver health interventions, and support case finding. Peer recruitment can be stimulated by offering adequate incentives, conducting formative research into recruitment barriers, and thoroughly motivating ‘seeds’ to initiate recruitment. In part two, we explored PHPs’ perspectives on self-led CT through interviews and surveys. PHPs were generally positive, anticipating that self-led CT could make the process more efficient and enable more autonomous participation. However, they also expressed concerns about losing oversight and the ability to support cases and contacts. PHPs considered self-led CT appropriate when dealing with digitally skilled and motivated individuals, and during outbreaks involving relatively many cases and contacts. They considered self-led CT less suitable in high-risk or complex situations. PHPs emphasized that self-led CT should complement—not replace—provider-initiated CT and recommended maintaining options for personal support. In part three, we investigated citizens’ perspectives on self-led CT during the COVID-19 pandemic using interviews and surveys. Citizens generally indicated to be willing to participate in self-led CT. Their willingness depended on various factors, including previous experiences with CT, sense of responsibility, self-efficacy, perceived impact, trust in digital tools, and privacy concerns. Citizens recommended enabling early participation, minimizing data collection, and offering both autonomous and supported options within the CT process. In part four, we conducted an experimental online questionnaire study to compare different approaches to support citizens in recalling and reporting their contacts. We found that using context-specific recall cues and asking participants to list contacts separately for different situations increased the number of reported contacts, but also raised the risk of participant dropout. Furthermore, not all additionally elicited contacts may equally contribute to CT effectiveness. Our findings suggest that self-led CT may be less feasible for individuals with many or high-risk contacts. In the final part of the thesis, we discuss limitations, opportunities for future research, and propose a framework for integrating self-led and provider-initiated CT to maximize benefits while addressing potential challenges.

An analytical evaluation of contact tracing systems using real-world individual-level data.

Data were essential to public health decision-making during the COVID-19 pandemic, yet no single data source was adequate for Tribes in Montana and Wyoming. We outlined data access, availability, and limitations for COVID-19 pandemic surveillance response to improve future data exchange. The Rocky Mountain Tribal Epidemiology Center (RMTEC) used various data sources to deliver data on the number of COVID-19 cases, deaths, and vaccinations at local, state, and regional levels to inform Tribes in Montana and Wyoming. RMTEC reviewed state, federal, and public datasets and then attached a score to each dataset for completeness of demographic information, including race, geographic level, and refresh rate. The RMTEC COVID-19 response team shared data weekly on the number of COVID-19 cases, deaths, and vaccinations distributed and the percentage of the population vaccinated with Tribal health departments in Montana and Wyoming. The Indian Health Service Epidemiology Data Mart dataset scored the highest (24 of 30), followed by datasets from Montana (18 of 30) and Wyoming (22 of 30). Publicly available datasets scored low largely due to data aggregation across larger geographic areas and lack of demographic variables. The absence of data on race and ethnicity from publicly available data and lack of access to real-time data limited RMTEC's ability to provide Tribal-specific updates on COVID-19 cases, deaths, and vaccinations to Tribal health departments. RMTEC should be fully funded to provide the necessary resources for data management and the capacity to respond to data requests from Tribal health departments and their programs to address current and future pandemics. Federal and state agencies should also be educated on Tribal Epidemiology Centers' public health authority status to improve access to infectious disease data among those agencies.

The Global Fund: replenishment and future-proofing

A novel methodology for assessing contact tracing precision: Phylogenetic validation of a contact tracing program for COVID-19 in Belgium.

For already overburdened health systems in low- and middle-income countries (LMICs), the COVID-19 pandemic presented an almost impossible challenge. In Kenya, efforts to mitigate the impact of the pandemic included the mobilization of community health volunteers (CHVs), a cadre that has been historically understaffed and under-resourced. These volunteers were required to sustain the delivery of routine community-based health services while also taking on additional responsibilities related to COVID-19 mitigation. This study explored the challenges faced by CHVs during the COVID-19 response in Kiambu County; focusing on their experiences with control measures, impacts on community-level healthcare delivery, and perspectives on the government's pandemic response within the community health framework. This study employed a phenomenological exploratory qualitative design. Due to logistical constraints, only two focus group discussions could be conducted with 24 CHVs, representing 48% of eligible participants who met the inclusion criteria: a minimum of five years of experience, active involvement in the pandemic response, and availability for the interview. Data were digitally recorded, transcribed, translated, and coded for thematic analysis. Specific themes from the experiences of the CHVs during the COVID-19 lockdown were: (1) dedication and commitment to serving the community; (2) overcoming demoralization; and (3) community barriers to health care delivery and access. In regards to the community perspectives of COVID-19, the CHVs relayed widespread misinformation among community members, with experiences of stigma due to COVID-19 misconceptions. They also gave second-person accounts of the economic strife the community went through as a result of mitigation measures. The CHVs were skeptical in the county's preparedness in dealing with both the COVID-19 and future pandemics. Despite facing stigma, misinformation, limited resources, and economic hardships, CHVs demonstrated commitment to their roles. Their efforts not only underscored their resilience but also revealed critical gaps in preparedness and resource allocation within the healthcare system. However, the small number of FGDs and insufficent data saturation should be considered when interpreting the findings. Nonetheless, our study provides a starting point for further research and comparative analysis across other counties in Kenya.

BackgroundThe contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation.ObjectiveThis study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases.MethodsThis was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contactsResultsDuring contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non–COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003).ConclusionsContact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19–related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings.