Counteractive Measures Against COVID-19: Navigating Medical Practice Through a Nascent, Evolving Evidence Base

Background: The European Pediatric Dialysis Working Group’s (EPDWG) recent Delphi study reported widely variable responses to COVID-19 during the first week of statutory public curfews by Pediatric Nephrology centers in 11 European countries with caseloads of 4 to 680 infected patients per million. In this follow-up study the EPDWG applied the capability, opportunity and motivation model of behavior (COM-B) to describe determinants of COVID-19 countermeasure implementation rates. Methods: 52 countermeasures clustered into eight response domains (Access Control, Patient Testing, Personnel Testing, Personal Protective Equipment Policy, Patient Cohorting, Personnel Cohorting, Suspension of Routine Care, Remote Work) were categorized by implementation status, drivers (expert opinion and/or hospital regulations) and resource dependency. Governmental Strictness and Media Attitude were independently assessed for each country and correlated with factors relevant to countermeasure implementation. Findings: Implementation rates varied widely among response domains (median 49·5%, range 20%-71%) and centers (median 46%, range 31%-62%). Center caseloads were insufficient to explain response rate variability. Increasing caseloads resulted in shifts from expert opinion-based to hospital regulation-based decisions to implement additional countermeasures despite increased resource dependency. Higher Governmental Strictness and positive Media Attitude toward countermeasure implementation were associated with higher implementation rates. Interpretation: COVID-19 countermeasure implementation (changes of ‘institutional behavior’) by EPDWG centers reflected drivers’ ability to overcome each center’s local resource dependency, motivated by local perception of growing global medical need and leading to heterogeneity of local rules and responses. Insight into mechanisms underlying these practices will foster ongoing reassessment, facilitating rapid change in ‘institutional behavior’ in response to emerging evidence of countermeasure efficacy. Funding: No funding was secured for this study. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Missing.