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      Communicating in a public health crisis

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          Abstract

          Despite previous pandemics and reports on pandemic preparedness, 1 many countries struggle to prevent and manage public health emergencies. 2 A key component of an effective pandemic response is communication between governments, health professionals, scientists, the media, and the public. 3 A potential concern is how to maintain public trust in science and high levels of support for control measures, such as contact tracing, especially if they potentially challenge personal privacy. 4 Despite only having a short time to accumulate, the volume of published evidence on COVID-19 is extensive, making it difficult to manage and verify. Development of systematic reviews, supported by artificial intelligence and crowdsourcing, could support the rapid analysis of evidence-based measures to help communicate the need for control measures to mitigate COVID-19. 5 The COVID-19 pandemic has encouraged a new phase of real-time, peer-to-peer sharing. Data concerning diseases and outbreaks are communicated through multiple channels, providing a view of global health that is fundamentally different from that provided by traditional public health organisations. Use of online information is becoming a dominant method for the surveillance of emerging public health threats. For example, a widely used information source on the numbers of global COVID-19 cases and deaths is an interdisciplinary collaboration between several groups at Johns Hopkins University (The Johns Hopkins Coronavirus Resource Center). 6 Similarly, HealthMap concatenates information from disparate data sources, including online news aggregators, eyewitness reports, expert-curated discussions, and validated official reports, to achieve a unified and comprehensive view of current infectious diseases. 7 Global communication for future pandemics requires a novel framework. Although formal international agreements and agencies play an important part in communicating information, non-governmental groups might be able to perform a critical function in the global response to emerging diseases, and we encourage expanded use of consortia to take advantage of the strength of diverse electronic information sources and innovative means to compile and communicate information. Poor health media literacy is common, and likewise a paucity of scientific knowledge has undermined responses to the COVID-19 pandemic. We have witnessed the amplification of unverified information, which has triggered misunderstandings, reactions of fear, and a loss of trust, which can inhibit effective responses to the pandemic. In preparation for the possible resurgence of COVID-19 or the occurrence of new infectious diseases, proactive public health investment in mechanisms for compiling, verifying, and communicating information is of paramount importance to ensuring public health. Emphasis should be placed on understanding specific factors, such as how the interplay between infectious agents and humans facilitates transmission through travelling and social activities in confined environments. During periods of uncertainty, strategies for communicating evolving information need to be developed and assessed. New curricula in systems medicine and effective communication strategies that examine the factors affecting preventive behaviour should be developed and used to train health-care professionals, researchers, teachers, media professionals, and decision makers with active involvement in communicating with the general public.

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          Most cited references5

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          An interactive web-based dashboard to track COVID-19 in real time

          In December, 2019, a local outbreak of pneumonia of initially unknown cause was detected in Wuhan (Hubei, China), and was quickly determined to be caused by a novel coronavirus, 1 namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak has since spread to every province of mainland China as well as 27 other countries and regions, with more than 70 000 confirmed cases as of Feb 17, 2020. 2 In response to this ongoing public health emergency, we developed an online interactive dashboard, hosted by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, Baltimore, MD, USA, to visualise and track reported cases of coronavirus disease 2019 (COVID-19) in real time. The dashboard, first shared publicly on Jan 22, illustrates the location and number of confirmed COVID-19 cases, deaths, and recoveries for all affected countries. It was developed to provide researchers, public health authorities, and the general public with a user-friendly tool to track the outbreak as it unfolds. All data collected and displayed are made freely available, initially through Google Sheets and now through a GitHub repository, along with the feature layers of the dashboard, which are now included in the Esri Living Atlas. The dashboard reports cases at the province level in China; at the city level in the USA, Australia, and Canada; and at the country level otherwise. During Jan 22–31, all data collection and processing were done manually, and updates were typically done twice a day, morning and night (US Eastern Time). As the outbreak evolved, the manual reporting process became unsustainable; therefore, on Feb 1, we adopted a semi-automated living data stream strategy. Our primary data source is DXY, an online platform run by members of the Chinese medical community, which aggregates local media and government reports to provide cumulative totals of COVID-19 cases in near real time at the province level in China and at the country level otherwise. Every 15 min, the cumulative case counts are updated from DXY for all provinces in China and for other affected countries and regions. For countries and regions outside mainland China (including Hong Kong, Macau, and Taiwan), we found DXY cumulative case counts to frequently lag behind other sources; we therefore manually update these case numbers throughout the day when new cases are identified. To identify new cases, we monitor various Twitter feeds, online news services, and direct communication sent through the dashboard. Before manually updating the dashboard, we confirm the case numbers with regional and local health departments, including the respective centres for disease control and prevention (CDC) of China, Taiwan, and Europe, the Hong Kong Department of Health, the Macau Government, and WHO, as well as city-level and state-level health authorities. For city-level case reports in the USA, Australia, and Canada, which we began reporting on Feb 1, we rely on the US CDC, the government of Canada, the Australian Government Department of Health, and various state or territory health authorities. All manual updates (for countries and regions outside mainland China) are coordinated by a team at Johns Hopkins University. The case data reported on the dashboard aligns with the daily Chinese CDC 3 and WHO situation reports 2 for within and outside of mainland China, respectively (figure ). Furthermore, the dashboard is particularly effective at capturing the timing of the first reported case of COVID-19 in new countries or regions (appendix). With the exception of Australia, Hong Kong, and Italy, the CSSE at Johns Hopkins University has reported newly infected countries ahead of WHO, with Hong Kong and Italy reported within hours of the corresponding WHO situation report. Figure Comparison of COVID-19 case reporting from different sources Daily cumulative case numbers (starting Jan 22, 2020) reported by the Johns Hopkins University Center for Systems Science and Engineering (CSSE), WHO situation reports, and the Chinese Center for Disease Control and Prevention (Chinese CDC) for within (A) and outside (B) mainland China. Given the popularity and impact of the dashboard to date, we plan to continue hosting and managing the tool throughout the entirety of the COVID-19 outbreak and to build out its capabilities to establish a standing tool to monitor and report on future outbreaks. We believe our efforts are crucial to help inform modelling efforts and control measures during the earliest stages of the outbreak.
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            Digital disease detection--harnessing the Web for public health surveillance.

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              Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries

              Summary Background Public health measures to prevent, detect, and respond to events are essential to control public health risks, including infectious disease outbreaks, as highlighted in the International Health Regulations (IHR). In light of the outbreak of 2019 novel coronavirus disease (COVID-19), we aimed to review existing health security capacities against public health risks and events. Methods We used 18 indicators from the IHR State Party Annual Reporting (SPAR) tool and associated data from national SPAR reports to develop five indices: (1) prevent, (2) detect, (3) respond, (4) enabling function, and (5) operational readiness. We used SPAR 2018 data for all of the indicators and categorised countries into five levels across the indices, in which level 1 indicated the lowest level of national capacity and level 5 the highest. We also analysed data at the regional level (using the six geographical WHO regions). Findings Of 182 countries, 52 (28%) had prevent capacities at levels 1 or 2, and 60 (33%) had response capacities at levels 1 or 2. 81 (45%) countries had prevent capacities and 78 (43%) had response capacities at levels 4 or 5, indicating that these countries were operationally ready. 138 (76%) countries scored more highly in the detect index than in the other indices. 44 (24%) countries did not have an effective enabling function for public health risks and events, including infectious disease outbreaks (7 [4%] at level 1 and 37 [20%] at level 2). 102 (56%) countries had level 4 or level 5 enabling function capacities in place. 32 (18%) countries had low readiness (2 [1%] at level 1 and 30 [17%] at level 2), and 104 (57%) countries were operationally ready to prevent, detect, and control an outbreak of a novel infectious disease (66 [36%] at level 4 and 38 [21%] at level 5). Interpretation Countries vary widely in terms of their capacity to prevent, detect, and respond to outbreaks. Half of all countries analysed have strong operational readiness capacities in place, which suggests that an effective response to potential health emergencies could be enabled, including to COVID-19. Findings from local risk assessments are needed to fully understand national readiness capacities in relation to COVID-19. Capacity building and collaboration between countries are needed to strengthen global readiness for outbreak control. Funding None.
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                Author and article information

                Contributors
                Journal
                Lancet Digit Health
                Lancet Digit Health
                The Lancet. Digital Health
                The Author(s). Published by Elsevier Ltd.
                2589-7500
                10 August 2020
                10 August 2020
                Affiliations
                [a ]School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, China
                [b ]Yale School of Public Health, New Haven, CT, USA
                [c ]School of Epidemiology and Public Health at the University of Ottawa, Ottawa, ON, Canada
                [d ]European Institute for Systems Biology and Medicine, Vourles, France
                Article
                S2589-7500(20)30197-7
                10.1016/S2589-7500(20)30197-7
                7417177
                32838253
                7df7bc11-686a-4b25-84b5-425f478a1771
                © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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