1451
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Beckett SJ, Dominguez-Mirazo M, Lee S, Andris C, Weitz JS. Spread of COVID-19 through Georgia, USA. Near-term projections and impacts of social distancing via a metapopulation model. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.28.20115642. [PMID: 32511490 PMCID: PMC7273258 DOI: 10.1101/2020.05.28.20115642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Epidemiological forecasts of COVID-19 spread at the country and/or state level have helped shape public health interventions. However, such models leave a scale-gap between the spatial resolution of actionable information (i.e. the county or city level) and that of modeled viral spread. States and nations are not spatially homogeneous and different areas may vary in disease risk and severity. For example, COVID-19 has age-stratified risk. Similarly, ICU units, PPE and other vital equipment are not equally distributed within states. Here, we implement a county-level epidemiological framework to assess and forecast COVID-19 spread through Georgia, where 1,933 people have died from COVID-19 and 44,638 cases have been documented as of May 27, 2020. We find that county-level forecasts trained on heterogeneity due to clustered events can continue to predict epidemic spread over multi-week periods, potentially serving efforts to prepare medical resources, manage supply chains, and develop targeted public health interventions. We find that the premature removal of physical (social) distancing could lead to rapid increases in cases or the emergence of sustained plateaus of elevated fatalities.
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1452
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Williamson B. Beyond COVID‐19 lockdown: A Coasean approach with optionality. ECONOMIC AFFAIRS 2020; 40:155-161. [PMCID: PMC7361444 DOI: 10.1111/ecaf.12414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Brian Williamson
- Economist, Partner at Communications ChambersLondonUnited Kingdom
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1453
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Dalton CB, Corbett SJ, Katelaris AL. COVID-19: implementing sustainable low cost physical distancing and enhanced hygiene. Med J Aust 2020; 212:443-446.e1. [PMID: 32356573 PMCID: PMC7267378 DOI: 10.5694/mja2.50602] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Stephen J Corbett
- Centre for Population HealthWestern Sydney Local Health DistrictSydneyNSW
| | - Anthea L Katelaris
- Centre for Population HealthWestern Sydney Local Health DistrictSydneyNSW
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1454
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Stutt ROJH, Retkute R, Bradley M, Gilligan CA, Colvin J. A modelling framework to assess the likely effectiveness of facemasks in combination with 'lock-down' in managing the COVID-19 pandemic. Proc Math Phys Eng Sci 2020; 476:20200376. [PMID: 32821237 PMCID: PMC7428039 DOI: 10.1098/rspa.2020.0376] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
COVID-19 is characterized by an infectious pre-symptomatic period, when newly infected individuals can unwittingly infect others. We are interested in what benefits facemasks could offer as a non-pharmaceutical intervention, especially in the settings where high-technology interventions, such as contact tracing using mobile apps or rapid case detection via molecular tests, are not sustainable. Here, we report the results of two mathematical models and show that facemask use by the public could make a major contribution to reducing the impact of the COVID-19 pandemic. Our intention is to provide a simple modelling framework to examine the dynamics of COVID-19 epidemics when facemasks are worn by the public, with or without imposed 'lock-down' periods. Our results are illustrated for a number of plausible values for parameter ranges describing epidemiological processes and mechanistic properties of facemasks, in the absence of current measurements for these values. We show that, when facemasks are used by the public all the time (not just from when symptoms first appear), the effective reproduction number, Re , can be decreased below 1, leading to the mitigation of epidemic spread. Under certain conditions, when lock-down periods are implemented in combination with 100% facemask use, there is vastly less disease spread, secondary and tertiary waves are flattened and the epidemic is brought under control. The effect occurs even when it is assumed that facemasks are only 50% effective at capturing exhaled virus inoculum with an equal or lower efficiency on inhalation. Facemask use by the public has been suggested to be ineffective because wearers may touch their faces more often, thus increasing the probability of contracting COVID-19. For completeness, our models show that facemask adoption provides population-level benefits, even in circumstances where wearers are placed at increased risk. At the time of writing, facemask use by the public has not been recommended in many countries, but a recommendation for wearing face-coverings has just been announced for Scotland. Even if facemask use began after the start of the first lock-down period, our results show that benefits could still accrue by reducing the risk of the occurrence of further COVID-19 waves. We examine the effects of different rates of facemask adoption without lock-down periods and show that, even at lower levels of adoption, benefits accrue to the facemask wearers. These analyses may explain why some countries, where adoption of facemask use by the public is around 100%, have experienced significantly lower rates of COVID-19 spread and associated deaths. We conclude that facemask use by the public, when used in combination with physical distancing or periods of lock-down, may provide an acceptable way of managing the COVID-19 pandemic and re-opening economic activity. These results are relevant to the developed as well as the developing world, where large numbers of people are resource poor, but fabrication of home-made, effective facemasks is possible. A key message from our analyses to aid the widespread adoption of facemasks would be: 'my mask protects you, your mask protects me'.
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Affiliation(s)
- Richard O. J. H. Stutt
- Epidemiology and Modelling Group, Department of Plant Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EA, UK
| | - Renata Retkute
- Epidemiology and Modelling Group, Department of Plant Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EA, UK
| | - Michael Bradley
- The Wolfson Centre for Bulk Solids Handling Technology, University of Greenwich, Chatham Maritime ME4 4TB, UK
| | - Christopher A. Gilligan
- Epidemiology and Modelling Group, Department of Plant Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EA, UK
| | - John Colvin
- Natural Resources Institute, University of Greenwich, Chatham Maritime ME4 4TB, UK
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1455
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Oliver N, Lepri B, Sterly H, Lambiotte R, Deletaille S, De Nadai M, Letouzé E, Salah AA, Benjamins R, Cattuto C, Colizza V, de Cordes N, Fraiberger SP, Koebe T, Lehmann S, Murillo J, Pentland A, Pham PN, Pivetta F, Saramäki J, Scarpino SV, Tizzoni M, Verhulst S, Vinck P. Mobile phone data for informing public health actions across the COVID-19 pandemic life cycle. SCIENCE ADVANCES 2020; 6:eabc0764. [PMID: 32548274 PMCID: PMC7274807 DOI: 10.1126/sciadv.abc0764] [Citation(s) in RCA: 278] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 05/19/2023]
Affiliation(s)
- Nuria Oliver
- ELLIS, the European Laboratory for Learning and Intelligent Systems, Alicante, Spain
- DataPop Alliance, New York, NY, USA
| | - Bruno Lepri
- DataPop Alliance, New York, NY, USA
- Fondazione Bruno Kessler, Trento, Italy
| | | | - Renaud Lambiotte
- University of Oxford, Oxford, UK
- The Alan Turing Institute, London, UK
| | | | | | - Emmanuel Letouzé
- DataPop Alliance, New York, NY, USA
- Open Algorithms (OPAL) collaborative project, New York, NY, USA
| | - Albert Ali Salah
- DataPop Alliance, New York, NY, USA
- Utrecht University, Utrecht, Netherlands
| | | | - Ciro Cattuto
- University of Turin, Turin, Italy
- Orange Group, Paris, France
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | - Till Koebe
- DataPop Alliance, New York, NY, USA
- Freie University, Berlin, Germany
| | - Sune Lehmann
- Technical University of Denmark, Copenhagen, Denmark
| | | | - Alex Pentland
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Phuong N Pham
- DataPop Alliance, New York, NY, USA
- Harvard University, Cambridge, MA, USA
| | | | | | | | | | | | - Patrick Vinck
- DataPop Alliance, New York, NY, USA
- Harvard University, Cambridge, MA, USA
- Corresponding author.
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1456
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Siedner MJ, Harling G, Derache A, Smit T, Khoza T, Gunda R, Mngomezulu T, Gareta D, Majozi N, Ehlers E, Dreyer J, Nxumalo S, Dayi N, Ording-Jesperson G, Ngwenya N, Wong E, Iwuji C, Shahmanesh M, Seeley J, De Oliveira T, Ndung'u T, Hanekom W, Herbst K. Protocol: Leveraging a demographic and health surveillance system for Covid-19 Surveillance in rural KwaZulu-Natal. Wellcome Open Res 2020; 5:109. [PMID: 32802963 PMCID: PMC7424917 DOI: 10.12688/wellcomeopenres.15949.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 12/28/2022] Open
Abstract
A coordinated system of disease surveillance will be critical to effectively control the coronavirus disease 2019 (Covid-19) pandemic. Such systems enable rapid detection and mapping of epidemics and inform allocation of scarce prevention and intervention resources. Although many lower- and middle-income settings lack infrastructure for optimal disease surveillance, health and demographic surveillance systems (HDSS) provide a unique opportunity for epidemic monitoring. This protocol describes a surveillance program at the Africa Health Research Institute's Population Intervention Platform site in northern KwaZulu-Natal. The program leverages a longstanding HDSS in a rural, resource-limited setting with very high prevalence of HIV and tuberculosis to perform Covid-19 surveillance. Our primary aims include: describing the epidemiology of the Covid-19 epidemic in rural KwaZulu-Natal; determining the impact of the Covid-19 outbreak and non-pharmaceutical control interventions (NPI) on behaviour and wellbeing; determining the impact of HIV and tuberculosis on Covid-19 susceptibility; and using collected data to support the local public-sector health response. The program involves telephone-based interviews with over 20,000 households every four months, plus a sub-study calling 750 households every two weeks. Each call asks a household representative how the epidemic and NPI are affecting the household and conducts a Covid-19 risk screen for all resident members. Any individuals screening positive are invited to a clinical screen, potential test and referral to necessary care - conducted in-person near their home following careful risk minimization procedures. In this protocol we report the details of our cohort design, questionnaires, data and reporting structures, and standard operating procedures in hopes that our project can inform similar efforts elsewhere.
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Affiliation(s)
- Mark J. Siedner
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Guy Harling
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anne Derache
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | | | - Dickman Gareta
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | | | - Eugene Ehlers
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Siyabonga Nxumalo
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Njabulo Dayi
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | | | - Nothando Ngwenya
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Emily Wong
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Collins Iwuji
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Janet Seeley
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Global Health and Development Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Tulio De Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP)), School of Laboratory Medicine and Medical Sciences, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
- Department of Global Health, University of Washington, Seattle, USA
| | - Thumbi Ndung'u
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - Willem Hanekom
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Kobus Herbst
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- SAPRIN, South African Medical Research Council, Cape Town, South Africa
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1457
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Massaroni C, Nicolò A, Schena E, Sacchetti M. Remote Respiratory Monitoring in the Time of COVID-19. Front Physiol 2020; 11:635. [PMID: 32574240 PMCID: PMC7274133 DOI: 10.3389/fphys.2020.00635] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
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1458
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Walger P, Heininger U, Knuf M, Exner M, Popp W, Fischbach T, Trapp S, Hübner J, Herr C, Simon A. Children and adolescents in the CoVid-19 pandemic: Schools and daycare centers are to be opened again without restrictions. The protection of teachers, educators, carers and parents and the general hygiene rules do not conflict with this. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc11. [PMID: 32547911 PMCID: PMC7273848 DOI: 10.3205/dgkh000346] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the opinion of the medical societies of hygiene and pediatrics undersigning the present statement, the analyses published to date regarding transmission of SARS-CoV-2 and the course of CoVid-19 show that children play a much less significant role in the spread of the virus than do adults. According to the findings available to date, not only do children and adolescents less frequently fall ill with CoVid-19, they also generally become less severely ill than do adults. The vast majority of infections in children and adolescents are asymptomatic or oligosymptomatic. Even the first analyses from China demonstrated that children and adolescents play a subordinate role in the transmission of the virus – not only to other children and adolescents, but also to adults. Taking into account regional infection rates and available resources, daycare centers, kindergartens and elementary schools promptly should be reopened. For children, this should be possible without excessive restrictions, such as clustering into very small groups, implementation of barrier precautions, maintaining appropriate distance from others or wearing masks. A factor more decisive than individual group size is the issue of sustaining the constancy of respective group members and the avoidance of intermixing. Children can be taught basic rules of hygiene such as handwashing and careful hygiene behavior when coming into contact with others during mealtimes and/or when using sanitary facilities. Independent of the prevention measures implemented for children and adolescents, the protection of teachers, educators and caregivers is crucial, (e.g., the maintenance of appropriate distance from others, use of medical masks, situation-dependent hand disinfection, when necessary, supported by regular pool testing). Children over the age of 10 and adolescents up to school graduation age are more capable of actively understanding and conforming to specific hygiene rules. For this group, maintaining appropriate distance from others (1.5 meters), wearing a mouth-and-nose protection (whenever they are not sitting in their assigned classroom seats) and consistent education regarding the basic rules of infection prevention may provide increased options for normalizing teaching activities. Children and adolescents suspected of infection with SARS-CoV-2 should be tested immediately in order to either confirm or rule out such an infection. Evidence of individual infections in children or students must not automatically lead to the closure of the entire daycare center or school. A detailed analysis of the chain of infection is a prerequisite for a balanced approach to infection control. The opening of schools and children’s facilities should be accompanied by specifically structured, model surveillance studies that further clarify outstanding questions about infectious disease events and hygiene control. These prospective, concomitant examinations will be essential for the purpose of evaluating and verifying the effectiveness of the required hygiene measures.
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Affiliation(s)
- Peter Walger
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Ulrich Heininger
- German Academy for Pediatric and Adolescent Medicine (DAKJ), Berlin, Germany
| | - Markus Knuf
- German Academy for Pediatric and Adolescent Medicine (DAKJ), Berlin, Germany
| | - Martin Exner
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Walter Popp
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Thomas Fischbach
- Professional Association of Pediatricians in Germany (bvkj e.V.), Cologne, Germany
| | - Stefan Trapp
- Professional Association of Pediatricians in Germany (bvkj e.V.), Cologne, Germany
| | - Johannes Hübner
- German Society for Pediatric Infectious Diseases (DGPI), Berlin, Germany
| | - Caroline Herr
- Society of Hygiene, Environmental and Public Health Sciences (GHUP), Munich, Germany
| | - Arne Simon
- German Society for Pediatric Infectious Diseases (DGPI), Berlin, Germany
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1459
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Lam TTY. Tracking the Genomic Footprints of SARS-CoV-2 Transmission. Trends Genet 2020; 36:544-546. [PMID: 32527617 PMCID: PMC7253973 DOI: 10.1016/j.tig.2020.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
There is considerable public and scientific interest in the origin, spread, and evolution of SARS-CoV-2. Lu et al. recently conducted genomic sequencing and analysis of SARS-CoV-2 in Guangdong, revealing its early transmission out of Hubei and shedding light on the effectiveness of controlling local transmission chains.
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Affiliation(s)
- Tommy Tsan-Yuk Lam
- State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong SAR, China.
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1460
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Elective Surgery during SARS-Cov-2/COVID-19 Pandemic: Safety Protocols with Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2973. [PMID: 32766088 PMCID: PMC7339337 DOI: 10.1097/gox.0000000000002973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022]
Abstract
Background: Health care systems worldwide have been affected by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emergence since December 2019. The coronavirus disease 2019 (COVID-19) pandemic caused a steep decrease in elective surgery scheduling, to the extent of complete cancellation without future planning of safe development. Purpose: We performed a review of the literature and diagnosis data analysis with the aim to reduce the risk of operating a patient infected with SARS-CoV-2/COVID-19 during the incubation period. Methods: We searched for specific words and phrases about SARS-CoV-2 and COVID-19 in the PubMed database (US National Library of Medicine) from December 2019 to April 2020. A detailed analysis of the clinical picture and existing diagnostic tests for COVID-19 was performed to achieve the desired objectives. Results: A total of 1273 out of 5930 articles about COVID-19/SARS-CoV-2 did meet the criteria for the searched terms. We reviewed 105 articles, and 60 were selected for analysis. Specific recommendations were described based on our revision. Conclusions: With the combination of immunoglobulin M and immunoglobulin G antibody tests + real-time polymerase chain reaction for SARS-CoV-2 implemented in different time periods by taking into account the natural history of the disease, it is possible to decrease the risk of operating a patient during the incubation period higher than 93%. Adding other security measures can further increase this percentage. As long as there is no immunity to COVID-19, these measures will help us to perform safer elective surgeries.
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1461
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Aleta A, Moreno Y. Evaluation of the potential incidence of COVID-19 and effectiveness of containment measures in Spain: a data-driven approach. BMC Med 2020; 18:157. [PMID: 32456689 PMCID: PMC7250661 DOI: 10.1186/s12916-020-01619-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We are currently experiencing an unprecedented challenge, managing and containing an outbreak of a new coronavirus disease known as COVID-19. While China-where the outbreak started-seems to have been able to contain the growth of the epidemic, different outbreaks are nowadays present in multiple countries. Nonetheless, authorities have taken action and implemented containment measures, even if not everything is known. METHODS To facilitate this task, we have studied the effect of different containment strategies that can be put into effect. Our work referred initially to the situation in Spain as of February 28, 2020, where a few dozens of cases had been detected, but has been updated to match the current situation as of 13 April. We implemented an SEIR metapopulation model that allows tracing explicitly the spatial spread of the disease through data-driven stochastic simulations. RESULTS Our results are in line with the most recent recommendations from the World Health Organization, namely, that the best strategy is the early detection and isolation of individuals with symptoms, followed by interventions and public recommendations aimed at reducing the transmissibility of the disease, which, although might not be sufficient for disease eradication, would produce as a second order effect a delay of several days in the raise of the number of infected cases. CONCLUSIONS Many quantitative aspects of the natural history of the disease are still unknown, such as the amount of possible asymptomatic spreading or the role of age in both the susceptibility and mortality of the disease. However, preparedness plans and mitigation interventions should be ready for quick and efficacious deployment globally. The scenarios evaluated here through data-driven simulations indicate that measures aimed at reducing individuals' flow are much less effective than others intended for early case identification and isolation. Therefore, resources should be directed towards detecting as many and as fast as possible the new cases and isolate them.
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Affiliation(s)
- Alberto Aleta
- ISI Foundation, Via Chisola 5, Torino, 10126, Italy.
| | - Yamir Moreno
- ISI Foundation, Via Chisola 5, Torino, 10126, Italy.,Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, 50018, Spain.,Department of Theoretical Physics, University of Zaragoza, Zaragoza, 50018, Spain
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1462
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Marín-Gabriel JC, Santiago ERD. AEG-SEED position paper for the resumption of endoscopic activity after the peak phase of the COVID-19 pandemic. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:389-407. [PMID: 32561216 PMCID: PMC7250749 DOI: 10.1016/j.gastrohep.2020.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022]
Abstract
Introducción La pandemia por COVID-19 ha conllevado la suspensión de la actividad programada en la mayoría de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscópica electiva de forma eficiente y segura. Material y métodos Se formuló una serie de preguntas consideradas de relevancia clínica y logística. Para la elaboración de las respuestas, se realizó una búsqueda bibliográfica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Pública y de endoscopia digestiva. Las recomendaciones finales se consensuaron por vía telemática. Resultados Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) la reevaluación y priorización de la indicación; 2) la restructuración de espacios, agendas y del personal sanitario; 3) el cribado de la infección, y 4) las medidas de higiene y los equipos de protección individual. Conclusión La AEG y la SEED recomiendan reiniciar la actividad endoscópica de forma escalonada, segura, adaptada a los recursos locales y a la situación epidemiológica de la infección por SARS-CoV-2.
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Affiliation(s)
- José Carlos Marín-Gabriel
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Consulta de Alto Riesgo, Hospital Universitario 12 de Octubre, Instituto de Investigación «i+12», Madrid, España.
| | - Enrique Rodríguez de Santiago
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, España
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1463
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Bizzoca ME, Campisi G, Lo Muzio L. Covid-19 Pandemic: What Changes for Dentists and Oral Medicine Experts? A Narrative Review and Novel Approaches to Infection Containment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3793. [PMID: 32471083 PMCID: PMC7312076 DOI: 10.3390/ijerph17113793] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 12/22/2022]
Abstract
The authors performed a narrative review on Severe Acute Respiratory Syndrome- CoronaVirus-2 ( SARS-CoV-2) and all infectious agents with the primary endpoints to illustrate the most accepted models of safety protocols in dentistry and oral medicine, and to propose an easy view of the problem and a comparison (pre- vs post-COVID19) for the most common dental procedures. The outcome is forecast to help dentists to individuate for a given procedure the differences in terms of safety protocols to avoid infectious contagion (by SARS-CoV-2 and others dangerous agents). An investigation was performed on the online databases Pubmed and Scopus using a combination of free words and Medical Subject Headings (MESH) terms: "dentist" OR "oral health" AND "COVID-19" OR "SARS-CoV-2" OR "coronavirus-19". After a brief excursus on all infectious agents transmittable at the dental chair, the authors described all the personal protective equipment (PPE) actually on the market and their indications, and on the basis of the literature, they compared (before and after COVID-19 onset) the correct safety procedures for each dental practice studied, underlining the danger of underestimating, in general, dental cross-infections. The authors have highlighted the importance of knowing exactly the risk of infections in the dental practice, and to modulate correctly the use of PPE, in order to invest adequate financial resources and to avoid exposing both the dental team and patients to preventable risks.
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Affiliation(s)
- Maria Eleonora Bizzoca
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90121 Palermo, Italy;
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
- C.I.N.B.O. (Consorzio Interuniversitario Nazionale per la Bio-Oncologia), 66100 Chieti, Italy
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1464
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Bousquet J, Anto JM, Iaccarino G, Czarlewski W, Haahtela T, Anto A, Akdis CA, Blain H, Canonica GW, Cardona V, Cruz AA, Illario M, Ivancevich JC, Jutel M, Klimek L, Kuna P, Laune D, Larenas-Linnemann D, Mullol J, Papadopoulos NG, Pfaar O, Samolinski B, Valiulis A, Yorgancioglu A, Zuberbier T. Is diet partly responsible for differences in COVID-19 death rates between and within countries? Clin Transl Allergy 2020; 10:16. [PMID: 32499909 PMCID: PMC7250534 DOI: 10.1186/s13601-020-00323-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023] Open
Abstract
Reported COVID-19 deaths in Germany are relatively low as compared to many European countries. Among the several explanations proposed, an early and large testing of the population was put forward. Most current debates on COVID-19 focus on the differences among countries, but little attention has been given to regional differences and diet. The low-death rate European countries (e.g. Austria, Baltic States, Czech Republic, Finland, Norway, Poland, Slovakia) have used different quarantine and/or confinement times and methods and none have performed as many early tests as Germany. Among other factors that may be significant are the dietary habits. It seems that some foods largely used in these countries may reduce angiotensin-converting enzyme activity or are anti-oxidants. Among the many possible areas of research, it might be important to understand diet and angiotensin-converting enzyme-2 (ACE2) levels in populations with different COVID-19 death rates since dietary interventions may be of great benefit.
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Affiliation(s)
- Jean Bousquet
- Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
- MACVIA-France, Montpellier, France
- CHU Montpellier, 273 Avenue d’Occitanie, 34090 Montpellier, France
| | - Josep M. Anto
- Centre for Research in Environmental Epidemiology (CREAL), ISGlobAL, Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | | | | | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Hubert Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France
- EA 2991, Euromov, University Montpellier, Montpellier, France
| | - G. Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan Italy
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron & ARADyAL research network, Barcelona, Spain
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil
| | - Maddalena Illario
- WHO GARD Planning Group, Salvador, Brazil
- Division for Health Innovation, Campania Region, Naples, Italy
| | - Juan Carlos Ivancevich
- Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
- Clinica Santa Isabel, Servicio de Alergia e Immunologia, Buenos Aires, Argentina
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Łódź, Poland
| | | | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Nikos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children’s Hospital, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, Athens General Children’s Hospital “P&A Kyriakou,”, University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Marburg, Germany
| | - Boleslaw Samolinski
- Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Arunas Valiulis
- Institute of Clinical Medicine & Institute of Health Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Torsten Zuberbier
- Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
- MACVIA-France, Montpellier, France
- CHU Montpellier, 273 Avenue d’Occitanie, 34090 Montpellier, France
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1465
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Protective effects of vaccinations and endemic infections on COVID-19: A hypothesis. Med Hypotheses 2020; 143:109849. [PMID: 32480250 PMCID: PMC7248637 DOI: 10.1016/j.mehy.2020.109849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 11/04/2022]
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1466
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Podile AR, Basu A. Opportunities, Challenges and Directions in Science and Technology for Tackling COVID-19. TRANSACTIONS OF THE INDIAN NATIONAL ACADEMY OF ENGINEERING : AN INTERNATIONAL JOURNAL OF ENGINEERING AND TECHNOLOGY 2020; 5:97-101. [PMID: 38624329 PMCID: PMC7250535 DOI: 10.1007/s41403-020-00111-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022]
Abstract
The ongoing global crisis due to Coronavirus disease-2019 (COVID-19) pandemic has caused an enormous socioeconomic burden. A novel coronavirus causing severe acute respiratory syndrome (SARS-CoV-2) that evolved from a virus infecting bats is responsible for COVID-19, first reported in the Chinese city of Wuhan. In the absence of any specific scientifically proven and clinically tested drug or vaccine against SARS-CoV-2, the virus is wreaking havoc across the world, claiming more than 2,50,000 lives in less than 5 months, and posed a global health emergency. The scientific community is relentlessly working on the design and testing of vaccines and antiviral drugs against the novel coronavirus, several of which have reached advanced stages of testing and are undergoing clinical trials. Here we discuss the recent advances and developments in understanding the etiology and epidemiology of the COVID-19 pandemic, the factors influencing the disease transmission, and the countermeasures adopted to combat and stop further spread of the disease.
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Affiliation(s)
- Appa Rao Podile
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, P.O. Central University Campus, Hyderabad, Telangana 500 046 India
| | - Anirban Basu
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, P.O. Central University Campus, Hyderabad, Telangana 500 046 India
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1467
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Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease, COVID-19, has demonstrated the devastating impact of a novel, infectious pathogen on a susceptible population. Here, we explain the basic concepts of herd immunity and discuss its implications in the context of COVID-19.
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Affiliation(s)
- Haley E Randolph
- Genetics, Genomics, and Systems Biology, University of Chicago, Chicago, IL, USA
| | - Luis B Barreiro
- Genetics, Genomics, and Systems Biology, University of Chicago, Chicago, IL, USA; Department of Medicine, Section of Genetic Medicine, University of Chicago, Chicago, IL 60637, USA; Committee on Immunology, University of Chicago, Chicago, IL 60637, USA.
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1468
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Friston KJ, Parr T, Zeidman P, Razi A, Flandin G, Daunizeau J, Hulme OJ, Billig AJ, Litvak V, Price CJ, Moran RJ, Lambert C. Second waves, social distancing, and the spread of COVID-19 across America. Wellcome Open Res 2020; 5:103. [PMID: 33954262 PMCID: PMC8063524 DOI: 10.12688/wellcomeopenres.15986.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 08/15/2023] Open
Abstract
We recently described a dynamic causal model of a COVID-19 outbreak within a single region. Here, we combine several of these (epidemic) models to create a (pandemic) model of viral spread among regions. Our focus is on a second wave of new cases that may result from loss of immunity-and the exchange of people between regions-and how mortality rates can be ameliorated under different strategic responses. In particular, we consider hard or soft social distancing strategies predicated on national (Federal) or regional (State) estimates of the prevalence of infection in the population. The modelling is demonstrated using timeseries of new cases and deaths from the United States to estimate the parameters of a factorial (compartmental) epidemiological model of each State and, crucially, coupling between States. Using Bayesian model reduction, we identify the effective connectivity between States that best explains the initial phases of the outbreak in the United States. Using the ensuing posterior parameter estimates, we then evaluate the likely outcomes of different policies in terms of mortality, working days lost due to lockdown and demands upon critical care. The provisional results of this modelling suggest that social distancing and loss of immunity are the two key factors that underwrite a return to endemic equilibrium.
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Affiliation(s)
- Karl J. Friston
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Thomas Parr
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Peter Zeidman
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Adeel Razi
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, 3800, Australia
| | - Guillaume Flandin
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Jean Daunizeau
- Institut du Cerveau et de la Moelle épinière, INSERM UMRS 1127, Paris, France
| | - Oliver J. Hulme
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- London Mathematical Laboratory, Hammersmith, UK
| | | | - Vladimir Litvak
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Catherine J. Price
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Rosalyn J. Moran
- Centre for Neuroimaging Science, Department of Neuroimaging, IoPPN, King's College London, London, UK
| | - Christian Lambert
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
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1469
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Bryant JE, Azman AS, Ferrari MJ, Arnold BF, Boni MF, Boum Y, Hayford K, Luquero FJ, Mina MJ, Rodriguez-Barraquer I, Wu JT, Wade D, Vernet G, Leung DT. Serology for SARS-CoV-2: Apprehensions, opportunities, and the path forward. Sci Immunol 2020; 5:5/47/eabc6347. [PMID: 32430309 DOI: 10.1126/sciimmunol.abc6347] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 01/15/2023]
Abstract
Serological testing for SARS-CoV-2 has enormous potential to contribute to COVID-19 pandemic response efforts. However, the required performance characteristics of antibody tests will critically depend on the use case (individual-level vs. population-level).
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Affiliation(s)
- Juliet E Bryant
- Laboratory of Emerging Pathogens, Fondation Mérieux, Lyon, France
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Médecins Sans Frontières, Geneva, Switzerland
| | - Matthew J Ferrari
- Department Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California San Francisco, CA, USA
| | - Maciej F Boni
- Department Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | | | - Kyla Hayford
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Michael J Mina
- Departments of Epidemiology and of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA USA
| | | | - Joseph T Wu
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Djibril Wade
- IRESSEF (Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation), Dakar, Senegal
| | - Guy Vernet
- Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
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1470
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Tam DY, Naimark D, Natarajan MK, Woodward G, Oakes G, Rahal M, Barrett K, Khan YA, Ximenes R, Mac S, Sander B, Wijeysundera HC. The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 Pandemic. Can J Cardiol 2020; 36:1308-1312. [PMID: 32447059 PMCID: PMC7241392 DOI: 10.1016/j.cjca.2020.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Abstract
In Ontario on March 16, 2020, a directive was issued to all acute care hospitals to halt nonessential procedures in anticipation of a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for 3 key groups of cardiovascular disease patients: coronary artery disease, valvular heart disease, and arrhythmias. We provided predictions based on COVID-19 epidemiology available in real-time, in 3 phases. First, in the initial crisis phase, in a worst case scenario, we showed that the potential number of waitlist related cardiac deaths would be orders of magnitude less than those who would die of COVID-19 if critical cardiac care resources were diverted to the care of COVID-19 patients. Second, with better local epidemiology data, we predicted that across 5 regions of Ontario, there may be insufficient resources to resume all elective outpatient cardiac procedures. Finally in the recovery phase, we showed that the estimated incremental growth in waitlist for all cardiac procedures is likely substantial. These outputs informed timely data-driven decisions during the COVID-19 pandemic regarding the provision of cardiovascular care.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Madhu K Natarajan
- Division of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Raphael Ximenes
- COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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1471
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Grifoni A, Weiskopf D, Ramirez SI, Mateus J, Dan JM, Moderbacher CR, Rawlings SA, Sutherland A, Premkumar L, Jadi RS, Marrama D, de Silva AM, Frazier A, Carlin AF, Greenbaum JA, Peters B, Krammer F, Smith DM, Crotty S, Sette A. Targets of T Cell Responses to SARS-CoV-2 Coronavirus in Humans with COVID-19 Disease and Unexposed Individuals. Cell 2020; 181:1489-1501.e15. [PMID: 32473127 PMCID: PMC7237901 DOI: 10.1016/j.cell.2020.05.015] [Citation(s) in RCA: 2627] [Impact Index Per Article: 656.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
Understanding adaptive immunity to SARS-CoV-2 is important for vaccine development, interpreting coronavirus disease 2019 (COVID-19) pathogenesis, and calibration of pandemic control measures. Using HLA class I and II predicted peptide "megapools," circulating SARS-CoV-2-specific CD8+ and CD4+ T cells were identified in ∼70% and 100% of COVID-19 convalescent patients, respectively. CD4+ T cell responses to spike, the main target of most vaccine efforts, were robust and correlated with the magnitude of the anti-SARS-CoV-2 IgG and IgA titers. The M, spike, and N proteins each accounted for 11%-27% of the total CD4+ response, with additional responses commonly targeting nsp3, nsp4, ORF3a, and ORF8, among others. For CD8+ T cells, spike and M were recognized, with at least eight SARS-CoV-2 ORFs targeted. Importantly, we detected SARS-CoV-2-reactive CD4+ T cells in ∼40%-60% of unexposed individuals, suggesting cross-reactive T cell recognition between circulating "common cold" coronaviruses and SARS-CoV-2.
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Affiliation(s)
- Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Sydney I Ramirez
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA
| | - Jose Mateus
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Jennifer M Dan
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA
| | | | - Stephen A Rawlings
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA
| | - Aaron Sutherland
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7290, USA
| | - Ramesh S Jadi
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7290, USA
| | - Daniel Marrama
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7290, USA
| | - April Frazier
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Aaron F Carlin
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA
| | - Jason A Greenbaum
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Bjoern Peters
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davey M Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA
| | - Shane Crotty
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA.
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA.
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1472
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Murru A, Manchia M, Hajek T, Nielsen RE, Rybakowski JK, Sani G, Schulze TG, Tondo L, Bauer M. Lithium's antiviral effects: a potential drug for CoViD-19 disease? Int J Bipolar Disord 2020; 8:21. [PMID: 32435920 PMCID: PMC7239605 DOI: 10.1186/s40345-020-00191-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its introduction in modern medicine, naturalistic observations emerged about possible uses of lithium treatment for conditions different from recurring affective disorders, for which it is still a first-line treatment option. Some evidence about the antiviral properties of lithium began in the early 1970s, when some reports found a reduction of labial-herpetic recurrences. The present review aims to present most of the pre-clinical and clinical evidence about lithium's ability to inhibit DNA and RNA viruses, including Coronaviridae, as well as the possible pathways and mechanisms involved in such antiviral activity. MAIN BODY Despite a broad number of in vitro studies, the rationale for the antiviral activity of lithium failed to translate into methodologically sound clinical studies demonstrating its antiviral efficacy. In addition, the tolerability of lithium as an antiviral agent should be addressed. In fact, treatment with lithium requires continuous monitoring of its serum levels in order to prevent acute toxicity and long-term side effects, most notably affecting the kidney and thyroid. Yet lithium reaches heterogeneous but bioequivalent concentrations in different tissues, and the anatomical compartment of the viral infection might underpin a different, lower need for tolerability concerns which need to be addressed. CONCLUSIONS Lithium presents a clear antiviral activity demonstrated at preclinical level, but that remains to be confirmed in clinical settings. In addition, the pleiotropic mechanisms of action of lithium may provide an insight for its possible use as antiviral agent targeting specific pathways.
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Affiliation(s)
- Andrea Murru
- Bipolar and Depressive Disorders Unit, IDIBAPS CIBERSAM, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - René E Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry-Aalborg University Hospital, Aalborg, Denmark
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
- Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August University Göttingen, Göttingen, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Genetic Epidemiology, Central Institute of Mental Health, Mannheim, Germany
| | - Leonardo Tondo
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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1473
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Maguire G. Better preventing and mitigating the effects of Covid-19. Future Sci OA 2020; 6:FSO586. [PMID: 32685190 PMCID: PMC7238752 DOI: 10.2144/fsoa-2020-0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/29/2020] [Indexed: 01/08/2023] Open
Abstract
Currently, there are no proven medical treatments against SARS-CoV-2, the virus responsible for Covid-19. In addition to the all important public health measures needed to prevent the spread of this disease, a number of strategies related to our exposome are recommended herein, to better prevent and mitigate the effects of a SARS-CoV-2 infection through enhancement of our immune system and reduction of inflammation.
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Affiliation(s)
- Greg Maguire
- BioRegenerative Sciences Inc., NeoGenesis Inc., San Diego, CA 94704, USA
- The California Physiological Society, Berkeley, CA 94704, USA
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1474
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Affiliation(s)
- Peter J Hotez
- Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, USA.
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1475
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Clemente-Suárez VJ, Hormeño-Holgado A, Jiménez M, Benitez-Agudelo JC, Navarro-Jiménez E, Perez-Palencia N, Maestre-Serrano R, Laborde-Cárdenas CC, Tornero-Aguilera JF. Dynamics of Population Immunity Due to the Herd Effect in the COVID-19 Pandemic. Vaccines (Basel) 2020; 8:E236. [PMID: 32438622 PMCID: PMC7349986 DOI: 10.3390/vaccines8020236] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
The novel Coronavirus 2 Severe Acute Respiratory Syndrome (SARS-Cov-2) has led to the Coronavirus Disease 2019 (COVID-19) pandemic, which has surprised health authorities around the world, quickly producing a global health crisis. Different actions to cope with this situation are being developed, including confinement, different treatments to improve symptoms, and the creation of the first vaccines. In epidemiology, herd immunity is presented as an area that could also solve this new global threat. In this review, we present the basis of herd immunology, the dynamics of infection transmission that induces specific immunity, and how the application of immunoepidemiology and herd immunology could be used to control the actual COVID-19 pandemic, along with a discussion of its effectiveness, limitations, and applications.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
- Studies Centre in Applied Combat (CESCA), Toledo 45007, Spain;
| | | | - Manuel Jiménez
- Departamento de Didáctica de la Educación Física y Salud, Universidad Internacional de La Rioja, Logroño 26006, Spain;
| | | | - Eduardo Navarro-Jiménez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080005, Colombia; (E.N.-J.); (R.M.-S.)
| | | | - Ronald Maestre-Serrano
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080005, Colombia; (E.N.-J.); (R.M.-S.)
| | | | - Jose Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Studies Centre in Applied Combat (CESCA), Toledo 45007, Spain;
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1476
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Moorkamp M, Torenvlied R, Kramer E. Organizational synthesis in transboundary crises: Three principles for managing centralization and coordination in the corona virus crisis response. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2020. [PMCID: PMC7276858 DOI: 10.1111/1468-5973.12294] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Boin (2019) argues that in transboundary crisis management it is almost impossible to achieve centralization and coordination. This article identifies three principles through which actors in a transboundary crisis can balance centralization with autonomy while shaping coordination along the way. We reanalysed three transboundary cases: the Dutch military mission in Afghanistan, the downing of MH17 and hurricane Irma striking Sint‐Maarten. The principles we found are as follows: (a) reformulating key strategic priorities, (b) flexible adaptation of crisis management protocols and (c) the emergence of multifunctional units. With these three principles, we reflect on challenges in the Dutch crisis response to the corona outbreak and propose improvements for progressing current crisis management efforts.
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Affiliation(s)
- Matthijs Moorkamp
- Institute for Management Research Radboud University Nijmegen Nijmegen The Netherlands
| | - René Torenvlied
- Department of Public Administration University of Twente Enschede The Netherlands
| | - Eric‐Hans Kramer
- Faculty of Military Sciences Netherlands Defense Academy Breda The Netherlands
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1477
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Reperant LA, Osterhaus ADME. COVID-19: losing battles or winning the war? ONE HEALTH OUTLOOK 2020; 2:9. [PMID: 32835169 PMCID: PMC7234818 DOI: 10.1186/s42522-020-00019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
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1478
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Baker RE, Yang W, Vecchi GA, Metcalf CJE, Grenfell BT. Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemic. Science 2020; 369:315-319. [PMID: 32423996 PMCID: PMC7243362 DOI: 10.1126/science.abc2535] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/14/2020] [Indexed: 01/14/2023]
Abstract
Preliminary evidence suggests that climate may modulate the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yet it remains unclear whether seasonal and geographic variations in climate can substantially alter the pandemic trajectory, given that high susceptibility is a core driver. Here, we use a climate-dependent epidemic model to simulate the SARS-CoV-2 pandemic by probing different scenarios based on known coronavirus biology. We find that although variations in weather may be important for endemic infections, during the pandemic stage of an emerging pathogen, the climate drives only modest changes to pandemic size. A preliminary analysis of nonpharmaceutical control measures indicates that they may moderate the pandemic-climate interaction through susceptible depletion. Our findings suggest that without effective control measures, strong outbreaks are likely in more humid climates and summer weather will not substantially limit pandemic growth.
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Affiliation(s)
- Rachel E Baker
- Princeton Environmental Institute, Princeton University, Princeton, NJ, USA. .,Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Wenchang Yang
- Department of Geosciences, Princeton University, Princeton, NJ, USA
| | - Gabriel A Vecchi
- Princeton Environmental Institute, Princeton University, Princeton, NJ, USA.,Department of Geosciences, Princeton University, Princeton, NJ, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.,Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.,Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA.,Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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1479
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van Heijningen I, Frank K, Giunta RE, Parreira JC, Zic R, Almeida F, Bösch U, Bradic N, Costa H, Demirdover C, Henley M, Kamolz LP, Rouif M, Spendel S, Russe-Wilflingseder K, Stark B. EASAPS/ESPRAS Considerations in getting back to work in Plastic Surgery with the COVID-19 Pandemic – A European point of view. HANDCHIR MIKROCHIR P 2020; 52:257-264. [DOI: 10.1055/a-1175-4169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AbstractThe aim of this paper is to summarize the results of a consensus process and a European webinar of the two societies, European Association of Societies of Aesthetic Surgery (EASAPS) and the European Society of Plastic, Reconstructive and Aesthetic Societies (ESPRAS) on what is considered safe practice based on the scientific knowledge we have today. This review of the current situations gives considerations which have to be taken into account when getting back to work in plastic surgery with COVID-19 in Europe. At all times, one should be familiar the local and regional infection rates in the community, with particular emphasis on the emergence of second and third waves of the pandemic. Due to the fast-evolving nature of the COVID-19 pandemic the recommendations aim to be rather considerations than fixed guidelines and might need to be revised in near future.
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Affiliation(s)
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University Munich, Germany
| | - Riccardo E. Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University Munich, Germany
| | - Jose Carlos Parreira
- Department of Plastic Surgery, Hospital Garcia de Orta, Almada , Portugal And Private Practice, Portugal
| | - Rado Zic
- University Hospital Dubrava Department of Plastic Reconstructive and Aesthetic Surgery, School of Medicine University of Zagreb
| | - Francisco Almeida
- Infection Prevention and control unit, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | | | - Nicola Bradic
- Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Horacio Costa
- Plastic Reconstructive Craniomaxilofacial Hand and Microsurgical Unit, Gaia Hospital Center and Aveiro University, Portugal
| | - Cenk Demirdover
- Department of Plastic, Reconstructive and Aesthetic Surgery of Dokuz Eylul University, Izmir, Turkey
| | - Mark Henley
- Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals, United Kingdom
| | - Lars Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | - Birgit Stark
- Kliniken för Rekonstruktiv Plastikkirurgi Karolinska Institute, Stockholm, Sweden
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1480
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Aleta A, Martín-Corral D, Piontti APY, Ajelli M, Litvinova M, Chinazzi M, Dean NE, Halloran ME, Longini IM, Merler S, Pentland A, Vespignani A, Moro E, Moreno Y. Modeling the impact of social distancing, testing, contact tracing and household quarantine on second-wave scenarios of the COVID-19 epidemic. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.06.20092841. [PMID: 32511536 PMCID: PMC7273304 DOI: 10.1101/2020.05.06.20092841] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The new coronavirus disease 2019 (COVID-19) has required the implementation of severe mobility restrictions and social distancing measures worldwide. While these measures have been proven effective in abating the epidemic in several countries, it is important to estimate the effectiveness of testing and tracing strategies to avoid a potential second wave of the COVID-19 epidemic. We integrate highly detailed (anonymized, privacy-enhanced) mobility data from mobile devices, with census and demographic data to build a detailed agent-based model to describe the transmission dynamics of SARS-CoV-2 in the Boston metropolitan area. We find that enforcing strict social distancing followed by a policy based on a robust level of testing, contact-tracing and household quarantine, could keep the disease at a level that does not exceed the capacity of the health care system. Assuming the identification of 50% of the symptomatic infections, and the tracing of 40% of their contacts and households, which corresponds to about 9% of individuals quarantined, the ensuing reduction in transmission allows the reopening of economic activities while attaining a manageable impact on the health care system. Our results show that a response system based on enhanced testing and contact tracing can play a major role in relaxing social distancing interventions in the absence of herd immunity against SARS-CoV-2.
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Affiliation(s)
- Alberto Aleta
- Institute for Scientific Interchange Foundation, Turin, Italy
| | - David Martín-Corral
- Department of Mathematics and GISC, Universidad Carlos III de Madrid, Leganés, Spain
- Zensei Technologies S.L., Madrid, Spain
| | - Ana Pastore y Piontti
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
| | - Marco Ajelli
- Bruno Kessler Foundation, Trento Italy
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Maria Litvinova
- Institute for Scientific Interchange Foundation, Turin, Italy
| | - Matteo Chinazzi
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
| | - Natalie E. Dean
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - M. Elizabeth Halloran
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Ira M. Longini
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | | | - Alex Pentland
- Connection Science, Institute for Data Science and Society, MIT, Cambridge, US
| | - Alessandro Vespignani
- Institute for Scientific Interchange Foundation, Turin, Italy
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
| | - Esteban Moro
- Department of Mathematics and GISC, Universidad Carlos III de Madrid, Leganés, Spain
- Connection Science, Institute for Data Science and Society, MIT, Cambridge, US
| | - Yamir Moreno
- Institute for Scientific Interchange Foundation, Turin, Italy
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Spain
- Department of Theoretical Physics, Faculty of Sciences, University of Zaragoza, Spain
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1481
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Marais BJ, Sorrell TC. Pathways to COVID-19 'community protection'. Int J Infect Dis 2020; 96:496-499. [PMID: 32425642 PMCID: PMC7233221 DOI: 10.1016/j.ijid.2020.05.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022] Open
Abstract
To date, no country has reached a natural COVID-19 epidemic peak and observed peaks essentially reflect the effectiveness of ‘lockdown’ measures. The major challenge is finding a responsible way out of ‘lockdown’, given that SARS- CoV-2 is now an established global pathogen. Acknowledging limitations in our knowledge regarding the sufficiency and durability of immune responses following natural SARS Cov-2 infection, we discuss three pathways to ‘community protection’. Uncontrolled epidemic spread (route 1; R0 > 2) has been associated with overwhelmed health care systems and high death rates, especially in the vulnerable. Controlled epidemic spread (route 2; effective R0 1–2) can be achieved with limited or strict control of social mixing; strict control will be necessary to ensure that only low-risk individuals become infected, without spill-over to vulnerable groups during their period of infectiousness. It has been demonstrated that local epidemic elimination (route 3; effective R0 < 1) can be achieved through prolonged ‘lock down’, supplemented by early active case finding with quarantine of close contacts to ensure rapid termination of transmission chains within the community. Although universal availability of a safe and effective vaccine remains the preferred ‘exit strategy’, this may be hard to achieve and alternative options must be considered with careful consideration of all adverse outcomes – including health, social and economic consequences.
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Affiliation(s)
- B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia.
| | - T C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
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1482
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Muzumdar S, Grant-Kels JM, Feng H. Web-based dermatology residency interviews in the time of coronavirus disease 2019 (COVID-19). J Am Acad Dermatol 2020; 83:707-708. [PMID: 32413445 PMCID: PMC7217072 DOI: 10.1016/j.jaad.2020.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sonal Muzumdar
- University of Connecticut School of Medicine, Farmington
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington.
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1483
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Basch CH, Hillyer GC, Erwin ZM, Mohlman J, Cosgrove A, Quinones N. News coverage of the COVID-19 pandemic: Missed opportunities to promote health sustaining behaviors. Infect Dis Health 2020; 25:205-209. [PMID: 32426559 PMCID: PMC7229940 DOI: 10.1016/j.idh.2020.05.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
Background Given that individuals may make health decisions based on mass media coverage, and given that such decisions have broad consequences in the case of highly contagious infectious disease, it is imperative that public health practitioners are aware of mass media coverage on emerging health threats such as COVID-19. The purpose of this study was to examine the content of news segments covering COVID-19 posted on-line. Methods Using the Google Videos function on a cleared browser, all videos identified from January and February, 2020 were archived by URL for analysis. After applying exclusion criteria, a total of 401 remained, comprising the sample. Content categories derived from trusted sources were applied to assess the content of broadcast news segments pertaining to COVID-19 on Google Videos. Results The most common topic mentioned across all videos was death and the death rate (43.6%) and many connoted anxieties surrounding the COVID-19 outbreak (37.4%). Critically important information about the prevention of COVID-19 spread received little attention. For example, only 3.0% of videos discussed coughing into or blowing one's nose into a tissue and throwing the tissue away, 6.2% talked about wearing a facemask when caring for the ill, and 8.8% covered disinfecting highly touched objects and surfaces. International videos more often presented captions and English subtitles (with and without narration) (7.8% vs. 0.9%, p = 0.018) and even more frequently discussed death and the death rate associated with COVID-19 (56.9% vs. 41.7%, p = 0.04). Conclusion Coupled with the resultant increase in negative emotion, the majority of videos missed an opportunity to reframe messages to encourage and promote coping strategies and health sustaining behaviors. Future videos should avoid contributing to negative emotion. Prevention information on reducing transmission was rarely covered in the news videos included in this sample. Death and death rate were the most commonly mentioned aspect of COVID-19 in these news videos. Forthcoming news clips should strive to demonstrate ways to enhance safety.
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Affiliation(s)
- Corey H Basch
- Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA.
| | - Grace Clarke Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University NY, NY, 10032, USA
| | - Zoe Meleo- Erwin
- Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA
| | - Jan Mohlman
- Department of Psychology, William Paterson University, Wayne, NJ, 07470, USA
| | - Alison Cosgrove
- Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA
| | - Nasia Quinones
- Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA
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1484
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Abstract
The transition from shutdown of elective orthopaedic services to the resumption of pre-COVID-19 activity presents many challenges. These include concerns about patient safety, staff safety, and the viability of health economies. Careful planning is necessary to allow patients to benefit from orthopaedic care in a safe and sustainable manner. Cite this article: Bone Joint J 2020;102-B(7):807-810.
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Affiliation(s)
- Sam Oussedik
- University College London Hospitals NHS Trust, London, UK
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | - Gee Yen Shin
- University College London Hospitals NHS Trust, London, UK
| | - Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | - Fares S Haddad
- University College London Hospitals NHS Trust, London, UK
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1485
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Pontual MLA, do Nascimento EHL, da Cruz Perez DE, Pontual AA, Ramos-Perez FM. Challenges in oral radiology teaching during COVID-19 pandemic. Dentomaxillofac Radiol 2020; 49:20200178. [PMID: 32406750 PMCID: PMC7333465 DOI: 10.1259/dmfr.20200178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Maria Luiza Anjos Pontual
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Andrea Anjos Pontual
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Flávia Moraes Ramos-Perez
- Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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1486
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Kanneganti A, Sia CH, Ashokka B, Ooi SBS. Continuing medical education during a pandemic: an academic institution's experience. Postgrad Med J 2020; 96:384-386. [PMID: 32404498 DOI: 10.1136/postgradmedj-2020-137840] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/11/2020] [Indexed: 01/17/2023]
Abstract
The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year's end.
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Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Balakrishnan Ashokka
- Department of Anaesthesia, National University Hospital, Singapore.,Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shirley Beng Suat Ooi
- Emergency Medicine Department, National University Hospital, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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1487
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Abstract
This paper presents an evolutionary algorithm that simulates simplified scenarios of the diffusion of an infectious disease within a given population. The proposed evolutionary epidemic diffusion (EED) computational model has a limited number of variables and parameters, but is still able to simulate a variety of configurations that have a good adherence to real-world cases. The use of two space distances and the calculation of spatial 2-dimensional entropy are also examined. Several simulations demonstrate the feasibility of the EED for testing distinct social, logistic and economy risks. The performance of the system dynamics is assessed by several variables and indices. The global information is efficiently condensed and visualized by means of multidimensional scaling.
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1488
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Hoffman BU. Significant Relaxation of SARS-CoV-2-Targeted Non-Pharmaceutical Interventions Will Result in Profound Mortality: A New York State Modelling Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.08.20095505. [PMID: 32511495 PMCID: PMC7273263 DOI: 10.1101/2020.05.08.20095505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Severe acute respiratory syndrome-coronavirus 2 (SARS CoV 2) is the most significant global health crisis of the 21st century. The aim of this study was to develop a model to estimate the effect of undocumented infections, seasonal infectivity, immunity, and non-pharmaceutical interventions (NPIs), such as social distancing, on the transmission, morbidity, and mortality of SARS-CoV-2 in New York State (NYS). Simulations revealed dramatic infectivity driven by undocumented infections, and a peak basic reproductive number in NYS of 5.7. NPIs have been effective, and relaxation >50% will result in tens-of-thousands more deaths. Endemic infection is likely to occur in the absence of profound sustained immunity. As a result, until an effective vaccine or other effective pharmaceutical intervention is developed, it will be critical to not reduce NPIs >50% below current levels. This study establishes fundamental characteristics of SARS CoV 2 transmission, which can help policymakers navigate combating this virus in the coming years.
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Affiliation(s)
- Benjamin U. Hoffman
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
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1489
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Park SW, Cornforth DM, Dushoff J, Weitz JS. The time scale of asymptomatic transmission affects estimates of epidemic potential in the COVID-19 outbreak. Epidemics 2020; 31:100392. [PMID: 32446187 PMCID: PMC7212980 DOI: 10.1016/j.epidem.2020.100392] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/04/2022] Open
Abstract
The role of asymptomatic carriers in transmission poses challenges for control of the COVID-19 pandemic. Study of asymptomatic transmission and implications for surveillance and disease burden are ongoing, but there has been little study of the implications of asymptomatic transmission on dynamics of disease. We use a mathematical framework to evaluate expected effects of asymptomatic transmission on the basic reproduction number R0 (i.e., the expected number of secondary cases generated by an average primary case in a fully susceptible population) and the fraction of new secondary cases attributable to asymptomatic individuals. If the generation-interval distribution of asymptomatic transmission differs from that of symptomatic transmission, then estimates of the basic reproduction number which do not explicitly account for asymptomatic cases may be systematically biased. Specifically, if asymptomatic cases have a shorter generation interval than symptomatic cases, R0 will be over-estimated, and if they have a longer generation interval, R0 will be under-estimated. Estimates of the realized proportion of asymptomatic transmission during the exponential phase also depend on asymptomatic generation intervals. Our analysis shows that understanding the temporal course of asymptomatic transmission can be important for assessing the importance of this route of transmission, and for disease dynamics. This provides an additional motivation for investigating both the importance and relative duration of asymptomatic transmission.
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Affiliation(s)
- Sang Woo Park
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Daniel M Cornforth
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jonathan Dushoff
- Department of Biology, McMaster University, Hamilton, Ontario, Canada; Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada; M. G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada.
| | - Joshua S Weitz
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA; School of Physics, Georgia Institute of Technology, Atlanta, GA, USA.
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1490
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Tuite AR, Fisman DN, Greer AL. Mathematical modelling of COVID-19 transmission and mitigation strategies in the population of Ontario, Canada. CMAJ 2020; 192:E497-E505. [PMID: 32269018 PMCID: PMC7234271 DOI: 10.1503/cmaj.200476] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Physical-distancing interventions are being used in Canada to slow the spread of severe acute respiratory syndrome coronavirus 2, but it is not clear how effective they will be. We evaluated how different nonpharmaceutical interventions could be used to control the coronavirus disease 2019 (COVID-19) pandemic and reduce the burden on the health care system. METHODS We used an age-structured compartmental model of COVID-19 transmission in the population of Ontario, Canada. We compared a base case with limited testing, isolation and quarantine to scenarios with the following: enhanced case finding, restrictive physical-distancing measures, or a combination of enhanced case finding and less restrictive physical distancing. Interventions were either implemented for fixed durations or dynamically cycled on and off, based on projected occupancy of intensive care unit (ICU) beds. We present medians and credible intervals from 100 replicates per scenario using a 2-year time horizon. RESULTS We estimated that 56% (95% credible interval 42%-63%) of the Ontario population would be infected over the course of the epidemic in the base case. At the epidemic peak, we projected 107 000 (95% credible interval 60 760-149 000) cases in hospital (non-ICU) and 55 500 (95% credible interval 32 700-75 200) cases in ICU. For fixed-duration scenarios, all interventions were projected to delay and reduce the height of the epidemic peak relative to the base case, with restrictive physical distancing estimated to have the greatest effect. Longer duration interventions were more effective. Dynamic interventions were projected to reduce the proportion of the population infected at the end of the 2-year period and could reduce the median number of cases in ICU below current estimates of Ontario's ICU capacity. INTERPRETATION Without substantial physical distancing or a combination of moderate physical distancing with enhanced case finding, we project that ICU resources would be overwhelmed. Dynamic physical distancing could maintain health-system capacity and also allow periodic psychological and economic respite for populations.
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Affiliation(s)
- Ashleigh R Tuite
- Dalla Lana School of Public Health (Tuite, Fisman), University of Toronto, Ont.; Department of Population Medicine (Greer), University of Guelph, Guelph, Ont.
| | - David N Fisman
- Dalla Lana School of Public Health (Tuite, Fisman), University of Toronto, Ont.; Department of Population Medicine (Greer), University of Guelph, Guelph, Ont
| | - Amy L Greer
- Dalla Lana School of Public Health (Tuite, Fisman), University of Toronto, Ont.; Department of Population Medicine (Greer), University of Guelph, Guelph, Ont
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1491
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Corey L, Mascola JR, Fauci AS, Collins FS. A strategic approach to COVID-19 vaccine R&D. Science 2020; 368:948-950. [PMID: 32393526 DOI: 10.1126/science.abc5312] [Citation(s) in RCA: 314] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Departments of Medicine and Lab Medicine, University of Washington, Seattle, WA 98195, USA
| | - John R Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Anthony S Fauci
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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1492
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Abstract
The global pandemic due to the emergence of a novel coronavirus (COVID-19) is a threat to humanity. There remains an urgent need to understand its transmission characteristics and design effective interventions to mitigate its spread. In this study, we define a non-linear (known in biochemistry models as allosteric or cooperative) relationship between viral shedding, viral dose and COVID-19 infection propagation. We develop a mathematical model of the dynamics of COVID-19 to link quantitative features of viral shedding, human exposure and transmission in nine countries impacted by the ongoing COVID-19 pandemic, and state-wide transmission in the United States of America (USA). The model was then used to evaluate the efficacy of interventions against virus transmission. We found that cooperativity was important to capture country-specific transmission dynamics and leads to resistance to mitigating transmission in mild or moderate interventions. The behaviors of the model emphasize that strict interventions greatly limiting both virus shedding and human exposure are indispensable to achieving effective containment of COVID-19. Finally, in the USA we find that by the summer of 2021, a difference of about 1.5 million deaths may be observed depending on whether the interventions are to be maintained strictly or lifted in entirety.
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1493
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Lipsitch M, Perlman S, Waldor MK. Testing COVID-19 therapies to prevent progression of mild disease. THE LANCET. INFECTIOUS DISEASES 2020; 20:1367. [PMID: 32618282 PMCID: PMC7202831 DOI: 10.1016/s1473-3099(20)30372-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Stanley Perlman
- Department of Microbiology and Immunology and Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Matthew K Waldor
- Department of Medicine and Department of Microbiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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1494
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Timpka T. Sport in the tracks and fields of the corona virus: Critical issues during the exit from lockdown. J Sci Med Sport 2020; 23:634-635. [PMID: 32416972 PMCID: PMC7199696 DOI: 10.1016/j.jsams.2020.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Toomas Timpka
- Athletics Research Center, Linköping University, Sweden; Department of Public Health and Statistics, Region Östergötland, Sweden.
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1495
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van Veelen MJ, Kaufmann M, Brugger H, Strapazzon G. Drone delivery of AED's and personal protective equipment in the era of SARS-CoV-2. Resuscitation 2020; 152:1-2. [PMID: 32380028 PMCID: PMC7198402 DOI: 10.1016/j.resuscitation.2020.04.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/20/2022]
Affiliation(s)
| | - Marc Kaufmann
- Emergency Medical Services 112, Health Care System Alto Adige, Bolzano, Italy.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
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1496
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Baldi E, Contri E, Savastano S, Cortegiani A. The challenge of laypeople cardio-pulmonary resuscitation training during and after COVID-19 pandemic. Resuscitation 2020; 152:3-4. [PMID: 32380029 PMCID: PMC7198416 DOI: 10.1016/j.resuscitation.2020.04.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Enrico Contri
- AAT Pavia - Azienda Regionale Emergenza Urgenza (AREU), c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
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1497
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Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.04.30.20086264. [PMID: 32511469 PMCID: PMC7255789 DOI: 10.1101/2020.04.30.20086264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Most European countries have responded to the COVID-19 threat by nationwide implementation of barrier measures and lockdown. However, assuming that population immunity will build up through the epidemic, it is likely to rebound once these measures are relaxed, possibly leading to a second or multiple repeated lockdowns. In this report, we present results of epidemiological modelling that has helped inform policy making in France. We used a stochastic agent-based microsimulation model of the COVID-19 epidemic in France, and examined the potential impact of post-quarantine measures, including social distancing, mask-wearing, and shielding of the population the most vulnerable to severe COVID-19 infection, on the disease's cumulative incidence and mortality, and on ICU-bed occupancy. The model calibrated well and variation of model parameter values had little impact on outcome estimates. While quarantine is effective in containing the viral spread, it would be unlikely to prevent a rebound of the epidemic once lifted, regardless of its duration. Both social distancing and mask-wearing, although effective in slowing the epidemic and in reducing mortality, would also be ineffective in ultimately preventing the overwhelming of ICUs and a second lockdown. However, these measures coupled with shielding of vulnerable people would be associated with better outcomes, including lower cumulative incidence, mortality, and maintaining an adequate number of ICU beds to prevent a second lockdown. Benefits would nonetheless be markedly reduced if these measures were not applied by most people or not maintained for a sufficiently long period, as herd immunity progressively establishes in the less vulnerable population.
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Affiliation(s)
- Nicolas Hoertel
- AP-HP.Centre, Paris University, Paris, France
- INSERM U1266, Paris, France
| | - Martin Blachier
- Division of Biostatistics, Modeling and Health Economics, Public Health Expertise, Paris, France
| | - Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA
| | - Mark Olfson
- Columbia University, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA
| | - Marc Massetti
- Division of Biostatistics, Modeling and Health Economics, Public Health Expertise, Paris, France
| | - Marina Sánchez Rico
- AP-HP.Centre, Paris University, Paris, France
- Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Frédéric Limosin
- AP-HP.Centre, Paris University, Paris, France
- INSERM U1266, Paris, France
| | - Henri Leleu
- Division of Biostatistics, Modeling and Health Economics, Public Health Expertise, Paris, France
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1498
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Brett TS, Rohani P. COVID-19 herd immunity strategies: walking an elusive and dangerous tightrope. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.04.29.20082065. [PMID: 32511597 PMCID: PMC7276024 DOI: 10.1101/2020.04.29.20082065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The rapid growth in cases of COVID-19 has threatened to overwhelm healthcare systems in multiple countries. In response, severely affected countries have had to consider a range of public health strategies achieved by implementing non-pharmaceutical interventions. Broadly, these strategies have fallen into two categories: i) "mitigation", which aims to achieve herd immunity by allowing the SARS-CoV-2 virus to spread through the population while mitigating disease burden, and ii) "suppression", aiming to drastically reduce SARS-CoV-2 transmission rates and halt endogenous transmission in the target population. Using an age-structured transmission model, parameterised to simulate SARS-CoV-2 transmission in the UK, we assessed the prospects of success using both of these approaches. We simulated a range of different non-pharmaceutical intervention scenarios incorporating social distancing applied to differing age groups. We found that it is possible to suppress SARS-CoV-2 transmission if social distancing measures are sustained at a sufficient level for a period of months. Our modelling did not support achieving herd immunity as a practical objective, requiring an unlikely balancing of multiple poorly-defined forces. Specifically, we found that: i) social distancing must initially reduce the transmission rate to within a narrow range, ii) to compensate for susceptible depletion, the extent of social distancing must be vary over time in a precise but unfeasible way, and iii) social distancing must be maintained for a long duration (over 6 months).
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Affiliation(s)
- Tobias S Brett
- Odum School of Ecology, University of Georgia, Athens, GA, USA
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA, USA
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
- Department of Infectious Diseases, University of Georgia, Athens, GA, USA
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1499
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Tilocca B, Soggiu A, Sanguinetti M, Babini G, De Maio F, Britti D, Zecconi A, Bonizzi L, Urbani A, Roncada P. Immunoinformatic analysis of the SARS-CoV-2 envelope protein as a strategy to assess cross-protection against COVID-19. Microbes Infect 2020; 22:182-187. [PMID: 32446902 PMCID: PMC7241347 DOI: 10.1016/j.micinf.2020.05.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
Envelope protein of coronaviruses is a structural protein existing in both monomeric and homo-pentameric form. It has been related to a multitude of roles including virus infection, replication, dissemination and immune response stimulation. In the present study, we employed an immunoinformatic approach to investigate the major immunogenic domains of the SARS-CoV-2 envelope protein and map them among the homologue proteins of coronaviruses with tropism for animal species that are closely inter-related with the human beings population all over the world. Also, when not available, we predicted the envelope protein structural folding and mapped SARS-CoV-2 epitopes. Envelope sequences alignment provides evidence of high sequence homology for some of the investigated virus specimens; while the structural mapping of epitopes resulted in the interesting maintenance of the structural folding and epitope sequence localization also in the envelope proteins scoring a lower alignment score. In line with the One-Health approach, our evidences provide a molecular structural rationale for a potential role of taxonomically related coronaviruses in conferring protection from SARS-CoV-2 infection and identifying potential candidates for the development of diagnostic tools and prophylactic-oriented strategies.
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Affiliation(s)
- Bruno Tilocca
- Department of Health Science, University "Magna Græcia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Alessio Soggiu
- Department of Biomedical, Surgical and Dental Sciences- One Health Unit, University of Milano, Via Celoria n10, 20133, Milano, Italy; Department of Veterinary Medicine, University of Milano, Via dell'Università 6, 26900, Lodi, Italy
| | - Maurizio Sanguinetti
- Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Roma, Italy; Dipartimento di Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Gabriele Babini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Flavio De Maio
- Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Roma, Italy; Dipartimento di Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli 8, 00168, Roma, Italy
| | - Domenico Britti
- Department of Health Science, University "Magna Græcia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Alfonso Zecconi
- Department of Biomedical, Surgical and Dental Sciences- One Health Unit, University of Milano, Via Celoria n10, 20133, Milano, Italy
| | - Luigi Bonizzi
- Department of Biomedical, Surgical and Dental Sciences- One Health Unit, University of Milano, Via Celoria n10, 20133, Milano, Italy
| | - Andrea Urbani
- Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Roma, Italy; Dipartimento di Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli 8, 00168, Roma, Italy.
| | - Paola Roncada
- Department of Health Science, University "Magna Græcia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
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1500
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Chowdhury R, Heng K, Shawon MSR, Goh G, Okonofua D, Ochoa-Rosales C, Gonzalez-Jaramillo V, Bhuiya A, Reidpath D, Prathapan S, Shahzad S, Althaus CL, Gonzalez-Jaramillo N, Franco OH. Dynamic interventions to control COVID-19 pandemic: a multivariate prediction modelling study comparing 16 worldwide countries. Eur J Epidemiol 2020; 35:389-399. [PMID: 32430840 PMCID: PMC7237242 DOI: 10.1007/s10654-020-00649-w] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022]
Abstract
To date, non-pharmacological interventions (NPI) have been the mainstay for controlling the coronavirus disease-2019 (COVID-19) pandemic. While NPIs are effective in preventing health systems overload, these long-term measures are likely to have significant adverse economic consequences. Therefore, many countries are currently considering to lift the NPIs-increasing the likelihood of disease resurgence. In this regard, dynamic NPIs, with intervals of relaxed social distancing, may provide a more suitable alternative. However, the ideal frequency and duration of intermittent NPIs, and the ideal "break" when interventions can be temporarily relaxed, remain uncertain, especially in resource-poor settings. We employed a multivariate prediction model, based on up-to-date transmission and clinical parameters, to simulate outbreak trajectories in 16 countries, from diverse regions and economic categories. In each country, we then modelled the impacts on intensive care unit (ICU) admissions and deaths over an 18-month period for following scenarios: (1) no intervention, (2) consecutive cycles of mitigation measures followed by a relaxation period, and (3) consecutive cycles of suppression measures followed by a relaxation period. We defined these dynamic interventions based on reduction of the mean reproduction number during each cycle, assuming a basic reproduction number (R0) of 2.2 for no intervention, and subsequent effective reproduction numbers (R) of 0.8 and 0.5 for illustrative dynamic mitigation and suppression interventions, respectively. We found that dynamic cycles of 50-day mitigation followed by a 30-day relaxation reduced transmission, however, were unsuccessful in lowering ICU hospitalizations below manageable limits. By contrast, dynamic cycles of 50-day suppression followed by a 30-day relaxation kept the ICU demands below the national capacities. Additionally, we estimated that a significant number of new infections and deaths, especially in resource-poor countries, would be averted if these dynamic suppression measures were kept in place over an 18-month period. This multi-country analysis demonstrates that intermittent reductions of R below 1 through a potential combination of suppression interventions and relaxation can be an effective strategy for COVID-19 pandemic control. Such a "schedule" of social distancing might be particularly relevant to low-income countries, where a single, prolonged suppression intervention is unsustainable. Efficient implementation of dynamic suppression interventions, therefore, confers a pragmatic option to: (1) prevent critical care overload and deaths, (2) gain time to develop preventive and clinical measures, and (3) reduce economic hardship globally.
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Affiliation(s)
- Rajiv Chowdhury
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Kevin Heng
- Center for Space and Habitability, University of Bern, Bern, Switzerland
- Department of Physics, Astronomy and Astrophysics Group, University of Warwick, Coventry, UK
| | | | - Gabriel Goh
- OpenAI Artificial Intelligence Research Laboratory, San Francisco, CA, USA
| | - Daisy Okonofua
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Carolina Ochoa-Rosales
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
| | | | - Abbas Bhuiya
- Independent health and population researcher, Dhaka, Bangladesh
| | - Daniel Reidpath
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shamini Prathapan
- Department of Community Medicine, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Sara Shahzad
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Christian L Althaus
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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