Background: Pathogen transmission among staff and residents in nursing homes can vary depending on their interactions and by the amount of time a resident receives care in the facility. Understanding the relative differences in transmission rates between and among staff and residents can identify the pathways that contributed most to the spread of SARS-CoV-2 in US nursing homes. Further exploring relative differences by categorizing facilities by residents’ lengths of stay can identify priority categories for intervention. Methods: Using US National Healthcare Safety Network (NHSN) surveillance data on resident and staff cases, vaccination, and resident deaths during June 2020–June 2022, we estimated SARS-CoV-2 transmission among and between residents and staff. We used a Bayesian inversion of a susceptible–exposed–infected–removed–virus–death (SEIRVD) compartmental model to produce the estimates. The facilities were divided into those with median length of stay (LOS) among the residents of 10 weeks. Additional inputs included the incidence and vaccination levels of the county where each facility was located. For the compartmental model, all data were averaged to form a representative facility for each category. Transmission was estimated separately for 3 periods: (1) June 2020–March 2021 as before the SARS-CoV-2 delta variant, (2) April 2021—October 2021 during SARS-CoV-2 delta variant dominance, and (3) November 2021—June 2022 during the prevalence of the SARS-CoV-2 omicron variant. Results: Regardless of facility category, transmission was highest from staff to residents or resident to resident (Fig.). These estimates of transmission were highest during the pre–SARS-CoV-2 delta variant phase. Transmission in that phase was highest in the facilities with LOS >10 weeks from staff to residents at 0.88 per week (95% credible interval [CrI], 0.06–1.85), in the facilities with LOS 6–10 weeks from staff to residents at 0.68 per week (95% CrI, 0.03–1.78), and in the facilities with LOS <6 weeks between residents at 0.47 per week (95% CrI, 0.02–0.95). Conclusions: Staff-to-resident or resident-to-resident transmission were the dominant pathways of spread of SARS-CoV-2 across the periods or the facility categories. Facilities with LOS 6 weeks or longer had higher median transmission estimates across the periods and transmission routes compared to facilities with LOS less than 6 weeks, implying that when prioritization of intervention resources is needed, facilities caring for populations with longer stays could be prioritized.

Disclosures: None

In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.

(Disaster Med Public Health Preparedness. 2012;6:67–71)

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.

(Disaster Med Public Health Preparedness. 2012;6:60–66)

One of the most common features of international investment treaties is the obligation of a state to grant ‘fair and equitable treatment’ to investors and investments. Treatment giving rise to allegations of breaches of this obligation has taken many forms, namely bad faith, discrimination, denial of justice, frustration of legitimate expectations, lack of transparency, coercion and harassment, and arbitrariness or arbitrary conduct. This latter form of treatment – arbitrariness – has rarely been the focus of scholarly works and, thus, its scope and meaning are difficult to ascertain. When examined in the context of international investment disputes, however, one may conclude that, while its scope and meaning may vary, arbitrariness is indeed a legitimate basis for claim under the fair and equitable treatment standard. The thresholds for demonstrating arbitrariness, however, are decidedly and consistently high.