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      Layering risk work amidst an emerging crisis: an ethnographic study on the governance of the COVID-19 pandemic in a university hospital in the Netherlands

      research-article
      , ,
      Health, Risk & Society
      Taylor & Francis
      SARS-CoV-2, COVID-19, risk work, risk governance, institutional layering, healthcare, organisational ethnography

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          Abstract

          The start of the COVID-19 pandemic early 2020 has confronted healthcare sectors with risks and uncertainties on an unprecedented scale in recent history. Healthcare organisations faced acute problems, the answers to which had to be provided, and recalibrated, at short notice and informally. University hospitals played a pivotal role in providing these answers and in (re)calibrating institutional arrangements. Based on ethnographic research in an elite university hospital in the Netherlands, in this article we explore the concrete practices of governing risks and uncertainties that COVID-19 posed for the organisation of healthcare. Our fieldwork consisted of the observation of meetings at the level of the hospital boards, the staff, and the regional level. We collected relevant documents and interviewed key-actors. This approach offers us a large dataset on acute risk governance ‘from within’ and allows us to offer a layered ethnographic account of managerial practices. In our analysis we focus on conceptualising the work-as-done in the university hospital as risk work. We show how the risk work of our participants is generally characterised by high speed and delineated by scarcities. We differentiate between three modes of risk work: working on numbers, working on expertise and working on logistics. This risk work appears innovative, but our analysis stresses how participants’ work happened in interaction with traditional institutional logics and routines.

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          Most cited references35

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          Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe

          Following the detection of the new coronavirus1 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics of coronavirus disease 2019 (COVID-19). In response, many European countries have implemented non-pharmaceutical interventions, such as the closure of schools and national lockdowns. Here we study the effect of major interventions across 11 European countries for the period from the start of the COVID-19 epidemics in February 2020 until 4 May 2020, when lockdowns started to be lifted. Our model calculates backwards from observed deaths to estimate transmission that occurred several weeks previously, allowing for the time lag between infection and death. We use partial pooling of information between countries, with both individual and shared effects on the time-varying reproduction number (Rt). Pooling allows for more information to be used, helps to overcome idiosyncrasies in the data and enables more-timely estimates. Our model relies on fixed estimates of some epidemiological parameters (such as the infection fatality rate), does not include importation or subnational variation and assumes that changes in Rt are an immediate response to interventions rather than gradual changes in behaviour. Amidst the ongoing pandemic, we rely on death data that are incomplete, show systematic biases in reporting and are subject to future consolidation. We estimate that-for all of the countries we consider here-current interventions have been sufficient to drive Rt below 1 (probability Rt < 1.0 is greater than 99%) and achieve control of the epidemic. We estimate that across all 11 countries combined, between 12 and 15 million individuals were infected with SARS-CoV-2 up to 4 May 2020, representing between 3.2% and 4.0% of the population. Our results show that major non-pharmaceutical interventions-and lockdowns in particular-have had a large effect on reducing transmission. Continued intervention should be considered to keep transmission of SARS-CoV-2 under control.
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            Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

            It is urgent to understand the future of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission. We used estimates of seasonality, immunity, and cross-immunity for betacoronaviruses OC43 and HKU1 from time series data from the USA to inform a model of SARS-CoV-2 transmission. We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022. Additional interventions, including expanded critical care capacity and an effective therapeutic, would improve the success of intermittent distancing and hasten the acquisition of herd immunity. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to SARS-CoV-2. Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.
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              12 Lessons Learned from the Management of the Coronavirus Pandemic

              Highlights • There have been diverse management strategies displayed in COVID-19 crisis response. • 12 key lessons can guide adjustments to our crisis response strategies. • These lessons can guide decisions to help reduce economic and social impacts. • Transparency, decisive leadership, effective communication, solidarity, and accountability are vital. • We can use innovative technologies and financing mechanisms in pandemic response.
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                Author and article information

                Journal
                Health Risk Soc
                Health Risk Soc
                Health, Risk & Society
                Taylor & Francis
                1369-8575
                1469-8331
                5 April 2021
                2021
                : 23
                : 3-4
                : 111-127
                Affiliations
                [0001]Erasmus School of Health Policy & Management, Erasmus University Rotterdam; , Rotterdam, The Netherlands
                Author notes
                Corresponding author Bert De Graaff degraaff@ 123456eshpm.eur.nl
                Author information
                https://orcid.org/0000-0001-9840-8626
                https://orcid.org/0000-0003-0887-6587
                https://orcid.org/0000-0001-7202-5053
                Article
                1910210
                10.1080/13698575.2021.1910210
                8352375
                34393612
                f4f74ccf-b414-4552-8eec-1ef31826d6ea
                © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

                History
                Page count
                Figures: 1, References: 35, Pages: 17
                Categories
                Research Article
                Research Article

                sars-cov-2,covid-19,risk work,risk governance,institutional layering,healthcare,organisational ethnography

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