assessing resilience of healthcare infrastructure exposed to covid 19 emerging risks CORD-Papers-2022-06-02 (Version 1)

Title: Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks resilience indicators interdependencies and international standards
Abstract: In the moment of preparation of this paper the world is still globally in grip of the Corona (COVID-19) crisis and the need to understand the broader overall framework of the crisis increases. As in similar cases in the past also with this one the main interest is on the first response. Fully appreciating the efforts of those risking their lives facing pandemics this paper tries to identify the main elements of the larger possibly global framework supported by international standards needed to deal with new (emerging) risks resulting from threats like Corona and assess the resilience of systems affected. The paper proposes that future solutions should include a number of new elements related to both risk and resilience. That should include broadening the scope of attention currently focused onto preparation and response phases to the phases of understanding risks including emerging risks and transformation and adaptation. The paper suggests to use resilience indicators in this process. The proposed approach has been applied in different cases involving critical infrastructures in Europe (energy supply water supply transportation etc. exposed to various threats) including the health system in Austria. The detailed indicator-based resilience analysis included mapping resilience resilience stress-testing visualization etc. showing already before the COVID-19 the resilience (stress-testing) limits of the infrastructures. A simpler (57 indicator based) analysis has then been done for 11 countries (including Austria). The paper links these results with the options available in the area of policies standards guidelines and tools (such as the RiskRadar) with focus on interdependencies and global standardsespecially the new ISO 31050 linking emerging risks and resilience.
Published: 2020-06-04
Journal: Environ Syst Decis
DOI: 10.1007/s10669-020-09779-8
DOI_URL: http://doi.org/10.1007/s10669-020-09779-8
Author Name: Jovanovi A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jovanovi_a
Author Name: Klimek P
Author link: https://covid19-data.nist.gov/pid/rest/local/author/klimek_p
Author Name: Renn O
Author link: https://covid19-data.nist.gov/pid/rest/local/author/renn_o
Author Name: Schneider R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/schneider_r
Author Name: ien K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ien_k
Author Name: Brown J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/brown_j
Author Name: DiGennaro M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/digennaro_m
Author Name: Liu Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/liu_y
Author Name: Pfau V
Author link: https://covid19-data.nist.gov/pid/rest/local/author/pfau_v
Author Name: Jeli M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jeli_m
Author Name: Rosen T
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rosen_t
Author Name: Caillard B
Author link: https://covid19-data.nist.gov/pid/rest/local/author/caillard_b
Author Name: Chakravarty S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chakravarty_s
Author Name: Chhantyal P
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chhantyal_p
sha: 0394885e0a28885c0c46aa9f45209e9d3b894f7c
license: no-cc
license_url: [no creative commons license associated]
source_x: Medline; PMC; WHO
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/https://www.who.int/
pubmed_id: 32837821
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32837821
pmcid: PMC7271643
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271643
url: https://www.ncbi.nlm.nih.gov/pubmed/32837821/ https://doi.org/10.1007/s10669-020-09779-8
has_full_text: TRUE
Keywords Extracted from Text Content: RiskRadar COVID-19 ISO RIL adapt/transform heart France (green)-"routine ISO TC292 humans Fig. 7 matrix Fig. 2 RL-T providers-from cognitive/decision-making Absorb/withstand GDP matrix UK 9 Fig. 2 COVID-19 coronavirus portal inner 120-150 bigdata-driven Fig. 17 Level 1 inpatients b, c × Human Security ticks IEC/ISO 31010 Swiss Federal Office green circle Vienna's management-Guidelines c COVID-2.0 cates PCPs b. SCIs stress-test globe lean line lockdown COVID-19 COVID-19 Brem 2015 ResilienceTool Adapt/transform PCP Linkov 2014 ✓ Fig. 11 Snapshot of anticipate/prepare OECD 2011b cyber-attacks Phase V Adapt/transform human B SARS-CoV-2 Sect. blogs Flu H5N1 Pandemic in 2003 patient handc ompar e.aspx) Table 5 Klimek Swine Flu stay-at-home Knowns ISO 31000 virus • hyper-long redness US COVID-19 Fig. 8 NAS 2012 ✓✓✓ EU macro-econometric ... Jovanović Fig. 13. Avian Flu patients b centre Phase IV Respond/ SmartResilience Vienna WEF cell FuncƟonality Steinbeis Anticipate/prepare aluminium persons blue circles reports- Fig. 19 Management-Risk Vorarlberg joint effects/impacts b, Fig. 16 maximum-the ResiStand SmartResilience project (2019) Footnote 4 Kantons blue lines Figs. 2, 3 pandemics-like people Linkov (2018) green consequences/impacts Phase II Anticipate/prepare Fox-Lent trade-fair rm.org/searc ANL/ € ISO ISO 31,000 macro-indicators globally-COVID-19 iNTeg-Risk Ganin based- Fig. 18 Level 2 supermarkets ResiStand InfraStress ISO JWG1 Steinbeis ex-colleagues iNTeg-Risk TC
Extracted Text Content in Record: First 5000 Characters:In the moment of preparation of this paper, the world is still globally in grip of the Corona (COVID-19) crisis, and the need to understand the broader overall framework of the crisis increases. As in similar cases in the past, also with this one, the main interest is on the "first response". Fully appreciating the efforts of those risking their lives facing pandemics, this paper tries to identify the main elements of the larger, possibly global, framework, supported by international standards, needed to deal with new (emerging) risks resulting from threats like Corona and assess the resilience of systems affected. The paper proposes that future solutions should include a number of new elements, related to both risk and resilience. That should include broadening the scope of attention, currently focused onto preparation and response phases, to the phases of "understanding risks", including emerging risks, and transformation and adaptation. The paper suggests to use resilience indicators in this process. The proposed approach has been applied in different cases involving critical infrastructures in Europe (energy supply, water supply, transportation, etc., exposed to various threats), including the health system in Austria. The detailed, indicator-based, resilience analysis included mapping resilience, resilience stress-testing, visualization, etc., showing, already before the COVID-19, the resilience (stress-testing) limits of the infrastructures. A simpler (57 indicator based) analysis has, then been done for 11 countries (including Austria). The paper links these results with the options available in the area of policies, standards, guidelines and tools (such as the RiskRadar), with focus on interdependencies and global standards-especially the new ISO 31,050, linking emerging risks and resilience. 1 Introduction, what is/was really new about COVID-19? As of April 2020 COVID-19 has "covered" the world (Fig. 1 ). More than any other crisis before, the Corona crisis comes as probably the most global one so far, not only in terms of geography. The crisis is unique also because it appears to be one of the first globally experienced emerging risks. Affecting resilience of the world and stress-testing the resilience of both the healthcare system and the society as a whole. Did it come as a surprise? Hardly. Despite the numerous preceding warnings and mentioning of new kind of pandemic risk in the WEF Global Risk Report starting as early as 2006, and the detailed OECD reports (2011a; b), preparedness level of almost all healthcare systems around the globe to fight a pandemic outbreak remained insufficient. The critical mix for a "successful pandemic outbreak" is a fast and efficient human to human transfer of the pathogen where, humans have little or no immunity against it, no vaccines currently exist and supply of antiviral drugs is insufficient or not existing. Most of these can now be seen during the current COVID-19 outbreak. In other words, the outbreak of COVID-19 is not a real surprise, the surprise is linked to its extremely high infection rate allowing a very fast worldwide progression. In the Global Risk Report of 2006 (written after the Avian Flu H5N1 Pandemic in 2003), it is mentioned that if the virus can no longer be contained and person to person infection were to become common place, "the vulnerabilities of our interconnected global system would intensify the human and economic impact. The worldwide spread would be facilitated by global travel patterns and insufficient warning mechanisms. Short term economic impacts would include severe travel impairments, tourism and other service industries, as well as manufacturing and retail supply chains. Deep shifts in social, economic and political relations are possible". What else could one have added? In its voluminous, almost 300 pages long report, OECD (2003, p. 31) has been forecasting this as follows: As underlying conditions of risk -from climate to pathogen resistance -change, risk management policies based on past records and experience are likely to be increasingly faced with "surprises". How to account for evolving conditions will become a central issue in the handling of many risks. This will entail, in particular, a framework for dealing with major uncertainties and gaps in scientific knowledge. Considering pandemics as aspects of public health and infectious diseases as "existential threats" to the society has been embedded already in the United Nations Development Programme (UNDP) of 1994 and reaffirmed in the 2003 UN Commission on Human Security (see OECD 2011b). The report points out, that "survival under a pandemic global shock clearly refers to taking every action to minimize morbidity and mortality as well as to minimize the effect of the pandemic on the economic, social and political stability of communities, nations and transnational organizations". Furthermore, the authors argue, that the global shock to public health in the form of
Keywords Extracted from PMC Text: Flu H5N1 Pandemic in 2003 Swine Flu cognitive/decision-making Knowns" US UK9 human redness " inpatients earlyExamine TC292 Investment(What Anticipate/prepare effects/impacts SCIs lean Fig. 13 swans aluminium SmartResilience RIL macro-econometric 's WEF people's tigers patients OECD 2011b Fig. 7 acceptanceDetect centre Vienna Lo Sardo b, Fig. 16 PCP Linkov (2018) Fig. 2 GDP B" matrix ... COVID-19 functionality?Phase VAdapt/transform COVID-19 coronavirus IEC/ISO 31010 × Øien b green circle macro-indicators go?Phase IVRespond/ 's" consequences/impacts Brem 2015 inner Adapt/transform ISO data6—it Swiss Federal Office pandemics-like people radar-like Absorb/withstand Ganin adapt/transform surveillance,8 employmentReturn COVID-19:Adopt COVID-2.0 globe WHO,1 joint ISO 31,000 OECD NAS 2012 Kantons seminal humans ANL/Argonne RL-T bed"—e.g blue lines b, c stress-test blue circles Jovanović breed" Avian Flu Vienna's — Linkov 2014 Fig. 22 Vorarlberg managementConsider heart patient Sect. shocks)—because cyber-attacks € PCPs Fig. 8 Human Security ISO 31000 Klimek and(in COVID-2.0" on).Anticipate/prepare hyper-long likeunPrivacy cell Fox-Lent ResilienceTool persons
Extracted PMC Text Content in Record: First 5000 Characters:As of April 2020 COVID-19 has "covered" the world (Fig. 1). More than any other crisis before, the Corona crisis comes as probably the most global one so far, not only in terms of geography. The crisis is unique also because it appears to be one of the first globally experienced emerging risks. Affecting resilience of the world and stress-testing the resilience of both the healthcare system and the society as a whole. Did it come as a surprise? Hardly. Despite the numerous preceding warnings and mentioning of new kind of pandemic risk in the WEF Global Risk Report starting as early as 2006, and the detailed OECD reports (2011a; b), preparedness level of almost all healthcare systems around the globe to fight a pandemic outbreak remained insufficient. The critical mix for a "successful pandemic outbreak" is a fast and efficient human to human transfer of the pathogen where, humans have little or no immunity against it, no vaccines currently exist and supply of antiviral drugs is insufficient or not existing. Most of these can now be seen during the current COVID-19 outbreak. In other words, the outbreak of COVID-19 is not a real surprise, the surprise is linked to its extremely high infection rate allowing a very fast worldwide progression. In the Global Risk Report of 2006 (written after the Avian Flu H5N1 Pandemic in 2003), it is mentioned that if the virus can no longer be contained and person to person infection were to become common place, "the vulnerabilities of our interconnected global system would intensify the human and economic impact. The worldwide spread would be facilitated by global travel patterns and insufficient warning mechanisms. Short term economic impacts would include severe travel impairments, tourism and other service industries, as well as manufacturing and retail supply chains. Deep shifts in social, economic and political relations are possible". What else could one have added? In its voluminous, almost 300 pages long report, OECD (2003, p. 31) has been forecasting this as follows:As underlying conditions of risk – from climate to pathogen resistance – change, risk management policies based on past records and experience are likely to be increasingly faced with "surprises". How to account for evolving conditions will become a central issue in the handling of many risks. This will entail, in particular, a framework for dealing with major uncertainties and gaps in scientific knowledge. Considering pandemics as aspects of public health and infectious diseases as "existential threats" to the society has been embedded already in the United Nations Development Programme (UNDP) of 1994 and reaffirmed in the 2003 UN Commission on Human Security (see OECD 2011b). The report points out, that "survival under a pandemic global shock clearly refers to taking every action to minimize morbidity and mortality as well as to minimize the effect of the pandemic on the economic, social and political stability of communities, nations and transnational organizations". Furthermore, the authors argue, that the global shock to public health in the form of a pandemic is unique among global shocks in having profound positive and negative externalities and interdependencies. But being officially classified as pandemic by WHO,1 would COVID-19 qualify as "global shock", too? Table 1 shows that it is clearly the case. But six months after the outbreak of COVID-19, it is rather understood and perceived as a "global threat" and the focus is on monitoring of the threat (e.g. Johns Hopkins2), media focused on response measures and science unable to make reliable predictions, or even provide consistent explanations. New, previously unknown or not considered, "emerging" risks can pose the greatest challenges to resilience, safety and operational and business continuity. These "new and/or increasing" risks can be related to different areas of activities, such as new processes, new technologies, new types of workplace, or social or organizational change. They can also be some long-standing issue, newly considered as a risk due to a change in social or public perceptions or due to new scientific knowledge. The increasing nature of these risks means that the number of hazards leading to the risk may be growing, or that the exposure to the hazard leading to the risk is increasing, or that the effects/impacts of the hazards are getting worse (e.g. seriousness of effects and/or the number of people affected). These risks will interrelate with the processes like globalization, digitalization, innovation, cross boundary operations and many others, inextricably, directly or indirectly influencing each other, being interconnected, systemic and/or interdependent. Starting from the ISO 31000 definition of risk ("effect of uncertainty on objectives") and understanding risk management as a significant contributor to value creation and preservation, the new "ISO 310503 Guidance for Managing Emerging Risks to Enhance Resilience", cur
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