As the COVID-19 pandemic started, the NO-FEAR project shifted to real-time experience sharing to improve response to an unknown new threat. The lessons observed during more than 20 webinars were collected and analyzed at the end of 2019 to identify those relevant for future preparedness and response to another outbreak or new threats.

A questionnaire using a 0-4 Likert scale was distributed to the wider NO-FEAR community, where they were asked to identify the relevance of the item for future preparedness. Later the results were discussed by the consortium and put for feedback in a large meeting in Madrid in March 2022. The 78 observations were clustered into five categories: 1) The human factor (23) 2) Knowledge sharing, cooperation and coordination (11) 3) Equipment and supplies (15) 4) Standard Operating Procedures (SOP) (20) 5) PPE (9).

The Top-rated observations were the following:

• The human factor: 2.3 need for updated, trustful information sharing with personnel (e.g. regarding treatment protocols, PPE, updates, etc.) to allow them a comprehensive understanding of the situation (3.73).

• Personal Protective Equipment (PPE): 6.1 need for PPE stockpile management, considering transportation, storage space, and risk of throwing away out-of-date PPE (3.63).

• Equipment and supplies: 4.3 need for solutions to increase equipment and beds capacity (3.56).

• The human factor: 2.22 need for management of fake news and mitigation of violent incidents against healthcare personnel (3.56).

• Knowledge sharing, cooperation and coordination: 3.5 need to collect data, needs, gaps, and lessons in preparation for future outbreaks (3.56).

Better integrating health care into crisis management structures was highlighted during the Madrid conference.

NO-FEAR highlighted the importance of real-time international real-time knowledge sharing in a crisis, the need to better address the needs of the personnel during a long-term crisis, and better integrate health into crisis management structures