The impact of implementing Egypt Pandemic preparedness plan for acute respiratory infections in combating the early stage of COVID-19 Pandemic, February-July 2020 (Preprint)

BACKGROUND Egypt is a transcontinental country in the Middle East. Most of the country is situated in northeastern Africa with the Sinai Peninsula located in Western Asia. The country covers an area of 1 million km² and has a coastline at the Mediterranean Sea in north, and the Red Sea in east. Most of its population are concentrated along the banks of the Nile, and on the river's delta, with only about 3% of the territory is inhabited. Egypt population are more than 100 million inhabitants, GDP per capita in 2017 was $10,799. Life expectancy was 74.4 in females and 68.0 in males and under 5 mortality rate was 19.2. The main causes of death in Egypt are Ischemic heart diseases, stroke and cirrhosis, healthcare access and quality index are 58.0 and the governmental health spending per person was $39 in 2018. (IHME 2020) The beginning of COVID-19 epidemic in Egypt On December 1st, 2019 cluster of pneumonia cases of unknown cause was noticed in Wuhan, China. On the 31st of December 2019 China announced an epidemic of acute respiratory disease of unknown cause (She 2020). As soon as the epidemic was announced and before WHO announce a pandemic, Egypt Ministry of Health and Population (MoHP) started to adapt its ARI pandemic preparedness plan to apply to the anticipated pandemic. Egypt is considered one of the oldest countries to monitor infectious diseases through a national surveillance system for reporting infectious diseases that was established in Egypt back in 1946. Egypt national surveillance was assessed, enhanced, and expanded to include all governmental healthcare facilities in 1999. The National Egyptian surveillance (NEDSS) targeting 40 communicable diseases including Acute Respiratory Infections (ARIs) has electronic reporting element (Madiha 2017). A comprehensive network of epidemiological and laboratory vertical system for reporting ARIs was developed in 2009 with an alert system for early detection of novel respiratory viruses. The network covers all the country and composes of surveillance systems targeting severe acute respiratory infections (SARI), influenza like illness (ILI), pneumonia, avian influenza and MERS-CoV. Event-based surveillance was introduced in Egypt in 2009 in response to the 2009 H1N1 pandemic to help timely detection and response to possible epidemics. This viewpoint aims at review and discuss the preventive and control measures that have been implemented by MoHP Egypt in response to the COVID-19 pandemic to share Egypt experience with the public health practitioners and authorities for better response to such events in the future. The specific objective of the preparedness plan for response to COVID-19 is to reduce morbidity and mortality in the event of a COVID-19 epidemic in Egypt. OBJECTIVE To briefly describe Egypt acute respiratory infections (ARIs) epidemic preparedness and containment plan. In addition to find out the effect of plan implementation in combating the early stage of COVID-19 epidemic in Egypt. METHODS Egypt preparedness 5 pillars ARI preparedness plan was briefly described. Pillars are: Crisis management, enhancing surveillance systems and contact tracing, case, and hospital management, raise community awareness, quarantine, and entry points. To identify the impact of plan implementation, all COVID-19 patients data February-July 2020 was obtained from Egypt national disease surveillance. Descriptive analysis was conducted to describe the epidemic situation in the early stage of the epidemic in Egypt. RESULTS Overall, 102,789 COVID-19 cases were reported to NEDSS in the study period including 78,048 (43.2%) confirmed COVID-19 cases giving an attack rate of 77.0 case/1,000,000 population, and 3,457 (4.4%) deaths due to COVID-19. Of all cases 44,969 (57.6%) had mild symptoms, 71.5% were > 53 years. Growth rate and R0 declines 1.18 to 0.13 and 6.5 to 1.6, respectively, while doubling time increased from 1.8 to 15.6 days by the end of July 2020. CONCLUSIONS Egypt was successful in mitigating the early stage of COVID-19 epidemic. Commitment of all partners to implementation of the ARI epidemic preparedness plan helped in flattening the curve and containing the epidemic. Post-epidemic evaluation is needed to better assess Egypt national response against COVID-19 epidemic.

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs

Study objectives: To quantify the readiness of individual academic emergency departments (EDs) in the United States for an outbreak of pandemic influenza.Methods, design, and setting: Cross-sectional assessment of influenza pandemic preparedness level of EDs in the United States via survey of medical directors and department chairs from the 135 academic emergency medicine departments in the United States. Preparedness assessed using a novel score of 15 critical preparedness indicators. Data analysis consisted of summary statistics, χ2, and ANOVA.Participants: ED medical directors and department chairs.Results: One hundred and thirty academic emergency medicine departments contacted; 66 (50.4 percent) responded. Approximately half (56.0 percent) stated their ED had a written plan for pandemic influenza response. Mean preparedness score was 7.2 (SD = 4.0) out of 15 (48.0 percent); only one program (1.5 percent) achieved a perfect score. Respondents from programs with larger EDs (=30 beds) were more likely to have a higher preparedness score (p 0.035), an ED pandemic preparedness plan (p = 0.004) and a hospital pandemic preparedness plan (p = 0.007). Respondents from programs with larger EDs were more likely to feel that their ED was prepared for a pandemic or other major disease outbreak (p = 0.01). Only one-third (34.0 percent) felt their ED was prepared for a major disease outbreak, and only 27 percent felt their hospital was prepared to respond to a major disease outbreak.Conclusions: Significant deficits in preparedness for pandemic influenza and other disease outbreaks exist in US EDs, relative to HHS guidelines, which appear to be related in part to ED size. Further study should be undertaken to determine the barriers to appropriate pandemic preparedness, as well as to develop and validate preparedness metrics.

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs

Study objectives: To quantify the readiness of individual academic emergency departments (EDs) in the United States for an outbreak of pandemic influenza.Methods, design, and setting: Cross-sectional assessment of influenza pandemic preparedness level of EDs in the United States via survey of medical directors and department chairs from the 135 academic emergency medicine departments in the United States. Preparedness assessed using a novel score of 15 critical preparedness indicators. Data analysis consisted of summary statistics, χ2, and ANOVA.Participants: ED medical directors and department chairs.Results: One hundred and thirty academic emergency medicine departments contacted; 66 (50.4 percent) responded. Approximately half (56.0 percent) stated their ED had a written plan for pandemic influenza response. Mean preparedness score was 7.2 (SD = 4.0) out of 15 (48.0 percent); only one program (1.5 percent) achieved a perfect score. Respondents from programs with larger EDs (=30 beds) were more likely to have a higher preparedness score (p 0.035), an ED pandemic preparedness plan (p = 0.004) and a hospital pandemic preparedness plan (p = 0.007). Respondents from programs with larger EDs were more likely to feel that their ED was prepared for a pandemic or other major disease outbreak (p = 0.01). Only onethird (34.0 percent) felt their ED was prepared for a major disease outbreak, and only 27 percent felt their hospital was prepared to respond to a major disease outbreak.Conclusions: Significant deficits in preparedness for pandemic influenza and other disease outbreaks exist in US EDs, relative to HHS guidelines, which appear to be related in part to ED size. Further study should be undertaken to determine the barriers to appropriate pandemic preparedness, as well as to develop and validate preparedness metrics.

Mathematical Assessment of Canada’s Pandemic Influenza Preparedness Plan

OBJECTIVE: The presence of the highly pathogenic avian H5N1 virus in wild bird populations in several regions of the world, together with recurrent cases of H5N1 influenza arising primarily from direct contact with poultry, have highlighted the urgent need for prepared-ness and coordinated global strategies to effectively combat a potential influenza pandemic. The purpose of the present study was to evaluate the Canadian pandemic influenza preparedness plan.PATIENTS AND METHODS: A mathematical model of the transmission dynamics of influenza was used to keep track of the population according to risk of infection (low or high) and infection status (susceptible, exposed or infectious). The model was parametrized using available Canadian demographic data. The model was then used to evaluate the key components outlined in the Canadian plan.RESULTS: The results indicated that the number of cases, mortalities and hospitalizations estimated in the Canadian plan may have been underestimated; the use of antivirals, administered therapeutically, prophylactically or both, is the most effective single intervention followed by the use of a vaccine and basic public health measures; and the combined use of pharmaceutical interventions (antivirals and vaccine) can dramatically minimize the burden of the pending influenza pandemic in Canada. Based on increasing concerns of Oseltamivir resistance (wide-scale implementation), coupled with the expected unavailability of a suitable vaccine during the early stages of a pandemic, the present study evaluated the potential impact of non-pharmaceutical interventions (NPIs) which were not emphasized in the current Canadian plan. To this end, the findings suggest that the use of NPIs can drastically reduce the burden of a pandemic in Canada.CONCLUSIONS: A deterministic model was designed and used to assess Canada’s pandemic preparedness plan. The study showed that the estimates of pandemic influenza burden given in the Canada pandemic preparedness plan may be an underestimate, and that Canada needs to adopt NPIs to complement its preparedness plan.

Stockpiling of anti-influenza drugs in private households: a survey in Germany

The pandemic preparedness plan for Germany published in January 2005 requires that all influenza patients have access to antiviral drugs in the event of an influenza pandemic.