Civil-military cooperation to contain COVID-19 epidemic in Israel- Lesson learned

Abstract Issue Public Health Services (PHS) has a major role in controlling COVID-19. As the epidemic propagated, and due to limited resources, PHS in Israel reached it capacity to contain the outbreak. Following a political decision in June 2020, the Home Front Command (HFC) of the Israeli Army was assigned to integrate in operating the National epidemiological efforts, while the PHS remained responsible for policy, setting guidelines and supervision. Problem The civilian PHS and the military HFC had to establish cooperation, institute new hierarchical structure and divide the responsibility, despite the differences in organizational cultures, financial and human resources. Additionally, inter and intra organizational interests had to be resolved. Results Formal and informal efforts were needed to bridge between the two organizations, while utilizing the comparative advantage of each agency. PHS has experience in controlling outbreaks, well-established intra-organizational communication, high professional identity, commitment and familiarity with different populations in Israel. HFC is a flexible, creative, learning and fast-responding organ, experienced in controlling emergencies and has well-established chains of command. HFC is supported by IT and intelligence officers. Organizational disadvantages had to be resolved. PHS is deficient in resources, has limited capacity in operating staff during irregular hours, and is obliged to share the health leadership and authority with the army. HFC has to confront high rotation of its manpower, difficulty in succumbing to non-military guidelines and regulations and possible mistrust between the army and special populations, such as Arabs or ultra-religious Jews. Lessons Civil-military epidemiological cooperation can boost the National response in containing epidemics. Policymakers from each agency should use leadership skills to encourage integration while being sensitive to the needs and expectations of all participants. Key messages • Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency. • Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.


Introduction:
In Italy a Covid-19 pandemic pattern was observed, characterized by several waves, with an excess total mortality of 178000 deaths. Alessandria, Italy is the Piedmont province with the highest proportion of mortality from Covid-19 in the first 4 months of 2020, compared to the rest of the region. Objectives: To analyze mortality in patients hospitalized for Covid-19 in the Alessandria Hospital (AO AL), considering the first 3 waves. Materials and methods: Subjects aged 18 with a diagnosis of Covid-19 admitted to the AO AL in the first 50 days of the first 3 waves were included. The first wave started on 24 February 2020 (first day of available data by the Ministry of Health), the second wave on 14 September 2020 (first day of the 2020/21 school year), the third wave on 15 February 2021 (peak of cases detected by the Italian College of Health). The causes of death were obtained from the National Institute of Statistics death cards and codified according to the International Classification of Diseases, 9th revision, classification.

Results:
We included 825 subjects (median age: 73 years; male prevalence: 60.7%). The subjects hospitalized in the first wave were 464, in the second wave 255, in the third wave 106. A total of 309 subjects died (37.5%), of which 218 in the first wave (70.6%), 69 in the second wave (22.3%), 22 in the third wave (7.1%). The most frequent causes of death were ''Covid-19 pneumonia'' (61.5%) and ''respiratory distress syndrome'' (19.4%). Death occurred after hospital discharge in 40% of cases. 6 months after admission, the survival rate was 53% among patients of the first wave, 73% and 78% for those of the second and third wave. Patients hospitalized in the first and second waves showed a greater risk of death compared to patients of the third wave (HR = 2.8; 95% CI 1.8-4.4 and HR = 1.4; 95% CI 0.8-2.2).

Conclusions:
Data showed a difference in mortality between the 3 waves with a statistically significant variation between the first and third waves.

Key messages:
Data showed a difference in mortality between the 3 waves. Data showed a statistically significant variation in mortality between the first and third waves.
Abstract citation ID: ckac131.059 Civil-military cooperation to contain COVID-19 epidemic in Israel-Lesson learned

Issue:
Public Health Services (PHS) has a major role in controlling COVID-19. As the epidemic propagated, and due to limited resources, PHS in Israel reached it capacity to contain the outbreak. Following a political decision in June 2020, the Home Front Command (HFC) of the Israeli Army was assigned to integrate in operating the National epidemiological efforts, while the PHS remained responsible for policy, setting guidelines and supervision.

Problem:
The civilian PHS and the military HFC had to establish cooperation, institute new hierarchical structure and divide the responsibility, despite the differences in organizational cultures, financial and human resources. Additionally, inter and intra organizational interests had to be resolved.

Results:
Formal and informal efforts were needed to bridge between the two organizations, while utilizing the comparative advantage of each agency. PHS has experience in controlling outbreaks, well-established intra-organizational communication, high professional identity, commitment and familiarity with different populations in Israel. HFC is a flexible, creative, learning and fast-responding organ, experienced in controlling emergencies and has well-established chains of command. HFC is supported by IT and intelligence officers.
Organizational disadvantages had to be resolved. PHS is deficient in resources, has limited capacity in operating staff during irregular hours, and is obliged to share the health leadership and authority with the army. HFC has to confront high rotation of its manpower, difficulty in succumbing to non-military guidelines and regulations and possible mistrust between the army and special populations, such as Arabs or ultra-religious Jews.

Lessons:
Civil-military epidemiological cooperation can boost the National response in containing epidemics. Policymakers from each agency should use leadership skills to encourage integration while being sensitive to the needs and expectations of all participants.

Key messages:
Civil-military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency. Civil-military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.

Background:
Vaccination is a critical intervention in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Various levels of COVID-19 vaccination acceptance have been observed around the world. However, a high percentage of the general population and healthcare professionals (HCPs), refuse the COVID-19 vaccination. This study aims to examine the factors influencing COVID-19 vaccine uptake among HCPs and the general population in Cyprus.

Methods:
An online cross-sectional study was conducted, using a selfadministered questionnaire to collect information covering various potential determinants including sociodemographic and health-related characteristics, trust in the healthcare system, satisfaction with it, utilization of preventive healthcare services, COVID-19 vaccination information, and general vaccination knowledge.

Results:
A total of 2582 participants completed the survey, with 53.5% of individuals in the general population, and 70.0% of the HCPs received the COVID-19 vaccination. We found that as the age increases by one year among the general population, the odds of being vaccinated against COVID-19 increase by 1.02 units (95% 1.00-1.03, p-value = 0.035), whilst those with increased trust in national healthcare authorities' guidelines (OR = 3.96, 95% CI: 3.41-4.61) and increased vaccination knowledge scores (OR = 1.11, 95% CI: 1.05-1.18) were significantly more likely to be vaccinated. Furthermore, male HCPs (OR = 1.91, 95% CI: 1.01-3.59), and those who reported increased trust in national healthcare authorities' guidelines (OR = 5.38, 95% CI: 3.65-7.95) were significantly more likely to be vaccinated.

Conclusions:
Public health policymakers can use national campaigns and long-term planning to build public trust in national healthcare authorities and educate and raise awareness about the benefits of vaccination. Such strategies could pave the way for adequate vaccine uptake and prepare the public for unfavorable scenarios, such as future pandemics.

Key messages:
Our results revealed the importance of vaccination knowledge and trust in healthcare system in respect to COVID-19 vaccination uptake. The urgent need for national campaigns and long-term planning to build public trust in national healthcare authorities.