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Responding to respiratory viral diseases

The SARS CoV-2 pandemic has punctuated the importance of preliminary screening of the respiratory diseases, given that they are highly contagious and easily transmitted. Airborne viruses can be transmitted within liquid droplets or aerosolized particles that are released when a person sneezes, coughs, or speaks. Droplets are bigger (20 μm), and consequently tend to spread only through short distances. Aerosolized particles (less than 5 μm) remain airborne and can reach the lower respiratory tract more easily.

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The SARS CoV-2 pandemic demonstrated how easily different healthcare systems can be outdated and revealed financial, personnel and infrastructure deficiencies. The STAMINA project aims to address these challenges by developing solutions to support preparedness and response to a pandemic crisis and provide appropriate tools to deal with complex decisions at operational, tactical and strategic level for decision makers. An essential element in this effort is the capacity to rapidly control data, make real-time realistic predictions, and include public opinion in decision making to bring about a more coordinated effort between countries in the EU and worldwide.

Stefan S Nicolau Institute of Virology (IVN) from Romania, the national planner in STAMINA project, is the National Centre for Reference of Influenza and Respiratory Viruses. He works with the World Health Organisation (WHO) to survey the epidemic’s course of the respiratory acute infections determined by the influenza and other viruses with affinity for the respiratory tract. The locations they target are in eight districts within the south-east area of Romania. These results are sent to the Ministry of Health and are corroborated with epidemic data that is processed using Epi-Info program. Records are drawn up and given to the National Health Ministry and WHO.

The WHO surveillance case definition for influenza-like illness (ILI) is an acute respiratory infection with a measured fever of ≥38oC and cough, with symptom onset within the last 10 days. Sentinel site data should be interpreted with caution since the number of sites reporting may vary between weeks.As of May 22, 2022 (week 20 / 2022) at national level in Romania, the total number of ILI were 39312, 1.2 times higher as compared to the same week of the last season (32357) This data reflects a high potential of influenza activity during this season, emphasizing the gravity of other epidemics we can confront annually, besides the SARS CoV-2 pandemic.

IVN establishes scientific connections by FluNet with other National Centres and transmits isolated strains of influenza viruses toward the International Centre of Influenza in London to be confirmed and deeply studied.

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Through a review of STAMINA tools which cover all the steps of a pandemic management, IVN partner dealt with the solutions to this simulation protocol in the following ways:

  • SmarKo device – a device that monitors patient’s temperature, oxygen saturation and pulse, we began by using a previously designed simulation methodology, with an emulator which allows simulating the biological parameters.
  • Flu and Coronavirus Simulator (FACS) – allows the elaboration of pandemic models, and consequently we provided the necessary information to the tool owner.
  • Web and Social Media Analytics (WSMA) is a search of social media networks (Reddit and Twitter) to identify pandemic / epidemic signs.
  • Data Management and Harmonization Tool (DMHT) – provides storage of user data, being available for other tools. For simulation, data were transmitted to the tool owner pandemic in different regions, taking into account the total population of the specific region, as well as the evolution of the epidemic assessing the total number of suspects, intubated and deceased patients. The Information Protection Tool (IPT) works in tandem with DMHT and ensures data security and authorized access to it.
  • Early Warning System (EWS) – data set are transmitted for training the Machine Learning module and the rules by which EWS transmits alert (warning) and alarm messages are based on information from SmarKo, WSMA and FACS.
  • CrisisHub – collects, orders, analyses and issues lists of actions and decisions, recommended to the decision makers in the management of a pandemic / epidemic. During our trial, we practised the simulation of a pandemic according to the scenario.
  • ENGAGE tool – allows the STAMINA platform to view several profiles of hospitals / infectious disease departments in various regions. We have provided publicly available resources from our region.
  • CHARM tool – based on information from ENGAGE. We have worked on simulations for redistributing resources between different hospitals in the country.
  • Emergency Mapping Tool (EMT) – provides decision makers and authorized people a real-time and realistic picture of the essential and detailed information from the other tools; the decisions taken by the responsible factors in the field are based on this tool.
  • Preparedness Pandemic Training (PPT) – allows the production of various scenarios and activities during the pandemic and establishment of the optimal situations that can be applied when an ongoing pandemic is present, by testing the organizational and public health resources in different regions.

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As a consequence, the paradigm of the SARS CoV-2 pandemic revealed ideas that are important for the STAMINA project’s implementation and these lessons can influence better management of any potential pandemic. Here are some of the key lessons learnt from this trial:

  • The importance of digitization
  • Inter-institutional coordination and collaboration with health education of the population as a permanent objective to understand and accept health measures
  • The need to reorganize the health information system and standardize it for all levels of medical services for all EU countries to obtain a unitary and homogenous system of surveillance which can adapt quickly to possible epidemics /pandemics through flexible organizational and funding conditions and regulations