Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Social Distancing Measures

Working from home and positive/negative experiences due to social distancing as interacting factors of depressive symptoms during the COVID-19 pandemic in a Chinese general population

PURPOSE

This study investigated the associations between some factors related to working from home status (WFHS) and positive/negative experiences due to social distancing and their interactions effects on depressive symptoms during the COVID-19 pandemic.

METHODS

A random population-based telephone survey interviewed income-earning adults in the Hong Kong general population during April 21-28, 2020 (n = 200).

RESULTS

Mild to severe depression (according to PHQ-9) was reported by 12% of the participants. The prevalence of WFHS categories was 14% for 3-7 days and 13% for ≥ 8 days (past 2 weeks). The multivariable regression analysis showed that, social isolation (β = 0.36; p < 0.001), relaxation feeling in daily life (β = - 0.22; p = 0.002), and WFHS ≥ 8 days (β = 0.15; p = 0.027), but not perceived huge inconvenience and improved family relationship, were associated with depressive symptoms. Statistically significant interaction effects were found. Some positive experiences buffered the potential harms of some negative experiences of social distancing on depressive symptoms; WFHS ≥ 8 days significantly moderated the risk/protective effects of social isolation, improved family relationship, and relaxation feeling on depressive symptoms.

CONCLUSIONS

Social distancing is double-edged. Positive experiences should be maximized while negative experiences be minimized, as both were directly and interactively associated with depression. Intensive but not mild to moderate (< 80%) WFHS may impact depressive symptoms negatively via its direct association with depression; it also moderated the associations between positive/negative experiences due to social distancing and depression. Further research is required to discern the inter-relationships among WFHS, positive/negative experiences of social distancing, and depression to better cope with the stressful pandemic.

Bacterial Epidemiology and Antimicrobial Resistance Profiles in Children Reported by the ISPED Program in China, 2016 to 2020

The Infectious Disease Surveillance of Pediatrics (ISPED) program was established in 2015 to monitor and analyze the trends of bacterial epidemiology and antimicrobial resistance (AMR) in children. Clinical bacterial isolates were collected from 11 tertiary care children’s hospitals in China in 2016 to 2020. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer method or automated systems, with interpretation according to the Clinical and Laboratory Standards Institute 2019 breakpoints. A total of 288,377 isolates were collected, and the top 10 predominant bacteria were Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Acinetobacter baumannii. In 2020, the coronavirus disease 2019 (COVID-19) pandemic year, we observed a significant reduction in the proportion of respiratory tract samples (from 56.9% to 44.0%). A comparable reduction was also seen in the primary bacteria mainly isolated from respiratory tract samples, including S. pneumoniae, H. influenzae, and S. pyogenes. Multidrug-resistant organisms (MDROs) in children were commonly observed and presented higher rates of drug resistance than sensitive strains. The proportions of carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant A. baumannii (CRAB), carbapenem-resistant P. aeruginosa (CRPA), and methicillin-resistant S. aureus (MRSA) strains were 19.7%, 46.4%%, 12.8%, and 35.0%, respectively. The proportions of CRKP, CRAB, and CRPA strains all showed decreasing trends between 2015 and 2020. Carbapenem-resistant Enterobacteriaceae (CRE) and CRPA gradually decreased with age, while CRAB showed the opposite trend with age. Both CRE and CRPA pose potential threats to neonates. MDROs show very high levels of AMR and have become an urgent threat to children, suggesting that effective monitoring of AMR and antimicrobial stewardship among children in China are required.

IMPORTANCE AMR, especially that involving multidrug-resistant organisms (MDROs), is recognized as a global threat to human health; AMR renders infections increasingly difficult to treat, constituting an enormous economic burden and producing tremendous negative impacts on patient morbidity and mortality rates. There are many surveillance programs in the world to address AMR profiles and MDRO prevalence in humans. However, published studies evaluating the overall AMR rates or MDRO distributions in children are very limited or are of mixed quality. In this study, we showed the bacterial epidemiology and resistance profiles of primary pathogens in Chinese children from 2016 to 2020 for the first time, analyzed MDRO distributions with time and with age, and described MDROs’ potential threats to children, especially low-immunity neonates. Our study will be very useful to guide antiinfection therapy in Chinese children, as well as worldwide pediatric patients.

Economic evaluations of interventions against influenza at workplaces: systematic review

BACKGROUND

The burden of influenza is mostly felt by employees and employers because of increased absenteeism rates, loss of productivity and associated direct costs. Even though interventions against influenza among working adults are effective, patronage and compliance to these measures especially vaccination are low compared to other risk groups.

AIMS

This study was aimed to assess evidence of economic evaluations of interventions against influenza virus infection among workers or in the workplace setting.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline for systematic reviews was followed. Three databases, PubMed, Web of Science and EconLit, were searched using keywords to identify relevant articles from inception till 25 October 2020. Original peer-reviewed papers that conducted economic evaluations of influenza interventions using cost-benefit, cost-effectiveness or cost-utility analysis methods focused on working-age adults or work settings were eligible for inclusion. Two independent teams of co-authors extracted and synthesized data from identified studies.

RESULTS

Twenty-four articles were included: 21 were cost-benefit analyses and 3 examined cost-effectiveness analyses. Two papers also presented additional cost-utility analysis. Most of the studies were pharmaceutical interventions (n = 23) primarily focused on vaccination programs while one study was a non-pharmaceutical intervention examining the benefit of paid sick leave. All but two studies reported that interventions against influenza virus infection at the workplace were cost-saving and cost-effective regardless of the analytic approach.

CONCLUSIONS

Further cost-effectiveness research in non-pharmaceutical interventions against influenza in workplace settings is warranted. There is a need to develop standardized methods for reporting economic evaluation methods to ensure comparability and applicability of future research findings.

COVID-19, Influenza and RSV: Surveillance-informed prevention and treatment - Meeting report from an isirv-WHO virtual conference

The International Society for Influenza and other Respiratory Virus Diseases (isirv) and the WHO held a joint virtual conference from 19th-21st October 2021. While there was a major focus on the global response to the SARS-CoV-2 pandemic, including antivirals, vaccines and surveillance strategies, papers were also presented on treatment and prevention of influenza and respiratory syncytial virus (RSV). Potential therapeutics for SARS-CoV-2 included host-targeted therapies baricitinib, a JAK inhibitor, tocilizumab, an IL-6R inhibitor, verdinexor and direct acting antivirals ensovibep, S-217622, AT-527, and monoclonal antibodies casirivimab and imdevimab, directed against the spike protein. Data from trials of nirsevimab, a monoclonal antibody with a prolonged half-life which binds to the RSV F-protein, and an Ad26.RSV pre-F vaccine were also presented. The expanded role of the WHO Global Influenza Surveillance and Response System to address the SARS-CoV-2 pandemic was also discussed. This report summarizes the oral presentations given at this meeting for the benefit of the broader medical and scientific community involved in surveillance, treatment and prevention of respiratory virus diseases.

Impact of social distancing in response to COVID-19 on hospitalizations for laryngitis, tracheitis, otitis media, and mastoiditis in children aged 0 to 9 years in Brazil

Objective

The objective of this study is to evaluate the impact of social distancing resulting from COVID-19 in hospitalizations for infections of the upper airways (URTI), such as acute laryngitis, tracheitis, and otitis media in children aged 0 to 9 years in Brazil, considering that they share the same forms of transmission.

Methods

Data on hospitalizations for acute airway changes and their complications in children <9 years old were obtained from the Database of the Brazilian Department of Public Health Informatics for the period 2015 to 2020. These data were also analyzed by macroregions of Brazil (North, Northeast, Southeast, South, and Midwest). The effect of the social distancing strategy on the increase of acute laryngitis, tracheitis, otitis media, and mastitis, as absolute and relative reductions, was calculated by analyzing the annual calculation of 2015-2019 vs 2020.

Results

All the hospitalizations compared in the Unified Health System (SUS) for laryngitis and acute tracheitis and otitis media decreased, considering all states of Brazil. The largest reduction in hospitalization reduction was in the North, with -94% in 2015-2019 vs 2020 in cases of laryngitis and acute tracheitis, and in the Midwest, with - 85% in 2015-2019 vs 2020 in cases of otitis media.

Conclusion

Hospitalizations for laryngitis, acute tracheitis, and acute otitis media in children <9 years old decreased between March and July 2020 in Brazil, when social distancing measures were adopted due to the COVID-19 pandemic.

Changes in Urban Walking Before and During the COVID-19 Pandemic in a Metropolitan City of South Korea

This study aimed to assess how social distancing measures impacted the choice of walking as a transportation mode, environmental preferences for walking, and walking practice among urban residents in Seoul, the capital city of South Korea. Data was collected through an online survey from September 21 to 28, 2020, when the second level of social distancing measures was implemented; 2,112 participants aged 19 years or older were included in the analysis. During the coronavirus disease 2019 (COVID-19) pandemic, the choice of walking as a means of transportation increased by 10.1 percent points, while that of public transportation decreased by 16.9 percent points. Environmental preferences for walking were more than moderate in neighborhood public open spaces, neighborhood streets, and riverside trails. Despite the increased choice of walking as a means of transportation during the COVID-19 pandemic, walking practices by purpose decreased significantly. In particular, the decrease in walking practice was more pronounced in utilitarian purpose than in leisure purpose. The present study suggests that social distancing measures have an overall effect on environmental preferences, travel attitudes, and behaviors related walking among urban residents in the metropolitan city. To break the physical inactivity habits established during the pandemic, guidelines for promoting walking should be developed, with a focus on increasing the frequency of walking practice. In the post-COVID-19 era, urban and transportation planning in metropolitan cities need to adjust their focus on the development of neighborhood assets related to walking as a health promotion strategy for the upcoming pandemic.

Disparities in case frequency and mortality of coronavirus disease 2019 (COVID-19) among various states in the United States

OBJECTIVE

To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the USA.

MATERIALS AND METHODS

Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests and mortality from March 14th through April 30th. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses.

RESULTS

A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p < .01), transportation volume (beta coefficient 0.1, p < .01), tourism index (beta coefficient -0.1, p = .02) and older age (beta coefficient 0.2, p = .01) are associated with case frequency and percent mortality.

CONCLUSIONS

There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality. Key messages There were wide variations in testing and case frequencies of COVID-19 among different states in the USA. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.

Should bike-sharing continue operating during the COVID-19 pandemic? Empirical findings from Nanjing, China

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has triggered a worldwide outbreak of pandemic, and transportation services have played a key role in coronavirus transmission. Although not crowded in a confined space like a bus or a metro car, bike-sharing users are exposed to the bike surface and take the transmission risk. During the COVID-19 pandemic, how to meet user demand and avoid virus spreading has become an important issue for bike-sharing.

METHODS

Based on the trip data of bike-sharing in Nanjing, China, this study analyzes the travel demand and operation management before and after the pandemic outbreak from the perspectives of stations, users, and bikes. Semi-logarithmic difference-in-differences model, visualization methods, and statistic indexes are applied to explore the transportation service and risk prevention of bike-sharing during the pandemic.

RESULTS

Pandemic control strategies sharply reduced user demand, and commuting trips decreased more significantly. Some stations around health and religious places become more important. Men and older adults may be more dependent on bike-sharing systems. The declined trips reduce user contacts and transmission risk. Central urban areas have more user close contacts and higher transmission risk than suburban areas. Besides, a new concept of user distancing is proposed to decrease transmission risk and the number of idle bikes.

CONCLUSIONS

This paper is the first research focusing on both user demand and transmission risk of bike-sharing during the COVID-19 pandemic. This study evaluates the mobility role of bike-sharing during the COVID-19 pandemic, and also provides insights into curbing the viral transmission within the city.

Human Influenza Epidemiology

Influenza virus infections are common in people of all ages. Epidemics occur in the winter months in temperate locations and at varying times of the year in subtropical and tropical locations. Most influenza virus infections cause mild and self-limiting disease, and around one-half of all infections occur with a fever. Only a small minority of infections lead to serious disease requiring hospitalization. During epidemics, the rates of influenza virus infections are typically highest in school-age children. The clinical severity of infections tends to increase at the extremes of age and with the presence of underlying medical conditions, and impact of epidemics is greatest in these groups. Vaccination is the most effective measure to prevent infections, and in recent years influenza vaccines have become the most frequently used vaccines in the world. Nonpharmaceutical public health measures can also be effective in reducing transmission, allowing suppression or mitigation of influenza epidemics and pandemics.

Multilayer Neural Network Design for the Calculation of Risk Factor Associated with COVID-19

Coronavirus disease 2019 (COVID-19) is a public health emergency and is of international concern. Till now, there is no effective pharmaceutical treatment available for this disease. This paper presents a multilayer neural network algorithm to calculate the risk factor of getting COVID-19 to the individual based on the symptoms described by World Health Organization. The aim of this study is to provide an approximate risk factor of getting COVID-19 to an individual that helps for further treatment.

The Effect of Local and Global Interventions on Epidemic Spreading

Epidemic spreading causes severe challenges to the global public health system, and global and local interventions are considered an effective way to contain such spreading, including school closures (local), border control (global), etc. However, there is little study on comparing the efficiency of global and local interventions on epidemic spreading. Here, we develop a new model based on the Susceptible-Exposed-Infectious-Recovered (SEIR) model with an additional compartment called “quarantine status”. We simulate various kinds of outbreaks and interventions. Firstly, we predict, consistent with previous studies, interventions reduce epidemic spreading to 16% of its normal level. Moreover, we compare the effect of global and local interventions and find that local interventions are more effective than global ones. We then study the relationships between incubation period and interventions, finding that early implementation of rigorous intervention significantly reduced the scale of the epidemic. Strikingly, we suggest a Pareto optimal in the intervention when resources were limited. Finally, we show that combining global and local interventions is the most effective way to contain the pandemic spreading if initially infected individuals are concentrated in localized regions. Our work deepens our understandings of the role of interventions on the pandemic, and informs an actionable strategy to contain it.

Sustained Effects of Government Response on the COVID-19 Infection Rate in China: A Multiple Mediation Analysis

Many scholars have considered the relationship between the government response to COVID-19, an important social intervention strategy, and the COVID-19 infection rate. However, few have examined the sustained impact of an early government response on the COVID-19 infection rate. The current paper fills this gap by investigating a national survey performed in February 2020 and infection data from Chinese cities surveyed 1.5 years after the outbreak of COVID-19. The results suggest that the Chinese government's early response to COVID-19 significantly and sustainedly reduced China's COVID-19 infection rate, and that this impact worked through risk perception, the adoption of protective action recommendations (PARs), and the chain-mediating effects of risk perception and the adoption of PARs, respectively. These findings have important practical value. In demonstrating how government response and infection rate at the macro level are connected to the behaviour of individuals at the micro level, they suggest feasible directions for curbing the spread of diseases such as COVID-19. When facing such public health emergencies, the focus should be on increasing the public's risk perception and adoption of PARs.

Model with transmission delays for COVID-19 control: Theory and empirical assessment

The paper focuses on modeling of public health measures to control the COVID-19 pandemic. The authors suggest a flexible integral model with distributed lags, which realistically describes COVID-19 infectiousness period from clinical data. It contains susceptible-infectious-recovered (SIR), susceptible-exposed-infectious-recovered (SEIR), and other epidemic models as special cases. The model is used for assessing how government decisions to lockdown and reopen the economy affect epidemic spread. The authors demonstrate essential differences in transition and asymptotic dynamics of the integral model and the SIR model after lockdown. The provided simulation on real data accurately describes several waves of the COVID-19 epidemic in the United States and is in good correspondence with government actions to curb the epidemic.

Assessing the impact of non-pharmaceutical interventions (NPI) on the dynamics of COVID-19: A mathematical modelling study of the case of Ethiopia

The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020 and by November 14, 2020 there were 53.3M confirmed cases and 1.3M reported deaths in the world. In the same period, Ethiopia reported 102K cases and 1.5K deaths. Effective public health preparedness and response to COVID-19 requires timely projections of the time and size of the peak of the outbreak. Currently, Ethiopia under the COVAX facility has begun vaccinating high risk populations but due to vaccine supply shortages and the absence of an effective treatment, the implementation of NPIs (non-pharmaceutical interventions), like hand washing, wearing face coverings or social distancing, still remain the most effective methods of controlling the pandemic as recommended by WHO. This study proposes a modified Susceptible Exposed Infected and Recovered (SEIR) model to predict the number of COVID-19 cases at different stages of the disease under the implementation of NPIs at different adherence levels in both urban and rural settings of Ethiopia. To estimate the number of cases and their peak time, 30 different scenarios were simulated. The results indicated that the peak time of the pandemic is different in urban and rural populations of Ethiopia. In the urban population, under moderate implementation of three NPIs the pandemic will be expected to reach its peak in December, 2020 with 147,972 cases, of which 18,100 are symptomatic and 957 will require admission to an Intensive Care Unit (ICU). Among the implemented NPIs, increasing the coverage of wearing masks by 10% could reduce the number of new cases on average by one-fifth in urban-populations. Varying the coverage of wearing masks in rural populations minimally reduces the number of cases. In conclusion, the models indicate that the projected number of hospital cases during the peak time is higher than the Ethiopian health system capacity. To contain symptomatic and ICU cases within the health system capacity, the government should pay attention to the strict implementation of the existing NPIs or impose additional public health measures.

Risk perception and optimism during the early stages of the COVID-19 pandemic

Slowing the spread of COVID-19 requires people to actively change their lives by following protective practices, such as physical distancing and disinfecting their hands. Perceptions about the personal risk of COVID-19 may affect compliance with these practices. In this study, we assessed risk perception and optimism about COVID-19 in a multinational (UK, USA and Germany), longitudinal design during the early stages of the pandemic (16 March 2020; 1 April 2020; 20 May 2020). Our main findings are that (i) people showed a comparative optimism bias about getting infected and infecting others, but not for getting severe symptoms, (ii) this optimism bias did not change over time, (iii) optimism bias seemed to relate to perceived level of control over the action, (iv) risk perception was linked to publicly available information about the disorder, (v) people reported adhering closely to protective measures but these measures did not seem to be related to risk perception, and (vi) risk perception was related to questions about stress and anxiety. In additional cross-sectional samples, we replicated our most important findings. Our open and partly preregistered results provide detailed descriptions of risk perceptions and optimistic beliefs during the early stages of the COVID-19 pandemic in three Western countries.

Increased urbanization reduced the effectiveness of school closures on seasonal influenza epidemics in China

BACKGROUND

School closure is a common mitigation strategy during severe influenza epidemics and pandemics. However, the effectiveness of this strategy remains controversial. In this study, we aimed to explore the effectiveness of school closure on seasonal influenza epidemics in provincial-level administrative divisions (PLADs) with varying urbanization rates in China.

METHODS

This study analyzed influenza surveillance data between 2010 and 2019 provided by the Chinese National Influenza Center. Taking into consideration the climate, this study included a region with 3 adjacent PLADs in Northern China and another region with 4 adjacent PLADs in Southern China. The effect of school closure on influenza transmission was evaluated by the reduction of the effective reproductive number of seasonal influenza during school winter breaks compared with that before school winter breaks. An age-structured Susceptible-Infected-Recovered-Susceptible (SIRS) model was built to model influenza transmission in different levels of urbanization. Parameters were determined using the surveillance data via robust Bayesian method.

RESULTS

Between 2010 and 2019, in the less urbanized provinces: Hebei, Zhejiang, Jiangsu and Anhui, during school winter breaks, the effective reproductive number of seasonal influenza epidemics reduced 14.6% [95% confidential interval (CI): 6.2-22.9%], 9.6% (95% CI: 2.5-16.6%), 7.3% (95% CI: 0.1-14.4%) and 8.2% (95% CI: 1.1-15.3%) respectively. However, in the highly urbanized cities: Beijing, Tianjin and Shanghai, it reduced only 5.2% (95% CI: -0.7-11.2%), 4.1% (95% CI: -0.9-9.1%) and 3.9% (95% CI: -1.6-9.4%) respectively. In China, urbanization is associated with decreased proportion of children and increased social contact. According to the SIRS model, both factors could reduce the impact of school closure on seasonal influenza epidemics, and the proportion of children in the population is thought to be the dominant influencing factor.

CONCLUSIONS

Effectiveness of school closure on the epidemics varies with the age structure in the population and social contact patterns. School closure should be recommended in the low urbanized regions in China in the influenza seasons.

Social Distancing Policies in the Coronavirus Battle: A Comparison of Denmark and Sweden

Social distancing measures have been a key component in government strategies to mitigate COVID-19 globally. Based on official documents, this study aimed to identify, compare and analyse public social distancing policy measures adopted in Denmark and Sweden regarding the coronavirus from 1 March 2020 until 1 October 2020. A key difference was the greater emphasis on laws and executive orders (sticks) in Denmark, which allowed the country to adopt many stricter policy measures than Sweden, which relied mostly on general guidelines and recommendations (sermons). The main policy adopters in Denmark were the government and the Danish Parliament, whereas the Public Health Agency issued most policies in Sweden, reflecting a difference in political governance and administrative structure in the two countries. During the study period, Sweden had noticeably higher rates of COVID-19 deaths and hospitalizations per 100,000 population than Denmark, yet it is difficult to determine the impact or relative effectiveness of sermons and sticks, particularly with regard to broader and longer-term health, economic and societal effects.

A multicenter study of short-term changes in mental health emergency services use during lockdown in Kitchener-Waterloo, Ontario during the COVID-19 pandemic

Background

The COVID-19 pandemic and subsequent lockdown measures have led to increasing mental health concerns in the general population. We aimed to assess the short-term impact of the pandemic lockdown on mental health emergency services use in the Kitchener-Waterloo region of Ontario, Canada.

Methods

We conducted an observational study during the 6-month period between March 5 and September 5, 2020 using National Ambulatory Care Reporting System metadata from mental health visits to three regional Emergency Departments (ED); mental health and substance related police calls; and calls to a regional mental health crisis telephone line, comparing volumes during the pandemic lockdown with the same period in 2019. Quasi-Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Significant changes in ED visits, mental health diagnoses, police responses, and calls to the crisis line from March 5 to September 5, 2020 were examined using changepoint analyses.

Results

Involuntary admissions, substance related visits, mood related visits, situational crisis visits, and self-harm related mental health visits to the EDs were significantly reduced during the lockdown period compared to the year before. Psychosis-related and alcohol-related visits were not significantly reduced. Among police calls, suicide attempts were significantly decreased during the period of lockdown, but intoxication, assault, and domestic disputes were not significantly different. Mental health crisis telephone calls were significantly decreased during the lockdown period. There was a significant increase in weekly mental health diagnoses starting in the week of July 12 – July 18. There was a significant increase in crisis calls starting in the week of May 31 – June 6, the same week that many guidelines, such as gathering restrictions, were eased. There was a significant increase in weekly police responses starting in the week of June 14 – June 20.

Conclusions

Contrary to our hypothesis, the decrease in most types of mental health ED visits, mental health and substance-related police calls, and mental health crisis calls largely mirrored the overall decline in emergency services usage during the lockdown period. This finding is unexpected in the context of increased attention to acutely deteriorating mental health during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11807-4.

A model for the co-evolution of dynamic social networks and infectious disease dynamics

Recent research shows an increasing interest in the interplay of social networks and infectious diseases. Many studies either neglect explicit changes in health behavior or consider networks to be static, despite empirical evidence that people seek to distance themselves from diseases in social networks. We propose an adaptable steppingstone model that integrates theories of social network formation from sociology, risk perception from health psychology, and infectious diseases from epidemiology. We argue that networking behavior in the context of infectious diseases can be described as a trade-off between the benefits, efforts, and potential harm a connection creates. Agent-based simulations of a specific model case show that: (i) high (perceived) health risks create strong social distancing, thus resulting in low epidemic sizes; (ii) small changes in health behavior can be decisive for whether the outbreak of a disease turns into an epidemic or not; (iii) high benefits for social connections create more ties per agent, providing large numbers of potential transmission routes and opportunities for the disease to travel faster, and (iv) higher costs of maintaining ties with infected others reduce final size of epidemics only when benefits of indirect ties are relatively low. These findings suggest a complex interplay between social network, health behavior, and infectious disease dynamics. Furthermore, they contribute to solving the issue that neglect of explicit health behavior in models of disease spread may create mismatches between observed transmissibility and epidemic sizes of model predictions.

Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review

BACKGROUND

Contact tracing in association with quarantine and isolation is an important public health tool to control outbreaks of infectious diseases. This strategy has been widely implemented during the current COVID-19 pandemic. The effectiveness of this nonpharmaceutical intervention is largely dependent on social interactions within the population and its combination with other interventions. Given the high transmissibility of SARS-CoV-2, short serial intervals, and asymptomatic transmission patterns, the effectiveness of contact tracing for this novel viral agent is largely unknown.

OBJECTIVE

This study aims to identify and synthesize evidence regarding the effectiveness of contact tracing on infectious viral disease outcomes based on prior scientific literature.

METHODS

An evidence-based review was conducted to identify studies from the PubMed database, including preprint medRxiv server content, related to the effectiveness of contact tracing in viral outbreaks. The search dates were from database inception to July 24, 2020. Outcomes of interest included measures of incidence, transmission, hospitalization, and mortality.

RESULTS

Out of 159 unique records retrieved, 45 (28.3%) records were reviewed at the full-text level, and 24 (15.1%) records met all inclusion criteria. The studies included utilized mathematical modeling (n=14), observational (n=8), and systematic review (n=2) approaches. Only 2 studies considered digital contact tracing. Contact tracing was mostly evaluated in combination with other nonpharmaceutical interventions and/or pharmaceutical interventions. Although some degree of effectiveness in decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality was observed, these results were highly dependent on epidemic severity (R0 value), number of contacts traced (including presymptomatic and asymptomatic cases), timeliness, duration, and compliance with combined interventions (eg, isolation, quarantine, and treatment). Contact tracing effectiveness was particularly limited by logistical challenges associated with increased outbreak size and speed of infection spread.

CONCLUSIONS

Timely deployment of contact tracing strategically layered with other nonpharmaceutical interventions could be an effective public health tool for mitigating and suppressing infectious outbreaks by decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality.

Social distancing and bacteraemia in the time of COVID-19

Background

Social distancing was the predominant strategy used to mitigate the spread of Coronavirus disease 2019 (COVID‐19) at the start of the COVID‐19 pandemic.

Aims

To study the impact of social distancing on the incidence of bacteraemia. The number of admitted patients with positive blood cultures in April–May 2020 in one tertiary medical centre was compared with the number during the same period in the previous 3 years (April–May 2017–2019).

Methods

Retrospective review of all positive blood cultures from January to July in the years 2017–2020.

Results

There were fewer cases of Streptococcus bacteraemia as well as coagulase‐negative Staphylococcus bacteraemia and other possible contaminated blood cultures in April–May 2020. Compared with the previous 3 years, the incidence of Streptococcus pneumoniae bacteraemia among all bacteraemias was lower in April–May 2020 (5%) than in 2017–2019 (12.0%; 95% confidence interval 10.3–14.1%). In general, fewer cases of bacteraemia caused by oropharynx organisms were observed in April–May 2020; only 6 cases versus 31 (95% confidence interval 10–53) during the same period in 2017–2019. Only one case of S. pneumoniae bacteraemia was observed in April–May 2020 and its percentage among all bacteraemias was lower in April–May 2020 (0.4%) than during the same period in 2017–2019 (3.3%).

Conclusion

The incidences of streptococcal bacteraemia and bacteraemia of organisms transmitted through respiratory secretions were lower when there were social distancing restrictions. Adopting measures of social distancing may decrease the morbidity from bacteraemia caused by oropharynx and respiratory bacteria.

Nationwide Social Distancing and the Epidemiology of Severe Acute Respiratory Infections

Nonpharmaceutical interventions (e.g., social distancing) are recommended to prevent the spread of respiratory viruses. However, few epidemiological studies have assessed whether social distancing in actual settings reduces the disease burden of severe acute respiratory infections (SARIs) in the general population. Accordingly, we aimed to assess associations between nationwide social distancing for coronavirus disease 2019 (COVID-19) and non-COVID-19 SARIs. We collected data on SARI epidemiologic characteristics recorded from January 2018 through December 2020 from the nationwide sentinel SARI surveillance data maintained by the Korea Disease Control and Prevention Agency. The number of SARIs per 1000 hospitalized patients decreased significantly to 18.61, 18.15, and 6.25 in 2018, 2019, and 2020 (p<0.001), respectively, during the surveillance period of 3 years. The number of intensive care unit admissions associated with SARIs per 1000 hospitalized patients was 0.83, 0.69, and 0.54 in 2018, 2019, and 2020 (p<0.001), respectively, and the number of SARI-associated mortalities per 1000 patients was 0.42, 0.29, and 0.27 in 2018, 2019, and 2020 (p<0.001), respectively. Moreover, SARIs had two peak seasons in 2 years of the surveillance period (2018 and 2019). However, seasonality was not observed since social distancing was initiated. Our sentinel surveillance data demonstrated a remarkable reduction in SARI disease burden and a change in seasonality following the implementation of nationwide social distancing. Accordingly, we suggest that social distancing could be effective in forthcoming seasonal epidemics of non-COVID19 origin, although the impact thereof on other aspects of society needs to be carefully considered.

Developmental Understanding of Death and Grief Among Children During COVID-19 Pandemic: Application of Bronfenbrenner's Bioecological Model

COVID-19 Pandemic has influenced death-related attitudes and understanding during the childhood development leading to a life-long impact. Factors like pandemic-related movement restrictions, school closures, and parents' stay-at-home have exposed children to the phenomenon of grief and death. In that case, children anticipate adverse outcomes and fear while they struggle with unanswered questions. Children may not have coping skills needed to manage their grief in constructive ways to identify, normalize, and express their responses to the loss in their lives. Naming and validating these responses as distinctive aspects of grief process and providing safe space to express their feelings are essential components of a child's coping with loss and grief. This is crucial to consider, as different children react to and are influenced by their environments differently. This article aims to explore the developmental understanding of the process of death and grief by applying the conceptual framework of Bronfenbrenner's theory. Understanding mutual interaction between a child and various ecological systems determines how children perceive death and process grief can facilitate effective communication that has significant implications.

Social Factors Associated With Adherence to Preventive Behaviors Related to COVID-19 Among Rural and Semi-urban Communities in Western Maharashtra, India

Background: To control the transmission of the coronavirus disease 2019 (COVID-19) infection, the Government of India (GoI) had taken stringent precautionary measures during the lockdown period. This study aimed to explore determinants affecting adherence to protective measures against COVID-19 infection among rural and semi-urban settings of Maharashtra, India.

Methods: A cross-sectional telephonic survey among 1,016 adults from randomly selected households was conducted between June 5 and July 16, 2020. The data were explored for knowledge, awareness, practices related to protective measures, and self-risk perception. Socio-demographic and attitudinal correlates of failure to use protective measures against COVID-19 were measured.

Results: In the survey, 72% of the participants were men. The mean age was 46 years (SD: 13.8). The main source of information was television (91%); however, information from healthcare providers (65%) and mass media announcements (49%) was trustworthy. Washing hands immediately with soap after returning from outdoors was reported by 95% of the respondents, always using a mask while outdoors by 94%, never attended social gatherings by 91%, always using hand sanitizer while outside by 77%, and 68% of the respondents followed all protective measures. The knowledge score [mean score 20.3 (SD: 2.4) out of 24] was independently associated with the risk of not using protective measures, with each unit increase in knowledge score, the risk of not using protective measures reduced by 16%. No source of income was independently associated with not using protective measures [AOR 1.5 95% CI (1.01–2.3)].

Conclusions: The COVID-19 public health interventions and behavior change communication strategies should be specifically directed towards the low socio-economic populations through trusted sources. The association between knowledge and practices demonstrates the importance of accurate public health communication to optimally follow preventive measures, such as structural interventions to address poverty and employment policies to address the unemployment crisis are required. Surveillance activity is needed to understand the actual behavior change among the population.

The Benefits of Physical Activity and Positive Mental Health for Reducing the Burden of COVID-19: Validation from a Cross-sectional and Longitudinal Investigation in China and Germany

Many people experience high burden by the outbreak of the coronavirus disease (COVID-19) and its consequences for health and everyday life. The present cross-national study investigated potential factors that can reduce the burden by COVID-19 in China and Germany. Cross-sectional and longitudinal (China: N = 474, baseline, BL: 2015, follow-up, FU: 2020; Germany: N = 359, BL: 2019, FU: 2020) data on physical activity (e.g., jogging) (BL/FU), positive mental health (PMH) (BL/FU), and burden by COVID-19 (FU) were collected via online surveys. In both countries, physical activity was positively associated with PMH, and both variables were negatively related to burden by COVID-19. Furthermore, PMH mediated the link between physical activity and burden. The mediation model was significant when physical activity and PMH were assessed at the BL, while burden was measured at the FU; and it was also significant when all variables were assessed at the FU. The present findings reveal that physical activity in combination with PMH can reduce the experience of burden by COVID-19. Conscious fostering of physical activity and PMH is supported as an effective strategy to reduce the negative impact of the pandemic outbreak on mental and physical health. Additional benefits such as increased adherence to governmental measures around COVID-19 are discussed.

De-escalation strategies for non-pharmaceutical interventions following infectious disease outbreaks: a rapid review and a proposed dynamic de-escalation framework

BACKGROUND

The severity of COVID-19, as well as the speed and scale of its spread, has posed a global challenge. Countries around the world have implemented stringent non-pharmaceutical interventions (NPI) to control transmission and prevent health systems from being overwhelmed. These NPI have had profound negative social and economic impacts. With the timeline to worldwide vaccine roll-out being uncertain, governments need to consider to what extent they need to implement and how to de-escalate these NPI. This rapid review collates de-escalation criteria reported in the literature to provide a guide to criteria that could be used as part of de-escalation strategies globally.

METHODS

We reviewed literature published since 2000 relating to pandemics and infectious disease outbreaks. The searches included Embase.com (includes Embase and Medline), LitCovid, grey literature searching, reference harvesting and citation tracking. Over 1,700 documents were reviewed, with 39 documents reporting de-escalation criteria included in the final analysis. Concepts retrieved through a thematic analysis of the included documents were interlinked to build a conceptual dynamic de-escalation framework.

RESULTS

We identified 52 de-escalation criteria, the most common of which were clustered under surveillance (cited by 43 documents, 10 criteria e.g. ability to actively monitor confirmed cases and contact tracing), health system capacity (cited by 30 documents, 11 criteria, e.g. ability to treat all patients within normal capacity) and epidemiology (cited by 28 documents, 7 criteria, e.g. number or changes in case numbers). De-escalation is a gradual and bi-directional process, and resurgence of infections or emergence of variants of concerns can lead to partial or full re-escalation(s) of response and control measures in place. Hence, it is crucial to rely on a robust public health surveillance system.

CONCLUSIONS

This rapid review focusing on de-escalation within the context of COVID-19 provides a conceptual framework and a guide to criteria that countries can use to formulate de-escalation plans.

COVID-19-associated school closures and related efforts to sustain education and subsidized meal programs, United States, February 18-June 30, 2020

Pre-emptive school closures are frontline community mitigation measures recommended by the US Centers for Disease Control and Prevention (CDC) for implementation during severe pandemics. This study describes the spatiotemporal patterns of publicly announced school closures implemented in response to the coronavirus disease 2019 (COVID-19) pandemic and assesses how public K-12 districts adjusted their methods of education delivery and provision of subsidized meals. During February 18–June 30, 2020, we used daily systematic media searches to identify publicly announced COVID-19–related school closures lasting ≥1 day in the United States (US). We also collected statewide school closure policies from state government websites. Data on distance learning and subsidized meal programs were collected from a stratified sample of 600 school districts. The first COVID-19–associated school closure occurred on February 27, 2020 in Washington state. By March 30, 2020, all but one US public school districts were closed, representing the first-ever nearly synchronous nationwide closure of public K-12 schools in the US. Approximately 100,000 public schools were closed for ≥8 weeks because of COVID-19, affecting >50 million K-12 students. Of 600 districts sampled, the vast majority offered distance learning (91.0%) and continued provision of subsidized meal programs (78.8%) during the closures. Despite the sudden and prolonged nature of COVID-19–associated school closures, schools demonstrated flexibility by implementing distance learning and alternate methods to continue subsidized meal programs.

Quantifying the relationship between lockdowns, mobility, and effective reproduction number (Rt) during the COVID-19 pandemic in the Greater Toronto Area

BACKGROUND

The effectiveness of lockdowns in mitigating the spread of COVID-19 has been the subject of intense debate. Data on the relationship between public health restrictions, mobility, and pandemic growth has so far been conflicting.

OBJECTIVE

We assessed the relationship between public health restriction tiers, mobility, and COVID-19 spread in five contiguous public health units (PHUs) in the Greater Toronto Area (GTA) in Ontario, Canada.

METHODS

Weekly effective reproduction number (Rt) was calculated based on daily cases in each of the five GTA public health units between March 1, 2020, and March 19, 2021. A global mobility index (GMI) for each PHU was calculated using Google Mobility data. Segmented regressions were used to assess changes in the behaviour of Rt over time. We calculated Pearson correlation coefficients between GMI and Rt for each PHU and mobility regression coefficients for each mobility variable, accounting for time lag of 0, 7, and 14 days.

RESULTS

In all PHUs except Toronto, the most rapid decline in Rt occurred in the first 2 weeks of the first province-wide lockdown, and this was followed by a slight trend to increased Rt as restrictions decreased. This trend reversed in all PHUs between September 6th and October 10th after which Rt decreased slightly over time without respect to public health restriction tier. GMI began to increase in the first wave even before restrictions were decreased. This secular trend to increased mobility continued into the summer, driven by increased mobility to recreational spaces. The decline in GMI as restrictions were reintroduced coincides with decreasing mobility to parks after September. During the first wave, the correlation coefficients between global mobility and Rt were significant (p < 0.01) in all PHUs 14 days after lockdown, indicating moderate to high correlation between decreased mobility and decreased viral reproduction rates, and reflecting that the incubation period brings in a time-lag effect of human mobility on Rt. In the second wave, this relationship was attenuated, and was only significant in Toronto and Durham at 14 days after lockdown.

CONCLUSIONS

The association between mobility and COVID-19 spread was stronger in the first wave than the second wave. Public health restriction tiers did not alter the existing secular trend toward decreasing Rt over time.

Social distancing measures: barriers to their implementation and how they can be overcome - a systematic review

BACKGROUND

Despite their central role in the global response to the COVID-19 pandemic and previous infectious disease outbreaks, factors influencing the acceptability and implementation of social distancing measures are poorly understood. This systematic review aims to identify such factors drawing on qualitative literature.

METHODS

A systematic search was carried out in eleven databases. Papers were included in the review if they reported on qualitative studies of factors influencing the implementation of social distancing measures in potentially epidemic infectious diseases. An adapted meta-ethnographical approach was used for synthesis. Review findings were assessed for strength and reliability using GRADE-CERQual.

RESULTS

Twenty-nine papers were included from the systematic search that yielded 5620 results, and supplementary methods. The review identifies two broad categories of barriers to social distancing measures: individual- or community-level psychosocial phenomena, and shortcomings in governmental action or communication. Based on this, 25 themes are identified that can be addressed to improve the implementation of social distancing.

CONCLUSION

Among other findings, the review identifies the need for good communication as well as the need for authorities to provide comprehensive support as two key opportunities to increase acceptability and adherence. Further important enablers of adherence are adequate preparedness and appropriate legislation, the presence of community involvement, solidarity within communities and trust in governments and authorities.

Impact of non-pharmacological initiatives for COVID-19 on hospital admissions due to pediatric acute respiratory illnesses

INTRODUCTION

Interventions to deal with the COVID-19 pandemic may impact the burden of other respiratory diseases. The aim of this study is to analyze the impact of non-pharmacological initiatives (NPI) against COVID-19 on the number of hospitalizations due to pediatric acute respiratory illnesses (ARIs).

MATERIAL AND METHODS

This is a retrospective analysis of pediatric hospitalizations in Porto Alegre, Brazil. We analyzed the monthly incidence of hospital admissions from 2018 to 2020 due to ARIs included in the study. The time series was divided into the period before introducing NPI (2018 and 2019), and the period when NPI were running (2020). We compared means between the years with Student's t-test. The Dickey-Fuller test was used for secular trend analysis. For seasonality, Fischer's G test was performed. Dynamic linear univariate and multivariate models were used to estimate the association between the predictors (the introduction of NPI, secular trend, and seasonality) and outcome (the incidence of ARI admissions). For the statistical analysis, the cut-off probability for rejecting the null hypothesis was defined as <5%.

RESULTS

From 2018 to 2020, 10,109 hospital admissions were due to the respiratory causes included in this study. There was a significant decrease in 2020 in the mean incidence of the ARIs studied compared with 2018 and 2019. The number of hospitalizations due to respiratory diseases in children decreased by 64% for asthma and 93% for bronchiolitis. A secular trend of monthly admissions rates due to ARIs was only observed in the laryngotracheitis data (p = 0.485), but seasonality was detected in all analyses. According to the univariate and multivariate analysis, the introduction of NPI was associated with a decrease in the incidence of ARI admissions.

CONCLUSION

There was a significant reduction in hospital admissions due to ARIs in children. Our data suggest a significant impact of NPI on reducing the spread of viruses associated with ARIs in children. These results support respiratory illness prevention strategies.

COVID-19 pandemic spread against countries' non-pharmaceutical interventions responses: a data-mining driven comparative study

Background

The first half of 2020 has been marked as the era of COVID-19 pandemic which affected the world globally in almost every aspect of the daily life from societal to economical. To prevent the spread of COVID-19, countries have implemented diverse policies regarding Non-Pharmaceutical Intervention (NPI) measures. This is because in the first stage countries had limited knowledge about the virus and its contagiousness. Also, there was no effective medication or vaccines. This paper studies the effectiveness of the implemented policies and measures against the deaths attributed to the virus between January and May 2020.

Methods

Data from the European Centre for Disease Prevention and Control regarding the identified cases and deaths of COVID-19 from 48 countries have been used. Additionally, data concerning the NPI measures related policies implemented by the 48 countries and the capacity of their health care systems was collected manually from their national gazettes and official institutes. Data mining, time series analysis, pattern detection, machine learning, clustering methods and visual analytics techniques have been applied to analyze the collected data and discover possible relationships between the implemented NPIs and COVID-19 spread and mortality. Further, we recorded and analyzed the responses of the countries against COVID-19 pandemic, mainly in urban areas which are over-populated and accordingly COVID-19 has the potential to spread easier among humans.

Results

The data mining and clustering analysis of the collected data showed that the implementation of the NPI measures before the first death case seems to be very effective in controlling the spread of the disease. In other words, delaying the implementation of the NPI measures to after the first death case has practically little effect on limiting the spread of the disease. The success of implementing the NPI measures further depends on the way each government monitored their application. Countries with stricter policing of the measures seems to be more effective in controlling the transmission of the disease.

Conclusions

The conducted comparative data mining study provides insights regarding the correlation between the early implementation of the NPI measures and controlling COVID-19 contagiousness and mortality. We reported a number of useful observations that could be very helpful to the decision makers or epidemiologists regarding the rapid implementation and monitoring of the NPI measures in case of a future wave of COVID-19 or to deal with other unknown infectious pandemics. Regardless, after the first wave of COVID-19, most countries have decided to lift the restrictions and return to normal. This has resulted in a severe second wave in some countries, a situation which requires re-evaluating the whole process and inspiring lessons for the future.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11251-4.

'Distant socializing,' not 'social distancing' as a public health strategy for COVID-19

Social distancing, also referred to as physical distancing, means creating a safe distance of at least two meters (six feet) between yourself and others. This is a term popularized during the COVID-19 pandemic, as it is one of the most important measures to prevent the spread of this virus. However, the term 'social distancing' can be misleading, as it may imply that individuals should stop socializing. However, socializing in a safe context (i.e. over the phone, video-chat, etc.) is especially important during this time of crisis. Therefore, in this narrative review, we suggest the term 'distant socializing' as more apt expression, to promote physical distancing measures while also highlighting the importance of maintaining social bonds. Further, articles discussing the practice, implementation, measurement, and mental health effects of physical distancing are reviewed. Physical distancing is associated with psychiatric symptoms (such as anxiety and depression), suicidal ideation, and domestic violence. Further, unemployment and job insecurity have significantly increased during COVID-19, which may exacerbate these negative mental health effects. Governments, medical institutions, and public health bodies should therefore consider increasing mental health resources both during and after the pandemic, with a specific focus on frontline workers, COVID-19 survivors, and marginalized communities.

A literature review of the economics of COVID-19

The goal of this piece is to survey the developing and rapidly growing literature on the economic consequences of COVID-19 and the governmental responses, and to synthetize the insights emerging from a very large number of studies. This survey: (i) provides an overview of the data sets and the techniques employed to measure social distancing and COVID-19 cases and deaths; (ii) reviews the literature on the determinants of compliance with and the effectiveness of social distancing; (iii) mentions the macroeconomic and financial impacts including the modelling of plausible mechanisms; (iv) summarizes the literature on the socioeconomic consequences of COVID-19, focusing on those aspects related to labor, health, gender, discrimination, and the environment; and (v) summarizes the literature on public policy responses.

Social distancing as risk reduction strategy during COVID-19 pandemic: A study of Delhi-NCT, India

COVID-19 pandemic impacted countries all over the world calling as urgent need to enhance the capacity of individuals and communities to respond in such disease outbreaks. Public health interventions, such as social distancing could help to protect many vulnerable people and reduce secondary transmissions within the community. This research was undertaken as a longitudinal study to identify and comprehend the preferences given to different preventive measures adopted by individuals to ensure protection against the spread of coronavirus. An online survey was conducted with a representative sample of 176 stakeholders to identify practices and behaviour adopted by the key stakeholders working in the domains of water, health and disaster risk reduction to curb the spread of COVID-19 in Delhi-National Capital Territory of India (Delhi-NCT). Findings of this study shown preferred willingness to adopt sanitisation measures, often by cleaning their hands with soap and water, and restricting any movement inside and outside of the house. Three-fourth of the respondents considered washing their hands after returning from outside an important measure to limit the spread of the disease. Moreover, two-third of the people stopped ordering food from outside as a prevention strategy. Furthermore, only about 36% of the respondents showed interest in stocking up on grocery items as their most preferred choice, reflecting that this was considered to be the least important of all choices. Research outcomes of this study will help policymakers to better understand mitigation options that are used in the early and later stages of the lockdown to improve resilience from such viruses. Further, it will assist decision-makers to understand the range of individual-level practices adopted by stakeholders to mitigate disease transmission at the community level and inform the government's planning efforts in the future.

Impact of nonpharmacological COVID-19 interventions in hospitalizations for childhood pneumonia in Brazil

BACKGROUND AND OBJECTIVE

The knowledge about the impact of the nonpharmacological measures to control the COVID-19 pandemic can give insight into ways in which they can also be applied for other respiratory diseases. To assess the impact of containment measures of the COVID-19 pandemic on pneumonia hospitalizations in children from 0 to 14 years of age in Brazil.

METHODS

Data from hospital admissions for pneumonia were obtained from the Department of Informatics of Brazilian Public Health System database in the period of 2015-2020 and analyzed by macroregions and age groups. To evaluate the effect of containment measures, on the incidence of pneumonia, the absolute reduction and relative reduction were calculated by analyzing the subsets 2015-2019 vs. 2020.

RESULTS

Comparing the subsets of April-August 2015-2019 vs. April-August 2020 for Brazil (total), there was an significant reduction in the average incidence of hospitalizations, with numbers ranging from -82% [IRR 0.17 (0.14-0.21)] for <4 years (prepandemic 741.8/100,000 vs. pandemic 132.7/100.000), -83% [IRR 0.17 (0.10-0.27)] for 5-9 years (prepandemic 113.6/100,000 vs. pandemic 19.6/100.000), -77% [IRR 0.23 (0.11-0.46)] for 10-14 (prepandemic 42.0/100,000 vs. pandemic 9.8/100.000) and -82% [IRR 0.18 (0.15-0.21)] for all children ≤14 years (prepandemic 897.4/100,000 vs. pandemic 162.1/100.000).

CONCLUSION

We found a significant decrease in cases of all cause pneumonia in children under 14 years and especially in the age group <9 years during the COVID-19 pandemic, which may be associated with the nonpharmacological measures applied to control the SARS-CoV-2.

Home Quarantine Induced Health Anxiety During the Beginning of the COVID-19 Pandemic - Evidence From Iraq

OBJECTIVE

This study aimed to assess the compliance to voluntary home quarantine and to examine the prevalence and associated factors of health anxiety among the voluntary home quarantined population during the onset of the coronavirus disease (COVID-19) pandemic.

METHODS

An online survey questionnaire, including the health anxiety questionnaire, was administered to 1578 eligible adults from the general population of 19 governorates of Iraq.

RESULTS

Self-reported compliance with home confinement was reported by a majority of respondents (83%) and was followed to a larger extent by young adults (62.2%), females (53.9%), unmarried individuals (56.7%), university graduates (54.5%), unemployed individuals (48.6%), and inhabitants of the northern provinces (50.2%). Compliance was significantly correlated to the level of personal knowledge on COVID-19. The quarantined individuals experienced greater health anxieties and preoccupations and exhibited increased reassurance-seeking behavior. Higher knowledge of COVID-19 was a protective factor against health anxiety.

CONCLUSIONS

A significant mental health burden is discovered among Iraqis during the quarantine period. Based on the insights gleaned from this study, psychological education and interventions should be prioritized to diminish the psychological impact of the quarantine experience, especially among the high-risk groups. Improvement in compliance to quarantine can be approached by providing better information regarding the novel infection.

An Assessment of Social Distancing Obedience Behavior during the COVID-19 Post-Epidemic Period in China: A Cross-Sectional Survey

Social distancing plays a critical role in reducing the disease diffusion risk during the COVID-19 pandemic and post-pandemic period. In order to explore the social distancing obedience behavior, a comprehensive survey was conducted in this study by collecting data from 1064 Chinese residents in January 2021 by means of a questionnaire. Structural equation modeling (SEM) and hierarchical linear regression (HLR) analyses were employed to investigate the research hypotheses considered, testing the three influencing factors of social distancing obedience behavior: public guidance, risk perception, and regulation punishment. The reliability and validity of the measurements are demonstrated. The outcomes from the conducted analyses show that the public guidance significantly affects risk perception of individuals, while risk perception imposes a positive impact on social distancing obedience behavior. Moreover, risk perception serves a mediating role in the relationship between the public guidance and social distancing obedience behavior. In addition, regulation punishment positively predicts social distancing obedience behavior and could even have a greater effect by enhancing risk perception. Hence, this study suggests that the relevant authorities and agencies implement strong social distancing policies during the COVID-19 post-pandemic period from the perspective of promoting the public guidance, risk perception, and regulation punishment.

Wearing a mask-For yourself or for others? Behavioral correlates of mask wearing among COVID-19 frontline workers

Human behavior can have effects on oneself and externalities on others. Mask wearing is such a behavior in the current pandemic. What motivates people to wear face masks in public when mask wearing is voluntary or not enforced? Which benefits should the policy makers rather emphasize in information campaigns-the reduced chances of getting the SARS-CoV-2 virus (benefits for oneself) or the reduced chances of transmitting the virus (benefits for others in the society)? In this paper, we link measured risk preferences and other-regarding preferences to mask wearing habits among 840 surveyed employees of two large Swiss hospitals. We find that the leading mask-wearing motivations change with age: While for older people, mask wearing habits are best explained by their self-regarding risk preferences, younger people are also motivated by other-regarding concerns. Our results are robust to different specifications including linear probability models, probit models and Lasso covariate selection models. Our findings thus allow drawing policy implications for effectively communicating public-health recommendations to frontline workers during the COVID-19 pandemic.

Evaluation of COVID-19 Mitigation Policies in Australia Using Generalised Space-Time Autoregressive Intervention Models

In handling the COVID-19 pandemic, various mitigation policies aiming at slowing the spread and protecting all individuals, especially the vulnerable ones, were implemented. A careful evaluation of the effectiveness of these policies is necessary so that policy-makers can implement informed decisions if another wave of COVID-19 or another pandemic happens in the future. This paper reports an assessment of some policies introduced by the Australian governments using a generalised space-time autoregressive model which incorporates multiple exogenous variables and delay effects. Our results show that the number of daily new cases from the states and territories are influenced by both temporal and spatial aspects. Business and border restrictions are found helpful in reducing the number of new cases a few days after implementation while gathering restrictions may not be effective.

Reducing influenza virus transmission: the value of antiviral treatment

Prompt antiviral treatment has the potential to reduce influenza virus transmission to close contacts, but rigorous data on the magnitude of treatment effects on transmission are limited. Animal model data indicate that rapid reductions in viral replication after antiviral treatment reduce the risk of transmission. Observational and clinical trial data with oseltamivir and other neuraminidase inhibitors indicate that prompt treatment of household index patients seems to reduce the risk of illness in contacts, although the magnitude of the reported effects has varied widely across studies. In addition, the potential risk of transmitting drug-resistant variants exists with all approved classes of influenza antivirals. A controlled trial examining baloxavir treatment efficacy to reduce transmission, including the risk of transmitting virus with reduced baloxavir susceptibility, is currently in progress. If reduced transmission risk is confirmed, modeling studies indicate that early treatment could have major epidemiologic benefits in seasonal and pandemic influenza.

Government responses and COVID-19 deaths: Global evidence across multiple pandemic waves

We provide an assessment of the impact of government closure and containment measures on deaths from COVID-19 across sequential waves of the COVID-19 pandemic globally. Daily data was collected on a range of containment and closure policies for 186 countries from January 1, 2020 until March 11th, 2021. These data were combined into an aggregate stringency index (SI) score for each country on each day (range: 0-100). Countries were divided into successive waves via a mathematical algorithm to identify peaks and troughs of disease. Within our period of analysis, 63 countries experienced at least one wave, 40 countries experienced two waves, and 10 countries saw three waves, as defined by our approach. Within each wave, regression was used to assess the relationship between the strength of government stringency and subsequent deaths related to COVID-19 with a number of controls for time and country-specific demographic, health system, and economic characteristics. Across the full period of our analysis and 113 countries, an increase of 10 points on the SI was linked to 6 percentage points (P < 0.001, 95% CI = [5%, 7%]) lower average daily deaths. In the first wave, in countries that ultimately experiences 3 waves of the pandemic to date, ten additional points on the SI resulted in lower average daily deaths by 21 percentage points (P < .001, 95% CI = [8%, 16%]). This effect was sustained in the third wave with reductions in deaths of 28 percentage points (P < .001, 95% CI = [13%, 21%]). Moreover, interaction effects show that government policies were effective in reducing deaths in all waves in all groups of countries. These findings highlight the enduring importance of non-pharmaceutical responses to COVID-19 over time.

Impact of Public Health Interventions on Seasonal Influenza Activity During the COVID-19 Outbreak in Korea

Background

COVID-19 was introduced in Korea early and experienced a large outbreak in mid-February. We aimed to review the public health interventions used during the COVID-19 outbreak and describe the impact on seasonal influenza activity in Korea.

Methods

National response strategies and public health interventions, along with daily COVID-19 confirmed cases in Korea were reviewed during the pandemic. National influenza surveillance data were compared between seven sequential seasons. Characteristics of each season, including the rate of influenza-like illness (ILI), duration of epidemic, date of termination of epidemic, distribution of influenza virus strain and hospitalization were analyzed.

Results

After various public health interventions including enforced public education on hand hygiene, cough etiquette and staying at home with respiratory symptoms, universal mask use in public places, refrain from non-essential social activities and school closure, the duration of the influenza epidemic in 2019/2020 decreased by 6-12 weeks and the influenza activity peak rated 49.8 ILI/1,000 visits compared to 71.9-86.2 ILI/1,000 visits of previous seasons. During the period of enforced social distancing from week 9 to 17 of 2020, influenza hospitalization cases were 11.9-26.9-fold lower compared with previous seasons. During the 2019/2020 season, influenza B accounted for only 4%, in contrast with previous seasons in which influenza B accounted for 26.6% to 54.9% of all cases.

Conclusions

Efforts to activate high level national response not only led to a decrease in COVID-19, but also substantial decrease in seasonal influenza activity. Interventions applied to control COVID-19 may serve as useful strategies for prevention and control of influenza in upcoming seasons.

Deep learning-based bird eye view social distancing monitoring using surveillance video for curbing the COVID-19 spread

The escalating transmission intensity of COVID-19 pandemic is straining the healthcare systems worldwide. Due to the unavailability of effective pharmaceutical treatment and vaccines, monitoring social distancing is the only viable tool to strive against asymptomatic transmission. Pertaining to the need of monitoring the social distancing at populated areas, a novel bird eye view computer vision-based framework implementing deep learning and utilizing surveillance video is proposed. This proposed method employs YOLO v3 object detection model and uses key point regressor to detect the key feature points. Additionally, as the massive crowd is detected, the bounding boxes on objects are received, and red boxes are also visible if social distancing is violated. When empirically tested over real-time data, proposed method is established to be efficacious than the existing approaches in terms of inference time and frame rate.

Assessing the Effect of Global Travel and Contact Restrictions on Mitigating the COVID-19 Pandemic

Travel restrictions and physical distancing have been implemented across the world to mitigate the coronavirus disease 2019 (COVID-19) pandemic, but studies are needed to understand their effectiveness across regions and time. Based on the population mobility metrics derived from mobile phone geolocation data across 135 countries or territories during the first wave of the pandemic in 2020, we built a metapopulation epidemiological model to measure the effect of travel and contact restrictions on containing COVID-19 outbreaks across regions. We found that if these interventions had not been deployed, the cumulative number of cases could have shown a 97-fold (interquartile range 79-116) increase, as of May 31, 2020. However, their effectiveness depended upon the timing, duration, and intensity of the interventions, with variations in case severity seen across populations, regions, and seasons. Additionally, before effective vaccines are widely available and herd immunity is achieved, our results emphasize that a certain degree of physical distancing at the relaxation of the intervention stage will likely be needed to avoid rapid resurgences and subsequent lockdowns.

Psychological and Demographic Determinants of Substance Use and Mental Health During the COVID-19 Pandemic

Background: Alcohol consumption and distress have increased among Canadians since the start of the COVID-19 pandemic. Methods: We examined whether sociodemographic and COVID-19-related worries are associated with various combinations of alcohol consumption and comorbid psychological distress variables among a Canadian sample of adults. Data were derived from a sample of Canadian adults (N = 1,005, 49.6% female) who participated in an online survey in May 2020. Four multivariate ordinal logistic regression models were used to estimate the odds of binge drinking, increased alcohol consumption during the pandemic, and psychological distress. Predictor variables used in the analyses included self-reported sociodemographic characteristics, financial worries, COVID-19 impact on work, and worrying about getting ill. Results: Women were found to have higher odds of increased drinking and anxiety. Also being divorced, separated, or widowed was associated with higher odds of binge drinking and anxiety, and binge drinking and depression. Furthermore, being 60 or older was associated with lower odds of binge drinking and depression and increased drinking and depression, as well as lower odds of increased drinking and depression and increased drinking and anxiety. High income groups were associated with higher odds of binge drinking, increased drinking, and mental distress. Compared to those less worried, being very worried about finances were associated with higher odds of binge drinking and anxiety, increased drinking and anxiety, and increased drinking and depression. Also, being very worried about getting ill with COVID was associated with higher odds of binge drinking and anxiety and increased drinking and anxiety. Conclusion: Our findings identify several demographic and COVID-related worries for increased odds of alcohol intake and co-morbid psychological distress during the COVID-19 pandemic, including identifying as a woman, high income groups, being divorced, separated or widowed, and experiencing financial worries and COVID illness worries. These characteristics should be considered when developing prevention and treatment programs for adults with problematic alcohol use and comorbid anxiety and depression.

Inter-provincial disparity of COVID-19 transmission and control in Nepal

Despite the global efforts to mitigate the ongoing COVID-19 pandemic, the disease transmission and the effective controls still remain uncertain as the outcome of the epidemic varies from place to place. In this regard, the province-wise data from Nepal provides a unique opportunity to study the effective control strategies. This is because (a) some provinces of Nepal share an open-border with India, resulting in a significantly high inflow of COVID-19 cases from India; (b) despite the inflow of a considerable number of cases, the local spread was quite controlled until mid-June of 2020, presumably due to control policies implemented; and (c) the relaxation of policies caused a rapid surge of the COVID-19 cases, providing a multi-phasic trend of disease dynamics. In this study, we used this unique data set to explore the inter-provincial disparities of the important indicators, such as epidemic trend, epidemic growth rate, and reproduction numbers. Furthermore, we extended our analysis to identify prevention and control policies that are effective in altering these indicators. Our analysis identified a noticeable inter-province variation in the epidemic trend (3 per day to 104 per day linear increase during third surge period), the median daily growth rate (1 to 4% per day exponential growth), the basic reproduction number (0.71 to 1.21), and the effective reproduction number (maximum values ranging from 1.20 to 2.86). Importantly, results from our modeling show that the type and number of control strategies that are effective in altering the indicators vary among provinces, underscoring the need for province-focused strategies along with the national-level strategy in order to ensure the control of a local spread.

A scoping review of research on the determinants of adherence to social distancing measures during the COVID-19 pandemic

This scoping review focused on answering key questions about the focus, quality and generalisability of the quantitative evidence on the determinants of adherence to social distancing measures in research during the first wave of COVID-19. The review included 84 studies. The majority of included studies were conducted in Western Europe and the USA. Many lacked theoretical input, were at risk for bias, and few were experimental in design. The most commonly coded domains of the TDF in the included studies were 'Environmental Context and Resources' (388 codes across 76 studies), 'Beliefs about Consequences' (34 codes across 21 studies), 'Emotion' (28 codes across 12 studies), and 'Social Influences' (26 codes across 16 studies). The least frequently coded TDF domains included 'Optimism' (not coded), 'Intentions' (coded once), 'Goals' (2 codes across 2 studies), 'Reinforcement' (3 codes across 2 studies), and 'Behavioural Regulation' (3 codes across 3 studies). Examining the focus of the included studies identified a lack of studies on potentially important determinants of adherence such as reinforcement, goal setting and self-monitoring. The quality of the included studies was variable and their generalisablity was threatened by their reliance on convenience samples.