The Utility of an Online Forward Triage Tool During the SARS-CoV-2 Pandemic: Health Care Provider and Health Authority Perspectives.

Introduction The SARS CoV-2 pandemic poses major challenges not only to patients but also to health care professionals and policy-makers, with rapidly changing, sometimes complex, recommendations, and guidelines to the population. Online forward triage tools (OFTT) got a major boost from the pandemic as they helped with the implementation and monitoring of recommendations. Methods A multiphase mixed method sequential explanatory study design was employed. Quantitative data were collected first and informed the qualitative interview guides. Video interviews were held with key informants (health care providers and health authorities) between 2 September and 10 December 2020. Audio-recordings were transcribed verbatim, coded thematically and compared with patient perspectives (framework). Objectives To explore the perspectives of health care providers and authorities in Canton Bern on the utility of a COVID-19 OFTT, as well as elicit recommendations for telehealth in future. Results The following themes emerged; (i) accessibility (ii) health system burden reduction (iii) utility in preventing onward transmission (iv) utility in allaying fear and anxiety (v) medical decision-making utility (vi) utility as information source (vii) utility in planning and systems thinking. The health care providers and health authorities further provided insights on potential barriers and facilitators of telehealth in future. Conclusion Similar to patients, health care providers acknowledge the potential and utility of the COVID-19 OFTT particularly as an information source and in reducing the health system burden. Data privacy, doctor-patient relationship, resistance to change, regulatory, and mandate issues, and lack of systems thinking were revealed as barriers to COVID-19 OFTT utility

Triggered earthquakes suppressed by an evolving stress shadow from a propagating dyke

Large earthquakes can generate small changes in static stress: increases that trigger aftershock swarms, or reductions that create a region of reduced seismicity—a stress shadow1, 2. However, seismic waves from large earthquakes also cause transient dynamic stresses that may trigger seismicity3, 4. This makes it difficult to separate the relative influence of static and dynamic stress changes on aftershocks. Dyke intrusions do not generate dynamic stresses, so provide an unambiguous test of the stress shadow hypothesis. Here we use GPS and seismic data to reconstruct the intrusion of an igneous dyke that is 46 km long and 5 m wide beneath Bárðarbunga Volcano, central Iceland, in August 2014. We find that during dyke emplacement, bursts of seismicity at a distance of 5 to 15 km were first triggered and then abruptly switched off as the dyke tip propagated away from the volcano. We calculate the evolving static stress changes during dyke propagation and show that the stressing rate controls both the triggering and then suppression of earthquake rates in three separate areas adjacent to the dyke. Our results imply that static stress changes help control earthquake clustering. Similar small static stress changes may be important for triggering seismicity near geothermal areas, regions being hydrofractured and deflating oil and gas fields