Research On The Comprehensive Public Health Intervention Strategies For Emerging Infectious Diseases

[Objective]As COVID-19 pandemic continues to spread,countries around the world are trying to contain the outbreak with the fastest and most efficient public health interventions.At present,there is still a lack of systematic research on the role of comprehensive public health interventions in the control of emerging infectious diseases.Such research is mainly dominated by the normative research of"should be",and empirical research based on real-world data is generally insufficient.From a global perspective,this study aims to explore the response mechanism to emerging infectious diseases by analyzing the implementation status of public health interventions in various countries,and build a theoretical analysis framework for comprehensive public health interventions on the basis of diagnosing the weak links in global epidemic prevention.Then,based on real-world data,the effect of comprehensive public health interventions on epidemic control was verified,and effective intervention strategies for emerging infectious diseases were proposed.[Method]Based on the literature analysis method and semi-structured interviews,we firstly sorted out the factors influencing the comprehensive public health interventions,defined the key concepts.Through the research path of"realistic problem→phenomenon description→problem discovery→concept refining",the elements of public health comprehensive interventions were continuously verified and modified,and the basic theoretical analysis framework of public health comprehensive interventions was constructed.Under the guidance of theoretical analysis framework,descriptive statistical analysis,multiple regression analysis and fuzzy-set qualitative comparison analysis were performed on the data collected from the projects responding to the COVID-19 pandemic of the World Health Organization,Johns Hopkins University,Oxford University,Our World in Data and other institutions.Descriptive statistical analysis was used to analyze the implementation status of public health interventions at global,regional and national levels,so as to continuously explore new elements of comprehensive public health interventions and revise the theoretical analysis framework.Multiple regression models were used to verify the hypothesis that the sub-elements of comprehensive public health interventions were conducive to epidemic control.Fuzzy-set qualitative comparative analysis(fs QCA)was used to verify the hypothesis that comprehensive public health interventions are effective for epidemic prevention and control,and to explore the effective combination of public health intervention strategies.In addition,government announcements,news reports and authoritative online reports were further included.The typical case study method was used to analyze the response to COVID-19 in China,the United States and Japan.In addition to focusing on specific public health interventions in response to COVID-19,the research hypothesis that the continuous of public health interventions positively affects the effectiveness of COVID-19 prevention and control was tested,and other factors that ensure the good operation of public health interventions was explored.[Results](1)Four dimensions were preliminarily determined to evaluate the comprehensiveness of public health interventions,namely the diversity(richness and abundance),timeliness,stringency and continuity of public health interventions.Comprehensive public health interventions are not only a series of activities,but also a continuous process.The implementation of"comprehensive public health interventions"has a certain goal orientation,which aims to establish a steady-state system of public health intervention that can block the spread of virus.There are two principles to evaluate the elements of comprehensive public health intervention:it should avoid the"short board"in the implementation of public health intervention measures;The whole effect of the intervention is equal to or greater than the sum of its parts.(2)Between January 2020 and December 2021,an average of 13 categories and 41 items of public health interventions were introduced globally.The median number of individual measures,detection and isolation measures,social distancing measures,international travel measures and biological measures were 5,11,69,15 and 7,respectively;only 16 categories of interventions were adopted by more than 100 countries and territories(hereinafter referred to as"countries"),including passive screening,cancelling/restricting of outdoor assemblies,cancellation of large-scale events,mask orders,temporary closure of businesses,temporary closure of school,entry quarantine and isolation,tracing of close contacts,adaptation measures of business establishments,etc.Interventions such as medical isolation,quarantine isolation,social distancing,restricting exit,restricting private gatherings at home,and restrictions on out-of-state entry were used in only 43 or fewer countries.(3)Countries initiated contact tracing,passive screening,travel restrictions,suspension or restriction of international shipping,and school closures on days 3,5,20,22,and 30(median)after the first confirmed case was reported;Travel advice or warning,medical quarantine,business adaptation measures,proactive screening,closure of international ports of entry,entry quarantine,suspension/restriction of international flights,and mask orders are not implemented until 50 days after the first confirmed case in each country.When the number of confirmed cases in each country had reached 100,only 8 countries introduced more than15 different types of interventions,24 countries introduced more than 10 different types of interventions,and 93 countries introduced less than 5 different types of interventions.When the number of confirmed cases in each country reached 10,000,the median number of types of individual measures,detection and isolation measures,social distancing measures and international travel measures were 1,2,7 and 2,respectively.After the World Health Organization declared COVID-19 a"Public Health Emergency of International Concern",most countries did not immediately implement public health interventions.It was not until March 2020,after the COVID-19 outbreak was declared a"pandemic",that many countries began to implement some public health interventions.(4)In the scenario with no more than 10,000 cases,the contribution degree(R~2)of the richness,abundance,stringency,and timeliness of public health interventions to the variation of intervention effect(days)were 0.338(P<0.001),0.506(P<0.001),0.068(P<0.001),and 0.482(P<0.001),respectively.The richness and abundance of public health interventions had a significant positive impact on epidemic control,while the timeliness and stringency of interventions had a significant negative impact on epidemic control.Except that the hypothesis that the stringency of interventions is conducive to epidemic control was contrary to the original hypothesis,the other hypotheses were verified.(5)There are three optimal strategies for epidemic control.Among them,the timeliness of public health interventions is the key factor to effectively control the epidemic,and detection and isolation measures are the important categories of public health intervention measures to control the epidemic.(6)China’s main prevention and control strategies are as follows:China’s response to emerging infectious diseases outbreak took decisive decision-making,the implementation of a comprehensive,rigorous,coherent public health comprehensive intervention,and through the unified and efficient control system realized the synergistic action of trans-regional,cross-sectoral,this contributes to the deployment of high quality resources across the country,ensuring the production and supply of materials for the health and life and interconnectivity of epidemic prevention and control information;Grass-roots grid management systems and the application of big data and artificial intelligence technologies have facilitated the implementation of public health interventions.Although the United States also took strict intervention measures such as temporarily closing schools and restricting unnecessary travel,it did not track the positive patients and their close contacts,and the interventions were relatively delayed.In addition,the"Freud incident",the election and other events made the stay-at-home order and social distancing measures ineffective.After the epidemic got out of control,the states gradually gave up the strict control measures.In the early stage of the epidemic,Japan quickly adopted public health interventions such as passive screening and entry restrictions,which effectively contained the further spread of the epidemic to a certain extent.However,due to the monotonous and low level of strict intervention measures,coupled with the lack of implementation of measures such as quarantine,tracing of close contacts,and other measures,the epidemic has been out of control to a certain extent.[Conclusion](1)The elements of comprehensive public health interventions were composed of the diversity,timeliness and continuity of public health interventions.(2)Countries with poor epidemic prevention and control are due to the lack of comprehensive public health interventions for the epidemic.To be specific,countries did not implement a certain variety of rich and appropriate number of public health interventions in the early stage of the epidemic,and the introduction of interventions was relatively slow.(3)Comprehensive public health intervention is an effective intervention strategy to effectively control emerging infectious diseases.In the early stage of the epidemic,it is necessary to rapidly implement a certain variety of rich and appropriate number of public health interventions.The diversity and timeliness of public health interventions directly determine the efficiency and effectiveness of epidemic prevention and control.[Innovation and Deficiency](1)Research innovation.1)Theoretical innovation.Based on project theory and system theory,a theoretical analysis framework of public health comprehensive intervention was constructed,and the elements of public health comprehensive interventions are determined by the diversity,timeliness and continuity of public health interventions.This study systematically describes the implementation status of public health interventions in countries around the world from the perspective of policy tools,and diagnoses the deficiencies of epidemic prevention and control.2)Innovative research perspectives and appropriate problem solving methods.Based on the reductionism perspective and the configuration perspective,the effects of each sub-characteristic attribute constituting the comprehensive public health interventions on epidemic control and the effects of the total elements of the comprehensive public health interventions on epidemic control were verified.This solves the problem that the existing research schemes,including simulation methods,cannot effectively verify the effect of comprehensive public health interventions on epidemic control.Among the published literature,this study included the most types of public health interventions and adopted the largest number of cases,providing higher quality evidence that comprehensive public health interventions are beneficial to epidemic control.(2)Limitations of the study.All the conclusions of this study are drawn based on the global response to COVID-19.The strong spread of COVID-19 put forward higher requirements for comprehensive public health intervention;The effectiveness indicators of public health interventions were based on the policy objective of containing the spread of the epidemic,without taking into account social and economic indicators;Data originated from third-party organizations,and data quality may affect the robustness of the results.