This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.

This portable reference addresses the spectrum of operational technical info required by humanitarian health professionals in health emergencies and disasters, offering a comprehensive toolkit for documenting conditions, assessing needs, managing operations & making informed, responsible decisions.

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Contents 7.1 Humanitarian Programs 141 7.2 Security Sector 153 7.3 Health Sector 158 Core Disciplines in Disaster Health 161 Primary Health Care Programs 162 Disease Prevention 162 Clinical Facilities 164 Reproductive Health 165 Water and Sanitation 166 Food and Nutrition 171 Chemical Weapons 181 Epi Methods 184 7.4 Tropical Medicine 187 Tropical Infectious Diseases—Vector-borne and Zoonotic 196 Tropical Infectious Diseases—Non-vector-borne 215 7.5 Epidemic Preparedness and Response 239 7.6 Communicable Disease Control 242 Diarrhea 244 Influenza 257 Malaria 263 Measles 267 Meningitis 269 Viral Hemorrhagic Fever 272 7.7 Diagnostic Laboratory 275 Indications, Laboratory Tests, and Expected Availability 276 Specimen Handling 278 7.8 Acronyms 282

This chapter provides guidance on technical issues in the health sector. The annexes contain selective compilations of frequently used reference information.

BackgroundA regional epidemiological analysis of Australasian disasters in the 20th century to present was undertaken to examine trends in disaster epidemiology; to characterise the impacts on civil society through disaster policy, practice and legislation; and to consider future potential limitations in national disaster resilience.MethodsA surveillance definition of disaster was developed conforming to the Centre for Research on the Epidemiology of Disasters (CRED) criteria (10 deaths, 100 affected, or declaration of state emergency or appeal for international assistance). The authors then applied economic and legislative inclusion criteria to identify additional disasters of national significance.ResultsThe surveillance definition yielded 165 disasters in the period, from which 65 emerged as disasters of national significance. There were 38 natural disasters, 22 technological disasters, three offshore terrorist attacks and two domestic mass shootings. Geographic analysis revealed that states with major population centres experienced the vast majority of disasters of national significance. Timeline analysis revealed an increasing incidence of disasters since the 1980s, which peaked in the period 2005-2009. Recent seasonal bushfires and floods have incurred the highest death toll and economic losses in Australasian history. Reactive hazard-specific legislation emerged after all terrorist acts and after most disasters of national significance.ConclusionTimeline analysis reveals an increasing incidence in natural disasters over the past 15 years, with the most lethal and costly disasters occurring in the past 3 years. Vulnerability to disaster in Australasia appears to be increasing. Reactive legislation is a recurrent feature of Australasian disaster response that suggests legislative shortsightedness and a need for comprehensive all-hazards model legislation in the future.

Disaster reports are common in the literature. Accurate and complete reporting assists readers and researchers in developing best practices. There have been notable efforts, such as the Utstein Template, to standardize the language of disasters and promote consistent use of definitions. However, case reports are complicated by the presence of four dominant types recognized in the literature. Moreover, the disciplines of medicine, public health, and disaster management differ in origins, definitions, research paradigms, and tools of evidence-based decision-making. Finally, biomedical journal guidelines for authors writing disaster case reports have lacked the rigor of standards associated with observational studies (2007 STROBE statement, 2010 MOOSE statement), or with randomized controlled trials (1996 CONSORT statement, 1999 QUORUM statement). This paper examines current efforts to intensify the rigor of future disaster case reports through uniform reporting requirements for authors. The initial workgroup comprised editorial board members of two biomedical journals indexed in the US National Library of Medicine—Prehospital and Disaster Medicine, and Emergency Medicine Australasia. The workgroup members self-selected based on extensive disaster field experience as technical advisor with governmental, non-governmental, Red Cross and UN agencies. The workgroup identified key information needed to understand the context, structure, process, and outcome/impact of disaster field interventions. Then, the workgroup organized this information in thematic domains. Consensus guidelines emerged for Reports of Field Interventions in Disasters and Emergencies (CONFIDE). The CONFIDE Statement addresses 16 keys areas within seven domains, including: field authorization for access, field logistics, initial assessment, clinical epidemiology, and funding. The Statement was first published in December 2010, at which time, the authors began integrating the guidelines with biomedical journal instructions for authors. The paper details current efforts to broaden editorial acceptance of the guidelines, implications for future authors, and potential benefits to the disaster medicine community.

Pandemic (H1N1) 2009 influenza has generated many controversies in Australia around case definitions, laboratory diagnosis, case management, medical logistics and travel restrictions. Our experience as clinical advisers in the Victorian Department of Human Services Emergency Operations Centre suggests the following: ➢Case definitions may change frequently, and will tend to become more clinically specific over time. ➢Early in a pandemic, laboratory diagnosis plays a critical role in case finding and pathogen identification. ➢Later in the pandemic, standardised case management applied to well crafted case definitions should reduce reliance on the diagnostic laboratory in clinical management. The diagnostic laboratory will remain critical to monitoring disease surveillance, pathogen virulence, and drug susceptibility. ➢Medical logistics will continue to challenge pandemic managers as the health sector struggles to do the most good for the greatest number of people. ➢Travel restrictions remain scientifically controversial public health recommendations. ➢Issues of scalability (escalation and de‐escalation of the response) relating to virus lethality need to be resolved in current pandemic planning.

This issue of the journal introduces new guidelines for authors of disaster case reports. This editorial examines the drivers and implications of these guidelines. Government agencies, professional societies, trade associations and special interest groups produce vast literature on various aspects of disasters. Much of this literature worldwide is ‘grey’– print published or web published – but unobtainable through electronic indexing services. The electronic information alone is now so extensive that the US National Library of Medicine has created a Disaster Information Management Research Center to help with national emergency preparedness and response efforts.1 Within the published biomedical literature, a recent 30 years review canvassing a range of electronically indexed databases found the majority of event-specific literature indexed in MEDLINE was published across a broad spectrum of disciplines. The top 10 journals cited are listed in Table 1.2 Over the last decade, disaster literature accelerated markedly prompted by the events of September 11, 2001, at the World Trade Center, which yielded the greatest number of event-specific, peer-reviewed publications to date (686).2 New journals devoted to disasters continue to emerge with recent ones receiving MEDLINE indexation before their first full year of publication. The challenge for the reader keeping up with disaster literature is therefore daunting. Finding good-quality evidence within this corpus of literature creates another set of hurdles for the reader. First, the disciplines of medicine, public health and disaster management differ in origins, definitions, research paradigms and tools of evidence-based decision making.3, 4 In evidence-based medicine, core concepts are well known to most physicians. These core concepts include population-intervention-comparison-outcome questions, hierarchy of evidence strength based upon methods of data acquisition and criteria for determining adequacy of studies. However, important questions in disaster medicine are not easily testable by evidence-based science. Disaster field conditions are fluid, data are perishable and compete with rumour, and security constraints prevail. As a consequence, controlled studies in disasters are difficult to run. The level of scientific evidence behind many of our actions in disaster medicine remains weak. Disaster relief operations continue to rely heavily on ‘eminence-based’ decisions by parties striving to broker goodwill and consensus.5 Underlying issues include lack of agency expertise, dyscoordination between agencies in the field, inappropriate proxy indicators, flawed scientific inference and erosion of the concept of minimum standards. Second, the cost-effectiveness of many disaster interventions remains unknown. For example, disaster medical assistance teams, mobile field hospitals and hospital ships operate in virtually uncharted cost-effectiveness territory. The extensive work of the US National Institutes of Health, the World Health Organization and the World Bank on cost-effectiveness analysis, such as the Disease Control Priorities Project (DCP2),6 is remarkable in part for its lack of external validity in disaster relief operations. Donor governments often choose options for disaster health interventions based on political criteria for engagement rather than scientific criteria for lives saved. Third, disaster case reports remain a prominent part of biomedical journal reporting on disasters with a reliance on descriptive accounts. Several different types of report have emerged in the literature. Brief case report Rapid epidemiological assessment Comprehensive case report Comprehensive country profile In our experience, the most common and least useful is the brief case report. These are typically written from a donor's or intervenor's perspective, and are often plagued by anecdotal, descriptive, breathless reporting of process rather than outcome. This type of reporting, as well as the field engagement described, has been characterized as ‘disaster tourism’.7 Dissemination occurs in proportion to the public interest in the event, and esteem of the parent journal, rather than the strength of the science. This practice creates disaster mythology. Peer-reviewed literature may take years to correct the misconceptions devolving from particular disasters.8-10 Nonetheless, there is still a role for duly diligent case reports – especially when the science is young. To do this, there needs to be an appropriate reporting structure that encompasses context, perspective and outcomes. There are reasons for optimism. Disaster relief operations are becoming increasingly standardized in management of information as well as interventions. Initial rapid assessments (IRAs), Health Resources Availability Mapping System (HeRAMS) and syndromic disease surveillance have long histories of development led by the World Health Organization. The cluster system, itself, now has over 30 iterations worldwide. Although field execution is sometimes poor – Haiti is a recent example – use of standardized data-gathering tools and inter-agency processes is increasingly seen as core responsibilities of responders in the health sector. We also take heart from the systematization of scientific reporting requirements undertaken by biomedical scientists and journal editors. These requirements inform investigators and authors what information is required to ensure readers and reviewers can properly evaluate a study. For randomized controlled trials, the Consolidated Standards of Reporting Trials (CONSORT) statement emerged in 199611 followed by the Quality of Reports of Meta-analyses (QUORUM) statement in 1999.12 For observational studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement emerged in 200713 followed by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement in 2010.14 There have also been efforts, such as the Utstein Template,15 to standardize the language of disasters and promote consistent use of definitions. In this issue of Emergency Medicine Australasia, we take the first step in systematizing disaster case reports by drawing up specific Instructions for Authors coupled with our CONsensus Guidelines on Reports of Field Interventions in Disasters and Emergencies (CONFIDE). We seek to help authors report on complex issues of disasters. We seek to help the reader make informed judgments about these issues by bringing the reader as close as possible to field data. We seek to foster the work of future scholars undertaking critical event analysis, disaster comparisons and translational research. Finally, we seek to engage with other biomedical journal editors in pursuit of best practice standards for disaster reporting. To these ends, key components of the CONFIDE guidelines are listed in Table 2. A summary of our case report typology is presented in Table 3. Additional information for authors is posted on the web.16 For reasons cited above, in the absence of extremely unusual hazards or compelling epidemiology, the journal is unlikely to publish brief case reports in the future. Other types of disaster case reports will be welcomed. We acknowledge there are many ways to report science. Disasters remain a multidisciplinary endeavour, and no one owns the truth. Indeed, in disasters of conflict, the first casualty may be truth itself. However, we believe these guidelines will increase the utility of case reports for the reader and other scholars. Improving disaster reporting is merely a first early step. The real goal is improving disaster science. We reaffirm to our readers and authors our commitment to that process, our respect for their work and our own willingness to learn from their experience. David A. Bradt: Editorial Board, Emergency Medicine Australasia. Peter Aitken: Section Editor Disaster Medicine, Emergency Medicine Australasia.

[Extract] Government agencies, professional societies, trade associations and special interest groups produce vast literature on various aspects of disasters. Much of this literature worldwide is 'grey'– print published or web published – but unobtainable through electronic indexing services. The electronic information alone is now so extensive that the US National Library of Medicine has created a Disaster Information Management Research Center to help with national emergency preparedness and response efforts. Within the published biomedical literature, a recent 30 years review canvassing a range of electronically indexed databases found the majority of event-specific literature indexed in MEDLINE was published across a broad spectrum of disciplines. The top 10 journals cited are listed in Table 1. Over the last decade, disaster literature accelerated markedly prompted by the events of September 11, 2001, at the World Trade Center, which yielded the greatest number of event-specific, peer-reviewed publications to date (686)New journals devoted to disasters continue to emerge with recent ones receiving MEDLINE indexation before their first full year of publication.

Recognized limitations to data in disaster management have led to dozens of initiatives to strengthen data gathering and decision-making during disasters. These initiatives are complicated by fundamental problems of definitions of terms, ambiguity of concepts, lack of standardization in methods of data collection, and inadequate attempts to strengthen the analytic capability of field organizations. Cross-cutting issues in needs assessment, coordination, and evaluation illustrate additional recurring challenges in dealing with evidence in humanitarian assistance. These challenges include lack of agency expertise, dyscoordination at the field level, inappropriate reliance on indicators that measure process rather than outcome, flawed scientific inference, and erosion of the concept of minimum standards. Decision-making in disaster management currently places a premium on expert or eminence-based decisions. By contrast, scientific advances in disaster medicine call for evidence-based decisions whose strength of evidence is established by the methods of data acquisition. At present, disaster relief operations may be data driven, but that does not mean that they are soundly evidence-based. Options for strengthening evidence-based activities include rigorously adhering to evidenced-based interventions, using evidence-based tools to identify new approaches to problems of concern, studying model programs as well as failed ones to identify approaches that deserve replication, and improving standards for evidence of effectiveness in disaster science and services.