Effective Contact Tracing System Minimizes COVID-19 Related Infections and Deaths: Policy Lessons to Reduce the Impact of Future Pandemic Diseases

One of the fundamental questions in the presence of Coronavirus Diseases 2019 (COVID-19) pandemic crisis and in general of new pandemic diseases is to design effective policy responses to reduce the impact in the initial phase of diffusion, when appropriate therapies and drugs lack. This study analyses a main case study given by Italy, one of the first European countries to be damaged of the impact of COVID-19 pandemic. In particular, this study focuses on health policy responses to the pandemic crisis across selected Italian regions that were the first areas to experience a rapid increase in confirmed cases and deaths of COVID-19. The analysis of early regional health policies, from January to July 2020 (during the first wave of the COVID-19 pandemic), reveals that some regions have managed pandemic crisis with appropriate health policy responses based on: a) a timely and widespread testing of individuals, b) effective units of epidemiological investigation in a pervasive contact-tracing system to detect and isolate all infected people. This health policy response has reduced total deaths and negative effects of COVID-19 on health of people during the first pandemic wave, when are not available pharmaceutical interventions, such as vaccines and other antiviral drugs. This evidence in the first wave of COVID-19 pandemic provides important lessons to design an effective public health policy to constraint future pandemic waves driven by new variants and new viral agents, when appropriate drugs are not ready.

Meta-analysis to explain unknown causes of the origins of SARS-COV-2

New Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes the Coronavirus Disease 2019 (COVID-19), an infectious illness that has generated a pandemic crisis worldwide. One of the fundamental questions in science and society is how SARS-CoV-2 has been originated to design best practices directed to prevent and/or to cope with future hazardous pathogens. The study confronts this question here developing a meta-analysis, which endeavors to explain, whenever possible, unknown sources of the SARS-CoV-2. Findings suggest that the natural spillover of novel viral agents that generate more than 6.00 M deaths worldwide in about two years (such as, SARS-CoV-2 from February 2020 to March 2022) has a remote probability of occurrence (using an analogy with the probability of natural disasters generating a lot of fatalities), whereas science advances on hazardous viral agents and consequential lab accident have a (higher) probability of occurrence (about 13-20% like in manifold lab accidents). The findings of this meta-analysis suggest the vital role of improving the technical guidelines of biosafety at all levels in laboratories during the development of scientific research of experimental virology on hazardous pathogens to minimize risks of pandemic threats in environment and human society.

Global analysis of timely COVID-19 vaccinations: improving governance to reinforce response policies for pandemic crises

Purpose

The goal of this study is to analyze the relationship between public governance and COVID-19 vaccinations during early 2021 to assess the preparedness of countries to timely policy responses to cope with pandemic crises.

Design/methodology/approach

This global study elaborates descriptive statistics, correlations, regression analyses and Independent Samples T-Test on 112 countries, comparing those with high/low level of governance, to determine whether statistical evidence supports the hypothesis that good governance can improve the timely administration of vaccines.

Findings

Bivariate correlation reveals that doses of vaccines administered × 100 inhabitants have a high positive association with the General Index of Governance (r = 0.58, p-value <0.01). The result is confirmed by partial correlation (controlling density of population per km2): r = 0.584, p-value <0.001. The coefficient of regression in the models also indicates that an increase in the General Index of Governance improves the expected administration of doses of COVID-19 vaccines (p-value <0.001).

Research limitations/implications

Although this study has provided interesting results that are, of course, tentative, it has several limitations. First, a limitation is the lack of data in several countries. Second, not all the possible confounding factors that affect the vaccination against COVID-19 are investigated, such as country-specific health investments and expenditures, and these aspects should be examined in the future development of this research. A third limit is related to the measurement of governance through the World Governance Indicators, which are based only on perceptions and can be biased by different socio-economic factors.

Practical implications

The identification of factors determining the timely vaccinations may help to design best practices of health policy for improving the resilience of countries to face pandemic crises.

Social implications

The improvement of preparedness of countries through good governance can foster a rapid rollout of vaccinations to cope with pandemic threats and the negative effects of their socio-economic impact.

Originality/value

This study presents a global analysis of the role of public governance for timely vaccinations to face pandemic crises in society.

P24 WEAREBLE CARDIOVERTER – DEFIBRILLATOR : UTILITY AND USER FRIENDLINESS

Background

Worldwide, cardiovascular disease are still a major mode of death, being sudden arrhythmic death (SCD)25 % of total death. Implantable cardioverter defibrillator (ICD) is an effective weapon for SCD prevention in high risk patients with reasonable expectation of survival with good functional status for &gt;1 year. However sometimes the risk of SCD can be transient, so the use of a wearable cardioverter defibrillator (WCD) is considered.

Methods

We considered consecutively 40 patients discharged from our cardiology department of Piacenza and Castel san Giovanni that, for potentially transient high risk of SCD, weared a WCD from August 2017 to September 2021, after a systematic education session lasting 30 – 45 minutes. They are followed through remote monitoring.

Results

Out of 40 patients, with average age 66 years old and average left ventricular ejection fraction (LVEF) 29%, 88% were males, 70 % suffered from arterial hypertension, 32% diabetes mellitus, 17,5 % peripheral vascular disease, 35 % chronic renal failure, 55% heart failure, 7,5% previous stroke. 56% of these patients weared WCD for severe systolic disfunction in ischemic cardiac disease after recent myocardial infarction, after percutaneous coronary intervention or coronary artery bypass graft, 7% after removal of an infected ICD, 9 % whilst awaiting completion of diagnostic tests (chanalopathies/right arrhythmogenic ventricular cardiomyopathy), 34% after newly diagnosed cardiomyopathy.The patients were discharged in high risk mode of SCD with WCD protection.The average wearing time of WCD was 51 days and 22,98 hours daily. We received 953 trasmissions, with 21 events: 7 ventricular tachicardia, 4 Sopraventricular tachicardia and 5 T wave oversensing .Neither inappropriate shock and neither death were detected .After wearing time and after clinical evaluation, only 52% of patients were subjected to ICD implantation.

Conclusions

In our experience we may consider that WCD use is effective, safe and with a good adherence in all patients, considering wearing time. The WCD allows saving resources with less hospitalization time.

C7 WEARABLE CARDIOVERTER – DEFIBRILLATOR IN PATIENTS WITH HIGH RISK OF SUDDEN CARDIAC DEATH: IS IT USEFUL A PATIENT SELECTION?

Background

The wearable cardioverter defibrillator (WCD) is considered in patients with increased risk of sudden cardiac death (SDC), in which implanted cardiac defibrillator (ICD) is temporary not definitively indicated. A few registry confirmed efficacy and safety of WCD and left ventricular ejection fraction recovery (LEVS)after wearing time.

Methods

We considered in our study 40 consecutively patients that used WCD in Piacenza and Castel San Giovanni Cardiology Department from August 2017 to September 2021 with recent acute myocardial infarction, newly diagnosed cardiomyopathy, primary arrhythmias syndrome awaiting diagnostic completation. They were followed by remore monitoring. The primary outcome were: the need of ICD implantation or not indication to ICD at the of the wearing time, We analyzed clinical variables related to primary outcome.

Results

Out of 40 patients, average age 66 years, average LEVS media 29%±12,5,88% were males, 32% suffered from diabetes mellitus, 35% renal failure, 55% acute and chronic heart failure, 10% previous ischemic stroke, 17% atrial fibrillation (AF), 12% cardiac arrest (ACC) after STEMI onset, 20% ventricular tachicardia (VT). 27% of these patients took amiodarone,92% beta blockers and 82% ACEi.The average wearing time of WCD was 51 days and 22,96 hours dailyAt the end of this period 48% of patients didn‘t receive ICD implantation for increasing LEVS.We evaluated clinical variables related to primary outcome with Chi Square test and Student’s t test.There weren’t significant difference regarding primary outcome between ischemic disease and other cardiophaties. The presence of AF, previous stroke, renal failure, hypertension, diabetes mellitus was more but not significant in ICD group. No significant age difference(66.8±14.1 vs 66.3±11.8, p = 0,6) neither FEVS (29.4±11.6 vs 29.5±12.7, p = 0,8) was in patients that received ICD versus not received .The clinical variables related to primary outcome only were: ACC after STEMI onset and amiodarone therapy.

Conclusions

In our study of patients with WCD, the percentage of LEVS increase is consistent with European registries. A few clinical variables may be related to ICD indication. Further studies can be useful to identify patients who need more of WCD for a lack of LEVS improvement.

COVID-19 pandemic over 2020 (withlockdowns) and 2021 (with vaccinations): similar effects for seasonality and environmental factors

How is the dynamics of Coronavirus Disease 2019 (COVID-19) in 2020 with an health policy of full lockdowns and in 2021 with a vast campaign of vaccinations? The present study confronts this question here by developing a comparative analysis of the effects of COVID-19 pandemic between April-September 2020 (based upon strong control measures) and April-September 2021 (focused on health policy of vaccinations) in Italy, which was one of the first European countries to experience in 2020 high numbers of COVID-19 related infected individuals and deaths and in 2021 Italy has a high share of people fully vaccinated against COVID-19 (>89% of population aged over 12 years in January 2022). Results suggest that over the period under study, the arithmetic mean of confirmed cases, hospitalizations of people and admissions to Intensive Care Units (ICUs) in 2020 and 2021 is significantly equal (p-value<0.01), except fatality rate. Results suggest in December 2021 lower hospitalizations, admissions to ICUs, and fatality rate of COVID-19 than December 2020, though confirmed cases and mortality rates are in 2021 higher than 2020, and likely converging trends in the first quarter of 2022. These findings reveal that COVID-19 pandemic is driven by seasonality and environmental factors that reduce the negative effects in summer period, regardless control measures and/or vaccination campaigns. These findings here can be of benefit to design health policy responses of crisis management considering the growth of COVID-19 pandemic in winter months having reduced temperatures and low solar radiations ( COVID-19 has a behaviour of influenza-like illness). Hence, findings here suggest that strategies of prevention and control of infectious diseases similar to COVID-19 should be set up in summer months and fully implemented during low-solar-irradiation periods (autumn and winter period).

Restriction policies and effects of COVID-19 pandemic in environment: analysis and role of sustainable technology to cope with future pandemics.. [DOI: 10.21203/rs.3.rs-1566878/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Restriction or containment policies (e.g., business and workplace closures, travel bans and restrictions, compulsory facemask coverings, mandatory vaccinations, etc.) can prevent high numbers of Coronavirus Disease 2019 (COVID-19) related infected individuals and deaths. However, one of the critical questions is varying degrees of strictness in containment policies to cope with negative effects of COVID-19 pandemic crisis in environment and society. This study confronts the question here by developing a comparative analysis between countries with high and low levels of strictness in containment measures to assess the effectiveness of their policy responses to cope with high numbers of infections and deaths of COVID-19 in society. A homogenous sample of 31 countries having a level of Gross Domestic Product (GDP) per capita higher than U$16,000 are categorized in two sets: countries with high or low containment index (100 = highest restrictions and strictness). The findings here seem to be that countries with a containment index lower than 50 (i.e., lower degree of strictness) have average COVID-19 confirmed cases on population (24.69% vs. 26.06%) and fatality rates (74.33% vs = 76.38%) lower than countries with high level of containment index (about 60). This empirical evidence reveals that government responses based on high degrees of strictness seem to be ineffective to cope with COVID-19 pandemic crisis because can create socioeconomic issues. This study suggests that one of the best strategy of prevention of high numbers of deaths of new airborne diseases generating respiratory disorders is based on high levels of investment in health sector and in particular, high investments in new sustainable technology of medical ventilators that can reduce negative effects of emerging infectious diseases similar to COVID-19, when specific drugs lack and/or need months or years for process of drug discovery.

Technology matters to cope with unforeseen pandemics: low COVID-19 fatality in countries with high numbers of medical ventilators.. [DOI: 10.21203/rs.3.rs-1465907/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

In the presence of global pandemic crisis of the Coronavirus Disease 2019 (COVID-19), nations have applied containment policies of varying degree of strictness to mitigate mortality in society, but these non-pharmaceutical interventions have generated a low effectiveness. However, some countries though high levels of infections have experienced lower numbers of COVID-19 related deaths. Why? This exploratory research here analyzes the vital role of technological innovation of medical ventilators to cope with the initial stage of COVID-19 pandemic without specific pharmaceutical treatments (drugs and vaccines). Preliminary results, based on a comparative analysis of a small sample of countries, suggest that countries having a high number of medical ventilators (26.76 per 100,000 inhabitants) have in general a fatality rate lower (1.44% in December 2020) than countries with low average number of medical ventilators (10.38 per 100,000) that have a high fatality rate of 2.46% in the same period. These findings bring us to suggest a strategy of preparedness to cope with future pandemic threats, which focuses on high levels of R&D investments in healthcare sectors to support drug discovery process, new infrastructures and skilled human resources associated with modern technologies in high-tech medical ventilators that really can reduce negative effects of emerging infectious disease when specific drugs lack.

Scientific laws of research funding to support citations and diffusion of knowledge in life science

One of the main problems in scientometrics is to explore the factors that affect the growth of citations in publications to identify best practices of research policy to increase the diffusion of scientific research and knowledge in science and society. The principal purpose of this study is to analyze how research funding affects the citation-based performance of scientific output in vital research fields of life science, which is a critical province (area of knowledge) in science to improve the wellbeing of people. This study uses data from the Scopus database in 2015 (to assess the impact on citations in 2021, after more than 5 years) concerning different disciplines of life science, given by “agricultural and biological sciences”, “biochemistry, genetics, and molecular biology”, “Immunology and microbiology”, “neuroscience” and “pharmacology, toxicology and pharmaceutics”. Results demonstrate that although journals publish un-funded articles more than funded publications in all disciplines of life science, the fraction of total citations in funded papers is higher than the share in the total number of publications. In short, funded documents receive more citations than un-funded papers in all research fields of life science under study. Findings also support that citations of total (funded + un-funded), funded, and un-funded published papers have a power-law distribution in all five research fields of life science. Original results here reveal a general property in scientific development: funded research has a higher scaling potential than un-funded publications. Critical implications of research policy, systematized in a decision-making matrix, suggest that R&D investments in “Neuroscience” can generate a positive impact of scientific results in science and society-in terms of citations-higher than other research fields in medicine. Overall, then, results here can explain some characteristics driving scientific change and help policymakers and scholars to allocate resources towards research fields that facilitate the development and diffusion of scientific research and knowledge in life science for positive societal impact.

Optimal levels of vaccination to reduce COVID-19 infected individuals and deaths: A global analysis

Coronavirus disease 2019 (COVID-19) continues to be a pandemic threat that is generating a constant state of alert in manifold countries. One of the strategies of defense against infectious diseases (e.g., COVID-19) is the vaccinations that decrease the numbers of infected individuals and deaths. In this context, the optimal level of vaccination for COVID-19 is a basic point to control this pandemic crisis in society. The study here,-using data of doses of vaccines administered per 100 inhabitants, confirmed cases and case fatality ratio of COVID-19 between countries (N=192) from March to May 2021,- clarifies the optimal levels of vaccination for reducing the number of infected individuals and, consequently, the numbers of deaths at global level. Findings reveal that the average level of administering about 80 doses of vaccines per 100 inhabitants between countries can sustain a reduction of confirmed cases and number of deaths. In addition, results suggest that an intensive vaccination campaign in the initial phase of pandemic wave leads to a lower optimal level of doses administered per 100 inhabitants (roughly 47 doses of vaccines administered) for reducing infected individuals; however, the growth of pandemic wave (in May, 2021) moves up the optimal level of vaccines to about 90 doses for reducing the numbers of COVID-19 related infected individuals. All these results here could aid policymakers to prepare optimal strategies directed to a rapid COVID-19 vaccination rollout, before the takeoff of pandemic wave, to lessen negative effects of pandemic crisis on environment and socioeconomic systems.

High impositions and stringent measures of countries to cope with COVID-19 reduce economic performance and do not lessen final fatality rate.. [DOI: 10.21203/rs.3.rs-1365546/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

The goal of this study is to develop a comparative analysis between countries having introduced a high or low level of restrictions and control measures in society to cope with Coronavirus Disease 2019 (COVID-19) pandemic crisis to assess if a policy response based on many pervasive compulsory measures is more effective to support a reduction of negative impact of COVID-19 on health of people and socioeconomic systems. In particular, the idea here is to analyze if countries with high restrictions and mandatory measures have lower fatality rates of COVID-19 and better economic performances than countries having policy responses based on little restrictions. The results of this analysis here seem to be that: Ž a strict policy of many restrictions and obligations does not reduce negative effects of COVID-19 pandemic in society in terms of lower mortality per 1,000 people and a lower-case fatality rate than countries with little restrictions (findings here show 1.19 vs. 0.89 and 0.82% vs. 0.43%, for countries with high and low restrictions respectively) Ž countries with high restrictions and obligations reduce the economic performance in terms of lower average growth of quarterly Gross Domestic Product than countries with little restrictions (0.14% vs. 0.38%, for countries with high and low restrictions respectively). This result can be explained with the fact that harsh containment policies are not a sufficient strategy to reduce the negative impact of new coronavirus in society, because there are manifold factors that support the diffusion of the novel coronavirus and mortality of COVID-19. Many countries applied hard and pervasive restrictions with the objective to reduce pandemic diffusion and support economic growth, but the evidence of this study shows that it is not a policy having effectiveness. These results can provide main information to extend knowledge in these topics to improve the crisis management and design best practices and effective policy responses to cope with COVID-19 and similar pandemic crisis.

Only vaccinations cannot reduce mortality and stop the COVID-19 pandemic because of manifold environmental and socioeconomic factors driving diffusion.. [DOI: 10.21203/rs.3.rs-1312175/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

One of the fundamental problems in COVID-19 pandemic crisis is whether vaccinations are a sufficient strategy to reduce mortality and mitigate negative effects of this novel infectious disease in society. This study confronts the problem here by developing an analysis of the relation between people fully vaccinated and mortality between countries to clarify sources and effects of COVID-19 pandemic in society. Methodology applies correlation and regression analyses based on global data of more than 150 countries. Findings reveal a strong positive correlation between share of people fully vaccinated and COVID-19 mortality in January 2022 (r= .65, p-value <.01). Multiple analysis of regression shows that a 1% higher share of people fully vaccinated, increases the expected deaths per 100 000 people by 0.7% (p-value < 0.001), controlling GDP per capita between countries. These results seem to suggest that COVID-19 vaccinations are not a sufficient strategy to reduce the negative impact of the new infectious disease in society, because socioeconomic and environmental factors, mutations of the novel coronavirus and technological aspects of countries (e.g., equipment of non-invasive ventilators in countries) affect the spread and mortality of this pandemic between countries. Overall, then, a pandemic policy only based on vaccinations cannot cope with the eradication of COVID-19 pandemic because manifold factors drive the transmission dynamics of COVID-19 and generate a lot of negative impacts in economic systems, though high levels of vaccinations in some countries.

Preparedness of countries to face COVID-19 pandemic crisis: Strategic positioning and factors supporting effective strategies of prevention of pandemic threats

The Coronavirus Disease 2019 (COVID-19) continues to generate a constant pandemic threat with new mutations of the viral agent (SARS-CoV-2) that create socioeconomic issues. One of the fundamental problems is the evaluation of the preparedness of countries to cope with COVID-19 pandemic crisis to detect and support factors associated with the reduction of mortality and the growth of vaccinations in society. The study here confronts this problem by developing two basic indexes, which measure the performance of countries to face pandemic threats. In particular, the Index r (as resilience) detects the countries having the best performance in the reduction of the negative impact of mortality related to COVID-19 pandemic and the Index p (as preparedness and prevention) assesses best-performer countries to support COVID-19 vaccinations in order to constrain future pandemic threats and support the recovery of socioeconomic systems. Index of resilience is a composite measure based on three indicators associated with COVID-19, given by average mortality, hospital occupancy and Intensive Care Units occupancy per 100 000 people, producing an overall score; Index of preparedness/prevention is a composite measure of two indicators related to COVID-19 vaccinations (i.e., doses of vaccines administered and total vaccinates per 100 000 people), producing also an overall score of performance. The application of these indexes on a case study of European countries, having a homogenous socioeconomic area, shows the strategic positioning of countries to cope with a major pandemic threat. Findings reveal that all countries have some weaknesses and no country has a high preparedness to cope with a major epidemic or pandemic. Moreover, results suggest that best-performer countries to cope with COVID-19 pandemic crisis have a smaller size of population and/or better public governance, associated with high expenditures in health system. These indexes can help policymakers for designing effective strategies to improve preparedness and prevention of countries to face future pandemic threats.