Table 1.

Practical Recommendations for the Management of the COVID-19 Pandemic from a Counter-Terrorism Medicine (CTM) Perspective

Topic of CTM	Recommendations
Preparedness	Provide training for hospital physicians, residents, and nurses in CBRN, in using personal protective equipment, and in terrorism risk assessment.
Prevention	Be wary of red flags in contact tracing: • Contact tracing teams should assign a terror expert (eg, an emergency physician or nurse trained in CTM) to the team to assess the clusters on terror susceptibility, especially in clusters without a clear internal index person in terror-sensitive locations: churches, synagogues, mosques, hospitals, and asylum centers. • Contract tracing apps might be prone to fraudulent modification of data in which false positives flood hospitals/triage centers, would eventually undermine government and health care systems.30
	Take cyberterrorism countermeasures: especially for laboratories, testing centers, and/or vaccination centers.
	Provide access barriers (against ram-raid or car bombings) at the main hospital entrance and the emergency ward entrance and at testing/vaccination centers.
Response	Anti-science, anti-lockdown, and anti-vaccination rhetoric can only be countered by profound information, open communication, and open government reaching out to the people. The lessons of the small island of Samoa in the South Pacific may inspire other countries in dealing with vaccination hesitance.31,32
Mitigation	• Provide a psychological debriefing team for your staff. • Limit team numbers, avoid mixing with other teams, and assign dedicated logistics staff in order to avoid large staff unavailability during outbreaks. • Provide support for employees and their families who fell ill or who are in quarantine.

Abbreviations: COVID-19, coronavirus disease 2019; CTM, counter-terrorism medicine; CBRN, chemical, biological, radiological, and nuclear.