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Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use. PLoS One 2022; 17:e0271517. [PMID: 36454947 PMCID: PMC9714953 DOI: 10.1371/journal.pone.0271517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in different exposure settings and age groups. DESIGN Systematic review and meta-analysis. We evaluated the risk of bias using the Cochrane Risk of Bias 2 tool (ROB2). DATA SOURCES We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials investigating the effect of face masks on respiratory infections published between 1981 and February 9, 2022. We followed the PRISMA 2020 guidelines. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomized controlled trials investigating the use of face mask intervention in mitigating the risk of spreading respiratory infections across different exposure settings. RESULTS We identified 2,400 articles for screening. 18 articles passed the inclusion criteria for both evidence synthesis and meta-analysis. There were N = 189,145 individuals in the face mask intervention arm and N = 173,536 in the control arm, and the follow-up times ranged from 4 days to 19 months. Our results showed between-study heterogeneity (p < 0.0001). While there was no statistically significant association over all studies when the covariate unadjusted intervention effect estimates were used (RR = 0.977 [0.858-1.113], p = 0.728), our subgroup analyses revealed that a face mask intervention reduced respiratory infections in the adult subgroup (RR = 0.8795 [0.7861-0.9839], p = 0.0249) and in a community setting (RR = 0.890 [0.812-0.975], p = 0.0125). Furthermore, our leave-one-out analysis found that one study biased the results towards a null effect. Consequently, when using covariate adjusted odds ratio estimates to have a more precise effect estimates of the intervention effect to account for differences at the baseline, the results showed that a face mask intervention did reduce respiratory infections when the biasing study was excluded from the analysis (OR = 0.8892 [0.8061-0.9810], p = 0.0192). CONCLUSION Our findings support the use of face masks particularly in a community setting and for adults. We also observed substantial between-study heterogeneity and varying adherence to protocol. Notably, many studies were subject to contamination bias thus affecting the efficacy of the intervention, that is when also some controls used masks or when the intervention group did not comply with mask use leading to a downward biased effect of treatment receipt and efficacy. TRIAL REGISTRATION PROSPERO registration number CRD42020205523.
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Loeb M, Bartholomew A, Hashmi M, Tarhuni W, Hassany M, Youngster I, Somayaji R, Larios O, Kim J, Missaghi B, Vayalumkal JV, Mertz D, Chagla Z, Cividino M, Ali K, Mansour S, Castellucci LA, Frenette C, Parkes L, Downing M, Muller M, Glavin V, Newton J, Hookoom R, Leis JA, Kinross J, Smith S, Borhan S, Singh P, Pullenayegum E, Conly J. Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers : A Randomized Trial. Ann Intern Med 2022; 175:1629-1638. [PMID: 36442064 PMCID: PMC9707441 DOI: 10.7326/m22-1966] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is uncertain if medical masks offer similar protection against COVID-19 compared with N95 respirators. OBJECTIVE To determine whether medical masks are noninferior to N95 respirators to prevent COVID-19 in health care workers providing routine care. DESIGN Multicenter, randomized, noninferiority trial. (ClinicalTrials.gov: NCT04296643). SETTING 29 health care facilities in Canada, Israel, Pakistan, and Egypt from 4 May 2020 to 29 March 2022. PARTICIPANTS 1009 health care workers who provided direct care to patients with suspected or confirmed COVID-19. INTERVENTION Use of medical masks versus fit-tested N95 respirators for 10 weeks, plus universal masking, which was the policy implemented at each site. MEASUREMENTS The primary outcome was confirmed COVID-19 on reverse transcriptase polymerase chain reaction (RT-PCR) test. RESULTS In the intention-to-treat analysis, RT-PCR-confirmed COVID-19 occurred in 52 of 497 (10.46%) participants in the medical mask group versus 47 of 507 (9.27%) in the N95 respirator group (hazard ratio [HR], 1.14 [95% CI, 0.77 to 1.69]). An unplanned subgroup analysis by country found that in the medical mask group versus the N95 respirator group RT-PCR-confirmed COVID-19 occurred in 8 of 131 (6.11%) versus 3 of 135 (2.22%) in Canada (HR, 2.83 [CI, 0.75 to 10.72]), 6 of 17 (35.29%) versus 4 of 17 (23.53%) in Israel (HR, 1.54 [CI, 0.43 to 5.49]), 3 of 92 (3.26%) versus 2 of 94 (2.13%) in Pakistan (HR, 1.50 [CI, 0.25 to 8.98]), and 35 of 257 (13.62%) versus 38 of 261 (14.56%) in Egypt (HR, 0.95 [CI, 0.60 to 1.50]). There were 47 (10.8%) adverse events related to the intervention reported in the medical mask group and 59 (13.6%) in the N95 respirator group. LIMITATION Potential acquisition of SARS-CoV-2 through household and community exposure, heterogeneity between countries, uncertainty in the estimates of effect, differences in self-reported adherence, differences in baseline antibodies, and between-country differences in circulating variants and vaccination. CONCLUSION Among health care workers who provided routine care to patients with COVID-19, the overall estimates rule out a doubling in hazard of RT-PCR-confirmed COVID-19 for medical masks when compared with HRs of RT-PCR-confirmed COVID-19 for N95 respirators. The subgroup results varied by country, and the overall estimates may not be applicable to individual countries because of treatment effect heterogeneity. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research, World Health Organization, and Juravinski Research Institute.
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Affiliation(s)
- Mark Loeb
- Department of Pathology and Molecular Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (M.L.)
| | - Amy Bartholomew
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (A.B., J.N., P.S.)
| | | | - Wadea Tarhuni
- University of Saskatchewan, Saskatoon, Saskatchewan, and Canadian Cardiac Research Centre, Windsor, Ontario, Canada (W.T.)
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt (M.Hassany)
| | - Ilan Youngster
- Shamir Medical Center, Tzrifin, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (I.Y.)
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Oscar Larios
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Joseph Kim
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Bayan Missaghi
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Joseph V Vayalumkal
- Department of Pediatrics, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (J.V.V.)
| | - Dominik Mertz
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (D.M., R.H.)
| | - Zain Chagla
- Department of Medicine, McMaster University, and St. Joseph's Healthcare, Hamilton, Ontario, Canada (Z.C.)
| | | | - Karim Ali
- Niagara Health System, Niagara, Ontario, Canada (K.A.)
| | | | - Lana A Castellucci
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (L.A.C.)
| | - Charles Frenette
- McGill University Health Centre, Montreal, Quebec, Canada (C.F.)
| | | | - Mark Downing
- Unity Health-St. Joseph's, Toronto, Ontario, Canada (M.D.)
| | - Matthew Muller
- Unity Health-St. Michael's, Toronto, Ontario, Canada (M.M.)
| | - Verne Glavin
- Brantford Community Health System, Brantford, Ontario, Canada (V.G.)
| | - Jennifer Newton
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (A.B., J.N., P.S.)
| | - Ravi Hookoom
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (D.M., R.H.)
| | - Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.A.L.)
| | | | - Stephanie Smith
- University of Alberta Hospital, Edmonton, Alberta, Canada (S.S.)
| | - Sayem Borhan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (S.B.)
| | - Pardeep Singh
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (A.B., J.N., P.S.)
| | | | - John Conly
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
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Barro RJ. Vaccination rates and COVID outcomes across U.S. states. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101201. [PMID: 36434953 PMCID: PMC9933209 DOI: 10.1016/j.ehb.2022.101201] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
Rates of COVID deaths, hospitalizations, and cases differ markedly across U.S. states, as do rates of vaccination. This study uses cross-state regressions to assess impacts of vaccinations on COVID outcomes. A number of familiar issues arise concerning cross-sectional regressions, including omitted variables, behavioral responses to vaccination, and reverse causation. The benefits from a field context and from the broad range of observed variations suggest the value from dealing with these issues. Results reveal sizable negative effects of vaccination on deaths, hospitalizations, and cases up to early December 2021, although vaccine efficacy seems to wane over time. The findings for deaths apply to all-cause excess mortality as well as COVID-related mortality. The estimates imply that one expected life saved requires 248 additional doses, with a marginal cost around $55000, far below typical estimates of the value of a statistical life. Results since December 2021 suggest smaller effects of vaccinations on deaths and, especially, hospitalizations and cases, possibly because of diminished effectiveness of vaccines against new forms of the virus, notably the omicron variant. A further possibility is that confidence engendered by vaccinations motivated individuals and governments to lessen non-pharmaceutical interventions, such as masking and social distancing.
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Affiliation(s)
- Robert J Barro
- Economics Department, Harvard University, Cambridge MA 02138, USA.
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104
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Liu CY, Smith S, Chamberlain AT, Gandhi NR, Khan F, Williams S, Shah S. Use of surveillance data to elucidate household clustering of SARS-CoV-2 in Fulton County, Georgia a major metropolitan area. Ann Epidemiol 2022; 76:121-127. [PMID: 36210009 PMCID: PMC9536872 DOI: 10.1016/j.annepidem.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Households are important for SARS-CoV-2 transmission due to high intensity exposure in enclosed spaces over prolonged durations. We quantified and characterized household clustering of COVID-19 cases in Fulton County, Georgia. METHODS We used surveillance data to identify all confirmed COVID-19 cases in Fulton County. Household clustered cases were defined as cases with matching residential address. We described the proportion of COVID-19 cases that were clustered, stratified by age over time and explore trends in age of first diagnosed case within households and subsequent household cases. RESULTS Between June 1, 2020 and October 31, 2021, 31,449(37%) of 106,233 cases were clustered in households. Children were the most likely to be in household clusters than any other age group. Initially, children were rarely (∼ 10%) the first cases diagnosed in the household but increased to almost 1 of 3 in later periods. DISCUSSION One-third of COVID-19 cases in Fulton County were part of a household cluster. Increasingly children were the first diagnosed case, coinciding with temporal trends in vaccine roll-out among the elderly and the return to in-person schooling in Fall 2021. Limitations include restrictions to cases with a valid address and unit number and that the first diagnosed case may not be the infection source for the household.
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Affiliation(s)
- Carol Y Liu
- Emory University Rollins School of Public Health, Atlanta, GA.
| | | | | | - Neel R Gandhi
- Emory University Rollins School of Public Health, Atlanta, GA; Emory School of Medicine, Atlanta, GA
| | - Fazle Khan
- Fulton County Board of Health, Atlanta, GA
| | | | - Sarita Shah
- Emory University Rollins School of Public Health, Atlanta, GA; Emory School of Medicine, Atlanta, GA
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105
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Fretheim A, Elgersma IH, Helleve A, Elstrøm P, Kacelnik O, Hemkens LG. Effect of Wearing Glasses on Risk of Infection With SARS-CoV-2 in the Community: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2244495. [PMID: 36454571 PMCID: PMC9716386 DOI: 10.1001/jamanetworkopen.2022.44495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
Importance Observational studies have reported an association between the use of eye protection and reduced risk of infection with SARS-CoV-2 and other respiratory viruses, but, as with most infection control measures, no randomized clinical trials have been conducted. Objectives To evaluate the effectiveness of wearing glasses in public as protection against being infected with SARS-CoV-2 and other respiratory viruses. Design, Setting, and Participants A randomized clinical trial was conducted in Norway from February 2 to April 24, 2022; all adult members of the public who did not regularly wear glasses, had no symptoms of COVID-19, and did not have COVID-19 in the last 6 weeks were eligible. Intervention Wearing glasses (eg, sunglasses) when close to others in public spaces for 2 weeks. Main Outcomes and Measures The primary outcome was a positive COVID-19 test result reported to the Norwegian Surveillance System for Communicable Diseases. Secondary outcomes included a positive COVID-19 test result and respiratory infection based on self-report. All analyses adhered to the intention-to-treat principle. Results A total of 3717 adults (2439 women [65.6%]; mean [SD] age, 46.9 [15.1] years) were randomized. All were identified and followed up in the registries, and 3231 (86.9%) responded to the end of study questionnaire. The proportions with a reported positive COVID-19 test result in the national registry were 3.7% (68 of 1852) in the intervention group and 3.5% (65 of 1865) in the control group (absolute risk difference, 0.2%; 95% CI, -1.0% to 1.4%; relative risk, 1.10; 95% CI, 0.75-1.50). The proportions with a positive COVID-19 test result based on self-report were 9.6% (177 of 1852) in the intervention group and 11.5% (214 of 1865) in the control group (absolute risk difference, -1.9%; 95% CI, -3.9% to 0.1%; relative risk, 0.83; 95% CI, 0.69-1.00). The risk of respiratory infections based on self-reported symptoms was lower in the intervention group (30.8% [571 of 1852]) than in the control group (34.1% [636 of 1865]; absolute risk difference, -3.3%; 95% CI, -6.3% to -0.3%; relative risk, 0.90; 95% CI, 0.82-0.99). Conclusions and Relevance In this randomized clinical trial, wearing glasses in the community was not protective regarding the primary outcome of a reported positive COVID-19 test. However, results were limited by a small sample size and other issues. Glasses may be worth considering as one component in infection control, pending further studies. Trial Registration ClinicalTrials.gov Identifier: NCT05217797.
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Affiliation(s)
- Atle Fretheim
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ingeborg Hess Elgersma
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Arnfinn Helleve
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Elstrøm
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Oliver Kacelnik
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars G. Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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106
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Coelho LE, Luz PM, Pires DC, Jalil EM, Perazzo H, Torres TS, Cardoso SW, Peixoto EM, Nazer S, Massad E, Silveira MF, Barros FC, Vasconcelos AT, Costa CA, Amancio RT, Villela DA, Pereira T, Goedert GT, Santos CV, Rodrigues NC, Grinsztejn B, Veloso VG, Struchiner CJ. Prevalence and predictors of anti-SARS-CoV-2 serology in a highly vulnerable population of Rio de Janeiro: A population-based serosurvey. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 15:100338. [PMID: 35936224 PMCID: PMC9337985 DOI: 10.1016/j.lana.2022.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background COVID-19 serosurveys allow for the monitoring of the level of SARS-CoV-2 transmission and support data-driven decisions. We estimated the seroprevalence of anti-SARS-CoV-2 antibodies in a large favela complex in Rio de Janeiro, Brazil. Methods A population-based panel study was conducted in Complexo de Manguinhos (16 favelas) with a probabilistic sampling of participants aged ≥1 year who were randomly selected from a census of individuals registered in primary health care clinics that serve the area. Participants answered a structured interview and provided blood samples for serology. Multilevel regression models (with random intercepts to account for participants’ favela of residence) were used to assess factors associated with having anti-S IgG antibodies. Secondary analyses estimated seroprevalence using an additional anti-N IgG assay. Findings 4,033 participants were included (from Sep/2020 to Feb/2021, 22 epidemic weeks), the median age was 39·8 years (IQR:21·8-57·7), 61% were female, 41% were mixed-race (Pardo) and 23% Black. Overall prevalence was 49·0% (95%CI:46·8%-51·2%) which varied across favelas (from 68·3% to 31·4%). Lower prevalence estimates were found when using the anti-N IgG assay. Odds of having anti-S IgG antibodies were highest for young adults, and those reporting larger household size, poor adherence to social distancing and use of public transportation. Interpretation We found a significantly higher prevalence of anti-S IgG antibodies than initially anticipated. Disparities in estimates obtained using different serological assays highlight the need for cautious interpretation of serosurveys estimates given the heterogeneity of exposure in communities, loss of immunological biomarkers, serological antigen target, and variant-specific test affinity. Funding Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), the European Union's Horizon 2020 research and innovation programme, Royal Society, Serrapilheira Institute, and FAPESP.
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107
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Pope J, Byrne P, Devane D, Purnat TD, Dowling M. Health misinformation: protocol for a hybrid concept analysis and development. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13641.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Misinformation represents a serious and growing concern in public health; and has attracted much interest from researchers, media, and the public over recent years. Despite increased concern about the impacts of misinformation on health and wellbeing, however, the concept of health misinformation remains underdeveloped. In particular, there is a need to clarify how certain types of health information come to be designated as “misinformation,” what characteristics are associated with this classification, and how the concept of misinformation is applied in public health interventions. Aim: Developing a shared understanding of what it means for health information to be “misinformation” is an important first step to accurately identifying at-risk groups, clarifying pathways of vulnerability, and agreeing goals for intervention. It will also help to ensure that misinformation interventions are accessible, acceptable, and of benefit to the populations to which they are directed. We will therefore examine the characteristics, measurement, and applications of misinformation in public health. Methods: We will undertake a hybrid concept analysis, following a framework from Schwartz-Barcott & Kim (2000). This framework comprises three phases: a theoretical phase, fieldwork phase, and final analysis phase. In the theoretical phase, a search of seven electronic citation databases (PsycInfo, socINDEX, JSTOR, CINAHL, Scopus, PubMed, and ScienceDirect) will be conducted in order to identify original research, review, and theoretical papers, published in English between 2016 and 2022, which examine “health misinformation.” Data from the literature will be synthesised using evolutionary concept analysis methods from Rodgers (2000). In the fieldwork phase, a purposive sampling strategy will be employed to recruit stakeholders for participation in semi-structured interviews. Interviews will be analysed using thematic analysis. The final phase will integrate findings from the theoretical and fieldwork analyses.
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108
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Hirt J, Janiaud P, Hemkens LG. Clinical trial research agenda on COVID-19 - the first two years in Germany and beyond. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 174:32-42. [PMID: 36180342 PMCID: PMC9514972 DOI: 10.1016/j.zefq.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND We have followed the COVID-19 clinical trial research agenda from the beginning using the COVID-evidence.org platform. Now, two years after the COVID-19 pandemic started, our aim was to re-examine this research agenda with the latest data to provide a global perspective on the research landscape with a focus on Germany. METHODS We reviewed and updated previously published data on the COVID-19 clinical research agenda as of 28February 2022 focusing on randomized trials. We used the COVID-evidence.org platform including registry entries from ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform as well as publications from the Living OVerview of Evidence platform for COVID-19 (L·OVE). RESULTS Two years on from the pandemic outbreak, there were 4,673 registered trials. The majority of these trials have remained small with a median of 120 planned participants (IQR 60-320). In the first hundred days of the pandemic most of them (50%) had been registered in China. More than two years later, the five countries with the most registered trials (alone or within a framework of international collaborations) were the USA (825 trials; 18%), Iran (619 trials; 13%), India (566 trials; 12%), China (353 trials; 8%), and Spain (309 trials; 7%). Only 119 trials were reported to have a study site in Germany (2.5% of the registered trials). Of the 4,673 trials registered, 15% (694 trials) had published their results by February 2022. The clinical research agenda has been marked by both successes, such as the large RECOVERY trial providing evidence on 10 treatments for COVID-19 including over 45,000 patients as of February 2022, and failures: worldwide only 57 randomized trials have been registered over two years that aimed to assess non-pharmaceutical interventions (e.g., face mask policies and lockdown measures) to prevent COVID-19, and only 11 of them had published results informing decisions that have an impact on the life of billions of people worldwide. CONCLUSIONS The COVID-19 clinical research agenda has highlighted the substantial effort of the research community but also the challenges of the clinical research ecosystem. Most importantly, it has shed light on the ability to circumvent traditional barriers and to make trials more useful even under extraordinary conditions. The time to learn our lessons and apply them is now, and the time to demonstrate how we have improved the system is before the next pandemic.
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Affiliation(s)
- Julian Hirt
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Perrine Janiaud
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lars G Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
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109
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Negussie H, Timothewos S, Fekadu B, Belay W, Selamu M, Getachew E, Wondimagegnehu A, Eshetu T, Birhane R, Ajeme T, Hanlon C, Makonnen E, Manyazewal T, Fekadu A. Adherence to COVID -19 protective practices in Ethiopia: Use and predictors of face mask-wearing. ETHIOPIAN MEDICAL JOURNAL 2022; 60:48-56. [PMID: 38156328 PMCID: PMC10753859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Introduction The Ethiopian Ministry of Health strongly recommends that anyone, regardless of vaccination status, wears a standard face mask consistently when in public. This study aimed to assess the self-reported use and predictors of wearing face masks in the general population in Ethiopia. Methods This was a population-based cross-sectional study using a telephone survey. Adults living in Ethiopia were randomly selected from the Ethio Telecom list of mobile phone numbers and interviewed about their mask-wearing practice and individual and household-level factors that could impact on the use of face masking. Multivariable logistic regression was used to measure associations. Results A total of 614 participants were interviewed from September to November 2021. The prevalence of self-reported face mask use when in public was 81.1%. Living outside Addis Ababa, including Oromia [adjusted odds ratio [(AOR) 0.30, 95% confidence interval (CI) (0.14, 0.63)], Amhara [AOR 0.11, 95% CI (0.05, 0.23)], and Southern Nations, Nationalities and People's Region [AOR 0.31, 95% CI (0.12-0.79)] and being divorced or widowed [AOR 0.18, 95% CI (0.06, 0.62)] were found to be inversely associated with face mask use. Female gender [AOR 1.91, 95% CI (1.02, 3.58)] and older age [age ≥ 50, AOR 2.96, 95% CI (1.09-7.97)] were positively associated with the use of face masks. Attending social events [AOR 0.51, 95% CI (0.31-0.82)], was negatively associated with the use of face masks. Conclusion Self-reported use of face masks was relatively high nationally, but inconsistent among different regions and demographics. The findings imply that policies and messaging campaigns may need to focus on specific populations and behaviors in this ongoing pandemic.
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Affiliation(s)
- Hanna Negussie
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Sewit Timothewos
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Winini Belay
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Medhin Selamu
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, WHO collaborating center for Mental Health research and capacity building, Department of Psychiatry, College of Health sciences, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Abigiya Wondimagegnehu
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
- Martin-Luther-University, Institute of Medical Epidemiology, Bio statistics and Informatics, Halle, Germany
| | - Tigist Eshetu
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Rahel Birhane
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Tigest Ajeme
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, WHO collaborating center for Mental Health research and capacity building, Department of Psychiatry, College of Health sciences, Addis Ababa, Ethiopia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Eyasu Makonnen
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Department of Pharmacology and Clinical Pharmacy, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, WHO collaborating center for Mental Health research and capacity building, Department of Psychiatry, College of Health sciences, Addis Ababa, Ethiopia
- Brighton and Sussex Medical School, Global Health and Infection Department, Brighton, UK
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110
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Yang L, Constantino SM, Grenfell BT, Weber EU, Levin SA, Vasconcelos VV. Sociocultural determinants of global mask-wearing behavior. Proc Natl Acad Sci U S A 2022; 119:e2213525119. [PMID: 36191222 PMCID: PMC9565043 DOI: 10.1073/pnas.2213525119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 12/04/2022] Open
Abstract
Behavioral responses influence the trajectories of epidemics. During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) reduced pathogen transmission and mortality worldwide. However, despite the global pandemic threat, there was substantial cross-country variation in the adoption of protective behaviors that is not explained by disease prevalence alone. In particular, many countries show a pattern of slow initial mask adoption followed by sharp transitions to high acceptance rates. These patterns are characteristic of behaviors that depend on social norms or peer influence. We develop a game-theoretic model of mask wearing where the utility of wearing a mask depends on the perceived risk of infection, social norms, and mandates from formal institutions. In this model, increasing pathogen transmission or policy stringency can trigger social tipping points in collective mask wearing. We show that complex social dynamics can emerge from simple individual interactions and that sociocultural variables and local policies are important for recovering cross-country variation in the speed and breadth of mask adoption. These results have implications for public health policy and data collection.
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Affiliation(s)
- Luojun Yang
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544
| | - Sara M. Constantino
- School of Public and International Affairs, Princeton University, Princeton, NJ 08544
- Andlinger Center for Energy and the Environment, Princeton University, Princeton, NJ 08544
- Department of Psychology, Northeastern University, Boston, MA 02115
- School of Public Policy and Urban Affairs, Northeastern University, Boston, MA 02115
| | - Bryan T. Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544
| | - Elke U. Weber
- Andlinger Center for Energy and the Environment, Princeton University, Princeton, NJ 08544
- Department of Psychology, Princeton University, Princeton, NJ 08544
| | - Simon A. Levin
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544
- Andlinger Center for Energy and the Environment, Princeton University, Princeton, NJ 08544
| | - Vítor V. Vasconcelos
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544
- Andlinger Center for Energy and the Environment, Princeton University, Princeton, NJ 08544
- Informatics Institute, University of Amsterdam, 1098 XH Amsterdam, The Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, The Netherlands
- Princeton Institute for International and Regional Studies, Princeton University, Princeton, NJ 08544
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111
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Sachs JD, Karim SSA, Aknin L, Allen J, Brosbøl K, Colombo F, Barron GC, Espinosa MF, Gaspar V, Gaviria A, Haines A, Hotez PJ, Koundouri P, Bascuñán FL, Lee JK, Pate MA, Ramos G, Reddy KS, Serageldin I, Thwaites J, Vike-Freiberga V, Wang C, Were MK, Xue L, Bahadur C, Bottazzi ME, Bullen C, Laryea-Adjei G, Ben Amor Y, Karadag O, Lafortune G, Torres E, Barredo L, Bartels JGE, Joshi N, Hellard M, Huynh UK, Khandelwal S, Lazarus JV, Michie S. The Lancet Commission on lessons for the future from the COVID-19 pandemic. Lancet 2022; 400:1224-1280. [PMID: 36115368 PMCID: PMC9539542 DOI: 10.1016/s0140-6736(22)01585-9] [Citation(s) in RCA: 274] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Jeffrey D Sachs
- Center for Sustainable Development, Columbia University, New York, NY, United States.
| | - Salim S Abdool Karim
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lara Aknin
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Joseph Allen
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, United States
| | | | - Francesca Colombo
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | | | | | - Vitor Gaspar
- Fiscal Affairs Department, International Monetary Fund, Washington, DC, United States
| | | | - Andy Haines
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Phoebe Koundouri
- Department of International and European Economic Studies, Athens University of Economics and Business, Athens, Greece; Department of Technology, Management and Economics, Technical University of Denmark, Kongens Lyngby, Denmark; European Association of Environmental and Resource Economists, Athens, Greece
| | - Felipe Larraín Bascuñán
- Department of Economics and Administration, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jong-Koo Lee
- National Academy of Medicine of Korea, Seoul, Republic of Korea
| | - Muhammad Ali Pate
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, United States
| | | | | | | | - John Thwaites
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | | | - Chen Wang
- National Clinical Research Center for Respiratory Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | | | - Lan Xue
- Schwarzman College, Tsinghua University, Beijing, China
| | - Chandrika Bahadur
- The Lancet COVID-19 Commission Regional Task Force: India, New Delhi, India
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Yanis Ben Amor
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | - Ozge Karadag
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | | | - Emma Torres
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | - Lauren Barredo
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | - Juliana G E Bartels
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | - Neena Joshi
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | | | | | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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112
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Shobako N. Lessons from the health policies for children during the pandemic in Japan. Front Public Health 2022; 10:1015955. [PMID: 36339184 PMCID: PMC9628751 DOI: 10.3389/fpubh.2022.1015955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/21/2022] [Indexed: 01/28/2023] Open
Abstract
It is everyone's desire to seek the sound growth of children through food education and there is a critical need for fostering an environment for this purpose. Health policies are important for this support. To the present, the Japanese society has been greatly disrupted by COVID-19 pandemic. "Stay at home", "mokusyoku (silent eating)", and mask wearing were encouraged in nationwide campaigns as public health measures to combat COVID-19. There are some papers reporting negative effects of "stay at home" and lockdowns such as weight gain, decrease in physical activities and change in eating habits. In Japan, while benefits and advantages of food education during mealtime were previously well studied, the "mokusyoku" rule may directly run counter to this food education. Moreover, there are several reports showing that nutrients might contribute to prevention of infectious diseases. Japanese children were also encouraged to wear masks all day long. The results of the clinical research, especially randomized control trials, show limited protective effect of masks. On the other hand, negative outcomes of the masks were reported in various scenes. This review focuses on these topics and arousing reconsideration for a better environment for children.
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Affiliation(s)
- Naohisa Shobako
- Division of Food Science and Biotechnology, Graduate School of Agriculture, Kyoto University, Uji, Japan
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113
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Yan L, Talic S, Wild H, Gasevic D, Gasević D, Ilic D, Deppeler J, Corrigan D, Martinez-Maldonado R, Trauer J. Transmission of SARS-CoV-2 in a primary school setting with and without public health measures using real-world contact data: A modelling study. J Glob Health 2022; 12:05034. [PMID: 36181503 PMCID: PMC9526455 DOI: 10.7189/jogh.12.05034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Stringent public health measures have been shown to influence the transmission of SARS-CoV-2 within school environments. We investigated the potential transmission of SARS-CoV-2 in a primary school setting with and without public health measures, using fine-grained physical positioning traces captured before the COVID-19 pandemic. Methods Approximately 172.63 million position data from 98 students and six teachers from an open-plan primary school were used to predict a potential transmission of SARS-CoV-2 in primary school settings. We first estimated the daily average number of contacts of students and teachers with an infected individual during the incubation period. We then used the Reed-Frost model to estimate the probability of transmission per contact for the SARS-CoV-2 Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron variant (B.1.1.529). Finally, we built a binomial distribution model to estimate the probability of onward transmission in schools with and without public health measures, including face masks and physical distancing. Results An infectious student would have 49.1 (95% confidence interval (CI) = 46.1-52.1) contacts with their peers and 2.00 (95% CI = 1.82-2.18) contacts with teachers per day. An infectious teacher would have 47.6 (95% CI = 45.1-50.0) contacts with students and 1.70 (95% CI = 1.48-1.92) contacts with their colleague teachers per day. While the probability of onward SARS-CoV-2 transmission was relatively low for the Alpha and Delta variants, the risk increased for the Omicron variant, especially in the absence of public health measures. Onward teacher-to-student transmission (88.9%, 95% CI = 88.6%-89.1%) and teacher-to-teacher SARS-CoV-2 transmission (98.4%, 95% CI = 98.5%-98.6%) were significantly higher for the Omicron variant without public health measures in place. Conclusions Our findings illustrate that, despite a lower frequency of close contacts, teacher-to-teacher close contacts demonstrated a higher risk of transmission per contact of SARS-CoV-2 compared to student-to-student close contacts. This was especially significant with the Omicron variant, with onward transmission more likely occurring from teacher index cases than student index cases. Public health measures (eg, face masks and physical distance) seem essential in reducing the risk of onward transmission within school environments.
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Affiliation(s)
- Lixiang Yan
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia.,Centre for Learning Analytics at Monash, Monash University, Clayton, Victoria, Australia
| | - Stella Talic
- School of Public Health and Preventive Medicine, Monash University Clayton, Victoria, Australia
| | - Holly Wild
- Public Health & Health Sciences, Torrens University Australia, Melbourne, Victoria, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University Clayton, Victoria, Australia.,Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Dragan Gasević
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia.,Centre for Learning Analytics at Monash, Monash University, Clayton, Victoria, Australia
| | - Dragan Ilic
- School of Public Health and Preventive Medicine, Monash University Clayton, Victoria, Australia
| | - Joanne Deppeler
- Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Deborah Corrigan
- Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Roberto Martinez-Maldonado
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia.,Centre for Learning Analytics at Monash, Monash University, Clayton, Victoria, Australia
| | - James Trauer
- School of Public Health and Preventive Medicine, Monash University Clayton, Victoria, Australia
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114
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Jamrozik E. Public health ethics: critiques of the "new normal". New Bioeth 2022; 40:1-16. [PMID: 36167921 PMCID: PMC9514707 DOI: 10.1007/s40592-022-00163-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022]
Abstract
The global response to the recent coronavirus pandemic has revealed an ethical crisis in public health. This article analyses key pandemic public health policies in light of widely accepted ethical principles: the need for evidence, the least restrictive/harmful alternative, proportionality, equity, reciprocity, due legal process, and transparency. Many policies would be considered unacceptable according to pre-pandemic norms of public health ethics. There are thus significant opportunities to develop more ethical responses to future pandemics. This paper serves as the introduction to this Special Issue of Monash Bioethics Review and provides background for the other articles in this collection.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Old Rd, OX3 7LF, Headington, Oxford, UK.
- Monash Bioethics Centre, Monash University, Melbourne, Australia.
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
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115
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Chikina M, Pegden W, Recht B. Re-analysis on the statistical sampling biases of a mask promotion trial in Bangladesh: a statistical replication. Trials 2022; 23:786. [PMID: 36109816 PMCID: PMC9479361 DOI: 10.1186/s13063-022-06704-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractA recent randomized trial evaluated the impact of mask promotion on COVID-19-related outcomes. We find that staff behavior in both unblinded and supposedly blinded steps caused large and statistically significant imbalances in population sizes. These denominator differences constitute the rate differences observed in the trial, complicating inferences of causality.
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116
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De Giorgi G, Geldsetzer P, Michalik F, Speziali MM. The impact of face-mask mandates on all-cause mortality in Switzerland: a quasi-experimental study. Eur J Public Health 2022; 32:818-824. [PMID: 36087339 PMCID: PMC9527954 DOI: 10.1093/eurpub/ckac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Whereas there is strong evidence that wearing a face mask is effective in reducing the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evidence on the impact of mandating the wearing of face masks on deaths from coronavirus disease 2019 (COVID-19) and all-cause mortality is more sparse and likely to vary by context. Focusing on a quasi-experimental setting in Switzerland, we aimed to determine (i) the effect of face-mask mandates for indoor public spaces on all-cause mortality; and (ii) how the effect has varied over time, and by age and sex. Methods Our analysis exploited the fact that between July and October 2020, nine cantons in Switzerland extended a face-mask mandate at different time points from being restricted to public transportation only to applying to all public indoor places. We used both a Difference-in-Differences approach with fixed-effects for canton and week and an event-study approach. Results In our main Difference-in-Differences model, the face-mask mandate was associated with a 0.3% reduction in all-cause mortality [95% confidence interval (CI): −3.4% to 2.7%; P = 0.818]. This null effect was confirmed in the event-study approach and a variety of robustness checks. Combining the face-mask mandate with social distancing rules led to an estimated 5.1% (95% CI: −7.9% to −2.4%; P = 0.001) reduction in all-cause mortality. Conclusions Mandating face-mask use in public indoor spaces in Switzerland in mid-to-late 2020 does not appear to have resulted in large reductions in all-cause mortality in the short term. There is some suggestion that combining face-mask mandates with social distancing rules reduced all-cause mortality.
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Affiliation(s)
- Giacomo De Giorgi
- Institute of Economics and Econometrics, Geneva School of Economics and Management, University of Geneva , Geneva 4, Switzerland
- BREAD, Bureau for Research and Economic Analysis of Development , E Providence, RI, USA
- CEPR, Centre for Economic Policy Research , London, UK
- IPA, Innovations for Poverty Action , Washington, DC, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University , Stanford, CA, USA
- Chan Zuckerberg Biohub , San Francisco, CA, USA
| | - Felix Michalik
- Heidelberg Institute of Global Health, Heidelberg University , Heidelberg, Germany
| | - M Maddalena Speziali
- Institute of Economics and Econometrics, Geneva School of Economics and Management, University of Geneva , Geneva 4, Switzerland
- University Magna Graecia of Catanzaro , Catanzaro, Italy
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117
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Brooks W, Donovan K, Johnson TR, Oluoch-Aridi J. Cash transfers as a response to COVID-19: Experimental evidence from Kenya. JOURNAL OF DEVELOPMENT ECONOMICS 2022; 158:102929. [PMID: 35784379 PMCID: PMC9238018 DOI: 10.1016/j.jdeveco.2022.102929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 06/09/2023]
Abstract
We deliver one month's average profit to a randomly selected group of female microenterprise owners in Dandora, Kenya, arriving just in advance of an exponential growth in COVID-19 cases. Relative to a control group, firms recoup about one third of their initial decline in profit, and food expenditures increase. Control profit responds to economic conditions and government announcements during our study period, and treatment effects are largest when control profit is at its lowest. PPE spending and precautionary management practices increase to mitigate the health risks of more intensive firm operation, but only among those who perceive COVID-19 as a major risk.
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Affiliation(s)
- Wyatt Brooks
- Arizona State University, United States of America
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118
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Bester JC. A Clinician's Obligation to be Vaccinated: Four Arguments that Establish a Duty for Healthcare Professionals to be Vaccinated Against COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:451-465. [PMID: 35362931 PMCID: PMC8972764 DOI: 10.1007/s11673-022-10182-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 05/14/2023]
Abstract
This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are:(1) The obligation to protect patients against COVID-19 spread;(2) The obligation to maintain professional competence and remain available for patients;(3) Clinicians' role and place in society in relation to COVID-19;(4) The obligation to encourage societal vaccination uptake.These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional's ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians.
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Affiliation(s)
- Johan Christiaan Bester
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas 2040 W Charleston Blvd, Las Vegas, NV, 89102, USA.
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119
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Chou R, Dana T, Jungbauer R. Update Alert 8: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings. Ann Intern Med 2022; 175:W108-W109. [PMID: 35878407 PMCID: PMC9380719 DOI: 10.7326/l22-0272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
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120
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Murakami M, Fujita T, Li P, Imoto S, Yasutaka T. Development of a COVID-19 risk assessment model for participants at outdoor music festivals: evaluation of the validity and control measure effectiveness based on two actual events in Japan and Spain. PeerJ 2022; 10:e13846. [PMID: 35966931 PMCID: PMC9368994 DOI: 10.7717/peerj.13846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/14/2022] [Indexed: 01/18/2023] Open
Abstract
We developed an environmental exposure model to estimate the coronavirus disease 2019 (COVID-19) risk among participants at outdoor music festivals and validated the model using two real events-one in Japan (Event 1) and one in Spain (Event 2). Furthermore, we considered a hypothetical situation in which Event 1 was held but enhanced measures were implemented to evaluate the extent to which the risk could be reduced by additional infection control measures, such as negative antigen tests on the day of the event, wearing of masks, disinfection of environmental surfaces, and vaccination. Among 7,392 participants, the total number of already- and newly-infected individuals who participated in Event 1 according to the new model was 47.0 (95% uncertainty interval: 12.5-185.5), which is in good agreement with the reported value (45). The risk of infection at Event 2 (1.98 × 10-2; 95% uncertainty interval: 0.55 × 10-2-6.39 × 10-2), calculated by the model in this study, was also similar to the estimated value in the previous epidemiological study (1.25 × 10-2). These results for the two events in different countries highlighted the validity of the model. Among the additional control measures in the hypothetical Event 1, vaccination, mask-wearing, and disinfection of surfaces were determined to be effective. Based on the combination of all measures, a 94% risk reduction could be achieved. In addition to setting a benchmark for an acceptable number of newly-infected individuals at the time of an event, the application of this model will enable us to determine whether it is necessary to implement additional measures, limit the number of participants, or refrain from holding an event.
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Affiliation(s)
- Michio Murakami
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Osaka, Japan
- Institute for Geo-Resources and Environment, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
| | - Tsukasa Fujita
- Institute for Geo-Resources and Environment, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
| | - Pinqi Li
- Institute for Geo-Resources and Environment, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Tetsuo Yasutaka
- Institute for Geo-Resources and Environment, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
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121
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Religious leaders can motivate men to cede power and reduce intimate partner violence: Experimental evidence from Uganda. Proc Natl Acad Sci U S A 2022; 119:e2200262119. [PMID: 35905318 PMCID: PMC9351535 DOI: 10.1073/pnas.2200262119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Violence committed by men against women in intimate relationships is a pervasive problem around the world. Patriarchal norms that place men as the head of household are often to blame. Previous research suggests that trusted authorities can shift perceptions of norms and create behavior change. In many settings, a compelling authority on behavior in relationships is religious leaders, who are influential sources of information about proper conduct in relationships and gatekeepers of marriage, but may also uphold traditional gender roles. One way leaders exert their influence is through premarital or couples counseling courses. In this study, we test whether, if given an opportunity to offer a more progressive religious interpretation of gender roles during these courses, religious leaders could motivate men to share power and thereby reduce violence. Building on existing faith networks of Christian religious leaders in western Uganda, we conducted a large pair-matched, randomized controlled trial among 1,680 heterosexual couples in which participants were randomized to attend a 12-session group counseling course or wait-listed. We find that the program shifted power from men to women and reduced intimate partner violence by five percentage points, comparable with more intensive secular programs. These improvements were largest among couples counseled by religious leaders who held the most progressive views at baseline and who critically engaged with the material. Our findings suggest that religious leaders can be effective agents of change for reducing violence.
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122
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González de Dios J, Martínez Rubio V, Giménez Díaz de Atauri Á, Ochoa Sangrador C, Rodríguez-Salinas Pérez E, Flores Villar S, Cuervo Valdés JJ. [Main changes in the «COVID-19 in paediatrics» clinical practice guideline]. An Pediatr (Barc) 2022; 97:129.e1-129.e8. [PMID: 35782910 PMCID: PMC9237022 DOI: 10.1016/j.anpedi.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
We present a summary of the main modifications to the «COVID-19 in Paediatrics» clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers.We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many of the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.
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Affiliation(s)
- Javier González de Dios
- Servicio de Pediatría, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | | | | | | | | | - Sergio Flores Villar
- Servicio de Pediatría, Hospital Universitario Mutua Terrasa, Terrasa, Barcelona, España
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González de Dios J, Martínez Rubio V, Giménez Díaz de Atauri Á, Ochoa Sangrador C, Rodríguez-Salinas Pérez E, Flores Villar S, Cuervo Valdés JJ. Main changes in the "COVID-19 in paediatrics" clinical practice guideline. An Pediatr (Barc) 2022; 97:129.e1-129.e8. [PMID: 35871151 PMCID: PMC9259469 DOI: 10.1016/j.anpede.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022] Open
Abstract
We present a summary of the main modifications to the "COVID-19 in Paediatrics" clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers. We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.
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Affiliation(s)
- Javier González de Dios
- Servicio de Pediatría, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante(ISABIAL), Alicante, Spain.
| | | | | | | | | | - Sergio Flores Villar
- Servicio de Pediatría. Hospital Universitario Mutua Terrasa, Terrasa, Barcelona, Spain
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Nagarajan R, Rubeshkumar P, Jagadeesan M, Raju M, Sakthivel M, Murali S, Sendhilkumar M, Ilangovan K, Harikrishnan D, Venkatasamy V, Ganeshkumar P, Kaur P. Knowledge, attitude, and practice towards face mask use among residents of Greater Chennai Corporation, India, March 2021. Front Public Health 2022; 10:938642. [PMID: 35968448 PMCID: PMC9367688 DOI: 10.3389/fpubh.2022.938642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background Wearing a mask is one of the simplest ways to reduce the spread of COVID-19. Studies reported poor mask compliance in Greater Chennai Corporation, India. Hence, we described the knowledge, attitude, and practice regarding mask use among adults (≥18 years) in Greater Chennai Corporation, Tamil Nadu, India. Methods We conducted a cross-sectional survey among residents of Greater Chennai Corporation in March 2021. We estimated the sample size to be 203 per strata (slum and non-slum). We used a simple random sampling technique to select 20 locations using a digital map in the slum and non-slum areas. After reaching the location chosen, we selected 10 consecutive households and one adult (≥18 years of age) from each household. We used a validated, semi-structured questionnaire for collecting data regarding knowledge, attitudes, and practices for mask use. We estimated proportions and 95% CI for key variables and compared the variables between slums and non-slums. Results Of 430 participants included in the study, 51.4% were males. The mean (S.D.) age of the participants is 41.1 (14.6) years. The majority (86.7%) of the participants felt that wearing a mask helped in reducing the spread of coronavirus and the knowledge differed (p-value < 0.05) between the slum (81.4%) and non-slum (92.3%). Nearly half (46.5%) of the participants did not like being forced to wear the mask. About 63.9% of the participants reported the practice of mask use while going out which was similar across slums and non-slums. Conclusion Although the knowledge regarding mask use was good among the public, the attitude was unfavorable. We suggest continuous reinforcement by spreading awareness and educating the community on the appropriate use of the mask.
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Affiliation(s)
- Ramya Nagarajan
- Department of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | - Polani Rubeshkumar
- Department of Epidemiology, ICMR-National Institute of Epidemiology, Chennai, India
| | | | - Mohankumar Raju
- Department of Epidemiology, ICMR-National Institute of Epidemiology, Chennai, India
| | | | - Sharan Murali
- Department of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | - Muthappan Sendhilkumar
- Department of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | - Kumaravel Ilangovan
- Department of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | | | - Prabhdeep Kaur
- Department of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
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125
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Marchetti S, Borin A, Conteduca FP, Ilardi G, Guzzetta G, Poletti P, Pezzotti P, Bella A, Stefanelli P, Riccardo F, Merler S, Brandolini A, Brusaferro S. An epidemic model for SARS-CoV-2 with self-adaptive containment measures. PLoS One 2022; 17:e0272009. [PMID: 35877667 PMCID: PMC9312378 DOI: 10.1371/journal.pone.0272009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
During the COVID-19 pandemic, several countries have resorted to self-adaptive mechanisms that tailor non-pharmaceutical interventions to local epidemiological and health care indicators. These mechanisms reinforce the mutual influence between containment measures and the evolution of the epidemic. To account for such interplay, we develop an epidemiological model that embeds an algorithm mimicking the self-adaptive policy mechanism effective in Italy between November 2020 and March 2022. This extension is key to tracking the historical evolution of health outcomes and restrictions in Italy. Focusing on the epidemic wave that started in mid-2021 after the diffusion of Delta, we compare the functioning of alternative mechanisms to show how the policy framework may affect the trade-off between health outcomes and the restrictiveness of mitigation measures. Mechanisms based on the reproduction number are generally highly responsive to early signs of a surging wave but entail severe restrictions. The emerging trade-off varies considerably depending on specific conditions (e.g., vaccination coverage), with less-reactive mechanisms (e.g., those based on occupancy rates) becoming more appealing in favorable contexts.
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Affiliation(s)
- Sabina Marchetti
- Directorate General for Economics, Statistics and Research, Bank of Italy, Rome, Italy
| | - Alessandro Borin
- Directorate General for Economics, Statistics and Research, Bank of Italy, Rome, Italy
| | | | - Giuseppe Ilardi
- Directorate General for Economics, Statistics and Research, Bank of Italy, Rome, Italy
| | - Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation (FBK), Trento, Italy
| | - Piero Poletti
- Center for Health Emergencies, Bruno Kessler Foundation (FBK), Trento, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation (FBK), Trento, Italy
| | - Andrea Brandolini
- Directorate General for Economics, Statistics and Research, Bank of Italy, Rome, Italy
| | - Silvio Brusaferro
- Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
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Greenhalgh T, Fisman D, Cane DJ, Oliver M, Macintyre CR. Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent. BMJ Evid Based Med 2022; 27:bmjebm-2022-111952. [PMID: 35853682 PMCID: PMC9510422 DOI: 10.1136/bmjebm-2022-111952] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/12/2022]
Abstract
Evidence-based medicine (EBM's) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday's research can be mapped more or less unproblematically onto today's clinical and policy questions. They have significant limitations when extended to complex questions about a novel pathogen causing chaos across multiple sectors in a fast-changing global context. Non-pharmaceutical interventions which combine material artefacts, human behaviour, organisational directives, occupational health and safety, and the built environment are a case in point: EBM's experimental, intervention-focused, checklist-driven, effect-size-oriented and deductive approach has sometimes confused rather than informed debate. While RCTs are important, exclusion of other study designs and evidence sources has been particularly problematic in a context where rapid decision making is needed in order to save lives and protect health. It is time to bring in a wider range of evidence and a more pluralist approach to defining what counts as 'high-quality' evidence. We introduce some conceptual tools and quality frameworks from various fields involving what is known as mechanistic research, including complexity science, engineering and the social sciences. We propose that the tools and frameworks of mechanistic evidence, sometimes known as 'EBM+' when combined with traditional EBM, might be used to develop and evaluate the interdisciplinary evidence base needed to take us out of this protracted pandemic. Further articles in this series will apply pluralistic methods to specific research questions.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Danielle J Cane
- Coalition for Healthcare Acquired Infection Reduction, Cambridge, Ontario, Canada
| | - Matthew Oliver
- Association of Professional Engineers and Geoscientists, Edmonton, Alberta, Canada
| | - Chandini Raina Macintyre
- The Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Lubega GB, Mendoza H, Nkeramahame J, Niyongabo F, Gonza J, Nakachwa B, Musoke D. Community mask wearing as a COVID-19 preventive measure, its barriers, and motivators among rural households of Uganda: A mixed methods approach. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000485. [PMID: 36962384 PMCID: PMC10021463 DOI: 10.1371/journal.pgph.0000485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
Adherence to mask wearing has the potential to reduce coronavirus disease 2019 acquisition risk. However, there is limited information about community mask wearing and its predictors among rural populations. This study aimed to assess the level of adherence to community mask wearing as a COVID-19 prevention measure, its barriers, and motivators among the Ugandan rural population of Wakiso District. This cross-sectional study utilised both quantitative and qualitative data collection methods. The quantitative component employed a semi-structured interviewer-administered questionnaire among 400 participants, to assess the level of adherence and associated predictors towards mask wearing. Modified Poisson regression with robust standard error estimates was used to obtain crude and adjusted prevalence ratios associated with mask wearing. Quantitative data analysis was performed using Stata 15.0 Statistical software. The qualitative component was used to further explore the barriers and motivators of community mask wearing whereseven focus group discussions among 56 community health workers were conducted. Data was analysed using a thematic approach with the help of Nvivo Version 12 software. The quantitative results showed that 70.8% (283/400) of the participants were adherent to mask wearing. Furthermore, reusable (cloth masks) were the most common form of face masks worn by the participants; 71.9% (282/400). Adequate knowledge about mask wearing as a COVID-19 prevention measure was positively associated with mask wearing (adjusted prevalence ratio (95% CI); 3.2 (1.19-8.56)). The qualitative results revealed; sensitization from health workers, provision of free masks, and fear of fines and arrests as motivators to mask wearing. Barriers to mask wearing included: inability to buy masks due to financial constraints, one-time provision of free masks, ill-fitting and worn-out masks, discomfort, and bribery. The practice of community mask wearing was sub-optimal among the study rural communities. Initiatives to scale up the practice need to be feasible for rural communities.
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Affiliation(s)
- Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hilbert Mendoza
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Juvenal Nkeramahame
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
- FIND, The Global Alliance for Diagnostics, Geneva, Switzerland
| | - Filimin Niyongabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joviah Gonza
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Betty Nakachwa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Baselga M, Uranga-Murillo I, de Miguel D, Arias M, Sebastián V, Pardo J, Arruebo M. Silver Nanoparticles-Polyethyleneimine-Based Coatings with Antiviral Activity against SARS-CoV-2: A New Method to Functionalize Filtration Media. MATERIALS (BASEL, SWITZERLAND) 2022; 15:4742. [PMID: 35888208 PMCID: PMC9318907 DOI: 10.3390/ma15144742] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 02/06/2023]
Abstract
The use of face masks and air purification systems has been key to curbing the transmission of SARS-CoV-2 aerosols in the context of the current COVID-19 pandemic. However, some masks or air conditioning filtration systems are designed to remove large airborne particles or bacteria from the air, being limited their effectiveness against SARS-CoV-2. Continuous research has been aimed at improving the performance of filter materials through nanotechnology. This article presents a new low-cost method based on electrostatic forces and coordination complex formation to generate antiviral coatings on filter materials using silver nanoparticles and polyethyleneimine. Initially, the AgNPs synthesis procedure was optimized until reaching a particle size of 6.2 ± 2.6 nm, promoting a fast ionic silver release due to its reduced size, obtaining a stable colloid over time and having reduced size polydispersity. The stability of the binding of the AgNPs to the fibers was corroborated using polypropylene, polyester-viscose, and polypropylene-glass spunbond mats as substrates, obtaining very low amounts of detached AgNPs in all cases. Under simulated operational conditions, a material loss less than 1% of nanostructured silver was measured. SEM micrographs demonstrated high silver distribution homogeneity on the polymer fibers. The antiviral coatings were tested against SARS-CoV-2, obtaining inactivation yields greater than 99.9%. We believe our results will be beneficial in the fight against the current COVID-19 pandemic and in controlling other infectious airborne pathogens.
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Affiliation(s)
- Marta Baselga
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (I.U.-M.); (D.d.M.); (M.A.); (V.S.); (J.P.); (M.A.)
| | - Iratxe Uranga-Murillo
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (I.U.-M.); (D.d.M.); (M.A.); (V.S.); (J.P.); (M.A.)
- Department of Microbiology, Pediatrics, Radiology and Public Health, Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
- Networking Research Center on Infectious Diseases, CIBERINFEC, 28029 Madrid, Spain
| | - Diego de Miguel
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (I.U.-M.); (D.d.M.); (M.A.); (V.S.); (J.P.); (M.A.)
- Department of Microbiology, Pediatrics, Radiology and Public Health, Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
| | - Maykel Arias
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (I.U.-M.); (D.d.M.); (M.A.); (V.S.); (J.P.); (M.A.)
- Department of Microbiology, Pediatrics, Radiology and Public Health, Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
- Networking Research Center on Infectious Diseases, CIBERINFEC, 28029 Madrid, Spain
| | - Victor Sebastián
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (I.U.-M.); (D.d.M.); (M.A.); (V.S.); (J.P.); (M.A.)
- Instituto de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Department of Chemical Engineering, Campus Río Ebro–Edificio I+D, University of Zaragoza, 50018 Zaragoza, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN, 28029 Madrid, Spain
| | - Julián Pardo
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (I.U.-M.); (D.d.M.); (M.A.); (V.S.); (J.P.); (M.A.)
- Department of Microbiology, Pediatrics, Radiology and Public Health, Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
- Networking Research Center on Infectious Diseases, CIBERINFEC, 28029 Madrid, Spain
| | - Manuel Arruebo
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (I.U.-M.); (D.d.M.); (M.A.); (V.S.); (J.P.); (M.A.)
- Instituto de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Department of Chemical Engineering, Campus Río Ebro–Edificio I+D, University of Zaragoza, 50018 Zaragoza, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN, 28029 Madrid, Spain
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129
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Garrett AD. The cross-over of statistical thinking and practices: A pandemic catalyst. Pharm Stat 2022; 21:778-789. [PMID: 35819112 PMCID: PMC9349759 DOI: 10.1002/pst.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022]
Abstract
Written during the SARS-CoV-2 pandemic, and in recognition of Andy Grieve, the polymath, this article looks at an eclectic mix of topics where statistical thinking and practices should transcend typical dividing lines-with a particular focus on the areas of drug development, public health and social science. The case is made for embedding an experimental (or quasi-experimental) framework within clinical practice for vaccines and treatments following their marketing authorisation. A similar case is made for public health interventions-facilitated by pre-specification of effect size and by the greater use of data standards. A number of recommendations are made whilst noting that progress is being made in some areas.
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130
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Zhang Y, Mayorga ME, Ivy J, Hassmiller Lich K, Swann JL. Modeling the Impact of Nonpharmaceutical Interventions on COVID-19 Transmission in K-12 Schools. MDM Policy Pract 2022; 7:23814683221140866. [PMID: 36479414 PMCID: PMC9720473 DOI: 10.1177/23814683221140866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/19/2022] [Indexed: 08/06/2023] Open
Abstract
Background. The novel coronavirus SARS-CoV-2 spread across the world causing many waves of COVID-19. Children were at high risk of being exposed to the disease because they were not eligible for vaccination during the first 20 mo of the pandemic in the United States. While children 5 y and older are now eligible to receive a COVID-19 vaccine in the United States, vaccination rates remain low despite most schools returning to in-person instruction. Nonpharmaceutical interventions (NPIs) are important for controlling the spread of COVID-19 in K-12 schools. US school districts used varied and layered mitigation strategies during the pandemic. The goal of this article is to analyze the impact of different NPIs on COVID-19 transmission within K-12 schools. Methods. We developed a deterministic stratified SEIR model that captures the role of social contacts between cohorts in disease transmission to estimate COVID-19 incidence under different NPIs including masks, random screening, contact reduction, school closures, and test-to-stay. We designed contact matrices to simulate the contact patterns between students and teachers within schools. We estimated the proportion of susceptible infected associated with each intervention over 1 semester under the Omicron variant. Results. We find that masks and reducing contacts can greatly reduce new infections among students. Weekly screening tests also have a positive impact on disease mitigation. While self-quarantining symptomatic infections and school closures are effective measures for decreasing semester-end infections, they increase absenteeism. Conclusion. The model provides a useful tool for evaluating the impact of a variety of NPIs on disease transmission in K-12 schools. While the model is tested under Omicron variant parameters in US K-12 schools, it can be adapted to study other populations under different disease settings. Highlights A stratified SEIR model was developed that captures the role of social contacts in K-12 schools to estimate COVID-19 transmission under different nonpharmaceutical interventions.While masks, random screening, contact reduction, school closures, and test-to-stay are all beneficial interventions, masks and contact reduction resulted in the greatest reduction in new infections among students from the tested scenarios.Layered interventions provide more benefits than implementing interventions independently.
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Affiliation(s)
- Yiwei Zhang
- Operations Research Program, North Carolina
State University, Raleigh, NC, USA
| | - Maria E Mayorga
- Department of Industrial and Systems
Engineering, North Carolina State University, Raleigh, NC, USA
| | - Julie Ivy
- Department of Industrial and Systems
Engineering, North Carolina State University, Raleigh, NC, USA
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health,
University of North Carolina at Chapel Hill, Raleigh, NC, USA
| | - Julie L. Swann
- Department of Industrial and Systems
Engineering, North Carolina State University, Raleigh, NC, USA
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131
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Høeg TB, Prasad V, Porter T. Contact Tracing Policy for Masked Students May be an Important Confounding Variable. Pediatrics 2022; 150:188362. [PMID: 35765968 DOI: 10.1542/peds.2022-057636a] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tracy Beth Høeg
- Florida Department of Health XXX, FL.,Department of Physical Medicine & Rehabilitation University of California-Davis Davis, CA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics University of California- San Francisco San Francisco, CA
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Lyngse FP, Mølbak K, Denwood M, Christiansen LE, Møller CH, Rasmussen M, Cohen AS, Stegger M, Fonager J, Sieber RN, Ellegaard KM, Nielsen C, Kirkeby CT. Effect of vaccination on household transmission of SARS-CoV-2 Delta variant of concern. Nat Commun 2022; 13:3764. [PMID: 35773247 PMCID: PMC9244879 DOI: 10.1038/s41467-022-31494-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Effective vaccines protect individuals by not only reducing the susceptibility to infection, but also reducing the infectiousness of breakthrough infections in vaccinated cases. To disentangle the vaccine effectiveness against susceptibility to infection (VES) and vaccine effectiveness against infectiousness (VEI), we took advantage of Danish national data comprising 24,693 households with a primary case of SARS-CoV-2 infection (Delta Variant of Concern, 2021) including 53,584 household contacts. In this setting, we estimated VES as 61% (95%-CI: 59-63), when the primary case was unvaccinated, and VEI as 31% (95%-CI: 26-36), when the household contact was unvaccinated. Furthermore, unvaccinated secondary cases with an infection exhibited a three-fold higher viral load compared to fully vaccinated secondary cases with a breakthrough infection. Our results demonstrate that vaccinations reduce susceptibility to infection as well as infectiousness, which should be considered by policy makers when seeking to understand the public health impact of vaccination against transmission of SARS-CoV-2.
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Affiliation(s)
- Frederik Plesner Lyngse
- Department of Economics & Center for Economic Behaviour and Inequality, University of Copenhagen, Copenhagen, Denmark.
- Danish Ministry of Health, Copenhagen, Denmark.
- Statens Serum Institut, Copenhagen, Denmark.
| | - Kåre Mølbak
- Statens Serum Institut, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Matt Denwood
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lasse Engbo Christiansen
- Department of Applied Mathematics and Computer Science, Dynamical Systems, Technical University of Denmark, Richard Petersens Plads, 324, DK-2800, Kgs. Lyngby, Denmark
| | | | | | | | | | | | | | | | | | - Carsten Thure Kirkeby
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Salvatore M, Purkayastha S, Ganapathi L, Bhattacharyya R, Kundu R, Zimmermann L, Ray D, Hazra A, Kleinsasser M, Solomon S, Subbaraman R, Mukherjee B. Lessons from SARS-CoV-2 in India: A data-driven framework for pandemic resilience. SCIENCE ADVANCES 2022; 8:eabp8621. [PMID: 35714183 PMCID: PMC9205583 DOI: 10.1126/sciadv.abp8621] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
India experienced a massive surge in SARS-CoV-2 infections and deaths during April to June 2021 despite having controlled the epidemic relatively well during 2020. Using counterfactual predictions from epidemiological disease transmission models, we produce evidence in support of how strengthening public health interventions early would have helped control transmission in the country and significantly reduced mortality during the second wave, even without harsh lockdowns. We argue that enhanced surveillance at district, state, and national levels and constant assessment of risk associated with increased transmission are critical for future pandemic responsiveness. Building on our retrospective analysis, we provide a tiered data-driven framework for timely escalation of future interventions as a tool for policy-makers.
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Affiliation(s)
- Maxwell Salvatore
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Ritoban Kundu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Zimmermann
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
| | - Debashree Ray
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Aditi Hazra
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Sunil Solomon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramnath Subbaraman
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, MA, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Corresponding author.
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134
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Leech G, Rogers-Smith C, Monrad JT, Sandbrink JB, Snodin B, Zinkov R, Rader B, Brownstein JS, Gal Y, Bhatt S, Sharma M, Mindermann S, Brauner JM, Aitchison L. Mask wearing in community settings reduces SARS-CoV-2 transmission. Proc Natl Acad Sci U S A 2022; 119:e2119266119. [PMID: 35639701 PMCID: PMC9191667 DOI: 10.1073/pnas.2119266119] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/28/2022] [Indexed: 12/11/2022] Open
Abstract
The effectiveness of mask wearing at controlling severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has been unclear. While masks are known to substantially reduce disease transmission in healthcare settings [D. K. Chu et al., Lancet 395, 1973–1987 (2020); J. Howard et al., Proc. Natl. Acad. Sci. U.S.A. 118, e2014564118 (2021); Y. Cheng et al., Science eabg6296 (2021)], studies in community settings report inconsistent results [H. M. Ollila et al., medRxiv (2020); J. Brainard et al., Eurosurveillance 25, 2000725 (2020); T. Jefferson et al., Cochrane Database Syst. Rev. 11, CD006207 (2020)]. Most such studies focus on how masks impact transmission, by analyzing how effective government mask mandates are. However, we find that widespread voluntary mask wearing, and other data limitations, make mandate effectiveness a poor proxy for mask-wearing effectiveness. We directly analyze the effect of mask wearing on SARS-CoV-2 transmission, drawing on several datasets covering 92 regions on six continents, including the largest survey of wearing behavior (n= 20 million) [F. Kreuter et al., https://gisumd.github.io/COVID-19-API-Documentation (2020)]. Using a Bayesian hierarchical model, we estimate the effect of mask wearing on transmission, by linking reported wearing levels to reported cases in each region, while adjusting for mobility and nonpharmaceutical interventions (NPIs), such as bans on large gatherings. Our estimates imply that the mean observed level of mask wearing corresponds to a 19% decrease in the reproduction number R. We also assess the robustness of our results in 60 tests spanning 20 sensitivity analyses. In light of these results, policy makers can effectively reduce transmission by intervening to increase mask wearing.
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Affiliation(s)
- Gavin Leech
- Department of Computer Science, University of Bristol, Bristol BS8 1TH, United Kingdom
| | - Charlie Rogers-Smith
- External collaborator to Oxford Applied and Theoretical Machine Learning Group, University of Oxford, Oxford OX1 2JD, United Kingdom
| | | | - Jonas B. Sandbrink
- Future of Humanity Institute, University of Oxford, Oxford OX1 2JD, United Kingdom
- Medical Sciences Division, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Benedict Snodin
- Future of Humanity Institute, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Robert Zinkov
- Department of Computer Science, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Benjamin Rader
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, MA 02215
| | | | - Yarin Gal
- Oxford Applied and Theoretical Machine Learning Group, Department of Computer Science, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Samir Bhatt
- Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London SW7 2BX, United Kingdom
| | - Mrinank Sharma
- Future of Humanity Institute, University of Oxford, Oxford OX1 2JD, United Kingdom
- Department of Statistics, University of Oxford, Oxford OX1 2JD, United Kingdom
- Department of Engineering Science, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Sören Mindermann
- Oxford Applied and Theoretical Machine Learning Group, Department of Computer Science, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Jan M. Brauner
- Future of Humanity Institute, University of Oxford, Oxford OX1 2JD, United Kingdom
- Oxford Applied and Theoretical Machine Learning Group, Department of Computer Science, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Laurence Aitchison
- Department of Computer Science, University of Bristol, Bristol BS8 1TH, United Kingdom
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135
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Barro RJ. Non-pharmaceutical interventions and mortality in U.S. cities during the great influenza pandemic, 1918-1919. RESEARCH IN ECONOMICS = RICERCHE ECONOMICHE 2022; 76:93-106. [PMID: 35784011 PMCID: PMC9232401 DOI: 10.1016/j.rie.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/24/2022] [Indexed: 11/01/2022]
Abstract
A key issue for the ongoing COVID-19 pandemic is whether non-pharmaceutical public-health interventions (NPIs) retard death rates. Good information about causal effects from NPIs comes from flu-related excess deaths in large U.S. cities during the second wave of the Great Influenza Pandemic, September 1918-February 1919. The measured NPIs are in three categories: school closings, prohibitions of public gatherings, and quarantine/isolation. Although an increase in NPIs flattened the curve in the sense of reducing the ratio of peak to overall flu-related excess death rates, the estimated effect on overall deaths is small and statistically insignificant. These findings differ from those associated with COVID-19 in the sense that facemask mandates and usage seem to reduce COVID-related cases.
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Raqib R, Sarker P, Akhtar E, Nurul Huda TM, Haq MA, Roy AK, Hosen MB, Haque F, Chowdhury MR, Reidpath DD, Emdadul Hoque DM, Islam Z, Ahmed S, Ahmed T, Tofail F, Razzaque A. Seroprevalence of SARS-CoV-2 infection and associated factors among Bangladeshi slum and non-slum dwellers in pre-COVID-19 vaccination era: October 2020 to February 2021. PLoS One 2022; 17:e0268093. [PMID: 35604947 PMCID: PMC9126397 DOI: 10.1371/journal.pone.0268093] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Seroprevalence studies have been carried out in many developed and developing countries to evaluate ongoing and past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data on this infection in marginalized populations in urban slums are limited, which may offer crucial information to update prevention and mitigation policies and strategies. We aimed to determine the seroprevalence of SARS-CoV-2 infection and factors associated with seropositivity in slum and non-slum communities in two large cities in Bangladesh. METHODS A cross-sectional study was carried out among the target population in Dhaka and Chattogram cities between October 2020 and February 2021. Questionnaire-based data, anthropometric and blood pressure measurements and blood were obtained. SARS-CoV-2 serology was assessed by Roche Elecsys® Anti-SARS-CoV-2 immunoassay. RESULTS Among the 3220 participants (2444 adults, ≥18 years; 776 children, 10-17 years), the overall weighted seroprevalence was 67.3% (95% confidence intervals (CI) = 65.2, 69.3) with 71.0% in slum (95% CI = 68.7, 72.2) and 62.2% in non-slum (95% CI = 58.5, 65.8). The weighted seroprevalence was 72.9% in Dhaka and 54.2% in Chattogram. Seroprevalence was positively associated with limited years of formal education (adjusted odds ratio [aOR] = 1.61; 95% CI = 1.43, 1.82), lower income (aOR = 1.23; 95% CI = 1.03, 1.46), overweight (aOR = 1.2835; 95% CI = 1.26, 1.97), diabetes (aOR = 1.67; 95% CI = 1.21, 2.32) and heart disease (aOR = 1.38; 95% CI = 1.03, 1.86). Contrarily, negative associations were found between seropositivity and regular wearing of masks and washing hands, and prior BCG vaccination. About 63% of the population had asymptomatic infection; only 33% slum and 49% non-slum population showed symptomatic infection. CONCLUSION The estimated seroprevalence of SARS-CoV-2 was more prominent in impoverished informal settlements than in the adjacent middle-income non-slum areas. Additional factors associated with seropositivity included limited education, low income, overweight and pre-existing chronic conditions. Behavioral factors such as regular wearing of masks and washing hands were associated with lower probability of seropositivity.
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Affiliation(s)
- Rubhana Raqib
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | - Protim Sarker
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | - Evana Akhtar
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | | | | | | | | | - Farjana Haque
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | | | - Daniel D. Reidpath
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
| | | | | | - Shehlina Ahmed
- Foreign, Commonwealth & Development Office (FCDO), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddrb, Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, icddrb, Dhaka, Bangladesh
| | - Abdur Razzaque
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
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137
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de Bruin M, Suk JE, Baggio M, Blomquist SE, Falcon M, Forjaz MJ, Godoy-Ramirez K, Leurs M, Rodriguez-Blazquez C, Romay-Barja M, Uiters E, Kinsman J. Behavioural insights and the evolving COVID-19 pandemic. Euro Surveill 2022; 27:2100615. [PMID: 35514309 PMCID: PMC9074394 DOI: 10.2807/1560-7917.es.2022.27.18.2100615] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Behavioural sciences have complemented medical and epidemiological sciences in the response to the SARS-CoV-2 pandemic. As vaccination uptake continues to increase across the EU/EEA - including booster vaccinations - behavioural science research remains important for both pandemic policy, planning of services and communication. From a behavioural perspective, the following three areas are key as the pandemic progresses: (i) attaining and maintaining high levels of vaccination including booster doses across all groups in society, including socially vulnerable populations, (ii) informing sustainable pandemic policies and ensuring adherence to basic prevention measures to protect the most vulnerable population, and (iii) facilitating population preparedness and willingness to support and adhere to the reimposition of restrictions locally or regionally whenever outbreaks may occur. Based on mixed-methods research, expert consultations, and engagement with communities, behavioural data and interventions can thus be important to prevent and effectively respond to local or regional outbreaks, and to minimise socioeconomic and health disparities. In this Perspective, we briefly outline these topics from a European viewpoint, while recognising the importance of considering the specific context in individual countries.
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Affiliation(s)
- Marijn de Bruin
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Radboud University Medical Center, Institute of Health Sciences, Nijmegen, the Netherlands
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Marianna Baggio
- Joint Research Centre, European Commission, Brussels, Belgium
| | | | - María Falcon
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB), University of Murcia, Murcia, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | | | - Mariken Leurs
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - María Romay-Barja
- Infectious Disease Network Research Center (CIBERINFEC), Madrid, Spain
- National Centre of Tropical Medicine, Carlos III Health Institute, Madrid, Spain
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - John Kinsman
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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138
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Marino M, Heintzman J. Randomized Trials in Primary Care: Becoming Pragmatic. Ann Fam Med 2022; 20:201-202. [PMID: 35606131 PMCID: PMC9199046 DOI: 10.1370/afm.2832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.,OCHIN Inc, Portland, Oregon
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139
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Watson SI, Rego RTT, Hofer T, Lilford RJ. Evaluations of water, sanitation and hygiene interventions should not use diarrhoea as (primary) outcome. BMJ Glob Health 2022; 7:e008521. [PMID: 35550338 PMCID: PMC9109038 DOI: 10.1136/bmjgh-2022-008521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
Water, sanitation and hygiene interventions have been the subject of cluster trials of unprecedented size, scale and cost in recent years. However, the question 'what works in water, sanitation, hygiene (WASH)?' remains poorly understood. Evaluations of community interventions to prevent infectious disease typically use lab-confirmed infection as a primary outcome; however, WASH trials mostly use reported diarrhoea. While diarrhoea is a significant source of morbidity, it is subjected to significant misclassification error with respect to enteric infection due to the existence of non-infectious diarrhoea and asymptomatic infection. We show how this may lead to bias of estimated effects of interventions from WASH trials towards no effect. The problem is further compounded by other biases in the measurement process. Alongside testing for infection of the gut, an examination of the causal assumptions underlying WASH interventions present several other reliable alternative and complementary measurements and outcomes. Contemporary guidance on the evaluation of complex interventions requires researchers to take a broad view of the causal effects of an intervention across a system. Reported diarrhoea can fail to even be a reliable measure of changes to gastrointestinal health and so should not be used as a primary outcome if we are to progress our knowledge of what works in WASH.
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Affiliation(s)
- Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ryan T T Rego
- Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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140
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Chou R, Dana T, Jungbauer R. Update Alert 7: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings. Ann Intern Med 2022; 175:W58-W59. [PMID: 35344376 PMCID: PMC8966624 DOI: 10.7326/l21-0783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
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141
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Osewe PL, Peters MA. Prioritizing Global Public Health Investments for COVID-19 Response in Real Time: Results from a Delphi Exercise. Health Secur 2022; 20:137-146. [PMID: 35420445 PMCID: PMC9081018 DOI: 10.1089/hs.2021.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In the first months of the COVID-19 pandemic, there was a lack of guidance on how to channel the unprecedented amount of health financing toward the pandemic response. We employed a multistep, interactive Delphi process to reach consensus on a “menu” of priority COVID-19 response interventions. In all, 27 health security experts—representing national governments, bilateral and multilateral organizations, academia, technical agencies, and nongovernmental organizations—participated in the exercise. The experts rated 11 technical investment areas and 37 interventions on a 5-point scale in terms of their importance to COVID-19 response. Initial findings were discussed at a virtual meeting where experts suggested modifications. A group of 19 experts then rated a revised list of 11 technical areas and 39 interventions. Consensus was defined as at least 80% of experts agreeing on the importance of a technical area or intervention; stability of scores across the rounds was identified using Wilcoxon matched-pairs and unpaired signed rank tests. Between the initial and final menu, 3 technical areas and 7 interventions were slightly modified, 3 interventions were added, and 1 intervention was removed. Consensus was reached on all 11 technical areas and 35 of the final 39 interventions, and between 34 and 37 interventions were stable across rounds depending on the test used. In this exercise, the health security experts agreed that COVID-19 response financing should prioritize interventions that enhance a country's capacity to test, trace, and treat high-risk populations. Simultaneously, supportive systems (eg, risk communication, community engagement, public health infrastructure, information systems, policy and coordination, workforce capacity, other social protections) should be developed to ensure that nonpharmaceutical and medical interventions can maximize the effectiveness of these systems.
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Affiliation(s)
- Patrick L Osewe
- Patrick L. Osewe, MD, MPH, is Chief of Health Sector Group, Asian Development Bank, Manila, Philippines
| | - Michael A Peters
- Michael A. Peters, MSPH, PhD, was a Consultant, Asian Development Bank, Manila, Philippines. He is now Associate Faculty, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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142
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Using high-resolution contact networks to evaluate SARS-CoV-2 transmission and control in large-scale multi-day events. Nat Commun 2022; 13:1956. [PMID: 35414056 PMCID: PMC9005731 DOI: 10.1038/s41467-022-29522-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
The emergence of highly transmissible SARS-CoV-2 variants has created a need to reassess the risk posed by increasing social contacts as countries resume pre-pandemic activities, particularly in the context of resuming large-scale events over multiple days. To examine how social contacts formed in different activity settings influences interventions required to control Delta variant outbreaks, we collected high-resolution data on contacts among passengers and crew on cruise ships and combined the data with network transmission models. We found passengers had a median of 20 (IQR 10-36) unique close contacts per day, and over 60% of their contact episodes were made in dining or sports areas where mask wearing is typically limited. In simulated outbreaks, we found that vaccination coverage and rapid antigen tests had a larger effect than mask mandates alone, indicating the importance of combined interventions against Delta to reduce event risk in the vaccine era.
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143
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Abstract
Masking was the single most common non-pharmaceutical intervention in the course of the coronavirus disease 2019 (COVID-19) pandemic. Most countries have implemented recommendations or mandates regarding the use of masks in public spaces. The aim of this short study was to analyse the correlation between mask usage against morbidity and mortality rates in the 2020-2021 winter in Europe. Data from 35 European countries on morbidity, mortality, and mask usage during a six-month period were analysed and crossed. Mask usage was more homogeneous in Eastern Europe than in Western European countries. Spearman's correlation coefficients between mask usage and COVID-19 outcomes were either null or positive, depending on the subgroup of countries and type of outcome (cases or deaths). Positive correlations were stronger in Western than in Eastern European countries. These findings indicate that countries with high levels of mask compliance did not perform better than those with low mask usage.
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Affiliation(s)
- Beny Spira
- Microbiology, Universidade de São Paulo, São Paulo, BRA
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144
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Bracis C, Moore M, Swan DA, Matrajt L, Anderson L, Reeves DB, Burns E, Schiffer JT, Dimitrov D. Improving vaccination coverage and offering vaccine to all school-age children allowed uninterrupted in-person schooling in King County, WA: Modeling analysis. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:5699-5716. [PMID: 35603374 PMCID: PMC9553324 DOI: 10.3934/mbe.2022266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The rapid spread of highly transmissible SARS-CoV-2 variants combined with slowing pace of vaccination in Fall 2021 created uncertainty around the future trajectory of the epidemic in King County, Washington, USA. We analyzed the benefits of offering vaccination to children ages 5-11 and expanding the overall vaccination coverage using mathematical modeling. We adapted a mathematical model of SARS-CoV-2 transmission, calibrated to data from King County, Washington, to simulate scenarios of vaccinating children aged 5-11 with different starting dates and different proportions of physical interactions (PPI) in schools being restored. Dynamic social distancing was implemented in response to changes in weekly hospitalizations. Reduction of hospitalizations and estimated time under additional social distancing measures are reported over the 2021-2022 school year. In the scenario with 85% vaccination coverage of 12+ year-olds, offering early vaccination to children aged 5-11 with 75% PPI was predicted to prevent 756 (median, IQR 301-1434) hospitalizations cutting youth hospitalizations in half compared to no vaccination and largely reducing the need for additional social distancing measures over the school year. If, in addition, 90% overall vaccination coverage was reached, 60% of remaining hospitalizations would be averted and the need for increased social distancing would almost certainly be avoided. Our work suggests that uninterrupted in-person schooling in King County was partly possible because reasonable precaution measures were taken at schools to reduce infectious contacts. Rapid vaccination of all school-aged children provides meaningful reduction of the COVID-19 health burden over this school year but only if implemented early. It remains critical to vaccinate as many people as possible to limit the morbidity and mortality associated with future epidemic waves.
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Affiliation(s)
- Chloe Bracis
- Université Grenoble Alpes, TIMC-IMAG/MAGE, Grenoble 38000, France
| | - Mia Moore
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David A. Swan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Larissa Anderson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel B. Reeves
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Joshua T. Schiffer
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
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145
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Khanolkar RA, Trajkovski A, Agarwal A, Pauls MA, Lang ES. Emerging evidence for non-pharmacologic interventions in reducing the burden of respiratory illnesses. Intern Emerg Med 2022; 17:639-644. [PMID: 35119570 PMCID: PMC8814568 DOI: 10.1007/s11739-022-02932-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/15/2022] [Indexed: 12/30/2022]
Abstract
The global pandemic caused by SARS-CoV-2 (COVID-19) has led to significant morbidity and mortality, and unprecedented economic and health system disruption. Non-pharmacologic interventions (NPIs) such as masking and physical distancing have formed the underpinnings of COVID-19 infection control strategies. Concomitantly, numerous jurisdictions have seen a decrease in hospitalizations for non-COVID-19 respiratory illnesses (NCRIs) such as asthma, community-acquired pneumonia, influenza, and chronic obstructive pulmonary disease relative to pre-pandemic levels. These associations give rise to a number of testable hypotheses regarding the efficacy of NPIs in reducing the substantial burden of NCRIs. Here, we review emerging perspectives on the role of NPIs in NCRI prevention with the ultimate goal of informing future research and public policy development as we move into what may be the endemic phase of the COVID-19 pandemic.
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Affiliation(s)
- Rutvij A Khanolkar
- Cumming School of Medicine, University of Calgary, #305, 2011 University Dr NW, Calgary, AB, T2N 4T4, Canada.
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Merril A Pauls
- Health Sciences Centre, Max Rady College of Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Eddy S Lang
- Cumming School of Medicine, University of Calgary, #305, 2011 University Dr NW, Calgary, AB, T2N 4T4, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
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146
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Zhao H, Jatana S, Bartoszko J, Loeb M. Nonpharmaceutical interventions to prevent viral respiratory infection in community settings: an umbrella review. ERJ Open Res 2022; 8:00650-2021. [PMID: 35651370 PMCID: PMC9149389 DOI: 10.1183/23120541.00650-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background Respiratory viruses pose an important public health threat to most communities. Nonpharmaceutical interventions (NPIs) such as masks, hand hygiene or physical distancing, among others, are believed to play an important role in reducing transmission of respiratory viruses. In this umbrella review, we summarise the evidence of the effectiveness of NPIs for the prevention of respiratory virus transmission in the community setting. Observations A systematic search of PubMed, Embase, Medline and Cochrane reviews resulted in a total of 24 studies consisting of 11 systematic reviews and meta-analyses, 12 systematic reviews without meta-analyses and one standalone meta-analysis. The current evidence from these data suggests that hand hygiene is protective against respiratory viral infection. The use of hand hygiene and facemasks, facemasks alone and physical distancing were interventions with inconsistent evidence. Interventions such as school closures, oral hygiene or nasal saline rinses were shown to be effective in reducing the risk of influenza; however, the evidence is sparse and mostly of low and critically low quality. Conclusions Studies on the effectiveness of NPIs for the prevention of respiratory viral transmission in the community vary in study design, quality and reported effectiveness. Evidence for the use of hand hygiene or facemasks is the strongest; therefore, the most reasonable suggestion is to use hand hygiene and facemasks in the community setting.
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Affiliation(s)
- Hedi Zhao
- McGill University, Faculty of Medicine, Montreal, QC, Canada
- These authors contributed equally
| | - Sukhdeep Jatana
- McGill University, Faculty of Medicine, Montreal, QC, Canada
- These authors contributed equally
| | - Jessica Bartoszko
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Dept of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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147
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Sheen JK, Haushofer J, Metcalf CJE, Kennedy-Shaffer L. The required size of cluster randomized trials of nonpharmaceutical interventions in epidemic settings. Stat Med 2022; 41:2466-2482. [PMID: 35257398 PMCID: PMC9111156 DOI: 10.1002/sim.9365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022]
Abstract
To control the SARS‐CoV‐2 pandemic and future pathogen outbreaks requires an understanding of which nonpharmaceutical interventions are effective at reducing transmission. Observational studies, however, are subject to biases that could erroneously suggest an impact on transmission, even when there is no true effect. Cluster randomized trials permit valid hypothesis tests of the effect of interventions on community transmission. While such trials could be completed in a relatively short period of time, they might require large sample sizes to achieve adequate power. However, the sample sizes required for such tests in outbreak settings are largely undeveloped, leaving unanswered the question of whether these designs are practical. We develop approximate sample size formulae and simulation‐based sample size methods for cluster randomized trials in infectious disease outbreaks. We highlight key relationships between characteristics of transmission and the enrolled communities and the required sample sizes, describe settings where trials powered to detect a meaningful true effect size may be feasible, and provide recommendations for investigators in planning such trials. The approximate formulae and simulation banks may be used by investigators to quickly assess the feasibility of a trial, followed by more detailed methods to more precisely size the trial. For example, we show that community‐scale trials requiring 220 clusters with 100 tested individuals per cluster are powered to identify interventions that reduce transmission by 40% in one generation interval, using parameters identified for SARS‐CoV‐2 transmission. For more modest treatment effects, or when transmission is extremely overdispersed, however, much larger sample sizes are required.
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Affiliation(s)
- Justin K Sheen
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - Johannes Haushofer
- Department of Economics, Stockholm University, Stockholm, Sweden.,Research Institute of Industrial Economics, Stockholm, Sweden.,Max Planck Institute for Research on Collective Goods, Bonn, Germany.,Jain Family Institute, New York, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA.,School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Lee Kennedy-Shaffer
- Department of Mathematics and Statistics, Vassar College, Poughkeepsie, New York, USA
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148
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Giardina J, Bilinski A, Fitzpatrick MC, Kendall EA, Linas BP, Salomon J, Ciaranello AL. Model-Estimated Association Between Simulated US Elementary School-Related SARS-CoV-2 Transmission, Mitigation Interventions, and Vaccine Coverage Across Local Incidence Levels. JAMA Netw Open 2022; 5:e2147827. [PMID: 35157056 PMCID: PMC8845023 DOI: 10.1001/jamanetworkopen.2021.47827] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/17/2021] [Indexed: 12/20/2022] Open
Abstract
Importance With recent surges in COVID-19 incidence and vaccine authorization for children aged 5 to 11 years, elementary schools face decisions about requirements for masking and other mitigation measures. These decisions require explicit determination of community objectives (eg, acceptable risk level for in-school SARS-CoV-2 transmission) and quantitative estimates of the consequences of changing mitigation measures. Objective To estimate the association between adding or removing in-school mitigation measures (eg, masks) and COVID-19 outcomes within an elementary school community at varying student vaccination and local incidence rates. Design, Setting, and Participants This decision analytic model used an agent-based model to simulate SARS-CoV-2 transmission within a school community, with a simulated population of students, teachers and staff, and their household members (ie, immediate school community). Transmission was evaluated for a range of observed local COVID-19 incidence (0-50 cases per 100 000 residents per day, assuming 33% of all infections detected). The population used in the model reflected the mean size of a US elementary school, including 638 students and 60 educators and staff members in 6 grades with 5 classes per grade. Exposures Variant infectiousness (representing wild-type virus, Alpha variant, and Delta variant), mitigation effectiveness (0%-100% reduction in the in-school secondary attack rate, representing increasingly intensive combinations of mitigations including masking and ventilation), and student vaccination levels were varied. Main Outcomes and Measures The main outcomes were (1) probability of at least 1 in-school transmission per month and (2) mean increase in total infections per month among the immediate school community associated with a reduction in mitigation; multiple decision thresholds were estimated for objectives associated with each outcome. Sensitivity analyses on adult vaccination uptake, vaccination effectiveness, and testing approaches (for selected scenarios) were conducted. Results With student vaccination coverage of 70% or less and moderate assumptions about mitigation effectiveness (eg, masking), mitigation could only be reduced when local case incidence was 14 or fewer cases per 100 000 residents per day to keep the mean additional cases associated with reducing mitigation to 5 or fewer cases per month. To keep the probability of any in-school transmission to less than 50% per month, the local case incidence would have to be 4 or fewer cases per 100 000 residents per day. Conclusions and Relevance In this study, in-school mitigation measures (eg, masks) and student vaccinations were associated with substantial reductions in transmissions and infections, but the level of reduction varied across local incidence. These findings underscore the potential role for responsive plans that deploy mitigation strategies based on local COVID-19 incidence, vaccine uptake, and explicit consideration of community objectives.
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Affiliation(s)
- John Giardina
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyssa Bilinski
- Department of Health Services, Policy, and Practice, Department of Biostatistics, Brown School of Public Health, Providence, Rhode Island
| | - Meagan C. Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Emily A. Kendall
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin P. Linas
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
| | - Joshua Salomon
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | - Andrea L. Ciaranello
- Division of Infectious Disease and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
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149
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Islam H, Islam A, Brook A, Rudrappa M. Evaluating the effectiveness of countywide mask mandates at reducing SARS-CoV-2 infection in the United States. J Osteopath Med 2022; 122:211-215. [PMID: 35086185 DOI: 10.1515/jom-2021-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT With the rise of the Delta variant of SARS-CoV-2 and the low vaccination rates in the United States, mitigation strategies to reduce the spread of SARS-CoV-2 are essential for protecting the health of the general public and reducing strain on healthcare facilities. This study compares US counties with and without mask mandates and determines if the mandates are associated with reduced daily COVID-19 infection. US counties have debated whether masks effectively decrease COVID-19 cases, and political pressures have prevented some counties from passing mask mandates. This article investigates the utility of mask mandates in small US counties. OBJECTIVES This study aims to analyze the effectiveness of mask mandates in small US counties and places where the population density may not be as high as in larger urban counties and to determine the efficacy of countywide mask mandates in reducing daily COVID-19 infection. METHODS The counties studied were those with populations between 40,000 and 105,000 in states that did not have statewide mask mandates. A total of 38 counties were utilized in the study, half with and half without mask mandates. Test counties were followed for 30 days after implementing their mask mandate, and daily new SARS-CoV-2 infection was recorded during this timeframe. The counties were in four randomly selected states that did not have statewide mask mandates. The controls utilized were from counties with similar populations to the test counties and were within the same state as the test county. Controls were followed for the same 30 days as their respective test county. Data were analyzed utilizing t-test and difference-in-difference analyses comparing counties with mask mandates and those without. RESULTS These data showed statistically significant lower averages of SARS-CoV-2 daily infection in counties that passed mask mandates when compared with counties that did not. The difference-in-difference analysis revealed a 16.9% reduction in predicted COVID-19 cases at the end of 30 days. CONCLUSIONS These data support the effectiveness of mask mandates in reducing SARS-CoV-2 infection spread in small US counties where the population density may be less than in urban counties. Small US counties that are considering passing mask mandates for the population can utilize these data to justify their policy considerations.
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Affiliation(s)
- Hadie Islam
- College of Osteopathic Medicine, Kansas City University, Joplin, MO, USA
| | - Amina Islam
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Alan Brook
- Internal Medicine/Pulmonology, Barnes Jewish Hospital, St. Peters, MO, USA
| | - Mohan Rudrappa
- Internal Medicine/Pulmonology, Mercy Hospital, Joplin, MO, USA
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150
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Karan A. What the face mask debacle can teach us about pandemic response. BMJ 2022; 376:o85. [PMID: 35022183 DOI: 10.1136/bmj.o85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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