Background: Recent infectious disease outbreaks have brought increased attention to strengthening the capacity to prevent, detect, and respond to natural biological threats. However, deliberate biological events also represent a significant global threat that have received relatively little attention. The Biological Weapons Convention provides a foundation for the response to deliberate biological events, but the political mechanisms to respond to and recover from such an event are poorly defined. Methods: We performed an analysis of the epidemiological timeline, the international policies triggered as a notional deliberate biological event unfolds, and the corresponding stakeholders and mandates assigned by each mandate. Findings: The results of this analysis identify a significant gap in both policy and stakeholder mandates: there is no single policy nor stakeholder mandate for leading and coordinating the response activities associated with a deliberate biological event. These results were visualized using an open source web-based tool published at https://dbe.talusanalytics.com. Interpretation: While there are organizations and stakeholders responsible for roles in leading security or public health response, these roles are non-overlapping and are led by organizations not with limited interaction outside such events. The lack of mandates highlights a gap in the mechanisms available to coordinate response and a gap in guidance for managing the response. The results of the analysis corroborate anecdotal evidence from stakeholder meetings and highlight a critical need and gap in deliberate biological response policy.

The COVID-19 pandemic has unveiled the critical role that supercomputers play in addressing global health crises. This perspective article explores the transformative impact of supercomputing in pandemic response, highlighting how these powerful machines have transitioned from crisis management tools to essential components of preparedness strategies. In this article, we examine the key contributions of supercomputers in combating the pandemic, including their ability to accelerate scientific research, facilitate data analysis, model complex scenarios, and optimize resource allocation. Furthermore, we delve into the role of supercomputing in strengthening public health infrastructure and preparedness. We analyze the lessons learned from the pandemic and emphasize the need for proactive investment in supercomputing capabilities, data infrastructure, and computational expertise as a crucial element of pandemic preparedness efforts. By harnessing the potential of supercomputers, countries can establish robust computational frameworks that enable real-time monitoring, early detection, and effective response to future outbreaks. Moreover, we address the challenges faced by supercomputing initiatives, including the need for enhanced international collaboration, equitable access to computing resources, and the ethical considerations associated with data privacy and security. We discuss potential strategies to overcome these challenges and foster a global network of interconnected supercomputing centers dedicated to pandemic preparedness and response. Finally, we highlight ongoing research and development efforts aimed at advancing supercomputing technologies, such as exascale computing and quantum computing, and their potential to revolutionize pandemic response. We emphasize the importance of sustained investment in research and development to ensure that supercomputing remains at the forefront of future pandemic preparedness strategies.

Background: The COVID-19 has put global health institutions on alert. Organizations such as the CDC and WHO have developed preparedness and prevention checklist of 2019-nCoV infection to be used by public and healthcare professionals. Since COVID 19 pandemic is unexpected and no country aware of it prior to outbreak, there is limited information on the overall preparations of healthcare providers in Ethiopia. Therefore, the aim of this study was to assess early healthcare professionals’ preparedness and response to COVID 19 Pandemic in Oromia regional state, Ethiopia. Methods: The study was conducted on healthcare professionals working in public hospitals of Oromia regional state. The study was carried out by online questionnaire prepared using SurveyMonkey©. The collected data was analyzed and One-way ANOVA was used to determine the significant differences between health professionals working in different hospitals. The statistical significance associations of variables of interest was determined at 95% confidence intervals. Results: Healthcare professionals in the public hospitals of Oromia regional state, Ethiopia perceived that they are not yet well prepared and may not respond to the pandemic quickly and efficiently. Even though, they have positive response towards identifying signs and symptoms, provide education and utilization of PPE, they are still lacking in practical responses like managing cases, implementing emergency plans and isolation procedures from many others. Conclusion: As the Federal Ministry of Health, Ethiopia Public health institute and Oromia health bureau are vigilant and continually conducting preventive measures programs, extensive and maximum effort should be done to improve healthcare providers’ preparedness and response towards any emergency related to COVID-19 pandemic.

Nearly three months have passed since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which caused the rapidly spreading Coronavirus Disease 2019 (COVID-19) pandemic. To date, there have been more than 550,000 confirmed cases and more than 25,000 deaths globally caused by COVID-19. Chinese health authorities, where the virus emerged, have taken prompt strict public health measures to control and prevent the spread of the outbreak. In the kingdom of Saudi Arabia, unprecedented precautionary strict measures were applied to slow virus entry and to mitigate the risk of the outbreak. Here, we review the experience learned during the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) epidemic in Saudi Arabia, which has been in the country since 2012, and is expected to have helped the country to be well prepared for the current COVID-19 pandemic. We also discuss the country readiness, improvement in research and development, and the unprecedented rapid precautionary measures that have been taken by the Saudi government thus far.

Artificial intelligence (AI) has emerged as a powerful tool for addressing the challenges posed by climate change and their impact on public health. By leveraging its capacity to analyze and predict climatic patterns, AI offers opportunities to enhance resource management and develop effective strategies for climate change mitigation. Moreover, AI can contribute to generating sustainable solutions that address the complex and interconnected nature of climate change. For example, AI can enable the optimization of energy consumption and facilitate the integration of renewable energy sources into existing systems. It can also support the development of climate models that provide timely and accurate predictions, enabling policymakers to implement proactive measures for disaster preparedness and response. Furthermore, AI-powered disease surveillance and mitigation techniques can improve public health outcomes by identifying patterns and trends in the spread of diseases in relation to climatic factors.However, the widespread adoption of AI-based solutions is not without challenges. Ethical concerns surrounding privacy and data ownership must be addressed, as the use of AI requires access to large datasets, raising potential privacy risks. Technical constraints, such as limited computational power and the need for sophisticated algorithms, also pose obstacles to the implementation of AI in climate change mitigation strategies. Furthermore, issues related to the accessibility and affordability of AI technologies must be resolved to ensure equitable distribution and maximize its potential impact on public health.To fully harness the power of AI in addressing climate change and improving public health outcomes, it is crucial to promote innovation, multidisciplinary collaboration, and open data science. Innovation can drive the development of new AI algorithms and technologies specifically tailored to address climate change challenges. Multidisciplinary approaches that bring together experts from diverse fields, including climate science, public health, and computer science, can foster a holistic understanding of complex systems and enable the design of comprehensive solutions. Finally, open data science practices, such as sharing data and algorithms, can facilitate collaboration and accelerate progress in mitigating climate change and its public health impacts.In conclusion, AI offers promising opportunities for effectively addressing climate change and its impact on public health. However, to fully realize its potential, it is essential to tackle ethical and privacy concerns, overcome technical constraints, and ensure accessibility and affordability. By promoting innovation, multidisciplinary collaboration, and open data science, we can unlock the transformative power of AI in mitigating climate change and improving public health outcomes.

The aims of the study to analyze the influence of knowledge, attitude, education and gender of the head of the family for household preparedness against flood from Bengawan Solo River in Kedungdowo Village, Balen District of Bojonegoro Regency. The method used in this study is survey method. This study is explanatory observational research. Population studied is 85 head of families from Kedungdowo Village, Balen District, Bojonegoro Regency. The sampling method for collecting the data from the families is stratified random sampling. Data analysis methods used in this study are descriptive statistical analysis and logistic regression analysis with a 95% confidence level to identify the level of preparedness and the relationship between factors that affect preparedness. The findings shows that knowledge, attitude, education and gender significantly influence household preparedness against Bengawan Solo flood. Attitude is the most dominant variable that influenced household preparedness

Rapidly providing a definitive diagnostic test that can be used broadly by healthcare providers and members of the public in the setting of a disease emergency is critical to limit pathogen spread, develop and deploy medical countermeasures, and mitigate the social and economic harms of a serious epidemic or pandemic. There is extraordinary expertise within and outside of government working on these issues, and major accomplishments have been made to accelerate test development, expand laboratory testing capacity, and establish widespread point-of-care testing. Still, the United States does not have a plan to rapidly respond, to develop, manufacture, or deploy at national scale diagnostic testing in the earliest days of a new infectious disease crisis. Nor does the nation have a plan to sustain testing capacity at high volume over the course ofan enduring epidemic or pandemic. To address this gap, we are proposing a National Diagnostics Action Plan that describes the steps that are urgently needed to prepare for future infectious disease emergencies, as well as the actions we must take at the first signs of such events. These recommendations require substantial collaboration between the US government (USG) and the private sector to solve a series of challenges now, as well as to prepare for the massive and rapid scale-up of laboratory and point-of-care test development and testing capacity in future emergencies. The recommendations include establishing pre-event contracts; ensuring rapid access to clinical samples; creating a permanent public-private testing coordinating body to allow for rapid information sharing and improved cooperation among the USG, test developers, and clinical laboratories; and accelerating testing rollout at the beginning of an event—andthus, the effective public health management of a disease crisis. These recommendations were informed by extensive discussion with people who managed the COVID-19 and monkeypox responses, review of past reports written on diagnostic challenges, and the experiences of the authors.

The socio-economic benefits of globalization cannot be overemphasized. However, the global spread of infectious diseases has so followed a parallel course. The recent wave of pandemics with emerging new diseases has shown that no part of the world is immune from the spread of infectious diseases. COVID-19 like previous pandemics has exposed inadequacies of our healthcare systems and global capacity for prevention, early detection, and response in pandemic outbreaks. Given the highly interconnected global economy and the high potential for passim spread of infections, every nation must not only come up with concerted efforts to prevent and better prepare for pandemics, international solidarity and engagements will also be critical to ensure a long-lasting and sustainable solution. We are only as strong as our weakest health system, global support to strengthen all health systems around the world is the most effective way to be pandemic – ready. ‘All for one and one for all’.

Background: Twitter is a major tool for communication in emergencies such as natural disasters. This online social network allows the user to produce content, and it is not designed exclusively for news releases, as opposed to other service providers. Aim: The aim of this study is to investigate Twitter uses in natural disasters and pandemics. Methods: The included studies reported the role of Twitter in natural disasters. The studies that report in settings other than the natural disasters (such as man-made disasters) and other social media were excluded. Electronic databases for a comprehensive literature search including MEDLINE, Web of Science, CINAHL, PsycINFO, Cochrane Register of Controlled Trials (CENTRAL) and EMBASE were used to identify the records that match the mentioned inclusion criteria published till May 2020. The study characteristics were extracted from the qualified studies including year of publication, findings, and geographical location of the study conduct. A narrative synthesis for this literature review was used. Results: The search identified 822 articles of which 780 articles were removed, 256 were not available, 311 papers were not relevant, 16 were duplicated articles, and 197 were non-related to the emergencies. 45 articles met the selection criteria and were included in the review. eleven themes were found in the narrative synthesis including early warning, disseminating information and misinformation, advocacy, personal gains, assessment, various roles of organizations, public mood, geographical analysis, charity, using influencers, and trust. Conclusions: It is recommended that influential individuals be identified in each country and community before disasters occur so that the necessary information can be disseminated in response to disasters. Preventing the spread of misinformation is one of the most important issues in times of disaster, especially pandemics. Disseminating accurate, transparent, and prompt information from relief organizations and governments can help. Also, analyzing Twitter data can be a good source for understanding the mental state of the community, estimating the number of injured people, estimating the points affected by natural disasters, and modeling the prevalence of epidemics. Therefore, various groups such as politicians, the government, non-governmental organizations, aid workers, and the health system can use this information to plan and implement interventions.

On entering higher education, students from disadvantaged schools seem unable to cope with new academic demands and all too often the need for adjustment is attributed to under-preparedness. The purpose of this paper is to identify the factors contributing to and mitigating the alienation of students in institutions of higher learning. The narrative inquiry with a qualitative method was employed to obtain the perceptions of 51 selected first-level science university students on their experiences. This is a case of the University of Venda first-year level students registered in the 2023 academic year. The findings of this paper build on and contribute to the literature on understanding alienation in higher education. In particular, the key findings of this paper reveal that the students failed to quickly adapt to a different culture of teaching and learning; the academic workload was overwhelming, and lecturers were unapproachable Students from previously disadvantaged backgrounds especially struggled to assimilate into the new university culture of teaching and learning. This paper concludes by recommending that there is a serious need to take cognisance of the influx of previously disadvantaged students into institutions that were not created with them in mind. Universities and their teaching staff should recognise the culturally diverse nature of the student body and thereby restructure teaching and assessment to foster social justice to promote student success.

Effective pandemic management requires understanding the level of community knowledge, attitude of people and preparedness towards COVID-19. This study aimed to assess the knowledge, attitude and preparedness toward COVID-2019 among Bangladeshi general people. A cross sectional survey was conducted from 20th March 2020 to 20th April 2020 among 1007 Bangladeshi adult people. A convenience sampling strategy was utilized and the data was collected through a self-administered questionnaire. Chi-square test was used to identify the gender differences regarding knowledge, attitude and preparedness towards COVID-19. Respondents predominately used social media to inform themselves about COVID-19 (68.10%) and female used social media more than male (p<0.001). Female had more correct knowledge about staying home with sickness and/or symptoms to contain the COVID-19 transmission (p=.02). While male had more negative attitude about staying out during the pandemic than female (<0.001) and men were less likely to take preventative measures than female counterparts. A number of people were still believing the myths like “COVID-19 can transmit via mosquito” (9.14%) and male had more incorrect knowledge regarding this (p<0.001). Moreover, 17.81% of the respondents thought that COVID-19 can spread in warm weather. Some findings are directing us to a knowledge gap among general population in Bangladesh which calls for uncovering those aspects. Adequate and effective communication are necessary so that general people can stay alert with positive attitude and hygienic practices to fight against this ongoing crisis.

This paper presents quantitative research results regarding the influence of demographic factors on the earthquake risk perception of the citizens of Belgrade. This research aims to determine how much the citizens of Belgrade are aware of the risk and prepared to react in the event of an earthquake. The relationship between gender, age, level of education, and facility ownership with risk perception was examined. T-test, One-way ANOVA, and Pearson correlation coefficient were used to examine the relationship between the variables and the earthquake risk perception. The survey was conducted using a questionnaire that was given and then collected online among 235 Belgrade respondents during September 2020. The questions were divided into three categories. The first part of the questionnaire was consisted of general questions about the demographic characteristics of the respondents, then the questions that would determine the level of awareness of the respondents about earthquakes, and finally, the questions for determining the respondents' preparedness. The results of the research show that women have a higher perception of risk. It has been proven that the youngest respondents from the age category of 18-30 have the lowest risk perception. The influence of education level in no case showed a statistically significant correlation with risk perception.

The purpose of this evaluation is to determine the effect of intensive, interactive training on hospital workers’ preparedness for special pathogen cases by utilizing the Frontline Facility Special Pathogens Training Course created by New York

Pharmacists’ roles in providing patient care remain limited in Indonesia, hence this study aimed to determine the preparedness of pharmacy graduates from one university in Indonesia to deliver patient care. Pharmacy graduates (both registered pharmacists [104] and recent graduates eligible for registration [45]) were sent a validated self-administered survey. The survey sought their perceptions about whether they had acquired 16 patient care related attributes. Further, it sought their opinion on the desirability of having those attributes. Data were analysed using SPSS version 22.0. Sixteen of 104 (15.4%) registered pharmacists and 40 of 45 (88.9%) recent pharmacy graduates participated in the study. More than 50% of participants in both groups were female and most participants were aged in their 20s. Of the recent pharmacy graduates the majority perceived they had at least partially acquired four of 16 list attributes. Male and female recent graduates had significantly different beliefs about their leadership ability (p=0.004). In comparison, most registered pharmacists perceived they had 10 out of the 16 listed attributes. The findings of this study suggested that pharmacy graduates should be better prepared to deliver patient care, and that curriculum redesign with expansion of experiential learning is required.

BackgroundThe novel virus COVID-19, also known as SARS-CoV‑2, is currently rapidly spreading around the globe and pushing healthcare systems to the limits of their capacity. One of the functions of predictive models is to timely act for epidemic preparedness including hospital preparedness. In Egypt, like many other countries in the world, the epidemic situation and forecasting have not yet sufficiently studied. ObjectiveThe study was carried out to develop a short-term forecast scenario for the COVID-19 epidemic situation in Egypt and predict the hospital needs to accommodate the growing number of cases.MethodsSecondary data from the COVID-2019 daily reports and the report issued 8^th of April by the Egyptian Ministry of Health and Population were used. Due to the daily changing level of knowledge and data, the article reflects the status up to 18 April 2020. The prediction was based on the exponential growth rate model. For the depiction of the situation, the full length of the epidemic timeline was analyzed (from February 14^th till April 18^th). The growth rates and their rates of decline during the period from the 22^nd of March till the 18^th of April were calculated and extrapolated in the coming 7 weeks. The predicted hospital needs were assessed against the announced allocated resources.ResultsThe epidemic curve in Egypt is on the ascending arm as of April, 18. The active cases showed exponential growth from the start of the epidemic till April, 18. At the end of this period time, the recovery rate was 23.12% and the case fatality rate (CFR) was7.39. The case fatality rate median level during the last four weeks was 6.64. The active cases are expected to reach more than 20,000 by late May then starts to decline. The allocated regular hospital beds are predicted to show shortage by the time of the release of the paper. The intensive care units (ICU) beds and ventilators are predicted to show insufficiency on May 6.Conclusions: The COVID-19 epidemic in Egypt is expected to continue on the rise for the next few weeks and expected to start to decline late in May, 2020. Our estimates should be useful in preparedness planning. Serious actions should be taken to provide ICU beds and ventilators enough for the predicted number of cases that would need them, not later than the end of April. Mitigation actions have to continue for the coming 6 weeks or until the epidemic situation is more clearly seen.

Authorities and governmental bodies strongly emphasize the importance of residents preparing for natural disasters, particularly underscoring the significance of readiness for geophysical hazards like earthquakes. In this study, which represents comparative quantitative research, the levels and predictors of the impact on preparedness for earthquake-induced disasters in South-Eastern Europe countries such as Montenegro, North Macedonia, and Serbia are examined. Using the snowball sampling technique (online questionnaire), a survey of 1245 respondents (Montenegro (n = 400), North Macedonia (n = 345), and Serbia (n = 500) was conducted from February 2023 to February 2024. The paper is based on the central hypothesis that the most significant predictor of earthquake preparedness in Montenegro, North Macedonia, and Serbia is age, followed by gender and education. Multivariate regression analysis was used to determine the extent to which five scores of the subscales (household preparedness, community preparedness, disaster preparation, earthquake risk awareness, reinforced house) were associated with seventh demographic and socio-economic variables. In addition to the mentioned analysis, other statistical analyses such as T-test, one-way ANOVA analysis, and Pearson correlation were also utilized. The results indicate that age emerges as a predictor in various aspects of earthquake-induced disaster preparedness and awareness in most models, followed by education. These findings confirm the significance of respondents' age in determining levels of preparedness and earthquake awareness. Overall, in North Macedonia, respondents recorded the highest ratings (M = 3.52) for household preparedness for earthquakes, compared to Montenegro (M = 2.98) and Serbia (M = 3.26), where the lowest ratings were recorded. Research findings, taking into account cultural characteristics, can serve as a basis for the development of targeted interventions, strategies, policies, and programs aimed at improving the level of societal preparedness for earthquake-induced disasters.

People living in areas of significant seismic risk seldom undertake sufficient preparations to safeguard their family. This is most problematic in remote communities such as those along the Dead Sea Fault, Israel, where self-reliance is a key factor in coping with disasters. To facilitate individual and familial involvement in earthquake preparedness in remote areas, we designed a tool for self-assessment of risk and preparedness. The personalized risk assessment is based on national hazard and building standards, and on personal input regarding structure characteristics. The risk and preparedness evaluations enhance awareness and provide immediate feedback to help users improve familial preparedness. Spatial analysis of the data collected is used to form high-resolution maps that expose specific challenges for emergency response. A study conducted in the town of Mitzpe Ramon exposed neighborhoods with relatively high risk of damage and low preparedness. Integrating these results with seasonal stress-factors such as peak tourism and extreme weather, provides new and important insights on the ability of the local community and emergency forces to cope with multi-hazard situations. Analysis of the heterogeneous distribution of expected hardship within a community should be implemented world-wide to improve risk mitigation.

This research aims to examine the level of readiness of the community to carry out sustainable tourism development, especially community-based tourism on small islands, such as Lombok Island, Indonesia. More specifically, the objectives of this study are as follows: (1) Knowing the level of community readiness in carrying out sustainable tourism development. (2) Knowing the various dimensions that influence sustainable tourism development. (3) Knowing the role of stakeholders in sustainable tourism development. The method applied in this research is mixed methods, a combination of quantitative and qualitative approaches. Quantitative methods are used to determine community readiness for sustainable tourism development. A qualitative approach is used to determine the various factors that influence the development of community-based tourism and to determine the role of stakeholders in the development of community-based tourism. The level of community readiness for sustainable tourism development is high in terms of economic, social, cultural, environmental, and symbolic capital aspects. Aspects that influence the development of sustainable tourism are economic, social, and cultural. Stakeholders who play a role in developing sustainable tourism in the research area are the government, the private sector, universities, non-governmental organizations, and the media.

This research was conducted on the Maribaya Timur school community in Lembang Subdistrict, West Bandung Regency, Indonesia, which is an active community in the area that is threatened by the potential for earthquake disasters due to the active Lembang fault. Disaster risk reduction efforts are pursued through increasing school-based preparedness that involves members of the school community, surrounding communities and various institutions that are associated with reducing the risk of school-based earthquake. Increasing preparedness against earthquakes focuses more on aspects of capacity building of school communities in reducing disaster risk, while aspects of vulnerability and threats have not been the focus of disaster risk reduction. The steps taken refer to the element of preparedness by aligning with the conditions, needs and potential that exist in the school community. Theoretically, if the school community has preparedness to face an earthquake disaster, the risk of earthquake disaster in the school community will be reduced so that it can minimize losses, victims and suffering that will be caused by the earthquake disaster.

Effective household and individual disaster preparedness can minimize physical harm and property damage during catastrophic events. To assess the risk and vulnerability of affected areas, it is crucial for relief agencies to understand the level of public preparedness. Traditionally, government agencies have employed nationwide random telephone surveys to gauge the public’s attitudes and actions towards disaster preparedness. However, these surveys may lack generalizability in certain affected locations due to low response rates or areas not covered by the survey. To address this issue and enhance the comprehensiveness of disaster preparedness assessments, we develop a framework that seamlessly integrates machine learning and simulation. Our approach leverages machine learning algorithms to establish relationships between public attitudes towards disaster preparedness and demographic characteristics. Using Monte Carlo simulation, we generate datasets that incorporate demographic information of the affected location based on government-provided demographic distribution data. The generated dataset is then input into the machine learning model to predict the disaster preparedness attitudes of the affected population. We demonstrate the effectiveness of our framework by applying it to Miami-Dade County, where it accurately predicts the level of disaster preparedness. With this innovative approach, relief agencies can have a clearer and more comprehensive understanding of public disaster preparedness.

This paper presents the results of quantitative research regarding the examination of the levels of efficiency of the fire protection system and the training of employees in Electrical power distribution of Serbia for fire protection, ie the analysis of the manner of implementation of fire protection measures, and determining whether these measures are adequately applied. Following the subject set in this way, the aim of the research was set, and that is the scientific analysis of the manner of application of fire protection measures. The results of this research showed that the employees of Electro distribution Belgrade perceive the preparedness of their company highly positively and certain socio-demographic characteristics also affect certain attitudes, especially those related to the experience with fire, the knowledge of employees to react in case of fire, and the choice of the appropriate response, assessment of the readiness of the company and the employees themselves. It was found that knowledge of how to react in case of fire is influenced by gender and level of education; the choice of one of the methods of action in case of fire is influenced by gender; the assessment of the readiness of the employees themselves is influenced by the marital status; the desire of employees to participate in training to increase their preparedness for fires is influenced by gender. The results of the research can be used to improve the preparedness of employees in various organizations to respond to disasters caused by fires.

Although vaccinating the world is adopted by the WHO to limit COVID-19 transmission, people’s worries about vaccines may suppress their desire for vaccination despite vaccine availability. This study aimed to evaluate the levels of stress and anxiety among 250 Jordanians who received their first vaccine dose at a local community health center. The respondents completed the stress and anxiety subscales of the Depression Anxiety and Stress scale 21 (DASS-21) pre- and post-vaccination. The respondents expressed more moderate-severe levels of stress pre than post vaccination (20.8% and 13.2%, respectively). Meanwhile, 37.2% and 45.2% of the respondents expressed moderate-severe anxiety pre and post vaccination, respectively. Wilcoxon signed-rank test revealed that the drop in the level of stress from pre (median (IQR) = 5 (1-8)) to post vaccination (median (IQR) = 3 (1-7)) was statistically significant (z = -3.81, p = 0.001, r = 0.17) while the increase in anxiety was not. Anxiety median significantly dropped among individuals experiencing mild to severe anxiety pre vaccination. Similarly, stress and anxiety significantly increased among individuals expressing normal anxiety pre vaccination (z = -3.57 and -8.24, p values = 0.001, r = 0.16 and 0.37, respectively). Age positively correlated with post vaccination anxiety among respondents with mild pre vaccination anxiety, and it negatively correlated with pre vaccination level of stress in the normal anxiety group. Gender, marital status, respondents’ level of education, and history of COVID-19 infection had no significant correlation with anxiety or stress at either point of measurement. Overcoming their hesitancy to receive COVID-19 vaccine, individuals with normal levels of anxiety experienced a rise in their distress symptoms following immunization. On the contrary, vaccination seemed to desensitize anxious individuals. Policymakers need to formulate a population-specific plan to increase vaccine preparedness and promote psychological well-being over all during the pandemic.

Context. During the COVID-19 pandemic, patient care was mainly organised around the hospital. Pre-hospital care has, to our knowledge, never been evaluated. Objective: To evaluate the impact of pre-hospital pathways on hospitalisation during the last part of the pandemic. Design. This was a monocentric retrospective analysis of prospectively collected medical records. Data from patients admitted to our institute between 1 February and 7 March 2022 were analysed. Main Outcome Measure(s): The primary outcomes were defined as the number of hospitalisations, resuscitations, and deaths at the time of interview and in the subsequent 30 days. The main explanatory variables were times from onset of symptoms to care, age, gender, News2 score, comorbidities, and pre-hospital pathways and their duration. Results: Three pre-hospital pathways have been identified: a pathway in which the patient consults a general practitioner for a test (PHP1); a pathway in which the patient consulted for care (PHP2); and no pre-hospital pathway and direct admission to hospital (PHP3). Factors independently associated with outcome (hospitalisation) were being male (OR 95% CI; 2.21 [1.01–4.84], p=0,04), News2 score (OR 95% CI; 2.04 [1.65–2.51], p<0.001), obesity (OR 95% CI; 3.45 [1.48–8.09], p=0.005), D-dimers > 0.5 µg/ml (OR 95% CI; 3.45 [1.47–8.12], p=0.005), prolonged time from symptoms to hospital care (PHP duration) (OR 95% CI; 1.07 [1.01–1.14], p=0.03). All things being equal, patients with a “PHP2” pre-hospital pathway had a higher probability of hospitalisation compared to those with a “PHP3” pre-hospital pathway (OR 95% CI; 4.31 [1.48–12.55], p=0.007). Conclusions. Along with recognised risk factors such as gender, News 2 score, and obesity, the patient’s pre-hospital pathway is an important risk factor associated with hospitalisation.

Emergency Management has not developed in a cohesive or comprehensive manner. Differing terms are used to name identical concepts. A standard comprehensive doctrine for the important development of emergency management is needed. In this paper I explain a doctrinal framework for emergency management. The paper states a clear identification of the five dimensions, and each of their components, necessary to the informed practice of Emergency Management. Although emergencies vary in cause and severity, the process of Emergency Management necessary for optimal handling of these emergencies varies little. The “All Hazards Approach” to emergency management establishes and reinforces commonality in processes, procedures, planning templates and organizational structure. The three types of agencies associated with emergency management activities are discussed, including the subject matter agency, coordinating agency, and supporting agency. The four critical functions of emergency management are detailed, and include mitigation, preparedness, response, and recovery, often all carried out concurrently. The ten activities, and seven resources of emergency management are highlighted. There are many ways to represent the integration of these five dimensions, to ensure completeness, while ensuring clarity; the two most common are described. When experts in Emergency Management follow the doctrine, they can coordinate all those involved to be sure that all aspects of any hazard are considered, and that all organizations/agencies, functions, activities, and resources of Emergency Management are coordinated and optimally active. Following this process is the only way to ensure the best outcomes from any emergency.

Abstract: This study aims to set up a system to evaluate nursing competencies in disaster preparedness for undergraduates and influencing factors in China. The evaluation system was established by using the modified Delphi. There were 3 phases in this study: 1) an environmental scan; 2) setting framework; 3) adjusting indicators based on the modified Delphi. The questionnaire for these undergraduates lied in their basic information and assessment of nursing competencies in disaster preparedness. Based on the survey, the average score of nursing competencies in disaster preparedness for undergraduate nursing students surveyed was 3.10 (out of 5). In addition, gender, grade, inhabitation, and disaster drills of the students were four factors affecting nursing competencies of undergraduates. This study indicates that the present nursing competencies in disaster preparedness for undergraduates are weak, and it is essential to strengthen nursing education in disaster preparedness for undergraduates.

The uniqueness of each system stems from the fact that the risks of disasters are specific and that their presence and manifestation are not universal and the same for every country. Just as no country is the same in all other segments, their disaster risk management systems are unequal. The paper describes the systems in four different countries, through observation and comparison of four areas of activity that are implemented in dealing with disasters. First of all, in the paper, the legal basis and institutional frameworks on which these systems rest in each of the countries were considered – starting from the international level and guidelines given at international conferences, to all by-laws and local disaster activity plans. It was considered how each of the states implements risk mitigation activities and how it increases preparedness for them. When the system recognizes risks, their probability and the frequency of their occurrence, activities are planned to prepare the country and every individual in it for a potentially unwanted event. Differences in the ways of mitigating risks and preparing all elements of the system and protected values for disasters are presented. The third element of action in the event of disasters concerns the response. In this segment, questions are raised regarding institutional solutions in the system, division of responsibilities, the priority of response and mobilization of resources at all levels. The last phase, the one that occurs after the disaster, and that is the recovery from it, depends on the reaction. In the paper, it was discussed how in the end, when a disaster occurs and when damage to the population, environment, material and other goods occurred, how each of the states implements reconstruction, i.e. how it recovers - whether that recovery was previously well planned or whether ad hoc solutions are applied.

Integrated disaster risk reduction in schools represents a key component of safety strategies within the educational sector of every country. In this study, a series of 850 face-to-face interviews (650 with students and 200 with teachers) were conducted throughout 2023 in 10 out of the total 18 municipalities in the Western Morava Basin of the Republic of Serbia. The paper proposes two central hypotheses regarding school-based disaster risk reduction. Firstly, it suggests that gender, age, parent's employment, academic achievement, living situation, paternal and maternal education levels, and engagement with social media collectively influence students' perspectives on this matter. Secondly, it posits that gender, age, marital status, parenthood, and educational background significantly impact teachers' viewpoints on school-based disaster risk reduction. Multivariate linear regression was used to explore predictors of students' and teachers' insights on school-based disaster risk reduction. Various statistical tests including Chi-square, t-tests, one-way ANOVA, and Pearson's correlation were employed to investigate the influence of demographic and socioeconomic factors on these insights. The results of multivariate regression analyses indicate that age, gender and marital emerge as the primary predictors across various facets of students' and teachers' insights on school-based disaster risk reduction (awareness of disasters, disaster education activities, attitudes on disaster risk reduction education, enhancement of disaster information accessibility, etc). The results of this study provide insight into the key factors influencing students' and teachers' perceptions of disaster risk reduction in schools. As such, they can serve as a basis for improving educational programs, developing policies and strategies, normative educational frameworks, teacher training, and further research in disaster education.

Background: This year has seen the emergence of two major crises, a significant increase in frequency and severity of hurricanes and the COVID-19 pandemic. However, little is known as to how each of these two events have impacted the other. A rapid qualitative assessment was conducted to determine the impact of the pandemic on preparedness and response to natural disasters and the impact of past experiences with natural disasters in responding to the pandemic. Methods: Semi-structured interviews were conducted with 26 representatives of 24 different community-based programs in southern Louisiana. Data were analyzed using procedures embedded in the Rapid Assessment Procedure – Informed Community Ethnography methodology, using techniques of immersion and crystallization and focused thematic analysis. Results: The pandemic has impacted the form and function of disaster preparedness, making it harder to plan for evacuations in event of a hurricane. Specific concerns included being able to see people in-person, providing food and other resources to residents who shelter in place, finding volunteers to assist in food distribution and other forms of disaster response, competing for funds to support disaster-related activities, developing new support infrastructures, and focusing on equity in disaster preparedness. However, several strengths based on disaster preparedness experience and capabilities were identified, including providing a framework for how to respond and adapt to COVID and integration of COVID response with their normal disaster preparedness activities. Conclusions: Although prior experience has enabled community-based organizations to respond to the pandemic, the pandemic is also creating new challenges to preparing for and responding to natural disasters.

Background: Recent disasters have demonstrated gaps in employers’ preparedness to protect employees and promote their well-being in the face of emergencies and disasters affecting the workplace and their communities. Total Worker Health (TWH), a comprehensive perspective developed by the National Institute for Occupational Safety and Health, is a helpful framework for addressing employer preparedness. It includes attention to health and safety at work, and the promotion of the health and well-being of the employee in the context of social determinants of health, such as work-life balance. Methods: TWH concepts, including the domains of TWH and the TWH Hierarchy of Controls, were investigated for their relevance to protecting employees and promoting their well-being during and after crises such as weather disasters, pandemics, and acts of terrorism. Building upon TWH concepts, an employer preparedness framework and model is proposed. Findings: The Model emphasizes upstream prevention, workplace-community linkages, social and economic impacts, and employer leadership through a cyclical planning process. Conclusions/Application to Practice: The Model can assist employers in advancing their preparedness for all hazards through self-assessment and planning agendas based upon the proposed domains.

Understanding the vulnerability of areas and the likelihood of specific disasters, particularly earthquakes, is one of the most important issues in Iran. One of the major concerns in Iran is the resilience of rural communities. The present study is devoted to spatial analysis of risk in rural areas and the evaluation of preparedness in the rural districts of the city of Abhar. In particular, this study evaluates the resilience to earthquakes. The research was conducted in two parts in which the first part has used the VIKOR Multiple criteria decision making model as well as the employment of this model in the ArcGis. The second part of the study used field studies, in the form of questionnaires, to evaluate the readiness of the local population against the risks of earthquakes. Four indicators, individual, physical, economic abilities and access, were assessed. The population included rural districts, where statistical samples were villagers. Results of the spatial analysis indicated that 15 villages are in the high-risk areas, 24 villages were in the medium-risk areas and all other villages were in low-risk areas. In terms of readiness of the locals, the results indicated a lack of planning with regards to the four mentioned indicators.

Outbreaks of Ebola ebolavirus (EBOV) have been associated with high morbidity and mortality. Milestones have been reached recently in the management of EBOV disease (EVD) with licensure of an EBOV vaccine and two monoclonal antibody therapies. However, neither vaccines nor therapies are available for other disease-causing filoviruses. In preparation for such outbreaks, and for more facile and cost-effective management of EVD, we seek a cocktail containing orally available and room temperature stable drugs with strong activity against multiple filoviruses. We previously showed that (bepridil + sertraline) and (sertraline + toremifene) synergistically suppress EBOV in cell cultures. Here we describe steps towards testing these combinations in a mouse model of EVD. We identified a vehicle suitable for oral delivery of the component drugs and determined that, thus formulated the drugs are equally active against EBOV as preparations in DMSO, and they maintain activity upon storage in solution for up to seven days. Pharmacokinetic (PK) studies indicated that the drugs in the oral delivery vehicle are well tolerated in mice at the highest doses tested. Collectively the data support advancement of these combinations to tests for synergy in a mouse model of EVD. Moreover, mathematical modeling based on human oral PK projects that the combinations would be more active in humans than their component single drugs.

This article examines air sampling as an environmental surveillance strategy for early pathogen detection and offers a preliminary comparison of air and wastewater surveillance. Air sampling involves collecting bioaerosols to analyze the microbial composition of the air, utilizing techniques like PCR and metagenomic sequencing. Air sampling appears especially promising for detecting respiratory pathogens and highly transmissible pandemic agents, as these spread primarily via aerosols and droplets. The article details various air sampling techniques, their efficiency, and practical considerations, categorizing them into filtration, impaction, impingement, electrostatic precipitation, and condensation methods. It also explores the composition of airborne microbes, emphasizing the low concentration of viral nucleic acids and the challenges this poses for metagenomic sequencing. The selection of sampling locations, including indoor environments and airplanes, is discussed as critical for effective pathogen detection. Finally, the article contrasts air and wastewater sampling, concluding that while both methods should ideally be explored as layered defenses, air sampling does not collectively appear more promising than wastewater sampling.

Technical sectors are an inseparable and elementary part of a critical infrastructure (CI) complex system. The services they provide are essential to the functioning of all the dependent sectors of CI on whose services society depends, especially in areas with high levels of urbanisation. The starting point for effective CI elements protection of is permanent assessing and strengthening their resilience to the negative effects of internal and external threats. Current perceptions of resilience focus primarily on repressive components responsive to incident (i.e., robustness, recoverability, and adaptability), while little attention is paid to preventative components. Therefore, the benefit of the article is to define resistance which could be seen as the CI element ability or characteristic to prevent the occurrence of incidents. Based on that, the article defines 1) the individual factors (variables and parameters) determining the CI resistance and 2) the methodological procedure for infrastructure elements resistance assessment in order to identify weak points and subsequently strengthen them. The essence of the article is defining the starting points for extending the CIERA method by a component strengthening the critical infrastructure resilience in the prevention phase. A practical example of resistance assessment for a selected critical energy infrastructure element is presented at the end of the article.

Abstract: This paper summarises an early and successful piece of citizen science, performed within The University of Queensland Seismograph Stations (UQSS) observatory, in cooperation with colleagues at CSIRO. It was designed to en-courage young STEM students from Brisbane high schools to engage in “real” re-search, back in 1995. Having completed the project report, their (analog) results sat in a cupboard until the report was dusted off and the project was re-analysed in 2022 by an honors student, considering timely climate change applications for the study. This is a time when science is changing considerably from analog to digital medium and operational methods. The original project was called Earthquake generated T phases on BRS Seismograph (Brisbane, Q’ld)- a predictor for Tasman Sea Tsunamis? [1] Fortunately, seismology is a very collaborative field. The research question has since changed. There is a lot of data analysis involved in the science of recording earthquake signals, with auxiliary definitive catalogues, observers logbooks, housing of the recordings themselves (analog and digital) and the software mediums that change over time. In other words, a lot of headaches can be encountered in longitudinal data collection study such as this. The citizen science students used a pre-prepared decadal collection (1980-90) derived from the BRS observatory data catalogue. BRS is part of the global World-Wide Seismograph Station Network (WWSSN). Currently in Australia, university earth science observatories have diminished, and in their place, public seismic networks (PSN) have evolved, either in back-yard sheds or school science labs. The level of expertise required fits the role of advancing citizen science for a real science advantage. This is a topical citizen disaster preparedness action area for today’s climate emergency, which is threatening the globe and all lifeforms. Citizen engagement or mobilisation is an essential preparedness strategy. Keywords: citizen science 1; seismology 2; earth observation 3; climate change 4; education for sustainable development 5; disaster preparedness 6; disaster alerts 7

Objectives: Our objective was to assess employer preparedness to protect their employees’ health and safety and promote their well-being in the face of potential disasters in a sample of Northeast United States employers. We developed survey instrument and index based on our model of Total Worker Health® (TWH) Employer Preparedness.Methods: We conducted a 40-question on-line survey with the membership of the Northeast Human Resources Association (US). Human resource managers reported their perceptions of their employers’ preparedness in seven domains: planning, human resources policies, hazard reduction, training, staffing, communications, and resources for resilience. Respondents were categorized by size, sector and reach and their responses scored.Results: Seventy-six individuals representing a diverse group of employers responded to the survey. Mean preparedness was “moderate,” with almost an equal number reporting a high level of preparedness as no preparedness. Employers were most prepared for severe weather events and least prepared for acts of violence. There were no significant differences by sector, size, or reach, although the healthcare sector was more prepared than others.Conclusions: There is a range of TWH® Employer Preparedness among Northeast US employers. The survey and model are important tools that can aid employers in the face of growing threats to “business as usual.”

(1) Background: Nursing homes’ preparedness in managing a public health crisis has been fragile, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in Southern Portugal, including personnel’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey to personnel was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the personnel survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were fragile areas among nursing homes’ contingency plans. We identified compliance with procedures and nonpunitive response to mistakes as fragile areas of safety culture, and teamwork as a strong safety area. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.

One of the most important problems in the presence of epidemics and pandemics is an accurate prediction and preparedness. Scholars and experts argue that future pandemics and/or epidemics are almost inevitable events and is not whether next pandemics will happen, but when a new heath emergency will emerge. Epidemiologic models for prediction of Coronavirus Disease 2019 (COVID-19) have shown many limitations because of unpredictable dynamics of the new viral agent SARS-CoV-2 in environment and society. The main goals of this study are twofold: first, the analysis of anthropogenic activities and factors that may trigger pandemic threats; second, the planning of new directions for strategies to reduce risks that a pandemic threat emerges and/or in the initial phase to reduce vast diffusion and negative impact of new viral agents that can generate hazards and problems in public health, environment and socioeconomic systems. In particular, the investigation and understanding of sources and driving factors concerning the emergence and diffusion of new pandemics have critical aspects for strategic actions of forecast, prevention and preparation of effective policy responses to cope with next pandemic crises and health emergencies. Insights here endeavor, whenever possible, to clarify these problems to increase the knowledge of the sources and factor determining the emergence of new viral agents in order to design optimal response policies to face next pandemic diseases similar to COVID-19. .

The past is an important lesson for facing the future with greater awareness. In this context, school plays a key role to spread knowledge on natural phenomena and to promote behavior change. Together with researchers, teachers can be strong allies to build more resilient future citizens. The Istituto Nazionale di Geofisica e Vulcanologia (INGV) school training activities provide tools to get ready for the next earthquake and/or tsunamis. About 5000 students from both Middle schools (ISCED 2) and High schools (ISCED 3) were involved in active learning activities based on a flipped-up approach during special online scientific events in the Pandemic. Online lab activities were conducted respectively during the European Researchers’ Night (“Earthquakes: history teaches us the future: researchers for a day with experimentation in didactics for ESL”) and during the World Water Day 2021 and the World Earth Day 2021 (“Tsunamis: history teaches us the future researchers for a day with experimentation in didactics for ESL”). These two Episodes of Situated Learning (ELS) experiences triggered students’ interest, favoring remote learning, developing life skills, focusing on historical seismic studies of both past earthquakes and tsunamis.

This article offers a theoretical framework to contextualise the concept of "Safety Culture" in the field of public safety and Disaster Risk Reduction (DRR), with the aim of supporting its understanding and measurement in our communities and finally attaining more disaster resilient societies. The work discusses the role of cultural dimensions in risk management and DRR and highlights the relevance of building knowledge and practices based on the consideration of culture and cultural variability in all phases of the risk management process. After an overview of the Safety Culture concept, including its origins, developments and applications, the text explores the transferability of this concept to the context of public safety. Then, based on the existing Safety Culture models, metrics and indicators from other sectors, the paper proposes an original definition of Safety Culture for the DRR context, shaped on a series of elements and dimensions specifically outlined for this context. Finally, the expected benefits of the application of Safety Culture concepts and techniques for further advances in DRR is discussed.

AbstractIntroduction: Increasing knowledge of obstetric danger signs (ODS) and encouraging birth preparedness and complication readiness (BPCR) practices are strategies to increase skilled maternal health service utilization in low-income countries. One of the methods to increase mothers' knowledge about ODS and promote BPCR practice is through health education intervention (HEI). However, the effect of context-specific community-based health education led by women's groups on these outcomes has not been comprehensively studied, and the existing evidence is inconclusive. Thus, we aimed to evaluate the effect of a context-specific community-based HEI led by women's groups on mothers' knowledge regarding ODS and BPCR practices in southern Ethiopia.Methods: An open-label, two-arm parallel group cluster-randomized controlled trial was conducted from January to August 2023 on pregnant women from 24 clusters (kebeles) (12 interventions and 12 controls) in the northern zone of the Sidama region. The Open Data Kit smartphone application was utilized to collect data. The intention-to-treat analysis was used to compare outcomes between groups. We fitted multi-level mixed-effects modified Poisson regression with robust standard error to account for between and within cluster effects. Results: One thousand and seventy pregnant women (540 in the intervention and 530 in the control clusters) responded to this study, making the overall response rate 95.02%. Excessive vaginal bleeding (94.3% in the interventional group vs. 88.7% in the control group) was the commonest ODS mentioned during childbirth. Overall, 68.7% of women in the intervention group and 36.2% of mothers in the control group had good knowledge of ODS (P-value < 0.001). Saving money and materials (97.1% in the interventional group vs. 92.7% in the control group) was the most frequently practiced BPCR plan. Overall, 64.3% of women in the intervention group and 38.9% of mothers in the control group practiced BPCR (P-value < 0.001). HEI significantly increased overall knowledge of ODS (adjusted risk ratio [ARR]: 1.71; 99% CI: 1.14-2.57) and improved overall BPCR practice (ARR: 1.55; 99% CI: 1.02-2.39). Conclusions: A community-based HEI led by women's groups improved mothers' knowledge regarding ODS and BPCR practices in a rural setting in southern Ethiopia. Interventions designed to increase women's knowledge of ODS and improve BPCR practice must implement context-specific, community-based HEI that aligns with World Health Organization recommendations. Trial registration: NCT05865873

Abstract Introduction:The Robert Koch Institute (RKI) managed the exchange of cross-border contact tracing data between public health authorities (PHA) in Germany and abroad during the COVID-19 pandemic. Aim: We aimed to describe the extent of RKI cross-border contact tracing and the challenges experienced. Methods:We analysed cross-border COVID-19 contact tracing events from 03 February to 05 April 2020 using information exchanged through the European “Early Warning Response System” (EWRS) as well as communication with International Health Regulation (IHR) national focal points. We described events by PHA involved, number of contact persons and exposure context. Results:The RKI processed 467 events, initiating contact to PHA 1,099 times (median 1, IQR [1;2]) and sharing data on 5,099 contact persons. Of 327 (70%) events with known exposure context, most common reported were exposures on aircraft 64 (14%), on cruise ships 24 (5%) and exposures related to non-transport contexts 210 (45%). Cruise ship and aircraft exposures yielded higher median numbers of authorities contacted (10[2;16], 4[2;11]) and contact persons (60 [9;269], 2[1;3]) than non-transport related exposures (1[1;6] and 1[1;2]), respectively. The median time spend on contact tracing activities was the highest for cruise ships: 5 days [IQR 3;9]. Conclusion:In the current COVID-19 pandemic cross-border contact tracing is considered a critical component of the outbreak response. While the majority of international contact tracing activities did not relate to exposure events in transport, they contributed substantially to the workload. The numerous communications highlight the need for fast and efficient global outbreak communication channels between PHA.

Our primary objectives were a) to determine the need for, and the availability of point-of-care testing (POCT) for infectious diseases and b) to recommend point-of-care testing strategies and spatial care paths (SCPs) that enhance public health preparedness in regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted field surveys. Medical professionals in 7 community health centers (CHCs), 7 district hospitals (DHs) and 1 provincial hospital (PH) participated. Survey questions (English and Vietnamese) determined the status of diagnostic testing capabilities for infectious diseases and other acute medical challenges in TTHP. Infectious disease testing was limited: 6 of 7 CHCs (86%) lacked infectious disease tests. One CHC (14%, 1/7) had two forms of diagnostic tests available for the detection of Malaria. All CHCs lacked adequate microbiology laboratories. District hospitals had few diagnostic tests for infectious diseases (Tuberculosis, Syphilis), blood culture (29%, 2/7), and pathogen culture (57%, 4/7) available. The PH had broader diagnostic testing capabilities but lacked preparedness for highly infectious disease threats (e.g., Ebola, MERS-CoV, SARS, Zika, and Monkeypox). All sites reported having COVID-19 rapid antigen tests; COVID-19 RT-PCR tests were limited to higher tier hospitals. We conclude that infectious disease diagnostic testing should be improved and POC tests must be supplied near patients’ homes and in primary care settings for the early detection of infected individuals and mitigation of the spread of new COVID-19 variants and other highly infectious diseases.

Historically, macrophages have been long implicated in the control of the severity of infectious diseases. This has been based on the observations of a higher risk of severe disease and death upon rechallenge with viral variants due to antibody dependent enhance-ment (ADE) of infection into macrophages. The question remains as to what can account for this potent heterologous protection in macrophages? Here it is argued that the elusive defense mechanism of M1-like pro-inflammatory macrophages may pertain to a novel virus anti-virus response. This system initiates with high replication of human endogenous retrovirus K102 (HERV-K102), a non-pathogenic, protector foamy retrovirus of humans which generates M1-like pro-inflammatory foamy macrophages, glycolysis, and epigenetic changes, all characteristic of trained immunity. This virus-anti-virus system kills virally infected cells by several mechanisms, amplifies the innate interferon response via ‘viral mimicry’, has many unique components that interfere with exoge-nous virus replication, and may be especially adept at neutralizing enveloped exogenous pandemic viruses, such as SARS-CoV-2 and HIV-1. The goal of this treatise is to introduce the multifaceted HERV-K102 protector system, to illustrate how SARS-CoV-2 may target the HERV-K102 protector system by ADE, and to explore how this innate defense system may be exploited for pandemic preparedness.