PONE-D-22-30776Iranian Primary Healthcare System's Response to COVID-19Pandemic using Healthcare Incident Command SystemPLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: No

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: “Iranian Primary Healthcare System’s Response to COVID-19Pandemic

using Healthcare Incident Command System”

Comments on the paper by Arezoo Yari et al

submitted to PLOS ONE (MS number PONE-D-22-30776)

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Author : P.N. Lee

Date : 23rd November 2022

While the paper is generally well written and the results clear and well analysed, there are a few points that demand some attention. These are considered below in the order they appear in the paper and not in order of importance.

1. The full title would be better if there were a space between “COVID-19” and “Pandemic” and if the word “the” was inserted after “Response to” and after “using”.

2. I found the Methods section of the Abstract somewhat confusing at first, as it stated that some DHNs had an active HICS and some did not, so how could data on HICS be collected from those that did not have an active HICS? Later on in the paper it appears that data were in fact collected from all the 60 DHNs. It might also be a good idea to mention the number of DHNs with active and inactive HICS. Perhaps the Method section might read something like the following:

“Methods: The study was performed in Iran in June 2020 in 60 DHNs, 41 of which had an active HICS. Data were collected on eight HCIS constructs from all 60 DHNs by trained crisis management experts to evaluate the effects of HICS use on management of the COVID-19 pandemic”.

3. The results might better start:

“For all the 60 DHNs, the mean score of the COVID-19 incident command and management was 78.79 ± 11.90 (range 20-100); with mean scores highest for organizational support and cooordination and lowest for logistic and planning”.

4. While it is clear enough from Tables 2 and 3 that scores on total incident command and the other seven dimensions were clearly higher in DHNs with an active HICS (p<0.01 in all cases), I wonder whether it is enough to infer from this that HICS should always be active. The study does not investigate health endpoints, and it would be interesting to know, for example, whether the 41 DHNs with active HICS had a lower mortality rate among patients admitted for COVID-19 than did the 19 DHNs without active HICS. Does having active HICS work as regards the virus?

5. Near the end of the Introduction section, there is a statement that MOHME “necessitated that all health systems use HICS as an essential infrastructure since 2011” and that the following the outbreak of SARS-COV-2 in Iran, “the authorities officially announced the activation of HICS in the healthcare system on all levels”. That being the case, how did it come about that 19 of the 60 DHNs did not use the HICS?

6. Under “data analysis” it is made clear that the classification of total incident management and command into low, average and high was based on putting the bottom 25% as low, the top 25% as high and the rest as average. But there is nothing about how low, average and high were defined for the seven constructs from organizational support to human resource management. It would be useful to give fuller details as to how these scores were derived, perhaps as a supplementary file which details the questions actually asked and the possible replies.

7. In the Discussion section there is a paragraph starting “In this study, among the studied dimensions, the lowest command scores in the DHNs belonged to the planning dimension”. But according to Table 1, the lowest score is for the logistic dimension.

8. While the paper is well written, the last paragraph of the introduction could be improved by replacing “didn’t” by “did not”, and by inserting “been” before “considered in our study”.

Reviewer #2: Dear Authors

This is good effort to explain Iranian Primary Healthcare System's Response to COVID-19Pandemic using Healthcare Incident Command System.

It is well written .

But in my opinion it is more useful for local Iranian Journal.

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Reviewer #1: Yes: Peter N Lee

Reviewer #2: No

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Iranian primary healthcare system's response to the COVID-19 pandemic using the healthcare incident command system

PONE-D-22-30776R1

Dear Dr. Motlagh,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Academic Editor

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Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for addressing the comments I made on the version of the paper as submitted originally. I have no further comments

Reviewer #2: Dear Authors

You said that your study was the evaluation of various

dimensions of COVID-19 crisis command based on a global algorithm, which

encompassed all the aspects of incident command and management in an emergency.

Therefore, the results of this study can be used anywhere in the world. this study is

effective in improving our understanding of the role of HICS systems in controlling the

COVID-19 pandemic.

But I am not sure about your response.

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Reviewer #1: Yes: Peter N Lee

Reviewer #2: No

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