In recent years, advances in communications technology and market factors have led to a substantial expansion of telemedicine practice. One potential use of telemedicine is in disaster response, both as a resource for responders as well as a direct link to patients. The advantages of using telehealth to assist in disaster response are accompanied by important questions related to social impact, ethical implications, and regulatory oversight. A narrative review of several of these issues is presented here. The next steps in the development of a robust disaster telemedicine system will include the development of best practices and ethical guidelines agreed upon by all stakeholders, as well as the development of public-private partnerships geared at providing the highest quality disaster telemedicine to the greatest possible number of patients.

The coronavirus disease 2019 (COVID-19) pandemic prompted universities across the United States to close campuses in Spring 2020. Universities are deliberating whether, when, and how they should resume in-person instruction in Fall 2020. In this essay, we discuss some practical considerations for the use of 2 potentially useful control strategies based on testing: (1) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) testing followed by case-patient isolation and quarantine of close contacts, and (2) serological testing followed by an “immune shield” approach, that is, low social distancing requirements for seropositive persons. The isolation of case-patients and quarantine of close contacts may be especially challenging, and perhaps prohibitively difficult, on many university campuses. The “immune shield” strategy might be hobbled by a low positive predictive value of the tests used in populations with low seroprevalence. Both strategies carry logistical, ethical, and financial implications. The main nonpharmaceutical interventions will remain methods based on social distancing (eg, capping class size) and personal protective behaviors (eg, universal facemask wearing in public space) until vaccines become available, or unless the issues discussed herein can be resolved in such a way that using mass testing as main control strategies becomes viable.

After Japan’s major nuclear accident in 2011, approximately 150,000 Fukushima residents were ordered to evacuate. Beginning in 2015, the evacuation orders have been systematically lifted. However, the health impacts of allowing residents to return to homes in areas previously uninhabitable due to nuclear radiation remain poorly understood.

Declaring radiation levels to be safe does not necessarily eliminate the concerns of residents about the effects of radiation exposure. Rebuilding medical, welfare, and commercial infrastructure and services takes time. Nontangible community elements, such as mutually dependent social networks, also require time to be re-established. Nevertheless, the Japanese government prioritizes policies that encourage evacuees to return home as soon as it is safe to do so.

Post-disaster evacuation situations and subsequent return home pose substantial—and as yet relatively unknown—mental and physical health threats for those affected, especially those in vulnerable groups, such as the sick, the elderly, and children.

Here we report a case of an elderly female evacuee with dementia, who was prevented from returning home after her hometown evacuation order was lifted, began exhibiting marked behavioral abnormalities. Loss of emotional ties that were created while she was housed in temporary accommodation appeared to be a critical contributing factor.

The public health community has recognized that it cannot handle responses to all possible public health emergencies on its own. The public health sector has deep scientific expertise and excels at initial identification, complex characterization, and test development. The private sector has many resources and capabilities that can complement and augment the public health response. This is especially true in the clinical laboratory sector. Many commercial laboratories are designed for high-volume, high-throughput diagnostic testing in a way that public health laboratories are not. Significant steps have been taken since 2017 to improve the communication and coordination between public health and the private clinical laboratory community, especially during a response to a public health emergency. This paper describes the strong foundation that has been built for an improved clinical and public health laboratory response to the next public health emergency.

An impressive reduction in emergency department patient attendance was observed during the coronavirus disease (COVID-19) pandemic coupled with an increase in the burden of patients with respiratory failure compared with the same period in 2019. These data are in line with the reduction in the hospital admissions rate for acute coronary syndrome observed during the COVID-19 outbreak, probably due to the patients’ fears of being infected during a hospital stay. All these factors may have contributed to the out-of-hospital cardiac arrest (OHCA) occurrence increase observed during the same period. The OHCAs rate increase can recognize 2 great sets of causes: the infection-related and the pandemic-related ones. If the first recognizes different underlying mechanisms that can be dealt with more and more effectively as evidence accumulates, we must remember also the latter: the fear of in-hospital contagion and the willingness not to further burden the health system, which can prevent some citizens from the activation of the emergency medical services (EMS) even in the case of symptoms suspected for time-dependent diseases, resulting in at-home deterioration until the OHCA occurrence. Information campaigns during pandemic must focus also on the importance of EMS early activation in case of real need to prevent COVID-19 from being a disease that kills at home.

Different coronavirus disease (COVID-19) testing approaches have been implemented among Italian regions, reflected in heterogeneous testing rates. We analyzed the number of COVID-19-related deaths in relation to the number of tests performed among the most affected Italian regions. We showed that regions with the highest number of tests performed (Veneto and Toscana) had the lowest 30-day crude mortality rate per 100 000 inhabitants. In addition, an inverse association between crude mortality rates and tests performed (mortality rate ratio for a unit increase in tests per 1000 inhabitants: 0.92; 95% CI: 0.89–0.94) was observed. Early identification and isolation of active cases (including asymptomatic or mildly symptomatic subjects) could have had an important effect in lowering COVID-19 mortality.

The COVID-19 pandemic has placed unprecedented demands on health systems, where hospitals have become overwhelmed with patients amidst limited resources. Disaster response and resource allocation during such crises present multiple challenges. A breakdown in communication and organization can lead to unnecessary disruptions and adverse events. The Federal Emergency Management Agency (FEMA) promotes the use of an incident command system (ICS) model during large-scale disasters, and we hope that an institutional disaster plan and ICS will help to mitigate these lapses. In this article, we describe the alignment of an emergency department (ED) specific Forward Command structure with the hospital ICS and address the challenges specific to the ED. Key components of this ICS include a hospital-wide incident command or Joint Operations Center (JOC) and an ED Forward Command. This type of structure leads to a shared mental model with division of responsibilities that allows institutional adaptations to changing environments and maintenance of specific roles for optimal coordination and communication. We present this as a model that can be applied to other hospital EDs around the country to help structure the response to the COVID-19 pandemic while remaining generalizable to other disaster situations.

This study aims at investigating the influencing factors on hospital resilience. For this purpose, a systematic review of the literature was conducted. Six databases, including Web of Science, Scopus, SAGE, EBSCO, Google Scholar, and PubMed were searched for articles published between 2000 and 2018. Sixteen studies were selected based on inclusion/exclusion criteria. Content analysis revealed 22 influencing factors were included in a framework with 2 dimensions: (1) phases of the hospital resilience process (preparation, response, and recovery/growth) and (2) the key components of the hospital (staff, infrastructure, management, and logistics). Considering the factors that emerged from this research, suggestions were made to improve hospital resilience. The results of this research will enable a hospital manager to develop better plans for hospital preparedness, as well as perform more effectively before, during, and after disasters.

With the uncertain physical and mental health implications of COVID-19 infection, companies have taken a myriad of actions that aim to reduce the risk of employees contracting the virus, with most grounded in reducing or eliminating in-person interactions. Our preliminary analysis indicates that while there is some data to support modelling absenteeism, there are gaps in the available evidence, requiring the use of assumptions that limit precision and efficacy for decision support. Improved data on time-to-recovery after hospitalization, absenteeism due to family or other household member illness, and mental health’s impact on returning to work will support the development of more robust absenteeism models and analytical approaches.

Coronavirus disease 2019 (COVID-19), first documented in December 2019, was declared a public health emergency by the World Health Organization (WHO) on January 30, 2020 (https://www.who.int/westernpacific/emergencies/covid-19). The disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has affected more than 9 million people and contributed to at least 490,000 deaths globally as of June 2020, with numbers on the rise (https://www.worldometers.info/coronavirus/#countries).

Increased numbers of patients seeking medical attention during disease outbreaks can overwhelm healthcare facilities, hence requiring an equivalent response from healthcare services. Surge capacity is a concept that has not only been defined as the “ability to respond to a sudden increase in patient care demands” (Hick et al., Disaster Med Public Health Prep. 2008;2:S51-S57) but also to “effectively and rapidly expand capacity” (Watson et al., Milbank Q. 2013;91(1):78-122).

This narrative review discusses how Singapore’s largest tertiary hospital has encapsulated the elements of surge capability and transformed a peacetime multi-story carpark into a flu screening area in response to the COVID-19 disease outbreak.