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 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 66-68

COVID-19 pandemic and cross-training for epidemiology surge capacity

Microbiologist, Intermediate Reference Laboratory, STDC, Kolkata; State TB Division, Department of Health and Family Welfare, Government of West Bengal, West Bengal, India

Date of Submission16-May-2021
Date of Decision05-Nov-2021
Date of Acceptance25-Nov-2021
Date of Web Publication1-Feb-2022

Correspondence Address:
Dr. Indranath Roy
1/B, Surji Dutta Lane, PO-Beadon Street, Kolkata - 700 006, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpsic.jpsic_10_21

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How to cite this article:
Roy I. COVID-19 pandemic and cross-training for epidemiology surge capacity. J Patient Saf Infect Control 2021;9:66-8

How to cite this URL:
Roy I. COVID-19 pandemic and cross-training for epidemiology surge capacity. J Patient Saf Infect Control [serial online] 2021 [cited 2022 Oct 2];9:66-8. Available from: https://www.jpsiconline.com/text.asp?2021/9/2/66/337088

The World Health Organization (WHO) has provided recommendations/guidelines to the different member states on strengthening health-care systems and rapidly reorganizing service delivery to respond to COVID-19. These published guidelines recommend the core maintenance of essential services across the continuum of care to the different tiers of the health-care system. However, the scenario in this pandemic has been difficult to tackle, particularly in low-middle-income countries (LMICs) and also in resource-poor settings.

It is observed that the outbreaks of infectious diseases can be resource intensive, and large outbreaks may require that public health authorities reassign staff to participate in the outbreak situation. Such reassignments definitely disrupt other necessary work of the health-care organization. During an outbreak or any public health emergency, epidemiology and infectious disease staff at local health departments can be stretched thin. The situation becomes worsened by aged health-care workers and also for staff who are on the verge of retirement. Few of the health staff has the experience to interact outbreak situation. The lack of optimum training to deal the outbreak is also one of the difficulties faced by public health authorities.[1] As per the WHO, surge capacity is the ability of a health system to manage a sudden and unexpected influx of patients in a disaster or emergency situation. Surge capacity can be created from intrinsic and extrinsic resources. The former covers all local resources that can be used for the response, while the latter involves leveraging resources from outside the affected area (across geography or across specialty).

However, there is an opportunity for public health departments and different health-care organizers to move the field forward to combat the situation at the ground level. These health system authorities need staff with diverse skill sets to help lead this task. Having cross-trained public health staff that can support laboratory activities or epidemiological investigation at field level or providing direct health care in frontline of an outbreak is a critical component of developing surge capacity. It does not only help to manage ongoing work burden but also supports to respond to emerging issues. Proactively working with staff ahead of time to develop baseline knowledge can save time and resources, and health care authorities can better prepare themselves[1] to be flexible when faced with an emergency or new challenge.[2]

In an emergency or public health disaster, hospital staff is generally required to go beyond their routine day-to-day roles and responsibilities and to take on tasks with which they are less familiar. Moreover, they will have to carry out tasks in a stressful environment. To meet these new demands, all staff members, irrespective of their hospital, departmental, and individual duties, need to be involved in the emergency planning process so that they familiarize themselves with the situation.[3]

The advantage of this training and mock drill will help the staff to understand to make a clear cut distinction between their routine and their emergency responsibilities and can better contribute to the emergency response. They also need training in implementing risk reduction measures and the procedures and protocols called for in the hospital emergency response plan. They must, in addition, participate in the regular drills and exercises needed to maintain a state of readiness for fulfilling the planned emergency tasks.

The WHO recommendations provide consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in public health emergency. It focuses mainly on the principles and frameworks for the expansion of intensive care services in hospitals.[4] Surge capacity must be built up in public health sector for epidemiological activities, particularly in active surveillance, contact tracing, tracking, and follow-up.

The surge capacity can be enhanced by different multifaceted approaches. Different countries have different approaches based on their resources. The WHO has published comprehensive guidelines for this, which involves a comprehensive approach linking the four S's of surge capacity: space, staff, supplies, and systems.

These four 'S's can be discussed very shortly focusing on the main objective of each recommendation and strategic area of enhancement.[3]

  1. Space: creation and activation of stepwise plan to expand physical space to care COVID-19 patients adhering to strict infection prevention and control protocols. Space, or structure, covers hospitals and beds including the facilities that are either already available in those settings or which could be equipped for specific emergency requirement, for example, wards for appropriate triage and cohort wards with adequate air ventilation facility.[5]
  2. Staff: identification of health-care workers available for surge capacity demands and repurpose and upskill for rapid deployment to meet the demand. The health authority is to ensure sufficient numbers of appropriately skilled and supervised health workers during the emergency situation
  3. Supplies: ensuring adequate supplies to support surge in demand. These relate to the (stored) availability of specific equipment for emergency deployment, both for patient care and health worker safety
  4. Systems: establishment of systems to manage and align policies to meet surge in demand. Systems refer to methods of working to ensure ongoing, sustainable, and proactive coordination for optimum surge capacity response. These methods of working ensure that integrated policies and procedures must exist and are activated in due time to develop optimized sustainable surge capacity.[6]

The national or the state health authorities must take a multipronged approach to meet the demand based on the abovementioned recommendations. The different tiers of health system can percolate the recommendations as policies to meet the surge capacity demand as per local or regional resource availability. However, enhancing human resources in the pandemic situation (staff) has been really a challenging task.

There are few recommendations of surge capacity in terms of human resources and in the present context of COVID-19. These recommendations cannot be overlooked. These recommendations are as follows:[7]

  1. Active involvement of staff and students at academic public health programs could serve as a potential source for surge capacity, many students in schools of public health do not have the opportunity to participate in public health emergency response or learn firsthand about many of the everyday aspects of public health practice
  2. A program using student or faculty volunteers provides surge capacity for the health department at low cost, while providing the volunteers an opportunity to obtain experience in public health practice at a local health department
  3. Although a student volunteer program can take significant time for preparation and training, such programs could add significantly to developing both useful surge capacity for the health department and valuable experience for the students I future.

To achieve surge capacity, the public health authorities and hospital authorities require a systemic approach that integrates and synchronizes public health measures taken by a broad “coalition” of stakeholders, including frontline care providers, community health organizers, private-sector service providers, and other health care establishments. All the stakeholders share responsibility for mitigating or containing a surge in demand that threatens to overwhelm the health-care organizations.[5]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Mass Casualty Management Systems. Strategies and Guidelines for Building Health Sector Capacity. Geneva, Switzerland: Health Actions in Crises, World Health Organization; 2007. Available from: http://www.who.int/hac/techguidance/tools/mcm_guidelines_en.pdf. [Last accessed on 2020 May 01].  Back to cited text no. 1
Ornelas J, Dichter JR, Devereaux AV, Kissoon N, Livinski A, Christian MD, et al. Methodology: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014;146:35S-41S.  Back to cited text no. 2
Barbisch DF, Koenig KL. Understanding surge capacity: Essential elements. Acad Emerg Med 2006;13:1098-102.  Back to cited text no. 3
Ferguson N, Laydon D, Nedjati-Gilani G et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College COVID-19 Response Team. 2020 Mar.https://doi.org/10.25561/77482.  Back to cited text no. 4
Chang SL, Harding N, Zachreson C, Cliff OM, Prokopenko M. Modelling transmission and control of the COVID-19 pandemic in Australia. Nat Commun. 2020;11(1):5710. Published 2020 Nov 11. doi:10.1038/s41467-020-19393-6.  Back to cited text no. 5
Fisher D, Hui DS, Gao Z, Lee C, Oh MD, Cao B, et al. Pandemic response lessons from influenza H1N1 2009 in Asia. Respirology 2011;16:876-82.  Back to cited text no. 6
Gebbie EN, Morse SS, Hanson H, McCollum MC, Reddy V, Gebbie KM, et al. Training for and maintaining public health surge capacity: A program for disease outbreak investigation by student volunteers. Public Health Rep 2007;122:127-33.  Back to cited text no. 7


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