Implementing public health and social measures: an integral part of the health emergency management cycle

Abstract Public health and social measures (PHSM) have been utilized as a tool to reduce the infection rates and disease burden throughout the COVID-19 pandemic and continue to play an important role even with vaccination campaigns well underway in preventing severe disease. In order to systematically track, analyze and report qualitative and quantitative data o PHSM implementation across the European Region and assist countries in the COVID-19 response, the COVID-19 Incident Management Support team at the WHO Regional Office for Europe developed PHSM Severity Index and PHSM Dashboard. The PHSM Severity Index captures the types, severity and timing of PHSMs implemented by a country across six main indicators. By providing standardized data on PHSM implementation, the PHSM Severity Index can support and inform the development of policy at country and regional levels. PHSM data, severity methodology and policy tools developed throughout the COVID-19 pandemic should be adapted to provide a foundation for preparedness for future large-scale health emergencies. In addition, discerning the epidemiological impact of specific PHSM and their combinations currently is a priority for policy-makers and can guide countries’ transition strategies. Analysing the impact of PHSM on COVID-19 transmission is of critical importance, especially as variants of concern bring new waves of COVID-19 cases and may challenge countries’ vaccination and response strategies. Reference PHSM in Response to COVID-19 (who.int)

The presentation will focus on two main outcomes of the WHO initiative: a global research agenda to steer future evidence generation on PHSM, and a central monitoring system for PHSM research.In September 2021, a global technical consultation with over 60 global experts was organized to review the existing evidence on PHSM and identify the initiative's priorities.The consultation provided an opportunity to have an initial discussion on potential research priorities.This became the basis for an iterative online consultation process.The draft research agenda includes seven main research themes including effectiveness, unintended consequences, methodological challenges and implementation considerations affecting the uptake of and adherence to PHSM.Workshop participants will be invited to comment on the suggested themes and propose additional priority questions for the research agenda.The central research monitoring system will consist of a global repository of primary studies and reviews investigating the effectiveness and broader multisectoral impact of PHSM.Indexed studies will be mapped against the key themes of the research agenda, facilitating real-time monitoring and evaluation of its progress.An AI-based mechanism for automated updating of systematic reviews will complement the database.This one-stop shop will allow researchers and decision-makers worldwide to access the latest evidence on PHSM and keep track of the synthesized effectiveness and impact of different interventions and combinations.The platform will further provide a protected working interface.This monitoring system for PHSM research enables timely access to and utilization of evidence indecisionmaking processes during health emergencies and fosters international collaboration on the analysis and interpretation of data.Workshop participants will be invited to review the alpha version of the platform.

Issue/problem:
In the context of the COVID-19 pandemic, public health and social measures (PHSM) are being implemented worldwide, but in very different ways.This is also due to a lacking common understanding of PHSM so far.As a result, there are limited insights regarding their components, implementation and effectiveness as well as impacts beyond health of PHSM.

Description of the problem:
The project contributes to the WHO PHSM initiative.A logic model is being developed that offers a shared language and understanding of how PHSM are intended to achieve transmission-related outcomes, but also that non-intended consequences need to be considered.The overall approach is informed by a system-based logic model template and a staged approach to logic modeling.The development process is making use of (i) existing COVID PHSM taxonomies and related literature, (ii) existing theoretical frameworks related to complex interventions in complex systems, (iii) consultations with WHO staff and the according PHSM steering group, and (v) iterative brainstorming within the working group.

Results:
The initial logic model is rooted in a complexity perspective which recognises that (i) all measures have both intended and unintended consequences for health and society and (ii) all elements within the logic model are interconnected and interact with each other.All PHSM operate through two basic mechanisms: reducing contacts and making contacts safer.Taken together, these two mechanisms work to reduce transmission-relevant contacts.Any specific PHSM is defined by a combination of the measure itself, the population and/or setting targeted and the mode of enactment.The central hub of the logic model connects and integrates all elements.The initial logic model was applied to school and travel measures as examples.

Main messages:
The PHSM logic model is a conceptual basis to facilitate research on PHSM, monitoring and evaluation of PHSM, and evidence-informed decision-making.

Abstract citation ID: ckac129.535 Implementing public health and social measures: an integral part of the health emergency management cycle
Tanja Schmidt J Addo 1 , D Cocciolone 1 , C Gapp 1 , A Latta 1 , S Lindmark 1 , L Owen 1 , J Sane 1 , I Perehinets 1 , T Schmidt 1 , C Wippel 1 1 Country Health Emergency Preparedness and IHR, WHO Regional Office for Europe, Copenhagen, Denmark Contact: schmidtt@who.intPublic health and social measures (PHSM) have been utilized as a tool to reduce the infection rates and disease burden throughout the COVID-19 pandemic and continue to play an important role even with vaccination campaigns well underway in preventing severe disease.In order to systematically track, analyze and report qualitative and quantitative data o PHSM implementation across the European Region and assist countries in the COVID-19 response, the COVID-19 Incident Management Support team at the WHO Regional Office for Europe developed PHSM Severity Index and PHSM Dashboard.The PHSM Severity Index captures the types, severity and timing of PHSMs implemented by a country across six main indicators.By providing standardized data on PHSM implementation, the PHSM Severity Index can support and inform the development of policy at country and regional levels.PHSM data, severity methodology and policy tools developed throughout the COVID-19 pandemic should be adapted to provide a foundation for preparedness for future large-scale health emergencies.In addition, discerning the epidemiological impact of specific PHSM and their combinations currently is a priority for policy-makers and can guide countries' transition strategies.Analysing the impact of PHSM on COVID-19 transmission is of critical importance, especially as variants of concern bring new waves of COVID-19 cases and may challenge countries' vaccination and response strategies.Reference PHSM in Response to  Abstract citation ID: ckac129.536Supporting decision making on public health and social measures in response to COVID-19-The PHSM calibration tool Dominic Cocciolone D Cocciolone 1 , K King 1 , A Latta 1 , S Lindmark 1 , L Owen 1 , I Perehinets 1 , C Roman 1 , J Sane 1 , T Schmidt 1 , C Wippel 1 1 Country Health Emergency Preparedness and IHR, WHO Regional Office for Europe, Copenhagen, Denmark Contact: coccioloned@who.intPublic health and social measures (PHSM) are preventative measures taken by individuals, communities and government institutions at national and local levels to prevent and reduce transmission of an infectious disease -in this instance SARS-CoV-2.The decision to introduce, adapt or lift PHSM should be based primarily on a situational assessment of the intensity of transmission of SARS-CoV-2 and the capacity of the health system to respond to subsequent increases in hospital admissions, but must also consider the effects these measures may have on the general welfare of society and individuals.The WHO Regional Office for Europe developed an online public health and social measures (PHSM) calibration tool to assist Member States in decision-making relating to PHSM implementation during the COVID-19 pandemic.The tool, designed to be used primarily by policy-makers in national and local government authorities, provides guidance based on a situational-level assessment framework that is determined by the level of community transmission and the overall capacity of health systems and public health services within a country or region to respond.By using a combination of countryreported and user-input data, the tool automatically generates Background: Due to SARS-CoV-2 rapid mutations, the ending of the pandemic is still proceeding at a slow pace and there is the need to strengthen and invest in health systems that avoid hospital overload and its consequences on patients' health.Most symptomatic infections have mild to moderate respiratory symptoms and patients are managed in the context of primary care.In Italy, literature on COVID-19 outpatients management by general practitioners (GPs) is scarce.This study explores the effect of GP active care and monitoring on COVID-19-related hospitalization in patients in the province of Modena (Italy) and investigates the possible determinants of GP's management.Methods: This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena (Italy).Data on GPs' characteristics, management strategies (visits and remote monitoring), patients' socio-demographic characteristics, and hospitalization were extracted from the GP's electronic medical records and were analyzed using descriptive statistics and multiple logistic regression.

Results:
46 GPs agreed to participate, and 5340 patients were included in the analyses.3014 (56%) patients received active daily remote monitoring and 840 (16%) were visited at home.Remote monitoring and home visits were both associated with a reduction of the probability of hospitalization rate of approximately 50% (respectively OR:0.52, 95%CI:0.33,0.80 and OR:0.50, 95%CI;0.33,0.78).Preliminary analysis of determinants showed that GPs' patient load, setting, age, and sex were significantly associated with management strategies.

Conclusions:
Active monitoring performed by GPs was effective in reducing the probability of hospitalization.Primary and hospital care integration can be effective for COVID-19 management.Studies on GPs' characteristics and patient load and their effect on their ability to care for patients are needed.

Key messages:
Active remote monitoring and visits performed by Italian general practitioners effectively reduced hospitalization for COVID-19.Primary and hospital care integration can be effective for COVID-19 management.
Abstract citation ID: ckac129.538 The health system and health impacts of primary healthcare reform in China: A systematic review