The COVID-19 pandemic highlights a long-known but often neglected aspect of international relations: the ability of disease to challenge and change all aspects of security, as well as the ability of public policies to change the course of disease progression. Diseases, especially mass epidemics like COVID-19, clearly affect political, economic, and social structures, but they can also be ameliorated or exacerbated by political policies, including public health policies. The threat of pandemic disease poses a widespread and increasing threat to international stability. Indeed, the political implications of pandemic disease have become increasingly evident as COVID-19 has precipitated death, economic collapse, and political instability around the globe. Any pandemic disease can precipitate catastrophes, from increasing health care costs to decreased productivity. This theoretical discussion highlights the intertwined interactions between social, political, and economic forces and the emergence and evolution of pandemic disease, with widespread implications for governance and international security.

As the Middle East respiratory syndrome coronavirus (MERS-CoV) continues to occur in small outbreaks in Saudi Arabia, we aimed to assess the knowledge, attitudes and intended practices of healthcare workers (HCWs) during the early stage of the COVID-19 pandemic and compare worry levels with previous findings during the MERS-CoV outbreak in 2015. We sent an adapted version of our previously published MERS-CoV questionnaire to the same cohort of HCWs at a tertiary hospital in Saudi Arabia. About 40% of our sample had previous experience with confirmed or suspected MERS-CoV patients, and those had a significantly higher knowledge score (13.16 ± 2.02 vs. 12.58 ± 2.27, P = 0.002) and higher adherence to protective hygienic practices (2.95 ± 0.80 vs. 2.74 ± 0.92, P = 0.003). The knowledge scores on COVID-19 were higher in the current cohort than the previous MERS-CoV outbreak cohort (68% vs. 79.7%, P < 0.001). HCWs from the current cohort who felt greater anxiety from COVID-19 compared to MERS-CoV were less likely to have been exposed to MERS-CoV infected/suspected cases (odds ratio (OR) = 0.646, P = 0.042) and were less likely to have attended the hospital awareness campaign on COVID-19 (OR = 0.654, P = 0.035). We concluded that previous experience with MERS-CoV was associated with increased knowledge and adherence to protective hygienic practices, and reduction of anxiety towards COVID-19.

In this study, we examine the impacts of retail promotions and flu/cold incidences on the demand for orange juice using weekly Nielsen grocery orange juice sales statistics and the flu/cold incidences reported by Surveillance Data Inc. The cross-section time-series pooling technique proposed by Parks was used to estimate the demand parameters. Results show that flu/cold incidences increased the effectiveness of retail promotions on the demand for orange juice.

Objectives: The Medical Reserve Corps (MRC) is a national network of community-based units created to promote the local identification, recruitment, training, and activation of volunteers to assist local health departments in public health activities. This study aimed to develop a toolkit for MRC coordinators to assess and monitor volunteer units' performance and identify barriers limiting volunteerism.

Methods: In 2008 and 2009, MRC volunteers asked to participate in influenza clinics were surveyed in 7 different locations throughout the United States. Two survey instruments were used to assess the performance of the volunteers who were able to participate, the specific barriers that prevented some volunteers from participating, and the overall attitudes of those who participated and those who did not. Validity and reliability of the instruments were assessed through the use of factor analysis and Cronbach's alpha.

Results: Two survey instruments were developed: the Volunteer Self-Assessment Questionnaire and the Barriers to Volunteering Questionnaire. Data were collected from a total of 1059 subjects, 758 participated in the influenza clinics and 301 were unable to attend. Data from the 2 instruments were determined to be suitable for factor analysis. Factor solutions and inter-item correlations supported the hypothesized domain structure for both survey questionnaires. Results on volunteers' performance were consistent with observations of both local health departments' staff and external observers.

Conclusions: The survey instruments developed for this study appear to be valid and reliable means to assess the performance and attitudes of MRC volunteers and barriers to their participation. This study found these instruments to have face and content validity and practicality. MRC coordinators can use these questionnaires to monitor their ability to engage volunteers in public health activities.

(Disaster Med Public Health Preparedness. 2010;4:213-219)

An influenza pandemic can overwhelm the capacities of hospitals, clinics, nursing facilities, and emergency services. The likelihood is that most of the individuals who are stricken will be cared for at home, and there is strong evidence that in-home caregivers bear a disproportionate risk of becoming infected. We reviewed the scientific literature after 2000 to identify steps that in-home caregivers can take to reduce the chances that they and other household members will become infected in the home. Personal hygiene, common masks, and technologies including air filters and UV light each offer incremental benefits, and in combination are expected to reduce a portion of the risk that household members face when caring for a member who has become infected. In pandemics and even seasonal epidemics, seemingly small steps can literally mean the difference between life and death, especially for in-home caregivers.

(Disaster Med Public Health Preparedness. 2011;5:266–271)

In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.

(Disaster Med Public Health Preparedness. 2012;6:67–71)