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Public Health Decision-Making in the Real World: Four Points to Reshape It After COVID-19

Published online by Cambridge University Press:  21 April 2020

Emanuele Torri Open the ORCID record for Emanuele Torri [Opens in a new window]  and
Giandomenico Nollo
Emanuele Torri*
Affiliation:
Department of Health and Social Policies, Autonomous Province of Trento, Trento, Italy
Giandomenico Nollo
Affiliation:
Department of Industrial Engineering - BIOtech Labs, University of Trento, Trento, Italy
*
Correspondence and reprint requests to Emanuele Torri, Department of Health and Social Policies, Autonomous Province of Trento, Trento, Italy (e-mail: emanuele.torri@provincia.tn.it).
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Abstract

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Keywords

public health practicepublic healthquality of health carerisk managementsafety management
Type
Commentary
Information
Disaster Medicine and Public Health Preparedness , Volume 14 , Issue 4 , August 2020 , pp. 504 - 505
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© 2020 Society for Disaster Medicine and Public Health, Inc.

The coronavirus disease 2019 (COVID-19) outbreak is rapidly progressing worldwide, tremendously impacting health systems, science, and society. Reference Farnoosh, Zarei and Hosseini Zijoud1 Uncertainty is unparalleled in living memory, and involves the urgency of deciding with limited resources and under pressures from conflicting interests. Drawing from the hard lessons of Italy’s experience, the European country most affected by the pandemics to date, Reference Gagliano, Villani and Có2 we wish to share ideas to improve emergency decision-making.

GOVERNANCE

Expanding international coordination Reference Anderson, Mckee and Mossialos3 and health-care accreditation programs to guarantee reliability of hygiene practices, surveillance, and safety systems on the ground is crucial now. A special attention toward strengthening education for leadership development of public health officials and clinicians is needed to enable engagement, resilience, and trust.

DATA-DRIVEN MANAGEMENT

Information and data sets for COVID-19 research should be in the public domain, to provide broader development of models and data supporting health authorities and agencies in public decisions. Peer observations and bottom-up inputs should be collected. Multiple scientific competence centers should be institutionalized as “scientific civil protection” for activations during emergencies to perform timely analysis and experiments tailored on policy questions.

HEALTH TECHNOLOGY ASSESSMENT

Context-based analysis of cultural, organizational, economic, social, and ethical issues is vital given the complexity of public health. First, politicians and the public should be thoroughly educated in health technology assessment. Second, we need practical models to expedite the appraisal process and resolve technological issues in emergencies. Third, in addition to the opinion of a few experts, we could exploit the value of collective knowledge and crowdsourcing data within structured consensus mechanisms.

CLINICAL GUIDELINES AND PROTOCOLS

With limited availability of evidence and the need for broad consensus meetings, relying only on eminences or slow bureaucratic orders is not the best choice. Instead, it is essential to prompt researchers and scientists to fully review “expert evidence” Reference Schünemann, Zhang and Oxman4 by basing decisional frameworks on practical insights of stakeholders and frame recommendations as actionable points disseminated through multiple channels.

While a wave of changes in culture, technology, and practice is sweeping the globe, Reference Lichfield5 we have an unprecedented opportunity for optimizing the compromise between science and real-word decisions.

Conflict of Interest

The authors declare no conflict of interest.

References

REFERENCES

Farnoosh, G, Zarei, S, Hosseini Zijoud, SS, et al. Is there a guarantee that the crisis of Covid-19 will not be repeated? Disaster Med Public Health Prep. 2020. doi: 10.1017/dmp.2020.83 CrossRefGoogle Scholar
Gagliano, A, Villani, PG, Có, FM, et al. COVID-19 epidemic in middle province of northern Italy: impact, logistic & strategy in the first line hospital. Disaster Med Public Health Prep. 2020. doi: 10.1017/dmp.2020.51 CrossRefGoogle ScholarPubMed
Anderson, M, Mckee, M, Mossialos, E. Covid-19 exposes weaknesses in European response to outbreaks. BMJ. 2020;368:m1075. doi: 10.1136/bmj.m1075 Google Scholar
Schünemann, HJ, Zhang, Y, Oxman, AD, et al. Distinguishing opinion from evidence in guidelines. BMJ. 2019;366:l4606. doi: 10.1136/bmj.l4606 CrossRefGoogle ScholarPubMed
Lichfield, G. We’re not going back to normal. Social distancing is here to stay for much more than a few weeks. It will upend our way of life, in some ways forever. MIT Technology Review; March 17, 2020. https://www.technologyreview.com/s/615370/coronavirus-pandemic-social-distancing-18-months/?truid=a497ecb44646822921c70e7e051f7f1a. Accessed April 21, 2020.Google Scholar