-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Brett-Major, David M., Elizabeth R. Schnaubelt, Hannah M. Creager, Abigail Lowe, Theodore J. Cieslak, Jacob M. Dahlke, Daniel W. Johnson, Paul D. Fey, Keith F. Hansen, Angela L. Hewlett, Bruce G. Gordon, Andre C. Kalil, Ali S. Khan, Mark G. Kortepeter, Christopher J. Kratochvil, LuAnn Larson, Deborah A. Levy, James Linder, Sharon J. Medcalf, Mark E. Rupp, Michelle M. Schwedhelm, James Sullivan, Angela M. Vasa, Michael C. Wadman, Rachel E. Lookadoo, John-Martin J. Lowe, James V. Lawler, and M. Jana Broadhurst. 2020. "Advanced Preparation Makes Research in Emergencies and Isolation Care Possible: The Case of Coronavirus Disease."
Abstract
The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high-quality research may launch during an emergency under the right conditions. These include an appropriate context, clarity in scientific aims, preexisting resources, strong operational and research structures that are facile, and good governance. Here, Nebraskan rapid research efforts early during the 2020 coronavirus disease pandemic, while participating in the first use of U.S. federal quarantine in 50 years, are described from these aspects, as the global experience with this severe emerging infection grew apace. The experience has lessons in purpose, structure, function, and performance of research in any emergency, when facing any threat.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online
URL
https://www.ncbi.nlm.nih.gov/pubmed/32228780
Read Online
Online location of the resource.
http://www.ajtmh.org/content/journals/10.4269/ajtmh.20-0205
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Advanced Preparation Makes Research in Emergencies and Isolation Care Possible: The Case of Coronavirus Disease.
Subject
The topic of the resource
Research
Description
An account of the resource
The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high-quality research may launch during an emergency under the right conditions.
Creator
An entity primarily responsible for making the resource
Brett-Major, David M., Elizabeth R. Schnaubelt, Hannah M. Creager, Abigail Lowe, Theodore J. Cieslak, Jacob M. Dahlke, Daniel W. Johnson, Paul D. Fey, Keith F. Hansen, Angela L. Hewlett, Bruce G. Gordon, Andre C. Kalil, Ali S. Khan, Mark G. Kortepeter, Christopher J. Kratochvil, LuAnn Larson, Deborah A. Levy, James Linder, Sharon J. Medcalf, Mark E. Rupp, Michelle M. Schwedhelm, James Sullivan, Angela M. Vasa, Michael C. Wadman, Rachel E. Lookadoo, John-Martin J. Lowe, James V. Lawler, and M. Jana Broadhurst.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-30
Type
The nature or genre of the resource
Publication
Relation
A related resource
Y - D0.1Res/D0.2Res Qualtrics # 1304, original # 1
2019-nCoV
Coronavirus
COVID-19
Epidemic
Lab
Laboratory
Outbreaks
Pandemic
R-Res&Pub
Research
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Wang, Xu, Wenhui Wu, Peipei Song, and Jiangjiang He. 2020. "An international comparison analysis of reserve and supply system for emergency medical supplies between China, the United States, Australia, and Canada." BioScience Trends 14 (4):231-40.
Abstract
Coronavirus disease 19 (COVID-19) has become a pandemic around the world. With the explosive growth of confirmed cases, emergency medical supplies are facing global shortage, which restricts the treatment of seriously ill patients and protection of medical staff. Taking China, the United States, Australia, and Canada as examples, this study compares and analyzes the reserve and supply systems of emergency medical supplies and problems exposed in response to the COVID-19 epidemic. Some common problems were found, such as insufficient types and quantities of emergency medical supplies in reserve, insufficient emergency production capacity, and imperfect command mechanism for emergency supplies deployment and transportation. A sound reserve system of emergency medical supplies is the basis and guarantee for dealing with public health emergencies such as major outbreaks. Based on the comparison of systems and practical experience, countries around the world should further improve the reserve and supply system of emergency medical supplies, and improve the coordination and cooperation mechanism for emergency supplies for international public health emergencies, so as to cope with increasingly severe public health emergencies in the context of globalization.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online, Free Access, 2020 Volume 14 Issue 4 Pages 231-240
URL
https://www.jstage.jst.go.jp/article/bst/14/4/14_2020.03093/_article
Read Online
Online location of the resource.
https://www.jstage.jst.go.jp/article/bst/14/4/14_2020.03093/_pdf/-char/en
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
An international comparison analysis of reserve and supply system for emergency medical supplies between China, the United States, Australia, and Canada
Subject
The topic of the resource
Research
Description
An account of the resource
Coronavirus disease 19 (COVID-19) has become a pandemic around the world. With the explosive growth of confirmed cases, emergency medical supplies are facing global shortage, which restricts the treatment of seriously ill patients and protection of medical staff. Taking China, the United States, Australia, and Canada as examples, this study compares and analyzes the reserve and supply systems of emergency medical supplies and problems exposed in response to the COVID-19 epidemic.
Creator
An entity primarily responsible for making the resource
Wang, Xu, Wenhui Wu, Peipei Song, and Jiangjiang He.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-20
Type
The nature or genre of the resource
Publication
2019-nCoV
Coronavirus
COVID-19
Emergency Management
Epidemic
Equipment and Supplies
Pandemic
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
URL
https://soundcloud.com/user-972010434-53971567/sets/are-we-ready-for-the-next-outbreak
Player
Field for the html for a video player.
<iframe width="100%" height="300" scrolling="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/424282158&color=%23ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&show_teaser=true&visual=true" title="Are We Ready Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Are We Ready for the Next Outbreak?
Subject
The topic of the resource
General
Description
An account of the resource
A three part pod-cast series discusses the need for new and improved tools to fight infectious disease, as demonstrated by the recent outbreaks of Ebola and Zika.
Creator
An entity primarily responsible for making the resource
U.S. Agency for International Development
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-04-01
Ebola
Epidemic
Epidemiology
Experimental Drugs
Federal
International Response
Medical Surveillance
Outbreaks
Pandemic
Prophylaxis
Public Health
R-Gen
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Wilkason, Colby, Christopher Lee, Lauren M. Sauer, Jennifer Nuzzo, and Amanda McClelland. 2020. "Assessing and Reducing Risk to Healthcare Workers in Outbreaks." Health security 18 (3):205-11.
Abstract
The 2014-2016 West African Ebola epidemic was devastating in many respects, not least of which was the impact on healthcare systems and their health workforce. Healthcare workers—including physicians, clinical officers, nurses, midwives, and community health workers—serve on the front lines of efforts to detect, control, and stop the spread of disease. Risk mitigation strategies, including infection prevention and control (IPC) practices, are meant to keep healthcare workers safe from occupational exposure to disease and to protect patients from healthcare-associated infections. Despite ongoing IPC efforts, steady rates of both healthcare-associated and healthcare worker infections signal that these mitigation measures have been inadequate at all levels and present a potential critical point of failure in efforts to limit and control the spread of outbreaks. The fact that healthcare workers continue to be infected or are a source of infection during public health emergencies reveals a weakness in global preparedness efforts. Identification of key points of failure—both within the health system and during emergencies—is the first step to mitigating risk of exposure. A 2-pronged solution is proposed to address long-term gaps in the health system that impact infection control and emergency response: prioritization of IPC for epidemic preparedness at a global level and development and use of rapid risk assessments to prioritize risk mitigation strategies for IPC. Without global support, evidence, and systems in place to support the lives of healthcare workers, the lives of their patients and the health system in general are also at risk.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Pay online through journal site.
URL
https://pubmed.ncbi.nlm.nih.gov/32559156/
Read Online
Online location of the resource.
https://www.liebertpub.com/doi/full/10.1089/hs.2019.0131
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Assessing and Reducing Risk to Healthcare Workers in Outbreaks
Subject
The topic of the resource
Personnel Management
Description
An account of the resource
The 2014-2016 West African Ebola epidemic was devastating in many respects, not least of which was the impact on healthcare systems and their health workforce. Healthcare workers—including physicians, clinical officers, nurses, midwives, and community health workers—serve on the front lines of efforts to detect, control, and stop the spread of disease.
Creator
An entity primarily responsible for making the resource
Wilkason, Colby, Christopher Lee, Lauren M. Sauer, Jennifer Nuzzo, and Amanda McClelland.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 217, original # 8a
Y - D0.1PM/D0.2PM Qualtrics # 913, original # 9
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-10
Ebola
Epidemic
Infection Prevention and Control
Occupational Exposure
Occupational Health
Outbreaks
Pandemic
R-IPC
R-PM
R-Res&Pub
-
https://repository.netecweb.org/files/original/48a3eba70e0564baf4cfddd040388db9.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Aswani, Vijay. 2016. "Being a Pediatrician in an Ebola Epidemic." Pediatrics 137 (1):e20152950.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Full text on HighWire
URL
https://www.ncbi.nlm.nih.gov/pubmed/26628728
Read Online
Online location of the resource.
https://pediatrics.aappublications.org/content/137/1/e20152950
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Being a Pediatrician in an Ebola Epidemic
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Narrative of his work in Sierra Leone in January and February 2015.
Creator
An entity primarily responsible for making the resource
Vijay Aswani
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-01
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group (3 years)
2022-10-07 by Kari, Special Populations Treatment & Care group (2 years)
Ebola
Epidemic
Epidemiology
Pediatrics
R-Res&Pub
R-SP
R-T&C
Treatment and Care
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Wilder-Smith, Annelies, Calvin J. Chiew, and Vernon J. Lee. 2020. "Can we contain the COVID-19 outbreak with the same measures as for SARS?" The Lancet Infectious Diseases.
Abstract
<h2 class="top"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<div class="section-paragraph">The severe acute respiratory syndrome (SARS) outbreak in 2003 resulted in more than 8000 cases and 800 deaths. SARS was eventually contained by means of syndromic surveillance, prompt isolation of patients, strict enforcement of quarantine of all contacts, and in some areas top-down enforcement of community quarantine. By interrupting all human-to-human transmission, SARS was effectively eradicated. By contrast, by Feb 28, 2020, within a matter of 2 months since the beginning of the outbreak of coronavirus disease 2019 (COVID-19), more than 82 000 confirmed cases of COVID-19 have been reported with more than 2800 deaths. Although there are striking similarities between SARS and COVID-19, the differences in the virus characteristics will ultimately determine whether the same measures for SARS will also be successful for COVID-19. COVID-19 differs from SARS in terms of infectious period, transmissibility, clinical severity, and extent of community spread. Even if traditional public health measures are not able to fully contain the outbreak of COVID-19, they will still be effective in reducing peak incidence and global deaths. Exportations to other countries need not result in rapid large-scale outbreaks, if countries have the political will to rapidly implement countermeasures.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30129-8/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30129-8/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Can we contain the COVID-19 outbreak with the same measures as for SARS?
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The severe acute respiratory syndrome (SARS) outbreak in 2003 resulted in more than 8000 cases and 800 deaths.
Creator
An entity primarily responsible for making the resource
Wilder-Smith, Annelies, Calvin J. Chiew, and Vernon J. Lee.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-05
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-10
2019-nCoV
Coronavirus
COVID-19
Epidemic
Infection Prevention and Control
R-IPC
R-Res&Pub
SARS
SARS-CoV-2
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.strong4life.com/~/media/files/Strong4Life/Programs/School-Programs/back-to-school-2020/childrens-reopening-toolkit-youth-organizations.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Children's Reopening Toolkit for Youth Organizations
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
As we reopen, children—and those who serve them—need support more than ever. Use the resources in this toolkit as a steppingstone to help protect the kids and staff within your organization. <br /><br />Find this and related resources: <a href="https://www.strong4life.com/en/landing-pages/schools-reopening" target="_blank" rel="noreferrer noopener">https://www.strong4life.com/en/landing-pages/schools-reopening</a>
Creator
An entity primarily responsible for making the resource
Children's Healthcare of Atlanta (CHOA)
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08
Contributor
An entity responsible for making contributions to the resource
2022-07 by Nicole, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-31
2019-nCoV
Children
Contingency and crisis capacities
Coronavirus
COVID-19
Emergency Management
Epidemic
Example
Pandemic
Pediatrics
R-EM
R-SP
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
URL
https://bioethicsarchive.georgetown.edu/pcsbi/node/5834.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Community Engagement in Ethics and Ebola
Subject
The topic of the resource
General
Creator
An entity primarily responsible for making the resource
Presidential Commission for the Study of Bioethical Issues
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-07-13
Description
An account of the resource
A learning module for students to discuss, identify, and consider issues related to community engagement in public health emergency planning and response.
Communications
Ebola
Epidemic
Ethics
Legal
Outbreaks
Patient Care
Public Health
Quarantine
R-Gen
Research
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Abstract
<h2 class="top" id="seccestitle10"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<div class="section-paragraph">The objective of this Personal View is to compare transmissibility, hospitalisation, and mortality rates for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with those of other epidemic coronaviruses, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and pandemic influenza viruses. The basic reproductive rate (<em>R</em><sub>0</sub>) for SARS-CoV-2 is estimated to be 2·5 (range 1·8–3·6) compared with 2·0–3·0 for SARS-CoV and the 1918 influenza pandemic, 0·9 for MERS-CoV, and 1·5 for the 2009 influenza pandemic. SARS-CoV-2 causes mild or asymptomatic disease in most cases; however, severe to critical illness occurs in a small proportion of infected individuals, with the highest rate seen in people older than 70 years. The measured case fatality rate varies between countries, probably because of differences in testing strategies. Population-based mortality estimates vary widely across Europe, ranging from zero to high. Numbers from the first affected region in Italy, Lombardy, show an all age mortality rate of 154 per 100 000 population. Differences are most likely due to varying demographic structures, among other factors. However, this new virus has a focal dissemination; therefore, some areas have a higher disease burden and are affected more than others for reasons that are still not understood. Nevertheless, early introduction of strict physical distancing and hygiene measures have proven effective in sharply reducing <em>R</em><sub>0</sub> and associated mortality and could in part explain the geographical differences.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30484-9/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30484-9/fulltext
Citation
Citation information for the publication itself.
Petersen, Eskild, Marion Koopmans, Unyeong Go, Davidson H. Hamer, Nicola Petrosillo, Francesco Castelli, Merete Storgaard, Sulien Al Khalili, and Lone Simonsen. 2020. "Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics." The Lancet Infectious Diseases.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
The objective of this Personal View is to compare transmissibility, hospitalisation, and mortality rates for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with those of other epidemic coronaviruses, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and pandemic influenza viruses.<br /><br />A response to this was published Aug. 11, 2020:<br />
<ul>
<li>Standl, Fabian, Karl-Heinz Jöckel, Bastian Brune, Börge Schmidt, and Andreas Stang. 2020. "<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30648-4/fulltext" target="_blank" rel="noreferrer noopener">Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics</a>." The Lancet Infectious Diseases.</li>
</ul>
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-03
Type
The nature or genre of the resource
Publication
Creator
An entity primarily responsible for making the resource
Petersen, Eskild, Marion Koopmans, Unyeong Go, Davidson H. Hamer, Nicola Petrosillo, Francesco Castelli, Merete Storgaard, Sulien Al Khalili, and Lone Simonsen.
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
2019-nCoV
Coronavirus
COVID-19
Epidemic
Flu
Influenza
Pandemic
R-EM
R-Res&Pub
SARS
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Dean, Natalie E., Pierre-Stéphane Gsell, Ron Brookmeyer, Forrest W. Crawford, Christl A. Donnelly, Susan S. Ellenberg, Thomas R. Fleming, M. Elizabeth Halloran, Peter Horby, Thomas Jaki, Philip R. Krause, Ira M. Longini, Sabue Mulangu, Jean-Jacques Muyembe-Tamfum, Martha C. Nason, Peter G. Smith, Rui Wang, Ana M. Henao-Restrepo, and Victor De Gruttola. 2020. "Creating a Framework for Conducting Randomized Clinical Trials during Disease Outbreaks." New England Journal of Medicine 382 (14):1366-9.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM.
URL
https://www.nejm.org/doi/full/10.1056/NEJMsb1905390
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMsb1905390
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Creating a Framework for Conducting Randomized Clinical Trials during Disease Outbreaks
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
Conducting trials of novel interventions during infectious disease emergencies, such as the ongoing Covid-19 pandemic, is increasingly recognized as important for determining the efficacy of potential vaccines and therapies.
Creator
An entity primarily responsible for making the resource
Dean, Natalie E., Pierre-Stéphane Gsell, Ron Brookmeyer, Forrest W. Crawford, Christl A. Donnelly, Susan S. Ellenberg, Thomas R. Fleming, M. Elizabeth Halloran, Peter Horby, Thomas Jaki, Philip R. Krause, Ira M. Longini, Sabue Mulangu, Jean-Jacques Muyembe-Tamfum, Martha C. Nason, Peter G. Smith, Rui Wang, Ana M. Henao-Restrepo, and Victor De Gruttola.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-02
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Clinical Trial
Epidemic
Laboratory Testing
Outbreaks
Pandemic
R-EM
R-Res&Pub
Therapeutics
Vaccine Study
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
URL
http://www.bu.edu/sph/news-events/signature-programs/public-health-fora/crises-calamities-and-chaos-how-public-health-can-improve-response-to-emerging-threats-wherever-they-arise/
Player
Field for the html for a video player.
<iframe width="560" height="315" src="https://www.youtube.com/embed/vDV6_NrH48c" frameborder="0" title="Crises, Calamities, and Chaos Lecture Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Crises, Calamities, and Chaos: How Public Health Can Improve Response to Emerging Threats Wherever They Arise
Creator
An entity primarily responsible for making the resource
Boston University
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
From Ebola to Zika, from hurricanes to opioids, threats to health make headlines and challenge our public health response. Lessons learned from CDC’s engagements around the world, and in our backyard, suggest a role for everyone in mitigating risk and building resilience.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-04-30
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Emergency Management
Epidemic
Pandemic
Public Health
R-EM
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
URL
https://www.researchgate.net/publication/322664653_Ebola_Response_in_cities_Learning_for_future_public_health_crises
Citation
Citation information for the publication itself.
Campbell, L. (2017) Ebola Response in cities: Learning for future public health crises. ALNAP Working Paper. London: ALNAP/ODI.
Abstract
Summary: <br />In November 2014, ALNAP launched a sub-group of the Urban Response Community of Practice (CoP) to gather learning from the urban aspects of the Ebola Virus Disease (EVD) response in West Africa. Informed by CoP discussions, interviews and review of literature and media articles, ALNAP has produced four brief learning reports. Three of these cover issues around population movement ; working in a context of quarantine ; and communication and engagement . This paper explores a variety of issues by looking at the case of one urban informal settlement, West Point, Monrovia, Liberia, and its experience of the EVD outbreak and response. <br />The EVD outbreak in West Africa was the first time EVD had infiltrated an urban area. The unprecedented scale of the outbreak combined with the dynamic urban contexts within the affected region challenged responders considerably. <br />The three most affected countries were Guinea, Liberia and Sierra Leone. All three have seen unprecedented urban growth in recent years. All three have a legacy of conflict and unplanned development, and they all struggle with health care and other related infrastructure, including water, sanitation and electricity. <br />West Point, Monrovia, is an informal settlement in Liberia that, despite being an official township of the capital city, has experienced decades of unplanned growth and expansion, particularly since internally displaced persons from the Liberian civil war began to arrive. It has significant water, sanitation, hygiene, electricity, access, land tenure, erosion and protection issues, which have been persistently present and unresolved pretty much since the settlement was established. Despite these challenges, West Point has been described as fairly cohesive, and its proximity both to the coast and to economic activity in Monrovia means many residents do have an income. At the time of the EVD outbreak, West Point was home to approximately 70,000 residents. <br />EVD reached Monrovia in June 2014, having arrived in the country in March. Few cases were reported in April and May, which led officials to believe the outbreak had been contained. However, over the summer, it became clear that failed messaging combined with denial, mistrust and scepticism had driven the outbreak underground, with illness and death occurring without being reported. In August, after an official visiting West Point discovered several cases of EVD deaths, the government enacted a swift plan to transform a school in the settlement into an Ebola holding centre. Within a matter of days the holding centre was opened, the community rioted, the entire settlement was put under quarantine and it was released, following long-overdue consultations between government and community leaders. <br />From September 2014, the response to EVD in West Point was largely community-led. While there was support from and programming by both the government and international actors, it was West Point community volunteers who tackled the denial, got cases reported and ultimately ended the crisis in the settlement, which reported its last case of EVD in December 2014. Leaders from West Point were later asked to help other parts of Monrovia still tackling the disease. <br />Today, though Ebola-free, West Point remains an informal settlement with great water, sanitation and hygiene, environmental, social and political challenges. The handful of upgrades and improvements it received during the response has not tackled issues that have persisted since long prior to the outbreak. And mistrust between the community and the government is likely to continue, as the future of West Point and its residents has yet to be determined. <br />West Point’s experience of EVD sheds light on many of the issues discussed throughout this series, including the challenges posed when quarantine is enacted in a dense informal settlement; the importance of community mobilisation, particularly in an urban environment; the critical role of population movement in informing the makeup of the community and also in illustrating behaviour throughout the outbreak; and why it took so long to apply an urban response to this largely urban crisis.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola Response in Cities
Subject
The topic of the resource
Emergency Management
Creator
An entity primarily responsible for making the resource
Active Learning Network for Accountability and Performance in Humanitarian Action
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-06-26
Type
The nature or genre of the resource
Publication
Description
An account of the resource
In November 2014, ALNAP launched a sub-group of the Urban Response Community of Practice (CoP) to gather learning from the urban aspects of the Ebola Virus Disease (EVD) response in West Africa.
Contributor
An entity responsible for making contributions to the resource
2024-02-26 by J. Mundy - updated url from ALNAP to ResearchGate, publication appears gone from ALNAP website.
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Communications
Ebola
Emergency Management
Epidemic
Epidemiology
Outbreaks
Public Health
Quarantine
R-EM
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Christie, Athalia, John C. Neatherlin, Stuart T. Nichol, Michael Beach, and Robert R. Redfield. 2020. "Ebola Response Priorities in the Time of Covid-19." New England Journal of Medicine 383 (13):1202-4.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM
URL
https://www.nejm.org/doi/full/10.1056/NEJMp2025512
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMp2025512
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola Response Priorities in the Time of Covid-19
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
On April 10, 2020, a total of 53 days after the last patient with Ebola virus disease (EVD) had been isolated and more than 23 months since the start of the 10th EVD outbreak in the Democratic Republic of Congo (DRC), a new confirmed case was reported in the Beni health zone. This case, and the six that followed, brought the total to 3462 cases — the second-largest Ebola outbreak in history. Although the outbreak was declared over on June 25, 2020, additional cases attributable to persistently infected survivors may occur. Therefore, surveillance and rapid-response capacity should be maintained, not only for a duration equivalent to two incubation periods (42 days) after the last confirmed case tested negative, but also for at least 90 additional days of enhanced surveillance.
Creator
An entity primarily responsible for making the resource
Christie, Athalia, John C. Neatherlin, Stuart T. Nichol, Michael Beach, and Robert R. Redfield.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-24
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
2019-nCoV
Coronavirus
COVID-19
Ebola
Emergency Management
Epidemic
International Response
Pandemic
R-EM
R-Res&Pub
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Online Course
Access portal to an online course.
URL
https://openwho.org/courses/GO-en
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Approximately 3 hours
Access
Description of access information (e.g. itunes).
Free with free OpenWHO account.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola: GO 2.0 (EN)
Creator
An entity primarily responsible for making the resource
WHO
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
All personnel responding to Ebola outbreaks need to have basic knowledge and skills in order to mount an effective response. The GO training package was developed for WHO deployees so they can work safely and effectively as part of the teams bringing outbreaks under control. The learning package consists of 7 modules, which include video lectures and downloadable presentations that have been updated with the latest information and developments. It begins with an introduction to Ebola virus disease before moving to the response strategy and essential information related to working for WHO. (WHO)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-07-05
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 231, original # 17a (additional resources)
Y - D0.1IC/D0.2IC Qualtrics # 206, original # 2b
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Ebola
Epidemic
Infection Prevention and Control
Outbreaks
Patient Care
Public Health
R-IPC
-
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
J. Y. Nau. "Ebola : comment faire pour rapatrier les soignants contaminés ?." Rev Med Suisse 10, no. 449 (Nov 5 2014): 2118-9.
Abstract
Les médias français n’en ont pas été informés : début octobre, une infirmière norvégienne, contaminée par le virus Ebola, a été rapatriée par une société française d’assistance médicale depuis Freetown jusqu’à Oslo, via Las Palmas et Le Bourget.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
free online
URL
https://www.ncbi.nlm.nih.gov/pubmed/25536838
Read Online
Online location of the resource.
https://www.revmed.ch/RMS/2014/RMS-N-449/Ebola-comment-faire-pour-rapatrier-les-soignants-contamines
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola: how to repatriate contaminated health care providers?/Ebola : comment faire pour rapatrier les soignants contaminés ?
Subject
The topic of the resource
Contenu Français
Description
An account of the resource
Les médias français n’en ont pas été informés : début octobre, une infirmière norvégienne, contaminée par le virus Ebola, a été rapatriée par une société française d’assistance médicale depuis Freetown jusqu’à Oslo, via Las Palmas et Le Bourget.
Creator
An entity primarily responsible for making the resource
Nau JY.
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-11-05
Type
The nature or genre of the resource
Publication
Contact Transmission
Droplet Transmission
Ebola
Epidemic
Epidemiology
Français
French
Infection Prevention and Control
Occupational Exposure
Occupational Health
Personnel Management
Quarantine
R-Res&Pub
Staffing
Therapeutics
Travel Screening
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/42cc1379f3523ef4c23835c9b4049a9b.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
URL
https://emergency.cdc.gov/coca/calls/2017/callinfo_110217.asp
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ecology of Emerging Zoonotic Diseases
Subject
The topic of the resource
General
Description
An account of the resource
This webinar discusses Nipah virus and Ebola in terms of how human activity increases contact with wildlife and thus zoonotic disease emergence, and discusses interventions that reduce such risk.
Creator
An entity primarily responsible for making the resource
CDC, Office of Public Health Preparedness and Response (CDC OPHPR)
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-11-02
Contributor
An entity responsible for making contributions to the resource
2022-03-17 by Anna Yaffee (Adult Care Group) keep in Resource Library
2023-02-19 by Anna Yaffee T&C group Q1 review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-02-19
Avian Influenza
Coronavirus
Crimean Congo Haemorrhagic Fever (CCHF)
Ebola
Epidemic
Lassa
Marburg
Nipah (NiV)
Outbreaks
Pandemic
Public Health
R-Gen
Respiratory Pathogen
SARS
Special Pathogens
Viral Hemorrhagic Fever
Zoonotic
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
77 minutes 46 seconds.
URL
http://www.ndhealth.gov/microlab/BTWorkshop/Emerging_Diseases_2017/index.htm
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emerging Diseases and Implementation of Emergency Use Authorizations
Subject
The topic of the resource
Laboratory
Description
An account of the resource
Emerging Infections and Implementation of Emergency Use Authorizations content was developed by Susanne Norris Zanto of Laboratory SolutionZ. The narrator is Tracy Hoke, the BT Coordinator at the North Dakota Department of Health, Division of Laboratory Services.
Creator
An entity primarily responsible for making the resource
North Dakota Department of Health
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-06-23
Contributor
An entity responsible for making contributions to the resource
2023-12-18 by Lab (Vicki and Kim), 3 yr / Example
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-18
Diagnosis
Ebola
Epidemic
Example
Lab
Laboratory
Laboratory Testing
Public Health
R-Lab
Special Pathogens
Specimen Collection
Specimen Handling
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
URL
https://www.coursera.org/course/ebola
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emory University Coursera Course – Ebola Virus Disease: An Evolving Epidemic
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
General
Description
An account of the resource
Ebola Virus Disease: An Evolving Epidemic - Emory University | Coursera
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Communications
Diagnosis
Donning and Doffing
Ebola
Epidemic
Epidemiology
Ethics
Example
Immunology
Infection Prevention and Control
Lab
Laboratory
Laboratory Testing
Nursing
Outbreaks
Outcomes
Patient Care
Personal Protective Equipment (PPE)
Prophylaxis
Public Health
Public Relations
Quarantine
R-PPE
Therapeutics
Virology
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Tuite, Ashleigh R., Victoria Ng, Erin Rees, and David Fisman. 2020. "Estimation of COVID-19 outbreak size in Italy." The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30227-9/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30227-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Estimation of COVID-19 outbreak size in Italy
Subject
The topic of the resource
Research
Description
An account of the resource
Italy is currently experiencing an epidemic of COVID-19 which emerged in the Lombardy region.
Creator
An entity primarily responsible for making the resource
Tuite, Ashleigh R., Victoria Ng, Erin Rees, and David Fisman.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-19
Type
The nature or genre of the resource
Publication
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Droplet Transmission
Epidemic
Pandemic
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Tuite, Ashleigh R., Victoria Ng, Erin Rees, David Fisman, Annelies Wilder-Smith, Kamran Khan, and Isaac I. Bogoch. 2020. "Estimation of the COVID-19 burden in Egypt through exported case detection." The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30233-4/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30233-4/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Estimation of the COVID-19 burden in Egypt through exported case detection
Subject
The topic of the resource
Research
Description
An account of the resource
In December, coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, causing a pandemic that continues to spread globally.
Creator
An entity primarily responsible for making the resource
Tuite, Ashleigh R., Victoria Ng, Erin Rees, David Fisman, Annelies Wilder-Smith, Kamran Khan, and Isaac I. Bogoch.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-26
Type
The nature or genre of the resource
Publication
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Droplet Transmission
Epidemic
Identify
Pandemic
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
URL
https://bioethicsarchive.georgetown.edu/pcsbi/node/5891.html
Player
Field for the html for a video player.
<iframe width="100%" height="300" scrolling="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/278844455&color=%23ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&show_teaser=true&visual=true" title="Ethically Sound Podcast"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ethically Sound
Subject
The topic of the resource
General
Creator
An entity primarily responsible for making the resource
Presidential Commission for the Study of Bioethical Issues
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-09-19
Description
An account of the resource
Episode of the 'Ethically Sound' podcast, discussing ethics and ebola.
Ebola
Epidemic
Ethics
Legal
Outbreaks
Patient Care
Public Health
Quarantine
R-Gen
Research
Special Pathogens
Survivors
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<iframe width="645" height="411" src="https://videocast.nih.gov/embed.asp?file=23678&w=640&h=360" frameborder="0" title="Keynote of Viral Networks Workshop Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Evolution of Viral Networks
Subject
The topic of the resource
General
Description
An account of the resource
This is a lecture that was the keynote of Viral Networks: An Advanced Workshop in Digital Humanities and Medical History. It focuses on H1N1, Ebola, and Zika.
Creator
An entity primarily responsible for making the resource
NLM, NIH
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-29
Diagnosis
Ebola
Epidemic
Epidemiology
Medical Surveillance
Pandemic
Public Health
R-Gen
Respiratory Pathogen
Viral Hemorrhagic Fever
Virology
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Joy, Mark, F. D. Richard Hobbs, Dylan McGagh, Oluwafunmi Akinyemi, and Simon de Lusignan. 2020. "Excess mortality from COVID-19 in an English sentinel network population." The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30632-0/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30632-0/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Excess mortality from COVID-19 in an English sentinel network population
Subject
The topic of the resource
Research
Description
An account of the resource
There have been several attempts to predict mortality from COVID-19 in the UK, including calculation of age-based case fatality rates and relative risk (RR) of mortality.
Creator
An entity primarily responsible for making the resource
Joy, Mark, F. D. Richard Hobbs, Dylan McGagh, Oluwafunmi Akinyemi, and Simon de Lusignan.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-04
Type
The nature or genre of the resource
Publication
2019-nCoV
Coronavirus
COVID-19
Epidemic
Outcomes
Pandemic
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Cagliuso, Nicholas V., Meghan McGinty, and Syra Madad. 2020. "Fierce Advocates for Building All-Hazards Resurgence and Resilience: NYC Health + Hospitals' COVID-19 Experiences Applied." Health security.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free access, ahead of print
URL
https://pubmed.ncbi.nlm.nih.gov/32706596/
Read Online
Online location of the resource.
https://www.liebertpub.com/doi/10.1089/hs.2020.0100
Dublin Core
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Title
A name given to the resource
Fierce Advocates for Building All-Hazards Resurgence and Resilience: NYC Health + Hospitals' COVID-19 Experiences Applied
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
The highly predictable advent of novel coronavirus disease 2019 (COVID-19), which researchers and practitioners alike have agreed was a longstanding, plausible hazard, coupled with civil unrest due to chronic injustices and the concurrent commencement of the 2020 Atlantic hurricane season, prompted New York City (NYC) Health + Hospitals, the largest municipal healthcare delivery system in the United States, to rethink its approach to all-hazards emergency management.
Creator
An entity primarily responsible for making the resource
Cagliuso, Nicholas V., Meghan McGinty, and Syra Madad.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-24
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
2019-nCoV
Coronavirus
COVID-19
Emergency Management
Epidemic
Pandemic
R-EM
R-Res&Pub
-
Dublin Core
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Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://echo.unm.edu/covid-19/sessions/firstresponder
Dublin Core
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Title
A name given to the resource
First Responder Resiliency ECHO
Subject
The topic of the resource
Personnel Management
Description
An account of the resource
First responders are the primary frontline professionals responding to emergencies and are the difference between life and death for patients and community members. Continually at risk for physical injury, compassion fatigue, “burn-out”, and PTSD, the COVID-19 global pandemic is impacting First Responders and Frontline Healthcare Workers in unprecedented ways.
<p>Join your colleagues in EMS, law enforcement, and healthcare from around the nation for our first-of-its-kind program based on real cases and situations generated by COVID-19. Learn techniques to manage self-care and increase resiliency and capacity during this crisis. Share best practices and receive support from peers, physicians, and mental health experts.</p>
Creator
An entity primarily responsible for making the resource
Project Echo
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-14
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - covid specific resource, relevancy for non covid environment
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-14
2019-nCoV
Anxiety
Burnout
Coping
Coronavirus
COVID-19
EMS
Epidemic
Example
First Responder
Mental Health
Nursing
Occupational Health
Pandemic
Post-traumatic stress disorder (PTSD)
R-PM
Resilience
Self-Care
Staff Support
Staffing
-
https://repository.netecweb.org/files/original/8bd46188feac6675a08f487406f93d9e.pdf
76c66c15c54e3f2a10e14f7ea3dcd65d
PDF Text
Text
�11-02-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
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Title
A name given to the resource
Gaining Strength and Developing Resiliency
Subject
The topic of the resource
Personnel Management
Description
An account of the resource
This printable flyer infographic tells you about gaining strength and developing resiliency as a health care provider, and key risk factors and signs of psychological distress.<br /><br />View this flyer in <a href="https://repository.netecweb.org/items/show/1579">Spanish "Desarrollando fuerza y resiliencia mental</a>."
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-11-02
Relation
A related resource
Y - D0.1PM/D0.2PM Qualtrics # 914, original # 10
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-14
2019-nCoV
Coronavirus
COVID-19
Epidemic
Occupational Health
Pandemic
Personnel Management
Post-traumatic stress disorder (PTSD)
R-Lead
R-PM
Staffing
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
URL
https://www.who.int/publications/i/item/9789241549837
Citation
Citation information for the publication itself.
WHO. 2016. Guidance for Managing Ethical Issues in Infectious Disease Outbreaks.
Read Online
Online location of the resource.
http://apps.who.int/iris/bitstream/10665/250580/1/9789241549837-eng.pdf?ua=1
Dublin Core
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Title
A name given to the resource
Guidance For Managing Ethical Issues In Infectious Disease Outbreaks
Subject
The topic of the resource
General
Creator
An entity primarily responsible for making the resource
World Health Organization (WHO)
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-10-18
Type
The nature or genre of the resource
Publication
Description
An account of the resource
Infectious disease outbreaks are frequently characterized by scientific uncertainty, social and institutional disruption, and an overall climate of fear and distrust. Policy makers and public health professionals may be forced to weigh and prioritize potentially competing ethical values in the face of severe time and resource constraints. This document seeks to assist policy-makers, health care providers, researchers, and others prepare for outbreak situations by anticipating and preparing for the critical ethical issues likely to arise. (WHO)
Ebola
Epidemic
Ethics
Legal
Outbreaks
Patient Care
Public Health
Quarantine
R-Gen
R-Res&Pub
Research
Special Pathogens
Survivors
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
URL
https://centerforhealthsecurity.org/sites/default/files/2023-02/hcidfinalreport05232017.pdf
Dublin Core
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Title
A name given to the resource
Health Sector Resilience Checklist for High-Consequence Infectious Diseases
Subject
The topic of the resource
General
Creator
An entity primarily responsible for making the resource
Johns Hopkins Center for Health Security
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-05-24
Description
An account of the resource
Using lessons learned from treating Ebola patients in the US during the 2014-2016 Ebola epidemic in West Africa, this paper works to develop an evidence-informed checklist that outlines action steps.
Source
A related resource from which the described resource is derived
Eric Toner, MD; Matthew P. Shearer, MPH; Tara Kirk Sell, PhD; Diane Meyer, RN, MPH; Hannah Chandler; Monica Schoch-Spana, PhD; Erin Thomas Echols, PhD; Dale Rose, PhD; Eric Carbone, MBA, PhD
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change R-EM)
2023-05-15 JCM - updated URL to PDF
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Communications
Decontamination
Ebola
Emergency Management
EMS
Epidemic
High Consequence Infectious Disease (HCID)
Identify
Infection Prevention and Control
Inform
Isolate
Lab
Laboratory
Medical Surveillance
Outbreaks
Patient Transport
Person Under Investigation (PUI)
Public Health
Quarantine
R-EM
Special Pathogens
Temperature Monitoring
-
Dublin Core
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Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Chen, Xuejiao, Junzhang Tian, Guanming Li, and Guowei Li. "Initiation of a new infection control system for the COVID-19 outbreak." The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free Online
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30110-9/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30110-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Initiation of a new infection control system for the COVID-19 outbreak
Subject
The topic of the resource
Infection Control
Description
An account of the resource
In December, 2019, a group of patients with pneumonia of unknown origin, most of whom had been exposed to the Huanan seafood wholesale market in Wuhan, China, was first reported.
Creator
An entity primarily responsible for making the resource
Chen, Xuejiao, Junzhang Tian, Guanming Li, and Guowei Li.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-02-18
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
2019-nCoV
Coronavirus
COVID-19
Epidemic
Infection Prevention and Control
R-IPC
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.kdhe.ks.gov/1505/Ebola-Virus-Disease
Objectives
See Resources under the "For Health Care Providers" section of the page. Requires login.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Kansas Highly Infectious Disease and Pandemic Plan
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
The Kansas Department of Health and Environment (KDHE) developed a preparedness and response plan following the 2014 Ebola outbreak in West Africa in response to the possibility of cases affecting Kansas. This "Kansas Ebola Virus Preparedness and Response Plan" has been updated to the "Kansas Highly Infectious Disease and Pandemic Plan."<br /><br /><a href="https://www.kdhe.ks.gov/1505/Ebola-Virus-Disease" target="_blank" rel="noreferrer noopener">https://www.kdhe.ks.gov/1505/Ebola-Virus-Disease</a>
Creator
An entity primarily responsible for making the resource
Kansas Department of Health and Environment
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01
Communications
CONOPS
Decontamination
Ebola
Emergency Management
EMS
Epidemic
Federal
Identify
Infection Prevention and Control
Inform
Isolate
Lab
Laboratory
Laboratory Testing
Medical Surveillance
Outbreaks
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Public Health
Quarantine
R-EM
Region 7
Specimen Collection
Specimen Handling
Specimen Transport
Temperature Monitoring
Waste Management
-
https://repository.netecweb.org/files/original/33fc46a2ef0427131874445e95642a86.pdf
fd4d62c7bab153baf45c9cd23cb9a51e
PDF Text
Text
Lessons Learned in Developing an Effective
Regional Ebola CONOPS
August 10, 2016
Click here to access the pre-recorded webinar.
�Welcome Message and Webinar Intent
• Melissa Harvey, RN, MSPH
– Director, Division of National Healthcare
Preparedness Programs
2
�Webinar Purpose
• Share lessons learned to assist regions
in the development of their Ebola
concept of operations (CONOPS)
3
�Learning Objectives
• Participants will:
– Learn how two regions developed their
CONOPS.
– Understand how lessons learned shaped
planning in those regions.
– Know more about resources that support
patient transport.
– Be able to apply promising practices to
their own regional CONOPS development
efforts.
4
�Region IV
5
�Region IV Approach
• Built upon established relationships.
• Shared more mature plans to jumpstart
planning in less advanced states and
facilities.
• Led partners to resources, but did not
force them to follow.
• Understood that planning is an ongoing
process.
6
�Region IV Lessons Learned
• Need for sound and exercised
communication pathways.
• Essential to have “Plan B” for transport.
• Just because something worked does
not mean it is finished.
7
�Regional Treatment Center Perspective
• Notification influences readiness.
• Clear and concise communication
strategies are key.
• Building relationships with regional
partners during times of inactivation
helps provide a foundation of trust.
8
�“!-ha” Moments and Promising Practices
• Don’t forget about your Field Project
Officer.
• Important to account for differing levels of
experience.
• Active support from leadership makes the
process easier.
9
�Region III
10
�Region III Approach
• Formation of dedicated
planning group.
• Constant communication
throughout the regional
CONOPS development
process.
• Engagement with the
Regional Treatment Center
every step of the way.
11
�Region III Lessons Learned
• Cannot overemphasize
importance of transparent
communication.
• States’ legislative construct posed
some challenges.
• Transportation remains a
challenge.
• Importance of inclusion of federal
installations in the process.
12
�Regional Treatment Center Perspective
• Involvement in planning at the outset is
critical.
• Forming strong partnerships with local
and state governments is imperative.
• Onsite multi-disciplinary and multiinstitutional training is key to success.
13
�“!-ha” Moments and Promising Practices
• Phoenix Air revelation.
• Who’s responsible for
transporting patient back
home?
• Early and active buy-in by
Deputy Secretary set the stage.
• SharePoint to facilitate
development of plan.
14
�Critical Issues in Patient Transportation
15
�EMS Biosafety Transport
• Development and implementation of:
– Administrative policies
– Work practices
– Environment design
– Safety equipment
To prevent transmission of biological agents
to workers, other persons and the
environment.
16
�EMS Biosafety Transport
• Education
• Training
• Policies
• Procedures
• Development and
maintenance of
competencies
17
�Important Principles
• Strong partner communications
– EMS, hospital, public health, law
enforcement, emergency management,
airport
• Strong EMS-hospital interface
– Shared development of policies and
procedures
– Shared drills and exercises
18
�Resources
• ASPR - Air to Ground Transport Fact Sheet
• CDC
– “Guidance for Developing a Plan for Interfacility
Transport of PUI . . .”
• Patient Hand-Off SOP
• Air-to-Ground Patient Hand-Off SOP
• Ambulance Decontamination
• NETEC - EMS-hospital interface
• NIEHS – Worker Training Program
19
�Resources
• EMS Biosafety Transport Consortium
– Emory University/Grady EMS
– UNMC/Omaha Fire Department
– NYC-Health and Hospitals-Bellevue/Fire Dept. of
New York
– NIH Div. of Fire and Rescue Services/NIH Div. of
Occupational Health and Safety
– Phoenix Air Group
– American Medical Response
– US Department of State/Office of Operational
Medicine
20
�Tackling Issues
•
•
•
•
•
Regional air ambulance transport
Prolonged ground transport
Deterioration in transit
Medical direction
Ambulance decon
and disinfection
• Waste management
• Post-mission surveillance
• Maintenance of competencies
21
�Wrap Up and What Comes Next?
22
�National Ebola Training and Education
Center (NETEC)
• Comprised of hospitals that have successfully
evaluated and treated patients with Ebola in
the U.S.
• Established in July 2015.
• ASPR and CDC providing $12 million over 5
years to support NETEC.
23
�NETEC Resources and Benefits
• Infrastructure to increase collaboration.
• In-person didactic and collaborative
training courses.
• In-person skills courses.
• Robust Learning Management System.
• Exercise templates.
24
�How NETEC Supports Facilities
• Annual site assessments for each of the
10 Regional Ebola Treatment Centers.
• 1 state visit during the 5 year program.
• Access to subject matter experts with
experience caring for patients with
Ebola.
• For more information visit netec.org.
25
�Question and Answer Logistics
• To ask a question– Type the question into the chat feature on
your GoToWebinar console.
– We will collect all questions and ask them
on your behalf.
26
�Closing Remarks
• Shayne Brannman, MS, MA
– Director, ASPR TRACIE
27
�Questions and Answers
28
�For Additional Support
• Contact National Ebola Training and
Education Center (netec.org)
• Contact your NHPP Field Project Officers
• Contact ASPR TRACIE
ASPRtracie.hhs.gov
1-844-5-TRACIE
askasprtracie@hhs.gov
29
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Lessons Learned in Developing an Effective Regional Ebola CONOPS
Dublin Core
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Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
URL
https://files.asprtracie.hhs.gov/documents/aspr-tracie-ebola-conops-webinar-slides.pdf
Alternate URL
Other URLs if necessary.
https://attendee.gotowebinar.com/recording/7535609970138234881
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Lessons Learned in Developing an Effective Regional Ebola CONOPS (Concept of Operations)
Subject
The topic of the resource
Emergency Management
Creator
An entity primarily responsible for making the resource
ASPR
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-08-10
Description
An account of the resource
This recorded webinar with slides aims to share lessons learned to assist regions in the development of their Ebola concept of operations (CONOPS) (ASPR).
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Communications
CONOPS
Ebola
Emergency Management
Epidemic
Identify
Inform
Isolate
Outbreaks
Pre-Hospital
Public Health
Quarantine
R-EM
R-EMS
R-PreH
-
https://repository.netecweb.org/files/original/45e9d41c887cd61b7f8b5ef3a3b82630.pdf
99e6c2f5f51702c3f6ae93501ac10062
PDF Text
Text
National Center for Emerging and Zoonotic Infectious Diseases
S t r a t e g i c Plan: 2018 –2023
�VISION
Prevent infections,
protect people,
save lives
MISSION
To reduce illness and
death associated with
emerging and zoonotic
infectious diseases and
to protect against the
unintentional or intentional
spread of infectious diseases
�NCEZID Strategic Plan: 2018—2023
The National Center for
Emerging and Zoonotic
Infectious Diseases (NCEZID)
was established in 2010 with a mission
and scientific activities that trace back to
the earliest days of the Centers for Disease
Control and Prevention (CDC) including
protecting against and responding to
infectious disease outbreaks.
This document is a strategic roadmap for
the work necessary to realize the Center’s
vision: prevent infections, protect people,
and save lives.
NCEZID is responsible for the prevention,
control, and management of a wide range of
infectious diseases, including rare but deadly
diseases such as anthrax and Ebola virus
disease, as well as more common illnesses
like foodborne disease and healthcareassociated infections. The Center’s expert
staff is on the frontlines every day preparing
for and responding to infectious disease
threats to the nation and the world. Our
world-renowned science staff and programs
also promote water safety, the health of
mobile populations, combatting antibiotic
resistance, and the identification and control
of diseases transmitted by animals and
insects (e.g., rabies, Zika, and Lyme disease).
NCEZID is one of the agency’s principal
sources of epidemiologic, clinical, and
laboratory expertise for bacterial, viral,
and fungal pathogens as well as infectious
diseases of unknown origin. The nation relies
on NCEZID to protect the country from more
than 800 dangerous pathogens.
Collaborations with an ever-expanding
network of partners—federal, state, and local
public health departments; industry; clinical
organizations; public health organizations;
academia; and global multilateral
organizations and ministries of health—help
NCEZID identify mysterious illnesses, contain
outbreaks, and prevent infections.
�Today’s infectious disease challenges
require collaboration and coordination with a wide variety
of stakeholders and partners to advance infectious disease
prevention and control.
Together, NCEZID and its partners are able to accomplish more
than any organization or institution can by working alone. Our
work would not be possible without the help and support of
these partners.
Our diverse programs are supported by a variety of valuable
stakeholders and partners including (but not limited to):
}} State and local health departments
}} Professional organizations
}} National medical associations
}} Patient safety advocates and organizations
}} Businesses
}} Academia
}} Other federal agencies
}} Non-governmental organizations
NCEZID’s first strategic plan (2012–2017)
was developed shortly after its inception as a Center. This
strategic plan is an update of the original one, a restatement and
recalibration of priorities for the next five years (2018–2023).
This document is not intended to be a comprehensive catalog for all
NCEZID activities. Rather, it provides an outline of work that
must be done to fulfill the Center’s mission, and emphasizes
special, urgent initiatives and activities that could have a
significant impact on the health of the nation going forward.
The strategic plan provides clear, consistent, and carefully
considered guidance focusing on Center activities that will most
efficiently prevent infections, protect people, and save lives.
4
�The success of NCEZID’s strategic plan
requires continued leadership, partnership, and excellence in a
wide range of diverse but interrelated areas such as:
}} Infectious disease surveillance, epidemiology,
laboratory, behavioral, and social science
}} State-of-the-art laboratory services and support for CDC’s
infectious disease laboratories
}} Domestic and global health security (e.g., preparedness and
response against emerging infections and biothreats)
}} Detection of and response to disease outbreaks caused by
bacterial, viral, and fungal organisms
}} Advanced Molecular Detection, including next-generation
sequencing and related technologies
}} Healthcare-associated infections
}} Antibiotic resistance
}} Foodborne and waterborne diseases
}} Vector-borne diseases
}} High-consequence but rare infectious diseases
(e.g., anthrax and Ebola)
}} Diseases that affect special and vulnerable populations
(e.g., Native Americans), and understanding the role of
sociodemographic and cultural factors in disease
}} Discovery of new pathogens and investigation of
undefined illnesses
}} The connection between human health, animal health,
and the environment (i.e., One Health)
}} Trend analysis, health economics, and predictive science
}} Health communication, education, evaluation, and
behavioral science
}} Clinical guidelines
5
�STRATEGY 1:
Strengthen public health fundamentals
1.1: Improve infectious disease epidemiologic capacity
domestically and globally
}}Apply advances in scientific methodologies for surveillance,
outbreak investigations, program evaluations, and applied
research in order to improve capacity for early disease
detection, response, and control.
}}Continue to enhance CDC surveillance to inform
prevention and treatment of disease and provide data
that can be used by CDC as well as public health,
academic, and clinical partners to prevent, control, and
manage infectious diseases.
}}Move toward seamless integration of epidemiologic,
laboratory, and clinical data.
}}Use evolving health information technology (IT) tools (e.g.,
electronic health records and portable digital informationcapturing and -transmittal devices) to improve timely reporting
and use of public health data at federal, state, and local levels.
}}Discover and share what is known about the behavioral and
social determinants of infectious diseases with a focus on
disease prevention and protective actions.
1.2: Continually improve laboratory quality, safety, and capacity
}}Create innovative, practical, and cost-effective laboratory
ests (e.g., culture-independent and point-of-service
laboratory tests) to provide more rapid diagnoses,
especially for outside-of-healthcare settings.
}}Improve the ability to rapidly translate diagnostic laboratory
information into effective public health interventions.
}}Embrace a culture of continuous quality improvement in
NCEZID laboratories to secure their identity as national and
nternational centers of high-quality reference diagnostics.
}}Support a network of state, local, federal, and international
laboratories that adhere to strict policies of safety and
security and provide rapid testing capacity to respond to
biological threats and other public health emergencies.
1.3: Strengthen state, local, and territorial public health systems
}}Strengthen collaborations and identify opportunities with
public health partners to bolster state and local public
health program fundamentals and program delivery.
6
}}Provide effective leadership and assistance for NCEZID’s
cooperative agreements (e.g., the Epidemiology and
Laboratory Capacity for Infectious Diseases (ELC) and the
Emerging Infections Program (EIP)) to support epidemiologic
investigations, laboratory infrastructure and expertise,
surveillance, and prevention and intervention strategies for
state and local health departments.
�}}Improve capacity of state and local health departments to
assess their impact and to communicate objectives and
accomplishments.
}}Use targeted approaches in partnership with healthcare and
community organizations to enhance public health program
fundamentals and efficiency of responses to outbreaks and
other public health emergencies.
}}Provide guidance and support to healthcare systems and
public health partners to prevent and treat infections
(e.g., infection control guidance, laboratory guidance,
and clinical guidance).
1.4: Develop partnerships, policy, and effective
communication messaging to protect the public’s health
}}Work with public and private partners to identify broadbased solutions to public health problems at the federal,
state, and local levels.
}}Conduct high-level policy analysis to inform decision-making
and forecast the impact of targeted public health actions.
}}Employ principles of clear communication and appropriate
mass media channels to ensure that NCEZID science
is effectively translated to prevent and control disease
through broad public awareness and action.
}}Develop novel, behavioral, and social science based health
communication strategies for infectious disease threats
that maximize electronic communications (e.g., social
media, web-based applications).
1.5: Attract, maintain, and develop a highly skilled, motivated,
and diverse workforce to fulfill the mission of NCEZID
}}Develop an NCEZID recruiting approach that emphasizes
scientific excellence and supports an effective and
efficient organization.
}}Strengthen the development of NCEZID staff’s technical
and leadership skills.
}}Support the agency’s commitment to diversity in
the workforce.
}}Continue NCEZID’s growth as a learning organization by
regularly evaluating its organizational culture, focusing
on fostering professional growth, innovation, and
cultural competence.
}}Plan for staff succession by actively engaging in workforce
analysis, talent development, knowledge management, and
recruitment strategies.
7
�8
�STRATEGY 2:
Implement high-impact prevention
and intervention strategies
2.1: Use targeted, effective strategies to reduce the burden
of foodborne and waterborne diseases
}}Apply new technologies to more quickly and effectively
detect and respond to foodborne and waterborne disease
outbreaks to reduce the incidence of common, but
preventable, infections.
}}Identify opportunities for prevention and intervention by
expanding scientific information on the incidence, trends,
burden, source attribution, and characteristics of foodborne
and waterborne pathogens and infections.
}}Use what is learned from outbreaks, inspections, and
monitoring systems to develop new and improve existing
strategies for preventing foodborne and waterborne disease.
}}Improve identification of antimicrobial resistance
mechanisms and best practices to slow the spread of
resistance in enteric and fungal pathogens, including in
animal and food production.
}}Strengthen efforts and partnerships to prevent water-,
sanitation-, and hygiene (WASH)-related diseases
domestically and globally, particularly to slow the spread
of cholera.
2.2: Conduct research and implement proven methods
to prevent and control unknown, emerging, and
re-emerging high-consequence pathogens
}}Improve domestic and global efforts to detect, prevent, and
control emerging, high-consequence pathogens, including
biothreat agents.
}}Develop and test laboratory methods to rapidly evaluate
vaccine ability to neutralize high-consequence pathogens.
}}Enhance and expand CDC’s work on developing innovative
diagnostic and surveillance technology, such as e-pathology
and laboratory reporting networks.
2.3: Develop and implement strategies to prevent, detect,
and control vector-borne pathogens
}}Identify and detect vector-borne pathogens and diseases
causing illness in people.
}}Work with jurisdictions and communities to prevent
exposure to vector-borne pathogens and mitigate
consequences of exposure.
}}Implement vector-borne disease diagnostics, surveillance,
control, and prevention programs in collaboration with
international and domestic public health partners.
}}Support the implementation and evaluation of innovative vector
control strategies (e.g., sterile insect techniques and traps).
2.4: Slow the development of new antibiotic resistance,
prevent the resistance that already exists from
spreading, and promote safety and quality in
healthcare delivery systems and patient care
}}Enhance state, local, and regional public health capacity
to prevent, detect, and respond to new and emerging
antibiotic resistance faster (e.g., state/local DOH capacity,
Antibiotic Resistance Lab Network).
}}Continue to prevent healthcare-associated infections and
other adverse health events using data-driven, tailored
approaches to aggressively target prevention implementation
in states and facilities with high infection rates.
}}Promote CDC’s guidelines for infection control and
enhance infection control in high-risk facilities
(e.g., skilled nursing homes).
}}Improve antibiotic use and implement antibiotic
stewardship programs in all healthcare settings.
2.5: Increase public health action to identify, prevent,
and reduce infectious diseases and disparities in
at-risk populations
}}Promote the standardized collection and reporting of data
to identify at-risk populations, including detailed race and
ethnicity, age, gender, pregnancy status, language, and
country of birth/country of origin.
}}Design and implement surveillance, prevention, and
intervention strategies for and with at-risk populations
or groups experiencing health disparities.
}}Develop new knowledge on infectious disease prevalence
in order to reduce health disparities among at-risk
populations specifically including Alaska Natives and other
Native American populations.
}}Conduct research and evaluation that identifies the role of
sociodemographic context and culture in infectious disease
transmission and control in order to better understand and
address health disparities in infectious disease.
9
�STRATEGY 3:
Enhance preparedness, outbreak
detection, and outbreak response
3.1: Improve public health laboratory capacity for
biological threat preparedness and response
}}Enhance capacity of federal, state, local, and other partners to
prepare for, detect, respond to, and prevent infectious disease
threats, including those associated with bioterrorism
(e.g., anthrax), to protect the health of all U.S. citizens.
}}Design and develop novel diagnostic laboratory tests
for biological threats and emerging infectious diseases
for deployment to a network of state, local, federal, and
international laboratories.
}}Strengthen domestic and international laboratory systems
to enhance biosecurity, including improving the capacity of
the Laboratory Response Network for timely detection and
characterization of biothreat agents.
}}Maintain a surge testing laboratory for outbreak response
and emergency support.
}}Develop and update medical countermeasures and
nonmedical mitigation strategies.
3.2: Strengthen outbreak prevention, management, and
response in collaboration with clinical and public
health partners
}}Respond rapidly in the investigation of local, state, national,
and international outbreaks of diseases.
}}Provide scientific and programmatic leadership to CDC’s
public health preparedness and responses, including
centralized scientific resources for CDC’s infectious
disease laboratories.
}}Increase the nation’s laboratory capability to identify
infectious disease threats (e.g., developing, manufacturing,
and distributing diagnostic test kits).
}}Develop and maintain regulatory mechanisms for the use of
medical countermeasures and CDC-developed laboratory tests.
}}Support interagency activities focused on preparedness and
response to emerging infectious diseases.
}}Increase the knowledge and use of incident management
structure and functions.
}}Encourage public compliance with proposed nonmedical
mitigation strategies during future emergencies by
examining psychological, structural, and cultural factors
that contribute towards cooperation.
10
�3.3:Strengthen global capacity to prevent, detect, and
respond to international outbreaks of public health
concern that cross borders by air, land, or sea
}}Promote effective surveillance and interventions designed
to prevent the importation of infectious diseases into the
United States.
}}Improve planning and operational preparedness through
lessons learned from prior emergency responses involving
imported infectious diseases.
}}Advance the adoption and implementation of 2005
International Health Regulations (IHR) core capacities and
other global health policies in collaboration with other U.S.
and international partners.
3.4: Detect and respond to infectious diseases spread
through the movement of people, animals, and cargo
}}Strengthen infectious disease screening, surveillance, and
prevention efforts for globally mobile populations
(e.g., tuberculosis prevention).
}}Provide recommendations to safeguard the health of U.S.
residents traveling internationally or living abroad.
}}Identify and implement behavioral and other sciencebased infectious disease prevention strategies to help
protect at-risk populations.
3.5: Improve international collaboration and capacities for
emerging infectious disease prevention, surveillance,
control, and research
}}Improve global infection prevention and control practices to
prevent and control outbreaks in healthcare facilities.
}}Provide technical support and assistance for infectious disease
laboratory, epidemiology, surveillance, and behavioral
science and evaluation capacity to international partners.
}}Provide consultation and training to domestic and global
partners to bolster their readiness to respond to
infectious diseases.
11
�12
�STRATEGY 4:
Innovate to stop emerging
and zoonotic infections
4.1: Optimize innovative ways to capture, analyze, and
visualize critical public health data for decision making
}}Develop tools to strengthen the ability to forecast changes
in patterns related to globally mobile populations and
disease outbreaks.
}}Identify and implement innovative approaches to
eliminate healthcare-associated infections.
}}Support the development of new surveillance strategies for
emerging threats.
}}Develop and validate new tools and tests to aid laboratory
detection and identification of new, unknown, emerging,
or bioterror disease threats.
4.2: Develop, implement, and evaluate innovative methods
}}Accelerate the development of metagenomic technologies
to enable faster diagnosis of infectious diseases and to
solve looming public health problems related to cultureindependent diagnostic technologies.
}}Ensure that CDC and state public health laboratories
implement methods and technologies to detect and prevent
new and emerging antimicrobial resistant threats.
4.4: Identify and deploy innovative clinical and public
health approaches through collaborations with state
and local health departments, academia, healthcare,
and the private sector
}}Identify opportunities for greater public health impact
by expanding collaboration across existing CDC-funded
partners and programs.
and tools to better prevent and control emerging and
zoonotic infectious diseases domestically and globally
}}Explore opportunities to transfer diagnostic and intervention
technologies to private sector for large scale application.
}}Advance a One Health approach to prevent, detect, and
respond to emerging and zoonotic infectious diseases.
}}Identify innovative vector control solutions through
collaborations with academia and the private sector
through the Vector-Borne Centers of Excellence.
}}Strengthen collaborations to prevent spread of zoonotic
infections by promoting best practices for environmental health
and animal health, including livestock, pets, and wildlife.
4.5: Conduct and invest in innovative research to identify
and combat antibiotic resistance
}}Develop and lead implementation of emerging
technologies in laboratory, epidemiology,
communications, and information technology.
}}Invest in extramural and intramural innovation to address
critical questions related to healthcare-associated infections
and antimicrobial resistance.
}}Implement the containment strategy as an important
approach to detect, identify, and stop germs with unusual
antibiotic resistance before they spread.
}}Look for new ways to identify and evaluate strategies
to combat antibiotic resistance and improve prevention
interventions in both healthcare and community settings.
}}Conduct vector-borne disease community prevention trials
(e.g. Lyme disease) in collaboration with state, local, and
tribal partners.
}}Continue to build the Antibiotic Resistance Isolate Bank
in collaboration with FDA to advance the development
of diagnostic tests to identify and characterize resistant
bacteria, and to accelerate research and development for
new antibiotics.
4.3:Accelerate development and application of novel
diagnostic methods and technology, including
advanced molecular detection
}}Develop practical applications of DNA sequencing
technology to support public health priorities.
}}Integrate practical applications of DNA sequencing into
routine public health practice while continuing to look for
and adapt other, related technologies with the potential to
benefit public health.
}}Inform and foster research to understand resistance
mechanisms in animal agriculture and food production to
advance development of new vaccines, improve prevention
and control interventions, and identify new approaches to
antibiotic use.
}}Explore unanswered questions about antibiotic resistance
and humans, animals, and the environment (e.g., surface
water and soil).
13
�14
�PREVENT INFECTIONS
PROTECT PEOPLE
SAVE LIVES
15
�CS283860AJ
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
National Center for Emerging and Zoonotic Infectious Diseases Strategic Plan: 2018-2023
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.cdc.gov/ncezid/pdf/ncezid-strategic-plan-2018-2023-508.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
National Center for Emerging and Zoonotic Infectious Diseases Strategic Plan: 2018-2023
Subject
The topic of the resource
General
Description
An account of the resource
This document is a strategic roadmap for the work necessary to realize the center’s vision: prevent infections, protect people, and save lives. (CDC)
Creator
An entity primarily responsible for making the resource
CDC, Office of Infectious Diseases (CDC OID)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-08
Epidemic
Epidemiology
Federal
Outbreaks
Public Health
R-Gen
Special Pathogens
Zoonotic
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
URL
https://www.nebraskamed.com/biocontainment/ebola
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Nebraska Biocontainment Unit Webinars
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
General
Description
An account of the resource
Resources - National Ebola Training and Education Center
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Format
The file format, physical medium, or dimensions of the resource
Under Construction
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (BH)
2023-03-30 by PPE group - Jill Morgan - General Asset Review - Kate B. confirmed
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-03-30
Communications
Diagnosis
Donning and Doffing
Ebola
Emergency Department
Emergency Management
Epidemic
Epidemiology
Ethics
Example
Immunology
Infection Prevention and Control
Lab
Laboratory
Laboratory Testing
Nursing
Outbreaks
Outcomes
Patient Care
Patient Transport
Personal Protective Equipment (PPE)
Prophylaxis
Public Health
Public Relations
Quarantine
R-PPE
Specimen Handling
Specimen Transport
Therapeutics
Virology
Waste
-
https://repository.netecweb.org/files/original/eb5c3d1f2ed416fd049148aa0160b701.png
6591d9720139ed4cf752d51a02619e88
https://repository.netecweb.org/files/original/4c59097afdf59894786edd2c616bc034.pdf
4c29b3e72969766dd5bd70c41ff2cc5f
PDF Text
Text
NETEC COVID-19 Webinar Series:
Pediatric Surge Responses
and
Crisis Standards of Care
�Content Outline (TOC)
Welcome
Shelly Schwedhelm, MSN, RN, NEA-BC
�Overview
Welcome: Shelly Schwedhelm, MSN, RN, NEA-BC
Crisis Standards of Care: Abbey Lowe, MA
The Pediatric Planning Process: Rachel Lookadoo, JD
Adult Critical Care in Support of Pediatric Patients:
Ryan C. Maves, MD, FCCP, FCCM, FIDSA
Questions and Answers with NETEC
NETEC Resources: Shelly Schwedhelm, MSN, RN, NEA-BC
�NETEC Vision
NETEC sets and advances the gold standard for
special pathogen preparedness and response across
health care delivery systems with the goals of driving
best practices, closing knowledge gaps, and
developing innovative resources.
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�Areas of Focus
Consultation
Education
Research Network
Deliver didactic and handson simulation training via
Build
Meet Fred
Empower hospitals to gauge
their readiness using
Self-Assessment
In-Person Courses
Measure facility and healthcare
worker readiness using
Central IRB Process
for rapid implementation of
clinical research protocols
Provide self-paced education through
Online Trainings
Metrics
Provide direct feedback to hospitals via
On-Site Assessment
Compile
Online Repository
Provide
of tools and resources
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
On-Site and Remote Guidance
Provide
Emergency On-Call
Mobilization
Develop customizable
Exercise Templates
based on the HSEEP model
Cross-Cutting, Supportive Activities
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Crisis Standards of Care (CSC)
Abbey Lowe, MA
�Crisis Standards of Care (CSC)
Demand for health care services and supply of resources
as a function of time after disaster onset
https://www.nap.edu/read/13351/chapter/2#42
�A Systems Approach
r
https://www.nap.edu/read/13351/chapter/2#32
�Nebraska Healthcare Surge Structure
r
�Nebraska Medical Emergency Operations Center
Monitoring the Pandemic
Transfer Center
The MEOC served as a touch point for data transparency across the
state, providing data at a local and healthcare coalition level for bed
availability, COVID hospitalizations, supply and equipment needs
and resources (see figure 3). Work groups were formed via the
MEOC to address challenges such as movement of COVID
recovered patients to bolster hospital capacity for surge, address
staffing challenges, and disseminate best practice information.
The NE State COVID-19 Transfer Center provided a 24/7 service designed
to facilitate patient load balancing. Hospitals seeking to transfer
suspected or confirmed COVID-19 patients were strongly encouraged to
use the State Transfer Center, where clinical staff sought placement at the
nearest hospital with capability and capacity to care for the patient. Due
to the significant rise in COVID-19 and corresponding impact on hospitals
across the state, patient preference was not a primary consideration in
determining transfer location. Data on transfer times and
acceptance/denial were reported via the MEOC.
Crisis Standards of Care Surge Team
Public Health Orders Implementing NPIs
The surge team conducted educational sessions across the state,
working with the healthcare coalition leaders and facilities that
reached out for training on CSC and triage decision-making. While
providers and healthcare leaders across the state were eager for
support in CSC planning, the language (e.g., SOFA scoring,
continuum of care, triggers, etc.), guidance documents, and
algorithms proved to be a steep learning curve for the already taxed
medical community.
During the first two major waves of the COVID-19 pandemic in Nebraska
used a series of directed health measures (DHMs) to attempt mitigate
community spread of the disease. These DHMs were implemented with
the explicit purpose of reducing the burden on healthcare facilities and
preventing the need to deviate from routine standards of care. DHMs
were not statewide but were targeted for specific geographic regions in
the state and included provisions that limited gathering size, restricted
occupancy levels of restaurants and businesses, specified distancing
requirements, detailed isolation and quarantine directions, required face
masks for certain situations, and placed limitations on hospital elective
procedures that were tied to hospital capacity.
�Crisis Standards of Care (CSC)
Nebraska CSC
CSC plan drafted and reviewed by numerous clinicians and
stakeholders across the state
CSC plan based on the Massachusetts CSC plan
11/24/2020 – Nebraska Hospital Association and Nebraska Medical
Association both endorsed the final plan
Pediatric, Critical Access, and EMS specific plans were developed
Education on CSC across the state
Coalition planning initiated on CSC triage and how to operationalize
the plan regionally across the state
�Content Outline (TOC)
Pediatric Planning Process
Rachel Lookadoo, JD
�Pediatric Planning Process
Nebraska Pediatric CSC Workgroup
Workgroup of physicians, nurses, EMS workers, and
representatives from the state health department and
education agencies
Representatives from rural and urban settings across the state
Group met bi-weekly during plan formation
• Reconvened during Delta surge
�Pediatric Planning Process
Pediatric Planning Process
Needed a pediatric annex to the general CSC plan that considered
the unique needs and concerns of children/pediatric populations
Adaptation of WRAP-EM CSC Template and existing plans
from Children’s Hospital in Omaha
Supplement to general Nebraska Healthcare Crisis Protocol document
�Pediatric Planning Process
Pediatric Triage Scoring
Use of different triage scoring systems (PELOD-2 vs. SOFA)
Multi-principle Strategy to
Allocate Critical Care/Ventilators
During a Public Health Emergency
�Pediatric Planning Process
Rural Versus Urban Planning Concerns
Assumption of pediatric ICU bed availability
Needs of critical access hospitals and smaller facilities
who may have to treat children
Staff needed for triage team decision-making
�Pediatric Planning Process
Prevailing Concerns During Fall 2021 Wave
Transfer availability
Staffing
Communications with the public and other healthcare providers
Solutions that are readily available
�Content Outline (TOC)
Adult Critical Care in Support of
Pediatric Patients
Ryan C. Maves, MD, FCCP, FCCM, FIDSA
�r
�Adult Critical Care in Support of Pediatric Patients
COVID-19 and Children
Initial waves of COVID-19 pandemic have largely
spared children
Typically, less severe in children
Pediatric hospitals provided support to adult ICUs
earlier in the pandemic:
• Increased age cutoffs for PICU admission
• Provided care for younger adults
�abcd
r
https://covid.cdc.gov/covid-data-tracker/#demographicsovertime
�COVID-19 and Children
“Pandemic of the
unvaccinated”
No vaccines currently
available for children
<12 years of age
r
PICU capacity
overwhelmed by
increased demand in
many regions
https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-vaccination-trends/
�r
�Adult Critical Care in Support of Pediatric Patients
PICUs and Crisis Standards of Care
84,000 staffed non-neonatal ICU beds in the USA
5,115 (6.0%) are pediatric ICU beds
• Concentrated in urban areas
• Fewer healthcare workers (HCWs) skilled in care of younger children
• Pediatric supplies not available at all hospitals
How can adult ICUs (with greater surge capacity)
support pediatric care?
�Adult Critical Care in Support of Pediatric Patients
PICUs and Crisis Standards of Care
Categories:
Conventional
Normal operations
Contingency
Additional resources utilized but usual standards of care
Crisis
Severe limitations lead to modification in standards of care
Critical care surge strategies seek to increase hospital capacity,
keep hospitals in a “contingency” status, and avoid crisis.
�Adult Critical Care in Support of Pediatric Patients
PICUs and Crisis Standards of Care
PICU support to adult ICUs in 2020:
• Underlying concepts in respiratory failure, shock, sepsis care
are similar in older children and younger adults
• Increased admission age to 26 years
• Adult hospitalist support for adult chronic needs;
ICU issues managed by pediatric intensivists
• Invasive procedures managed by clinicians with experience
in adult and pediatric care (e.g., pediatric surgeons and
anesthesiologists)
�PICUs and Crisis Standards of Care
C.S. Mott Children’s Hospital (Ann Arbor, Michigan):
• Common protocols for broad age ranges
across ICUs (e.g., ventilator liberation,
ECMO)
• Prioritizing transfer of adult patients to
PICUs with single-system illness
r
• Overlapping skill sets where possible
• Twice-daily multidisciplinary rounds to
review PPE availability, protocol
changes, bed status
• Central management of schedules and
clinical staffing based on demand
�Adult Critical Care in Support of Pediatric Patients
How can adult ICUs return the favor?
�Adult Critical Care in Support of Pediatric Patients
Goals
Focus of this contingency strategy is to preserve pediatric
systems of care for those children who depend on PICUs’
unique skills
Not all pediatric diagnoses are suitable for adult ICU transfer
�Adult Critical Care in Support of Pediatric Patients
Category
Age Cutoffs
Conventional
18 years and older
Contingency
Crisis
15 years and older
12 years and older
AND >40 kg
Comments
•
Standard adult ICU admission criteria
•
Equipment size and medical dosing will
be generally the same as in adult,
consistent with trauma system practices
•
Using a Broselow measurement cutoff of
12 years and 40 kg, one can typically use
adult medication doses and equipment
sizes
�Adult Critical Care in Support of Pediatric Patients
Equipment, Supply and Management
Older children: ≥12 years and 40 kg)
• Adult-size equipment is usually adequate, e.g., ETT size 6.5-7.0 cuffed
tube, 7.5 French CVC
• Similar indications for NIV, IMV, CVC placement in older children and
adults
• Similar strategies for volume resuscitation, management of shock, initial
vasopressor management with norepinephrine
• ARDSnet / low-tidal volume ventilation
�Common PICU Diagnoses
Suitable for Adult ICU
•
•
•
•
•
•
•
•
Community-acquired sepsis
Cystic fibrosis
Sickle cell disease
Post-solid organ and hematopoietic stem
cell transplantation
Diabetes mellitus
Adolescent trauma (if the adult ICU is
part of a trauma center) and poisonings
Critical illness due to COVID-19
pneumonia
Multisystem inflammatory syndrome in
children (MIS-C)
Not Suitable for Adult ICU
r
•
Congenital heart diseases with
residual disease
•
Active pediatric malignancy
•
Chronic kidney disease and
end-stage kidney disease
•
Significant developmental delay
•
Rare genetic diseases
�Adult Critical Care in Support of Pediatric Patients
Pediatric Decision-Making
Critically-ill children unable to communicate are treated similar to adults:
• Emergency care rendered first
• Goals of care established with parents/guardians, care team, and patient
• Issues of assent versus consent
Ethics consultations for discordant opinions between parents,
care team, and patient
Child protective services for suspected harm and neglect
�Adult Critical Care in Support of Pediatric Patients
Visitations, Family Support and Staff Wellness
Greater emphasis on family visitation during COVID-19 for children
Consider permitting two adult visitors be authorized per day
Emotional impact of dying children on adult ICU staff
Palliative and end-of-life care
Brain death evaluations similar in children but require a second
confirmatory examination after >12 hours of observation
�Adult Critical Care in Support of Pediatric Patients
Pediatric Subspecialty Consultation
Need to develop systems to ensure available consultant support
Role of telemedicine
Specific specialties:
• General surgeons and anesthesiologists likely able to manage routine pediatric
needs, outside of specific congenital disorders and highly subspecialized areas
• Adult cardiologists may be able to manage general ICU issues (e.g., cardiac
function assessment), but pediatric expertise needed for many conditions
• Bronchoscopy in younger patients requires pediatric pulmonary or critical care
assistance
• Pediatric neurologic disease in the ICU differs in presentation and therapy (e.g.,
seizures and epilepsy)
• Electrolytes, fluid management, and dialysis catheter insertion in children ≤12
years need specialist input in the setting of CKD and AKI
�Adult Critical Care in Support of Pediatric Patients
Summary
More similarities than differences
Adult ICUs can care for well-selected pediatric patients
Need clear admission criteria and protocols, plus availability of
pediatric-specific consultation
Goal is to preserve effective care for all children
�Adult Critical Care in Support of Pediatric Patients
My Gratitude to:
Mary A. King, MD, MPH
Renee I. Matos, MD, MPH
Mitchell T. Hamele, MD
Matthew A. Borgman, MD
Luke A. Zabrocki, MD
Samir K. Gadepalli, MD
Vikram Mukherjee, MD
Asha Devereaux, MD, MPH
Jeffrey Dichter, MD
And many, many others
�r
Thank you again for the opportunity
to speak to you all today.
STAY SAFE
rmaves@wakehealth.edu
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Shelly Schwedhelm, MSN, RN, NEA-BC
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Monday, October 11, 2021 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/dmwuduZWNiQ
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/dmwuduZWNiQ?autoplay=0" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (10/11/21): Pediatric Surge Responses and Crisis Standards of Care
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Join us Monday, October 11th, at 1pm EDT / 12pm CDT for the next NETEC COVID-19 Webinar Series presentation, Pediatric Surge Responses and Crisis Standards of Care. Join our presenters as they discuss the impact of the pediatric surge during the COVID-19 pandemic. Topics will include pediatric crisis standards of care planning, concerns, and surge strategy to preserve pediatric systems of care. Questions from the audience will be welcome during the webinar.
Webinar slides attached.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-10-11
Contributor
An entity responsible for making contributions to the resource
2022-07 by Kari, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group (3 yr) C&C
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-31
Type
The nature or genre of the resource
Webinar only
2019-nCoV
Children
Contingency and crisis capacities
Coronavirus
COVID-19
Critical Care
Epidemic
Pandemic
Pediatrics
R-SP
Surge
Treatment and Care
-
https://repository.netecweb.org/files/original/8247580376a09bd99b4c6e22f497aa5e.pdf
583a6bf868afefe3b5abdfbc068dd099
PDF Text
Text
Influenza (Flu) + COVID
What personnel in healthcare settings should know
Flu and COVID are both:
•
•
It is important to address flu + COVID together
Respiratory illnesses
spread by droplet or in
the air containing the
viruses.
Can cause severe illness
and life-threatening
complications.
We are entering a unique flu
season where there are two
dangerous respiratory diseases
spreading - flu and COVID-19.
It is important to protect
yourself and those around you
by following the steps outlined
below.
What you can do
Precautions used to prevent the spread of COVID-19 also help to reduce the spread of- and exposure to the flu
Wash hands frequently
Cover coughs and sneezes
Practice social distancing
Do not touch face
If you’re sick, stay home
except to get medical care
Wear face coverings
consistently and correctly
Get a flu shot & continue to follow precautions
While you work
Regardless of
vaccination status or
the location of your
workspace within a
facility, all staff should
continue to wear a mask
while at work.
During all
clinical patient
encounters,
eye protection
(goggles or face
shield) should
be worn.
A cloth face covering
should not be worn
in lieu of a mask
in the clinical care
setting. Contact your
supervisor if you need
additional face masks.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
The written content on this document is used with permission from NYC Health + Hospitals. Updated October 29, 2020
�Influenza (Flu) + COVID
What personnel in healthcare settings should know
FAQ
Q: If I get vaccinated can I still get the flu?
A: Vaccination provides protection against
the most prevalent influenza viruses and
lowers the chance of getting sick.
Q: Are there any side effects to the flu vaccine?
A: Serious side effects are rare.
Any reaction is generally mild and disappears within one to two
days. Reactions may include: - soreness, redness, or swelling at the
vaccination site - mild fever - body ache.
You can still get the flu if you are exposed to the influenza
virus- especially before vaccination or during the two-week
period that the body takes to develop protection. However,
symptoms are typically less severe.
Q: Is there any reason I should consult my doctor
before getting the flu vaccine?
A: Only under certain circumstances.
Q: Can you get the flu from the flu vaccine?
You should speak to your doctor before receiving flu vaccination if you:
• Are acutely ill or currently suspected or confirmed with COVID-19.
You do not need to test negative for COVID-19 to get vaccinated
– just ensure you are well and check with your doctor.
• Have had a major previous reaction requiring medical care to
either flu vaccine or to eggs.
• Have had Guillain-Barre Syndrome.
A: You cannot get the flu from the flu vaccine.
The flu vaccine contains inactivated (killed) flu viruses that
cannot cause illness.
The safety and wellness of all personnel in healthcare settings is a
priority. That’s why it’s especially important to stay protected against
respiratory illness and get vaccinated this season. The importance of
flu vaccination this year:
• Seasonal influenza, commonly called “flu,” is a contagious illness
caused by influenza viruses that infect the respiratory tract (the
nose, throat, and lungs) and can cause severe illness and lifethreatening complications.
• Respiratory illnesses, such as the flu and COVID-19, may have
common symptoms of fever, chills, fatigue, body aches, and
cough.
• Similar symptoms between flu and COVID-19 makes it difficult
to differentiate between the two. Both spread through large
droplets within 6 feet, and potentially smaller droplets that can
travel further.
• To stay prepared for the possibility of influenza viruses and SARSCoV-2 (the virus that causes COVID-19) spreading at the same
time this season, getting a flu vaccine will be more important
than ever.
• Routine infection prevention practices – such as hand washing
and wearing a face mask – remain essential to prevent yourself
from getting sick from respiratory illness, but getting vaccinated
provides even further protection against the circulating influenza
viruses.
• Children, older adults, pregnant women, and people with some
chronic medical conditions are at higher risk for severe flu.
Wearing a face mask is essential in preventing the spread of respiratory
droplets which may contain viruses such as influenza or SARS-CoV-2.
• Some people can be asymptomatic with COVID-19.
• Regardless of vaccination status or the location of your workspace
within a facility, all staff should continue to wear a mask while at
work.
• Additionally, staff must wear eye protection (goggles or face
shield) for all clinical patient encounters.
• A cloth face covering should not be worn in lieu of a mask in the
clinical care setting. Contact your supervisor if you need additional
face masks.
What should I do to protect myself and others from flu and other
respiratory illnesses?
• Get vaccinated. As long as flu viruses are circulating in the
community, it’s not too late to get vaccinated.
• Routinely wash or sanitize your hands thoroughly. Hand hygiene is
one of the simplest yet most effective ways to prevent illness.
• Avoid touching your face. Touching your eyes, nose, or mouth with
dirty or contaminated hands may lead to infection.
• Wear a mask, ensuring it covers your nose and mouth.
• Cover your cough or sneeze: use a tissue, throw it away, and
thoroughly wash your hands.
• If you touch communal objects, such as door handles, elevator
buttons, sink faucets, phones, or keyboards, remember to follow
up with hand hygiene as needed.
• If you feel ill, please stay home.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
The written content on this document is used with permission from NYC Health + Hospitals. Updated October 29, 2020
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COVID19 Testing + Influenza Vaccination Sites: Operational & IPC
Considerations
Name of Facility/Location:
Designated Infection Preventionist or Supervisor:
Date:
Y
N
Comments/Notes
Vaccine Transport, Storage, and Handling
Vaccine was shipped directly to the
facility/clinic site, where adequate storage
is available.
Vaccines were transported using a
portable vaccine refrigerator or qualified
container and pack out designed to
transport vaccines within the temperature
range recommended by the
manufacturer’s recommendations.
Coolers available at general merchandise
stores or coolers used to transport food
are NOT ACCEPTABLE.
Confirm the manufacturer instructions for packing
configuration and proper conditioning of coolants were
followed, and vaccines where transported in the passenger
compartment.
Upon arrival at the facility/clinic,
vaccines are immediately unpacked and
placed in proper storage equipment
(i.e., a portable vaccine refrigerator),
remain protected and within
recommended temperature
Vaccine temperature is being monitored
during the clinic using a digital data
logger with a buffered probe (placed
directly with vaccines) and a current and
valid Certificate of Calibration Testing.
Vaccine temperature data are being
routinely reviewed and documented a
minimum of 2 times during each clinic
workday.
Vaccine Safety and Supply
A contingency plan is in place in case
vaccines need to be replaced.
If vaccines cannot be stored in a storage unit at the site, they
are being kept in the portable vaccine refrigerator or qualified
pack out with a temperature monitoring device (with a probe
in a thermal buffer) placed as close as possible to the
vaccines, and temperatures are being read and recorded at
least once an hour. The container is being kept closed as
much as possible.
�An emergency medical kit (including
epinephrine and equipment for
maintaining an airway) is at the site for
the duration of the clinic.
All vaccination providers at the site are certified in
cardiopulmonary resuscitation (CPR), are familiar with the
signs and symptoms of anaphylaxis, know their role in an
emergency, and know the location of epinephrine and are
trained in its indications and use.
Staff administering vaccines have
reviewed vaccine manufacturer
instructions for administration and all
related protocols related to their specific
role and operations
Manufacturers instructions/manuals, site specific protocols
and contact information are current and available at the site.
A process for screening for
contraindications and precautions is in
place.
Adequate supply is provided, including
biohazard sharps containers, supplies for
hand hygiene, adhesive bandages,
individually packaged sterile alcohol
wipes, sterile needles and syringes,
waste bins, and waste bags.
A sufficient number of vaccine
information statements (VISs or
Emergency Use Authorization [EUA])
forms, if required) is available at the
clinic/facility site and are provided to
every individual before vaccination (as
required by federal law).
Expiration dates of vaccines and supply
are being checked and monitored.
A qualified individual has been
designated to oversee infection control
practices.
Sufficient supply of PPE for staff is
available, including face masks, gloves,
and, eye protection (face shield or
goggles)
Sufficient supply of face coverings is
available for visitors and patients who
may not have one.
Sufficient hand sanitizer is available so
that staff and patients can repeatedly
practice hand hygiene.
All supply, especially sharps, must be secured and
monitored.
�Cleaning and disinfection supplies are
available so workspaces can be cleaned
regularly
Sufficient supply of thermometers to
check patient temperatures prior to
entering the vaccination clinic and COVID
symptom checklists along with exposure
history.
Vaccine Preparation and Administration
Vaccinations should NOT be
administered to individuals displaying
symptoms of COVID-19. Immediate
isolation and testing must be done
OUTSIDE of the vaccination facility.
Vaccines are being prepared in a clean,
designated area, away from any
potentially contaminated items, only at
the time of administration.
If using reconstituted vaccines, they are being prepared
according to the manufacturer’s guidelines.
Vaccines are normal in appearance (i.e.,
not discolored, without precipitate, and
easily resuspended when shaken).
If vaccines are pre drawn from a
multidose vial, only the contents of 1
multidose vial are being drawn up at one
time by each staff member administering
vaccines and labeled appropriately (the
maximum number of doses per vial is
described in the package insert).
Staff is using proper hygiene techniques
to clean hands before each vaccine
administration, between patients, and
anytime hands become soiled.
Each staff member is administering only
the vaccines they have prepared.
If more than one vaccine type is being
administered, separate preparation
stations are set up for each vaccine type
to prevent medication errors.
If gloves are being worn by staff administering vaccines, they
are being changed and hands are being cleaned using
proper hygiene techniques between each patient.
�Vaccines are being administered using
aseptic technique, safe injection
practices, using the correct route and
dosage
Staff is administering vaccine to the
correct patient (patient’s name and date
of birth are verified prior to vaccination).
Staff has checked age indications for the vaccines and
is administering vaccines to the correct age groups.
A new needle and new syringe are being
used for each injection.
Used needles and syringes are being
immediately placed in a sharps container
following administration.
Any persons with a needlestick injury, a
vaccine administration error, or an urgent
medical problem are being evaluated
immediately and referred for additional
medical care if needed.
If vaccine administration errors are
observed, corrective action is being taken
immediately.
There is a designated area at the site
for management of patients with urgent
medical problems (e.g., fainting).
Ensure seating is at least 6 ft apart.
Vaccine Documentation
Each vaccination is being fully
documented with name of person
vaccinated; vaccination date; vaccine
type, lot number, manufacturer; patient
receipt of vaccine information statement
(VISs or Emergency Use Authorization
[EUA] form), including edition date and
date VIS was provided; injection site;
vaccination route; dosage; and name,
title, and office/company address of
person who administered the vaccine.
Patients are receiving documentation for
their personal records and to share with
their medical providers.
Patients should be encouraged to stay at the clinic for 15
minutes after vaccination to be monitored for adverse events.
�Preventing Transmission of COVID-19: Enhanced Infection Prevention and Safety Measures
All staff and patients have their
temperature checked along with
exposure history before entering the clinic
and are answering the COVID screening
questions before entering the clinic.
Physical distancing of at least 6 ft at all
point of the visit (check in, screening) is
being followed, by including signs,
banners, floor markers, or barriers to
instruct staff and patients where to stand,
and to follow one-way traffic flow..
Additional controls, such as counters and plastic shields,
may be used to minimize contact where patients and staff
interact (e.g., registration or screening areas).
Physical barriers, coupled with signage,
are used to separate flu vaccination from
COVID19 testing areas, if in close
proximity.
All patients are wearing a face covering.
Face masks should not be placed on children under age 2,
anyone who has trouble breathing, or anyone who is
unconscious, incapacitated, or otherwise unable to remove
the mask without assistance.
All staff are wearing recommended
personal protective equipment (PPE) to
administer a vaccine including face
masks, gloves and eye protection
Staff should adhere to all safety and PPE guidelines and tips,
in order to maintain infection control (i.e.: proper donning,
doffing, reuse, extended use, disinfection, hand hygiene,
social distance, etc).
Designated areas must be in place for
donning and doffing
All areas are cleaned and disinfected
more frequently vaccine preparation and
administration and between patients.
Staff should always wear gloves when
administering intranasal and oral
vaccines, as there is increased risk in
contact with bodily fluids.
Staff must change gloves and perform
hand hygiene between patients when
administering intramuscular and
subcutaneous vaccines.
Post-Clinic Actions
�Temperature of remaining vaccine was
checked and recorded at the end of clinic.
Any remaining vaccine in provider pre
drawn syringes, opened multi dose vials,
or activated manufacturer-filled syringes
(MFSs) are properly discarded.
Viable, unused vaccine was placed back
in proper storage equipment that
maintains the manufacturer
recommended temperature range at the
end of the clinic day and was not stored
in a dormitory-style or bar-style combined
refrigerator/freezer unit under any
circumstances.
Any vaccine administration errors were
reported to all appropriate entities.
All biohazardous material was disposed
of properly. Sharps containers are stored
in a secure location.
Vaccinations were recorded in the
jurisdiction’s immunization information
system (IIS) where available.
Any adverse events were reported to the
Vaccine Adverse Event Reporting
System (VAERS): vaers.hhs.gov/index.
All patient medical information was
placed in a secured storage location for
privacy protection.
The staff sign-in sheet was attached to
this document (with shift times, clinic
location, and date).
If not submitted to an IIS, vaccination information was sent to
primary health care providers as directed by an established
procedure based on state or jurisdiction regulations.
�Engineering Considerations
Indoor or outdoor walk through clinic (Unidirectional**)
Curbside or drive through clinic:
Separate track for COVID19 testing with
uni-directional flow and separate track for
flu vaccine administration with unidirectional flow
References:
Clinic Operations Checklist: https://www.izsummitpartners.org/content/uploads/2019/02/off-site-vaccination-clinicchecklist.pdf
Vaccine Guidance: https://www.cdc.gov/vaccines/pandemic-guidance/index.html
Vaccine Storage Regulations: https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html
Operation Considerations: https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/maintaining-immunizationservices.html
�
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NETEC COVID-19 Webinar Series:
Influenza in the Age of COVID-19
�Content Outline (TOC)
Welcome
Shelly Schwedhelm, MSN, RN, NEA-BC
�Overview
Welcome: Shelly Schwedhelm, MSN, RN, NEA-BC
Influenza and COVID-19: Predictions and Clinical Illnesses:
Bruce S. Ribner, MD, MPH
Influenza Vaccination Issues in the Age of COVID-19:
Mark E. Rupp, MD
Influenza Testing and Antiviral Treatment 2020-2021 Season:
Tim Uyeki, MD, MPH, MPP
Influenza Campaign: Healthcare System Planning Considerations:
Syra Madad, DHSc, MSc, MCP
NETEC Resources: Shelly Schwedhelm, MSN, RN, NEA-BC
Questions and Answers with NETEC:
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Influenza and COVID-19:
Predictions and Clinical Illnesses
Bruce S. Ribner, MD, MPH
�Influenza and COVID-19:
Predictions and Clinical Illnesses
“It's tough to make predictions, especially about the future”
-Yogi Berra
Credit: NIAID - Colorized scanning electron micrograph of an apoptotic cell (green) infected with SARS-COV-2 virus particles (yellow)
�Urban-Rural COVID-19 Trends
r
https://www.bloomberg.com/news/newsletters/2020-10-19/a-troubling-rural-trend-in-america
�Influenza and COVID-19:
Predictions and Clinical Illnesses
Possible Reasons for Increased COVID-19 Activity
Mask and isolation fatigue
More indoor activity
Colder and less humid weather
�Percentage Positive Influenza Tests by Year 2016/2017-2019/2020
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https://www.cdc.gov/mmwr/volumes/69/wr/mm6937a6.htm?s_cid=mm6937a6_w#F1_down
�Australian Influenza Surveillance Report
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https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-14-2020.pdf [health.gov.au]
�Influenza
VERSUS
COVID-19
Influenza virus A, B, C, D
Pathogen
SARS-CoV-2
Mainly large droplets although
fomite possible
Primary
Mode of Transmission
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Highly contagious from 1-2 days
prior to onset of symptoms to 7
days after symptom onset
ü Age >65 y and <2 y
ü Immunosuppression
ü Pregnancy
(through 2 weeks postpartum)
Infectivity
Mainly large droplets (airborne,
fomite, and fecal-oral transmission
possible but less important)
Highly contagious for 1-2 days prior
to onset of symptoms, to 10 or more
days after symptom onset;
Asymptomatic still contagious
super spreaders
Groups at Greatest Risk:
•
•
•
•
•
•
Morbid obesity
Chronic lung disease
Cardiac disease
Advanced liver disease
Chronic kidney disease
Residence in nursing home or LTC
ü Advanced age
ü Male sex
ü Hypertension
�Influenza
Symptoms peak days 5-7
COVID-19
VERSUS
Symptoms
•
Majority of infections are either
subclinical or mild: Fever or
chills, cough, shortness of breath
or difficulty breathing, fatigue,
sore throat, runny or stuffy nose,
muscle pain or body aches,
headache, vomiting and diarrhea
•
•
•
(more common in children)
r
•
Common in children, especially
high risk in children <2 yr
Pediatrics
≈ .1%
Case Fatality Rate
•
•
Cytokine storm frequently peaks
in week 2 to 3 of illness
Anosmia
Clotting disorders
Long haulers - 50% to 80% with
fatigue, body aches, shortness of
breath, difficulty concentrating,
inability to exercise, headache,
difficulty sleeping for 3-6 months
Uncommon, with typically mild
disease
Most fatalities in teenagers
Multisystem inflammatory
syndrome (MIS-C) has been
observed in children, but is rare
.25% to 3%
�Influenza
• Neuraminidase inhibitorsoseltamivir, zanamivir, peramivir
Therapy
• Cap-dependent endonuclease
inhibitors-baloxavir
Multiple approved
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Vaccines
•
•
•
•
Nucleoside analogue – Remdesivir
Corticosteroids
Anticoagulants
Immunoglobulins ?
Stage 1 to 3 testing
As of October 23,2020
2019-2020 Season
39,000,000 – 56,000,000 illnesses
410,000 – 740,000 hospitalizations
24,000 – 62,000 deaths
COVID-19
VERSUS
Therapy
8,387,047 diagnosed cases
10,195,992 positive tests
458,782 hospitalizations
222,447 deaths
�Content Outline (TOC)
Influenza Vaccination Issues
in the Age of COVID-19
Mark E. Rupp, MD
�Influenza Vaccination Issues
in the Age of COVID-19
Introduction: Influenza & COVID-19
Influenza and COVID-19 have significant overlap in clinical presentation
Treatment and infection prevention interventions differ widely (contact
tracing, isolation, quarantine, etc.)
Co-infection with influenza and COVID-19 can occur
The healthcare delivery system is critically stressed due to COVID-19 and
it is vitally important to avoid further burden due to influenza
(potentially preventable)
Therefore,
we must maximize influenza prevention efforts through continued
non-pharmacologic interventions and influenza vaccination
�Influenza Vaccination Issues
in the Age of COVID-19
SARS-CoV-2 and Influenza Co-Infection
Co-infection relatively rare:
• US: 1 (0.9%) co-infected patients amongst 116 COVID-19; 24 (20.7%) were positive
for other respiratory viruses (rhinovirus (6.9%), RSV (5.2%), other coronaviruses
(4.3%). (Kim et al. JAMA 323,20: 2085-86.)
• China: 64 co-infected patients amongst 544 COVID-19 (11.7%). (Yu et al. J Med Virol.
2020;1-9)
• Viral shedding of SARS-CoV-2 was longer (17d vs 12 d) for co-infected patients.
• UK: 58 co-infected patients amongst 4501 COVID-19 (1.3%). Stowe et al. (pre-print)
• Patients with co-infection had risk of death 2.27 times greater (95% CI: 1.234.19) than those with SARS-CoV-2 alone
• Risk of testing positive for SARS-CoV-2 was 58% lower among flu positive
patients (pathogenic competition?)
�Influenza Vaccination Issues
in the Age of COVID-19
When is the Best Time to Get an Influenza Vaccine?
It takes about two weeks to develop protective
antibody levels after vaccination
Peak antibody levels are observed about six weeks
after vaccination
Antibody levels wane over time
• ~7%-10% decline in vaccine effectiveness per
month. Some protection for at least 5-6
months. (Ferdinands et al. Clin Infect Dis. 2017.)
When does influenza incidence peak in the US?
• 36 seasons (1982-2018)
https://www.cdc.gov/flu/about/season//flu-season.htm
�Influenza Vaccine Effectiveness
Influenza vaccine effectiveness varies from year-to-year depending on circulating
strain and vaccine match
2019-20 VE 39%
(preliminary)
r
https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm
Influenza vaccine effectiveness:
• In 2018-2019 4.4 million infections, 2.3 million medical visits, and 58,000 hospitalizations prevented
• Reduced hospitalization by 40% and ICU admission for adults by 82%
https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm
�Influenza Vaccine and COVID-19
Influenza vaccine does not increase risk of infection by non-SARS-CoV-2 coronavirus
• Analysis of Canadian Sentinel Practitioner Network (2010-2017)
• Influenza vaccination reduced ILI by >40% with no effect on coronaviruses or
other respiratory viruses. Skowronski et al. Clin Infect Dis, 2020.
Influenza vaccine is associated with improved outcomes in patients with COVID-19
• Analysis of 92,664 patients with COVID-19
in Brazil. Those patients who
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received influenza vaccine experienced 8% lower odds of needing ICU care,
18% lower odds of needing mechanical ventilation, and 17% lower odds of
death. (Fink et al. Preprint: MedRxIV)
Influenza vaccination in the elderly (>65 y/o) is negatively associated with mortality
from COVID-19
• Comparison of COVID-19 mortality data vs influenza vaccination data at
county level in US. (Zanettini et al. Preprint MedRxIV)
�Influenza Vaccination and COVID-19 Mortality
Zanettini et al. Johns Hopkins University. MedRxIV Preprint
Influenza vaccination effect on COVID-19
mortality in the US over time
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Mortality Rate Ratio: Percentage change in
the death rate from COVID-19 associated
with 10% increase in vaccination coverage
https://www.medrxiv.org/content/10.1101/2020.06.24.20129817v1.full.pdf+html
�Recommendations for Influenza Vaccination During COVID-19 Pandemic
Influenza vaccination at any time in the fall is better than not at all!
If postponement of influenza vaccination is being considered, it must be weighed
against likelihood of vaccination later
Use visit for influenza vaccination to review need for other vaccines (pneumococcal, etc)
It is unknown how COVID-19 infection or treatment (steroids, immunomodulation)
r
influences response to influenza vaccine
When administering influenza vaccine take measures to prevent transmission of SARSCoV-2:
üScreen vaccine recipients for symptoms (preferentially before visit)
üLimit degree and duration of contact with patient
üFace coverings for all patients; face masks and consider eye protection for all providers
üHand hygiene and standard precautions
üEnsure physical distancing throughout visit: waiting area, check-in, etc
üSpecific appointment times
üUse electronic means to communicate, register, etc.
�Considerations for Influenza Vaccination
Patient Setting
Pt with no known
exposure to a person
with confirmed COVID-19
in past 14 d
Pt with close contact to a
person with COVID-19 in past
14 d
Pt with asymptomatic or
pre-symptomatic COVID-19
Pt with symptomatic COVID-19
Outpatient Care
Vaccinate
Can vaccinate during quarantine
period (within 14 days of
exposure), particularly if they
might not have another
opportunity to be
vaccinated. However, patient
should not seek outpatient care
solely for vaccination until
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quarantine period ends.
Can vaccinate during isolation
(within 10 days of positive test
result). However, patient should
not seek outpatient care solely
for vaccination until isolation
period ends.
Should consider deferring (postponing)
vaccination for at least 10 days after symptom
onset AND 24 hours with no fever without the
use of fever-reducing medications AND COVID19 symptoms are improving AND no longer
moderately or severely ill. Consider further
deferring vaccination until fully recovered from
acute illness.
Emergency Department
Vaccinate
Can vaccinate during quarantine
period (within 14 days of
exposure) particularly if they might
not have another opportunity to
be vaccinated.
Can vaccinate during
isolation (within 10 days of
positive test result).
Same as above
Inpatient acute care
Vaccinate at discharge
Can vaccinate at discharge.
Can vaccinate at discharge
Same as above
Congregate Healthcare
Setting
LTC; group home; etc
Vaccinate
Can vaccinate.
Can vaccinate
Same as above
Correctional or Detention
Facility, Shelters
Vaccinate
Should consider deferring
(postponing) vaccination until
quarantine has ended.
Can vaccinate
Same as above
Urgent care, outpatient
clinics, community influenza
vaccination events
(Adapted From: https://www.cdc.gov/vaccines/pandemic-guidance/index.html)
�Influenza Activity in the United States
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Outpatient ILI (ILINet)
https://www.cdc.gov/flu/weekly/index.htm
�Influenza & SARS-CoV-2 (COVID-19) Testing
Because the treatment and infection prevention recommendations are quite different for
influenza and COVID-19, it is important to test and differentiate
For patients presenting with acute respiratory illness (ILI – influenza like illness):
• All patients should have testing for SARS-CoV-2 (COVID-19)
• For patients not requiring hospitalization:
• Test for influenza if result will change
clinical management or for infection
r
control reasons (pt returning to LTC or other congregate setting) or
• Prescribe empiric anti-influenza treatment for patients with progressive disease
or high risk of influenza complications
• For patients who do require hospitalization:
• Implement appropriate infection prevention measures
• Test for SARS-CoV-2 and influenza: multiplex NAAT, separate NAAT for both.
Negative Ag detection should be confirmed with NAAT
• Prescribe empiric anti-influenza treatment while influenza testing pending
(Adapted From: https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians-hospitaized.htm)
�Content Outline (TOC)
Influenza Testing and Antiviral Treatment
2020-2021 Season
Tim Uyeki, MD, MPH, MPP
�Influenza Tests in Clinical Settings
Variety of diagnostic tests available to clinicians to detect
influenza viruses in respiratory specimens
ØDiffer by time to produce results, information provided, approved respiratory
specimens, approved clinical settings, and accuracy
§ Antigen detection (FDA-cleared single-plex, multiplex)
§ One multiplex assay (detects SARS-CoV-2 & influenza viruses) received FDA EUA
§ Nucleic acid detection (FDA-cleared rsingle-plex, multiplex)
§ 9 multiplex assays (detect SARS-CoV-2 & influenza viruses) received FDA EUA
§ Point-of-care assays (CLIA-waived)
§ Moderately complex (requires clinical laboratory)
§ Highly complex (large clinical laboratories, public health labs)
ü
ü
ü
ü
CDC. Information for Clinicians on Influenza Virus Testing: https://www.cdc.gov/flu/professionals/diagnosis/index.htm
CDC. Rapid Influenza Diagnostic Tests (RIDTs): https://www.cdc.gov/flu/professionals/diagnosis/table-ridt.html
CDC. Nucleic Acid Detection Based Tests for Influenza Viruses: https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html
CDC. Multiplex Assays Authorized for Simultaneous Detection of Influenza Viruses and SARS-CoV-2 by FDA: https://www.cdc.gov/flu/professionals/diagnosis/table-flu-covid19-detection.html
�FDA-cleared Tests Available to Detect Influenza Viruses
in Respiratory Specimens
Method
Clinical Setting
Viruses Detected
Result Time
Complexity
Rapid Influenza Diagnostic Tests
(antigen detection)
Outpatients, Point-of-Care
Influenza A, B
10-15 minutes
Moderate, CLIAwaived
Immunofluorescence, Direct (DFA) or Indirect
(IFA) Florescent Antibody Staining
(antigen detection)
Hospitalized Patients
Influenza A, B
2-4 hours
Moderate
Outpatients, Emergency Department r
Patients, Hospitalized Patients
Influenza A, B
15-30 minutes
Moderate, CLIAwaived
Rapid Molecular Assays
(nucleic acid detection)
Other Molecular Assays, RT-PCR
(single-plex, and multiplex)
(nucleic acid detection)
Hospitalized Patients
Influenza A, B
Influenza A, B, RSV
Influenza A, A(H1), A(H1pdm09),
A(H3), B
30 minutes to 8
hours
High, Moderate
Multiplex Molecular Respiratory Panels (nucleic
acid detection)
Hospitalized Patients
Influenza A, A(H1), A(H1pdm09),
A(H3), B, RSV, adenovirus, HCoV, HRV,
PIV, HMPV, Bocavirus
1-2 hours
High, Moderate,
CLIVA-waived
ü https://www.cdc.gov/flu/professionals/diagnosis/index.htm
ü https://www.cdc.gov/flu/professionals/diagnosis/table-ridt.html
ü https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html
�FDA EUAs Issued for Multiplex Assays
to Detect Influenza Viruses and SARS-CoV-2 in Respiratory Specimens
Manufacturer
Method
Assay
Viruses detected
Result Time
Complexity
Biofire
Nucleic acid
detection
Respiratory Panel 2.1
Influenza A(H1), A(H1)pdm09, A(H3), B;
SARS-CoV-2*
1 hour
High, Moderate
Biofire
Nucleic acid
detection
Respiratory Panel 2.1 -EZ
Influenza A(H1), A(H1)pdm09, A(H3), B;
SARS-CoV-2*
45 minutes
High, Moderate
Waived
Genmark
Nucleic acid
detection
ePlex Respiratory Pathogen Panel 2
Influenza A(H1), A(H1)pdm09, A(H3), B;
SARS-CoV-2*
<2 hours
High, Moderate
QIAGEN
Nucleic acid
detection
QIAstat-Dx Respiratory SARS-CoV-2 Panel
Influenza A(H1), A(H1)pdm09, A(H3), B;
SARS-CoV-2*
1 hour
High, Moderate
Roche
Nucleic acid
detection
cobas SARS-CoV-2 & Influenza A/B
Influenza A, B;
SARS-CoV-2
3-8 hours
High, Moderate
Roche
Nucleic acid
detection
cobas SARS-CoV-2 & Influenza A/B Nucleic Acid
Test
Influenza A, B;
SARS-CoV-2
20 minutes
High, Moderate
Waived
Cepheid
Nucleic acid
detection
Xpert Xpress SARS-CoV-2/ Flu/RSV
Influenza A, B;
SARS-CoV-2
<40 minutes
High, Moderate
Cepheid
Nucleic acid
detection
Xpert Xpress SARS-CoV-2/ Flu/RSV
Influenza A, B;
SARS-CoV-2
<40 minutes
Waived
Quidel
Antigen
detection
Sofia 2 Flu + SARS Antigen FIA
Influenza A, B;
SARS-CoV-2
15 minutes
High, Moderate
Waived
CDC
Nucleic acid
detection
Influenza SARS-CoV-2 (Flu SC2) Multiplex Assay
Influenza A, B;
SARS-CoV-2
4 hours
High
r
https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/vitro-diagnostics-euas#individual-molecular
https://www.cdc.gov/flu/professionals/diagnosis/table-flu-covid19-detection.html
�What Influenza Tests are Recommended?
Outpatients
ØRapid influenza molecular assays are recommended over rapid influenza antigen detection tests
Hospitalized patients
ØRT-PCR or other influenza molecular assays recommended
(2020-2021: Influenza A/B, SARS-CoV-2)
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§ Rapid antigen detection tests and immunofluorescence assays are not recommended should not
be used unless molecular assays are not available
ØImmunocompromised patients: Multiplex RT-PCR assays targeting a panel of respiratory pathogens,
including influenza viruses are recommended
§ Do not order viral culture for initial or primary diagnosis of influenza
§ Do not order serology for influenza
ØResults from a single serum specimen cannot be reliably interpreted, and collection of
paired acute and convalescent sera 2-3 weeks apart are needed
IDSA 2018 Influenza Clinical Practice Guidelines Clinical Infect Dis 2019
�Influenza Testing and Specimen Source
Upper respiratory tract
§ Influenza viruses are generally detectable for 3-4 days by antigen detection; and 5-6 days by
nucleic acid detection in uncomplicated disease, longer in infants and immunosuppressed
Ø Highest yield: Nasopharyngeal (NP) swabs (ideally collected within 3-4 days of illness onset)
§ Other acceptable specimens: nasal swabs, NP aspirates, nasal aspirates, combined nasal
and throat swabs
§ Slower clearance of influenza viruses in severe disease
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Ø Influenza viral replication and viral RNA detection may be prolonged with corticosteroids,
immunosuppression
Lower respiratory tract
ØHigher, prolonged viral replication in severe lower respiratory tract disease
ØInfluenza viruses may be detectable when cleared from the upper respiratory tract
ØRT-PCR was negative in 10-19% of patients in upper respiratory tract specimens versus
lower respiratory tract (BAL specimens) for influenza A(H1N1)pdm09 viral RNA
Rello Crit Care 2009; Fleury Eurosurveillance 2009; Blyth NEJM 2009
�Recommended Antivirals 2020-2021
Four FDA-approved antivirals are recommended for use in the United States
§ Neuraminidase inhibitors:
§ Oseltamivir (oral)
§ Zanamivir (inhaled)
§ Peramivir (intravenous)
§ Cap-dependent endonuclease inhibitor: Baloxavir marboxil (oral)
All have demonstrated efficacy for early treatment (<2 days of illness onset) in
r
outpatients with uncomplicated influenza
Drug
Route of Administration
Recommended Ages for Treatment
Oseltamivir
Oral
All ages
Zanamivir
Inhaled
≥5 years
Peramivir
Intravenous
≥2 years
Baloxavir
Oral
≥12 years
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�People at High Risk for Influenza Complications
for Whom Antiviral Treatment is Recommended
ü Children <2 years old (although all children <5 years old are considered at high
risk for complications, highest risk is for children <2 years old)
ü Adults ≥65 years old
ü Pregnant/postpartum women
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ü American Indians/Alaska Natives
ü Children <18 years old receiving long-term aspirin therapy
ü People with underlying medical conditions (e.g., pulmonary, cardiac,
immunosuppression, neurologic and neurodevelopment conditions, BMI ≥40)
ü Residents of nursing homes/chronic care facilities
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�CDC Antiviral Treatment Recommendations
Prioritize prompt treatment of persons with severe disease
and those at increased risk of influenza complications
Antiviral treatment is recommended as soon as possible for any patient with
confirmed or suspected influenza who is:
§ Hospitalized (without waiting for testing results)
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§ Outpatients with complicated or progressive illness of any duration
§ Outpatients who are at high risk for influenza complications
Antiviral treatment can be considered for any previously healthy, non-high-risk
outpatient with confirmed or suspected influenza (e.g. with influenza-like illness) on
the basis of clinical judgment, if treatment can be initiated within 48 hours of illness
onset; including empiric treatment (e.g. in-person visit or via telemedicine)
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�Oseltamivir Recommended for Hospitalized Patients
Oseltamivir treatment (oral or enterically-administered) is recommended as soon as
possible for hospitalized patients with confirmed or suspected influenza
(without waiting for testing results)
• Observational studies have reported that starting neuraminidase inhibitor treatment
within 6 hours of admission or at the time of admission was associated with shorter
duration of hospitalization
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§ Inhaled zanamivir and oral baloxavir are not recommended because of the lack of data
in hospitalized influenza patients
§ Insufficient data for peramivir treatment of hospitalized influenza patients
ØFor patients who cannot tolerate or absorb oral or enterically-administered
oseltamivir (e.g. gastric stasis, malabsorption, or gastrointestinal bleeding),
intravenous peramivir is an option
§ Optimal duration of oseltamivir treatment for critically ill patients is unclear
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm; Katzen Clin Infect Dis 2018; Venkatesan J Infect Dis 2020
�Recommended Antiviral Treatment for Outpatients
For outpatients with complications or progressive disease and suspected or confirmed influenza
(e.g., pneumonia, or exacerbation of underlying chronic medical conditions) regardless of
duration, antiviral treatment with oral Oseltamivir is recommended as soon as possible
For outpatients with suspected or confirmed uncomplicated influenza, oral oseltamivir, inhaled
zanamivir, intravenous peramivir, or oral baloxavir may be used for early treatment, depending
r
upon approved age groups and contraindications
§ In one randomized controlled trial, baloxavir had greater efficacy than oseltamivir in high-risk
adolescents and adults with influenza B virus infection
Clinicians can consider starting early (≤48 hours after illness onset) empiric antiviral treatment
of non-high-risk outpatients with suspected influenza [e.g., influenza-like illness (fever with
either cough or sore throat)], based upon clinical judgement, including without an office visit.
SARS-CoV-2 and other etiologies of influenza-like illness should also be considered.
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm; Ison Lancet Infect Dis 2020
�Special Groups
Pregnant Women
§ For treatment of pregnant women or women who are up to 2 weeks postpartum,
oral oseltamivir is preferred
§ Baloxavir is not recommended for treatment of pregnant women or breastfeeding mothers
§ No efficacy or safety data for baloxavir in pregnant or lactating women
r
Immunocompromised
Persons
§ Prolonged influenza viral replication is a possibility, with emergence of
antiviral resistant viruses during/after treatment
§ Monitoring for antiviral resistance is advised
§ Infection prevention and control precautions are recommended to
reduce nosocomial transmission risk
Ø Neuraminidase inhibitor treatment is recommended
Ø Baloxavir treatment is not recommended
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�Influenza and COVID-19
Implications
ØTesting is needed to distinguish influenza from COVID-19
ØConsider influenza virus infection, SARS-CoV-2 infection, co-infection
§ Treatment issues
• FDA-approved antiviral medications for influenza have no effect on COVID-19
• Oseltamivir, baloxavir have no in-vitror activity against SARS-CoV-2
• No drug interactions with remdesivir
• Corticosteroids may prolong influenza viral replication in the upper and lower respiratory
tracts (e.g. dexamethasone treatment of severe COVID-19)
• Conflicting observational study findings on corticosteroids and influenza mortality
• Community-acquired bacterial co-infection appears more common with influenza than
COVID-19 (MRSA, MSSA, pneumococcus, group A Strept)
Tan Bioorganic Chem 2020; Choy Antiviral Research 2020; Langford Clin Microbiol Infect 2020; Adler Lancet Microbe 2020; Vaughn
Clin Infect Dis 2020; Zhou Sci Reports 2020;Lee Clin Infect Dis 2008; Gianella Clin Microbiol Infect 2010; Lee J Infect Dis 2009
�CDC: Information for Clinicians on Influenza Virus Testing
r
https://www.cdc.gov/flu/professionals/diagnosis/index.htm
�Testing Guidance for Clinicians When SARS-CoV-2 and
Influenza Viruses are Co-circulating
r
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians.htm
�Testing Guidance for Clinicians When SARS-CoV-2 and
Influenza Viruses are Co-circulating
r
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-outpatient.htm
�Testing Guidance for Clinicians When SARS-CoV-2 and
Influenza Viruses are Co-circulating
r
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians-hospitaized.htm
�Content Outline (TOC)
Influenza Campaign:
Healthcare System Planning Considerations
Syra Madad, DHSc, MSc, MCP
�Influenza Campaign:
Healthcare System Planning Considerations
“This year’s flu vaccine could be the
most important one you ever get”
- Dr. Dave Chokshi, NYC DOHMH Health Commissioner
Credit: NIAID - Colorized scanning electron micrograph of an apoptotic cell (green) heavily infected with SARS-COV-2 virus particles (purple)
�Influenza Campaign:
Healthcare System Planning Considerations
Planning & Operational Considerations
Enhanced Infection Prevention and Control
Screening
Personal Protective Equipment (PPE)
Physical distancing
Infection Prevention & Control (IPC) measures
Operational Considerations for Vaccine Clinic
Floor plans
Layout for vaccination clinics
Clinic flow (e.g. unidirectional)
�Planning & Operational Considerations
Programmatic
Vaccination documentation
Scheduling & extended influenza season
Vaccine supply, storage and handling
Administrative
Management support
r
Incident management system
Guidance and policies
Environmental cleaning
Staffing
Staffing plan
IPC training and education
�Influenza Campaign:
Healthcare System Planning Considerations
Planning & Operational Considerations
Partnerships & Collaboration
Aware of updated public health guidance
Local public health agency collaboration
Communication and Outreach
Targeted outbreak on populations at higher risk from COVID-19
Coordinated and aligned messaging on COVID-19 and influenza vaccination
Visual alerts
�Resources: Downloads
Resource Downloads
for
Influenza in the Age of
COVID-19
https://repository.netecweb.org/items/show/1368
�Resources
Bloomberg: A Troubling Rural Trend in America
https://www.bloomberg.com/news/newsletters/2020-10-19/a-troubling-rural-trend-in-america
CDC: Deceased Influenza Activity During the COVID-19 Pandemic: United States, Australia, Chile, and South Africa, 2020
https://www.cdc.gov/mmwr/volumes/69/wr/mm6937a6.htm?s_cid=mm6937a6_w#F1_down
Australian Department of Health: Australian Influenza Surveillance Report - PDF
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-14-2020.pdf
CDC: Seasonal Influenza: Peak Months for Seasonal Influenza
https://www.cdc.gov/flu/about/season//flu-season.htm
CDC: Seasonal Influenza: CDC Seasonal Flu Vaccine Effectiveness Studies
https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm
CDC: Seasonal Influenza: Vaccine Effectiveness: How Well do the Flu Vaccines Work?
https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm
MedRxiv: Influenza Vaccination and COVID-19 Mortality in the USA
httphttps://www.medrxiv.org/content/10.1101/2020.06.24.20129817v1.full.pdf+htmls
CDC: Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic
https://www.cdc.gov/vaccines/pandemic-guidance/index.html
CDC: Weekly U.S. Influenza Surveillance Report: FluView
https://www.cdc.gov/flu/weekly/index.htm
CDC: Testing Guidance for Clinicians When SARS-CoV-2 and Influenza Viruses are Co-circulating: Hospitalized
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians-hospitaized.htm
�Resources
CDC: Information for Clinicians on Influenza Virus Testing
https://www.cdc.gov/flu/professionals/diagnosis/index.htm
CDC: Rapid Influenza Diagnostic Tests (RIDTs)
https://www.cdc.gov/flu/professionals/diagnosis/table-ridt.html
CDC: Seasonal Influenza: Nucleic Acid Detection Based Tests
https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html
CDC: Multiplex Assays Authorized for Simultaneous Detection of Influenza Viruses and SARS-CoV-2 by FDA
https://www.cdc.gov/flu/professionals/diagnosis/table-flu-covid19-detection.html
CDC: Information for Clinicians on Influenza Virus Testing
https://www.cdc.gov/flu/professionals/diagnosis/index.htm
FDA: In Vitro Diagnostics EUAs
https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/vitro-diagnostics-euas#individual-molecular
CDC: Influenza Antiviral Medications: Summary for Clinicians
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
Testing Guidance for Clinicians When SARS-CoV-2 and Influenza Viruses are Co-circulating: Outpatient Clinic
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians.htm
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Shelly Schwedhelm, MSN, RN, NEA-BC
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
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Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, October 30, 2020 | 1:00 PM EST | 90 minute webinar
Event Type
Webinar, watch at link below.
URL
https://youtu.be/qmfqPp7X5po
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Influenza in the Age of COVID webinar" src="https://www.youtube.com/embed/qmfqPp7X5po?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-flu" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-flu</a>
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NETEC COVID-19 Webinar Series (10/30/20)/Online Course: Influenza in the Age of COVID
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
Influenza in the Age of COVID: In this webinar, we will summarize the similarities and differences between seasonal influenza and COVID-19, describe influenza vaccination planning efforts, discuss testing and antiviral treatment of influenza when SARS-CoV-2 and influenza viruses are co-circulating, and share NETEC resources and tools to help healthcare systems in their influenza planning efforts. Please note this is a 90-minute webinar.<br /><br />Webinar slides attached.<br /><br /><br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-flu" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-30
Type
The nature or genre of the resource
Webinar and Online Course
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Emergency Management
Epidemic
Flu
Flurona
Influenza
Online Course
Pandemic
R-EM
-
https://repository.netecweb.org/files/original/9c7a59a58490a91cde0689a7fd70c93f.png
2d13b14d4c7e26197ccaecdc9cc4c293
https://repository.netecweb.org/files/original/faf2cb93c26fa13a5bcdd4ab5275514c.pdf
999a436c3f11c4a1025115620087890a
PDF Text
Text
NETEC COVID-19 Webinar Series:
Influenza in the Age of COVID:
2021 Seasonal Update
�Content Outline (TOC)
Welcome
Shelly Schwedhelm, MSN, RN, NEA-BC
�Overview
Welcome: Shelly Schwedhelm, MSN, RN, NEA-BC
Influenza and COVID-19: Clinical Presentation and Vaccination:
Mark E. Rupp, MD
Influenza Testing and Antiviral Treatment 2021-2022 Season:
Tim Uyeki, MD, MPH, MPP
Pediatric Considerations: Influenza in the Age of COVID-19:
Kari Simonsen, MD, MBA
Questions and Answers with NETEC
NETEC Resources: Shelly Schwedhelm, MSN, RN, NEA-BC
�NETEC Vision
NETEC sets and advances the gold standard for
special pathogen preparedness and response across
health care delivery systems with the goals of driving
best practices, closing knowledge gaps, and
developing innovative resources.
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�Areas of Focus
Consultation
Education
Research Network
Deliver didactic and handson simulation training via
Build
Meet Fred
Empower hospitals to gauge
their readiness using
Self-Assessment
In-Person Courses
Measure facility and healthcare
worker readiness using
Central IRB Process
for rapid implementation of
clinical research protocols
Provide self-paced education through
Online Trainings
Metrics
Provide direct feedback to hospitals via
On-Site Assessment
Compile
Online Repository
Provide
of tools and resources
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
On-Site and Remote Guidance
Provide
Emergency On-Call
Mobilization
Develop customizable
Exercise Templates
based on the HSEEP model
Cross-Cutting, Supportive Activities
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Influenza and COVID-19:
Clinical Presentation and Vaccination
Mark E. Rupp, MD
�Influenza-like Illness in US in Previous Seasons
2020-21 influenza season
was remarkably mild
Reason:
• Non-pharmacologic measures
to prevent COVID-19
transmission (masks, social
separation, travel limitations)
• Viral population dynamics
It would be reckless to
count on a mild flu season
for 2021-22
https://www.cdc.gov/flu/weekly
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2020-21
�US Hospital Census is High
There is currently very little surge capacity in US hospitals to
absorb possible influx of patients with influenza
90%
r
11/9/2021
https://www.aha.org/statistics/fast-facts-us-hospitals 11/4/2021
�Influenza and COVID-19: Clinical Presentation
and Vaccination
Influenza and COVID-19
Influenza and COVID-19 have significant overlap in clinical presentation
Treatment and infection prevention interventions differ widely (contact
tracing, isolation, quarantine, etc.)
Co-infection with influenza and COVID-19 can occur
The healthcare delivery system is critically stressed due to COVID-19. It is
vitally important to avoid further burden due to influenza
We must maximize influenza prevention efforts through continued
non-pharmacologic interventions and influenza vaccination
�Influenza and COVID-19: Clinical Presentation
and Vaccination
COVID-19 Prediction
Reasons Why COVID-19 Activity Could Increase in the Upcoming Winter Months
Continued mask and isolation fatigue, governmental and
individual relaxation of non-pharmacologic measures
More indoor activity (holiday gatherings, travel, etc.)
Waning immunity from previous infection or vaccination
�Influenza
VERSUS
COVID-19
Influenza virus A, B, C, D
Pathogen
SARS-CoV-2
Mainly large droplets although
fomite possible
Primary
Mode of Transmission
r
Contagious from 1-2 days prior
to onset of symptoms to 7 days
after symptom onset
Infectivity
Mainly large droplets, but airborne
transmission is possible
Contagious for 2 days prior to onset
of symptoms, to 10 or more days
(longer in immunosuppressed) after
symptom onset.
Asymptomatic still contagious.
Risk Factors for Influenza and COVID-19 are Similar
ü Advanced Age
ü Chronic medical conditions
(heart, lung, liver, kidney disease)
ü Immunosuppression
ü
ü
ü
ü
Obesity
Diabetes
Pregnancy
Cancer
ü
ü
ü
ü
People with disabilities
Racial and ethnic minorities
Mental health disorders
Residents of group living facilities
�Influenza
Symptoms peak days 5-7
COVID-19
VERSUS
Symptoms
•
Majority of infections are either
subclinical or mild: Fever or
chills, cough, shortness of breath
or difficulty breathing, fatigue,
sore throat, runny or stuffy nose,
muscle pain or body aches,
headache, vomiting and diarrhea
•
•
•
(more common in children)
r
•
Common in children, especially
high risk in children <2 yrs
Pediatrics
≈ .1%
Case Fatality Rate
•
•
Cytokine storm frequently peaks
in week 2 to 3 of illness
Anosmia
Clotting disorders
Long haulers - fatigue, body aches,
shortness of breath, difficulty
concentrating, inability to
exercise, headache, difficulty
sleeping for 3-6 months
Common, typically with mild
disease
More severe disease with
underlying illnesses
Multisystem inflammatory
syndrome (MIS-C) has been
observed in children, but is rare
.25% to 3%
�Influenza
• Neuraminidase inhibitorsoseltamivir, zanamivir, peramivir
COVID-19
VERSUS
•
•
•
•
•
•
Therapy
• Cap-dependent endonuclease
inhibitors-baloxavir
•
Multiple approved
r
Vaccines
Remdesivir
Dexamethasone
Monoclonal Antibodies
Baricitinib/Tofacitinib
Tociluzimab/Sarilumab
Many others in clinical trials
In US:
• Pfizer-BioNTech (mRNA)
• Moderna (mRNA)
• Johnson and Johnson/Janssen
(Viral Vector)
As of November 1, 2021
�Influenza and COVID-19: Clinical Presentation
and Vaccination
SARS-CoV-2 and Influenza Co-Infection
Meta-analysis: prevalence of influenza infection was 0.8% in patients with confirmed COVID-19
Da
Dadashi et al. COVID-19 and Influenza Co-infection: A Systematic Review and Meta-Analysis. https://www.frontiersin.org/articles/10.3389/fmed.2021.681469/full
�Routine Vaccination Decreased due to COVID-19
MMWR June 11, 2021
Data from 10 US States and cities:
Idaho, Iowa, Louisiana, Michigan,
Minnesota, NYC, N Dakota,
Oregon, Washington, Wisconsin
COVID-19 pandemic resulted in a
precipitous drop in delivery of
routine vaccinations in children
and adolescents
r
�Influenza and COVID-19: Clinical Presentation
and Vaccination
When is the Best Time to Get an Influenza Vaccine?
It takes about two weeks to develop protective
antibody levels after vaccination
Peak antibody levels are observed about six weeks
after vaccination
Antibody levels wane over time
• ~7%-10% decline in vaccine effectiveness per
month. Some protection for at least 5-6
months. (Ferdinands et al. Clin Infect Dis. 2017.)
When does influenza incidence peak in the US?
• 36 seasons (1982-2018)
https://www.cdc.gov/flu/about/season//flu-season.htm
�Influenza Vaccine Effectiveness
Influenza vaccine effectiveness varies from year-to-year depending on circulating
strain and vaccine match
r
https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm
�Influenza and COVID-19: Clinical Presentation
and Vaccination
Effectiveness of Influenza Vaccination
CDC provides estimates of overall influenza
burden and vaccine effectiveness after each
season
Estimated vaccine effectiveness for 2019-2020:
• 39% overall
Estimated burden averted through vaccination:
• 7.5 million illnesses
• 105,000 hospitalizations
• 6,300 deaths
https://www.cdc.gov/flu/resource-center/freeresources/graphics/flu-vaccine-protected-infographic.htm
�Influenza Vaccination and COVID-19 Clinical Outcome
AJIC 2021
AJIC 2021
Retrospective cohort study of
27,201 patients testing for
COVID-19. 12,997 received flu
vaccine; 14,204 did not receive
flu vaccine
Influenza vaccinated COVID-19
patients were less likely to
require hospitalization, require
mechanical ventilation, and
had shorter hospital stay
r
�Influenza Vaccination and COVID-19 Clinical Outcome
Taghioff SM, et al. Examining the potential benefits
of the influenza vaccine against SARS-CoV-2: A
retrospective cohort analysis of 74,754 patients.
73,346,583 patient records retrospectively
screened
Two cohorts of 37,377 patients having
received or not received influenza vaccine 6 r
months to 2 weeks prior to COVID-19
diagnosis.
Adverse outcomes assessed at d 30, 60, 90,
& 120
Propensity score matching: age, race,
ethnicity, gender, HTN, D<, HLD, COPD,
Obesity, heart dz, smoking
Flu vaccinated patients had decreased DVT,
wound dehiscence, MI (<0.050. Less SSI,
CVA, pneumonia, death
PLoS ONE 16(8) e0255541
�Influenza Vaccination and COVID-19 Clinical Outcome
Taghioff SM, et al. The impact of influenza vaccine
on postoperative outcomes in COVID-19 patients:
An analysis of 43,580 patients utilizing a globally
federated EMR network.
73,341,020 patient records retrospectively
screened
Two cohorts of 21,790 patients having received
or not received influenza vaccine 6 months to 2
weeks prior to COVID-19 diagnosis and
undergoing any type of surgery.
r
Adverse outcomes assessed at d 30, 60,
90, & 120
Propensity score matching: age, race, ethnicity,
gender, HTN, D<, HLD, COPD, Obesity, heart dz,
smoking
Flu vaccinated patients had decreased
sepsis, CVA, DVTs, ICU admits, ED visits
Abstract: Amer Col Surg Clinical
Congress. Oct 23, 2021
�Influenza Vaccination and COVID-19 Mortality
Zanettini et al. Vaccines. 2021. https://doi.org/10.3390/vaccines9050427
• County level association between
flu vaccination status in those over
65 and mortality due to COVID-19
r
• Poisson regression modeling with
flu vaccine as the independent
variable and COVID-19 as outcome
with adjustment for array of
confounders
• At county level, influenza
vaccination in elderly is negatively
associated with COVID-19
mortality
�Recommendations for Influenza Vaccination During COVID-19 Pandemic
Influenza vaccination at any time in the fall is better than not at all!
If postponement of influenza vaccination is being considered, it must be weighed
against likelihood of vaccination later
Use visit for influenza vaccination to review need for other vaccines (pneumococcal, etc)
It is unknown how COVID-19 infection or treatment (steroids, immunomodulation)
r
influences response to influenza vaccine
When administering influenza vaccine take measures to prevent transmission of SARS CoV-2:
üScreen vaccine recipients for symptoms (preferentially before visit)
üLimit degree and duration of contact with patient
üFace coverings for all patients; face masks and consider eye protection for all providers
üHand hygiene and standard precautions
üEnsure physical distancing throughout visit: waiting area, check-in, etc.
üSpecific appointment times
üUse electronic means to communicate, register, etc.
�Considerations for Influenza Vaccination
Patient fully vaccinated
against COVID-19 with no
known close contact
exposure to a person
with confirmed COVID-19
Patient (not fully vaccinated
against COVID-19) with close
contact exposure to a person
with COVID-19
Patient with asymptomatic
or pre-symptomatic
COVID-19
Patient with symptomatic COVID-19
Vaccinate
Can vaccinate during quarantine
period, particularly if they might
not have another opportunity to
be vaccinated. However, patient
should not seek outpatient care
solely for vaccination until
r
quarantine period ends.
Can vaccinate during isolation
period. However, patient should
not seek outpatient care solely
for vaccination until isolation
period ends.
Should consider deferring (postponing)
vaccination for at least 10 days after symptom
onset AND 24 hours with no fever without the
use of fever-reducing medications AND COVID19 symptoms are improving AND no longer
moderately or severely ill. Consider further
deferring vaccination until fully recovered from
acute illness.
Emergency Department
Vaccinate
Can vaccinate during quarantine
period particularly if they might
not have another opportunity to
be vaccinated.
Can vaccinate during isolation
Same as above
Inpatient acute care
Vaccinate at discharge
Can vaccinate at discharge.
Can vaccinate at discharge
Same as above
Congregate Healthcare
Setting
LTC; group home; etc.
Vaccinate
Can vaccinate.
Can vaccinate
Same as above
Vaccinate
Should consider deferring
(postponing) vaccination until
quarantine has ended.
Can vaccinate
Same as above
Patient Setting
Outpatient Care
Urgent care, outpatient
clinics, community influenza
vaccination events
Correctional or Detention
Facility, Shelters
(Adapted From: https://www.cdc.gov/vaccines/pandemic-guidance/index.html)
�Influenza Activity in the United States
r
Outpatient ILI (ILINet)
https://www.cdc.gov/flu/weekly/index.htm
�Content Outline (TOC)
Influenza Testing and Antiviral Treatment
2021-2022 Season
Tim Uyeki, MD, MPH, MPP
�Co-circulation of Influenza Viruses and SARS-CoV-2
Co-infection with influenza A or B viruses and SARS-CoV-2 can occur
§ Documented in case reports, case series
§ Frequency, severity, and risk factors unknown (may result in more severe disease)
Overlapping signs, symptoms, some differences with either infection
•
•
•
•
•
Incubation period is shorter for influenza (1-3 days) than COVID-19 (2-14 days)
r
Viral shedding, period of viral RNA detection is generally shorter for influenza
Ageusia/dysgeusia, anosmia are more common with COVID-19 than influenza
Diarrhea can occur in young children with influenza; at any age with COVID-19
Timing of onset of complications/severe disease is earlier with influenza
High-risk groups for influenza and COVID-19 are similar
•
Young children are at high-risk for influenza complications
Cuadrado-Payan Lancet 2020; Azekawa ID Cases 2020; Ma Int J Infect Dis 2020; Ding J Med Virology 2020; Wu Emerg Inf Dis 2020; Beltran-Corellini Eur J Neurology 2020; Zayet Microbes and Infect 2020; Stowe Int J Epidemiology 2021
�Influenza Tests in Clinical Settings
Variety of diagnostic tests available to clinicians to detect influenza viruses
in respiratory specimens
ØDiffer by time to produce results, information provided, approved respiratory
specimens, approved clinical settings, and accuracy
§ Antigen detection (FDA-cleared single-plex, multiplex)
§ Two multiplex assays (detect SARS-CoV-2 & influenza viruses) received FDA EUA
r
§ Nucleic acid detection (FDA-cleared single-plex, multiplex)
§ At least 15 multiplex assays (detect SARS-CoV-2 & influenza viruses) received FDA EUA
§ Point-of-care assays (CLIA-waived)
§ Moderately complex (requires clinical laboratory)
§ Highly complex (large clinical laboratories, public health labs)
ü
ü
ü
ü
CDC. Information for Clinicians on Influenza Virus Testing: https://www.cdc.gov/flu/professionals/diagnosis/index.htm
CDC. Rapid Influenza Diagnostic Tests (RIDTs): https://www.cdc.gov/flu/professionals/diagnosis/table-ridt.html
CDC. Nucleic Acid Detection Based Tests for Influenza Viruses: https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html
CDC. Multiplex Assays Authorized for Simultaneous Detection of Influenza Viruses and SARS-CoV-2 by FDA: https://www.cdc.gov/flu/professionals/diagnosis/table-flu-covid19-detection.html
�FDA-cleared Tests Available to Detect Influenza Viruses
in Respiratory Specimens
Method
Clinical Setting
Viruses Detected
Result
Time
Complexity
Rapid Influenza Diagnostic Tests
(antigen detection)
Outpatients, Point-of-Care
Influenza A, B
10-15 minutes
Moderate,
CLIA-waived
Immunofluorescence, Direct (DFA) or Indirect
(IFA) Florescent Antibody Staining
(antigen detection)
Hospitalized Patients
Influenza A, B
2-4 hours
Moderate
Moderate,
CLIA-waived
r
Rapid Molecular Assays
(nucleic acid detection)
Other Molecular Assays, RT-PCR
(single-plex, and multiplex)
(nucleic acid detection)
Multiplex Molecular Respiratory Panels
(nucleic acid detection)
Outpatients, Emergency Department
Patients, Hospitalized Patients
Influenza A, B
15-30 minutes
Hospitalized Patients
Influenza A, B
Influenza A, B, RSV
Influenza A, A(H1), A(H1pdm09),
A(H3), B
>30 minutes to
8 hours
High, Moderate
1-2 hours
High, Moderate,
CLIA-waived
Hospitalized Patients
Influenza A, A(H1), A(H1pdm09),
A(H3), B, RSV, adenovirus, HCoV, HRV,
PIV, HMPV, Bocavirus
ü https://www.cdc.gov/flu/professionals/diagnosis/index.htm
ü https://www.cdc.gov/flu/professionals/diagnosis/table-ridt.html
ü https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html
�FDA-Authorized (Emergency Use Authorization) Tests Available to Detect
SARS-CoV-2 and Influenza Viruses in Respiratory Specimens
Method
Clinical Setting
Viruses Detected
Result
Time
Rapid Multiplex Antigen Tests
(antigen detection)
Outpatients, Point-of-Care
SARS-CoV-2, Influenza A, B
15 minutes
Rapid Multiplex Molecular Assays
(nucleic acid detection)
Outpatients, Point-of-Care
Hospitalized Patients
SARS-CoV-2, Influenza A, B
(some detect RSV)
20-45 minutes
SARS-CoV-2, Influenza A, B (some
detect RSV)
80 minutes to 3
hours
(1-4 days after
home specimen
collection)
Multiplex Molecular Assays
(nucleic acid detection)
Multiplex Molecular Respiratory Panels
(nucleic acid detection)
Outpatients, Emergency Department
Patients, Hospitalized Patients
Hospitalized Patients
r
Influenza A, A(H1), A(H1pdm09),
A(H3), B, RSV, adenovirus, HCoV, HRV,
PIV, HMPV, Bocavirus
45 minutes to
<2 hours
Complexity
High, Moderate,
CLIA-waived
High, Moderate,
CLIA-waived
High, Moderate,
CLIA-waived, Use
with Home
collection kit
High, Moderate,
CLIA-waived
ü https://www.cdc.gov/flu/professionals/diagnosis/index.htm
ü https://www.cdc.gov/flu/professionals/diagnosis/table-ridt.html
ü https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html
�What Influenza Tests are Recommended?
Outpatients
ØRapid influenza molecular assays are recommended over rapid influenza antigen detection tests
ØMultiple assays that detect SARS-CoV-2 and Influenza A/B viruses may be useful
Ø NIH COVID-19 Treatment Guidelines recommend influenza testing + SARS-CoV-2 in outpatients with acute
respiratory illness if results will change management of the patient (e.g. antiviral treatment) (BIII)
Hospitalized patients
r
ØRT-PCR or other influenza molecular assays recommended (2021-2022: Influenza A/B, SARS-CoV-2)
Ø NIH COVID-19 Treatment Guidelines recommend influenza and SARS-CoV-2 testing in hospitalized patients
with acute respiratory illness (AIII)
§ Rapid influenza antigen detection tests and immunofluorescence assays are not recommended
Ø Immunocompromised patients: Multiplex RT-PCR assays targeting a panel of respiratory pathogens, including
influenza viruses are recommended
Ø Do not order viral culture for initial or primary diagnosis of influenza
Ø Do not order serology for influenza
Ø Results from a single serum specimen cannot be reliably interpreted, and collection of paired acute
and convalescent sera 2-3 weeks apart are needed
IDSA 2018 Influenza Clinical Practice Guidelines Clinical Infect Dis 2019; NIH COVID-19 Treatment Guidelines
�Influenza Testing and Specimen Source
Upper respiratory tract
Influenza viruses are generally detectable for 3-4 days by antigen detection; and 5-6 days by
nucleic acid detection in uncomplicated disease, longer in infants and immunosuppressed
Ø Highest yield: Nasopharyngeal (NP) swabs (ideally collected within 3-4 days of illness onset)
• Other acceptable specimens: nasal swabs, NP aspirates, nasal aspirates, combined nasal
and throat swabs
• Slower clearance of influenza viruses in severe disease
r
Ø Influenza viral replication and viral RNA detection may be prolonged with corticosteroids,
immunosuppression
•
Lower respiratory tract
ØHigher, prolonged viral replication in severe lower respiratory tract disease
ØInfluenza viruses may be detectable when cleared from the upper respiratory tract
ØRT-PCR was negative in 10-19% of patients in upper respiratory tract specimens versus
lower respiratory tract (BAL specimens) for influenza A(H1N1)pdm09 viral RNA
Rello Crit Care 2009; Fleury Eurosurveillance 2009; Blyth NEJM 2009
�Recommended Antivirals 2021-2022
Four FDA-approved antivirals are recommended for use in the United States
• Neuraminidase inhibitors:
• Oseltamivir (oral)
• Zanamivir (inhaled)
• Peramivir (intravenous)
• Cap-dependent endonuclease inhibitor: Baloxavir marboxil (oral)
All have demonstrated efficacy for early treatment (<2 days of illness onset) in
r
outpatients with uncomplicated influenza
Drug
Route of Administration
Recommended Ages for Treatment
Oseltamivir
Oral
All ages
Zanamivir
Inhaled
≥5 years
Peramivir
Intravenous
≥2 years
Baloxavir
Oral
≥12 years
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�People at High Risk for Influenza Complications
for Whom Antiviral Treatment is Recommended
ü Children <2 years old (although all children <5 years old are considered at high risk
for complications, highest risk is for children <2 years old)
ü Adults ≥65 years old
ü Pregnant/postpartum women
ü American Indians/Alaska Natives
r
ü Children <18 years old receiving long-term aspirin therapy
ü People with underlying medical conditions (e.g., pulmonary, cardiac,
immunosuppression, neurologic and neurodevelopment conditions, BMI ≥40)
ü Residents of nursing homes/chronic care facilities
ü Certain racial & ethnic minority groups are at increased risk for hospitalization
(non-Hispanic Black, Hispanic or Latino, American Indian or Alaska Native persons)
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�CDC Antiviral Treatment Recommendations
Prioritize prompt treatment of persons with severe disease
and those at increased risk of influenza complications
Antiviral treatment is recommended as soon as possible for any patient with
confirmed or suspected influenza who is:
• Hospitalized (without waiting for testing results)
r
• Outpatients with complicated or progressive illness of any duration
• Outpatients who are at high risk for influenza complications
Antiviral treatment can be considered for any previously healthy, non-high-risk
outpatient with confirmed or suspected influenza (e.g. with influenza-like illness) on
the basis of clinical judgment, if treatment can be initiated within 48 hours of illness
onset; including empiric treatment (e.g. in-person visit or via telemedicine)
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�Oseltamivir Recommended for Hospitalized Patients
Oseltamivir treatment (oral or enterically-administered) is recommended as soon as
possible for hospitalized patients with confirmed or suspected influenza
(without waiting for testing results)
• Observational studies have reported that starting neuraminidase inhibitor treatment
within 6 hours of admission or at the time of admission was associated with shorter
duration of hospitalization
r
• Inhaled zanamivir and oral baloxavir are not recommended because of the lack of data
in hospitalized influenza patients
• Insufficient data for peramivir treatment of hospitalized influenza patients
ØFor patients who cannot tolerate or absorb oral or enterically-administered
oseltamivir (e.g. gastric stasis, malabsorption, or gastrointestinal bleeding),
intravenous peramivir is an option
• Optimal duration of oseltamivir treatment for critically ill patients is unclear
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm; Katzen Clin Infect Dis 2018; Venkatesan J Infect Dis 2020
�Recommended Antiviral Treatment for Outpatients
For outpatients with complications or progressive disease and suspected or confirmed influenza
(e.g., pneumonia, or exacerbation of underlying chronic medical conditions) regardless of
duration, antiviral treatment with oral Oseltamivir is recommended as soon as possible
For outpatients with suspected or confirmed uncomplicated influenza, oral oseltamivir, inhaled
zanamivir, intravenous peramivir, or oral baloxavir may be used for early treatment, depending
r
upon approved age groups and contraindications
• In one randomized controlled trial, baloxavir had greater efficacy than oseltamivir in high-risk
adolescents and adults with influenza B virus infection
Clinicians can consider starting early (≤48 hours after illness onset) empiric antiviral treatment
of non-high-risk outpatients with suspected influenza [e.g., influenza-like illness (fever with
either cough or sore throat)], based upon clinical judgement, including without an office visit.
SARS-CoV-2 and other etiologies of influenza-like illness should also be considered.
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm; Ison Lancet Infect Dis 2020
�Special Groups
Pregnant Women
•
For treatment of pregnant women or women who are up to two weeks postpartum,
oral oseltamivir is preferred
• Baloxavir is not recommended for treatment of pregnant women or breastfeeding mothers
• No efficacy or safety data for baloxavir in pregnant or lactating women
r
Immunocompromised
Persons
Prolonged influenza viral replication is a possibility, with emergence of
antiviral resistant viruses during/after treatment
• Monitoring for antiviral resistance is advised
• Infection prevention and control precautions are recommended to
reduce nosocomial transmission risk
Ø Neuraminidase inhibitor treatment is recommended
Ø Baloxavir monotherapy is not recommended
•
https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
�Influenza and COVID-19
Implications
Ø Testing is needed to distinguish influenza from COVID-19
ØConsider influenza virus infection, SARS-CoV-2 infection, co-infection
• Treatment issues
• FDA-approved antiviral medications for influenza have no effect on COVID-19
• Oseltamivir, baloxavir have no in-vitro
r activity against SARS-CoV-2
• No drug interactions with remdesivir
• Corticosteroids may prolong influenza viral replication in the upper and lower respiratory
tracts (e.g. dexamethasone treatment of severe COVID-19)
• Conflicting observational study findings on corticosteroids and influenza mortality
• Community-acquired bacterial co-infection appears more common with influenza than
COVID-19 (MRSA, MSSA, pneumococcus, group A Strept)
Tan Bioorganic Chem 2020; Choy Antiviral Research 2020; Langford Clin Microbiol Infect 2020; Adler Lancet Microbe 2020; Vaughn
Clin Infect Dis 2020; Zhou Sci Reports 2020;Lee Clin Infect Dis 2008; Gianella Clin Microbiol Infect 2010; Lee J Infect Dis 2009
�Influenza & SARS-CoV-2 (COVID-19) Testing
Because the treatment and infection prevention recommendations are quite different for
influenza and COVID-19, it is important to test and differentiate
For patients presenting with acute respiratory illness (ILI – influenza like illness):
• All patients should have testing for SARS-CoV-2 (COVID-19)
• For patients not requiring hospitalization:
• Test for SARS-CoV-2 in all patients and test for influenza if result will change clinical
management or for infection control reasons
(pt returning to LTC or other congregate
r
setting) or
• Prescribe empiric anti-influenza treatment for patients with progressive disease or high
risk of influenza complications
• For patients who do require hospitalization:
• Implement appropriate infection prevention measures
• Test for SARS-CoV-2 and influenza: multiplex NAAT, separate NAAT for both. Negative
Ag detection should be confirmed with NAAT
• Prescribe empiric anti-influenza treatment while influenza testing pending
(Adapted From: https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians-hospitaized.htm)
�Influenza & SARS-CoV-2 (COVID-19) Treatment
Antiviral Treatment
of Influenza
When Influenza(COVID-19)
Viruses and SARS-CoV-2
Influenza
& SARS-CoV-2
TreatmentAre Cocirculating
Antiviral treatment of influenza is the same in all patients with or without SARS-CoV-2
coinfection (AIII).
• For information on using antiviral drugs to treat influenza in hospitalized and
non-hospitalized patients, see the CDC and IDSA recommendations.
The Panel recommends that hospitalized patients with suspected influenza be started on
r
empiric treatment for influenza with oseltamivir
as soon as possible and without waiting
for influenza test results (AIIb).
Antiviral treatment for influenza can be stopped when influenza has been ruled out by the
results of a nucleic acid detection assay in upper respiratory tract specimens for
non-intubated patients and in both upper and lower respiratory tract specimens for
intubated patients
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials without major limitations; IIa = Other randomized trials or subgroup analyses of
randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion
https://www.covid19treatmentguidelines.nih.gov/special-populations/influenza/
�CDC: Information for Clinicians on Influenza Virus Testing
r
https://www.cdc.gov/flu/professionals/diagnosis/index.htm
�Testing Guidance for Clinicians When SARS-CoV-2 and
Influenza Viruses are Co-circulating
r
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians.htm
�Testing Guidance for Clinicians When SARS-CoV-2 and
Influenza Viruses are Co-circulating
r
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-outpatient.htm
�Testing Guidance for Clinicians When SARS-CoV-2 and
Influenza Viruses are Co-circulating
r
https://www.cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians-hospitaized.htm
�Content Outline (TOC)
Pediatric Considerations:
Influenza in the Age of COVID-19
Kari Simonsen, MD, MBA
�Pediatric Considerations:
Influenza in the Age of COVID-19
Impact of Influenza in Children
https://www.emergency.cdc.gov/coca/ppt/2021/100721_slide.pdf
�Pediatric Considerations:
Influenza in the Age of COVID-19
Distinguishing Influenza from COVID-19
https://www.emergency.cdc.gov/coca/ppt/2021/100721_slide.pdf
�Pediatric Considerations:
Influenza in the Age of COVID-19
Influenza in Children
2020-21 Flu activity was unusually low in US and globally
Dramatically fewer illnesses, hospitalizations, deaths related to flu
CDC received one report of pediatric flu death in 2020-21 season
• Previous range 37 (2011-12) to 199 (2019-20)
WHY?
COVID-19 mitigation measures including physical distancing, masks, improved
hand hygiene, school closures, improvements in indoor ventilation
Record number of flu vaccines distributed 193.8 million
https://www.emergency.cdc.gov/coca/ppt/2021/100721_slide.pdf
�Number of Influenza-Associated Pediatric Deaths
By Week of Death, 2017-2018 to 2020-2021
r
https://www.emergency.cdc.gov/coca/ppt/2021/100721_slide.pdf
�Influenza Vaccines Protect Children from Severe Influenza and Death
PICU Hospitalization
r
• 44 cases vs 172 PICU and 93 community controls (6 mos-17 yrs.) in 21 PICUs
• Vaccinated children 74% (95% CI 19-91%) or 82% (95% CI 23-96%) less likely to be
admitted to PICU for influenza vs PICU or community controls
• 1 dose when 2 needed was NOT protective
Death
• 359 influenza associated deaths among children 6 mos-17 years
• 26% received flu vaccine vs 48% in comparative survey cohort
• VE against death: 65% (95% CI 54-74%)
�Pediatric Considerations:
Influenza in the Age of COVID-19
Pediatric Influenza Recommendations
Routine influenza vaccination recommended for all persons ≥ 6 months of age who do not have
contraindications
Children who need 2 doses include those 6 mos-8 yrs. who haven't received prior influenza vaccine or
haven't received a total of ≥2 doses
• First dose should be given as soon as vaccine is available, second dose must be given ≥ 4 weeks later,
to finish the series by end of October
Contraindications and precautions
• Who should not be vaccinated with injectable (IIV)
• Infants younger than 6 months
• Children with moderate to severe acute illness
• People with history of known anaphylactic reaction to a previous influenza vaccine dose or to
vaccine components
• Guillain-Barre Syndrome (GBS) within 6 weeks of a previous dose of flu vaccine
https://www.cdc.gov/flu/professionals/index.htm
�Does this Child Need Two Doses of Flu Vaccine?
Age at which child receives first influenza vaccine
Dose this 2021-2022 season
r
6 months through 8 years of age
Has child received 2 or more total
doses*of any influenza vaccine prior
to July 1, 2021?
9 years of age or older
YES
Only 1 dose needed
Administer 2 doses of influenza
vaccine, given 4 weeks apart as
minimum interval†
https://www.emergency.cdc.gov/coca/ppt/2021/100721_slide.pdf
�Pediatric Considerations:
Influenza in the Age of COVID-19
Coadministration of Flu and COVID-19 Vaccines
https://www.emergency.cdc.gov/coca/ppt/2021/100721_slide.pdf
�Pediatric Considerations:
Influenza in the Age of COVID-19
Pediatric Influenza Antiviral Treatment
Antiviral treatment recommended as early as possible for patients with confirmed or
suspected influenza who are: hospitalized, severely ill, at high risk for complications
Pediatric groups considered at high risk for complications include:
• Children <5 years, with <2 years at highest risk
• Children ≤ 18 who are on long term aspirin therapy
• American Indian/Alaska Native
• Underlying medical conditions (pulmonary, cardiac, immunosuppressed, neurologic
and neurodevelopmental disorders)
• Reside in group/chronic care settings
Antiviral treatment can be considered for those not meeting high risk definition if treatment
can be initiated within 48 hrs of illness onset
Clinical benefit greatest when treatment administered early
�Pediatric Considerations:
Influenza in the Age of COVID-19
Pediatric Influenza Treatment Recommendations
https://www.emergency.cdc.gov/coca/ppt/2021/100721_slide.pdf
�Pediatric Considerations:
Influenza in the Age of COVID-19
Getting Children Vaccinated!
Vaccinated children at their medical home is recommended and ideal
Routine care, including any catch-up vaccinations, can be accomplished
together with influenza vaccine and COVID-19 vaccines
Adapting to current conditions to maintain safety:
• Maintain infection prevention measures for vaccine clinic settings
(symptom screening, respiratory and hand hygiene, physical distancing)
• Innovative opportunities (drive through vaccination clinics, mobile
units, outreach to community sites)
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Shelly Schwedhelm, MSN, RN, NEA-BC
�NETEC Resources
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
“Transmission Interrupted”
youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
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Deploy
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
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Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, November 12, 2021 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/GPiYd9alYws
Objectives
PRESENTERS<br /><br />Kari A. Simonsen, MD<br />Chair, Department of Pediatrics<br />University of Nebraska Medical Center<br />Pediatrician-in-Chief, Children’s Hospital and Medical Center<br />Omaha, Nebraska.<br /><br />Mark Rupp, MD<br />Professor, Department of Internal Medicine<br />Section of Infectious Diseases<br />University of Nebraska Medical Center<br />Medical Director, Nebraska Medical Center Department of Healthcare Epidemiology<br />Co-Director, Antimicrobial Stewardship Program.<br /><br />Tim Uyeki, MD, MPH, MPP<br />Chief Medical Officer<br />Office of the Director<br />CDC Influenza Division<br /><br />CONTINUING EDUCATION<br /><br />Continuing education credits will be provided for this activity. Participants will be asked to complete a post-webinar evaluation immediately following the webinar. We recommend accessing the webinar from a PC or Mac computer using the Chrome, Firefox, or Safari (Mac) web browser.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/GPiYd9alYws?autoplay=0" title="YouTube video player" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/21-web-111221">https://courses.netec.org/courses/21-web-111221</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (11/12/21)/Online Course: Influenza in the Age of COVID: 2021 Seasonal Update
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
Join us Friday, November 12th, at 12pm CST for the next NETEC COVID-19 Webinar Series presentation, Influenza in the Age of COVID: 2021 Seasonal Update. Join our presenters as they discuss important topics surrounding the upcoming 2021 influenza season. Topics to include discussion on the similarities and differences between seasonal influenza and COVID-19, current influenza vaccination planning efforts, pediatric concerns, the testing and antiviral treatment of influenza when SARS-CoV-2 and influenza viruses are co-circulating, and NETEC resources for healthcare systems to help in their influenza planning efforts.
Webinar slides attached.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-11-12
Type
The nature or genre of the resource
Webinar and Online Course
Contributor
An entity responsible for making contributions to the resource
2023-11-30 by Amy Mead / EM - note "recommend update for current respiratory virus season"
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-30 - recommend updating
2019-nCoV
Coronavirus
COVID-19
Epidemic
Flu
Flurona
Influenza
Not updated
Pandemic
R-EM
-
https://repository.netecweb.org/files/original/6d25c1b6276e61dc83f3c6fbbe66d9a1.pdf
0c68b9e0503da382d0118ec9534865d7
PDF Text
Text
NETEC COVID-19 Webinar Series:
Ethical Issues in Pandemic Response:
Triage and Beyond
�Content Outline (TOC)
Welcome
Ted Cieslak, MD, MPH
�Overview
Welcome: Ted Cieslak, MD, MPH
COVID-19 Ethics Advisory Committee: Abbey Lowe, MA
Matthew Wynia, MD, MPH, FACP
Crisis Standard of Care: Matthew Wynia, MD, MPH, FACP
Kathy Kinlaw, MDiv, HEC-C
Emerging Issues:
Abbey Lowe, MA
Kathy Kinlaw, MDiv, HEC-C
Matthew Wynia, MD, MPH, FACP
NETEC Resources: Ted Cieslak, MD, MPH
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical Assistance
Research Network
Empower hospitals to gauge
their readiness using
Provide self-paced education
through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker readiness
using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and hands-on
simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback to
hospitals via
On-Site Assessment
COVID-19 focused
Webinars
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Built for rapid implementation
of clinical research protocols
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
COVID-19 Ethics Advisory Committee
Abbey Lowe, MA
Matt Wynia, MD, MPH, FACP
�Ethical Issues in Pandemic Response
National COVID-19 Ethics Advisory Committee
Convened by the Global Center for Health
Security at the University of Nebraska
Medical Center
Standing at the ready to provide guidance to
ethical issues inherent to pandemic planning
and response
Copyright, Nathan Gray, MD, 2020. Used with permission.
https://inkvessel.com/2020/03/18/palliative-care-in-the-time-of-covid/
��Ethical Issues in Pandemic Response
Committee Composition and Committee Action
• Clinical
• Policy
• Regulatory
• Academic Leadership
• Law
• Public Health
• Pediatric
• International Representations
• Palliative
• Critical Care/Intensivist
• Pandemic
• Disparities or Access Ethics
• Immunocompromised Populations
Copyright, Nathan Gray, MD, 2020. Used with permission.
https://inkvessel.com/2020/03/18/palliative-care-in-the-time-of-covid/
�Ethical Issues in Pandemic Response
Ethics Requests
Triage Decision-Making
End of Life and Palliative Care in the Pandemic
Health Disparity and Fairness in Public Health Response
PPE Allocation Strategies for Training Programs for
Frontline Workers
�Content Outline (TOC)
Crisis Standards of Care
Matt Wynia, MD, MPH, FACP
Kathy Kinlaw, MDiv, HEC-C
�Ethical Issues in Pandemic Response
Crisis standards of care are applied when a pervasive
or catastrophic disaster make it impossible to meet
usual healthcare standards
• Conventional care is everyday healthcare services
• Contingency care arises when demand for medical staff, equipment, or
pharmaceuticals begins to exceed supply. Contingency care seeks functionally
equivalent care, recognizing that some adjustments to usual care are necessary
• Crisis care occurs when resources are so depleted that functionally equivalent
care is no longer possible
Rapid Expert Consultation on Guiding Principles, Key Elements, and Core Messages for Crisis Standards of Care, March 28[1]
�Ethical Issues in Pandemic Response
During a crisis, it is vitally important to adhere to core ethical principles
Fairness
Consistency
The Duty of Care
Proportionality
The Duty of
Steward Resources
Accountability
Transparency in Decision-Making
�Ethical Issues in Pandemic Response
ed ss
nc ne
ha ed
En ar
ep
of
Pr
ty
i
l
s
bi
d ss
la urce
i te e
ai
m dn
Av so
Li are
Re
ep
Pr
DEMAND FOR
HEALTHCARE
SERVICES
SUPPLY OF
RESOURCES
Contingency/Crisis
Standard
TIME
Figure 1: Demand for healthcare services and supply of resources as a function of time after disaster onset,
taking into account care capacity as a function of time (Hanfling, Aletevogt, Viswanathan, & Gostin, 2012, pp. 42)
CDPHE All Hazards Internal Emergency Response and Recovery Plan. Annex B. Colorado Crisis Standards of Care Plan, December 20, 2017
�Ethical Issues in Pandemic Response
GUIDING PRINCIPLES: Crisis Standard of Care (CSC)
Planners must do everything possible never to enter CSC, and to spend
as little time in CSC as possible (proportionality principle)
CSC have the joint goals of extending the availability of key resources
and minimizing the impact of shortages
CSC strive to save the most lives possible, recognizing that some
individual patients will die, who might survive under usual care
Implementation of CSC will require facility-specific decisions regarding
allocation of limited resources, but should be coordinated across
facilities to ensure equity
Adapted from: Rapid Expert Consultation on Guiding Principles, Key Elements, and Core Messages for Crisis Standards of Care, March 28[1]
�Ethical Issues in Pandemic Response
Ethics in Critical Care Resource Allocation
Setting of Extreme Scarcity
• “Save the most lives” or “maximize benefits”
• But how are these defined?
• Survival to discharge? Life-years saved?
Any additional priorities/ethical approaches beyond lives
saved?
• Life Cycle Approach
• Healthcare Workers, Essential Workers
• “Instrumental Value”; Multiplier Effect
• Random allocation/lottery
• Children, pregnant women...
�Content Outline (TOC)
Emerging Issues
Kathy Kinlaw, MDiv, HEC-C
Matt Wynia, MD, MPH, FACP
Abbey Lowe, MA
�Ethical Issues in Pandemic Response
Disparities, Justice and COVID-19
Why certain groups of people have been disproportionately
affected by the virus will take extensive study
• Higher rates of exposure, more comorbidities, differential
care
• Other social determinants of health, “structural” racism
Concerns of those living with disabilities
How to mitigate the disease in populations impacted?
How does Crisis Standard of Care planning account for
those being disproportionately affected by COVID-19?
�Ethical Issues in Pandemic Response
Personal Protective Equipment (PPE)
Ethical process for allocating PPE?
Ethical criteria for allocating PPE?
Communication challenges
What counts as “safe enough” use of PPE?
�Ethical Issues in Pandemic Response
Other Clinical Issues in a Time of Scarcity
CPR decisions
• CPR and use of PPE
Implications for advance care planning
• Early discussions
• Altered pathways to securing patient information
• Support for altruism versus risk of coercion
Communicating effectively and compassionately
Surgical scheduling
�Content Outline (TOC)
NETEC Resources
Ted Cieslak, MD, MPH
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Resources
Slide 13: Palliative Care in the Time of COVID
https://inkvessel.com/2020/03/18/palliative-care-in-the-time-of-covid/
Slide 14: Ethics Advisory Committee
https://www.unmc.edu/healthsecurity/ethics/index.html
Hastings Center: Ethics Resources on Coronavirus (COVID-19)
https://www.thehastingscenter.org/ethics-resources-on-the-coronavirus/
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
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Description
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, April 29, 2020 | 1:00 PM CST
Event Type
Webinar, watch at link below
URL
https://youtu.be/MZxAG2J00Qg
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Ethical issues in Pandemic Response webinar" src="https://www.youtube.com/embed/MZxAG2J00Qg?autoplay=0" frameborder="0"></iframe>
Objectives
Self-paced, 1 credit
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-ethics" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-ethics</a>
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NETEC COVID-19 Webinar Series (4/29/20)/Online Course: Ethical issues in Pandemic Response, Triage and Beyond
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
Discuss Critical Standards of Care – what they are, when they occur, and the ethical principles to adhere to during a crisis. Additional topics will include resource allocation, triage, and disparities and limitations related to COVID-19.<br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-ethics" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-29
Type
The nature or genre of the resource
Webinar and Online Course
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Epidemic
Ethics
Online Course
Pandemic
R-EM
-
https://repository.netecweb.org/files/original/ab54adca01630a8c9b91da67439b2b17.pdf
05a633d614bf0d1b6b0dba6559037491
PDF Text
Text
NETEC COVID-19 Webinar Series:
Tackling the COVID-19 Storm
Through the Lens of Long-Term Care Facilities
�Content Outline (TOC)
Welcome
Ted Cieslak, MD, MPH
�Overview
Welcome: Ted Cieslak, MD, MPH
Washington State Public Health Response to COVID-19:
Sara Podczervinski, RN, MPH, CIC, FAPIC
Patty Montgomery, RN, MPH, CIC
House of Hope Alzheimer’s Care Response to COVID-19:
Carly Snider, Community Nurse, LPN
Tawny McWilliams,
NETEC Resources: Ted Cieslak, MD, MPH
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Washington State Public Health
Response to COVID-19
Sara Podczervinski, RN, MPH, CIC, FAPIC
Patty Montgomery, RN, MPH, CIC
�Washington State Public Health Response to COVID-19
First in the Nation
https://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_home
�Washington State Public Health Response to COVID-19
COVID-19 Preparedness?
“Nursing homes have been caught in the crosshairs of the coronavirus pandemic. As
of early May 2020, COVID-19 had claimed the lives of more than 28,000 nursing home
residents and staff in the United States. But U.S. nursing homes were unstable even
before COVID-19 hit. They were like tinderboxes, ready to go up in flames with just a
spark. The tragedy unfolding in nursing homes is the result of decades of neglect of
long-term care policy.”
Werner RM. NEJM. 5/27/20. https://www.nejm.org/doi/full/10.1056/NEJMp2014811
�Washington State Public Health Response to COVID-19
First in the Nation
167 cases COVID-19 linked to Facility A
• 101 facility residents (77%)
• 50 health care personnel (39%)
• 16 visitors
Preliminary case fatality rate
• 33.7% for residents
• 6.2% for visitors
• No staff members died
https://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_home
�Facility Cases
Werner RM. NEJM. 5/27/20. https://www.nejm.org/doi/full/10.1056/NEJMp2014811
�Transmission Facility to Facility
Werner RM. NEJM. 5/27/20. https://www.nejm.org/doi/full/10.1056/NEJMp2014811
�Washington State Public Health Response to COVID-19
Gaps Contributing to COVID-19 Transmission at Facility A
Staff worked while symptomatic
Staff worked in more than one facility
Inadequate familiarity with, and adherence to, PPE recommendations
Challenges in implementing proper infection control practices
Inadequate supplies of PPE and hand sanitizer
Delayed recognition of cases
Limited availability of testing
Difficulty identifying persons with COVID-19 based on signs and symptoms alone
�Washington State Public Health Response to COVID-19
What Went Well
1
Good collaboration with facility and the hospital
2
The state, county and federal teams worked well together
3
The dedication and courage of the staff at the facility
4
We were able to test everyone which really helped us
gain a better understanding to cohort residents
�Washington State Public Health Response to COVID-19
It Would Have Been Great…
1
The media attention
2
More PPE (National Stockpile?)
3
Nursing home regulations had been updated sooner
4
An awareness of other at-risk settings for elders
�Washington State Public Health Response to COVID-19
Other Settings of Interest
Continuum of Settings
Neighborhood
homes where
direct-care
providers assist
2 to 6 residents
Neighborhood
facilities where
direct-care
providers assist 7
or more residents
Specialized
facilities to serve
individuals with
complex medical
and behavioral
heath needs
Facilities
providing 24/7
nursing care to
residents with
significant needs
Adult
Family
Homes
Assisted
Living
Facilities
Enhanced
Service
Facilities
Skilled
Nursing
Facilities
Clients living in
their own homes
in the community
Group Homes
Supported Living
Supported
Living
(CCRSS)
�LTC Associated Cases by Illness Onset Date 7/6/2020
Universal Masking 4/7
Visitor restrictions 3/16
Universal eye protection 7/9
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/Weekly-COVID-19-Long-Term-Care-Report.pdf
�Washington State Public Health Response to COVID-19
Mitigate Risks in LTC
We have providing infection prevention assessments both onsite and remote
Long-term Care
Facility
156
Adult Family Home
155
Total
311
�Washington State Public Health Response to COVID-19
Next Steps
LATER: Reforms and regulation?
ü Higher standards for infection control programs
ü Higher staff to resident ratio
ü Higher educational standards
ü Better pay for caregivers
ü Paid sick leave and insurance
ü Different payment models for elder care
�Content Outline (TOC)
House of Hope Alzheimer’s Care
Response to COVID-19
Carly Snider, Community Nurse, LPN
Tawny McWilliams, Administrator
�Background: House of Hope Alzheimer’s Care
Location: North Omaha, Nebraska
Layout: 4 Neighborhoods with a total of 42 private apartments
• Each neighborhood houses 10 or 11
Services: Assisted Living Memory Support providing all inclusive care
Memory Care Staffing:
• One Community Nurse Manager day shift and on-call
• Two Medication Aides (1st & 2nd Shift)
• Four C.N.A’s (1st & 2nd Shift)
• One Med Aide & 3 C.N.A’s Overnight
�Preparedness: Prior to the COVID Positive Residents
Staff Support
COVID-19 Training Manual
• Hand Hygiene
• Proper PPE Donning &
Doffing
• Cleaning/Sanitizing
Engaging in 1:1 activities
with residents
�Preparedness: Prior and During pandemic
Processes to support COVID-19 Positive Residents:
•
•
•
•
Screening staff and residents
PPE
Visitor restrictions
Volunteer restrictions
•
•
•
•
Non-essential staffing (E.g. hairdresser)
Staff break rooms
Staffing and job duties
Stocking up supplies
�The Experience: Discovering COVID-19 Positive Residents
Discovery: Staff Member
How many? 10 Resident and 2 Staff
How many residents may have been exposed? 42
What about staff? 4 directly and up to 10 potential
�COVID-19 Activation
All planning processes were kept in place from the preparation stage
• Moved screening process from paper to digital
Worked closely with ICAP to verify processes, this collaboration led to changes
• Entrance and exit locations
• Doffing and donning areas
�COVID-19 Activation
Isolating patients went better than expected
• Challenges with residents understanding the limitations
placed on movement outside of their individual apartments
Creating COVID negative and COVID positive zones
• Isolated patients by room
• Did not move residents to different areas
• Dedicated C.N.A.s, Medication Aide and Nurse
manager for each area
• Used a color sign system to differentiate positive and
negative rooms
• Offered staff a safe area to change clothes and shower
prior to exiting their shift
• Memory Care staff did not use the main timeclock
• Implemented a paper time sheet
�COVID-19 Activation
Possible resident exposure:
• Monitored for signs/symptoms
• Initial symptoms: diarrhea and runny nose
Testing:
• Tested 8 residents on April 7th due to being
symptomatic
• Received positive results on April 8th, which
prompted further testing in the two adjoining
neighborhoods on April 9th
• Positives remained in the two adjoining
neighborhoods
• All residents and staff were tested May 2nd
• Results received May 7th with all negative,
• Exception - one resident remained positive, tested
negative May 19th
�COVID-19 Activation
Mealtime
• C.N.As delivered meals
• Served on paper products
• Residents that could feed themselves and
did not need cues or reminders were
served first
• Residents that needed assistance were
served last after in order to provide
appropriate attention
�What Worked Well
1
ü
ü
ü
ü
ü
Leadership/Teamwork/Support
Being present and a leader on the floor
Communication: being open, honest, and listening
Strong support system
Open to ideas
Continuous teaching and learning, being an example
�What Worked Well
2
Building Layout
Memory Care layout was beneficial
All private apartments and bathrooms
Separate entrances and exits for positive/negative areas
Dedicated staff in negative areas – did not cross staff
between other parts of community
ü Staff was all-inclusive
ü
ü
ü
ü
�What Worked Well
3
ü
ü
ü
ü
ü
Infection Control Practices
Direct care staff cleaned/sanitized multiple times a shift
Dedicated staff: no maintenance, housekeeping, activity, or management
Removed and turned around furniture
Snacks and treats were individualized
Washable gowns
�Three Things That Would Have Been Good to Have in Place
1
Staff preparation
2
Training
3
Supplies and dedicated equipment
�Content Outline (TOC)
NETEC Resources
Ted Cieslak, MD, MPH
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, July 15, 2020 | 1:00 PM EST
Event Type
Webinar, view at link below
URL
https://youtu.be/G62D2h9vW-w
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Long-Term Care part 1 webinar" src="https://www.youtube.com/embed/G62D2h9vW-w?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="http://courses.netec.org/courses/20-web-ltc1" target="_blank" rel="noreferrer noopener">http://courses.netec.org/courses/20-web-ltc1</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (7/15/20)/Online Course: Tackling the COVID-19 Storm through the Lens of Long-Term Care Facilities: Part 1
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
In this webinar, participants will discuss different policies and processes taken at long-term care facilities caring for COVID-19 positive residents based on case-based experiences, describe mitigation strategies involved to promptly identify and isolate residents with possible COVID-19 utilizing appropriate infection prevention practices, and describe the role of local and state public health in the identification, prevention, and control of COVID-19 in long-term facilities.<br /><br />Webinar slides attached.<br />
<h3>Go to <a href="https://repository.netecweb.org/items/show/1207">Part 2 of this webinar</a>.</h3>
<h2>Get educational credit for this webinar through <a href="http://courses.netec.org/courses/20-web-ltc1" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-15
Type
The nature or genre of the resource
Webinar and Online Course
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Epidemic
Long-term Care
Online Course
Pandemic
R-LTC
-
https://repository.netecweb.org/files/original/fb5128e83021383c6ee969b886452bfb.pdf
15e33005abd8ec32e7a0af2c0b1a1c45
PDF Text
Text
NETEC COVID-19 Webinar Series:
Identifying Hazards and Mitigating Risks
for Long Term Care Facilities
�Content Outline (TOC)
Welcome
Shelly Schwedhelm, MSN, RN, NEA-BC
�Overview
Welcome:
Shelly Schwedhelm, MSN, RN, NEA-BC
Considerations for Long Term Care Facilities:
Kate Boulter, RN, BAN, MPH
Infection Control for Long Term Care Facilities:
Trish Tennill, RN, BSN
Personal Protective Equipment for Long Term Care Facilities:
Jill Morgan, RN, BSN
NETEC Resources: Shelly Schwedhelm, MSN, RN, NEA-BC
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Considerations for Long Term Care Facilities
Kate Boulter, RN, BAN, MPH
�Considerations for Long Term Care Facilities
COVID-19 Cases and Deaths in Long Term Care
Data reported as of the week ending: 07/05/2020 https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/
�Considerations for Long Term Care Facilities
Why Long Term Care Facilities
Communal living
High representation of:
• High risk population >65 yrs old
• Chronic medical conditions
Staffing Model
• Agency and staff who work in multiple facilities
Transfers from other care areas
�Surveillance
Identify
• Symptom surveillance of residents
and everyone entering the facility
Isolate
• Separate from rest of the facility
Inform
• Public health and other stakeholders
CDC Guidance on preparing nursing homes
https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
�Isolation and Quarantine Strategy
Red Zone
Cohort residents
Cohort staff
Residents who
attend outpatient
appointments
(Isolation Zone)
Yellow Zone
(Quarantine Zone)
Green Zone
(COVID-19 FREE Zone)
Gray Zone
(Transitional Zone)
COVID-19 Positive residents and
symptomatic residents suspected of
having COVID-19
Symptomatic residents suspected of
having COVID-19
Asymptomatic residents without any
exposure to COVID-19
Residents who are being transferred
from the hospital/outside facilities
(but have no known exposure to COVID-19)
�Challenges for Long Term Care Facilities
Facility design:
• Airflow
• Doors
• Poly walls
Floor coverings
Home style decor and personal
furnishings and decorations
�Considerations for Long Term Care Facility
Challenges in Long Term Care Facilities
Resident cohorts
Shared vs private accommodations
Visitors and volunteers
Staffing model
Resident activities
Non-essential services
�Considerations for Long Term Care Facility
Being Prepared – Two Conditions
Facilities without COVID-19 positive cases
Implementing measures to prevent
COVID-19 from entering the facility
Facilities with COVID-19 positive cases
Care for the residents who are infected
Implementing measures to protect the
residents who are not infected
�Content Outline (TOC)
Infection Control
for Long Term Care Facilities
Trish Tennill, RN BSN
�Infection Control for Long Term Care Facilities
Symptom Screening
Screen everyone:
• Staff
• Visitors (if allowed)
• Vendors
EMS
�Infection Control for Long Term Care Facilities
Education
qStaff
qResidents
•
•
•
•
•
qVisitors
Hand hygiene
Visitation policy
Masking policy
PPE
What to do if they become ill
�Infection Control for Long Term Care Facilities
Maintaining Infection Prevention Standards
A dedicated infection
preventionist
Maintain adequate supplies
Bedside staff
Environmental cleaning
Dietary
�Infection Control for Long Term Care Facilities
Laundry, Food Service and Waste
Management of laundry, food service
utensils, and medical waste can be
performed in accordance with standard
procedures
�Infection Control for Long Term Care Facilities
Where Do We Go From Here?
Back to the basics
https://www.cdc.gov/coronavirus/2019-ncov/community/clean-disinfect/index.html
�Infection Control for Long Term Care Facilities
Cleaning and Disinfection
Surfaces must be cleaned before they are disinfected
Cleaning
Disinfection
The removal of visible soil to
prepare for disinfection
The process of destroying
pathogenic microorganisms
Some organic or inorganic
material can interfere with the
effectiveness of the disinfectant
Disinfectants destroy the cell
wall of microbes or interfere
with their metabolism.
Use EPA approved disinfectants that are labeled for use against the pathogen
�Infection Control for Long Term Care Facilities
How to Clean and Disinfect
Cleaning
Use a clean, reusable cloth or disposable wipe
Apply friction to remove gross contamination
Rinse or wipe with cloth dampened with water
to remove cleaning product residue
Disinfection
Read and follow the instructions provided by the
disinfectant manufacturer
Observe the contact time by ensuring the
surface being cleaned stays wet for the time
indicated and allowed to air dry
Clean and Disinfect all “high-touch” surfaces daily and as needed - often
Include ALL high-touch surfaces
Create daily and high touch cleaning checklist
�Infection Control for Long Term Care Facilities
Name:
Date:
/
/
High-touch Room Surfaces
Create a checklist
ü
when complete
Disinfectant Agent to be
Used
Bed rails / controls
Tray table (both surfaces) (positioning buttons)
IV pole/pump control panel
IV pumps
Call light and cord
Telephone
Determine who is
responsible for cleaning
and disinfection HCW/ EVS
Television control panel and/or television remote
O2/Air/Suction controls on headwall
Bedside storage drawer handles
Chair (seat and arm rests)
Horizontal surfaces (window sill/cupboards)
Room light switch
Room door knob (inner only)
Door frame area above/below door handle (inside of door only)
High touch areas on equipment i.e. ventilator control panel
Educate on technique
and contact times
Check sharps container (replace per protocol if 2/3 full)
Computer workstation (exposed surfaces)
Alcohol gel dispenser
Thermometer
Others
Evaluate the following additional sites for visible soil
Floor contamination/Wall contamination/Horizontal surface contamination
Empty/re-bag trash/ Check sharps container
Disinfectant
Contact time
�Infection Control for Long Term Care Facilities
Infection Control
Staff who screen positive
Return to work policies
https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
�Content Outline (TOC)
Personal Protective Equipment
For Long Term Care Facilities
Jill Morgan, RN, BSN
�Risk and Respiratory Protection
ü N95's all shifts, all staff, fit-tested,
seal check done
ü Private Rooms
ü Negative Pressure AIIR
ü Disposable single-use gowns
ü Clients in masks
ü ABHR throughout
ü Staff space >6' separation
ü Staff able to self-quarantine
ü Staff have no familial/home risks
ü Supplies and equipment cleaned
or isolated
N95 with fit-testing and user seal
check (or reusable equivalent FFR)
KN95, R95, P95
FDA approved Surgical
Or procedure mask
Cloth mask
�Respiratory Protection
WHAT you wear may be less important than HOW you wear it
?
Can you wear w/o touching, manipulating, repositioning?
?
?
Can you wear for the entire time you are near others or in a confined space?
?
?
Can you perform hand hygiene immediately
if you do have to touch your mask or respirator?
?
?
N95's - Can you get a good seal?
Do you always perform a user seal check?
?
Evidence shows that a poorly fitting N95 provides about the
same protection as a conventional surgical or procedure mask
�Source Control and PPE
Cloth masks serve as Source Control protecting others
q Reduce small exhaled particles
q Reduce larger wet droplets that could contaminate surfaces, others
q Keeps our hands off our noses and mouths
Surgical masks or N95-type respirators serve as PPE for Personal Protection
q Reduce small exhaled and inhaled particles
q Reduce and repel larger wet droplets
q Keep our hands off our noses and mouths
�PPE Fundamentals
COVER your nose and mouth when you are performing patient care, do not touch the
PPE once on, perform hand hygiene if you must touch or adjust PPE
Protect your eyes with goggles, safety glasses or a face shield
• Corrective lenses do not count
Use gloves as normal but pay close attention to what you are touching, perform
hand hygiene or gloved-hand hygiene. Be thorough and rub until dry
Have a safe, clean space like a paper gift bag to store your PPE in between uses
Re-use PPE only when safe to do so – still protective, not grossly contaminated
Do not attempt to clean or sanitize your PPE yourself
• Do not microwave, wipe or soak
�Personal Protective Equipment
Residents with known or suspected COVID-19 should be cared for using all recommended PPE, which includes use
of an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (i.e., goggles or a face
shield that covers the front and sides of the face), gloves, and gown. Cloth face coverings are not considered PPE
and should not be worn when PPE is indicated.
Because of the higher risk of unrecognized infection among residents, universal use of all recommended PPE for the
care of all residents on the affected unit (or facility-wide depending on the situation) is recommended when even a
single case among residents or HCP is newly identified in the facility; this could also be considered when there is
sustained transmission in the community.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
�Personal Protective Equipment
q Trash can outside room to receive discarded PPE
q Convenient placement of ABHR, portable stand, or on staff work cart
q A location and procedure for cleaning PPE and storing for re-use –
goggles, face shields, masks, respirators, gowns
q Bundle care tasks
q Replace PPE mask or respirator with cloth mask when outside of resident
care environment
q Prioritize gowns to patients with concurrent infections – like C. Diff, wet
procedures, or when staff will be on close physical contact with residents
�PPE Re-use
How can you make the re-use of PPE safe and effective?
Stations, tables or carts outside rooms, in the hallways
Cleaning and storage supplies
Small trash can
Alcohol-based hand rub
(ABHR)
�PPE for Long Term Care Facilities
Personal Protective Equipment Resources
Know Your PPE:
https://repository.netecweb.org/files/original/8a4e0ca69136f087ca297dafa15d1760.pdf
PPE Safety:
https://repository.netecweb.org/files/original/f227e6c708549b770225b9883e686403.pdf
ASHRAE.ORG COVID-19 Resources:
https://www.ashrae.org/technical-resources/healthcare#disinfection [ashrae.org]
�Content Outline (TOC)
NETEC Resources
Shelly Schwedhelm, MSN, RN, NEA-BC
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, July 22, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below
URL
https://youtu.be/1HBVVeVOAuk
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Long-Term Care part 2 webinar" src="https://www.youtube.com/embed/1HBVVeVOAuk?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="http://courses.netec.org/courses/20-web-ltc2" target="_blank" rel="noreferrer noopener">http://courses.netec.org/courses/20-web-ltc2</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (7/22/20)/Online Course: Tackling the COVID-19 Storm through the Lens of Long-Term Care Facilities: Part 2
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
In this webinar, participants will discuss different policies and processes taken at long-term care facilities caring for COVID-19 positive residents based on case-based experiences, describe mitigation strategies involved to promptly identify and isolate residents with possible COVID-19 utilizing appropriate infection prevention practices, and describe the role of local and state public health in the identification, prevention, and control of COVID-19 in long-term facilities.<br /><br />Webinar slides attached.<br />
<h3>Go to <a href="https://repository.netecweb.org/items/show/1206">Part 1 of this webinar</a>.</h3>
<h2>Get educational credit for this webinar through <a href="http://courses.netec.org/courses/20-web-ltc2" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-22
Type
The nature or genre of the resource
Webinar and Online Course
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Epidemic
Long-term Care
Online Course
Pandemic
R-LTC
-
https://repository.netecweb.org/files/original/53cf2eb5e0fc5d60650c7f9024e4e23b.pdf
511ea32ff3d658ac404d9c7123677b05
PDF Text
Text
NETEC COVID-19 Webinar Series:
COVID-19: Current State of the Pandemic
�Content Outline (TOC)
Welcome
Trish Tennill, RN, BSN
�Overview
Welcome: Trish Tennill, RN, BSN
COVID-19 Current State of the Pandemic : Amanda Klinger, MD
NETEC Resources: Trish Tennill, RN, BSN
Questions and Answers with NETEC: Vikram Mukherjee, MD
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
COVID-19: Current State of the Pandemic
Amanda Klinger, MD
�Objectives
Describe the current pandemic hotspots, in the US and globally including
the epidemiology of the current wave of infections
Discuss the country-wide testing needs to mitigate and suppress COVID-19
infections
Review the evidence regarding possible re-infections of COVID-19
Interpret the data behind the newest therapeutic guidelines for COVID-19
(remdesivir, convalescent plasma, and steroids)
�Where Are We Now?
World COVID-19 Case Counts
United States COVID-19 Case Counts
r
r
https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html
r
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
�Where Are We Now?
r
rr
�Worldwide Hotspots: South East Asia
Highest number of new cases:
• Bangladesh
• India • Indonesia
India
• Strict lockdown late March to late May
• Movement from urban cases to rural cases
r
(people traveling)
• Second highest in rtotal cases and third highest
in death toll
• >90,000 new infections per day
• Fastest increase of all countries
• Hotspot region = state of Maharashtra, home
to Mumbai
• Lowest per capita death rate
�Worldwide Hotspots: Europe
Second waves of infection developing
Spain
• Attributed to faster opening of nightclubs
and bars
• Mortality rate = 50% of May (12%à6.6%)
• Median age of sufferers = 37 compared to 60
• Asymptomatic cases are approximately 50%
r
r
France
• Mostly affecting young people
• Schools have had to reclose
• Cause thought to be waning social distancing
efforts
United Kingdom
• Boris Johnson to pass restrictions on bars and restaurants
• Projecting 50,000 new cases per day in the next month
�Worldwide Hotspots: Israel
Israel
• Current increase began in July
• Significant infighting in government
about how to manage outbreaks
• Daily cases surpassing 3,000
r
• Highest per capita
7-day average in
r
new cases
• New lockdown started
• Highest prevalence areas:
• Arab communities
• Ultra-Orthodox communities
�The Americas
Highest number of cases:
• United States of America
• Brazil
• Argentina
• Colombia
r
Argentina’s test positivity rates = 40%!
�The Americas
r
https://ais.paho.org/phip/viz/COVID-19EpiDashboard.asp
�The Americas
r
https://ais.paho.org/phip/viz/COVID-19EpiDashboard.asp
�The Americas
r
https://ais.paho.org/phip/viz/COVID-19EpiDashboard.asp
�US Hotspots
#
Highest percentages:
• Region 4 (South East) = 7.5%
• Region 6 (South Central) = 8.3%
• Region 7 (Central) = 8.9%
Slight increase in positive tests:
• Regions 2 and 8
10
HHS Regions
1
8
r
r
2
5
7
9
6
3
4
�Who is Getting Infected?
r
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
�Changing Age Distribution
r
�College Openings
r
https://www.nytimes.com/interactive/2020/us/covid-college-cases-tracker.html
�COVID-19-Associated Hospitalization Rates by Age Group
r
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
�Characteristics and Outcomes of COVID-19
From: Characteristics
and Outcomes of COVID-19 Patients During Initial Peak and Resurgence
in the Houston Metropolitan Area JAMA. 2020;324(10):998-1000. doi:10.1001/jama.2020.15301
Table Title: Sociodemographic, Comorbidity, Clinical, and Outcome Differences Between Surge 1 and Surge 2 of COVID-19 Hospitalizations at Houston Methodist, Texas
r
Date of download: 9/11/2020
Copyright 2020 American Medical Association. All Rights Reserved.
�Racial Disparities
r
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
�Racial Disparities
r
https://covid.cdc.gov/covid-data-tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fcases-in-us.html#demographics
�Seroprevalence in the US
Utah Data from Round 4
New York City Data from Round 2
r
https://covid.cdc.gov/covid-data-tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fcommercial-labs-interactive-serology-dashboard.html#serology-surveillance
�COVID-19 Current State of the Pandemic
Testing Needs
Minimum level of testing needed to
mitigate the disease:
• Daily capacity to test anyone
who has flu-like symptoms
• AND an additional 10 people
per positive virus test
Goals for suppression of the virus are
much higher
Image credit: https://covid19.sanantonio.gov/News-Events/Featured-News/Getting-Tested
�Two Approaches to Combating COVID-19
r
�Current Testing Levels Worldwide
Daily Testing Levels
for the
World
Positive Testing Levels
for the
World
r
https://globalepidemics.org/july-6-2020-state-testing-targets/
�Current Testing Levels in the US
Daily Testing Levels in the United States
Positive Testing Levels in the United States
r
https://globalepidemics.org/july-6-2020-state-testing-targets/
�EXAMPLE:
EXAMPLE:
Meets Mitigation
and
Does not Meet Suppression
r
Does not Meet Mitigation
And
Does not Meet Suppression
�COVID-19 Current State of the Pandemic
Barriers
Next Steps
Testing capacity and speed in
each state is variable
Move to rapid antigen tests?
Supply chain is overstressed
�Test and Tracing Corps – New York City
r
https://hhinternet.blob.core.windows.net/uploads/2020/09/test-and-trace-data-metrics-20200909.pdf
�Test and Tracing Corps – New York City
r
https://hhinternet.blob.core.windows.net/uploads/2020/09/test-and-trace-data-metrics-20200909.pdf
�COVID-19 Current State of the Pandemic
Massachusetts Test and Tracing Through PIH
https://www.mass.gov/doc/weekly-covid-19-public-health-report-september-9-2020/download
�COVID-19 Current State of the Pandemic
Are Re-infections Possible?
Several reports have been published of possible re-infection cases
Until end of August, all were found to have other explanations for their
repeat positive PCR test
2 new published cases in Hong Kong and Nevada were announced at
the end of August
�COVID-19 Current State of the Pandemic
Re-infections
Rhesus Macaques exposed to SARS-CoV-2
were re-challenged with the same strain of
virus on day 35 after initial infection
Peak viral load was lower in the nasal swab
and bronchoalveolar lavage specimens
Limitations:
• Rhesus macaques, not human infection
• Re-infected very soon after initial
infection
�Case #1
33-year-old man living in Hong Kong
In March 2020 had cough, sore throat, fever, headache
3/26/20: positive for SARS-CoV-2
3/29/20: hospitalized
4/14/20: discharged from hospital
r
• 2 negative PCR tests done prior to discharge
Traveled to Spain, with stop in the United Kingdom
8/15/20: Tested positive for SARS-CoV-2 on return at the Hong Kong airport
Remained asymptomatic
• No changes on CXR
• No significant lab abnormalities
Serial PCR tests showed reduction in cycle threshold
�Case #1
Specimens from first episode and second episode = negative for IgG
Test done on day 5 post-second episode = positive for IgG
Genomic analysis done
r
• Cases were from a different clade/lineage
• First genome = closely related to USA and England strains from March +
April 2020
• Second genome = closely related to Switzerland and England strains from
July + August 2020
4.5 months between the two infection episodes
�Case #2
25-year-old from Reno, Nevada
• No history of immunosuppressing conditions
• Not on any immunosuppressive medications
3/25/20: Onset of sore throat, cough, headache, nausea, diarrhea
4/18/20: Tested positive for SARS-CoV-2
4/27/20: Symptoms resolved
5/9/20: Negative PCR test
r
5/26/20: Negative PCR test
5/28/20: started to develop fevers, headache, dizziness, cough, nausea, diarrhea
5/31/20: presented to care, CXR performed with normal appearance, sent home
6/5/20: presented again, was found to be hypoxemic, transferred to nearest ED
• CXR showed new patchy bilateral interstitial opacities
• RT-PCR positive for SARS-CoV-2
6/6/20: IgM/IgG for SARS-CoV-2 positive
�Case #2
Second infection occurred at the same time as their parent was diagnosed
positive for SARS-CoV-2
Sequencing is ongoing of the parent’s viral genome to see if it is similar to the
second infection in the index patient
r
Number of mutations from Case A to Case B = rate of 83.64 substitutions per year
compared to 23.12 per year
Virus A and B were in the same clade --> exposure to the virus may not result in
100% immunity for all individuals
�Cases #3 and #4
One case in the Netherlands and one in Belgium have been reported, but not
published
Most details unknown so far
r
Netherlands
• Elderly person with weakened immune system
Belgium
• 50-year-old woman had coronavirus in March and diagnosed again in June
• First and second case were mild
• Developed very few antibodies after her first infection
�COVID-19 Current State of the Pandemic
Ongoing Questions
?
How often does re-infection happen and why?
?
Will cases be as severe as the first infection?
?
When re-infection happens, will these new cases carry
the same risk of transmission as the first infection?
�Influenza + COVID-19
Summer circulation of influenza in the US is
currently at historical lows
• 0.20% in 2020 versus 2.35% in 2019
Data from Australia, Chile, South Africa show very
low influenza activity during June-August 2020
• 0.06% compared to 13.7%
r
�COVID-19 Current State of the Pandemic
Latest Treatment Updates
Remdesivir
Corticosteroids
Convalescent Plasma
Image credit: NIAID - Colorized scanning electron micrograph of an apoptotic cell (tan)
infected with SARS-COV-2 virus particles (orange), isolated from a patient sample
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Remdesivir
Nucleotide analogue, inhibitor of the viral RNA-dependent, RNA
polymerase
Shows inhibitory activity against MERS-CoV and SARS-CoV-1
Originally trialed in Ebola epidemic
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Remdesivir
�Latest Treatment Updates: Remdesivir
r
�Latest Treatment Updates: Remdesivir
r
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Remdesivir
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Remdesivir
Remdesivir for severe COVID-19 versus a cohort receiving standard of care
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Remdesivir
Lingering Questions:
?
Optimal patient population?
?
Optimal duration of therapy?
?
Effect on meaningful clinical outcomes?
?
Any interaction with corticosteroids?
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Corticosteroids
Background:
• Steroid use in ARDS has been
studied and recently shown
improvement in mortality
• There have been studies in SARSCoV-1, MERS, and influenza which
showed slower clearance of viral
RNA
�Latest Treatment Updates: Corticosteroids
The Recovery Trial
r
�Latest Treatment Updates: Corticosteroids
The Recovery Trial
r
�Latest Treatment Updates: Corticosteroids
The Recovery Trial
r
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Corticosteroids
Steroid WHO Meta-Analysis
• After the RECOVERY trial was published, most studies stopped enrollment early
• WHO REACT working group spoke to all the trial investigators for the steroid
trials registered; agreed to participate and share data
• Risk of bias in trials was assessed as “low” for 6/7 trials
• Summary odds ratio = 0.66 (95% CI, 0.53-0.82, p<0.001) for all-cause mortality
• Excluding RECOVERY trial, OR = 0.77 (95% CI, 0.56-1.07)
• No increase in adverse events
• Strength = 1703 patients included
• Limitation = RECOVERY trial provided 57% of the data
�Latest Treatment Updates: Corticosteroids
From: Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill
Patients With COVID-19: A Meta-analysis
JAMA. Published online September 02, 2020. doi:10.1001/jama.2020.17023
r
https://jamanetwork.com/journals/jama/fullarticle/2770279
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Corticosteroids
Steroids in COVID-19
CoDEX trial
•
•
•
•
Studied in LMIC, mortality rate was much higher than in RECOVERY trial
Patients not on many other treatments due to lack of availability
35% of standard care group received steroids
Trial was underpowered for mortality
REMAP-CAP trial
• Adaptive, point-of-care trial
• Fixed dose versus shock dependent steroid treatment
• 15% of standard care received steroids
CAPE COVID trial
• Double-blinded trial
• Excluded septic shock patients
• Trial underpowered - only 50% of target were enrolled
�Latest Treatment Updates: Corticosteroids
From: Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill
Patients With COVID-19: A Meta-analysis
JAMA. Published online September 02, 2020. doi:10.1001/jama.2020.17023
r
Figure Legend:
Association Between Corticosteroids and 28-Day All-Cause Mortality in Each Trial, Overall, and According to Corticosteroid DrugThe area of the data marker for each trial is proportional to its weight in the fixed-effect meta-analysis. The Randomized Evaluation of COVID-19
Therapy (RECOVERY) trial result is for patients who were receiving invasive mechanical ventilation at randomization. CAPE COVID indicates Community-Acquired Pneumonia: Evaluation of Corticosteroids in Coronavirus Disease; CoDEX, COVID-19 Dexamethasone; COVID
STEROID, Hydrocortisone for COVID-19 and Severe Hypoxia; DEXA-COVID 19, Efficacy of Dexamethasone Treatment for Patients With ARDS Caused by COVID-19; REMAP-CAP, Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia;
Steroids-SARI, Glucocorticoid Therapy for COVID-19 Critically Ill Patients With Severe Acute Respiratory Failure.
aThe random-effects analysis estimates both the average and variability of effects across studies. The 95% CI for the average effect (shown here) is wide because there is a small number of studies, some of which have very small sample size. The prespecified primary analysis
was the fixed-effect analysis, which should be used to guide clinical interpretation of the results.
https://jamanetwork.com/journals/jama/fullarticle/2770279
�Latest Treatment Updates: Corticosteroids
From: Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill
Patients With COVID-19: A Meta-analysis
JAMA. Published online September 02, 2020. doi:10.1001/jama.2020.17023
r
Figure Legend:
Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups Defined by Patient Characteristics at the Time of Randomization. The area of the data markers is proportional to
their weight in the meta-analysis. The estimated odds ratios were derived using fixed-effect meta-analyses across all trials for which data on the specified subgroup were available. The results for patients
in the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial who required oxygen with or without noninvasive ventilation but were not receiving invasive mechanical ventilation at randomization
is shown in a light blue box because these data were not otherwise included in this prospective meta-analysis.
https://jamanetwork.com/journals/jama/fullarticle/2770279
�Latest Treatment Updates: Corticosteroids
WHO Recommendations
Recommendation #1
We recommend systemic corticosteroids
rather than no systemic corticosteroids for
the treatment of patients with severe and
critical COVID-19 (strong recommendation,
based on moderate certainty evidence).
Recommendation #2
We suggest not to use corticosteroids in
the treatment of patients with non-severe
COVID-19 (conditional recommendation,
based on low certainty evidence).
r
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Corticosteroids
Lingering Questions
?
?
?
?
?
?
Optimal dose of corticosteroid?
Optimal durations of corticosteroid?
When to start treatment with corticosteroid?
• What are the effects of corticosteroids on non-severe disease?
What is the long-term effect of corticosteroids on mortality and
functional outcomes?
Can corticosteroids be used in under-represented populations?
How do corticosteroids interact with other COVID-19 treatments?
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Convalescent Plasma
FDA Emergency Use Authorization enacted August 23rd, 2020
• Decision made based on historical evidence, in addition to new publications by
Mayo Clinic
• Reiterated that RCTs need to be done to truly evaluate its benefit
• Should not amend current ongoing RCTs due to the EUA announcement
• Units must be tested for antibody titer levels
• Use of high titer is recommended
• Low titer is at discretion of physician in specific patients
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Convalescent Plasma
Historical evidence:
• Systematic review of convalescent plasma in SARS-CoV-1 and severe
influenza showed a trend towards reduction in mortality
• Studies were of low quality, lacked control groups, were at risk of bias
• In MERS, some small studies were done, but very few plasma samples
had high enough levels of neutralizing antibodies
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Convalescent Plasma
The COVID-19 Evidence:
2 RCTs
• Liu et al. in Wuhan, China
• Gharbharan et al. in the Netherlands
3 Controlled trials
• 2 in the Middle East
• 1 in China
4 Retrospective matched cohort studies
Several small case series
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Convalescent Plasma
Mayo Clinic EAP
• Primary goal = provide access to convalescent plasma
• Secondary goal = demonstrate safety of convalescent plasma
• Population: 35,322 patients
• 52.3% in ICU, 27.5% receiving mechanical ventilation
• Findings
• Low overall rate of adverse events
• Efficacy assessment was based on dose-response relationship between antibody titers and clinical
outcomes
• 21% reduction in 7-day mortality (14% to 11%) in non-intubated patients treated with high titer
plasma versus low titer plasma
• In patients <80 years old, not intubated, given plasma within 72 hours of diagnosis, there was a
reduction in 7-day mortality from 11.3% to 6.3% with high titer plasma versus low titer plasma
• For adjusted 7-day and 30-day mortality, transfusion within 3 days and high antibody levels was
associated with reduced mortality
�COVID-19 Current State of the Pandemic
Latest Treatment Updates: Convalescent Plasma
Mayo Clinic EAP
https://www.fda.gov/news-events/press-announcements/fda-issues-emergency-useauthorization-convalescent-plasma-potential-promising-covid-19-treatment
Figure 2. Seven day (A, B) and 30-day (C, D) adjusted mortality stratified by antibody
520 groupings in patients transfused with COVID-19 convalescent plasma
�Latest Treatment Updates: Convalescent Plasma
Table 2.
Patients’ Clinical Status at Randomization and Medications Received
a
The values shown were based on total number of patients who contributed values. Details of medications used were provided in eTable 7 in Supplement 3.
r
�Latest Treatment Updates: Convalescent Plasma
Table 3. Primary and Secondary Clinical Outcomes at Day 28a
Convalescent
plasma group
(n = 52)
Control group
(n = 51)
Absolute
Effect estimate
difference
(95%
(95% CI)
b
CI)
P value
Primary clinical
outcome
Indeterminate
(18.00Indeterminate)
−2.15 (−5.28 to
0.99)
HR, 1.40 (0.792.49)
Control group
(n = 51)
Absolute
difference (95%
b
CI)
Effect estimate
(95% CI)
P value
Discharge rate at 26/51 (51.0)
28 d, No./total (%)
18/50 (36.0)
15.0% (−4.1% to
34.1%)
OR, 1.85 (0.834.10)
.13
Time from
28.00 (13.00randomization to Indeterminate)
discharge, median
d
(IQR), d
Indeterminate
(19.00Indeterminate)
−2.43 (−5.56 to
0.69)
HR, 1.61 (0.882.95)
.12
Time from
41.00 (31.00hospitalization to Indeterminate)
discharge, median
d
(IQR),d
53.00 (35.00Indeterminate)
−11.95 (−26.33 to HR, 1.68 (0.922.43)
3.08)
.09
Mortality at 28 d, 8/51 (15.7)
No./total (%)
12/50 (24.0)
−8.3% (−23.8% to OR, 0.59 (0.227.2%)
1.59)
.30
Time from
Indeterminate
randomization to
death, median
d
(IQR), d
Indeterminate
(26.00Indeterminate)
0.52 (−2.10 to
3.14)
HR, 0.74 (0.301.82)
.52
29.7% (11.7% to
47.7%)
35.6% (15.9% to
55.3%)
49.7% (32.0% to
67.5%)
OR, 4.58 (1.6212.96)
OR, 4.43 (1.8010.92)
OR, 11.39 (3.9133.18)
.003
Secondary clinical
outcomes
All patients
Time to clinical 28.00 (13.00improvement, Indeterminate)
d
median (IQR),d
Convalescent
plasma group
(n = 52)
c
.26
Clinical
improvement
rate, No./total
e
(%)
r
At day 7
5/52 (9.6)
5/51 (9.8)
−0.2% (−11.6% to OR, 0.98 (0.2711.2%)
3.61)
.97
At day 14
17/52 (32.7)
9/51 (17.6)
15.0% (−1.4% to OR, 2.27 (0.9031.5%)
5.71)
.08
At day 28
27/52 (51.9)
22/51 (43.1)
8.8% (−10.4% to OR, 1.42 (0.6528.0%)
3.09)
.37
Critical and severe disease outcomes can be found here:
URL will go here
Viral nucleic acid
negative rate,
No./total (%)
At 24 h
21/47 (44.7)
6/40 (15.0)
At 48 h
32/47 (68.1)
13/40 (32.5)
At 72 h
41/47 (87.2)
15/40 (37.5)
<.001
<.001
c
�Latest Treatment Updates: Convalescent Plasma
Figure 2.
Time to Clinical Improvement in Patients With COVID-19
The cumulative improvement rate is the percentage of patients who experienced a 2-point improvement or were discharged alive from the hospital. Ticks on the curves indicate
censored events. All patients who did not reach clinical improvement were observed for the full 28-day period or until death. COVID-19 indicates coronavirus disease 2019.
The median (IQR) follow-up times for the convalescent plasma group and control group, respectively, were 15 (10-28) days and 24 (13-28) days overall; 13 (10-16) and 18.5 (11-26)
days among those with severe COVID-19; and 28 (12-28) and 26 (15-28) days among those with life-threatening COVID-19.
r
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270883/
�Latest Treatment Updates: Convalescent Plasma
r
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Trish Tennill, RN, BSN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
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Title
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Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
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Friday, September 25, 2020 | 1:00 PM EST
Event Type
Webinar, register at link below
URL
https://youtu.be/_nnoNOou_Nw
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="State of the Pandemic webinar" src="https://www.youtube.com/embed/_nnoNOou_Nw?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-csotp" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-csotp</a>
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NETEC COVID-19 Webinar Series (9/25/20)/Online Course: COVID-19: Current State of the Pandemic
Subject
The topic of the resource
General
Description
An account of the resource
In this webinar, we will describe the current pandemic hotspots in the US and globally, including the epidemiology of the current wave of infections. We will also discuss country-wide testing needs to mitigate and suppress COVID-19 infections, review the evidence regarding possible re-infections of COVID-19, and interpret the data behind the newest therapeutic guidelines for COVID-19.<br /><br />Webinar slides attached.<br /><br />
<h2>Get educational credit for this webinar "COVID-19: Current State of the Pandemic" through <a href="https://courses.netec.org/courses/20-web-csotp" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
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NETEC
Date
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2020-09-25
Type
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Webinar and Online Course
Contributor
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2024-03-27 R-Lead – never reviewed – make due in 6 months
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Emergency Management
Epidemic
Online Course
Pandemic
R-Lead
Webinar
-
Dublin Core
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Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Guilamo-Ramos, Vincent, Marco Thimm-Kaiser, Adam Benzekri, Andrew Hidalgo, Yzette Lanier, Sheila Tlou, María de Lourdes Rosas López, Asha B. Soletti, and Holly Hagan. 2021. "Nurses at the frontline of public health emergency preparedness and response: lessons learned from the HIV/AIDS pandemic and emerging infectious disease outbreaks." The Lancet Infectious Diseases.
Abstract
The years 2020–21, designated by WHO as the International Year of the Nurse and Midwife, are characterised by unprecedented global efforts to contain and mitigate the COVID-19 pandemic. Lessons learned from successful pandemic response efforts in the past and present have implications for future efforts to leverage the global health-care workforce in response to outbreaks of emerging infectious diseases such as COVID-19. Given its scale, reach, and effectiveness, the response to the HIV/AIDS pandemic provides one such valuable example, particularly with respect to the pivotal, although largely overlooked, contributions of nurses and midwives. This Personal View argues that impressive achievements in the global fight against HIV/AIDS would not have been attained without the contributions of nurses. We discuss how these contributions uniquely position nurses to improve the scale, reach, and effectiveness of response efforts to emerging infectious diseases with pandemic potential; provide examples from the responses to COVID-19, Zika virus disease, and Ebola virus disease; and discuss implications for current and future efforts to strengthen pandemic preparedness and response.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site and PubMed Central.
URL
https://pubmed.ncbi.nlm.nih.gov/37805603/
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30983-X/fulltext
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Nurses at the frontline of public health emergency preparedness and response: lessons learned from the HIV/AIDS pandemic and emerging infectious disease outbreaks
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
The years 2020–21, designated by WHO as the International Year of the Nurse and Midwife, are characterised by unprecedented global efforts to contain and mitigate the COVID-19 pandemic.
Creator
An entity primarily responsible for making the resource
Guilamo-Ramos, Vincent, Marco Thimm-Kaiser, Adam Benzekri, Andrew Hidalgo, Yzette Lanier, Sheila Tlou, María de Lourdes Rosas López, Asha B. Soletti, and Holly Hagan.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-03-18
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-07-14
2019-nCoV
Coronavirus
COVID-19
Ebola
Emergency Management
Epidemic
Example
Outbreaks
Pandemic
R-EM
R-PM
R-Res&Pub
Staff Rotation Schedules
Staffing
Staffing Model
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
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Citation information for the publication itself.
Dawood, Fatimah S., Philip Ricks, Gibril J. Njie, Michael Daugherty, William Davis, James A. Fuller, Alison Winstead, Margaret McCarron, Lia C. Scott, Diana Chen, Amy E. Blain, Ron Moolenaar, Chaoyang Li, Adebola Popoola, Cynthia Jones, Puneet Anantharam, Natalie Olson, Barbara J. Marston, and Sarah D. Bennett. 2020. "Observations of the global epidemiology of COVID-19 from the prepandemic period using web-based surveillance: a cross-sectional analysis." The Lancet Infectious Diseases.
Abstract
<div class="section-paragraph">
<div class="section-paragraph"><strong>Background</strong></div>
<div class="section-paragraph">Scant data are available about global patterns of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread and global epidemiology of early confirmed cases of COVID-19 outside mainland China. We describe the global spread of SARS-CoV-2 and characteristics of COVID-19 cases and clusters before the characterisation of COVID-19 as a pandemic.</div>
<h3>Methods</h3>
<div class="section-paragraph">Cases of COVID-19 reported between Dec 31, 2019, and March 10, 2020 (ie, the prepandemic period), were identified daily from official websites, press releases, press conference transcripts, and social media feeds of national ministries of health or other government agencies. Case characteristics, travel history, and exposures to other cases were abstracted. Countries with at least one case were classified as affected. Early cases were defined as those among the first 100 cases reported from each country. Later cases were defined as those after the first 100 cases. We analysed reported travel to affected countries among the first case reported from each country outside mainland China, demographic and exposure characteristics among cases with age or sex information, and cluster frequencies and sizes by transmission settings.</div>
<h3>Findings</h3>
<div class="section-paragraph">Among the first case reported from each of 99 affected countries outside of mainland China, 75 (76%) had recent travel to affected countries; 60 (61%) had travelled to China, Italy, or Iran. Among 1200 cases with age or sex information, 874 (73%) were early cases. Among 762 early cases with age information, the median age was 51 years (IQR 35–63); 25 (3%) of 762 early cases occurred in children younger than 18 years. Overall, 21 (2%) of 1200 cases were in health-care workers and none were in pregnant women. 101 clusters were identified, of which the most commonly identified transmission setting was households (76 [75%]; mean 2·6 cases per cluster [range 2–7]), followed by non-health-care occupational settings (14 [14%]; mean 4·3 cases per cluster [2–14]), and community gatherings (11 [11%]; mean 14·2 cases per cluster [4–36]).</div>
<h3>Interpretation</h3>
<div class="section-paragraph">Cases with travel links to China, Italy, or Iran accounted for almost two-thirds of the first reported COVID-19 cases from affected countries. Among cases with age information available, most were among adults aged 18 years and older. Although there were many clusters of household transmission among early cases, clusters in occupational or community settings tended to be larger, supporting a possible role for physical distancing to slow the progression of SARS-CoV-2 spread.</div>
<h3>Funding</h3>
<div class="section-paragraph">None.</div>
</div>
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Observations of the global epidemiology of COVID-19 from the prepandemic period using web-based surveillance: a cross-sectional analysis
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Scant data are available about global patterns of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread and global epidemiology of early confirmed cases of COVID-19 outside mainland China. We describe the global spread of SARS-CoV-2 and characteristics of COVID-19 cases and clusters before the characterisation of COVID-19 as a pandemic.
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Dawood, Fatimah S., Philip Ricks, Gibril J. Njie, Michael Daugherty, William Davis, James A. Fuller, Alison Winstead, Margaret McCarron, Lia C. Scott, Diana Chen, Amy E. Blain, Ron Moolenaar, Chaoyang Li, Adebola Popoola, Cynthia Jones, Puneet Anantharam, Natalie Olson, Barbara J. Marston, and Sarah D. Bennett.
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2020-07-29
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2019-nCoV
Coronavirus
COVID-19
Epidemic
Epidemiology
Pandemic
R-Res&Pub
SARS-CoV-2
-
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Online Audiocasts From the SHEA/CDC ORTP (Society for Healthcare Epidemiology of America/Centers for Disease Control and Prevention Outbreak Response Training Program) Regional Training Workshop
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These audiocasts, recorded at the SHEA/CDC ORTP Regional Training Workshop, discuss successes and failures of past infectious disease outbreaks and offer insights into the key steps involved in preparing your facility for the next high-consequence pathogen infection, communicating during hospital crises, defining leadership roles during responses, and identifying actions that can and should be taken to care for patients, staff, and public.
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Centers for Disease Control and Prevention
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2023-10-18
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2022-01-31 by Joanna Mundy and Shelly Schwedhelm (url updated)
2023-02-01 by Joanna Mundy waiting for re-review until I receive first reviews from T&E.
2023-10-17 by Darrell, T&E group.
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2024-10-17
Behavioral Health
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Clinical Care Guidelines
Communications
CONOPS
Diagnosis
Ebola
Emergency Management
Epidemic
Exercises and Drills
MERS-CoV
Person Under Investigation (PUI)
Preparedness
Public Health
R-T&E
Special Pathogens
Therapeutics
Training
Treatment and Care
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/6ce5f8dfdde6a4d11f15346146283e0b.png
f94e53b328532bd376ec8ebfaa7c7ad4
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Predicting the Effects of the COVID Pandemic On US Health System Capacity
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Emergency Management
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<h3>Predicting the Effects of the COVID-19 Pandemic On US Health System Capacity</h3>
<p><i><span style="font-weight:400;">Qventus works with leading health systems across the country to improve operations and drive more efficient patient flow. Over recent weeks, they have been helping their partners with COVID-19 planning and preparation, including adapting the </span></i><i><span style="font-weight:400;">CDC Flu Surge</span></i><i><span style="font-weight:400;"> model to COVID-19 and running it for key metropolitan areas and all states. </span></i></p>
<p><i><span style="font-weight:400;">They’re sharing the information at the link with the hope that health systems find it informative as they plan for the impact of COVID-19. This analysis is preliminary, and they will continue to refine it as they get more information.</span></i></p>
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Qventus
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2020-03-13
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2024-03-27 Emergency Management skipped in review – bump to next quarter
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2024-07-27
2019-nCoV
Coronavirus
COVID-19
Emergency Management
Epidemic
Pandemic
R-EM
-
https://repository.netecweb.org/files/original/f49f01cc54c5c9d2e5a0de305a902d74.pdf
105a922fad9575f2cd808b5e624ba62e
PDF Text
Text
PREGNANT WOMEN &
VACCINES AGAINST
EMERGING EPIDEMIC
THREATS
Ethics Guidance for
Preparedness, Research,
and Response
The PREVENT
Working Group
�Johns Hopkins Berman Institute of Bioethics
The Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies
(PREVENT) Project
This work is a product of The PREVENT Working Group. PREVENT is a grant-funded
project led by faculty at Johns Hopkins University alongside co-investigators at
Georgetown University and the University of North Carolina at Chapel Hill, with
external contributions from Working Group Members.
The PREVENT Project is funded by the Wellcome Trust (203160/Z/16/Z).
The recommendations, interpretations, and conclusions expressed in this work
do not necessarily reflect the views of the institutions with which Working Group
members are affiliated.
Suggested citation:
The PREVENT Working Group. Pregnant Women & Vaccines Against Emerging
Epidemic Threats: Ethics Guidance for Preparedness, Research, and Response.
Baltimore, MD: September 2018.
* Corresponding Author: Carleigh B. Krubiner (ckrubiner@cgdev.org)
Available at: vax.pregnancyethics.org
RIGHTS AND PERMISSIONS
The material in this work is subject to copyright with a Creative Commons
Attribution-Non-Commercial-NoDerivs 3.0 IGO (CC BY-NC-ND 3.0 IGO) license.
Because the PREVENT Project encourages dissemination of its knowledge, this
work may be reproduced, in whole or in part, for non-commercial purposes as long
as full attribution to this work is given and changes are indicated. If you remix,
transform, or build upon the material, you must distribute your contributions under
the same license as the original.
�EXECUTIVE SUMMARY
Recent epidemics, including Zika virus, Lassa
Fever, Ebola, and H1N1 influenza, have
highlighted the ways in which infectious disease
outbreaks can severely—and at times uniquely—
affect the health interests of pregnant women
and their offspring.i For some pathogens,
pregnant women are at significantly higher
risk of serious disease and death. Infection
in pregnancy can also result in pregnancy
loss or severe congenital harms. Even if the
disease caused by the pathogen is no worse in
pregnancy, the harms of infection in pregnant
women can potentially affect two lives.
These serious and often disproportionate risks
underscore the critical need to proactively
consider the interests of pregnant women and
their offspring in efforts to combat epidemic
threats. This is especially true for vaccines,
essential tools in the public health response to
infectious diseases. Despite increasing support
of maternal immunization strategies and
efforts to develop certain vaccines specifically
targeted to pregnant women, the vast majority
of new vaccine products are rarely designed
with pregnant women in mind. Moreover,
widespread failure to appropriately include
pregnant women in vaccine research means
that evidence about safety and efficacy in
pregnancy has been limited and late in coming.
As a result, in numerous outbreaks and
epidemics, pregnant women have been denied
opportunities to receive vaccines that would
have protected them and their offspring from
the ravages of these diseases.
This way of treating pregnant women in
vaccine research and deployment is
not acceptable. Business as usual can
no longer continue.
To ensure that the needs of pregnant women
and their offspring are fairly addressed, new
approaches to public health preparedness,
vaccine research and development (R&D),
and vaccine delivery are required. This
Guidance provides a roadmap for the ethically
responsible, socially just, and respectful
inclusion of the interests of pregnant women in
the development and deployment of vaccines
against emerging pathogens. The Guidance is
a product of the Pregnancy Research Ethics for
Vaccines, Epidemics, and New Technologies
(PREVENT) Working Group—a multidisciplinary,
international team of 17 experts specializing in
bioethics, maternal immunization, maternal-fetal
medicine, obstetrics, pediatrics, philosophy,
public health, and vaccine research and policy—
in consultation with a variety of external experts
and stakeholders.
We recognize the recommendations contained
in this Guidance will not always be easy to
follow. For some, it will require a new way of
thinking about pregnant women and vaccines.
For many, it will require a commitment of
will and of financial resources. Addressing
inequities in biomedical research and public
health rarely comes cheaply or without hard
work. In terms of the lives saved and the
suffering averted, the resources and the effort
needed to ensure that pregnant women and
their offspring are treated fairly will be more
than worth it.
i We use the term “women” throughout this document, and while we appreciate that individuals who do not identify as women can
still become pregnant, transgender and gender non-conforming individuals face different (though also substantial and problematic)
barriers to participating in clinical research and having their health needs met that lie beyond the scope of this work. We use the term
“offspring” throughout this report to broadly refer to fetuses as well as any persons born whose interests may be affected by in utero
exposures to pathogens or vaccine administrations.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 1
�VISION
The guidance aims to realize a world in which:
Pregnant women
are not unjustifiably
excluded from participating
in vaccine studies.
Pregnant women and their
offspring benefit from advances in
vaccine technologies and are
not left behind as new vaccine
products are developed.
Pregnant women
have access to safe and effective
vaccines to protect them and their
offspring against emerging
and re-emerging pathogenic
threats.
2 | Executive Summary
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�RECOMMENDATIONS
PUBLIC HEALTH EMERGENCY PREPAREDNESS
RECOMMENDATION 1
Health information systems and infectious
disease surveillance systems should be
strengthened and integrated to ensure
that data relevant to maternal, obstetric,
and newborn health outcomes can inform
scientific and public health responses to
emerging pathogenic threats.
RECOMMENDATION 2
Evidence-based strategies to promote
confidence about vaccination in pregnancy
should be developed and implemented
ahead of outbreaks, including stakeholder
engagement with health care providers,
women, their families, and their
communities.
. DIRECTED TO: public health authorities; the
World Health Organization (WHO) and regional
health organizations; developers and users of
routine health information and global health
security systems, including organizations with a
focus on maternal and child health outcomes;
organizations developing innovative approaches
to data collection and surveillance; funders and
sponsors of maternal health studies and global
health surveillance
. DIRECTED TO: public health authorities; health
care providers; professional medical associations;
medical and health training programs; community
leaders; civil society organizations and vaccine
advocacy groups; research institutes; funders and
sponsors; the media
Routine health information systems and
infectious disease surveillance systems are
both essential to an appropriate and rapid
response to emerging pathogenic threats.
Collecting baseline data on maternal,
obstetric, and newborn health can advance
the interests of pregnant women and their
offspring by enabling detection of increases in
adverse events that may signal the presence
of infectious disease threats. These baseline
rates are also needed to help interpret whether
adverse events surrounding pregnancy have
any causal link to vaccination. Infectious
disease surveillance systems should routinely
include pregnancy status and maternal,
obstetric, and newborn outcomes in case
reports. These data, when integrated with
baseline rates from health information systems,
can help determine whether a circulating
pathogen causes additional or more severe
harms in pregnancy.
For immunization programs to be successful,
it is critical that populations have confidence
in the benefits of a vaccine and its safety, and
in the health benefits of vaccination more
broadly. Inadequate confidence in vaccines can
be especially pronounced among pregnant
women and those who care for them. Evidence
about safety in pregnancy is limited because
of the historic absence of vaccine trials in
pregnant women. Moreover, pregnant women
and health care providers are understandably
concerned about fetal harm, and they are
frequently bombarded with mixed messages
about what may or may not be harmful in
pregnancy. Working now to better understand
and address the various sources and drivers of
vaccine confidence among pregnant women
and their communities will be critical to ensure
appropriate vaccine uptake by pregnant
women during outbreaks and epidemics.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 3
�RECOMMENDATION 3
Communication plans should be developed
for clear, balanced, and contextualized
dissemination of vaccine study findings,
recommendations for vaccine use in
pregnancy, and any pregnancy-specific
adverse events.
.
DIRECTED TO: clinical investigators; scientific
journal editors; funders and sponsors; public health
authorities; global, regional, and local vaccine
advisory groups; professional medical associations;
regulatory authorities; civil society organizations
and vaccine advocacy groups; the media
Because pregnant women, health providers,
and the public often overestimate potential
fetal harms associated with medications
and biologics, effective communication in
vaccine development and delivery is critical. In
research studies, the required timely reporting
of clinically relevant signals and findings on
vaccine safety and efficacy in pregnancy to
regulatory authorities is not enough. Effective
communication to the public and to clinicians
through a variety of channels, including
traditional and social media, is essential. In
an epidemic response that recommends
vaccination in pregnancy, communication
plans must be clear about any known risks to
pregnant women and their offspring, and why
the anticipated benefits of vaccination outweigh
these risks. When immunization in pregnancy is
not recommended, communication plans should
be sensitive to fears and concerns about the
pathogenic threat that pregnant women share
with the rest of the population, and provide
them with information about what alternatives,
if any, are available to them. In both research
and epidemic responses, one best practice for
communicating reports of adverse pregnancy
or birth outcomes is to present the findings
alongside the best available information about
the baseline rates of these adverse events, and
to acknowledge that many of them have no
known cause.
4 | Executive Summary
RECOMMENDATION 4
Research efforts that aim to advance vaccine
development by using new technologies
to study human immune system function
and response should include investigations
specific to pregnant women and their
offspring.
. DIRECTED TO: clinical investigators; basic
research scientists; funders
Because pregnancy can alter immune
response and because both maternal and
fetal immune responses may change over the
course of gestation, it is important that these
foundational studies examine the distinctive
characteristics of maternal and fetal immune
systems. Understanding these differences
could critically inform the development and
identification of new vaccines that are safe and
effective in pregnancy.
RECOMMENDATION 5
Mechanisms for incentivizing vaccine
development for emerging and re-emerging
infections and mitigating existing
disincentives should include and address
pregnancy-specific concerns of vaccine
developers.
. DIRECTED TO: policymakers; regulatory
authorities; funders and sponsors; vaccine
developers; civil society organizations and
those who are positioned to influence vaccine
research, adoption, and delivery, including WHO,
the World Economic Forum, and the Coalition
for Epidemic Preparedness Innovations (CEPI)
Vaccine developers and manufacturers face
significant market challenges and uncertainties
in pursuing products targeting emerging and
re-emerging pathogens. These challenges
can become even more complicated when
vaccine products are studied in and ultimately
offered to pregnant women—for whom
there may be heightened concerns of legal
and financial liability. Current mechanisms
in place to encourage development of
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�beneficial biomedical products and protect
developers and manufacturers against liability
concerns—as well as new incentive programs
being explored for vaccines against epidemic
threats—need to be intentionally inclusive of
the needs and interests of pregnant women.
RECOMMENDATION 6
To help ensure systematic and enduring
change in the treatment of pregnant women
in global vaccine policy and practices, the
World Health Organization should convene
a consultation of relevant stakeholders and
experts. The Consultation should identify
specific strategies to establish for pregnant
women the presumption of inclusion in both
vaccine research and deployment, including
whether a dedicated, standing expert group
is needed.
Throughout this Guidance we make multiple
recommendations to help ensure that pregnant
women and their offspring can fairly benefit
from the protection that vaccines offer
against emerging epidemic threats. These
recommendations outline specific actions that
need to be taken, but institutional change
at every level—globally, regionally, and
nationally—will be required to operationalize
these new approaches and move advisory
and decision-making bodies toward the
new default of presumptive inclusion of
pregnant women. To seed this institutional
change and explore specific strategies for the
Institutional change
at every level will be
required to establish
a new default of
presumptive inclusion
of pregnant women.
The Presumptive Inclusion of
Pregnant Women
“Presumption of inclusion” does not
entail the automatic or absolute inclusion
of pregnant women in every vaccine
study or every vaccine campaign. Instead,
a presumption of inclusion changes
the default position. It normalizes the
position that pregnant women are
to be included in vaccine deployment
programs and vaccine R&D. With
inclusion of pregnant women as the
default position, the burden of proof,
both scientific and ethical, falls on those
who want to argue for their exclusion.
There will certainly be cases where the
exclusion of pregnant women from
a particular vaccine trial or vaccine
campaign will be justified, but starting
from a presumption of inclusion helps
instantiate and maintain a fundamental
shift in the way pregnancy and pregnant
women are viewed in the field of
vaccines.
systematic consideration of pregnant women in
international policies and practices governing
vaccine research and delivery, WHO should
convene a multi-day, global Consultation of
relevant stakeholders. The Consultation should
provide a critical opportunity to discuss and
determine the best strategies to systematically
integrate consideration of the interests
of pregnant women and their offspring
throughout all relevant WHO-supported
activities, including whether a dedicated,
standing group of relevant and diverse experts
is needed. The Consultation should also
consider ways to support regional and national
public health authorities who may wish to
establish similar expert groups.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 5
�VACCINE RESEARCH & DEVELOPMENT
RECOMMENDATION 7
Suitability for use in pregnancy should be
a strong consideration in development and
investment decisions for vaccines against
emerging pathogenic threats.
. DIRECTED TO: CEPI, U.S. Biomedical Advanced
Research and Development Authority (BARDA),
and other funders and sponsors; WHO emergency
response teams, R&D Blueprint teams and
TPP Working Groups; vaccine developers
If pregnant women, and the offspring they
carry, are among those threatened by an
emerging pathogen, then suitability for use
during pregnancy should be an important
vaccine development priority. Organizations
investing in the vaccine pipeline against
emerging pathogenic threats should try to
ensure that, among candidates prioritized for
development, at least some use platforms
and adjuvants that would make them suitable
for use in pregnancy. Early investment in
options that are most likely to be acceptable
in pregnancy can pave the way for pregnant
women and their offspring to realize benefits
from vaccine candidates that ultimately prove
successful—and help ensure that they, like
other population groups, will be protected
against emerging infectious diseases. For
pathogens that pose significantly greater
threats in pregnancy—of fetal harm, maternal
harm, or both—funding calls should designate
greater investment priority to candidates
likely to be suitable for use in pregnancy.
When pregnant women or their offspring are
at higher risk of harm, it would be particularly
unjust for their needs not to be included in
vaccine development priorities.
6 | Executive Summary
RECOMMENDATION 8
When pathogens pose a risk of severe harm
to pregnant women or their offspring and
the most promising vaccine candidates are
likely to be contraindicated for routine use
in pregnancy, investments should be made in
alternative vaccine candidates that could be
more readily used in pregnancy.
. DIRECTED TO: CEPI, BARDA, and other
funders; vaccine developers
It is possible that the vaccine candidates
that move most rapidly through the R&D
pipeline are found to be problematic for use
in pregnancy. Unless other vaccines with more
favorable profiles for use in pregnancy are
then prioritized, it is possible that pregnant
women and their offspring will end up without
any vaccine protection against the emerging
pathogenic threat. This prospect is particularly
dire when the target pathogen has more
severe consequences in pregnancy. When
pregnant women and their offspring suffer
disproportionately compared with other
population groups from an emerging infectious
disease threat, justice calls for the vaccine
enterprise to make every reasonable effort to
bring to market a safe and effective product
that pregnant women can use.
Pregnant women
need to be on the
agenda when decisions
about investment and
funding are made.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�RECOMMENDATION 9
Non-clinical studies that are a prerequisite
for clinical trials in pregnant women, such as
developmental toxicology studies, should be
initiated early in the clinical development of
promising vaccine candidates, before efficacy
trials are planned.
. DIRECTED TO: CEPI, BARDA, and other
funders and sponsors; vaccine developers;
national regulatory authorities
Current regulatory guidance often requires
that certain non-clinical studies must be
completed prior to including pregnant women
in clinical trials. Because pregnant women
should be able to participate in large-scale
efficacy studies conducted during outbreaks
whenever the benefits outweigh the risks
(see Recommendation 11), any non-clinical
studies required prior to clinical evaluation
in pregnant women should be conducted as
soon as promising vaccine candidates move
from phase 1 to phase 2 clinical trials.
RECOMMENDATION 10
Studies to assess immune responses to
vaccines in pregnancy should be conducted
before or between outbreaks whenever
scientifically possible and ethically and
legally acceptable.
. DIRECTED TO: CEPI, BARDA, and other
funders and sponsors; vaccine developers;
clinical investigators
Although much of the work to evaluate vaccines
in pregnancy will be done during outbreaks and
epidemics (see Recommendation 11), there will
be some cases in which it will be both beneficial
and feasible to generate immunogenicity data
in pregnancy before or between outbreaks.
Because immune system functioning is altered
in pregnancy, it is possible that a vaccine will be
less immunogenic or induce atypical immune
responses in pregnant women, with potential
implications for its effectiveness as well as the
dosing and frequency required in pregnancy
to generate sufficient protection. Such
immunogenicity studies would be particularly
valuable if a correlate of protection for the
vaccine has already been established. In the
absence of an outbreak or epidemic, it may be
difficult to demonstrate that studies to assess
immune response in pregnant women have a
favorable risk-benefit profile. However, there
may be instances in which the future exposure
to a pathogen among a particular population
is likely enough to conclude that the potential
benefits of being protected would outweigh
the risks associated with a particular candidate
vaccine.
RECOMMENDATION 11
Clinical development plans for investigational
vaccines against emerging and re-emerging
pathogens should include studies designed
to evaluate vaccines in pregnancy. Pregnant
women should have opportunities to enroll in
vaccine studies conducted during outbreaks
and epidemics whenever the prospect of
benefit outweighs the risks to pregnant
women, their offspring, or both.
. DIRECTED TO: CEPI, BARDA, and other
funders and sponsors; vaccine developers;
clinical investigators and trial implementation
partners; research ethics committees;
national regulatory authorities
This recommendation rests on two claims
of justice about the importance of treating
pregnant women and their offspring fairly in the
conduct of research on vaccines for emerging
and re-emerging infections. The first of these
justice claims pertains to pregnant women as
a class: as a matter of equity, as well as public
health, the evidence base for pregnant women
should be as good as possible and generated as
contemporaneously as possible to the evidence
for the general population. The second,
independent reason motivated by justice is that
pregnant women, as the moral equals of others,
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 7
�should have fair access to the prospect of
direct benefit that may ensue from receiving
an experimental vaccine. For both of these
reasons, it is critical that vaccine research
conducted during outbreaks include
appropriate plans for research with pregnant
women when there is a reasonable judgment
that the prospective benefits of enrollment
outweigh the risks.
RECOMMENDATION 12
Vaccine studies that include women
of childbearing potential should have
plans to systematically collect data on
immunogenicity and pregnancy-specific
indicators of safety from participants who
are unknowingly pregnant at the time
of exposure or become pregnant within
a relevant window following vaccine
administration.
. DIRECTED TO: CEPI, BARDA, and other funders
and sponsors; vaccine developers; clinical
investigators and trial implementation partners;
research ethics committees; national regulatory
authorities
In trials enrolling women of childbearing
potential, including vaccine trials conducted in
outbreak contexts, it is predictable that some
women not known to be pregnant at the time
of enrollment will nevertheless be pregnant at
enrollment, or become pregnant in the course
of the trial. Historically, data from inadvertent
exposures during pregnancy have been a key
source of information regarding the safety
profiles of vaccines in pregnancy. Having a
plan to systematically generate evidence from
participants who are unknowingly pregnant
at the time of administration also enables
capturing data from vaccine exposures earlier
in pregnancy than would be likely in trials
prospectively enrolling pregnant women.
Wherever possible, systematic observational
studies that are designed to capture
inadvertent exposures to vaccine during
pregnancy should also include longitudinal
8 | Executive Summary
evaluation of safety, immunogenicity, and other
relevant outcomes. Data from inadvertent
exposures during pregnancy should be
collected using standardized methods and case
definitions and must be cautiously interpreted,
particularly when adverse events occur in early
pregnancy, as these very commonly occur
unrelated to vaccine exposure.
RECOMMENDATION 13
Women participating in vaccine trials who
become aware of a pregnancy during the
trial should be guaranteed the opportunity,
through a robust re-consent process, to
remain in the trial and complete the vaccine
schedule when the prospect of direct benefit
from completing the schedule can reasonably
be judged to outweigh the incremental risks
of receiving subsequent doses.
. DIRECTED TO: clinical investigators and
trial implementation partners; vaccine developers;
research ethics committees; national regulatory
authorities
In vaccine trials that include prospectively
enrolled pregnant women, participants who
become pregnant after enrollment should
be provided the opportunity to continue to
receive vaccine doses after a renewed consent
process. In trials that exclude pregnant women
from prospective enrollment, determinations
about continued dosing should be based on
assessment of the potential benefits and harms
specific to the circumstances of the pregnant
participant, including possible risks associated
with receiving an incomplete vaccination series
and the risks already incurred from the first
vaccination. In both cases, a robust re-consent
process will be essential to allowing pregnant
women to determine whether they want to
receive additional doses. Regardless of whether
they choose or are permitted to continue with
the vaccine schedule, participants who become
pregnant should be provided all study-related
benefits and ancillary care to which they would
otherwise be entitled.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�RECOMMENDATION 14
When a pregnant woman of legal standing
to consent is judged eligible to enroll or
continue in a vaccine trial, her voluntary and
informed consent should be sufficient to
authorize her participation.
. DIRECTED TO: clinical investigators and trial
implementation partners; research ethics
committees; national authorities in charge of
governance and oversight of human subjects
research
As a matter of respect, and as a key aspect of
ensuring fair access to investigational vaccines,
the consent of pregnant women who are
judged eligible to participate in or continue
receiving doses in a vaccine trial should be
sufficient for participation. Pregnant women
are the moral equals of other self-governing
adults. Further, requiring the consent of
additional actors can present a material
barrier to the benefits research may offer to
the offspring. At the same time, researchers
should support pregnant women who wish to
involve partners, family members, and other
personal supports in decisions to join or remain
in vaccine trials.
RECOMMENDATION 15
Experts in maternal and perinatal health,
pediatrics, and research ethics should be
involved in decisions about funding; trial
design; research ethics oversight; and the
generation, analysis, and evaluation of
evidence on vaccine use in pregnancy.
. DIRECTED TO: funders and sponsors; vaccine
developers; clinical investigators; research ethics
committees; national health authorities in charge
of research governance and regulations; data
safety monitoring boards
Pregnant women deserve that decisions
affecting them will be made in careful,
thoughtful, and evidence-based ways, involving
the most informed experts possible. Experts
in obstetrics and gynecology, maternalfetal medicine, pediatrics, and neonatology,
especially those who have experience with
infectious diseases, immunology, and maternal
immunization, have specialized knowledge
that is critical to properly identifying and
addressing the needs and interests of pregnant
women and their offspring in research and
development.
RECOMMENDATION 16
Whenever possible, the perspectives of
pregnant women should be taken into
account in designing and implementing
vaccine studies in which pregnant women
are enrolled or in which women enrolled may
become pregnant.
. DIRECTED TO: clinical investigators; vaccine
developers; research ethics committees;
community advisory boards; funders and sponsors;
public health authorities
Community engagement and participatorybased approaches to biomedical research
have been increasingly recognized as good
practice in the design and conduct of human
subjects research. In the context of vaccine
studies enrolling pregnant women, soliciting
the perspectives of pregnant women from
the communities in which the research will
be conducted offers a way to demonstrate
respect, and can be critical to the success of
a study. The perspectives of pregnant women
can improve various aspects of study design
by, for example, determining what information
and outcomes are most important to pregnant
women, ascertaining culturally relevant
considerations for the consent process, and
establishing the appropriate frequency and
location of study visits based on the daily
demands on women’s lives throughout
pregnancy and after delivery.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 9
�VACCINE DELIVERY DURING THE EPIDEMIC RESPONSE
RECOMMENDATION 17
Pregnant women should be offered vaccines
as part of an outbreak or epidemic response.
Pregnant women should only be excluded
if a review of available evidence by relevant
experts concludes that the risks to pregnant
women and their offspring from the vaccine
are demonstrably greater than the risks of
not being vaccinated.
. DIRECTED TO: public health authorities;
national immunization programs; recommending
and advisory bodies, including professional
medical associations, SAGE, and other relevant
WHO advisory committees; teams overseeing
the epidemic response, such as Public Health
Emergency Operations Centers and incident
management teams; organizations involved
in vaccine delivery in the outbreak response,
including UNICEF, MSF, and International
Federation of Red Cross
Because pregnant women are the moral equals
of others, and because there is nothing about
being pregnant that would make them or
their offspring less susceptible to the harms
of emerging pathogenic threats, the default
position of advisory bodies and public health
authorities should be that pregnant women
are offered vaccines alongside other affected
populations during an epidemic response.
Any recommendations or decisions not to use
vaccines in pregnancy during an outbreak or
epidemic requires justification of exclusion
based on a reasonable determination that the
risks to pregnant women and their offspring
from vaccination are demonstrably greater
than the likely benefits of being protected
from the pathogen. This determination should
be made by relevant experts, including those
in maternal, perinatal, and pediatric health.
The absence of evidence and the mere
theoretical or even documented risk of fetal
harm is generally not sufficient to justify
10 | Executive Summary
denying pregnant women access to a vaccine
in an outbreak or epidemic. Even when the
risk of fetal harm from the vaccine is significant,
if the likelihood and severity of harms from
the pathogen are high enough for pregnant
women and their offspring, then the benefits of
vaccination may still outweigh the risks.
RECOMMENDATION 18
When there is a limited supply of
vaccine against a pathogenic threat that
disproportionately affects pregnant women,
their offspring, or both, or when only one
vaccine among several is appropriate for use
in pregnancy, then pregnant women should
be among the priority groups to be offered
the vaccine.
. DIRECTED TO: public health authorities; national
immunization programs; teams overseeing
the epidemic response, such as Public Health
Emergency Operations Centers and incident
management teams; WHO; organizations
involved in vaccine delivery as part of the
outbreak response, including UNICEF, MSF, and
International Federation of Red Cross
It is not uncommon in outbreak and epidemic
settings for vaccine demand to exceed supply.
For some pathogenic threats, pregnant women
and their offspring may be among the hardest
hit groups; in these cases, as with any other
high-risk group, they should be a priority
in the allocation of a vaccine that is in short
supply. Additionally, even when the threat is
no worse for pregnant women than it is for
other affected population groups, vaccinating
a pregnant woman protects not only the
pregnant woman but also her offspring.
Particularly for high-consequence pathogens
with significant mortality rates, there may be
considerable additional benefit in vaccinating
pregnant women.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�During an epidemic,
the default should
be to offer vaccines
to pregnant women
alongside other
affected populations.
RECOMMENDATION 19
When vaccines are offered to pregnant
women during outbreaks or epidemics,
prospective observational studies should be
conducted with pregnant women and their
offspring to further advance the evidence
base for use in pregnancy.
. DIRECTED TO: vaccine manufacturers; public
health and regulatory authorities; national
immunization programs; organizations involved in
vaccine delivery as part of the outbreak response,
including UNICEF, MSF, and International
Federation of Red Cross; researchers; funders;
groups that oversee research with human subjects,
including research ethics committees
Implementing prospective observational
studies in pregnant women and their
offspring who receive the vaccine as part of
the outbreak or epidemic response provides
an important opportunity to narrow the
evidence gap between pregnant women and
other population groups. If such studies are
not conducted, decision-makers in future
outbreaks and epidemics will be faced with
the same evidence gap as current decision
makers—an unacceptable outcome from both
an equity and a public health perspective.
Moreover, safety data obtained from
evaluating a vaccine derived using a novel
platform in pregnant women may inform future
decision-making regarding the suitability of
that platform for development of vaccines
against other pathogens.
RECOMMENDATION 20
When vaccines are offered to pregnant
women during outbreaks and epidemics,
the consent of the pregnant woman should
be sufficient to authorize administration
whenever the pregnant woman is of legal
standing to consent to medical care.
. DIRECTED TO: public health authorities; national
immunization programs; teams overseeing
the epidemic response, such as Public Health
Emergency Operations Centers and incident
management teams; organizations involved in
vaccine delivery as part of the outbreak response,
including UNICEF, MSF, and International
Federation of Red Cross; clinicians and
obstetricians; pregnant women and communities
As a matter of respect, and as a key aspect
of ensuring fair access to vaccines during
an outbreak or epidemic, when vaccines
are offered to pregnant women, their
consent should be sufficient to authorize
administration. Women should be presumed
to have authority for decisions about their
own medical care. Women are no different
from men in this respect, and pregnant
women are no different than women who
are not pregnant. All adults, regardless of
gender or pregnancy status, have rights of
self-determination over decisions that affect
their bodies and their health. Pregnant women
who wish to engage or consult with their
partners or other family or friends in making
their decisions about vaccination should be
supported in doing so.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Ensuring that pregnant
women have vaccines to
protect them and their
offspring will require
generation of evidence
from pregnant women.
Executive Summary | 11
�RECOMMENDATION 21
When evidence supports a determination
that the risk of serious maternal or fetal
harm from the vaccine outweighs the
vaccine’s benefits, pregnant women should
be a priority group for access to alternative
preventative or treatment measures.
. DIRECTED TO: public health authorities; teams
overseeing the epidemic response, such as
Public Health Emergency Operations Centers
and incident management teams; organizations
involved in vaccine delivery as part of the
outbreak response, including UNICEF, MSF, and
International Federation of Red Cross; providers
Despite the best possible research and
development efforts, the available vaccine
for a given outbreak or epidemic may have
sufficiently severe pregnancy-specific risks,
even compared with the risks posed by the
pathogen, that it is not made available to
pregnant women. The moral objective remains,
however, of giving pregnant women and
their offspring as close to an equal chance of
avoiding the harms of infection as the rest of
the population. If they cannot be protected
by immunization, then pregnant women,
along with any other population group that
cannot receive the vaccine, should be given
preferential access to alternative preventive
interventions and treatments.
12 | Executive Summary
RECOMMENDATION 22
When vaccines against emerging pathogens
are not recommended for use in pregnancy,
inadvertent vaccine exposures during
pregnancy should be anticipated and
mechanisms put in place for the collection
and analysis of data from pregnant women
and their offspring on relevant indicators and
outcomes.
. DIRECTED TO: public health and regulatory
authorities; vaccine manufacturers; national
immunization programs; funders and sponsors
Even when pregnant women are intentionally
excluded from the vaccine response effort, it is
reasonable to expect that some of the women
who are vaccinated will be unknowingly
pregnant at the time of vaccine administration,
or will become pregnant within a relevant
window of its administration. Collecting data
about outcomes in these women and their
offspring in the midst of an active outbreak
or epidemic will be difficult and costly, but
there are two sets of ethical and public health
reasons why it is critically important to do
so. First, collecting data from unintentional
exposures to vaccine in pregnancy during an
outbreak or epidemic affords an important
opportunity to gather evidence about novel
vaccine technologies and thus to help ensure
that pregnant women are not left behind
as vaccine technology advances. Second,
research and public health communities have
a responsibility to pursue evidence about the
likelihood and nature of any associated risks
pregnant women and their offspring face from
these unintended exposures to inform personal
and clinical decision-making.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�MEMBERS OF THE PREVENT WORKING GROUP
Ruth Faden
Principal Investigator
Johns Hopkins Berman
Institute of Bioethics
Carleigh Krubiner
Co-Principal Investigator
Johns Hopkins Berman
Institute of Bioethics
Ruth Karron
Co-Principal Investigator
Johns Hopkins Bloomberg
School of Public Health
Margaret Little
Co-Investigator
Georgetown University
Kennedy Institute of Ethics
Anne Lyerly
Co-Investigator
University of North Carolina
Center for Bioethics
Jon Abramson
Wake Forest University
School of Medicine
Richard Beigi
Magee-Womens Hospital of
University of Pittsburgh Medical Center
Alejandro Cravioto
Universidad Nacional Autónoma de México
Faculty of Medicine
Anna Durbin
Johns Hopkins Bloomberg
School of Public Health
Bruce Gellin
Sabin Vaccine Institute
Swati Gupta
International AIDS Vaccine Initiative (IAVI)
David C. Kaslow
PATH Essential Medicines
Sonali Kochhar
Global Healthcare Consulting
Florencia Luna
FLACSO-Argentina Bioethics Program
& CONICET
Carla Saenz
Pan American Health Organization
Regional Program on Bioethics
Jeanne Sheffield
Johns Hopkins University
School of Medicine
Paulina Tindana
Navrongo Health
Research Centre
��
Dublin Core
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Title
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Deploy
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
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Citation
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Krubiner, Carleigh B., Ruth R. Faden, Ruth A. Karron, Margaret O. Little, Anne D. Lyerly, Jon S. Abramson, Richard H. Beigi, Alejandro R. Cravioto, Anna P. Durbin, Bruce G. Gellin, Swati B. Gupta, David C. Kaslow, Sonali Kochhar, Florencia Luna, Carla Saenz, Jeanne S. Sheffield, and Paulina O. Tindana. 2019. "Pregnant women & vaccines against emerging epidemic threats: Ethics guidance for preparedness, research, and response." Vaccine.
Abstract
<div class="Abstracts u-font-serif">
<div class="abstract author">
<h2 class="section-title u-h3 u-margin-l-top u-margin-xs-bottom">Abstract</h2>
<div>
<p id="sp0005">Zika virus, influenza, and Ebola have called attention to the ways in which infectious disease outbreaks can severely – and at times uniquely – affect the health interests of pregnant women and their offspring. These examples also highlight the critical need to proactively consider pregnant women and their offspring in vaccine research and response efforts to combat emerging and re-emerging infectious diseases. Historically, pregnant women and their offspring have been largely excluded from research agendas and investment strategies for vaccines against epidemic threats, which in turn can lead to exclusion from future vaccine campaigns amidst outbreaks. This state of affairs is profoundly unjust to pregnant women and their offspring, and deeply problematic from the standpoint of public health. To ensure that the needs of pregnant women and their offspring are fairly addressed, new approaches to public health preparedness, vaccine research and development, and vaccine delivery are required. This Guidance offers 22 concrete recommendations that provide a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance was developed by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group – a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy – in consultation with a variety of external experts and stakeholders.</p>
</div>
</div>
</div>
<div class="Keywords u-font-serif">
<div class="keywords-section">
<h2 class="section-title u-h3 u-margin-l-top u-margin-xs-bottom">Keywords</h2>
<div class="keyword"><span>Epidemics</span></div>
<div class="keyword"><span>Pregnancy</span></div>
<div class="keyword"><span>Emerging infectious diseases</span></div>
<div class="keyword"><span>Maternal immunization</span></div>
<div class="keyword"><span>Public health ethics</span></div>
<div class="keyword"><span>Research ethics</span></div>
<div class="keyword"><span>Vaccines</span></div>
<div class="keyword"><span>Research & development</span></div>
</div>
</div>
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https://www.sciencedirect.com/science/article/pii/S0264410X19300453?via%3Dihub
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https://www.sciencedirect.com/science/article/pii/S0264410X19300453?via%3Dihub
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Pregnant Women and Vaccines Against Emerging Epidemic Threats: Ethics Guidance for Preparedness, Research, and Response
Description
An account of the resource
<div class="sqs-block html-block sqs-block-html">
<div class="sqs-block-content">
<h2 style="white-space:pre-wrap;">PREVENT Guidance</h2>
<p style="white-space:pre-wrap;">This Guidance provides a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance is a product of the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group—a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy— in consultation with a variety of external experts and stakeholders.</p>
<p style="white-space:pre-wrap;">The Guidance begins by setting forth an aspirational vision and makes the case for its moral importance. We then specify 22 concrete recommendations, organized around three key areas: public health preparedness, R&D, and vaccine delivery.</p>
<p style="white-space:pre-wrap;">The recommendations are directed at a range of actors, including global and national policymakers, regional and national regulatory authorities, funders and sponsors, vaccine manufacturers, research institutions, trial networks and research groups, individual researchers, oversight bodies, ethics review committees, community advisory boards, and civil society organizations.</p>
<p style="white-space:pre-wrap;">The Guidance is also now available in Vaccine: <a href="https://doi.org/10.1016/j.vaccine.2019.01.011">https://doi.org/10.1016/j.vaccine.2019.01.011</a></p>
</div>
</div>
Creator
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Johns Hopkins Berman Institute of Bioethics, The Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Project
Source
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Krubiner, Carleigh B., Ruth R. Faden, Ruth A. Karron, Margaret O. Little, Anne D. Lyerly, Jon S. Abramson, Richard H. Beigi, Alejandro R. Cravioto, Anna P. Durbin, Bruce G. Gellin, Swati B. Gupta, David C. Kaslow, Sonali Kochhar, Florencia Luna, Carla Saenz, Jeanne S. Sheffield, and Paulina O. Tindana.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-05-03
Type
The nature or genre of the resource
Publication
Subject
The topic of the resource
Research
Contributor
An entity responsible for making contributions to the resource
2022-11-07 Clayton, Treatment & Care general asset review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-11-07
Epidemic
Ethics
Labor and Delivery
Neonates
Pediatrics
Public Health
R-Res&Pub
R-SP
Research
Treatment and Care
Vaccine Study
-
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Develop
Description
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
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Citation
Citation information for the publication itself.
WHO. 2019. Preliminary results on the efficacy of rVSV-ZEBOV-GP Ebola vaccine using the ring vaccination strategy in the control of an Ebola outbreak in the Democratic Republic of the Congo: an example of integration of research into epidemic response. https://www.who.int/csr/resources/publications/ebola/vaccines/en/
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Free online, copyright WHO.
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https://www.who.int/publications/m/item/preliminary-results-on-the-efficacy-of-rvsv-zebov-gp-ebola-vaccine-using-the-strategy-in-the-control-of-an-ebola-outbreak
Dublin Core
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Preliminary results on the efficacy of rVSV-ZEBOV-GP Ebola vaccine using the ring vaccination strategy in the control of an Ebola outbreak in the Democratic Republic of the Congo: an example of integration of research into epidemic response.
Subject
The topic of the resource
Infection Control
Description
An account of the resource
ABOUT THIS ANALYSIS: DRC’s national research institute, the Institut National pour la Recherche Biomedicale (INRB) and WHO have conducted a preliminary analysis of the data being collected from the ring vaccination protocol. The analysis summarized here includes data between May 1, 2018 and March 25, 2019.This preliminary analysis was completed with the aim to better understand whether or not the rVSV-ZEBOV-GP candidate vaccine is effective and is contributing to prevent cases when delivered using the ring vaccination strategy.A more detailed analysis is being prepared and will be available in a peer-reviewed journal.
Creator
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WHO
Date
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2019-04-12
Type
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Publication
Contributor
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2022-12-07 general asset review - IPC (move to R-T&C)
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2023-12-10
Clinical Trial
Ebola
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Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
Published in final edited form as:
Microbiol Spectr. 2016 June ; 4(3): . doi:10.1128/microbiolspec.EI10-0011-2016.
Preparing for Serious Communicable Diseases in the United
States: What the Ebola Virus Epidemic Has Taught Us
Jay B Varkey, MD [Assistant Professor of Medicine] and
Emory University School of Medicine
Bruce S Ribner, MD, M.P.H. [Professor of Medicine]
Emory University School of Medicine
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INTRODUCTION
The largest and deadliest outbreak of Ebola virus disease began on December 2, 2013 when
a 2 year old child developed an illness characterized by fever, black stools, and vomiting in a
town called Meliandou, Guinea—a remote and sparsely populated village of 31 households
approximately 20 miles from the borders of Liberia and Sierra Leone.(1) The exact source of
infection is unclear but likely involved contact with an infected animal. The child died on the
5th day of his illness.(2)
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Over the next three weeks, the child's 3 year old sister, mother and grandmother also died.
Two women from a nearby village attended the funeral of the child's grandmother; they died
three weeks later. A midwife from the child's village was hospitalized and subsequently
died. Two healthcare workers who worked at the hospital where the midwife was admitted
also became ill and died. Multiple family members who attended the funerals of the
healthcare workers also became ill and died.(2) By then, the illness, initially thought to be
cholera, had spread to several surrounding districts as well as the capital of Guinea, Conkary
—a city of 2 million people.(1)
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By March 2014, cases were identified in neighboring Liberia and the disease was identified
as being caused by the Ebola virus. In April 2014, cases of Ebola virus disease (EVD) were
identified in Sierra Leone. Guinea, Liberia and Sierra Leone had previously never
experienced an outbreak of EVD. All previous EVD outbreaks had occurred in mostly rural
villages in the central African nations of the Democratic Republic of Congo, Sudan, Gabon,
Uganda and the Republic of the Congo. Prior to 2013, the largest documented EVD outbreak
occurred in 2000-2001 in the Gulu District of Uganda and resulted in over 400 cases and
over 200 deaths.(3) As of December 2015, the West Africa EVD outbreak has resulted in
over 28,000 cases and over 11,000 deaths in Guinea, Liberia and Sierra Leone—more than
all previous EVD outbreaks combined.(4)
The 42 day waiting period after the last known case of EVD had recovered ended in Sierra
Leone on November 7, 2015 and ended in Guinea on December 28, 2015. In Liberia, as of
the time of writing this chapter, the 42 day waiting period will end on January 14, 2016.(4)
Ending the West Africa EVD outbreak required an unprecedented international response.
For the United States, participation in the international response to the West Africa EVD
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outbreak provided an opportunity to learn important lessons in 4 key domains critical to
preparing for future outbreaks of EVD and other serious communicable diseases: 1. Safe and
Effective Patient Care; 2. The Role of Experimental Therapeutics and Vaccines; 3. Infection
Control; 4. Hospital and Community Preparedness.
SAFE AND EFFECTIVE PATIENT CARE
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There are no specific therapies approved by the US Food and Drug Administration for the
treatment of EVD. Therefore, the primary treatment for EVD is supportive care, specifically
fluid replacement and electrolyte management. Prior to the West Africa outbreak, the ability
of health care workers to provide aggressive supportive care was often hampered by the
resource limitations in many central African Ebola treatment centers.(5) Oral rehydration,
though readily available even in resource-limited settings, may have been inadequate given
the severe fluid losses (5-10 liters per day) caused by EVD-associated gastroenteritis and the
intractable nausea and vomiting that frequently accompanies this illness.(6, 7) Similarly, the
ability to safely provide intravenous fluids for rehydration and correction of electrolyte
abnormalities was often limited by inadequate staffing, limited supplies of intravenous
fluids, and inadequate or unavailable laboratory testing.(5) When laboratory testing was
available, as during the 2000 outbreak of Sudan ebolavirus in Uganda, it demonstrated that
renal failure, liver failure, hypocalcemia, hypoalbuminemia and an elevated D-Dimer were
associated with increased mortality.(8)
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The historic size of this West Africa EVD outbreak required an international response that
resulted in both the construction of new Ebola treatment units in Guinea, Liberia and Sierra
Leone, as well as the treatment of 27 individuals in Western Europe and the United States.
As a result, the ability of heath care workers to provide aggressive supportive care was
enhanced. In Conakry, Guinea, aggressive supportive care may have contributed to a reduced
case fatality rate compared to other more resource-limited areas of the country and
compared to historical cohorts.(6) Among patients evacuated to Western Europe and the
United States, the majority of patients had significant electrolyte abnormalities
(hyponatriemia, hypokalemia, hypocalcemia and hypomagnesemia) diagnosed by laboratory
monitoring. The patients received multiple different, sometimes overlapping, interventions
including supportive care. The case-fatality proportion of patients treated in Western Europe
and the United States was 18.5% which is substantially lower than the mortality seen in
West Africa ETUs.(9)
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The treatment of EVD patients in resource-enhanced settings like Western Europe and the
United States also allowed patients with EVD-associated multiorgan system failure to
receive, for the first time, advanced critical care interventions like mechanical ventilation
and renal replacement therapy.(10) Multi-organ system failure in EVD historically, and
during the West Africa outbreak, has been associated with poor outcomes.(11) However,
11/27 patients treated in Western Europe and the United States required advanced critical
care interventions (non-invasive mechanical ventilation, mechanical ventilation, vasopressor
or inotropic support, and renal replacement therapy); six of the 11 survived.(9) In addition,
the experience of providing critical care support to patients with EVD demonstrated that
invasive interventions like mechanical ventilation and renal replacement therapy can be
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performed safely if performed by trained health care workers who strictly adhere to infection
control practices.(10)
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The clinical care of patients with EVD does not end with the resolution of viremia. EVD
survivors can develop a diverse array of complications during convalescence. Survivors of
the 2007 outbreak of Bundibugyo ebolavirus in Uganda developed joint pain, sleep
disturbances, and neurological abnormalities including hearing loss, memory loss and
confusion. In addition, ocular complaints including retro-orbital pain and blurred vision
were common.(12) Ocular complaints including sight-threatening uveitis has also been
described in survivors of the 1995 outbreak of Zaire ebolavirus in Kikwit, Democratic
Republic of Congo.(13) In a small survey of 85 EVD survivors of the West Africa, 40% of
participants reported “eye problems.”(14) During the current outbreak, one survivor
developed severe uveitis during convalescence and viable Ebola virus was isolated from his
anterior eye chamber 9 weeks after clearance of viremia.(15)
The pathogenesis of complications that occur during EVD convalescence is unclear but may
be multifactorial. It has been hypothesized that some of the complications may be related to
post-viral auto-immune disease.(12) It has also been postulated that complications may be
from persistent viral replication in immune-privileged sites.(15) Persistent viable Ebola virus
has been isolated from semen and aqueous humor of EVD survivors.(15, 16) In addition, one
survivor developed meningoencephalitis 10 months after she had cleared her viremia, and
Ebola virus was isolated from her cerebrospinal fluid.(17) It is unclear whether Ebola virus
persists in other bodily fluids or tissues that are thought to be immune-privileged (e.g.
synovial fluid). Prospective cohort studies are underway in West Africa that will hopefully
elucidate the causes of complications that occur to EVD survivors during convalescence.
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ROLE OF EXPERIMENTAL THERAPEUTICS
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While the key to surviving Ebola virus disease is aggressive supportive care, it is possible
that the discovery of effective therapeutic agents may improve patient outcomes.
Unfortunately, disproportionate media attention to unproven therapeutics during the recent
Ebola outbreak led to unrealistic expectations and the almost universal compassionate use of
experimental therapeutics in patients repatriated to resource-rich centers. Of the 27 patients
treated in resource-rich centers, 70% received at least two investigational therapeutics (9),
despite the fact that none had human efficacy or safety data; patients experienced a wide
range of possible adverse effects. These adverse effects included systemic inflammatory
response syndrome, hypotension, elevated transaminase levels, and transfusion-associated
acute lung injury. It is of interest to note that two of the agents that were felt to be the most
promising at the beginning of the outbreak were ultimately found to offer no survival
benefits (see below). The use of therapeutics and vaccines in resource-limited environments
will face a number of challenges, including supply and distribution uncertainty,
administration difficulties with agents that must be given parenterally or intravenously, and
the difficulties of utilizing oral agents in patients with intractable nausea and emesis (18).
Above all, it is imperative that the search for a “magic bullet” not detract from a focus on
supplying aggressive supportive care to all patients presenting with Ebola virus infection.
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Therapeutics currently considered the best candidates for efficacy in patients infected with
the Ebola virus fall into two categories: boosting of passive immunity and pharmaceutical
antivirals. Recovery from Ebola virus disease is associated with the production of antibody
against the virus (19, 20). It has therefore been hypothesized that the boosting of passive
immunity until the host can produce antibody may be of benefit. In a prior outbreak in 1995,
8 patients with Ebola virus infection were given whole blood from outbreak survivors (21)
Seven of the 8 patients survived, for a mortality rate of 12.5%, which compared with a
mortality rate of 80% in patients who did not receive such transfusions. However, due to the
small numbers and other confounding factors this survival difference was not felt to be
definitive evidence of efficacy (22). Studies of convalescnet serum in non human primates
have been inconclusive. While the administration of convalescent whole blood transfusion to
rhesus macaques was not found to be protective (23), infected rhesus macaques who
received multiple administrations of purified, polyclonal, species-matched IgG from
vaccinated animals did appear to be protected (22). In addition to the use of convalescent
antibodies, pooled antibodies produced in vitro have been studied. ZMapp, a combination of
3 chimeric human/murine IgG1 monoclonal antibodies produced by a tobacco plant
(Nicotiana benthamiana) has recently been developed (24). In a non human primate trial,
ZMapp was 100% protective against Ebola virus infection even when administered 5 days
after the animals were infected. While anecdotal evidence supports the efficacy of this
preparation in a few of the patients who survived the current outbreak (25), no randomized
controlled studies have been completed to date. A definitive answer as to the role of passive
immunity in treating patients with Ebola virus disease will await more robust trials in
humans.
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Pharmaceutical antivirals directed against the Ebola virus have fallen into two categories:
small-molecule inhibitors of virus entry and endosomal escape, and compounds that block
viral replication. In the first category is a product called TKM-100802, a small interfering
ribonucleic acid that silences RNA replication by enzymatic cleavage of mRNA.
TKM-100802 targets the L polymerase, viral protein VP24 and VP35 (26). In both guinea
pig and non human primate challenge studies, this agent was found to offer protection (27,
28). Unfortunately, in one of the few randomized controlled trials in humans to be performed
during the current outbreak, this agent was not found to offer a survival advantage in humans
and the trial was halted (29). Favipiravir, a broad spectrum antiviral that inhibits RNAdependent RNA polymerase, also showed promise in initial animal studies, but again was
not found to offer a survival advantage in a randomized trial involving humans. However, a
post hoc analysis did suggest that favipiravir might be of benefit in patients presenting early
in disease with lower viral loads (30). Other agents that have shown promise in in vitro or
animal studies include GS-5734, BCX4430 and AVI7537 (18, 26). As these agents have not
been evaluated in randomized human trials, their efficacy in humans is yet to be determined.
VACCINES
The high mortality rate associated with Ebola virus infection has added urgency to the
search for effective vaccines. Practical difficulties in performing controlled clinical trials for
Ebola vaccines are that Ebola outbreaks tend to be unpredictable and sporadic, and the
ethical concerns about using a placebo control in the face of exposure to a highly lethal
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disease. In 2002, the FDA promulgated the “animal rule” as an alternative pathway to
license products against highly lethal pathogens such as Ebola (31). The animal rule has 4
conditions: 1. animal efficacy data (GLP); 2. immune correlate establishment and protection
in animals; 3. human safety and immunogenicity data (GCP); 4. induction of an immune
correlate in humans. It is anticipated that an effective vaccine will need to elicit both
humoral and cell mediated immunity against the Ebola virus. Vaccines for pre-exposure (no
identified exposure to the virus) and post-exposure (identified exposure to the virus) use
have slightly different requirements. A vaccine for pre-exposure use would optimally induce
protection after one, or at most 2, vaccinations. It should protect against multiple strains of
the Ebola virus. It should have minimal adverse effects. A vaccine for post-exposure use
should produce rapid induction of immunity. For all vaccines, ability to tolerate suboptimal
storage conditions will be important, given the supply chain issues in most parts of the world
where the Ebola virus is endemic.
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Attenuated and inactivated vaccines have not shown protection in non-human primate
studies (32), and there have been safety concerns due to the risk of incomplete inactivation.
Genetic and subunit vaccines have resulted in incomplete protection (33, 34). The leading
candidate vaccines at the present time are vector-based: a live, recombinant vesicular
stomatitis virus (VSV) vaccine, and a replication-incompetent adenoviral vector vaccine.
Both of these vaccines promote immunity to the Ebola virus glycoprotein. The Ebola virus
glycoprotein is responsible for attachment and fusion between the viral and host membranes
and produces inhibition of host immune responses. In non human primate models, an
antiglycoprotein antibody level of 1:3700 and above allows the animal to survive subsequent
lethal challenges with Ebola virus. The VSV vaccine encodes for the Ebola glycoprotein
instead of the VSV glycoprotein. The immunity produced by this vaccine is primarily
humoral. In non human primates, one dose of vaccine induces immunity and is 100%
protective at 14 months(35). As the vaccine virus is capable of replication, the majority of
volunteers exhibit some adverse events: 90% reported systemic symptoms, including fever,
chills, myalgia and headache (36). Pre exposure studies with this vaccine are limited. In one
post exposure study, 7651 individuals in Guinea who were contacts of patients with
laboratory confirmed EVD were vaccinated either immediately or 21 days following
exposure. In the immediate vaccination group there were no cases of Ebola virus disease
with symptom onset at least 10 days after randomization, whereas in the delayed vaccination
group there were 16 cases of Ebola virus disease from seven clusters, showing a vaccine
efficacy of 100% (37).
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The adenovirus vaccine encodes for the Ebola glycoprotein of two Ebola strains: Zaire and
Sudan. Unlike the VSV vaccine, it promotes cellular as well as humoral immunity (38). As
preexisting immunity to the adenovirus is more common than immunity to VSV, alternate
immunization strategies such as multiple doses must be utilized. In human volunteers, minor
adverse reactions were seen in 70% (fever and transient leukopenia) (39). Human trials in
endemic areas are planned.
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INFECTION CONTROL
Prior to the West Africa EVD outbreak, there were relatively limited data in the medical
literature to help guide infection control practices when caring for patients with EVD in the
United States. The literature that was available was based on the experience of caring for
patients with EVD in central Africa—a setting markedly different to modern hospitals in the
United States.(40) As of December 2015, 11 patients with EVD have been treated in the
United States; ten of the 11 patients were treated in specialized biocontainment patient care
units at Emory University Hospital, the University of Nebraska Medical Center and the
National Institutes of Health Clinical Center. The eleventh was cared for in an isolation unit
developed in Bellevue Hospital Center. In these settings, key lessons were learned to guide
infection control policies and procedures to safely care for patients with EVD and other
serious communicable diseases.
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Although biocontainment patient care units are not required to treat a patient with EVD (41),
specific features in the design of these facilities make them ideal environments to effectively
treat patients with serious communicable diseases while minimizing the risk of transmission
to healthcare workers, other patients, and the public.(42) In biocontainment patient care
units, including the Serious Communicable Diseases Unit (SCDU) at Emory University
Hospital (see Figure 1), individual patient care rooms are designed to deliver a level of care
equivalent to that of a standard ICU, allowing healthcare workers to provide aggressive
supportive care to patients who may be critically ill. To maintain staff safety, the SCDU
includes dedicated space for staff changing areas and to store personal protective equipment
(PPE). Patient care rooms are constructed with seamless surfaces for walls and floors to
facilitate effective surface disinfection. To maintain the safety of other hospitalized patients
and healthcare workers, the SCDU is located in a secured area of Emory University Hospital
that is separate from other patient care areas. All entrances and exits in the SCDU are
continuously monitored and limited only to healthcare workers and other individuals
authorized to be in the unit (43).
The SCDU is also designed to safely care for patients with diseases that, unlike Ebola, can
be spread through the airborne route. Specifically, air in the patients’ rooms is under net
negative pressure relative to the surrounding areas. Air in the patient rooms has laminar air
flow across the patient bed and all air from the patient rooms undergoes high-efficiency
particulate air filtration before being 100% exhausted to the outside. The outside exhaust is
geographically separate from any hospital air intake locations and is high enough to allow
for dilutional disbursement (43).
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Independent of the specific design features of the treatment facility, the West African EVD
outbreak clearly demonstrated that establishing a trained, competent, interdisciplinary team
of providers and emphasizing a culture of safety are critical to effectively care for patients
with EVD.(44,45) To staff the SCDU, a core team of nurses, physicians and other healthcare
workers with expertise in infectious diseases, critical care and an expressed interest in caring
for patients with serious communicable diseases were identified. In order to be part of the
team, all providers were required to demonstrate a commitment to practice and promote a
“culture of safety.” In a culture of safety, all team members commit to strictly adhere to safe
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and effective practices outlined in standard operating protocols and are empowered to ask
questions and voice concerns as they arise. Team members were also required to meet the
following criteria: 1. Participate in regularly scheduled drill exercises; 2. Demonstrate
competency in infection control practices with specific emphasis on protocols for donning
and doffing PPE, specimen handling and waste management.(43) Providers who were
unable to demonstrate these competencies were not permitted to provide direct patient care
to patients with EVD. Drills, training sessions, and competency verification are performed
every 3-6 months.
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The selection of appropriate PPE for the clinical care team is a critical step to maintaining
staff safety when caring for a patient with EVD. The specific type of PPE used by healthcare
workers caring for patients with EVD should include a coverall or surgical gowns with head
cover that leave no skin exposed. An apron and shoe covers should be added when there is a
high risk of exposure to infectious body fluids. At least two sets of gloves should be worn
including an outer glove that has extended cuffs. Although Ebola virus is not transmitted
through the air, wearing a powered air purifying respirator or N-95 respirator together with a
faceshield protects the face and mucus membranes from exposure to infectious fluids and
provides additional protection if aerosol-generating procedures are performed.(46)
Regardless of the specific type of PPE selected, it is imperative that PPE provide adequate
protection but remain comfortable for healthcare workers. It is especially important that
direct care providers receive adequate training and demonstrate competency in donning and
doffing PPE. Inappropriate donning and doffing of PPE has been identified as a possible risk
factor for EVD acquisition among healthcare workers.(47) Therefore, it is imperative that
healthcare workers donning and doffing PPE should always be monitored by partners to
ensure strict adherence to proper procedures.
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In addition to the core group of nurses and physicians providing direct care to patients with
EVD, laboratory technologists are critical members of the interdisciplinary team who need
to maintain strict adherence to infection control practices. Patients with EVD have a high
viral load that can reach levels of >108 viral particles/ml of body fluid. Ebola virus is highly
infectious with an infectious dose that has been estimated to be as low as 0.001 ml of blood.
(48) As a result, it is critical that hospitals that care for patients with EVD develop detailed
standard operating protocols to maintain safety during laboratory specimen collection,
transport and processing. Guidelines from the Centers for Disease Control and Prevention
(CDC) state that hospital clinical laboratories can safely handle specimens from patients
with EVD if risk mitigation strategies (engineering controls, administrative and work
controls, use of appropriate PPE) are implemented.(49) The American Society for
Microbiology has, however, issued guidelines suggesting that specimens from patients with
EVD should be limited to point-of-care (POC) testing equipment and performed either in the
patient's room or in a biological safety cabinet in an isolated area.(50) The SCDU at Emory
University Hospital established a self-contained POC laboratory and processed all
specimens within a 4-foot laminar flow biosafety containment hood.(51) All laboratory
technologists involved in the transport and processing of specimens containing Ebola virus
should receive PPE training and demonstrate competency in donning and doffing.
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Hospitals preparing to care for patients with EVD also require a multidisciplinary team to
develop standard protocols for the management of regulated medical waste. This team
should include environmental services, infection prevention and control, biosafety officers,
hospital administration, public health officials, and others with expertise in hazardous waste
removal. All waste from patients with EVD is disposed in compliance with local, state, and
federal regulations. EVD patient care waste is defined and regulated by the United States
Department of Transportation as a Category A infectious substance. Therefore, all solid
medical waste generated in the SCDU during the care of patients with EVD was sterilized in
an autoclave that allowed the waste to be transported and disposed safely as regular medical
waste. For units that do not have access to an autoclave, contractors who transport and
dispose of Category A waste have special procedures in place for the packaging of such
waste. Although CDC guidelines state that liquid waste may be disposed of without
treatment in to sanitary sewers, local waste treatment authorities may have different
requirements.(52) In the SCDU, a disinfectant was added to all liquid waste in accordance
with manufacturers’ directions prior to disposal in the sanitary sewer.
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Because of the low infectious dose of Ebola virus, health care workers who care for patients
with EVD must develop standard protocols to ensure that environmental surfaces in the
direct patient care area, laboratory and in the waste stream receive regular cleaning with an
appropriate effective disinfectant. The United States Environmental Protection Agency
(EPA) has identified EPA-registered disinfectants with a label claim of potency at least
equivalent to that for a non-enveloped virus which meet CDC criteria for use against Ebola
virus.(53, 54) All disinfectants should be used by trained health care workers in accordance
with manufacturers’ instructions. Strict adherence to regular cleaning significantly reduces
the risk of Ebola virus transmission from bodily fluids and fomites in the environment.(40)
For terminal cleaning of the environment after discharge of a patient with Ebola virus
disease, it is essential that meticulous attention be paid to disinfection of all surfaces. Most
units have followed this with a supplemental disinfection modality such as vaporized
hydrogen peroxide or a UV generator.(55)
HOSPITAL AND COMMUNITY PREPAREDNESS FOR EMERGING
INFECTIOUS DISEASES
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One of the key lessons that the Ebola outbreak of 2013-2015 has taught us is that the United
States and the world were ill prepared to address an outbreak of an emerging infectious
disease (56, 57, 58). This lesson was particularly jarring given that outbreaks of SARS
(severe acute respiratory syndrome), H1N1 influenza, and MERS (Middle East respiratory
syndrome) have marked the last decade. Partially due to this lack of preparation, the Ebola
outbreak has dwarfed all other outbreaks of Ebola virus disease in terms of number infected
and mortality. On the international front, factors that have been identified as contributing to
the unprecedented extent of this outbreak have been identified (Table 1).(58, 59)
In addition to the lack of preparedness for isolating and managing infected patients, the
delay in implementing research protocols to evaluate treatment algorithms, therapeutic
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agents, and vaccines means that many questions regarding these interventions will not be
resolved prior to the next outbreak.
In response to this outbreak, many initiatives, both globally and in the United States, have
begun. On the international arena, an independent, multinational Commission on a Global
Health Risk Framework for the Future has been established to recommend a more effective
global architecture for mitigating the threat of epidemic infectious diseases.(57, 60) The
U.S. National Academy of Medicine is the secretariat for this commission. In addition, an
independent Panel convened by the World Health Organization has proposed an agenda for
change (Table 2) which has been largely accepted by WHO administration.(61)
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The United States has also witnessed a marked increase in activities focused on emergency
preparedness for emerging infectious diseases. In 2015 Congress appropriated $5.48 billion
to the effort to control Ebola virus infection.(62) These funds will be utilized to address a
number of areas that require strengthening in order to improve the U.S. response to
emerging infectious diseases. Under the Hospital Preparedness Program of the Assistant
Secretary for Preparedness and Response (ASPR), funding was distributed to the states and
to other grantees to enhance state, local and healthcare system preparedness. These funds
were also designed to create one regional Ebola and other special pathogen treatment center
in each of the ten Health and Human Services regions.(63) In addition, the Centers for
Disease Control and Prevention has developed a tiered approach to manage patients with
possible or confirmed Ebola virus disease or infections caused by other serious
communicable pathogens.(41) Under this strategy, acute healthcare facilities can serve one
of three roles: frontline healthcare facility; Ebola assessment hospital; or Ebola treatment
center. Frontline healthcare facilities should, in coordination with local and state health
authorities, be able to rapidly identify and triage patients who are suspected of being
infected with the Ebola virus. Ebola assessment hospitals are facilities prepared to receive
and isolate suspect patients and care for the patient until a diagnosis of Ebola virus disease
can be confirmed or ruled out and until discharge or transfer is completed. Ebola treatment
centers are facilities that plan to care for and manage a patient with confirmed Ebola virus
disease for the duration of the patient's illness. As the Ebola virus outbreak in West Africa is
contained, the focus of this network should gradually shift to other serious communicable
diseases, although exactly what these infectious diseases should be is yet to be resolved.
ASPR has also funded the National Ebola Training and Education Center (NETEC) to
develop a robust educational program to improve infectious disease emergency preparedness
in the United States. The NETEC will be using a multipronged approach including: site
visits for regional Ebola treatment units; establishment of a web based learning management
system; development of exercise templates for entities to test their state of preparedness; and
a research agenda to answer some of the fundamental questions regarding the treatment of
patients with Ebola virus disease and other serious communicable pathogens. The goal of
the site visits and exercises is to demonstrate that an institution-wide approach is essential
when it comes to managing patients with serious communicable diseases. Areas of
preparedness that will receive targeted attention are listed in (Table 3) . One of the most
challenging areas for many facilities is to develop a laboratory that can safely evaluate
patients for serious communicable pathogens in a timely manner while at the same time
testing for other, more common, rapidly fatal diseases such as malaria and typhoid fever.
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CONCLUSIONS
The EVD outbreak that began in Guinea in December 2013 has been the largest and
deadliest EVD outbreak in human history. The outbreak cruelly demonstrated the significant
degree to which developing nations, like those in West Africa, are vulnerable to serious
morbidity and mortality caused by the rapid spread of serious communicable diseases like
EVD. Paradoxically, the outbreak has also resulted in the largest number of EVD survivors
in history. Therefore, it is critical, that the unprecedented international response that helped
end the EVD outbreak be sustained to build the infrastructure of vulnerable developing
nations. Building and maintaining adequate healthcare infrastructure will be critical to
manage the prevalent and poorly understood complications that can occur in EVD survivors
as well as to prevent future outbreaks.
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The West African EVD outbreak also demonstrated again that emerging infectious diseases
have no borders. As such, it is imperative that developed nations with advanced healthcare
systems, like the United States, identify lessons that can be learned from the West African
EVD outbreak. Specifically, key lessons learned in 4 domains: 1. Safe and Effective Patient
Care; 2. The Role of Experimental Therapeutics and Vaccines; 3. Infection Control; 4.
Hospital and Community Preparedness will hopefully help both the United States and the
international community more effectively respond to future outbreaks of EVD and other
emerging serious communicable diseases in the future.
REFERENCES
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Figure 1.
Schematic of the Serious Communicable Diseases Unit (SCDU), Emory University Hospital
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Factors Contributing to 2013-2015 Ebola Outbreak (58, 59)
• Failure of member States to implement the core capacities called for under the International Health Regulations (2005)
• The implementation of travel bans and other measures that interfered with the response to the outbreak
• Delays in the declaration of a Public Health Emergency of International Concern (PHEIC) by WHO
• Lack of familiarity with Ebola by healthcare providers and public health officials in West Africa
• The unique introduction of Ebola into an urban setting for the first time as opposed to rural villages
• Poor public health infrastructure due to years of civil war
• A severe shortage of healthcare workers exacerbated by the many healthcare workers who became infected with the Ebola virus early in the
outbreak
• Closure of healthcare facilities and departure of foreign healthcare workers due to perceived danger as the outbreak peaked
• High risk funeral and burial practices in West African countries
• Community resistance due to suspicion of the government and lack of familiarity with Ebola
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WHO's Agenda for Change (61)
• Strengthening of the International Health Regulations
• Identifying addition resources to support public health infrastructure in member states
• Implementation of objective measures to assess core capacities of member states
• Altering the WHO structure and culture to improve emergency preparedness and response capacity
• Development of a global health emergency workforce to respond to outbreaks and emergencies with health consequences
• Improved integration of health security and humanitarian systems
• Development of a unified WHO program for outbreaks and emergencies
• Development of an “R and D Blueprint” to accelerate research and development on diagnostics, vaccines and therapeutics during outbreaks
and health emergencies
• Establishment of a WHO Contingency Fund for Emergencies to establish adequate international financing for pandemics and other health
emergencies
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Emergency Medical Services and Emergency Department preparedness
• Patient transport
• Staffing
• PPE and donning/doffing procedures
• HCW Monitoring and management of exposures
• Lab safety and capacity
• Environmental infection control
• Waste management
• Coordinated communication
• Management of special populations
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�
Dublin Core
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Preparing for Serious Communicable Diseases in the United States: What the Ebola Virus Epidemic Has Taught Us
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Discover
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An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
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URL
https://www.ncbi.nlm.nih.gov/pubmed/27337477
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922497/
Citation
Citation information for the publication itself.
Varkey, J. B. and B. S. Ribner (2016). "Preparing for Serious Communicable Diseases in the United States: What the Ebola Virus Epidemic Has Taught Us." Microbiol Spectr 4(3).
Abstract
Ending the West Africa Ebola virus disease (EVD) outbreak required an unprecedented international response. For the United States, participation in the international response to the West Africa EVD outbreak provided an opportunity to learn important lessons in four key domains critical to preparing for future outbreaks of EVD and other serious communicable diseases: (i) safe and effective patient care, (ii) the role of experimental therapeutics and vaccines, (iii) infection control, and (iv) hospital and community preparedness.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
free online - Pubmed Central
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Preparing for Serious Communicable Diseases in the United States: What the Ebola Virus Epidemic Has Taught Us
Creator
An entity primarily responsible for making the resource
Varkey, J. B. and B. S. Ribner
Subject
The topic of the resource
General
Description
An account of the resource
Ending the West Africa Ebola virus disease (EVD) outbreak required an unprecedented international response.
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-06-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Antibodies
Contact Transmission
Critical Care
Droplet Transmission
Ebola
Epidemic
Infection Prevention and Control
Outbreaks
Patient Care
Personal Protective Equipment (PPE)
Prophylaxis
Public Health
R-PPE
R-Res&Pub
Therapeutics
Vaccine Study
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/8df853d7cbf6e38897cc9822e2f157b2.png
1b6b01a22c0ec5517f95feb53db57c40
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.who.int/activities/prioritizing-diseases-for-research-and-development-in-emergency-contexts
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Prioritizing diseases for research and development in emergency contexts
Subject
The topic of the resource
General
Description
An account of the resource
Worldwide, the number of potential pathogens is very large, while the resources for disease research and development (R&D) is limited. To ensure efforts under WHO’s R&D Blueprint are focused and productive, a list of diseases and pathogens are prioritized for R&D in public health emergency contexts.
Creator
An entity primarily responsible for making the resource
World Health Organization
Date
A point or period of time associated with an event in the lifecycle of the resource
2022
Coronavirus
Crimean Congo Haemorrhagic Fever (CCHF)
Ebola
Epidemic
Experimental Drugs
Lassa
Marburg
Medical Surveillance
MERS-CoV
Mpox
Orthopox Virus
Outbreaks
Pandemic
Plague
Prophylaxis
Public Health
R-Gen
Respiratory Pathogen
SARS
Special Pathogens
Therapeutics
Vaccine Study
Variola
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://bioethicsarchive.georgetown.edu/pcsbi/sites/default/files/Conversation%20Series%20Public%20Health%20Emergencies%20Hype.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Public Health Emergencies and the Media
Subject
The topic of the resource
Emergency Management
Creator
An entity primarily responsible for making the resource
Presidential Commission for the Study of Bioethical Issues
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-08-01
Description
An account of the resource
This release discusses how non-scientists can spot the hype in media coverage on public health emergencies.
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Communications
Ebola
Emergency Management
Epidemic
Outbreaks
Public Health
R-EM
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
URL
https://openwho.org/courses/public-health-interventions
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Approximately 3 hours.
Access
Description of access information (e.g. itunes).
Free with free OpenWHO account.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Public health interventions in pandemics and epidemics
Creator
An entity primarily responsible for making the resource
WHO
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
The 21st century has witnessed changes - travel and trade, urbanization, environmental degradation and other trends that increase the risk of disease outbreaks, their spread and amplification into epidemics and pandemics. At the same time, the science and knowledge around infectious hazards are constantly evolving. This introductory level online course will guide you through the new landscape by providing information and tools you need to better manage disease outbreaks and health emergencies. (WHO)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-07-05
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Emergency Management
Epidemic
Flu
Influenza
Pandemic
Public Health
R-EM
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
National Academies of Sciences, Engineering, and Medicine. 2020. Rapid Expert Consultation on Staffing Considerations for Crisis Standards of Care for the COVID-19 Pandemic (July 28, 2020). Washington, DC: The National Academies Press. https://doi.org/10.17226/25890.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online.
URL
https://www.nap.edu/catalog/25890/rapid-expert-consultation-on-staffing-considerations-for-crisis-standards-of-care-for-the-covid-19-pandemic-july-28-2020
Read Online
Online location of the resource.
https://www.nap.edu/read/25890/chapter/1
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Rapid Expert Consultation on Staffing Considerations for Crisis Standards of Care for the COVID-19 Pandemic (July 28, 2020)
Subject
The topic of the resource
Personnel Management
Description
An account of the resource
This rapid expert consultation builds on prior National Academies reports on the Crisis Standards of Care (CSC) and the rapid expert consultation on March 28, 2020, and focuses on staffing needs for the care of COVID patients, including the deployment and allocation of expert clinical staff during COVID-19. It does not attempt to dictate exactly what choices should be made under exactly what circumstances, as that should be left to the judgment of the professional, institutional, community, and civic leaders who are best situated to understand the local conditions.
Creator
An entity primarily responsible for making the resource
National Academies of Sciences, Engineering, and Medicine.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-28
Relation
A related resource
Y - D0.1PM/D0.2PM Qualtrics # 907, original # 5
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - worth to see if new resources developed by this agencu post-covid
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-07-14
2019-nCoV
Coronavirus
COVID-19
Epidemic
Example
Pandemic
Personnel Management
R-Lead
R-PM
Staffing
Staffing Model
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Mantha, Srinivas. 2020. "Ratio, rate, or risk?" The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30439-4/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30439-4/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ratio, rate, or risk?
Subject
The topic of the resource
Research
Description
An account of the resource
In epidemiology, the terms ratio, rate, and risk have clear definitions. In the emerging publications related to coronavirus disease 2019 (COVID-19), the phrase case fatality rate is being used instead of case fatality ratio.
Creator
An entity primarily responsible for making the resource
Mantha, Srinivas.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-27
Type
The nature or genre of the resource
Publication
2019-nCoV
Coronavirus
COVID-19
Epidemic
Pandemic
R-Res&Pub
-
https://repository.netecweb.org/files/original/e674529cbda09584635f64ba58fee8d5.pdf
0ec2a916ab2bd4dccfccb30dc3d19409
PDF Text
Text
Regional Treatment Network for Ebola and
Other Special Pathogens
November 2017
U.S. Department of Health and Human Services
Office of the Assistant Secretary for Preparedness and Response
�Table of Contents
Executive Summary................................................................................................................ 2
Purpose of the Report ......................................................................................................... 2
Background......................................................................................................................... 2
Section I: Regional Treatment Network Approach .................................................................. 3
Progression from Interim Guidance to the Regional Treatment Network ............................. 3
Four Tiers in the Regional Treatment Network .................................................................... 4
Patient Decision Algorithm for the Regional Treatment Network ......................................... 7
Section II: Oversight and Financing for the Regional Treatment Network ............................... 7
Regional Treatment Network Funding Strategy ................................................................... 7
Section III: The State of Preparedness ..................................................................................10
Regional Treatment Network Performance Measurement Strategy ....................................11
Progress and Capabilities by Tier ......................................................................................15
Health Care Delivery System-Level Readiness ..................................................................19
Section IV: Planning and Future Considerations....................................................................23
Hospital Preparedness Program (HPP) and National Ebola Training and Education Center
(NETEC) Plans in Support of the Regional Treatment Network..........................................23
Ongoing HHS Ebola Response Improvement Plan Activities .............................................24
Future Considerations ........................................................................................................25
Appendix A: HPP Ebola Preparedness Measures Year One Results ....................................26
The Ebola Measures ..........................................................................................................26
Year One (2015-2016) Results ..........................................................................................27
HPP Ebola Performance Measures Glossary.....................................................................31
1
�Executive Summary
Purpose of the Report
This report, prepared by the Department of Health and Human Services (HHS), Office of the
Assistant Secretary for Preparedness and Response (ASPR), Office of Emergency
Management’s Division of National Healthcare Preparedness Programs, is in response to a
request by the House Committee on Appropriations in House Report 114-699 accompanying
H.R. 5926, the Departments of Labor, Health and Human Services, and Education, and Related
Agencies Appropriations Bill, 2017:
Regional Treatment Centers —The Committee is aware that HHS has created a regional
treatment network for future infectious disease outbreaks through a tier system using
Ebola funds. The Committee requests a report on the Department’s plans, including
funding and timetables, for each tier outlining capabilities for infrastructure, training, and
other key parameters, such as waste management. HHS should make a public version
of the report available on the HHS website.
Background
Beginning in March 2014, West Africa experienced the largest Ebola virus disease outbreak on
record. Unlike many smaller previous outbreaks of Ebola, this outbreak spread to multiple
African countries and caused 28,616 suspected, probable, and/or confirmed human cases. 1 In
August 2014, the first American patient with Ebola was flown to the United States (U.S.) for
treatment. Additional patients were subsequently medically evacuated to the U.S. and two
returned travelers were diagnosed and treated in Dallas, Texas, and New York City, New York.
These experiences, and the secondary infections of two health care workers in a Dallas
hospital, identified opportunities to improve preparedness for and treatment of suspected and
confirmed patients with Ebola. In response, Congress appropriated emergency supplemental
funding in fiscal year (FY) 2015, in part to ensure that the health care system would be
adequately prepared to respond to future Ebola outbreaks. In doing so, Congress directed HHS
to develop a regional approach to caring for future patients with Ebola.
Building upon a state- and jurisdiction-based tiered hospital approach and meeting Congress’
regional directive, ASPR worked to develop a nationwide, regional treatment network for Ebola
and other special pathogens, which balances geographic need, considers differences in
institutional capabilities, and accounts for the potential need to care for a patient with Ebola.
The Department’s statutory authority for implementing this regional approach is derived from
Title VI of Division G of the Consolidated and Continuing Appropriations Act, 2015, and section
311 of the Public Health Service Act, as amended. The funding provided through the ASPR
Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities Funding
Opportunity Announcement (FOA) cooperative agreement is intended to ensure that the
nation’s health care system is ready to safely and successfully identify, isolate, assess,
transport, and treat patients with Ebola or patients under investigation for Ebola, and that it is
well prepared for a future Ebola or other special pathogen outbreak. While the focus has been
1
As of April 13, 2016, which marks the end of updated case counts after the World Health Organization terminated the Public Health
Emergency of International Concern.
2014 Ebola Outbreak in West Africa - Case Counts, Centers for Disease Control and Prevention.
http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html. Accessed May 3, 2017.
2
�preparedness for Ebola, it is likely that preparedness for other novel, highly pathogenic diseases
will also be enhanced through these activities.
“While the focus is on Ebola preparedness and response, it is likely that other novel, highly infectious
diseases will also be enhanced through Ebola-related activities. The preparatory work funded through
the (HPP) initiative has led to the beginning stages of the establishment of an in-state infectious
disease system that includes a network of assessment hospitals, EMS/inter-facility transport services,
and health care coalition.” (HPP awardee)
Since 2015, the HPP Ebola Preparedness and Response Activities cooperative agreement has
provided significant support to build the regional tiered network from a framework on paper to a
prepared, functional system of care for Ebola and other special pathogens; however, it is
important to note that the current capacity of this system is not likely to be sufficient for many
types of infectious disease outbreaks (e.g., pandemic influenza and other respiratory
pathogens).
Section I: Regional Treatment Network Approach
Progression from Interim Guidance to the Regional Treatment Network
In December 2014, HHS released its initial Interim Guidance for U.S. Hospital Preparedness for
Patients under Investigation or with Confirmed Ebola Virus Disease: A Framework for a Tiered
Approach 2, which outlined the different roles U.S. acute health care facilities could play in
preparing to identify, isolate, and evaluate patients with possible Ebola or to treat patients with
confirmed Ebola. These roles included serving as Ebola treatment centers, assessment
hospitals, and frontline health care facilities. Beginning in fall 2014, hospitals that had been
assessed by a Centers for Disease Control and Prevention (CDC)-led Rapid Ebola
Preparedness (REP) team were designated by state health officials to serve as Ebola treatment
centers. HPP staff participated in REP team assessments of potential Ebola treatment centers
during that time.
Experience with patients with Ebola in the U.S. has shown that care of such individuals is
clinically complex, requiring highly skilled health care providers and technologically-advanced
care. This led Congress, experts, and key health stakeholder groups to suggest that,
subsequent to the interim guidance, care for patients with Ebola should be concentrated in a
small number of facilities. At the same time, however, a patient may present at any U.S. health
care facility with any number of symptoms, exposures, or travel histories; therefore, all of the
nation’s acute care facilities must be prepared to identify, isolate, and provide initial treatment to
one or more simultaneous clusters of patients with Ebola until they can be transferred to a
facility that can provide a more thorough assessment and/or definitive care. To that end, HHS
built upon the interim approach that focused on state- and jurisdiction-based tiered hospitals to
develop a strategy for a nationwide, regional treatment network for Ebola and other infectious
diseases, which balances geographic need, differences in institutional capabilities, and
accounts for the potential risk of needing to care for a patient with Ebola.
2
Centers for Disease Control and Prevention (CDC). Interim Guidance for U.S. Hospital Preparedness for Patients under
Investigation (PUI) or with Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered Approach. Available at:
http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html. Updated August 28, 2015.
3
�Four Tiers in the Regional Treatment Network
The regional tiered approach allows for each of HHS’ 10 regions to augment preparedness and
response coverage across the spectrum of required capabilities, while also strategically
concentrating resources at regional Ebola and other special pathogen treatment centers to
maximize the impact of federal funding and minimize the risk of exposure to a highly infectious
disease like Ebola.
Map of the U.S. displaying the
locations of 63 state or jurisdiction
Ebola treatment centers, 10
regional Ebola and other special
pathogen treatment centers, and a
400 mile radius of each of the
regional treatment centers. Map
date 8/8/2017. Map produced by
ASPR Division of Fusion. Data
sources: CDC, ESRI, HHS, HSIP.
Figure 1: Regional Ebola Treatment Network
The HHS regional framework for the tiered approach designates four roles for health care
facilities: frontline health care facilities, Ebola assessment hospitals, Ebola treatment centers,
and regional Ebola and other special pathogen treatment centers (see Figure 1). To implement
the approach, state and local public health officials collaborated with private health care system
stakeholders to designate health care facilities across the state and in the regions to serve in
one of these four roles. Aligned to the HHS framework and guidance, the nationwide regional
treatment network for Ebola and other infectious diseases currently contains the following:
•
4
Regional Ebola and other special pathogen treatment centers that can be ready within
eight hours to receive a patient with confirmed Ebola from their region, across the U.S., or
medically-evacuated from outside of the U.S., as necessary. These hospitals have
enhanced capacity to care for other highly infectious diseases. The HPP-financed regional
Ebola and other special pathogen treatment centers are:
�•
•
•
•
•
•
•
•
•
•
•
•
•
3
4
Region 1: Massachusetts Department of Public Health in partnership with
Massachusetts General Hospital (Boston, Massachusetts);
Region 2: New York City Department of Health and Mental Hygiene in
partnership with New York City Health and Hospitals Corporation/HHC Bellevue
Hospital Center (New York City, New York);
Region 3: Maryland Department of Health and Mental Hygiene in partnership
with Johns Hopkins Hospital (Baltimore, Maryland);
Region 4: Georgia Department of Public Health in partnership with Emory
University Hospital and Children’s Healthcare of Atlanta/Egleston Children’s
Hospital (Atlanta, Georgia);
Region 5: Minnesota Department of Health in partnership with University of
Minnesota Medical Center (Minneapolis, Minnesota);
Region 6: Texas Department of State Health Services in partnership with
University of Texas Medical Branch at Galveston (Galveston, Texas);
Region 7: Nebraska Department of Health and Human Services in partnership
with Nebraska Medicine – Nebraska Medical Center (Omaha, Nebraska);
Region 8: Colorado Department of Public Health and Environment in partnership
with Denver Health Medical Center (Denver, Colorado);
Region 93: California Department of Public Health in partnership with CedarsSinai Medical Center (Los Angeles, California); and,
Region 10: Washington State Department of Health in partnership with
Providence Sacred Heart Medical Center and Children’s Hospital (Spokane,
Washington).
State or jurisdiction Ebola treatment centers that can safely care for patients with Ebola
in the event of a cluster of patients with Ebola that overwhelms the regional Ebola and other
special pathogen treatment center. Clinical judgment, available logistical resources, and
patient preference may indicate that the patient should receive treatment at a state or
jurisdiction Ebola treatment center rather than be transferred to a regional Ebola and other
special pathogen treatment center.
Assessment hospitals that can receive and isolate patients under investigation for Ebola
and care for the patient until a diagnosis of Ebola can be confirmed or ruled out and until
discharge or transfer is completed.
Frontline health care facilities that are prepared to rapidly identify and isolate patients who
may have Ebola. These facilities must be able to promptly inform the hospital/facility
infection control program and state and local public health agency and assessment hospitals
or Ebola treatment centers (as necessary) to arrange patient transfer. Frontline health care
facilities are also responsible to provide stabilizing treatment, per the Emergency Medical
Treatment and Labor Act (EMTALA) requirements. 4
Region 9 did not have a Part B awardee in budget period one. Cedars-Sinai was named the Region 9 awardee in June 2016.
The Emergency Medical Treatment and Labor Act (EMTALA) (1986).
5
�Table 1: Regional Treatment Network Capabilities Required by Tier
Tier and Count ∗
Role and Capabilities Required 56
Frontline health care
facility (4,845)
•
•
•
•
Ebola assessment
hospital (217)
•
•
•
•
•
•
•
Ebola treatment center
(63)
•
•
•
•
•
•
•
Regional Ebola and other
special pathogen
treatment centers (10)
Safely receives and isolates a patient with possible Ebola;
Provides immediate laboratory evaluation and coordinates Ebola testing;
Has enough Ebola PPE for up to 96 hours of evaluation and care for patient(s)
under investigation for Ebola;
Has staffing plans to support 96 consecutive hours of clinical care. All staff
involved in or supporting patient care are appropriately trained for their roles;
Cares for a patient for up to 96 hours (including evaluation and management of
alternative diagnoses) until Ebola diagnosis is confirmed or ruled out;
Secured the services of a waste management vendor capable of managing and
transporting Category A infectious substances; and,
Coordinates with necessary stakeholders (including transport providers) to
transport a patient to an Ebola treatment center, depending on the status of the
patient and the capacity of the Ebola assessment hospital.
Collaborates with the state and local public health agency, emergency medical
services provider(s) on the development of interfacility transportation plans;
Safely receives and isolates a patient with confirmed Ebola;
Cares for patients with Ebola for duration of illness;
Has enough Ebola PPE for at least seven days of care (will restock as needed);
Has sustainable staffing plan to manage several weeks of care. Staff members
who will be involved in managing the patient are familiar with the clinical
protocols for management of patients with Ebola;
Secured the services of a waste management vendor capable of managing and
transporting Category A infectious substances; and,
CDC Ebola Response Teams are ready to deploy to provide assistance as
needed.
These hospitals are part of the network of Ebola treatment centers across the country
but have what HHS calls "enhanced capabilities." The selected hospitals are required
to do the following:
•
•
•
•
•
•
∗
Quickly identifies and isolates patients with possible Ebola;
Notifies the hospital/facility infection control program, other appropriate facility
staff, state and local public health agencies, and assessment hospitals or Ebola
treatment centers (as necessary) to arrange patient transfer;
Has enough Ebola personal protective equipment (PPE) for at least 12–24 hours
of care; and,
Provides stabilizing treatment per EMTALA requirements.
Accept patients within eight hours of notification;
Be able to treat simultaneously at least two patients with Ebola for duration of
illness;
Have respiratory infectious disease isolation capacity or negative pressure
rooms for at least 10 patients;
Conduct trainings and exercises each quarter;
Be able to treat pediatric patients with Ebola or another highly infectious disease
or partner with a nearby facility to do so;
Be able to safely handle waste from such patients; and,
Frontline and assessment hospital counts are current as of 2015-2016 data. Ebola treatment center and regional Ebola and other
special pathogen treatment center counts reflect July 2017 data. HPP will have updated hospital counts for all tiers of the regional
treatment network following the validation and analysis of 2016-2017 reported data. Final 2016-2017 performance data was due
from awardees to ASPR in September 2017. ASPR’s validation and analysis of the data will be complete by late 2017.
5
Interim Guidance for U.S. Hospital Preparedness for Patients under Investigation (PUI) or with Confirmed Ebola Virus Disease
(EVD): A Framework for a Tiered Approach. http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html.
6
HPP Ebola Preparedness and Response Activities FOA
https://www.grants.gov/web/grants/view-opportunity.html?oppId=274709.
6
�•
Receive annual readiness assessment from the National Ebola Training and
Education Center.
Patient Decision Algorithm for the Regional Treatment Network
In addition to the overarching framework and guidance outlined in the table above, HHS
developed an Ebola patient decision algorithm that helps stakeholders across the regional
treatment network decide where a patient under investigation for Ebola should be screened,
evaluated, and treated based on factors such as availability of logistical resources (e.g.,
available beds and transport resources), facility capacity, and clinical judgement. This Ebola
patient decision algorithm provides critical guidance on how the regional treatment tiers, as
described above in Table 1, should work together to safely and successfully treat a patient with
Ebola.
A visual depiction and simplification of the algorithm is shown in Figure 2, below.
Flow chart that depicts first,
second, and third preferences for
treatment of a confirmed patient
with Ebola among the regional
treatment network tiers.
Figure 2: Ebola Patient Decision Algorithm Depiction
Section II: Oversight and Financing for the Regional Treatment
Network
Regional Treatment Network Funding Strategy
In response to the 2014-2015 Ebola outbreak, Congress appropriated $5.4 billion in emergency
supplemental funding to a number of federal agencies, including HHS, which have a key role in
response and preparedness activities. This emergency Ebola funding was directed towards
supporting international response, research and development, and the U.S. domestic response.
Within the federal government, HHS is primarily responsible for overseeing domestic
preparedness and response for Ebola and other emerging infectious disease outbreaks. 7 Of the
$5.4 billion in total emergency funding, $259.7 million was directed to HHS for Ebola
preparedness and response activities in support of the regional treatment network. HHS’
standup of the regional treatment network was a key feature of the U.S. domestic response.
7
National Response Framework and Public Health Service Act:
https://www.phe.gov/Preparedness/planning/authority/Pages/default.aspx.
7
�Table 2: Regional Treatment Network Funding
Funding Type
Funding Amount
Goal of Funding
HPP Ebola Part A
$181,171,000
Support state- or jurisdiction-level preparedness for
frontline health care facilities, assessment hospitals,
state or jurisdiction Ebola treatment centers, and
health care coalitions, in addition to emergency
medical services (EMS) and the overall health care
system.
HPP Ebola Part B
$32,500,000
Establishment of an Ebola and other special pathogen
treatment center (one per each of the 10 HHS
regions).
National Ebola Training
and Education Center
(NETEC)
$24,000,000
Establish a national training and education center to
increase the competency of health care and public
health workers and the capability of health care
facilities to deliver safe, efficient, and effective care to
patients with Ebola and other special pathogens.
Health Care System
Training Simulation and
Quarantine Center for
Ebola and Other Special
Pathogens
$20,000,000
Establish a training, simulation, and quarantine center
for Ebola and other special pathogens.
ASPR Technical
Resources, Assistance
Center, and Information
Exchange (TRACIE)
$2,000,000
Support ASPR TRACIE to develop and disseminate
topic collections and resources specific to Ebola (e.g.,
EMS checklist for Ebola preparedness), which are
available to all health care stakeholders.
Total
$259,671,000
Jointly funded by ASPR
and CDC
Although building on the all-hazards health care preparedness and response capacity and
capabilities developed since 2002 through ASPR’s HPP, the U.S. regional treatment network for
Ebola is primarily supported through emergency supplemental funding. Through the Ebola
Preparedness and Response Activities cooperative agreement, ASPR HPP has awarded
$213.7 million for the establishment of the regional treatment network for Ebola and other
special pathogens. HHS has also used the emergency Ebola funding to establish the National
Ebola Training and Education Center (NETEC) and support the development of the Health Care
System Training Simulation and Quarantine Center for Ebola and Other Special Pathogens.
The funding directly supports the development of key capabilities needed for response to an
Ebola outbreak in the U.S.
ASPR purposefully distributed the vast majority of the supplemental funding in the first year of
the five-year HPP project period to encourage a rapid buildup of key capabilities across each
facility tier. The remaining years of supplemental and competitive funds are intended to sustain
and maintain the regional treatment network’s preparedness and response capabilities. FY
2019 marks the final year in which emergency funds provided for Ebola will be available to
support the regional treatment network. Per the cooperative agreements with HPP awardees,
ASPR’s staff and subject matter experts have substantial involvement with Ebola preparedness
activities that is above and beyond routine grant administration. ASPR’s active participation
amplifies the impact of Ebola preparedness activities; for example, HPP Field Project Officers
participate in NETEC site assessment visits and also monitor outcomes from the HPP-required
exercises.
8
�The HPP Ebola preparedness and response funding for the regional tiered approach are split
into two parts: Part A and Part B, which are described below.
Part A: Health Care System Preparedness for Ebola
ASPR allocated Part A funding to all current 62 HPP awardees (the 50 states, the District of
Columbia, three directly-funded cities, and all U.S. territories and freely associated states) over
a five-year project period. HPP allocated $181.2 million in Part A funding to support state- or
jurisdiction-level preparedness for frontline health care facilities, assessment hospitals, state or
jurisdiction Ebola treatment centers, and health care coalitions, in addition to emergency
medical services (EMS) and the overall health care system. ASPR’s Part A funding strategy
included a base amount + population + Ebola risk formula that determined funding levels for
each awardee, which ranged from $203,000 to $15.8 million, with an average award of $2.9
million. The risk portion was based on the percentage of returning travelers from impacted
countries and reflected West African diaspora population centers and jurisdictions with
enhanced airport screenings. 8 Through Part A, jurisdictions could use a portion of the funding
to compensate health care facilities retroactively for Ebola preparedness activities undertaken
since July 2014; build additional capabilities to ensure that the nation’s health care system and
health care workers are ready to safely and successfully identify, isolate, assess, transport, and
treat patients under investigation for Ebola or confirmed to have Ebola; and be well prepared for
a future Ebola-like event. HPP requires that all entities (Ebola treatment centers, assessment
hospitals, and health care coalitions) receiving funding through Part A establish a plan to
maintain their readiness to care for a patient with Ebola for the duration of the full five-year
project period (May 2015-May 2019) through annual staff trainings and exercises and
sustainment of Ebola PPE.
Part B: Development of a Regional Treatment Network for Ebola Patient Care
For Part B, ASPR competitively awarded funding to 10 HPP awardees who partnered with a
health care facility (or facilities) within their jurisdictions to develop regional Ebola and other
special pathogen treatment centers (one in each of the 10 HHS regions). Part B funding totaled
$32.5 million, with $3.25 million in funding allocated to each of the 10 Part B awardees over the
course of the five-year project period. Each regional Ebola and other special pathogen
treatment center serves as a regional asset and is required to accept patients from outside of its
jurisdiction. The regional Ebola and other special pathogen treatment centers have enhanced
preparedness capabilities to ensure that they are the leading provider of care and treatment for
patients with Ebola in the U.S. and that they have the capabilities needed to manage other highcontainment infectious diseases in the future. 9 Part B awardees also lead the coordinated
regional planning effort for all jurisdictions within their region, including agreements and plans
for the inter-facility transfer of patients within the region.
Of the total Part B funding amounts, HPP provided at least $2.25 million during the first year and
allocated $250,000 in the four subsequent years for each regional Ebola and other special
pathogen treatment center to sustain and maintain capabilities. The funding is initially received
by the awardee, who then directs no less than 90 percent of funds to their regional Ebola and
other special pathogen center hospital partners. Through the funding agreement, HPP requires
8
High-risk jurisdictions include: California, Chicago, Connecticut, District of Columbia, Georgia, Maryland, Massachusetts,
Minnesota, New Jersey, New York, New York City, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Virginia, and
Washington. Risk is based on the percentage of returning travelers from affected countries and reflects West African diaspora
population centers and jurisdictions with enhanced airport entrance screenings.
9
Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities FOA
https://www.grants.gov/web/grants/view-opportunity.html?oppId=274709.
9
�the Part B awardee to provide lead support for regional planning for the development of the
regional network for Ebola care in addition to developing, supporting, and maintaining center
capabilities to provide immediate and effective care to a patient with Ebola.
National Ebola Training and Education Center (NETEC)
Key lessons learned from the initial health care system response to Ebola cases include the
importance of protecting the health care workforce and the critical role of early case recognition
in improving outcomes, given the clinical complexity of caring for a patient with Ebola. Building
on these fundamental lessons, ASPR and CDC partnered to allocate $24 million in emergency
Ebola funds to establish the NETEC. The NETEC is funded through a five-year CDC and ASPR
joint cooperative agreement that began in 2015. The NETEC uses HHS funding to support the
regional treatment network by leveraging public and private expertise to share promising
practices and scale activities to address Ebola. More information about NETEC is provided in a
separate section below.
Health Care System Training Simulation and Quarantine Center for Ebola and Other
Special Pathogens
Through evaluation of the domestic Ebola response, HHS also found a significant gap in
quarantine capacity in the U.S. health care delivery system. The U.S. lacked adequate space to
monitor individuals coming to the U.S. who may have been exposed to Ebola patients from
impacted regions. To close this gap, HPP awarded nearly $20 million to the University of
Nebraska Medical Center (UNMC) for a training, simulation, and quarantine center. Upon
completion in 2018, this center will provide simulated clinical training to federal responders (the
National Disaster Medical System and the U.S. Public Health Service Commissioned Corps)
and now has the capacity to quarantine up to 20 individuals simultaneously, if necessary, on the
UNMC campus.
10
�Section III: The State of Preparedness
Regional Treatment Network
Performance Measurement Strategy
Prior to the 2014-2015 Ebola outbreak, the
U.S. did not have a systematic approach to
preparing for and responding to an outbreak
of a highly infectious special pathogen.
Through HHS’ investments, specifically the
HPP Ebola Preparedness and Response
Activities cooperative agreement and
NETEC, the U.S. health care system has
achieved marked progress in the
development of a regional network of tiered
hospitals specifically for Ebola and other
special pathogens.
HPP Ebola Cooperative Agreement
Performance Measurement
As required in the HPP Ebola Preparedness
and Response Activities cooperative
agreement, HPP collects annual performance
measures data, which allow the U.S.
government to evaluate and monitor the
“state of preparedness” across the U.S. HPP
collects and analyzes quantitative and
qualitative data from awardees, regional
Ebola and other special pathogen treatment
centers, state or jurisdiction Ebola treatment
centers, assessment hospitals, and health
care coalitions to understand
comprehensively the strengths, progress,
and gaps across the regional treatment
network. 10 At the request of the House
Committee on Appropriations, the
Department also details the U.S. regional
treatment network’s state of preparedness at
a system and tier level for clarity and to
demonstrate how each tier and the
overarching regional treatment network are
progressing against the required capabilities
needed to ensure health security in the
emerging infectious disease space.
10
Report of the Independent Panel
on the HHS Ebola Response
In the immediate aftermath of the
Ebola outbreak, the Secretary of HHS
tasked ASPR with convening an
independent expert panel to review
the HHS Ebola response and provide
recommendations on improving the
Department’s preparedness and
response efforts.
The independent panel released its
findings in the June 2016, Report of
the Independent Panel on the U.S.
Department of Health and Human
Services (HHS) Ebola Response.
Shortly thereafter, the Department
released the U.S. Department of
Health and Human Services Ebola
Response Improvement Plan,
outlining how the panel’s findings and
recommendations would be
addressed. The independent panel
report captured many of the
overarching systematic gaps that
prevented the U.S. from being
adequately prepared for its first Ebola
case in 2014.
The panel found that the U.S.
government was not prepared to
activate a coordinated response and
did not anticipate complications
associated with establishing domestic
Ebola treatment centers.
Furthermore, federal, local, and state
governments issued conflicting
guidance for response measures (e.g.,
waste management).10 The panel’s
report and the Department’s response
plan captured key lessons learned
from the domestic response to the
2014-2015 Ebola outbreak that serve
as a foundation for building and
assessing the regional treatment
network’s state of preparedness.
At the time the Department prepared this report, year one (2015-2016) HPP Ebola performance and impact data were available.
11
�National Ebola Regional Training and Education Center: Role and Progress in Support of
Regional Treatment Network Readiness
NETEC’s Role, Purpose, and Achievements
The NETEC’s purpose is to increase the competency of
the health care and public health workforce and improve
the capability of health care facilities to deliver safe,
efficient, and effective care to patients with Ebola and
other special pathogens. Although it is a separate entity
from the actual tiers, the NETEC’s establishment and
ongoing support of the regional treatment network is
critical to elevating the nation’s state of readiness for an
Ebola or other special pathogen threat.
The NETEC is a consortium of the three U.S. health
Figure 3: Regional Ebola
facilities that safely and successfully treated a confirmed
Treatment Network and NETEC
Combined Logo
patient with Ebola in the U.S. during the 2014-2015
outbreak: Emory University in Atlanta, Georgia; UNMC in
Omaha, Nebraska; and the New York City Health and Hospitals Corporation/HHC Bellevue
Hospital Center in New York, New York. NETEC experts work directly with ASPR and CDC to
provide direct training, peer assessment, and technical consultation with health care facilities to
support their preparedness efforts for Ebola and other special pathogens. Many of the
NETEC’s activities directly benefit the regional treatment network, including NETEC metrics that
assess facility and workforce readiness for Ebola patient care; annual, on-site peer
assessments at regional Ebola and other special pathogen treatment centers and state or
jurisdiction Ebola treatment centers; and a suite of educational resources including exercises
and trainings related to care of patients with Ebola or other special pathogens.
Since its establishment in 2015, the NETEC has proven to be a unique national resource that
has supported the tiered, regional treatment network through education and collaboration. From
June 2015 through July 2017, the NETEC developed metrics to measure facility and health care
worker readiness to care for patients with Ebola and other special pathogens; trained over 3,000
participants in special pathogens readiness trainings; and completed annual site visits and
readiness assessments at each of the 10 regional Ebola and other special pathogen treatment
centers, among other accomplishments outlined in the table below. The NETEC releases an
annual report that outlines its activities, site assessment findings, areas for improvement, and
recommendations for strengthening national capabilities for an Ebola or special pathogens
outbreak response; the NETEC Annual Report FY 2016 will be referenced throughout this
report. 11 Table 3, provided below, outlines selected NETEC year one and year two
accomplishments.
Table 3: NETEC Key Achievements, 2015-2017
June 2015-June 2016 (Year One)
June 2016-June 2017 (Year Two)
•
•
•
One hundred percent of HHS regions were
represented at the May 2016 Regional Ebola
Treatment Center Summit hosted by NETEC;
Ten domains were developed by NETEC to
measure facility and health care worker readiness
•
Fifteen facilities assessed for readiness in 14 U.S.
states or territories;
Forty states, the District of Columbia, and five U.S.
territories represented at in-person trainings;
11
NETEC Annual Report FY 2016
https://netec.org/wp-content/uploads/2017/05/NETEC-Annual-Report-FY-2016_v7_111016-Final.pdf.
12
�June 2015-June 2016 (Year One)
•
•
•
•
•
•
•
•
to care for patients with Ebola and other special
pathogens;
NETEC visited all 10 HHS designated regional
Ebola and other special pathogen treatment
centers for readiness assessments;
Five NETEC faculty members took part in five
symposia and exercises in Hawaii, Louisiana,
Maryland, Minnesota, and New Jersey;
Thirty-four exercise design templates were
developed by NETEC for use in an Ebola exercise;
Six readiness assessment state visits were
conducted by NETEC in Hawaii, Idaho, Illinois,
New Jersey, Texas, and at the Chicago Ebola
Response Network;
NETEC.org website received 1,058 page views;
Four didactic Ebola preparedness courses were
conducted by NETEC faculty;
Thirty-two clinicians participated in hands-on
practice of several skills needed to care for a
patient with Ebola at NETEC’s one clinical Ebola
preparedness simulation course; and,
Three hundred eighty attendees participated in
the clinical course and the four didactic Ebola
preparedness courses conducted.
June 2016-June 2017 (Year Two)
•
•
•
•
•
•
•
•
•
•
Twenty-four educational activities held, including
eight immersive simulation scenarios used for
training;
NETEC educational activities reached 3,490
people (189 percent increase since year one);
Six new and 38 updated exercise design templates
were developed;
Six hundred and six technical assistance
requests addressed;
NETEC.org website received 31,687 page views;
One hundred thirty-eight people attended the
2017 NETEC Regional Ebola Treatment Center
Summit, representing all 10 regional Ebola and
other special pathogen treatment centers;
Health care facility self-assessment tool developed
and implemented: 132 self-assessment metrics
were reviewed and revised by 20 subject matter
experts;
Health care facility on-site assessment process
developed and implemented: 23 capabilities
developed;
Special Pathogens Research Network established;
and,
A 24/7/365 phone line established for emergency
consultation with federal partners and health care
facilities requiring assistance with patients
suspected of or proven to have infections with
special pathogens.
NETEC’s Hospital Readiness and Assessment Activities
The NETEC’s activities and assessments have benefits across all four tiers of the regional
treatment network. Regional Ebola and other special pathogen treatment centers work most
closely with the NETEC to guide investment, development, training, and exercising for
advanced treatment capabilities.
NETEC experts worked with CDC and ASPR to conduct non-punitive, non-regulatory, nonaccreditation assessment site visits at hospitals. In 2016 and 2017, NETEC experts conducted
annual site visits to the nation’s 10 regional Ebola and other special pathogen treatment
centers; these visits facilitated best practice sharing and also allowed for experts to assess
regional Ebola and other special pathogen treatment centers’ strengths and gaps. In the
NETEC Annual Report FY 2016, NETEC’s experts outlined year one (2015-2016) aggregated
insights from their site assessments at regional Ebola and other special pathogen treatment
centers and described the focus areas where regions felt the least and most prepared. The
NETEC found that in the first year, regions felt least ready in the areas of clinical care and
special populations, pre-hospital transport plans, and management of the deceased. According
to NETEC analysis, regions felt most prepared in patient placement, PPE and procedures for
donning and doffing, and staffing, training, and management of the patient care team. Further
analysis of where regional Ebola and other special pathogen treatment centers are the least and
most ready is detailed in Figure 4 below.
13
�Domain where Regional Ebola & Other Special Pathogen Treatment Centers are Least ready
Domain 6: Clinical Care & Special Populations
Domain 2: Pre-hospital Transport Plans, EMS ED Preparedness
Domain 10: Management of the Deceased
Domain 4: Staffing, Training & Management of Patient Care Team
Domain 1: Emergency Management & Facility Preparedness
Domain 5: PPE & Procedures for Donning and Doffing
Domain 9: Management of Waste
Domain 3: Patient Placement
Domain 8: Environmental Infection Control and Equipment
Domain 7: Laboratory Safety
Percentage (n=83)
39%
16%
14%
10%
7%
5%
4%
2%
2%
1%
Domain where Regional Ebola & Other Special Pathogen Treatment Centers are Most ready
Domain 3: Patient Placement
Domain 5: PPE & Procedures for Donning and Doffing
Domain 4: Staffing, Training & Management of Patient Care Team
Domain 2: Pre-hospital Transport Plans, EMS ED Preparedness
Domain 7: Laboratory Safety
Domain 1: Emergency Management & Facility Preparedness
Domain 8: Environmental Infection Control and Equipment
Domain 9: Management of Waste
Domain 10: Management of the Deceased
Domain 6: Clinical Care & Special Populations
Percentage (n=88)
26%
23%
20%
14%
7%
3%
3%
2%
2%
1%
Figure 4: NETEC Regional Readiness Year One Findings 12
The NETEC’s year two (2016-2017) site assessments initial results show that treatment and
care (specifically special population care), laboratory, external transport, and staff and family
well-being within health care worker management are areas for growth in future years. The
NETEC developed mitigation strategies to provide targeted training, technical assistance, and
resources in year three (2017-2018) to address these gaps. The NETEC works with hospital
partners to proactively identify current barriers and areas of future need, enabling NETEC to
develop recommendations and provide appropriate support.
In 2017, the NETEC hosted a Regional Ebola Treatment Summit; 138 individuals attended from
all 10 regional Ebola and other special pathogen centers, CDC, and ASPR. These regional
partners shared innovations and best practices, engaged in breakout groups in key topic areas,
discussed national gaps, and developed working groups to address ongoing challenges in the
maintenance and advancement of the regional treatment network. During the Summit,
attendees identified the following regional or national issues as requiring further discussion or
guidance:
•
•
•
•
•
Laboratory specimen transportation;
Coordinating regional EMS transportation;
PPE validation, standardization, and training;
Sustaining funding and stakeholder engagement; and,
Waste management and transportation.
In year three, NETEC aims to expand its online course offerings, host courses at partner
facilities, and continue to provide specialized courses such as a Clinical Pediatrics Infectious
Disease Simulation course. Throughout the next year, NETEC plans to increase the number of
online resources and will establish a repository to increase accessibility of NETEC guidance,
protocols, and educational materials. Through the remaining three years of the cooperative
12
NETEC Annual Report FY 2016
https://netec.org/wp-content/uploads/2017/05/NETEC-Annual-Report-FY-2016_v7_111016-Final.pdf.
14
�agreement, NETEC will continue to conduct annual site assessments at regional Ebola and
other special pathogen treatment centers. The NETEC’s year one and two findings inform its
future training and educational activities for regional Ebola and other special pathogen treatment
centers, which will enable continued learning and advancement of enhanced capabilities at this
“top tier” of the regional treatment network.
Progress and Capabilities by Tier
As described earlier in this report and detailed in Table 1, all U.S. acute health care facilities
have a role in preparing to identify, evaluate, and facilitate treatment for patients under
investigation for Ebola and other emerging infectious diseases. HPP awardees are required to
report annually on a small set of ASPR-defined performance measures that will demonstrate or
show progress toward the accomplishment of program outcomes of the cooperative agreement.
There are specific HPP performance measures that measure readiness at each tier of the
regional treatment network; selected year one findings and associated strategies are outlined in
the tier-specific sections below.
Regional Ebola and Other Special Pathogen Treatment Centers
The regional Ebola and other special pathogen treatment centers are the cornerstone of the
regional treatment network. These advanced, leading patient-care centers are encouraged to
work outside of state lines to truly collaborate within their regions and the greater U.S. to
support planning, coordination, and development of innovative treatment protocols and
practices that benefit the regional treatment network as a whole.
HPP has eight distinct performance measures that guide and account for foundational planning
and exercise activities for the regional Ebola and other special pathogen treatment centers. 13
The planning performance measures ensure the regional Ebola and other special pathogen
treatment centers are engaging the correct stakeholders within their region. This required
engagement promotes better coordination between all facility tiers within a region. Regional
Ebola and other special pathogen treatment centers were largely successful in meeting their
required planning goals in the initial budget period:
•
•
•
13
One hundred percent of regional Ebola and other special pathogen treatment centers
coordinated with public health and emergency management leaders and elected
officials, such as governors, to ensure permissible movement of patients between
states.
Eight of the nine regional Ebola and other special pathogen treatment centers had
100 percent participation rate from their region’s states and jurisdictions in the
development of the regional concept of operations (CONOPS).
Four regional Ebola and other special pathogen treatment centers were successful in
ensuring a written and signed agreement was in place to transfer patients from
assessment hospitals or Ebola treatment centers to the regional Ebola and other
special pathogen treatment center. ASPR recognizes that this measure will be an
area for improvement in future years, as the regional treatment network relies on
clearly defined, tactical plans and protocols for the transport of patients between the
different facility tiers.
Please note, at the time of writing, HPP had budget period one data available (June 2015-June 2016); HHS region 9 did not have
a regional treatment center during the first budget period.
15
�The regional Ebola and other special pathogen treatment center performance measures also
account for workforce training, in addition to investment in essential, advanced treatment
equipment and infrastructure needed to care for a patient with Ebola or other special pathogen.
HPP’s requirements allow for regional flexibility and encourage regional Ebola and other special
pathogen treatment centers to invest in the PPE and infrastructure their facility needs to ensure
their facility’s infrastructure is ready and policies are established to accept a patient with Ebola
or emerging infectious disease within eight hours of notification. Key year one capability
progress includes:
•
•
•
Five hundred eighty-four total rostered staff across the regional Ebola and other
special pathogen treatment centers were pre-identified to provide care for patients
with confirmed Ebola; 98 percent of these pre-identified rostered staff received
quarterly training in infection control, safety, and care for a patient with Ebola.
One hundred percent of regional Ebola and other special pathogen treatment centers
have seven days of PPE supply on hand, as recommended by CDC; 100 percent of
centers also have a plan for just-in-time acquisition of PPE for additional needs.
Seven of the nine regional Ebola and other special pathogen treatment centers have
an on-site, high volume autoclave or incinerator to handle Ebola-contaminated or
other highly-contaminated infectious waste.
Finally, the regional Ebola and other special pathogen treatment centers practiced their ability to
activate improved response capabilities in each region. All of the regional Ebola and other
special pathogen treatment centers conducted quarterly exercises that incorporated
unannounced first-person drills, patient transport, and patient care simulation and were
successful in meeting the HPP exercise goals.
Ebola Treatment Centers
The regional treatment network depends on the willingness and capabilities of a small number
of acute health care facilities distributed throughout the U.S. to care for a patient with Ebola or
another highly infectious special pathogen for the duration of their illness. HHS overcame
significant challenges to establish the first Ebola treatment centers. In its report, the
Independent Panel on the HHS Ebola Response found that costs and concerns around
contagion initially discouraged hospitals from volunteering to serve as Ebola treatment
centers. 14 Given these barriers, it is a significant achievement that the Department was able to
quickly establish a network of these higher capability facilities.
As of July 2017, there are currently 63 state- or jurisdiction-designated Ebola treatment centers
across the nation. 15 During the first budget period, awardees allocated $47.3 million to support
preparedness activities at Ebola treatment centers. HPP requires Ebola treatment centers to
participate in and report back on regional planning, training, and exercise activities in
coordination with other members of the regional tiered system. HPP Ebola performance
measures for this tier test are accessibility of the facility’s PPE supply; whether facility staff are
trained in proper PPE donning and doffing protocol; the facility’s effectiveness and efficiency in
preparation to admit an Ebola patient; facility communication systems; and, capability of a
facility to fulfill Ebola or other special pathogen staffing needs. First-year data and performance
14
Report of the Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response
https://www.phe.gov/Preparedness/responders/ebola/EbolaResponseReport/Pages/default.aspx.
15
The number of state- or jurisdiction-designated Ebola treatment centers does not include the regional Ebola and other special
pathogen treatment centers.
16
�results from the HPP Ebola cooperative agreement associated with the state of readiness for
Ebola treatment centers include the following:
•
•
•
•
•
•
One-hundred-twelve percent (7,046 of 6,265) of rostered staff 16 in Ebola treatment
centers across the U.S. are trained in safely donning and doffing PPE (goal is 100
percent). HPP recognizes that this performance measure may exceed 100 percent
because more staff were trained in PPE use than the number of staff pre-identified to
care for a patient with Ebola. HPP will assist awardees in understanding how to
report this data in future performance years. 17
Ninety-six percent of Ebola treatment centers met the goal of accessing their PPE
supply within 10 minutes of a suspected Ebola patient’s arrival.
Ebola treatment centers averaged approximately 33.7 hours to execute required justin-time refresher trainings on Ebola care protocols and procedures with their
identified treatment staff. Every facility met the 72-hour target.
Ebola treatment centers averaged 11.8 hours to prepare their facility to be fully ready
to admit a suspected patient with Ebola; the goal is 72 hours. Every Ebola treatment
center met the 72-hour goal.
Sixty-five percent, or 4,073 of 6,265, of the rostered staff were contacted by the
hospital within four hours of a patient confirmed with Ebola or other special pathogen
admitted to a regional Ebola and other special pathogen treatment center (goal is
100 percent).
Eighty-nine percent, or 3,612 of 4,073, of the contacted rostered staff indicated that
they are able to fulfill Ebola-related staffing needs within 72 hours (goal is 100
percent).
In subsequent budget years, HPP will continue to track Ebola treatment center activities to
ensure facilities across this tier have and maintain the required capabilities to respond to an
Ebola or other special pathogen outbreak. The majority of state- or jurisdiction-designated
Ebola treatment centers met the HPP exercise targets in year one. To help these Ebola
treatment centers enhance their capabilities for other special pathogens outside of Ebola, the
NETEC has developed a special pathogen (airborne) tabletop exercise template.
“The program [HPP Ebola Activities] has had a profound, positive impact through the multiple tabletop,
functional and full-scale exercises, and trainings that have been provided as a direct result of the HPP
Ebola funding.” (HPP Part A awardee)
Ebola Assessment Hospitals
Assessment hospitals are pre-designated facilities that are prepared to receive and isolate a
patient under investigation and have the capabilities to care for the patient until an Ebola or
other special pathogen diagnosis can be confirmed or ruled out. The HPP FOA recommends
that the 18 states/jurisdictions at higher risk for Ebola will have assessment hospitals located
within 75 miles of at least 85 percent of their returning traveler populations. All other
states/jurisdictions will have at least one assessment hospital. 18 This geographic guidance aims
16
Rostered staff are individuals that have been pre-identified to provide ongoing care and treatment to patients with confirmed Ebola
or under investigation for Ebola.
17
It is possible that facilities trained a higher number of staff in donning and doffing PPE than the number of staff they identified to
provide Ebola care.
18
EP-U3R-15-002 Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities FOA
https://www.grants.gov/view-opportunity.html?oppId=274709.
17
�to ensure a sufficient number of facilities are prepared for assessment activities across the
regional treatment network.
In the first year of the HPP Ebola cooperative agreement, awardees reported that 217 U.S.
hospitals 19 across the U.S. serve as Ebola assessment hospitals. During the first year of the
HPP Ebola cooperative agreement, awardees allocated $26.4 million to support Ebola
assessment hospitals.
HPP has seven required performance measures to assure and test readiness at the
assessment hospital tier; these measures are primarily tested through exercise. These
performance measures are tactical in nature, and test at the facility-level how quickly patients
are isolated upon arrival, the accessibility of the proper PPE, and proportion of health care
facility and EMS workers in the appropriate PPE that come into contact with the suspected
Ebola patient. First-year data and performance results from the HPP Ebola cooperative
agreement associated with the state of readiness for Ebola assessment hospitals include the
following:
•
•
•
•
Assessment hospitals averaged 147 seconds to isolate a patient under active
monitoring for Ebola symptoms upon arrival to the facility (goal is 60 seconds); 108
of the reporting assessment hospitals met the 60-second goal.
Assessment hospitals averaged 8.5 minutes to isolate a patient suspected with
Ebola following an emergency department triage, as evidenced by an exercise (goal
is five minutes).
Two hundred two, or 93 percent, of assessment hospitals reported the ability to
access their PPE supply within 10 minutes of a suspected Ebola patient’s arrival or
notification of potential arrival.
More than 26,000 assessment hospital emergency department staff and nearly
20,000 intensive care unit staff were trained on infection control.
In many cases, the year one data outlined above reflects a facility’s first attempt at an exercise
that practices an Ebola or other special pathogen event. HPP will continue to administer
technical assistance and other educational and exercise support at the assessment hospital tier
for the remainder of the five-year cooperative agreement project period.
The NETEC also developed resources, exercises, and templates tailored to assessment
hospitals that should facilitate improvement in readiness. Assessment hospitals have access to
the NETEC’s tabletop exercise template and assessment hospital special pathogen (airborne)
tabletop exercise template to practice skillsets required to respond to an Ebola or other special
pathogen outbreak. In the NETEC’s second year (2016-2017), assessment hospital
representatives made up the largest proportion of in-person training participants (24 percent).
Frontline Health Care Facilities
The overwhelming majority of U.S. acute health care facilities that are equipped for emergency
care fall into this tier. In the first year of the HPP Ebola cooperative agreement, awardees
reported a total of 4,845 frontline facilities across the U.S. Frontline facilities are acute care
centers that are not designated as Ebola assessment hospitals or Ebola treatment centers, but
19
It is also important to note that per HHS guidance, states and jurisdictions have flexibility in implementing the tiered approach. In
some cases, a hospital may be prepared to serve in more than one role. Some hospitals may serve simultaneously as an Ebola
assessment hospital and as an Ebola treatment center.
18
�may encounter a suspected Ebola or other special pathogen if a patient were to access the
health care system. ASPR requires HPP Ebola Part A funding awardees to include frontline
facilities in readiness-building. The most important capabilities for frontline facilities are having
the systems and trained workforce in place to initially identify and isolate a patient; understand
how to access, don, and doff PPE; and, coordinate transportation for the patient to an
assessment or treatment facility. These exact competencies are tested in NETEC-facilitated
exercises, which were developed and tailored specifically for frontline facilities participating in an
Ebola tabletop exercise or special pathogen (airborne) tabletop exercise.
First-year data and performance results from the HPP Ebola cooperative agreement associated
with the state of readiness for frontline health care facilities include the following:
•
•
Eighty-two percent, or 3,690, of frontline facilities received information from their
health care coalition on the quantity and location of their PPE supply within eight
hours of arrival of a patient under investigation for Ebola at a coalition member
facility (goal is 100 percent).
Fifty-three percent, or 2,572, of frontline facilities received coalition-funded training
(goal is 75 percent).
In subsequent performance years, ASPR expects a greater number of frontline facilities to
receive information on PPE in the target time period and an increased proportion of frontline
facilities to receive coalition-funded training. HPP has adjusted performance measures for
budget period two to allow for frontline facility participation in exercises for other special
pathogens, which should facilitate enhanced preparedness and response capabilities for
emerging infectious diseases other than Ebola.
Health Care Delivery System-Level Readiness
ASPR HPP’s Ebola Preparedness and Response Activities cooperative agreement have
contributed to a marked improvement in the U.S. health care system’s overall capabilities to
respond to an Ebola or other special pathogen outbreak. Prior to July 2014, nearly 85 percent
of HPP’s awardees felt “not prepared” or “slightly prepared” for an Ebola event. The most
recent available data, as of June 2016, show just over 65 percent of these awardees feel
“adequately prepared” or “very prepared” for an Ebola event. The regional Ebola and other
special pathogen treatment centers that serve as the regional assets for the network also
expressed improved perceptions of preparedness for their regions; the majority of regional
treatment centers went from “slightly prepared,” before July 2014, to “adequately prepared” as
of July 2016. In year one feedback, awardees outlined how HPP Ebola Preparedness and
Response funding and activities have contributed directly to the development of the desired
tiered-hospital approach within their jurisdiction, which will have a secondary impact by
improving preparedness for other special pathogens outbreaks at a health care system-level.
While there are defined capabilities tied to each tier of the regional treatment network, it is also
important to assess progress of system-level capabilities that enable the entire regional tiered
network to safely and successfully identify, isolate, assess, transport, and treat patients with
Ebola or patients under investigation for Ebola, and that it is well prepared for a future Ebola or
other special pathogen outbreak.
Concept of Operations (CONOPS) Planning
Awardees (both Part A and Part B) are required to report on important planning and exercising
activities at the conclusion of every budget period (performance year). HPP reporting
19
�requirements on performance measures promote better tactical planning and encourage
awardees to practice proactive self-awareness and accountability due to the objective nature of
the measures and associated guidance. Awardee CONOPS strategies must include
coordination plans with the regional treatment center, transportation procedures, and
communication protocols to notify health care partners and defined roles and responsibilities for
each facility tier within that awardee’s jurisdiction. Figure 5 below demonstrates Part A awardee
progress in CONOPS planning. These operating planning requirements provide the regional
treatment network with a strong foundation.
Stakeholder/CONOPS Requirement
Frontline Facilities
Assessment Hospital
Ebola Treatment Center
Air Transport
Regional Treatment Center
EMS
CONOPS includes communications plan for notifying health
care partners
CONOPS includes plan for intra-state patient transfer
CONOPS includes plan for inter-state transfer to regional
treatment center
Percent of the 62 Part A awardees that engage the
stakeholder/meet the CONOPS requirement
76%
84%
69%
71%
74%
82%
90%
89%
74%
Figure 5: CONOPS Planning in Year One (2015-2016)
Coordination Capabilities
Overall system-level preparedness in the regional
“This system has shown how to effectively
integrate hospitals, public health, EMS, and
treatment network depends on effective
other partners to accomplish increasing the
communication, collaboration, and coordination within
effectiveness and efficiency of the health care
the tiered hospital approach. Awardee feedback
system overall.”
provided to HPP points to the connection between
(HPP awardee)
ASPR funding, planning, and exercise activities
“Communications and information sharing
required through the HPP Ebola Preparedness and
capabilities have been dramatically affected
to include local and district plans that will
Response Activities cooperative agreement, and
increase the amount of communication
better coordination between health care system
among and between partners, as well as to
stakeholders who would need to be activated during
determine the kinds of information that can
an Ebola or special pathogen outbreak. As
and should be shared within the confines of
public health and healthcare to ensure risk to
demonstrated in the CONOPS graphic above, nearly
the public and health care workers is held to a
90 percent of awardees included a communications
minimum.”
protocol for notifying health care partners in their
(HPP awardee)
operational plans. Awardees have also repurposed
existing stakeholder workgroups, or established new ones, to focus on emerging infectious
disease preparedness and response activities. In year one, more than 270 health care
coalitions across the 10 HHS regions participated in a health care-associated infection
(HAI)/infection control advisory group, accounting for 57 percent of eligible health care coalitions
in awardee jurisdictions. In subsequent performance years, HPP will work with awardees to
20
�emphasize and assist engagement with HAI/infection control advisory groups to meet a goal
participation rate of 80 percent.
This type of institutionalized collaboration has immediate impacts, such as the development of
approved CONOPS, scaled trainings, or purchases of PPE, that enable sharing of promising
practices for Ebola patient care and workforce preparation within the regional treatment
network. Health care delivery system coordination has long-term benefits as well. New
awardee and regional health care partnerships built through Ebola preparedness activities may
support the maintenance of situational awareness for other emerging infectious disease threats
and encourage better coordination within health care systems overall. Health care system
coordination is a key overarching capability for which ASPR will continue to assess and support
progress in future supplemental funding years.
Transportation Capabilities
With regard to patient transportation, HPP Ebola supplemental funding awardees pointed to
challenges with engaging the correct patient transportation stakeholders (e.g., EMS) and
accounting for geographic complexities in their transportation planning (e.g., need for air
transport, intra-state transport) as a system-wide preparedness gap.
First-year data and performance results from the HPP Ebola cooperative agreement associated
with the state of readiness for system-level transportation capabilities include the following:
•
•
•
Approximately 50 percent of HPP Part A awardees identified issues around
transportation as an Ebola preparedness gap.
Fifty-four percent, or 1,021, of EMS agencies required to execute their jurisdiction’s
CONOPS were engaged in all phases of the Ebola and other special pathogen
preparedness process (goal is 100 percent).
NETEC identified two specific transport-related gaps: long-distance transport
planning related to air versus ground and integration of pre-hospital planning with
hospital planning. 20
HHS recognizes that the regional treatment network relies on effective transportation plans and
engagement of stakeholders to ensure that patients can be transferred safely between hospital
tiers. In response to this gap, the NETEC recommended that local stakeholders, including prehospital, public health, and hospital clinical and operational leaders, collaborate with state and
regional partners to determine the safest and most effective patient transport options. HPP has
also worked to develop resources, trainings, and exercises that help close transportation-related
gaps. These efforts include the following:
•
20
ASPR Technical Resources, Assistance Center, and Information Exchange
(TRACIE) used HPP Ebola funding to develop targeted EMS Ebola transportation
resources, including guidance documents (e.g., EMS Infectious Disease Playbook)
and training webinars.
NETEC Annual Report FY 2016
https://netec.org/wp-content/uploads/2017/05/NETEC-Annual-Report-FY-2016_v7_111016-Final.pdf.
21
�•
•
In April 2017, ASPR participated in the Operation
Tranquil Shift exercise to test the ability of the
nation’s health care system to provide safe medical
transport to American citizens infected with Ebola
while abroad. In this scenario, a cluster of 11
American health care workers were notionally
exposed to Ebola in Sierra Leone. During the
exercise, the mock patients were transported back to
five of the 10 HPP-funded regional Ebola and other
special pathogen treatment centers using specialized
biocontainment units. This exercise was funded by
the U.S. Department of State, which jointly led the
exercise together with ASPR.
Figure 5: Operation Tranquil Shift
In year two (June 2016-June 2017), the NETEC’s
facility self-assessments, on-site facility capabilities
assessments, and course evaluations clearly identified a need to expand the scope
of resources offered by the NETEC for EMS systems. As a result, NETEC
leadership established an expert EMS and pre-hospital workgroup to address EMS
needs across the NETEC’s metrics development, facility assessment, and training
and education activities. The role of the EMS and pre-hospital workgroup is to
evaluate standard operating procedures and guidelines for patient isolation and
transport, increase accessibility of EMS subject matter experts to providers, integrate
workgroup members into readiness assessment teams, review existing EMS metrics
for infectious disease transport, develop exercises to test EMS protocols, and
develop NETEC EMS training materials. Additionally, in year two, the NETEC
facilitated two immersive simulation courses that addressed patient transport.
HPP will continue to support awardees in addressing transportation-specific gaps in the
remaining years of its Ebola cooperative agreement funding support. ASPR has also supported
planning for Operation Tranquil Terminus, which will occur in late 2017. This exercise will test
the domestic air and ground patient movement capabilities of the U.S. health care system by
transporting nine patients from assessment hospitals to the regional Ebola and other special
pathogen treatment centers. EMS coordination is also tested in HPP-required exercises and in
NETEC exercise templates, both of which promote accountability and improvement in this
important aspect of the regional treatment network.
Waste Management Capabilities
The House Committee on Appropriations also recognized waste management as a key
parameter in its report request to the Department. During the 2014-2015 domestic Ebola
outbreak, the U.S. government faced challenges regarding guidance associated with
transporting and disposing of Ebola waste. The U.S. Department of Transportation (DOT)
regulations classify Ebola waste as a Category A infectious waste, meaning that there are more
stringent packaging and waste disposal requirements.
•
22
The Independent Panel on the HHS Ebola Response found that federal, state, and
local governments applied different policies and authorities for waste management
response measures. The panel found that nationally inconsistent transportation
procedures hindered movement of Ebola waste across state borders, and delays in
�•
clarifying Ebola waste packaging requirements caused facility-level waste
backlogs. 21
During year one, the NETEC identified waste management protocols as a notable
gap based on site assessment findings. Specifically, the NETEC identified a serious
gap in the lack of defined agreements and protocols for transporting medical waste
as Category A infectious substances.
In response to the identified gaps in Ebola waste management, HHS has actively supported the
evidence-based interagency CONOPS for waste management related to Category A agents.
The U.S. government initiated an extensive interagency coordination effort among ASPR, CDC,
the U.S. DOT, the U.S. Environmental Protection Agency, and the U.S. Department of Labor to
release Interim Planning Guidance for the Handling of Solid Waste Contaminated with a
Category A Infectious Substance. 22 The interim planning guidance is for local EMS, hospital, or
health care facility personnel, environmental officials, individuals involved in waste
management, and federal, state (or, in some jurisdictions, tribal or territorial), or local officials
who have to handle, transport, or dispose of waste from a person with a suspected or known
exposure to a Category A infectious substance. Interim planning guidance users can reference
this document to identify waste management considerations for their locality, develop or update
their waste management protocols and plans, and inform worker protection needs. 23
Further activities to close the waste management gaps identified, include:
•
•
•
HHS and the NETEC will continue to work with facility and transportation
stakeholders within the regional treatment network to understand and address any
questions stemming from the interim planning guidance. HHS’ involvement in
developing this guidance will support preparedness for other fatal, infectious
diseases that can be transmitted through contaminated waste.
In collaboration with ASPR and CDC, the NETEC will continue to conduct site
assessments and produce targeted educational materials based on identified gaps
and areas for improvement related to waste management. In year three, the NETEC
plans to develop online courses on waste management, autoclave use, and infection
control.
ASPR TRACIE has developed a topic collection of resources and guidance materials
for Ebola decontamination and waste management.
Section IV: Planning and Future Considerations
HPP and NETEC Plans in Support of the Regional Treatment Network
At the time of this report, awardees had just completed their second year of the HPP Ebola
Preparedness and Response Activities cooperative agreement in support of the regional
treatment network (May 2016-June 2017). Year two data was due to ASPR from awardees in
September 2017. ASPR expects to complete analysis and validation of these data by late 2017.
Many HPP awardees and facilities reported having met the Ebola performance measure goals
in the first year. Given the lessons learned during year one, and the Department’s desire to
strengthen and institutionalize the regional treatment network to prepare for other emerging
21
Report of the Independent Panel on the HHS Ebola Response
https://www.phe.gov/Preparedness/responders/ebola/EbolaResponseReport/Documents/ebola-panel.pdf
22
Interim Planning Guidance for the Handling of Solid Waste Contaminated with a Category A Infectious Substance
https://phmsa.dot.gov/staticfiles/PHMSA/DownloadableFiles/Files/Interim_Planning_Guidance_for_Handling_Category_A_Solid_Wa
ste.pdf
23
Ibid.
23
�infectious diseases, ASPR has developed modified performance measures that allow awardees
and facilities to prepare for other special pathogens. To be eligible to start planning and
exercising for a scenario other than Ebola, an awardee must successfully test and meet all
Ebola performance measures. The NETEC has also proactively worked to release exercise
templates for airborne special pathogens, in addition to Ebola exercise templates. The
Department and the NETEC’s efforts will help all facility tiers across the regional treatment
network maintain, diversify, and strengthen their Ebola and other special pathogen response
capabilities.
The NETEC plans to address identified gaps through targeted technical assistance and tailored
educational resources, and broaden their scope to focus on special pathogens other than Ebola.
The NETEC’s expanded and newly established activities 24 include:
•
•
•
•
Metrics, Readiness Assessment, and Annual Readiness Reports;
Establish Educational Curricula and Develop Educational Materials, Resources, and
Tools;
Virtual Technical Assistance; and,
Creation of the Special Pathogens Research Network.
NETEC’s newest effort to create a Special Pathogens Research Network demonstrates its
ability to incorporate lessons learned and proactively explore system-wide opportunities for
improvement in the regional treatment network. In subsequent years, the NETEC will continue
to serve as a coordinated public-private partnership to strengthen the nation’s health security
through preparing heath care facilities throughout the U.S. for Ebola and other special
pathogens.
Ongoing HHS Ebola Response Improvement Plan Activities
ASPR currently serves as the lead coordinator at HHS for delivering semiannual status reports
on the HHS Ebola Response Improvement Plan (ERIP). In this role, ASPR monitors progress
on specific Department action items that are relevant to the regional treatment network’s
capabilities. For example, HHS will incorporate outcomes from an ongoing study by the CDC
National Institute for Occupational Safety and Health (NIOSH) on PPE use, burn rate, and
stockpiling. Since 2015, NIOSH has collaborated with Vanderbilt University Medical Center,
Nashville, Tennessee, and other federal and academic partners to develop a PPE surveillance
system to track equipment use and anticipate shortages. In August 2015, the project was
expanded to incorporate Ebola PPE use. Findings from this surveillance can inform promising
practices for Ebola and other special pathogen PPE storage and use in the regional treatment
network.
The HHS ERIP also outlines HHS’ commitment to determine whether additional strategies could
be employed to ensure health care facilities participate in responding to future emerging public
health threats. As follow-up on that action, ASPR worked with MITRE and RAND Corporations
to conduct a study on the need for a formalized emerging infectious disease network. During
the course of this project, stakeholders provided extensive input on whether this health care
network could be built on the foundation of the regional Ebola treatment network. The final
report is pending and will contain analysis on the strategies required to ensure sufficient
geographic distribution, access, and capabilities of health care facilities for an emerging
infectious disease outbreak response. ASPR will consider this report’s findings and
24
“The National Ebola Training and Education Center: Preparing the United States for Ebola and Other Special Pathogens” Health
Security Volume 15, Number 3 (2017).
24
�recommendations as it plans future support for the HPP-funded regional treatment network for
Ebola and other special pathogens.
Future Considerations
Global trends, such as the increasing mobility of
In 2015, a New Jersey hospital used
people and products, have contributed to an amplified
HPP funds to effectively and safely
likelihood of an emerging infectious disease
manage a viral hemorrhagic feveroutbreak. 25 Recent international incidents of emerging
Lassa fever patient from time of
infectious disease outbreaks, such as Lassa fever
admission to decedent management.
cases in West Africa and an Ebola outbreak in the
Zero hospital staff who came into
contact with the Lassa patient became
Democratic Republic of the Congo, illustrate the
infected. This case illustrates how
continued risk of an imported special pathogen incident
HPP-funded training and equipment
in the United States and highlight the need for
investments prepare for emerging
maintained readiness to respond. In the event of a
infectious diseases other than Ebola.
future special pathogen threat, hospitals will most likely
be the first place that new disease threat is recognized.
The tiered, regional treatment network developed following the 2014-2015 Ebola outbreak is a
foundational asset to the nation’s health security and has proven to be applicable to other
special pathogens and emerging infectious diseases.
When asked to describe the impact of the HPP Ebola Preparedness Response Activities
funding on overall preparedness for an Ebola or other special pathogen event, more than a third
of Part A and Part B awardees explained how HPP has had tangible impacts on their health
care system’s preparedness for other special
“The focus on Ebola has been a
pathogens and infectious disease readiness overall.
catalyst for improved infection
Many of these awardees credited the Ebola outbreak’s
prevention and control practices for all
visible impact on the U.S. health care system as a
infectious diseases (not just Ebola).
catalyst
for enhanced preparedness measures.
Awareness of patient screening
techniques, and the need to continue
asking travel questions for all
infectious diseases worldwide has
been acknowledged and embraced
throughout the health care and public
health community.” (HPP awardee)
The Department recognizes that initial momentum and
awardees’ rapid buildup of required response
capabilities will require continued attention to maintain
and improve capabilities. Predictable forces, such as
the need for equipment maintenance and replacement
of PPE used in exercises and turnover of trained and
pre-identified staff, will be a challenge for facilities at all tiers across the regional treatment
network. HPP’s initial emergency funding stream has proven critical in developing the
foundational capabilities for the regional treatment network; sustained funding will be just as
important to maintain and build upon accomplishments.
25
Globalization and infectious diseases: A review of the linkages.
http://www.who.int/tdr/publications/documents/seb_topic3.pdf
25
�In the Independent Panel Report on the HHS Ebola Response, the outside panel of experts
found that the U.S. government did not anticipate the complications associated with establishing
Ebola treatment centers and other domestic preparedness measures. Many facilities were
initially resistant to volunteer for treatment center designations because of public perception and
lost revenue concerns. These barriers, which HPP activities helped mitigate through its
supplemental funding, highlight the need to maintain the
progress that has been achieved in institutionalizing the
“Continuing education,
regional tiered approach. 26
personnel hours dedicated to
Sustained funding would support ongoing education and
capability maintenance activities at the frontline and
assessment hospitals that serve as the nation’s first line of
defense. State- and jurisdiction-designated Ebola treatment
centers and the 10 regional Ebola and other special
pathogen treatment centers also require a funding stream to
continue their progress in developing and maintaining
advanced capabilities. Additionally, the HPP-funded NETEC
requires ongoing funding to continue its role as the key
convener of these hospital tiers and as the platform for
collaborative development of innovative strategies to improve
preparedness for Ebola and other special pathogens.
donning and doffing properly
have been a notable detriment
once funding is no longer
offered for these purposes.
Daily operational needs will
drive the training of personnel
instead of the ever continuing
threats from worldwide disease
concerns. Ongoing support to
infectious disease
preparedness is strongly
encouraged but may not be
embraced due to the daily
budgetary constraints.” (HPP
awardee)
The HPP Ebola supplemental funding has been instrumental
in establishing the regional treatment network, and continued federal investment will ensure that
readiness gains are maintained and enhanced in preparation for future emerging infectious
disease outbreaks.
Appendix A: HPP Ebola Preparedness Measures Year One Results
The Ebola Measures
There are 26 core Ebola measures that address both Part A (18 measures) and Part B (eight
measures). The data to support these measures will be collected by the awardee, coalitions,
Ebola treatment centers, and assessment hospitals for Part A, and the awardee and the
regional Ebola and other special pathogen treatment center for Part B. While the measures
primarily aim to address health care workforce training and patient care, much of the data will be
collected during training, exercises, and real-world events. Per the FOA, the awardee,
coalitions, Ebola treatment centers, and assessment hospitals must conduct annual exercises,
and regional Ebola and other special pathogen treatment centers must conduct quarterly
exercises. To ensure these exercises result in sufficient data for each measure, NETEC
develops exercise templates. These exercise templates are shared publicly and are accessible
to awardees, coalitions, and individual health care facilities to assist in capturing the required
metrics.
•
26
2015 HPP Measure Manual: Implementation Guidance for Ebola Preparedness
Measures
Report of the Independent Panel on the HHS Ebola Response
http://www.phe.gov/Preparedness/responders/ebola/EbolaResponseReport/Documents/ebola-panel.pdf
26
�Year One (2015-2016) Results
Year one results are presented below as they were reported to HPP in year one of the
cooperative agreement. Year one results are reported as a national average or aggregated to
provide a national proportion. As this was the first year of the HPP Ebola Preparedness and
Response Activities cooperative agreement, and the regional treatment network was stood up in
a compressed timeframe, there were certain challenges that reflect in select performance
measure results, which are noted in the tables below. HPP continues to work with its awardees
to streamline, clarify, and provide technical assistance on the objectives of the cooperative
agreement and on the required data reporting elements.
Develop a CONOPS
Number
HPP Part
Measure
Data Source
Year One Result
(national
average or
proportion)
1
A
Time, in minutes, it takes from an
assessment hospital’s notification to the
health department of the need for an interfacility transfer of a patient with confirmed
Ebola to the arrival of a staffed and
equipped EMS/inter-facility transport unit,
as evidenced by a no-notice exercise
(Goal: within 240 minutes or four hours).
Coalition or
assessment
hospital
exercise or real
event
148 minutes
Assure Readiness of Ebola Treatment Centers
Number
HPP Part
Measure
Data Source
Year One Result
(national
average or
proportion)
2
A
Proportion of rostered staff that are trained
in safely donning and doffing PPE) (Goal:
100%).
Ebola treatment
center measure
7,046/6,265
(112%) 27
3
A
Time, within hours, it takes for all rostered
staff, upon notification of a patient with
Ebola at the regional Ebola and other
special pathogen treatment center, to
receive just-in-time training (Goal: within 72
hours).
Ebola treatment
center exercise
or real event
33.7 hours
4
A
Time, within hours, until an Ebola treatment
center is ready to admit a patient with Ebola
as evidenced by an exercise or actual
patient transfer (Goal: within 72 hours of
confirmation of an Ebola patient at a
regional center).
Ebola treatment
center exercise
or real event
11.8 hours
27
It is possible that facilities trained a higher number of staff in donning and doffing PPE than the number of staff they identified to
provide Ebola care.
27
�Number
HPP Part
Measure
Data Source
Year One Result
(national
average or
proportion)
5
A
Proportion of rostered staff contacted by a
hospital within four hours of a patient with
confirmed Ebola’s admission to a regional
Ebola and other special pathogen treatment
center (Goal: 100%).
Ebola treatment
center exercise
or real event
4,073/6,265
(65%)
6
A
Proportion of rostered staff contacted that
indicated they are able to report to fulfill
Ebola-related staffing needs within 72
hours (Goal: 100%).
Ebola treatment
center exercise
or real event
3,612/4,073
(89%)
7
A
Proportion of Ebola treatment centers that
can access their PPE supply (e.g., know
location and have sufficient quantity of
unexpired supply) within 10 minutes of
patient with suspected Ebola transfer
notification or upon the patient’s arrival (if
no notification) (Goal: 100%).
Ebola treatment
center exercise
or real event
78/81 (96%)
Assure Readiness of Ebola Assessment Hospitals
Number
HPP Part
Measure
Data Source
Year One Result
(national
average or
proportion)
8
A
Time, in seconds, from active
monitoring/direct active monitoring
(AM/DAM) patient’s arrival to placement in
isolation at assessment hospital (Goal: <60
seconds).
Assessment
hospital
exercise or real
event
147 seconds
9
A
Time, in minutes, it takes an assessment
hospital to identify and isolate a patient with
Ebola or other highly infectious disease
(e.g., Middle East Respiratory Syndrome,
measles, etc.) following emergency
department triage, as evidenced by a realworld case or no-notice exercise (Goal:
within five minutes).
Assessment
hospital or
coalition
exercise, or
real world event
8.5 minutes
10
A
Proportion of health care and EMS workers
in PPE that an AM/DAM suspected Ebola
patient under investigation (PUI) makes
contact with after health department
notification to the assessment hospital or
Ebola treatment center (Goal: 100%).
Assessment
hospital
exercise or real
event
407/531 (77%)
11
A
Number of health care and EMS workers in
PPE that an AM/DAM suspected Ebola
patient makes contact with after health
department notification until isolation (Goal:
<3).
Assessment
hospital
exercise or real
event
Four health care
and EMS workers
in PPE
28
�Number
HPP Part
Measure
Data Source
Year One Result
(national
average or
proportion)
12
A
Proportion of emergency department staff
trained at least annually in infection control
and safety (Goal: 100%).
Assessment
hospital
measure
26,167/26,706
(98%)
13
A
Proportion of intensive care unit staff
trained at least annually in infection control
and safety (Goal: 100%).
Assessment
hospital
measure
19,640/20,991
(94%)
14
A
Proportion of assessment hospitals that can
access their PPE supply (e.g., know
location and have sufficient quantity of
unexpired supply) within 10 minutes of a
patient with suspected Ebola transfer
notification or arrival, if no notification
(Goal: 100%).
Assessment
hospital
exercise
202/217 (93%)
Develop HPP Capabilities to Enable their Members to Care for a Patient with Ebola
Number
HPP Part
Measure
Data Source
Year One Result
(national
average or
proportion)
15
A
Proportion of frontline facilities that receive
information from their coalition on the
quantity and location of PPE supply within
eight hours of a PUI’s arrival at a coalition
member facility (Goal: 100%).
Coalition
exercise
3,690/4,845
(76%)
16
A
Proportion of frontline facilities that have
received coalition-funded training (Goal:
75%).
Coalition
measure
2,572/4,845
(57%)
17
A
Proportion of EMS agencies that are
required to execute the awardee’s
CONOPS that are engaged in all phases of
the Ebola and other special pathogen
preparedness process (Goal: 100%).
Coalition and
awardee
measure
1,021/1,892
(54%)
18
A
Proportion of coalitions within an awardee’s
jurisdiction that participate in the
HAI/Infection Control advisory group (Goal:
80%).
Awardee
measure
270/482 (56%)
Supporting Regional Planning for the Development of a Regional Network for Ebola
Patient Care
Region 9 did not have a Part B awardee in year one of the HPP Part B cooperative agreement.
29
�Number
HPP Part
Measure
Data Source
Year One Result
(national
average or
proportion)
19
B
Time, within minutes, from confirmation of
patient with Ebola at assessment hospital
or Ebola treatment center to notification by
the health department and/or transferring
hospital (assessment hospital or Ebola
treatment center) to the health department
in the state/jurisdiction where the regional
Ebola and other special pathogen treatment
center is located about the need for patient
transfer (Goal: within 30 minutes).
Assessment
hospital or
Ebola treatment
center exercise
19.4 minutes
20
B
Proportion of member states/jurisdictions in
the region that have participated in the
development of the regional CONOPS
(Goal: 100%).
Part B awardee
measure
48/50 (96%)
21
B
Proportion of states/jurisdictions in the HHS
region for which a current written and
signed agreement is in place to transfer
patients from assessment hospitals or
Ebola treatment centers to the regional
Ebola and other special pathogen treatment
center (Goal: 100%).
Part B awardee
measure
27/50 (54%)
22
B
Proportion of states/jurisdictions in the HHS
region that have demonstrated the ability to
move a patient across jurisdictions by
ground or air to a regional Ebola and other
special pathogen treatment center, as
evidenced by a real-world event or
participation in a multi-jurisdiction exercise
(Goal: 100%).
Part B awardee
measure
30/50 (60%)
Developing, Supporting, and Maintaining Regional Ebola and Other Special Pathogen
Treatment Centers
Number
HPP Part
23
B
24
B
30
Measure
Data Source
Year One Result
(national average
or proportion)
Proportion of rostered staff at the regional
Ebola and other special pathogen treatment
center that received quarterly training in
infection control and safety and patient care
for a patient with Ebola (Goal: 100%).
Regional Ebola
and other
special
pathogen
treatment
center measure
570/584 (98%)
Part B exercise
or real event
2.3 hours
Time, within hours, it takes for the on-call
team to report to the unit upon notification
of an incoming patient with Ebola, as
evidenced by a real-world event or nonotice exercise (Goal: four hours).
�Number
HPP Part
Measure
Data Source
Year One Result
(national average
or proportion)
25
B
Proportion of rostered staff contacted by
the regional Ebola and other special
pathogen treatment center within four hours
upon notification of an incoming patient with
Ebola, as evidenced by a real-world event
or no-notice exercise (Goal: 100%).
Part B exercise
or real event
641/584 (110%) 28
26
B
Time, within hours, until a regional Ebola
and other special pathogen treatment
center is ready to admit a patient with
confirmed Ebola (adult or pediatric patient),
as evidenced by an exercise or actual
patient transfer (Goal: within eight hours of
notification).
Part B exercise
or actual
patient transfer
4.5 hours
HPP Ebola Performance Measures Glossary
All phases of the Ebola and other special pathogen preparedness process: All Phases
includes planning, training, exercising, and responding with other Ebola preparedness partners.
Actively monitored or directly actively monitored (AM/DAM): Active monitoring means that
the state or local public health authority assumes responsibility for establishing regular
communication with potentially exposed individuals, including checking daily to assess for the
presence of symptoms and fever, rather than relying solely on individuals to self-monitor and
report symptoms if they develop. Direct active monitoring means the public health authority
conducts active monitoring through direct observation.
Assessment hospital: Pre-designated facilities that are prepared to receive and isolate a PUI
for Ebola virus disease and care for the patient until an Ebola diagnosis can be confirmed or
ruled out and until discharge or transfer is completed.
Confirmation: Laboratory-confirmed diagnostic evidence of Ebola virus infection.
Contact: The hospital successfully contacted the staff member (and received a response) by
phone, email, or automated call-back system.
Doffing: The removal of used PPE; this is a high-risk process that requires a structured
procedure, a trained observer, and a designated area for removal to ensure protection.
Donning: The administration or act of putting on PPE.
EMS agencies required to execute the awardee’s CONOPS: EMS agencies that will provide
9-1-1 emergency medical services to suspected Ebola patients’ homes or other locations. Interfacility EMS agencies that will transport suspected or confirmed patients with Ebola between
frontline health care facilities, assessment hospitals, Ebola treatment centers, regional Ebola
and other special pathogen treatment centers, and airports.
28
It is possible that facilities contacted a higher number of staff than the number identified to provide immediate Ebola care.
31
�EMS/inter-facility transport unit: EMS agencies are those identified in the awardee’s
CONOPS to transport an AM/DAM patient to an Ebola assessment facility or to provide interfacility transport (e.g., from a frontline facility to an Ebola assessment/treatment facility or from
an Ebola assessment facility to an Ebola treatment facility).
Frontline facility: Frontline facilities are hospitals and other health care providers that are not
designated Ebola assessment hospitals or Ebola treatment centers but have the possibility of an
encounter with a patient with suspected Ebola if the patient were to access the health care
system outside of the AM/DAM program.
Healthcare-associated infection (HAI)/infection control advisory group: An advisory
committee charged with making recommendations on the prevention of health care-associated
infections.
Infection control and safety: Policies and procedures used to minimize the risk of spreading
infections, especially within health care facilities.
Inter-facility transport providers: Staff that support the transport between two entities, for
example, between an assessment hospital and an Ebola treatment center.
Isolation: Precautions that are taken in a health care facility to prevent the spread of an
infectious agent from an infected or colonized patient to susceptible persons. Isolation practices
can include placement in a private room or with a select roommate, the use of protective
barriers such as masks, gowns and gloves, and special handling of contaminated articles.
Just-in-time (JIT) training: Training that is conducted as a refresher to prepare for a patient
with Ebola, including donning and doffing, facility-specific protocols and procedures, and
care/treatment protocols.
No-notice exercise: Exercise that is given unannounced.
Notification: The definition of notification may vary relative to the context of the measure.
On-call team: Group of individuals that are pre-designated to staff the Ebola treatment unit at
the time of the patient’s scheduled arrival.
Participation: The involvement in the development, implementation, or sustainment of the
regional CONOPS.
PPE: Devices or equipment designated to provide protection while providing care for a
confirmed or suspected patient with Ebola.
PPE Access: The ability to identify the location and have sufficient quantity of unexpired supply
of PPE at the patient care location (e.g., emergency department, intensive care unit, Ebola
treatment unit).
Sufficient: The extent to which the availability of PPE supplies meets the pre-identified needs
(e.g., CDC guidelines, needs assessment, CONOPS).
Rostered staff: Individuals pre-identified to provide patient care for patients with confirmed
Ebola.
32
�Trained: Individuals who have completed Ebola infection control and safety training to
specifically include proper donning and doffing methods. (CDC Ebola Personal Protective
Equipment (PPE) Donning and Doffing Procedures)
Transfer agreement: Written, signed document that denotes a formal willingness to transfer
patients from assessment hospitals or Ebola treatment centers to regional Ebola and other
special pathogen treatment centers.
33
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Regional Treatment Network for Ebola and Other Special Pathogens
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.phe.gov/Preparedness/planning/hpp/reports/Documents/RETN-Ebola-Report-508.pdf
Dublin Core
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Title
A name given to the resource
Regional Treatment Network for Ebola and Other Special Pathogens
Subject
The topic of the resource
General
Creator
An entity primarily responsible for making the resource
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-11-01
Description
An account of the resource
This report, prepared by the Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (AS PR), Office of Emergency Management’s Division of National H ealthcare Preparedness Program s, is in response to a request by the House Committee on Appropriations in House Rep ort 114- 699 accompanying H.R. 5926, the Departments of Labor, H ealth and Human Services , and Education, and Related Agencies Appropriations Bill, 2017: <br /><br />Regional Treatment Centers — The Committee is aware that HHS has created a regional treatment network for future infectious disease outbreaks through a tier system using Ebola funds. T he Committee requests a report on the Department’s plans, including funding and timetables, for each tier outlining capabilities for infrastructure, training, and other key parameters , such as waste management. HHS should make a public version of the report available on the HHS website. (page 2)
Ebola
Epidemic
Federal
Outbreaks
Public Health
R-Gen
Special Pathogens
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Gibbs, Shawn G., Jocelyn J. Herstein, Aurora B. Le, Elizabeth L. Beam, Theodore J. Cieslak, James V. Lawler, Joshua L. Santarpia, Terry L. Stentz, Kelli R. Kopocis-Herstein, Chandran Achutan, Gary W. Carter, and John J. Lowe. 2019. "Review of Literature for Air Medical Evacuation High-Level Containment Transport." Air Medical Journal 38 (5):359-65.
Abstract
<div class="abstr">
<h3>Abstract</h3>
<div>
<h4>INTRODUCTION:</h4>
<p>Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD). We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs.</p>
<h4>METHODS:</h4>
<p>A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). Authors screened abstracts for inclusion criteria and full articles were reviewed if the abstract was deemed to contain information related to the aim.</p>
<h4>RESULTS:</h4>
<p>Our search criteria yielded 14 publications and were separated based upon publication dates, with the natural break point being the beginning of the 2013-2016 Ebola virus disease epidemic. Best practices and recommendations from identified articles are subdivided into pre-flight preparations, inflight operations, and post-flight procedures.</p>
<h4>CONCLUSIONS:</h4>
<p>Limited peer-reviewed literature exists on AE-HLCT, including important aspects related to healthcare worker fatigue, alertness, shift scheduling, and clinical care performance. This hinders the sharing of best practices to inform evacuations and equip teams for future outbreaks. Despite the successful use of different aircraft and technologies, the unique nature of the mission opens the opportunity for greater coordination and development of consensus standards for AE-HLCT operations.</p>
<p class="copyright">Copyright © 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.</p>
</div>
</div>
Accessibility
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Online with Elsevier or ClinicalKey
URL
https://www.ncbi.nlm.nih.gov/pubmed/31578975
Read Online
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https://www.airmedicaljournal.com/article/S1067-991X(19)30041-0/fulltext
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Title
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Review of Literature for Air Medical Evacuation High-Level Containment Transport.
Subject
The topic of the resource
Pre-Hospital
Description
An account of the resource
Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD).
Creator
An entity primarily responsible for making the resource
Gibbs, Shawn G., Jocelyn J. Herstein, Aurora B. Le, Elizabeth L. Beam, Theodore J. Cieslak, James V. Lawler, Joshua L. Santarpia, Terry L. Stentz, Kelli R. Kopocis-Herstein, Chandran Achutan, Gary W. Carter, and John J. Lowe.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10
Type
The nature or genre of the resource
Publication
Relation
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Y - D0.1Res/D0.2Res Qualtrics # 1311, original # 9
Contributor
An entity responsible for making contributions to the resource
2024-03-27 EMS/Pre-Hospital never reviewed – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Air Transport
Ebola
EMS
Epidemic
High Consequence Infectious Disease (HCID)
Isolation/Biocontainment
R-EMS
R-PreH
R-Res&Pub
Research
Special Pathogens
-
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Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Online Course
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URL
https://openwho.org/courses/risk-communication
Duration
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This course consists of an introductory video lecture, presentation slides that can be downloaded and reviewed at your own pace, and instructions for simulation exercises. Course duration may vary. It will take most participants approximately 8 hours to thoroughly complete all components.
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Free with free OpenWHO account.
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Risk communication essentials
Creator
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WHO
Subject
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Training and Exercises
Description
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Risk communication is a core public health intervention in any disease outbreak and health emergency. It refers to the real-time exchange of information, advice and opinions between experts, officials and people who face a threat to their wellbeing, to enable informed decision-making and to adopt protective behaviors. (WHO)
Date
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2018-07-05
Contributor
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2023-10-17 by Darrell Ruby, T & E group
Coverage
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2026-10-17
Emergency Management
Epidemic
Example
MERS-CoV
Pandemic
Public Health
R-Lead
R-T&E
-
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Discover
Description
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Stringhini, Silvia, Ania Wisniak, Giovanni Piumatti, Andrew S. Azman, Stephen A. Lauer, Hélène Baysson, David De Ridder, Dusan Petrovic, Stephanie Schrempft, Kailing Marcus, Sabine Yerly, Isabelle Arm Vernez, Olivia Keiser, Samia Hurst, Klara M. Posfay-Barbe, Didier Trono, Didier Pittet, Laurent Gétaz, François Chappuis, Isabella Eckerle, Nicolas Vuilleumier, Benjamin Meyer, Antoine Flahault, Laurent Kaiser, and Idris Guessous. 2020. "Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study." The Lancet.
Accessibility
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Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31304-0/fulltext
Read Online
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https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31304-0/fulltext
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Title
A name given to the resource
Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study
Subject
The topic of the resource
Research
Description
An account of the resource
Assessing the burden of COVID-19 on the basis of medically attended case numbers is suboptimal given its reliance on testing strategy, changing case definitions, and disease presentation. Population-based serosurveys measuring anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) antibodies provide one method for estimating infection rates and monitoring the progression of the epidemic.
Creator
An entity primarily responsible for making the resource
Stringhini, Silvia, Ania Wisniak, Giovanni Piumatti, Andrew S. Azman, Stephen A. Lauer, Hélène Baysson, David De Ridder, Dusan Petrovic, Stephanie Schrempft, Kailing Marcus, Sabine Yerly, Isabelle Arm Vernez, Olivia Keiser, Samia Hurst, Klara M. Posfay-Barbe, Didier Trono, Didier Pittet, Laurent Gétaz, François Chappuis, Isabella Eckerle, Nicolas Vuilleumier, Benjamin Meyer, Antoine Flahault, Laurent Kaiser, and Idris Guessous.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-11
Type
The nature or genre of the resource
Publication
2019-nCoV
Coronavirus
COVID-19
Epidemic
Laboratory Testing
Pandemic
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Joseph, Andrew, Helen Branswell, and Elizabeth Cooney. August 17, 2020. "Seven months later, what we know about Covid-19 — and the pressing questions that remain." Stat News.
Accessibility
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Free online - public article.
URL
https://www.statnews.com/2020/08/17/what-we-now-know-about-covid19-and-what-questions-remain-to-be-answered/
Read Online
Online location of the resource.
https://www.statnews.com/2020/08/17/what-we-now-know-about-covid19-and-what-questions-remain-to-be-answered/
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Title
A name given to the resource
Seven months later, what we know about Covid-19 — and the pressing questions that remain
Subject
The topic of the resource
General
Description
An account of the resource
Summary of the status of what is known about COVID-19.
Creator
An entity primarily responsible for making the resource
Stat News
Source
A related resource from which the described resource is derived
Joseph, Andrew, Helen Branswell, and Elizabeth Cooney.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-07 by Amyna, Special Populations Treatment & Care group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-07-31
Relation
A related resource
Y
2019-nCoV
Coronavirus
COVID-19
Epidemic
Outbreaks
Pandemic
Pediatrics
R-Res&Pub
R-SP
-
https://repository.netecweb.org/files/original/75493b04c70c06e990289e68854f85a3.pdf
5f446fdb08f02db6e6fb2341d57a28f7
PDF Text
Text
05-12-20
�
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Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Telemedicine Flyer
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Treatment & Care
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Telehealth: providing support, clinical care (education, administration, public health) to the client, or program planning at a distance.<br /><br />Go to the <a href="https://repository.netecweb.org/exhibits/show/ppe-cons/item/932">NETEC COVID-19 webinar on Telemedicine Innovations</a>.
Creator
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NETEC
Date
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2020-05-13
Coverage
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2023-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2019-nCoV
Coronavirus
COVID-19
Epidemic
Isolate
Pandemic
R-T&C
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Castanha, Priscila M. S., and Ernesto T. A. Marques. 2020. "Vaccine development during global epidemics: the Zika experience." The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30360-1/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30360-1/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Vaccine development during global epidemics: the Zika experience
Subject
The topic of the resource
Laboratory
Description
An account of the resource
The North and South American continents experienced a major epidemic of Zika virus in 2015–16, which infected up to 70% of the population in some areas.
Creator
An entity primarily responsible for making the resource
Castanha, Priscila M. S., and Ernesto T. A. Marques.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-06
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2023-12-18 skipped for review by Lab, bump to next round
Identifier
An unambiguous reference to the resource within a given context
Laboratory
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-04-01
Epidemic
Outbreaks
Pandemic
R-Lab
R-Res&Pub
Vaccine Study
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
URL
https://www.researchgate.net/publication/322664589_Working_with_people_and_communities_in_urban_humanitarian_crises
Citation
Citation information for the publication itself.
Campbell, L. (2017) ‘Working with people and communities in urban humanitarian crises’ ALNAP Working Paper. London: ODI/ALNAP.
Abstract
This Working Paper explores the topic of working with urban populations and communities. It draws on practical challenges and approaches in relation to targeting and communication with urban populations, and in the mobilisation of urban communities. The paper was informed by a literature review, as well as ALNAP’s ongoing urban webinar series and Community of Practice discussions, which have consistently raised these issues over the past few years. (4)
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free Online
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Working with People and Communities in Urban Humanitarian Crises
Subject
The topic of the resource
Emergency Management
Creator
An entity primarily responsible for making the resource
Active Learning Network for Accountability and Performance in Humanitarian Action
Source
A related resource from which the described resource is derived
Leah Campbell, author.
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-06-01
Type
The nature or genre of the resource
Publication
Description
An account of the resource
This Working Paper explores the topic of working with urban populations and communities.
Contributor
An entity responsible for making contributions to the resource
2024-02-26 by J. Mundy - updated the URL from ALNAP to ResearchGate, publication appears gone from ALNAP website.
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Communications
Ebola
Emergency Management
Epidemic
Epidemiology
Outbreaks
Public Health
Quarantine
R-EM
R-Res&Pub
Special Pathogens
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
http://www.who.int/ebola/en/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
World Health Organization Ebola Virus Disease Information
Creator
An entity primarily responsible for making the resource
WHO
Subject
The topic of the resource
General
Description
An account of the resource
WHO | World Health Organization
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Ebola
Epidemic
Follow up
Infection Prevention and Control
Outbreaks
Patient Care
Public Health
R-IPC
Survivors