One of the concerns of health managers in Iran in case COVID-19 reached a new peak is a shortage of hospital beds. In response, the country designed and created intermediate treatment centers, known as fangcang hospitals, which are prepared quickly at low cost and with high capacity. The aim of this study is to provide health managers with an effective post-hospital discharge strategy for COVID-19 patients.

The study was conducted from April 2020 to June 2020, with a narrative case study design. Setting up a fangcang hospital was based on a narrative analysis of 2 in-depth interviews with 4 fangcang hospital managers in Iran, a field visit of these places, and a review of their protocols and guidelines.

The patient flow for screening, treatment, and follow-up includes the following: Patients will be hospitalized if their symptoms are severe. If they are infected with mild symptoms, they will be referred to a fangcang hospital and admitted there if necessary, to prevent further spread of the disease. Patients will be monitored regularly and treated with routine health services. At the end of the 14-day quarantine period, patients approved for discharge are sent home.

Traditional hospitals and fangcang hospitals are working together under the supervision of the Iran University of Medical Sciences. Our experience can serve as guidance for other clinics and recovery shelters. Having guidelines in place assists health care workers and managers in responding quickly to patients' needs during times of a disaster.

To analyze the evacuation preparedness of hospitals within the European Union (EU).

This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries.

The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time.

Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

Recent terror attacks led the Norwegian government to develop a procedure for emergency and law enforcement services cooperation during Active Violent Incidents (AVI, abbreviated PLIVO in Norwegian). To address further national initiatives to improve preparedness for mass casualty events and penetrating injuries among emergency medical services (EMS) in Norway, training and equipment status were mapped.

All EMS regions in Norway were invited to participate in an electronic nation-wide survey about practical medical training in PLIVO scenario training and specific training in hemorrhage control and penetrating injuries.

Ninety percent (842/938) had attended at least 1 PLIVO training scenario. Of these, 76% (642/938) reported only evacuation training during the exercise, while only 20% (168/938) had practiced hemorrhage control. Eighty-one percent (760/938) respondents reported that they were equipped with tourniquets and 91% (853/938) were equipped with gauze to pack wounds. However, only 52% (487/938) and 48% (450/938) reported practical training in tourniquet application and wound packing, respectively, while 30% (280/938) reported that they had no training or only theoretical education in tourniquet application. Supervised practical training on penetrating thoracic injuries was reported by <20%, and <50% reported practical training in needle decompression of a tension pneumothorax.

Enhanced focus on training in hemorrhage control and penetrating injuries is needed. This supports the recent decision from the Norwegian government to strengthen the training for EMS in AVI (PLIVO) exercises, by focusing on medical procedures in addition to evacuation training. Although the estimated response rate is 17%, we believe the large number of respondents still make the results valuable.

Our objective is to forecast the number of coronavirus disease 2019 (COVID-19) cases in the state of Maryland, United States, using transfer function time series (TS) models based on a Social Distancing Index (SDI) and determine how their parameters relate to the pandemic mechanics.

A moving window of 2 mo was used to train the transfer function TS model that was then tested on the next week data. After accounting for a secular trend and weekly cycle of the SDI, a high correlation was documented between it and the daily caseload 9 days later. Similar patterns were also observed on the daily COVID-19 cases and incorporated in our models.

In most cases, the proposed models provide a reasonable performance that was, on average, moderately better than that delivered by TS models based only on previous observations. The model coefficients associated with the SDI were statistically significant for most of the training/test sets.

Our proposed models that incorporate SDI can forecast the number of COVID-19 cases in a region. Their parameters have real-life interpretations and, hence, can help understand the inner workings of the epidemic. The methods detailed here can help local health governments and other agencies adjust their response to the epidemic.

A simple evaluation tool for patients with novel coronavirus disease 2019 (COVID-19) could assist the physicians to triage COVID-19 patients effectively and rapidly. This study aimed to evaluate the predictive value of 5 early warning scores based on the admission data of critical COVID-19 patients.

Overall, medical records of 319 COVID-19 patients were included in the study. Demographic and clinical characteristics on admission were used for calculating the Standardized Early Warning Score (SEWS), National Early Warning Score (NEWS), National Early Warning Score2 (NEWS2), Hamilton Early Warning Score (HEWS), and Modified Early Warning Score (MEWS). Data on the outcomes (survival or death) were collected for each case and extracted for overall and subgroup analysis. Receiver operating characteristic curve analyses were performed.

The area under the receiver operating characteristic curve for the SEWS, NEWS, NEWS2, HEWS, and MEWS in predicting mortality were 0.841 (95% CI: 0.765-0.916), 0.809 (95% CI: 0.727-0.891), 0.809 (95% CI: 0.727-0.891), 0.821 (95% CI: 0.748-0.895), and 0.670 (95% CI: 0.573-0.767), respectively.

SEWS, NEWS, NEWS2, and HEWS demonstrated moderate discriminatory power and, therefore, offer potential utility as prognostic tools for screening severely ill COVID-19 patients. However, MEWS is not a good prognostic predictor for COVID-19.

Since December 2019, a new coronavirus viral was initially detected in Wuhan, China. Population migration increases the risk of epidemic transmission. Here, the objective of study is to estimate the output risk quantitatively and evaluate the effectiveness of travel restrictions of Wuhan city.

We proposed a modified susceptible-exposed-infectious-recovered (SEIR) dynamics model to predict the number of coronavirus disease 2019 (COVID-19) symptomatic and asymptomatic infections in Wuhan. And, subsequently, we estimated the export risk of COVID-19 epidemic from Wuhan to other provinces in China. Finally, we estimated the effectiveness of travel restrictions of Wuhan city quantitatively by the export risk on the assumption that the measure was postponed.

The export risks of COVID-19 varied from Wuhan to other provinces of China. The peak of export risk was January 21-23, 2020. With the travel restrictions of Wuhan delayed by 3, 5, and 7 d, the export risk indexes will increase by 38.50%, 55.89%, and 65.63%, respectively.

The results indicate that the travel restrictions of Wuhan reduced the export risk and delayed the overall epidemic progression of the COVID-19 epidemic in China. The travel restrictions of Wuhan city may provide a reference for the control of the COVID-19 epidemic all over the world.

In response to increasing caseloads of foodborne illnesses and high consequence infectious disease investigations, the Texas Department of State Health Services (DSHS) requested funding from the Texas Legislature in 2013 and 2015 for a new state-funded epidemiologist (SFE) program.

Primary cross-sectional survey data were collected from 32 of 40 local health departments (LHDs) via an online instrument and analyzed to quantify roles, responsibilities, and training of epidemiologists in Texas in 2017 and compared to similar state health department assessments.

Sixty-six percent of SFEs had epidemiology-specific training (eg, master’s in public health) compared to 45% in state health department estimates. For LHDs included in this study, the mean number of epidemiologists per 100 000 was 0.73 in medium LHDs and 0.46 in large LHDs. SFE positions make up approximately 40% of the LHD epidemiology workforce of all sizes and 56% of medium-sized LHD epidemiology staff in Texas specifically.

Through this program, DSHS increased epidemiology capacity almost twofold from 0.28 to 0.47 epidemiologists per 100 000 people. These findings suggest that capacity funding programs like this improve epidemiology capacity in local jurisdictions and should be considered in other regions to improve general public health preparedness and epidemiology capacity.

To review Emergency Department internet connectivity, cyber risk factors, perception of risks and preparedness, security policies, training and mitigation strategies.

A validated targeted survey was sent to Canadian ED physicians and nurses between March 5, 2019 and April 28, 2019.

There were 349 responses, with physicians making up 84% of the respondents (59% urban teaching, 35% community teaching, 6% community non-teaching hospitals). All had multiple passwords, 93% had more than 1 user account, over 90% had to log repeatedly each workday, 52% had to change their passwords every 3 months, 75% had multiple methods of authentication and 53% reported using a terminal where someone else was already logged in. Passwords were used to review laboratory and radiology data, access medical records and manage patient flow. Majority of the respondents (51%) did not know if they worked with internet linked devices. Only 7% identified an ‘air gapped’ computer in their facility and 76% used personal devices for patient care, with less than a third of those allowing the IT department to review their device. A total of 26 respondents received no cyber security training.

This paper revealed significant computer-human interface dysfunctionality and readiness gaps in the event of an IT failure. These stemmed from poor system design, poor planning and lack of training. The paper identified areas with technical or training solutions and suggested mitigation strategies.

Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak.

Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS.

The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student’s worry regarding their studies/graduation. Perceived stress was decreased if participants’ self-rated health status score increased.

In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

Coronavirus disease 2019 (COVID-19) is a communicable disease transmitted via respiratory droplet from 1 person to another caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to investigate the knowledge, attitudes, and practice of Jordanian people toward COVID-19 during the COVID-19 pandemic. In addition, the paper explores the lack of perception and adherence to preventive measures toward COVID-19.

A quantitative, cross-sectional, descriptive online survey was used to explore study variables. A convenience sample of individual who are of Jordanian nationality, were aged 18 years or older, understood the content of the questionnaire, and agreed to participate voluntarily was surveyed.

The average correct score of COVID-19 knowledge was 84.44% (12.66/15). In addition, knowledge scores significantly differed across demographic characteristics of participants. Moreover, 93.8% (1009) of the study sample had confidence that Jordan can win the battle against the COVID-19 virus. However, study participants acknowledged that they did not visit crowded places in recent days (91.6%), while 71.3% (767) wore masks when leaving home.

The current study added a new knowledge that generally the Jordanian people during the quarantine period have a high knowledge and optimistic attitudes and practices toward COVID-19.

The aim of this study was to compare primary care appointment disruptions around Hurricanes Ike (2008) and Harvey (2017) and identify patterns that indicate differing continuity of primary care or care systems across events.

Primary care appointment records covering 5 wk before and after each storm were identified for Veterans Health Affairs (VA) facilities in the greater Houston and surrounding areas and a comparison group of VA facilities located elsewhere. Appointment disposition percentages were compared within and across storm events to assess care disruptions.

For Hurricane Harvey, 14% of primary care appointments were completed during the week of landfall (vs 33% for Hurricane Ike and 69% in comparison clinics), and 49% were completed the following week (vs 58% for Hurricane Ike and 71% for comparison clinics). By the second week after Hurricane Ike and third week after Harvey, the scheduled appointment completion percentage returned to prestorm levels of approximately 60%.

There were greater and more persistent care disruptions for Hurricane Harvey relative to Hurricane Ike. As catastrophic emergencies including major natural disasters and infectious disease pandemics become a more recognized threat to primary and preventive care delivery, health-care systems should consider implementing strategies to monitor and ensure primary care appointment continuity.

This study evaluated the relationships between the occurrence of recent and recurring natural disasters on the incidence of acute and chronic health outcomes at the census tract level in 500 cities across the United States between 2001 and 2015.

Using the Centers for Disease Control and Prevention (CDC) 500 cities data set, the CDC Social Vulnerability Index, and the US Small Business Administration (SBA) Disaster Loan Database, we modeled the incidence of self-reported, poor mental and physical health, or a clinical diagnosis of high blood pressure or asthma in census tracts (N = 27 204 tracts in 500 cities) that had experienced recent or recurring natural disasters while controlling for social and environmental risk factors.

Communities that experienced a natural disaster in the previous 5 years compared to those that had not had a higher incidence of poor mental health (RR: 1.02, 95% CI: 1.01-1.02), poor physical health (RR: 1.03, 95% CI: 1.02-1.04), high blood pressure (RR: 1.04, 95% CI: 1.02-1.05), and asthma (RR: 1.01, 95% CI: 1.01-1.02). The incidence of these poor health outcomes increased 1-2% with each additional year that a community experienced a disaster.

Prevention and preparedness plans that work to build resilience in communities before disasters should focus on closing the gap in environmental and social determinants that have been linked with disproportionate health burdens and slow recovery post-disaster.

Early Identification of disaster victims with mental health problems may be useful, but information within a short period after a disaster is scarce in developing countries. This study examined anxiety, depression, and post-traumatic stress symptoms at 1 month following 2019 Cyclone Fani in Odisha, India.

Post-traumatic stress symptoms (PTSS) were assessed by the Primary care PTSD screen for DSM 5 (PC-PTSD-5), anxiety symptoms by the Generalised Anxiety Disorder (GAD-7), and depression by the Patient Health Questionnaire (PHQ-9). The survey included participants’ disaster experience e.g., evacuation, fear of death, injury, death in family, damage to house, difficulty for food, displacement, and effect on livelihood.

Proportion of sample (n = 80) with probable PTSD was 42.9%, with severe anxiety was 36.7%, moderately severe depression was 16.5%, and severe depression was 3.8%. Suicidal cognitions were reported to increase by 14%. Comorbidity was common; with significant (P < 0.01) correlation between PTSS and anxiety (r = 0.69), depression (r = 0.596), and between anxiety and depression (r = 0.63). Damage of house and displacement were associated significantly with PTSD; evacuation and displacement with moderate and severe depression; and displacement with severe anxiety. No specific demographic factors were significantly linked to the psychiatric morbidities.

A considerable proportion of victims had psychiatric morbidities at 1 month. Associated risk factors included housing damages, evacuation, and displacement, suggesting the need to improve the disaster-management process.

Hurricane Sandy made landfall across New York City (NYC) in October 2012, but the long-term consequences of the storm are still not fully understood. We analyzed NYC data to quantify the extent of Hurricane Sandy-related concerns over time.

Data on NYC 311 Call Center inquiries were downloaded from the NYC Open Data website (October 29, 2012 to May 26, 2020) to provide information about Sandy-related calls using the keywords “Hurricane” and “Sandy”.

In the first 2 wk after Hurricane Sandy, 15.6% of 311 calls were related to the storm. From 2012 to 2020, the volume of inquiries decreased from 87,209 to 25. The majority of calls in 2012 (49,181; 56%) was requesting general Hurricane Sandy information, and in 2020 assistance with property restoration (20; 79%)

The long-term consequences of Hurricane Sandy in NYC persist into 2020, almost 8 y after the initial event. The needs of Hurricane Sandy victims have changed over time from requiring general information regarding closures, property destruction and immediate disaster relief to aid with legal, financial, and mental health consequences. Disaster response policy-makers must understand the changing needs of NYC residents to provide resources and prepare for future disasters.

The aim of this study was to evaluate hospital and emergency department (ED) preparedness in France facing the coronavirus disease 2019 (COVID-19) rapid growth epidemic-phase, and to determine the link between preparedness and responsiveness.

In this cross-sectional study, from March 7 to March 11, 2020, all heads of ED departments in France were contacted to answer an electronic survey, including 23 questions. Quality, Organization, Training, Resources, Management, Interoperability, and Responsiveness were evaluated by calculating scores (10 points). Multivariate analysis of variance was used to compare scores. Spearman’s correlation coefficient and multifaceted regression analysis were performed between Responsiveness and dimensions scores.

A total of 287 of 636 French EDs were included (45.1%). Calculated scores showed (median): Quality 5.38; Organization 6.4; Training 4.6; Resources 4.13; Management 2.38; Interoperability 4.0; Responsiveness 6.25; seasonal influenza score was 5. Significant differences between scores as a function of hospital and ED main characteristics were found. Furthermore, we found significant correlations (P < 0.01) between Responsiveness and all preparedness dimensions. Organization (adjusted-R2 0.2897), Management (aR2 0.321), and Interoperability (aR2 0.422) were significantly associated with Responsiveness.

Preparedness in all its dimensions is low, indicating vulnerability. Preparedness and responsiveness face a certain and ongoing risk are close linked, and that Organizational, Management, and Interoperability dimensions are main determinants.

The outbreak of coronavirus disease 2019 (COVID-19) has exerted unprecedented pressure on healthcare systems throughout the world. This study was designed to develop a national health emergency management program based on risk assessment for COVID-19.

Mixed-methods research was used. Based on recommendations of the national epidemiology committee, 2 risk scenarios were used as basic scenarios for risk assessment. Two rounds of Focus Group Discussions (FGDs) were conducted between January and May 2020 with 30 representatives of the health system. The data were collected, analyzed, and integrated by the research team.

In the risk matrix, “contamination of environment and individuals” and “burnout of medical staff” occupied the red zone (intolerable risk). “Defects in screening and admissions,” “process disruption in medical care and rehabilitation,” “increased mental disorders,” “social dissatisfaction,” “the decline in healthcare services,” and “loss of medical staff” were identified as the orange zone (significant risk) of the matrix.

The avoidance of environmental and individual contamination and healthcare worker burnout are the priorities in Iran. Attention to intersectoral cooperation, the involvement of non-governmental organizations and private center capacities, integration of information health systems, and developing evidence-based protocols are other measures that can improve the health system’s capacity in the response COVID-19.