A number of 1245 studies was generated by initial search. After removing the duplication, 555 references were identified for screening. Out of 555 extracted studies, 530 articles were removed due to meeting the exclusion criteria. The full texts of 25 studies were read and 13 articles which included the co-occurrence of natural disasters and COVID-19 as well as implications for health system were selected for final analysis (Figure 1) (Table 1).
Table 1) The characteristics of the final selected articles
No
|
Title
|
Publication month
|
Article type
|
Disaster type
|
Health effects
|
1
|
The COVID-19 Pandemic and Wildfire Smoke: Potentially Concomitant Disasters
|
August 2020
|
Editorial
|
Wildfire
|
Physical health;
Environmental health
|
2
|
Stay home while going out – Possible impacts of earthquake co-occurring with COVID-19 pandemic on mental health and vice versa
|
April 2020
|
Editorial
|
Earthquake
|
Mental health
|
3
|
Mitigating the Twin Threats of Climate-Driven Atlantic Hurricanes and COVID-19 Transmission
|
July 2020
|
Policy analysis
|
Hurricane
|
Healthcare system
|
4
|
Living in a Multi-Risk Chaotic Condition: Pandemic, Natural Hazards and Complex Emergencies
|
August 2020
|
Original research
|
Flood/earthquake
|
Healthcare system
|
5
|
From natural disaster to pandemic: A health system pharmacy rises to the challenge
|
May 2020
|
Case report
|
Tornado
|
Health system pharmacy
|
6
|
Floods in China, COVID-19, and climate change
|
August 2020
|
Editorial
|
Flood
|
Health system
|
7
|
Earthquake in the time of COVID-19: The story from Croatia (CroVID-20)
|
June 2020
|
View point
|
Earthquake
|
Healthcare system
|
8
|
COVID-19 pandemic and Zagreb earthquakes as stressors in patients with temporomandibular disorders
|
June 2020
|
Original research
|
Earthquake
|
Physical health
|
9
|
COVID-19 jeopardizes the response to coming natural disasters
|
May 2020
|
Editorial
|
Natural disasters
|
Health system
|
10
|
Cascading Risks of COVID-19 Resurgence During an Active 2020 Atlantic Hurricane Season
|
August 2020
|
View point
|
Hurricane
|
Healthcare system
|
11
|
An Eye on Covid: Hurricane Preparedness at a COVID-19 Alternative Care Site
|
September 2020
|
Case report
|
Hurricane
|
Health system and facilities
|
12
|
A multi‑hazards earth science perspective on the COVID‑19 pandemic: the potential for concurrent and cascading crises
|
May 2020
|
Original research
|
Earthquake
|
Health system
|
13
|
The Southwest Monsoon During COVID-19 Pandemic: A Potential Concern
|
July 2020
|
Editorial
|
Flood
|
Health system
|
The subjects of all 13 articles included the coincidence of COVID-19 and natural disaster as well as communities’ healthcare systems at the same time. Earthquake, flood, hurricane, tornado and wildfire were the natural disasters which their coincidence with COVID-19 had been investigated. Of these, earthquake was the most frequent disaster which its coincidence with COVID-19 was studied by researchers (31%). All selected articles were published between April and September 2020. Editorial articles had the highest rate of document type (38.5%) and policy analysis was published at least (7.7%). About 10 out of 13 articles (77%) were investigated the effects of COVID-19 and natural disasters coincidence on healthcare system and had implications for the health system rather than mental or physical health (Table 2).
Table 2) The frequency of hazard type, article type and health effect
No
|
Subjects
|
N
|
N (%)
|
1
|
Hazard type
|
Earthquake
|
4
|
31
|
Flood
|
2
|
15.4
|
Hurricane
|
3
|
23
|
Tornado
|
1
|
7.6
|
Wildfire
|
1
|
7.6
|
All hazard approach
|
2
|
15.4
|
2
|
Article type
|
Editorial
|
5
|
38.5
|
Original research
|
3
|
23
|
Viewpoint
|
2
|
15.4
|
Case report
|
2
|
15.4
|
Policy analysis
|
1
|
7.7
|
3
|
Health section
|
Health system
|
10
|
77
|
Physical/environmental health
|
2
|
15.4
|
Mental health
|
1
|
7.6
|
Implications for health system preparedness and response
Coincidence of COVID-19 and natural disasters requires a prepared health system for effective response which can prevent more deaths and disabilities. Accordingly, the suggestions, recommendations and implications of public health scholars who have studied the co-occurrence of COVID-19 and natural disasters were considered in three sections of climatic events, earthquakes and all hazard approach.
1. Climatic events and COVID-19
Some authors discussed the co-occurrence of climatic events such as flood, hurricane and tornado and COVID-19. For example, the study of southwest monsoon during COVID-19 pandemic concluded that a timely preparedness for monsoon season during ongoing COVID-19 is necessary. Planning mitigations and preparedness of health systems should be done by the participations of health staff, departments of disaster management as well as South Asian countries officials (11). Accordingly, designing and activating the MMS by Louisiana Department of Health to lessen the pressure on hospitals overwhelmed by COVID-19 epidemic can be considered as a suitable implication. Experience on historical exposure to hurricanes caused MMS to plan for possible hurricane event as a priority. The plan included preparedness for medical supplies, staffing, incident command, patient care and coordination. Utilizing the patient safety and medical operations continuity as well as meeting the health needs of people affected by the Tropical Strom were the benefits of creating MMS. Establishing such structure can reinforce the emergency operations during an unexpected pandemic of COVID-19 (19).
Similarly, three steps have been suggested to reduce the risk of COVID-19 and hurricane coincidence in the near future. The first step is to establish COVID-19 prevention lifestyle at the time of occurring convergent disasters. Such prevention includes reconsidering physical distancing as well as effective disaster risk reduction strategies. The second step consists of strengthening communication in order to forming safer sheltering and evacuation in the regions affected by co-occurrence of COVID-19 and hurricane. Communication strategies should motivate and encourage people to evacuate and shelter safely, more especially vulnerable populations who may not evacuate at the time of hurricane threats. The COVID-19 prevention guide should be provided for populations living in highly hazard-prone regions. The prepared guidance needs to include such preventive criteria as washing hands, wearing mask, suitable ventilation and surface cleaning. The third step consists of learning from the lessons obtained from the coincidence of COVID-19 and the last storm (2020) to improve the disaster management actions (20). Similarly, the study which investigated flood impacts during COVID-19 epidemic in China, discussed that the effects of floods on physical and mental health of people infected by COVID-19 have not been obvious. The authors suggested urgent measures to prevent health and livelihood consequences of floods at the time of COVID-19 pandemic in China (21).
While addressing COVID-19 pandemic requires resources and supplies, tornado destroyed the pharmacy storage in March 2020. The pharmacy system tried to respond to tornado as a natural disaster and the COVID-19 pandemic. Accordingly, a number of implications has been suggested as lessons learned from the pharmacy system measures during the coincidence of COVID-19 and natural disasters. External and multidisciplinary collaborations, effective communication among departments and teamwork were the most important implications learned from the authors’ experiences. Since tornado affected supply storage, medications and health delivery system, a strong disaster response system as well as effective collaborations and communications facilitated responding to COVID-19 epidemic (22).
In the similar article, the authors discussed two scenarios regarding the dual risk of COVID-19 pandemic and hurricane. Firstly, higher rates of hurricane related injuries and deaths among people who declined to evacuate due to being afraid of COVID-19 and secondly, increase of COVID-19 cases due to sheltering the evacuees. The authors suggested that sheltering or evacuating along with protective actions for limiting the spread of COVID-19 can be much safer for the highly hurricane prone communities. Such precaution actions included physical distancing, use of mask, hand washing and mass gatherings avoidance. Considering and following the public health surveillance steps such as case identification, isolation, quarantine, and contact tracing can be crucial as well. To control COVID-19 pandemic, the anti-contagion policies and strategies as well as hygiene interventions were chosen by public health managers and healthcare providers in the absence of COVID-19 vaccine. The health system needs to balance the reduction of COVID-19 transmission possibility and minimize the risk of hurricane exposure. Releasing guidance and protocols on sheltering during COVID-19 pandemic can be helpful. In addition, a 14-days self-quarantine of people who used mass shelters at the time of hurricanes, control of infections in shelter settings, checking symptom frequently, prepackaged meal and disinfection of surfaces as well as staying in assigned places can be considered at the time of sheltering. Finally, educating evacuation and sheltering behaviors to people during COVID-19 and applying lessons learnt from the previous hurricanes were suggested by the authors (23).
Healthcare providers should be prepared for wildfire season in order to protect patients and vulnerable people from smoke. There has been a number of conflicts during the coincidence of COVID-19 pandemic and wildfire events. For example, in-home sheltering and applying portable air cleaners may be more emphasized due to physical distancing guideline in wildfire seasons during COVID-19 pandemic. Furthermore, although surgical mask and cloth can help decrease COVID-19 transmission, they provide limited protection from wildfire smoke. Accordingly, balancing the actions for responding to the dual risks of COVID-19 and wildfire events can be vital. For instance, in addition to personal protective operations, healthcare facilities should be supplied and assessed by ventilation, heating and air conditioning experts to be prepared for the COVID-19 pandemic in the summer months. The preparedness for wildfire smoke requires the collaborative actions of public and environmental health experts as well (24).
2. Earthquakes and COVID-19
Balancing the risks of COVID-19 and disaster response and recovery actions has been considered in the evidence which studied the co-occurrence of COVID-19 and earthquake. In addition, including natural disaster inputs into COVID-19 epidemiological modeling has been suggested as an effective action which can improve the disaster preparedness and planning for COVID-19 mitigation strategies in the future. Furthermore, sharing scientific information such as models with developing countries has been recommended due to their lack of capacity to generate resilience-related knowledge. In addition, planning for equipping the poor and developing countries and regions in order to preparation and response to natural disasters at the time of COVID-19 pandemic can help decrease the consequences of disasters. The evacuation centers should be available with the social distancing capacity as well as the availability of personal protective equipment and medical supplies such as respirators in regions affected by COVID-19. Other implications included strengthening disaster coordination to inform COVID-19 epidemic response; identifying economic implication for COVID-19; improving community-based response and preparedness for coincidence of COVID-19 and disasters; preparing recovery plan at early phase. Finally, building resilience and disaster risk governance can reduce the risk of natural disasters during the pandemic such as COVID-19 (25).
The risk of increasing the cases of COVID-19 in combination with a natural disaster such as earthquakes is higher. The experiences of Croatia earthquake at the time of COVID-19 showed that a well-established health system as well as coordinated collaborations during outbreak response helped healthcare managers mitigate possible effects (26). On the other hand, the coincidence of COVID-19 and earthquakes played as a stressor for a number of illness such as patients with TMD disorders. However, a related study revealed that COVID-19 were more stressful than earthquakes for TMD patients who lived in earthquake affected regions. Relevant evaluation can identify the psychological information of patients. Such evaluation can help understand the pain and disability problems of patients who were affected by co-occurrence of COVID-19 and natural disasters (27). In addition, COVID-19 pandemic which is reinforced by disastrous events affected people’s mental health remarkably. The level of people susceptibility to mental health effects of pandemic and earthquakes co-occurrence is related to individual’s resiliency or resistance. In addition, pre and post-disaster context as well as people’s characteristics can influence the mental health interventions. The required care should be provided by resources allocated to mental health system activation in the regions affected by both natural disasters and COVID-19 pandemic (28).
3. All hazard approach
The plans which need to be made regarding the coincidence of COVID-19 and natural disasters have been classified into two parts of contingency planning; and pre-crisis planning and coordination. Reducing the health impacts of natural disasters at the time of COVID-19 transmission needs contingency plan with the aim of improving disaster health management affairs. Contingency planning includes protocols for safe work, social distancing actions and analysis of worst-case scenarios based on the results of risk assessment. On the other hand, pre-disaster planning focuses coordination of stakeholders as well as optimizing resources in order to responding to potential effects of COVID-19 and upcoming natural disasters coincidence. The increase of international cooperation as well as improving disaster health management systems can help countries, especially developing ones, encounter dual risk of COVID-19 pandemic and natural disasters (10). In addition, the cascading effects of natural disaster, COVID-19 pandemic and complex emergencies are not well known. Responding to such multi-hazard situation should be considered in risk legislation and planning during disaster prevention and preparedness phases. Furthermore, additional financial resources allocation for doing research in regions affected by multi-hazard risk of natural disaster and COVID-19 pandemic can help decrease their unsafe future as well as strengthening community resiliency through policy-making and planning (7).