251
|
Banholzer N, van Weenen E, Lison A, Cenedese A, Seeliger A, Kratzwald B, Tschernutter D, Salles JP, Bottrighi P, Lehtinen S, Feuerriegel S, Vach W. Estimating the effects of non-pharmaceutical interventions on the number of new infections with COVID-19 during the first epidemic wave. PLoS One 2021; 16:e0252827. [PMID: 34077448 DOI: 10.1101/2020.04.16.20062141] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/23/2021] [Indexed: 05/21/2023] Open
Abstract
The novel coronavirus (SARS-CoV-2) has rapidly developed into a global epidemic. To control its spread, countries have implemented non-pharmaceutical interventions (NPIs), such as school closures, bans of small gatherings, or even stay-at-home orders. Here we study the effectiveness of seven NPIs in reducing the number of new infections, which was inferred from the reported cases of COVID-19 using a semi-mechanistic Bayesian hierarchical model. Based on data from the first epidemic wave of n = 20 countries (i.e., the United States, Canada, Australia, the EU-15 countries, Norway, and Switzerland), we estimate the relative reduction in the number of new infections attributed to each NPI. Among the NPIs considered, bans of large gatherings were most effective, followed by venue and school closures, whereas stay-at-home orders and work-from-home orders were least effective. With this retrospective cross-country analysis, we provide estimates regarding the effectiveness of different NPIs during the first epidemic wave.
Collapse
Affiliation(s)
- Nicolas Banholzer
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Eva van Weenen
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Adrian Lison
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Alberto Cenedese
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Arne Seeliger
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Bernhard Kratzwald
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Daniel Tschernutter
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Joan Puig Salles
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Pierluigi Bottrighi
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Sonja Lehtinen
- Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland
| | - Stefan Feuerriegel
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Werner Vach
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
- Department of Environmental Sciences, University of Basel, Basel, Switzerland
| |
Collapse
|
252
|
Kishimoto K, Bun S, Shin JH, Takada D, Morishita T, Kunisawa S, Imanaka Y. Early impact of school closure and social distancing for COVID-19 on the number of inpatients with childhood non-COVID-19 acute infections in Japan. Eur J Pediatr 2021; 180:2871-2878. [PMID: 33791861 PMCID: PMC8012019 DOI: 10.1007/s00431-021-04043-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/05/2021] [Accepted: 03/21/2021] [Indexed: 11/24/2022]
Abstract
Many countries have implemented school closures as part of social distancing measures intended to control the spread of coronavirus disease 2019 (COVID-19). The aim of this study was to assess the early impact of nationwide school closure (March-May 2020) and social distancing for COVID-19 on the number of inpatients with major childhood infectious diseases in Japan. Using data from the Diagnosis Procedure Combination system in Japan, we identified patients aged 15 years or younger with admissions for a diagnosis of upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), influenza, gastrointestinal infection (GII), appendicitis, urinary tract infection (UTI), or skin and soft tissue infection (SSTI) between July 2018 and June 2020. Changes in the trend of the weekly number of inpatients between the two periods were assessed using interrupted time-series analysis. A total of 75,053 patients in 210 hospitals were included. The overall weekly number of inpatients was decreased by 52.5%, 77.4%, and by 83.4% in the last week of March, April, and May 2020, respectively, when compared on a year-on-year basis. The estimated impact was a reduction of 581 (standard error 42.9) inpatients per week in the post-school-closure period (p < 0.001). The main part of the reduction was for pre-school children. Remarkable decreases in the number of inpatients with URI, LRTI, and GII were observed, while there were relatively mild changes in the other groups.Conclusion: We confirmed a marked reduction in the number of inpatients with childhood non-COVID-19 acute infections in the post-school-closure period. What is Known: • Most countries have implemented social distancing measures to limit the spread of the novel coronavirus disease 2019 (COVID-19). • A large decrease in pediatric emergency visits has been reported from several countries after the social distancing. What is New: • Based on administrative claims data, a marked reduction in the number of inpatients for childhood non-COVID-19 acute infections was found in the post-school-closure period in Japan. • The magnitude of the reduction was different between the disease groups.
Collapse
Affiliation(s)
- Kenji Kishimoto
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Seiko Bun
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan ,Department of Pharmacy, National Center for Child Health and Development Hospital, Tokyo, Japan
| | - Jung-ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Daisuke Takada
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Tetsuji Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| |
Collapse
|
253
|
Ippolito G, La Vecchia A, Umbrello G, Di Pietro G, Bono P, Scalia Catenacci S, Pinzani R, Tagliabue C, Bosis S, Agostoni C, Marchisio PG. Disappearance of Seasonal Respiratory Viruses in Children Under Two Years Old During COVID-19 Pandemic: A Monocentric Retrospective Study in Milan, Italy. Front Pediatr 2021; 9:721005. [PMID: 34422733 PMCID: PMC8374241 DOI: 10.3389/fped.2021.721005] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/14/2021] [Indexed: 02/01/2023] Open
Abstract
Background: The containment measures adopted during COVID-19 pandemic have influenced the epidemiology of other respiratory viruses. Aim: We analyzed the modification of the incidence and etiology of lower respiratory tract infections (LRTIs) in young children during COVID-19 pandemic. Methods: Case series of all children under 2 years old hospitalized at a tertiary care Hospital in the Center of Milan, Italy diagnosed with LRTIs in three consecutive winter seasons (from the 1st of November to the last day of February in 2018/2019, 2019/2020 and 2020/2021). We compared the number of hospitalizations and viral detections in the 2020/2021 with the average of 2018/2019 and 2019/2020 (pre-COVID-19) using the Poisson distribution. Results: we enrolled 178 patients (66 from 2018/2019, 96 from 2019/2020, 16 from 2020/2021) 94 males (53%) and 84 females (47%), with a median (IQR) age of 5 (2-13) months. The number of hospitalizations during the 2020/2021 season was 80% lower than the average of the pre-COVID-19 seasons (16 vs. 81, p<0.001). Overall, 171 (96%) patient's nasopharyngeal aspirate (NPA) detected at least one virus (110, 64%, single-detection, 61, 36%, co-detections). In 2020/2021 we observed the disappearance of Respiratory Syncytial virus (0 vs. 54, p < 0.001), Influenza virus (0 vs. 6.5, p = 0.002), Metapneumovirus (0 vs. 8, p < 0.001), Parainfluenza viruses (0 vs. 3.5, p = 0.03) and a significant reduction of Adenovirus (2 vs. 7, p = 0.03), Bocavirus (2 vs. 7.5, p = 0.02) and Enterovirus (1 vs. 5, p = 0.04). No significant difference was found for Rhinoviruses (14 cases vs. 17, p = 0.2), other Coronaviruses (0 vs. 2, p = 0.1), and Cytomegalovirus (1 vs. 1, p = 0.7). Conclusions: We observed a striking reduction in hospitalizations due to LRTIs and a modification of the etiology, with enveloped viruses mainly affected.
Collapse
Affiliation(s)
| | | | | | | | - Patrizia Bono
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Laboratory of Virology, Milan, Italy
| | - Stefano Scalia Catenacci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intensive Care Unit, Milan, Italy
| | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Claudia Tagliabue
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, Milan, Italy.,Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Paola Giovanna Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
254
|
Piovani D, Christodoulou MN, Hadjidemetriou A, Pantavou K, Zaza P, Bagos PG, Bonovas S, Nikolopoulos GK. Effect of early application of social distancing interventions on COVID-19 mortality over the first pandemic wave: An analysis of longitudinal data from 37 countries. J Infect 2021; 82:133-142. [PMID: 33275956 PMCID: PMC7706420 DOI: 10.1016/j.jinf.2020.11.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/28/2020] [Accepted: 11/28/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To estimate the effect of early application of social distancing interventions on Covid-19 cumulative mortality during the first pandemic wave. METHODS Ecological longitudinal study using multivariable negative binomial regression for panel data. Daily numbers of Covid-19 cases and deaths, and data on social distancing interventions, for the 37 member countries of the Organization for Economic Cooperation and Development (OECD) were analysed. RESULTS Covid-19 cumulative mortality over the first pandemic wave varied widely across countries (range, 4.16 to 855 deaths per million population). On average, one-day delay in application of mass gatherings ban was associated with an adjusted increase in Covid-19 cumulative mortality by 6.97% (95% CI, 3.45 to 10.5), whilst a one-day delay in school closures was associated with an increase of 4.37% (95% CI, 1.58 to 7.17) over the study period. We estimated that if each country had enacted both interventions one week earlier, Covid-19 cumulative mortality could have been reduced by an average of 44.1% (95% CI, 20.2 to 67.9). CONCLUSIONS Early application of mass gatherings ban and school closures in outbreak epicentres was associated with an important reduction in Covid-19 cumulative mortality during the first pandemic wave. These findings may support policy decision making.
Collapse
Affiliation(s)
- Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | | | - Andreas Hadjidemetriou
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | | | - Paraskevi Zaza
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Pantelis G Bagos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Clinical and Research Center - IRCCS, Milan, Italy.
| | | |
Collapse
|
255
|
Amuedo-Dorantes C, Kaushal N, Muchow AN. Timing of social distancing policies and COVID-19 mortality: county-level evidence from the U.S. JOURNAL OF POPULATION ECONOMICS 2021; 34:1445-1472. [PMID: 33846667 PMCID: PMC8027710 DOI: 10.1007/s00148-021-00845-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/22/2021] [Indexed: 05/04/2023]
Abstract
Using county-level data on COVID-19 mortality and infections, along with county-level information on the adoption of non-pharmaceutical interventions (NPIs), we examine how the speed of NPI adoption affected COVID-19 mortality in the United States. Our estimates suggest that adopting safer-at-home orders or non-essential business closures 1 day before infections double can curtail the COVID-19 death rate by 1.9%. This finding proves robust to alternative measures of NPI adoption speed, model specifications that control for testing, other NPIs, and mobility and across various samples (national, the Northeast, excluding New York, and excluding the Northeast). We also find that the adoption speed of NPIs is associated with lower infections and is unrelated to non-COVID deaths, suggesting these measures slowed contagion. Finally, NPI adoption speed appears to have been less effective in Republican counties, suggesting that political ideology might have compromised their efficacy.
Collapse
Affiliation(s)
| | - Neeraj Kaushal
- School of Social Work, Columbia University, New York, NY USA
| | - Ashley N. Muchow
- Criminology, Law, and Justice, University of Illinois at Chicago, Chicago, IL USA
| |
Collapse
|
256
|
Verdini N, LeClair J, Quinn E, El-Haddad A. Social Determinants of Health Amplify the Association Between Ethnicity and COVID19: A Retrospective-Cohort study. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2021; 9:282-287. [PMID: 34956659 PMCID: PMC8699061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND People in racial and ethnic minority groups have been shown to be at increased risk for a variety of diseases, including COVID-19. However, the role that social needs play in this increased risk has not yet been quantified. Investigating these roles can elicit a greater understanding of how social needs influence the manner in which this disease is contracted and spread. METHODS A retrospective analysis was conducted of 1,969 Lynn Community Health Center patients. Patients that visited the center between February 1st and July 1st, 2020, tested for COVID-19, and screened for social determinants of health (SDOH) risk factors. Demographics were compared between COVID-19 positive and negative patients. Confounding by age on the association between ethnicity and COVID-19 status was evaluated. A stratified analysis was performed to evaluate the effect modification of SDOH on the relationship between race, ethnicity, and COVID-19 status. RESULTS Hispanic patients had 2.93 times the odds of a positive COVID-19 test compared to non-Hispanics (95% CI: 2.37 - 3.64, p<0.0001). With at least one SDOH risk factor, Hispanics had 4.71 times the odds of a positive COVID-19 test relative to non-Hispanics (95% CI: 3.10 - 7.14). With no SDOH risk factors, Hispanics had 2.45 times the odds of a positive COVID-19 test relative to non-Hispanics (95% CI: 1.91 - 3.16). No significant associations were found for race. CONCLUSION Ethnicity had a significant impact on COVID-19 status in our population, where the effect of ethnicity on COVID-19 status was amplified for those with SDOH risk factors.
Collapse
Affiliation(s)
| | - Jessica LeClair
- B.S, Department of Biostatistics, Boston University School of Public Health
| | | | | |
Collapse
|
257
|
Bo Y, Guo C, Lin C, Zeng Y, Li HB, Zhang Y, Hossain MS, Chan JWM, Yeung DW, Kwok KO, Wong SYS, Lau AKH, Lao XQ. Effectiveness of non-pharmaceutical interventions on COVID-19 transmission in 190 countries from 23 January to 13 April 2020. Int J Infect Dis 2021; 102:247-253. [PMID: 33129965 PMCID: PMC7598763 DOI: 10.1016/j.ijid.2020.10.066] [Citation(s) in RCA: 162] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/05/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To evaluate and compare the effectiveness of four types of non-pharmaceutical interventions (NPIs) to contain the time-varying effective reproduction number (Rt) of coronavirus disease-2019 (COVID-19). METHODS This study included 1,908,197 confirmed COVID-19 cases from 190 countries between 23 January and 13 April 2020. The implemented NPIs were categorised into four types: mandatory face mask in public, isolation or quarantine, social distancing and traffic restriction (referred to as mandatory mask, quarantine, distancing and traffic hereafter, respectively). RESULTS The implementations of mandatory mask, quarantine, distancing and traffic were associated with changes (95% confidence interval, CI) of -15.14% (from -21.79% to -7.93%), -11.40% (from -13.66% to -9.07%), -42.94% (from -44.24% to -41.60%) and -9.26% (from -11.46% to -7.01%) in the Rt of COVID-19 when compared with those without the implementation of the corresponding measures. Distancing and the simultaneous implementation of two or more types of NPIs seemed to be associated with a greater decrease in the Rt of COVID-19. CONCLUSION Our study indicates that NPIs can significantly contain the COVID-19 pandemic. Distancing and the simultaneous implementation of two or more NPIs should be the strategic priorities for containing COVID-19.
Collapse
Affiliation(s)
- Yacong Bo
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China; Department of Nutrition, School of Public Health, Zhengzhou University, China
| | - Cui Guo
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China
| | - Changqing Lin
- Division of Environment and Sustainability, the Hong Kong University of Science and Technology, Hong Kong, China
| | - Yiqian Zeng
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China
| | - Hao Bi Li
- Shenzhen Dong Fang Tech Development Co., LTD, Shenzhen, Guangdong, China
| | - Yumiao Zhang
- Division of Environment and Sustainability, the Hong Kong University of Science and Technology, Hong Kong, China
| | - Md Shakhaoat Hossain
- Division of Environment and Sustainability, the Hong Kong University of Science and Technology, Hong Kong, China
| | - Jimmy W M Chan
- Division of Environment and Sustainability, the Hong Kong University of Science and Technology, Hong Kong, China
| | - David W Yeung
- Institute for the Environment, the Hong Kong University of Science and Technology, Hong Kong, China
| | - Kin On Kwok
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, China
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China
| | - Alexis K H Lau
- Division of Environment and Sustainability, the Hong Kong University of Science and Technology, Hong Kong, China; Department of Civil and Environmental Engineering, the Hong Kong University of Science and Technology, Hong Kong, China.
| | - Xiang Qian Lao
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China.
| |
Collapse
|
258
|
Hong SH, Hwang H, Park MH. Effect of COVID-19 Non-Pharmaceutical Interventions and the Implications for Human Rights. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E217. [PMID: 33396689 PMCID: PMC7794954 DOI: 10.3390/ijerph18010217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 12/16/2022]
Abstract
In response to the COVID-19 pandemic, many governments swiftly decided to order nationwide lockdowns based on limited evidence that such extreme measures were effective in containing the epidemic. A growing concern is that governments were given little time to adopt effective and proportional interventions protecting citizens' lives while observing their freedom and rights. This paper examines the effectiveness of non-pharmaceutical interventions (NPIs) in containing COVID-19, by conducting a linear regression over 108 countries, and the implication for human rights. The regression results are supported by evidence that shows the change in 10 selected countries' responding strategies and their effects as the confirmed cases increase. We found that school closures are effective in containing COVID-19 only when they are implemented along with complete contact tracing. Our findings imply that to contain COVID-19 effectively and minimize the risk of human rights abuses, governments should consider implementing prudently designed full contact tracing and school closure policies, among others. Minimizing the risk of human rights abuses should be a principle even when full contact tracing is implemented.
Collapse
Affiliation(s)
- Seung-Hun Hong
- Division of Regulatory Innovation Research, Korea Institute of Public Administration, Seoul 03367, Korea;
| | - Ha Hwang
- Division of Disaster and Safety Research, Korea Institute of Public Administration, Seoul 03367, Korea
| | - Min-Hye Park
- Mechanical and Aerospace Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Korea;
| |
Collapse
|
259
|
Wibbens PD, Koo WWY, McGahan AM. Which COVID policies are most effective? A Bayesian analysis of COVID-19 by jurisdiction. PLoS One 2020; 15:e0244177. [PMID: 33373384 PMCID: PMC7771876 DOI: 10.1371/journal.pone.0244177] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022] Open
Abstract
This paper reports the results of a Bayesian analysis on large-scale empirical data to assess the effectiveness of eleven types of COVID-control policies that have been implemented at various levels of intensity in 40 countries and U.S. states since the onset of the pandemic. The analysis estimates the marginal impact of each type and level of policy as implemented in concert with other policies. The purpose is to provide policymakers and the general public with an estimate of the relative effectiveness of various COVID-control strategies. We find that a set of widely implemented core policies reduces the spread of virus but not by enough to contain the pandemic except in a few highly compliant jurisdictions. The core policies include the cancellation of public events, restriction of gatherings to fewer than 100 people, recommendation to stay at home, recommended restrictions on internal movement, implementation of a partial international travel ban, and coordination of information campaigns. For the median jurisdiction, these policies reduce growth rate in new infections from an estimated 270% per week to approximately 49% per week, but this impact is insufficient to prevent eventual transmission throughout the population because containment occurs only when a jurisdiction reduces growth in COVID infection to below zero. Most jurisdictions must also implement additional policies, each of which has the potential to reduce weekly COVID growth rate by 10 percentage points or more. The slate of these additional high-impact policies includes targeted or full workplace closings for all but essential workers, stay-at-home requirements, and targeted school closures.
Collapse
|
260
|
Peters A, Rospleszcz S, Greiser KH, Dallavalle M, Berger K. The Impact of the COVID-19 Pandemic on Self-Reported Health. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:861-867. [PMID: 33295275 DOI: 10.3238/arztebl.2020.0861] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/06/2020] [Accepted: 11/18/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The pandemic caused by the coronavirus SARS-CoV-2 and the countermeasures taken to protect the public are having a substantial effect on the health of the population. In Germany, nationwide protective measures to halt the spread of the virus were implemented in mid-March for 6 weeks. METHODS In May, the impact of the pandemic was assessed in the German National Cohort (NAKO). A total of 113 928 men and women aged 20 to 74 years at the time of the baseline examination conducted 1 to 5 years earlier (53%) answered, within a 30-day period, a follow-up questionnaire on SARS-CoV-2 test status, COVID-19- associated symptoms, and self-perceived health status. RESULTS The self-reported SARS-CoV-2 test frequency among the probands was 4.6%, and 344 participants (0.3%) reported a positive test result. Depressive and anxiety-related symptoms increased relative to baseline only in participants under 60 years of age, particularly in young women. The rate of moderate to severe depressive symptoms increased from 6.4% to 8.8%. Perceived stress increased in all age groups and both sexes, especially in the young. The scores for mental state and self-rated health worsened in participants tested for SARS-CoV-2 compared with those who were not tested. In 32% of the participants, however, self-rated health improved. CONCLUSION The COVID-19 pandemic and the protective measures during the first wave had effects on mental health and on self-rated general health.
Collapse
Affiliation(s)
- Annette Peters
- Institute for Epidemiology, Helmholtz Center Munich, Germany,Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Susanne Rospleszcz
- Institute for Epidemiology, Helmholtz Center Munich, Germany,Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karin H Greiser
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | | |
Collapse
|
261
|
Maisch B. [The ESC recommendations for COVID-19-no guideline, but a learning guidance]. Herz 2020; 46:46-55. [PMID: 33315146 PMCID: PMC7735183 DOI: 10.1007/s00059-020-05006-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
„No guideline but guidance“ ist das Motto dieses Leitfadens der European Society of Cardiology (ESC), der als lernende Orientierungshilfe für Ärzte in der Coronapandemie konzipiert ist. 62 europäische Kardiologen haben als Autoren und 29 weitere Experten als Reviewer zu dem 119 Seiten starken Dokument beigetragen. Der Leitfaden ist geprägt von einer vorsichtigen Strategie im Umgang mit einer Pandemie, von der vieles noch nicht bekannt ist. Er beschränkt sich bewusst auf kardiovaskuläre Erkrankungen. In seiner letzten Fassung vom 10. Juni 2020 gibt er zahlreiche praktische Anleitungen zur kardiovaskulären Diagnostik und Therapie unter Pandemiebedingungen. Die Empfehlungen sind oft redundante Rückgriffe auf die bekannten Leitlinien der ESC. Informativ, aber in Teilen ergänzungsbedürftig sind die Abschnitte zur Pathophysiologie und zu den Pathomechanismen, über die SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) spezifisch auf das Herz-Kreislauf-System wirken dürfte. Kontraproduktiv ist die Empfehlung, auf pathohistologische und molekulare Untersuchungen von Gewebe betroffener oder verstorbener Patienten zu verzichten. Den hohen Ansprüchen an einen sich immer wieder ergänzenden Leitfaden genügt die letzte verfügbare Fassung dennoch in weiten Teilen. Sie benötigt aber eine baldige Aktualisierung, wenn sie ihren Ambitionen gerecht werden will.
Collapse
Affiliation(s)
- Bernhard Maisch
- Philipps-Universität, Marburg, Deutschland. .,Herz- und Gefäßzentrum Marburg, Marburg, Deutschland. .,, Feldbergstr. 45, 35043, Marburg, Deutschland.
| |
Collapse
|
262
|
Newton S, Zollinger B, Freeman J, Moran S, Helfand A, Authelet K, McHarg M, Vargas NM, Shesser R, Cohen J, Cummings D, Ma Y, Meltzer AC. Factors associated with clinical severity in Emergency Department patients presenting with symptomatic SARS-CoV-2 infection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33330879 DOI: 10.1101/2020.12.08.20246017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic Emergency Department (ED) patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Methods This study is a retrospective case-series of symptomatic patients presenting to a single ED with laboratory-confirmed SARS-CoV-2 infection from March 12-August 9, 2020. We collected patient-level information regarding demographics, public insurance status (Medicare or Medicaid), comorbidities, level of care, and mortality using a structured chart review. We compared demographics and comorbidities of patients who were (1) able to convalesce at home, (2) required admission to general medical service, (3) required admission to intensive care unit (ICU), or (4) died within 30 days of the index visit. Multivariable logistic regression analyses were performed to report adjusted odds ratios (aOR) and the associated 95% confidence intervals (95% CI) with hospital admission versus ED discharge home. Results In total, 993 patients who presented to the ED with symptoms were included in the analysis with 370 (37.3%) patients requiring hospital admission and 70 (7.1%) patients requiring ICU care. Patients requiring admission were more likely to be Black or African American, to be Hispanic or Latino, or to have public insurance (either Medicaid or Medicare.) On multivariable logistic regression analysis comparing which patients required hospital admission, African-American race (aOR 1.4, 95% CI 0.7-2.8) and Hispanic ethnicity (aOR 1.1, 95% CI 0.5-2.0) were not associated with need for admission but, public insurance (Medicaid: aOR 3.4, 95% CI 2.2-5.4; Medicare: aOR 2.6, 95% CI 1.2-5.3; Medicaid and Medicare: aOR 3.6 95% CI 2.1-6.2) and the presence of hypertension (aOR 1.8, 95% CI 1.2-2.7), diabetes (aOR 1.6, 95% CI 1.1-2.5), obesity (aOR 1.7, 95% CI 1.1-2.5), heart failure (aOR 3.9, 95% CI 1.4-11.2), and hyperlipidemia (aOR 1.8, 95% CI 1.2-2.9) were identified as independent predictors of hospital admission. Conclusion Comorbidities and public insurance are predictors of more severe illness for patients with SARS-CoV-2. This study suggests that the disparities in severity seen in COVID-19 among African Americans and Hispanics are likely to be closely related to low socioeconomic status and chronic health conditions and do not reflect an independent predisposition to disease severity.
Collapse
|
263
|
Retrospective study identifies infection related risk factors in close contacts during COVID-19 epidemic. Int J Infect Dis 2020; 103:395-401. [PMID: 33310026 PMCID: PMC7832759 DOI: 10.1016/j.ijid.2020.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aimed to compare the risk of infection of children with that of adults and to explore risk factors of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by following up close contacts of COVID-19 patients. METHOD The retrospective cohort study was performed among close contacts of index cases diagnosed with COVID-19 in Guangzhou, China. Demographic characteristics, clinical symptoms and exposure information were extracted. Logistic regression analysis was employed to explore the risk factors. The restricted cubic spline was conducted to examine to the dose-response relationship between age and SARS-CoV-2 infection. RESULTS The secondary attack rate (SAR) was 4.4% in 1,344 close contacts. The group of household contacts (17.2%) had the highest SAR. The rare-frequency contact (p < 0.001) and moderate-frequency contact (p < 0.001) were associated with lower risk of infection. Exposure to index cases with dry cough symptoms was associated with infection in close contacts (p = 0.004). Compared with children, adults had a significantly increased risk of infection (p = 0.014). There is a linear positive correlation between age and infection (p = 0.001). CONCLUSIONS Children are probably less susceptible to COVID-19. Close contacts with frequent contact with patients and those exposed to patients with cough symptoms are associated with an increased risk of infection.
Collapse
|
264
|
Oertel M, Elsayad K, Engenhart-Cabillic R, Reinartz G, Baues C, Schmidberger H, Vordermark D, Marnitz S, Lukas P, Ruebe C, Engert A, Lenz G, Eich HT. Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Strahlenther Onkol 2020; 196:1096-1102. [PMID: 33125504 PMCID: PMC7596809 DOI: 10.1007/s00066-020-01705-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.
Collapse
Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - K Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - G Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Marnitz
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - C Ruebe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - A Engert
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - G Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany.
| |
Collapse
|
265
|
Yoon Y, Choi GJ, Kim JY, Kim KR, Park H, Chun JK, Kim YJ. Childcare Exposure to Severe Acute Respiratory Syndrome Coronavirus 2 for 4-Year-Old Presymptomatic Child, South Korea. Emerg Infect Dis 2020; 27:341-347. [PMID: 33252327 PMCID: PMC7853589 DOI: 10.3201/eid2702.203189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Data on transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from preschool-age children to children and adults are limited. We investigated SARS-CoV-2 exposure at a childcare center in South Korea. A 4-year-old child, probably infected by his grandmother, attended the center during the presymptomatic period (February 19–21, 2020). Fever developed on February 22, and he was given a diagnosis SARS-CoV-2 infection on February 27. At the center, 190 persons (154 children and 36 adults) were identified as contacts; 44 (23.2%) were defined as close contacts (37 children and 7 adults). All 190 persons were negative for SARS-CoV-2 on days 8–9 after the last exposure. Two close contacts (1 child and 1 adult) showed development of symptoms on the last day of quarantine. However, subsequent test results were negative. This investigation adds indirect evidence of low potential infectivity in a childcare setting with exposure to a presymptomatic child.
Collapse
|
266
|
Sebastiani G, Palù G. COVID-19 and School Activities in Italy. Viruses 2020; 12:E1339. [PMID: 33238494 PMCID: PMC7700378 DOI: 10.3390/v12111339] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
After a linear growth during September, the diffusion in Italy of SARS-CoV-2, responsible for COVID-19, has been growing exponentially since the end of that month with a doubling time approximately equal to one week [...].
Collapse
Affiliation(s)
- Giovanni Sebastiani
- Istituto per le Applicazioni del Calcolo “Mauro Picone”, Consiglio Nazionale delle Ricerche, 00185 Rome, Italy
- Dipartimento di Matematica “Guido Castelnuovo”, Sapienza University, 00185 Rome, Italy
- Department of Mathematics and Statistics, UIT The Arctic University of Norway, N-9037 Tromsø, Norway
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy;
| |
Collapse
|
267
|
Haug N, Geyrhofer L, Londei A, Dervic E, Desvars-Larrive A, Loreto V, Pinior B, Thurner S, Klimek P. Ranking the effectiveness of worldwide COVID-19 government interventions. Nat Hum Behav 2020; 4:1303-1312. [DOI: 10.1038/s41562-020-01009-0] [Citation(s) in RCA: 655] [Impact Index Per Article: 163.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022]
|
268
|
Garduño-Soto M, Choreño-Parra JA, Cazarin-Barrientos J. Dermatological aspects of SARS-CoV-2 infection: mechanisms and manifestations. Arch Dermatol Res 2020; 313:611-622. [PMID: 33159236 PMCID: PMC7646711 DOI: 10.1007/s00403-020-02156-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 02/08/2023]
Abstract
The human infection caused by the novel SARS-CoV-2 is a public health emergency of international concern. Although the disease associated to this virus, named COVID-19, mainly affects the lungs, the infection can spread to extrapulmonary tissues, causing multiorgan involvement in severely ill patients. The broad infective capacity of SARS-CoV-2 is related to the pattern of expression of the viral entry factors ACE2 and TMPRSS2 in human tissues. As such, the respiratory and gastrointestinal tracts are at high risk for SARS-CoV-2 infection due to their high expression of ACE2 and TMPRSS2, which explains the clinical phenotype described in the vast majority of infected patients that includes pneumonia and diarrhea. Recently, preoccupation about the potential of the virus to infect the skin has been raised by dermatologists due to the increasing observations of cutaneous manifestations in patients with SARS-CoV-2 infection. Although there is little evidence of the expression of ACE2 and TMPRSS2 in the normal skin, the dermatological findings observed among COVID-19 patients warrants further investigation to delineate the mechanisms of skin affection after SARS-CoV-2 infection. Here, we provide a summary of the dermatological findings observed among patients with laboratory-confirmed SARS-CoV-2 infection based on recent reports. In addition, we analyze possible mechanisms of skin injury in COVID-19 patients and discuss about the risk of individuals with chronic skin conditions for SARS-CoV-2 infection. The present review constitutes a useful informative tool to improve our understanding of the pathophysiological mechanisms of COVID-19 and the possible implications of the current pandemic in dermatology.
Collapse
Affiliation(s)
- Myriam Garduño-Soto
- Department of Dermatology, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico.
| | | | - Jorge Cazarin-Barrientos
- Department of Dermatology, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| |
Collapse
|
269
|
Lelieveld J, Helleis F, Borrmann S, Cheng Y, Drewnick F, Haug G, Klimach T, Sciare J, Su H, Pöschl U. Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218114. [PMID: 33153155 DOI: 10.1101/2020.09.22.20199489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 05/25/2023]
Abstract
The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This "highly infective" category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that "super infective" subjects, representing the top 5-10% of subjects with a positive test, plus an unknown fraction of less-but still highly infective, high aerosol-emitting subjects-may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols.
Collapse
Affiliation(s)
- Jos Lelieveld
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
- The Cyprus Institute, Climate and Atmosphere Research Center, 2121 Nicosia, Cyprus
| | - Frank Helleis
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | | | - Yafang Cheng
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - Frank Drewnick
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - Gerald Haug
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - Thomas Klimach
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - Jean Sciare
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
- The Cyprus Institute, Climate and Atmosphere Research Center, 2121 Nicosia, Cyprus
| | - Hang Su
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - Ulrich Pöschl
- Max Planck Institute for Chemistry, 55128 Mainz, Germany
| |
Collapse
|
270
|
Lelieveld J, Helleis F, Borrmann S, Cheng Y, Drewnick F, Haug G, Klimach T, Sciare J, Su H, Pöschl U. Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8114. [PMID: 33153155 PMCID: PMC7662582 DOI: 10.3390/ijerph17218114] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023]
Abstract
The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This "highly infective" category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that "super infective" subjects, representing the top 5-10% of subjects with a positive test, plus an unknown fraction of less-but still highly infective, high aerosol-emitting subjects-may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols.
Collapse
Affiliation(s)
- Jos Lelieveld
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
- The Cyprus Institute, Climate and Atmosphere Research Center, 2121 Nicosia, Cyprus;
| | - Frank Helleis
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| | - Stephan Borrmann
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| | - Yafang Cheng
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| | - Frank Drewnick
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| | - Gerald Haug
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| | - Thomas Klimach
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| | - Jean Sciare
- The Cyprus Institute, Climate and Atmosphere Research Center, 2121 Nicosia, Cyprus;
| | - Hang Su
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| | - Ulrich Pöschl
- Max Planck Institute for Chemistry, 55128 Mainz, Germany; (F.H.); (S.B.); (Y.C.); (F.D.); (G.H.); (T.K.); (H.S.); (U.P.)
| |
Collapse
|
271
|
Christakis DA, Van Cleve W, Zimmerman FJ. Estimation of US Children's Educational Attainment and Years of Life Lost Associated With Primary School Closures During the Coronavirus Disease 2019 Pandemic. JAMA Netw Open 2020; 3:e2028786. [PMID: 33180132 PMCID: PMC7662136 DOI: 10.1001/jamanetworkopen.2020.28786] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE United States primary school closures during the 2020 coronavirus disease 2019 (COVID-19) pandemic affected millions of children, with little understanding of the potential health outcomes associated with educational disruption. OBJECTIVE To estimate the potential years of life lost (YLL) associated with the COVID-19 pandemic conditioned on primary schools being closed or remaining open. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration, and the US Census Bureau. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated. MAIN OUTCOMES AND MEASURES Years of life lost. RESULTS A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.31 (95% credible interval [CI], 0.10-0.65) years of final educational attainment for boys and 0.21 (95% CI, 0.06-0.46) years for girls. Summed across the population, an estimated 5.53 million (95% CI, 1.88-10.80) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, 1.47 million (95% credible interval, 0.45-2.59) additional YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both "schools open" and "schools closed" conditions, the analysis observed a 98.1% probability that school opening would have been associated with a lower total YLL than school closure. CONCLUSIONS AND RELEVANCE In this decision analytical model of years of life potentially lost under differing conditions of school closure, the analysis favored schools remaining open. Future decisions regarding school closures during the pandemic should consider the association between educational disruption and decreased expected lifespan and give greater weight to the potential outcomes of school closure on children's health.
Collapse
Affiliation(s)
- Dimitri A. Christakis
- Department of Pediatrics, Seattle Children’s Research Institute, University of Washington, Seattle
| | - Wil Van Cleve
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Frederick J. Zimmerman
- Department of Health Policy & Management, Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
272
|
The Right to Education and ICT during COVID-19: An International Perspective. SUSTAINABILITY 2020. [DOI: 10.3390/su12219091] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There is a lack of concluding evidence among epidemiologists and public health specialists about how school closures reduce the spread of COVID-19. Herein, we attend to the generalization of this action throughout the world, specifically in its quest to reduce mortality and avoid infections. Considering the impact on the right to education from a global perspective, this article discusses how COVID-19 has exacerbated inequalities and pre-existing problems in education systems around the world. Therefore, the institutional responses to guaranteeing remote continuity of the teaching–learning process during this educational crisis was compared regionally through international databases. Three categories of analysis were established: infrastructure and equipment, both basic and computer-based, as well as internet access of schools; preparation and means of teachers to develop distance learning; and implemented measures and resources to continue educational processes. The results showed an uneven capacity in terms of response and preparation to face the learning losses derived from school closure, both in low-income regions and within middle- and high-income countries. We concluded that it is essential to articulate inclusive educational policies that support strengthening the government response capacity, especially in low-income countries, to address the sustainability of education.
Collapse
|
273
|
Affiliation(s)
- Zoë Hyde
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA
| |
Collapse
|
274
|
White ER, Hébert-Dufresne L. State-level variation of initial COVID-19 dynamics in the United States. PLoS One 2020; 15:e0240648. [PMID: 33048967 PMCID: PMC7553297 DOI: 10.1371/journal.pone.0240648] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/30/2020] [Indexed: 01/01/2023] Open
Abstract
During an epidemic, metrics such as R0, doubling time, and case fatality rates are important in understanding and predicting the course of an epidemic. However, if collected over country or regional scales, these metrics hide important smaller-scale, local dynamics. We examine how commonly used epidemiological metrics differ for each individual state within the United States during the initial COVID-19 outbreak. We found that the detected case number and trajectory of early detected cases differ considerably between states. We then test for correlations with testing protocols, interventions and population characteristics. We find that epidemic dynamics were most strongly associated with non-pharmaceutical government actions during the early phase of the epidemic. In particular, early social distancing restrictions, particularly on restaurant operations, was correlated with increased doubling times. Interestingly, we also found that states with little tolerance for deviance from enforced rules saw faster early epidemic growth. Together with other correlates such as population density, our results highlight the different factors involved in the heterogeneity in the early spread of COVID-19 throughout the United States. Although individual states are clearly not independent, they can serve as small, natural experiments in how different demographic patterns and government responses can impact the course of an epidemic.
Collapse
Affiliation(s)
- Easton R. White
- Department of Biology, University of Vermont, Burlington, VT, United States of America
- Gund Institute for Environment, University of Vermont, Burlington, VT, United States of America
| | - Laurent Hébert-Dufresne
- Department of Computer Science, University of Vermont, Burlington, VT, United States of America
- Vermont Complex Systems Center, University of Vermont, Burlington, VT, United States of America
| |
Collapse
|
275
|
Kant S, Morris A, Ravi S, Floyd L, Gapud E, Antichos B, Dhaygude A, Seo P, Geetha D. The impact of COVID-19 pandemic on patients with ANCA associated vasculitis. J Nephrol 2020; 34:185-190. [PMID: 33034038 PMCID: PMC7543954 DOI: 10.1007/s40620-020-00881-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/27/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The coronavirus 2019 (COVID-19) pandemic has brought on challenges not only to acute care, but also chronic care of patients. Individuals maintained on immunosuppression appear to be especially susceptible to COVID-19 infection. Patients with ANCA-associated vasculitis (AAV) frequently require immunosuppression and may be at increased risk for developing COVID-19. The incidence and impact of COVID-19 on patients with AAV is currently not known. We aimed to investigate this impact via a telephone questionnaire-based patient survey and chart review. METHODS A cross-sectional study of AAV patients followed at two centers was conducted. Data regarding demographics, disease characteristics and therapy were confirmed by chart review. A telephone survey was conducted to ascertain symptoms and contact exposure related to COVID-19, as well as changes in health care delivery during the pandemic period between January and July, 2020. RESULTS Of the 206 patients surveyed, the median age was 64 years, 51% were female and mean (SD) disease duration was 7 (5) years. The majority had kidney (n = 160) and lung (n = 108) involvement. Seventy-five percent (n = 155) were receiving immunosuppression, with 77 patients (50%) receiving rituximab during the pandemic period. Of the 10 patients tested for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) by PCR, three were positive. Patients had a significant disruption in care; none had an in-person visit and 69% had a telemedicine consultation. Rituximab maintenance was postponed in 21 patients. Twelve patients experienced disease relapse. CONCLUSION The incidence of COVID-19 in patients with AAV appears to be similar to that of the general population. For a patient population that requires active clinical surveillance, there is significant disruption in care as a result of the pandemic. Reduction of immunosuppression may not be indicated, and the risk of relapse likely far outweighs the risk of COVID-19.
Collapse
Affiliation(s)
- Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Srekar Ravi
- Florida Atlantic University, Boca Raton, FL, USA
| | | | - Eric Gapud
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan Antichos
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Phil Seo
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
276
|
Endres P, Rosovsky R, Zhao S, Krinsky S, Percy S, Kamal O, Roberts RJ, Lopez N, Sise ME, Steele DJR, Lundquist AL, Rhee EP, Hibbert KA, Hardin CC, Mc Causland FR, Czarnecki PG, Mutter W, Tolkoff-Rubin N, Allegretti AS. Filter clotting with continuous renal replacement therapy in COVID-19. J Thromb Thrombolysis 2020; 51:966-970. [PMID: 33026569 PMCID: PMC7539277 DOI: 10.1007/s11239-020-02301-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) appears to be associated with increased arterial and venous thromboembolic disease. These presumed abnormalities in hemostasis have been associated with filter clotting during continuous renal replacement therapy (CRRT). We aimed to characterize the burden of CRRT filter clotting in COVID-19 infection and to describe a CRRT anticoagulation protocol that used anti-factor Xa levels for systemic heparin dosing. Multi-center study of consecutive patients with COVID-19 receiving CRRT. Primary outcome was CRRT filter loss. Sixty-five patients were analyzed, including 17 using an anti-factor Xa protocol to guide systemic heparin dosing. Fifty-four out of 65 patients (83%) lost at least one filter. Median first filter survival time was 6.5 [2.5, 33.5] h. There was no difference in first or second filter loss between the anti-Xa protocol and standard of care anticoagulation groups, however fewer patients lost their third filter in the protocolized group (55% vs. 93%) resulting in a longer median third filter survival time (24 [15.1, 54.2] vs. 17.3 [9.5, 35.1] h, p = 0.04). The rate of CRRT filter loss is high in COVID-19 infection. An anticoagulation protocol using systemic unfractionated heparin, dosed by anti-factor Xa levels is reasonable approach to anticoagulation in this population.
Collapse
Affiliation(s)
- Paul Endres
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Rachel Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sophia Zhao
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Scott Krinsky
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Shananssa Percy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Omer Kamal
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Russel J Roberts
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Natasha Lopez
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - David J R Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Andrew L Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Eugene P Rhee
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Kathryn A Hibbert
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - C Corey Hardin
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Finnian R Mc Causland
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter G Czarnecki
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Walter Mutter
- Division of Nephrology, Department of Medicine, Newton Wellesley Hospital, Newton, MA, USA
| | - Nina Tolkoff-Rubin
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
| |
Collapse
|
277
|
First results of the "Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS)". Infection 2020; 49:63-73. [PMID: 33001409 PMCID: PMC7527665 DOI: 10.1007/s15010-020-01499-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/01/2020] [Indexed: 12/24/2022]
Abstract
Purpose Knowledge regarding patients’ clinical condition at severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection is sparse. Data in the international, multicenter Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort study may enhance the understanding of COVID-19. Methods Sociodemographic and clinical characteristics of SARS-CoV-2-infected patients, enrolled in the LEOSS cohort study between March 16, 2020, and May 14, 2020, were analyzed. Associations between baseline characteristics and clinical stages at diagnosis (uncomplicated vs. complicated) were assessed using logistic regression models. Results We included 2155 patients, 59.7% (1,287/2,155) were male; the most common age category was 66–85 years (39.6%; 500/2,155). The primary COVID-19 diagnosis was made in 35.0% (755/2,155) during complicated clinical stages. A significant univariate association between age; sex; body mass index; smoking; diabetes; cardiovascular, pulmonary, neurological, and kidney diseases; ACE inhibitor therapy; statin intake and an increased risk for complicated clinical stages of COVID-19 at diagnosis was found. Multivariable analysis revealed that advanced age [46–65 years: adjusted odds ratio (aOR): 1.73, 95% CI 1.25–2.42, p = 0.001; 66–85 years: aOR 1.93, 95% CI 1.36–2.74, p < 0.001; > 85 years: aOR 2.38, 95% CI 1.49–3.81, p < 0.001 vs. individuals aged 26–45 years], male sex (aOR 1.23, 95% CI 1.01–1.50, p = 0.040), cardiovascular disease (aOR 1.37, 95% CI 1.09–1.72, p = 0.007), and diabetes (aOR 1.33, 95% CI 1.04–1.69, p = 0.023) were associated with complicated stages of COVID-19 at diagnosis. Conclusion The LEOSS cohort identified age, cardiovascular disease, diabetes and male sex as risk factors for complicated disease stages at SARS-CoV-2 diagnosis, thus confirming previous data. Further data regarding outcomes of the natural course of COVID-19 and the influence of treatment are required. Electronic supplementary material The online version of this article (10.1007/s15010-020-01499-0) contains supplementary material, which is available to authorized users.
Collapse
|
278
|
Pericàs JM, Cucchiari D, Torrallardona-Murphy O, Calvo J, Serralabós J, Alvés E, Agelet A, Hidalgo J, Alves E, Castells E, Seijas N, Hernández C, Bodro M, Cardozo C, Coloma E, Nicolás D. Hospital at home for the management of COVID-19: preliminary experience with 63 patients. Infection 2020; 49:327-332. [PMID: 32995970 PMCID: PMC7523688 DOI: 10.1007/s15010-020-01527-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
Alternatives to conventional hospitalization are needed to increase health systems resilience in the face of COVID-19 pandemic. Herein, we describe the characteristics and outcomes of 63 patients admitted to a single HaH during the peak of COVID-19 in Barcelona. Our results suggest that HaH seems to be a safe and efficacious alternative to conventional hospitalization for accurately selected patients with COVID-19.
Collapse
Affiliation(s)
- Juan M Pericàs
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain. .,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain. .,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain. .,Vall D'Hebron Institute for Research (VHIR), Barcelona, Spain.
| | - David Cucchiari
- Renal Transplantation Service, Hospital Clinic Barcelona, Barcelona, Spain
| | | | - Júlia Calvo
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain
| | - Júlia Serralabós
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisenda Alvés
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Aleix Agelet
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Judit Hidalgo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eduarda Alves
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Hernández
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Infectious Disease Department, Hospital Clínic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - David Nicolás
- Internal Medicine Service, Hospital Clinic Barcelona, Villarroel Street, 170, 08036, Barcelona, Spain.,Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain.,Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | |
Collapse
|
279
|
Matzinger P, Skinner J. Strong impact of closing schools, closing bars and wearing masks during the Covid-19 pandemic: results from a simple and revealing analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.09.26.20202457. [PMID: 33024976 PMCID: PMC7536875 DOI: 10.1101/2020.09.26.20202457] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many complex mathematical and epidemiological methods have been used to model the Covid-19 pandemic. Among other results from these models has been the view that closing schools had little impact on infection rates in several countries1. We took a different approach. Making one assumption, we simply plotted cases, hospitalizations and deaths, on a log2 Y axis and a linear date-based X axis, and analyzed them using segmented regression, a powerful method that has largely been overlooked during this pandemic. Here we show that the data fit straight lines with correlation coefficients ranging from 92% - 99%, and that these lines broke at interesting intervals, revealing that school closings dropped infection rates in half, lockdowns dropped the rates 3 to 4 fold, and other actions (such as closing bars and mandating masks) brought the rates even further down. Hospitalizations and deaths paralleled cases, with lags of three to ten days. The graphs, which are easy to read, reveal changes in infection rates that are not obvious using other graphing methods, and have several implications for modeling and policy development during this and future pandemics. Overall, other than full lockdowns, three interventions had the most impact: closing schools, closing bars and wearing masks: a message easily understood by the public.
Collapse
|
280
|
Comparison of four commercial SARS-CoV-2 IgG immuno-assays in RT-PCR negative patients with suspect CT findings. Infection 2020; 49:145-148. [PMID: 32910322 PMCID: PMC7482374 DOI: 10.1007/s15010-020-01523-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
A subset of patients with Covid-19 presents with negative RT-PCR screening but suspect CT findings. Using four commercially available anti-SARS-CoV-2 IgG immuno-assays, we found this subset constituted 9.2% of all consecutively admitted outpatients with Covid-19 in our hospital. Clinical specificity for Covid-19 of some N protein-based immuno-assays was suboptimal, as positive results were observed in control patients with recent common human coronavirus, influenza B and adenovirus infections.
Collapse
|
281
|
de Souza TH, Lanziotti VS, Lee JH. COVID-19 and Children: Many Questions Yet To Be Answered. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Jan Hau Lee
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore; Duke-NUS Medical School, Singapore
| |
Collapse
|
282
|
Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Can J Anaesth 2020; 68:64-70. [PMID: 32803468 PMCID: PMC7427754 DOI: 10.1007/s12630-020-01787-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Prone positioning of non-intubated patients with coronavirus disease (COVID-19) and hypoxemic respiratory failure may prevent intubation and improve outcomes. Nevertheless, there are limited data on its feasibility, safety, and physiologic effects. The objective of our study was to assess the tolerability and safety of awake prone positioning in COVID-19 patients with hypoxemic respiratory failure. METHODS This historical cohort study was performed across four hospitals in Calgary, Canada. Included patients had suspected COVID-19 and hypoxic respiratory failure requiring intensive care unit (ICU) consultation, and underwent awake prone positioning. The duration, frequency, tolerability, and adverse events from prone positioning were recorded. Respiratory parameters were assessed before, during, and after prone positioning. The primary outcome was the tolerability and safety of prone positioning. RESULTS Seventeen patients (n = 12 ICU, n = 5 hospital ward) were included between April and May 2020. The median (range) number of prone positioning days was 1 (1-7) and the median number of sessions was 2 (1-6) per day. The duration of prone positioning was 75 (30-480) min, and the peripheral oxygen saturation was 91% (84-95) supine and 98% (92-100) prone. Limitations to prone position duration were pain/general discomfort (47%) and delirium (6%); 47% of patients had no limitations. Seven patients (41%) required intubation and two patients (12%) died. CONCLUSIONS In a small sample, prone positioning non-intubated COVID-19 patients with severe hypoxemia was safe; however, many patients did not tolerate prolonged durations. Although patients had improved oxygenation and respiratory rate in the prone position, many still required intubation. Future studies are required to determine methods to improve the tolerability of awake prone positioning and whether there is an impact on clinical outcomes.
Collapse
|
283
|
Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol 2020; 17:543-558. [PMID: 32690910 PMCID: PMC7370876 DOI: 10.1038/s41569-020-0413-9] [Citation(s) in RCA: 831] [Impact Index Per Article: 207.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 01/18/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by a strain of coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic that has affected the lives of billions of individuals. Extensive studies have revealed that SARS-CoV-2 shares many biological features with SARS-CoV, the zoonotic virus that caused the 2002 outbreak of severe acute respiratory syndrome, including the system of cell entry, which is triggered by binding of the viral spike protein to angiotensin-converting enzyme 2. Clinical studies have also reported an association between COVID-19 and cardiovascular disease. Pre-existing cardiovascular disease seems to be linked with worse outcomes and increased risk of death in patients with COVID-19, whereas COVID-19 itself can also induce myocardial injury, arrhythmia, acute coronary syndrome and venous thromboembolism. Potential drug-disease interactions affecting patients with COVID-19 and comorbid cardiovascular diseases are also becoming a serious concern. In this Review, we summarize the current understanding of COVID-19 from basic mechanisms to clinical perspectives, focusing on the interaction between COVID-19 and the cardiovascular system. By combining our knowledge of the biological features of the virus with clinical findings, we can improve our understanding of the potential mechanisms underlying COVID-19, paving the way towards the development of preventative and therapeutic solutions.
Collapse
Affiliation(s)
- Masataka Nishiga
- Stanford Cardiovascular Institute, Stanford, CA, USA. .,Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yaling Han
- Cardiovascular Research Institute, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - David B Lewis
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford, CA, USA. .,Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
284
|
de Havenon A, Ney JP, Callaghan B, Yaghi S, Majersik JJ. Excess neurological death in New York City after the emergence of COVID-19. J Neurol 2020; 268:2026-2028. [PMID: 32691234 PMCID: PMC7370626 DOI: 10.1007/s00415-020-10084-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, 175 N. Medical Dr., Salt Lake City, UT, 84132, USA.
| | - John P Ney
- Department of Neurology, Boston University, Boston, USA
| | - Brian Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, USA
| | - Shadi Yaghi
- Department of Neurology, New York University, New York City, USA
| | - Jennifer J Majersik
- Department of Neurology, University of Utah, 175 N. Medical Dr., Salt Lake City, UT, 84132, USA
| |
Collapse
|
285
|
Chakravarty D, Nair SS, Hammouda N, Ratnani P, Gharib Y, Wagaskar V, Mohamed N, Lundon D, Dovey Z, Kyprianou N, Tewari AK. Sex differences in SARS-CoV-2 infection rates and the potential link to prostate cancer. Commun Biol 2020; 3:374. [PMID: 32641750 PMCID: PMC7343823 DOI: 10.1038/s42003-020-1088-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
The recent outbreak of infections and the pandemic caused by SARS-CoV-2 represent one of the most severe threats to human health in more than a century. Emerging data from the United States and elsewhere suggest that the disease is more severe in men. Knowledge gained, and lessons learned, from studies of the biological interactions and molecular links that may explain the reasons for the greater severity of disease in men, and specifically in the age group at risk for prostate cancer, will lead to better management of COVID-19 in prostate cancer patients. Such information will be indispensable in the current and post-pandemic scenarios.
Collapse
Affiliation(s)
- Dimple Chakravarty
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Sujit S Nair
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Nada Hammouda
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Parita Ratnani
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Yasmine Gharib
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Vinayak Wagaskar
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Nihal Mohamed
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dara Lundon
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zachary Dovey
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Natasha Kyprianou
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ashutosh K Tewari
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| |
Collapse
|
286
|
Fritz MA, Howell RJ, Brodsky MB, Suiter DM, Dhar SI, Rameau A, Richard T, Skelley M, Ashford JR, O'Rourke AK, Kuhn MA. Moving Forward with Dysphagia Care: Implementing Strategies during the COVID-19 Pandemic and Beyond. Dysphagia 2020; 36:161-169. [PMID: 32519150 PMCID: PMC7282541 DOI: 10.1007/s00455-020-10144-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
Growing numbers of SARS-CoV-2 cases coupled with limited understanding of transmissibility and virulence, have challenged the current workflow and clinical care pathways for the dysphagia provider. At the same time, the need for non-COVID-19-related dysphagia care persists. Increased awareness of asymptomatic virus carriers and variable expression of the disease have also focused attention to appropriate patient care in the context of protection for the healthcare workforce. The objective of this review was to create a clinical algorithm and reference for dysphagia clinicians across clinical settings to minimize spread of COVID-19 cases while providing optimal care to patients suffering from swallowing disorders. Every practitioner and healthcare system will likely have different constraints or preferences leading to the utilization of one technique over another. Knowledge about this pandemic increases every day, but the algorithms provided here will help in considering the best options for proceeding with safe and effective dysphagia care in this new era.
Collapse
Affiliation(s)
- Mark A Fritz
- Department of Otolaryngology, Head and Neck Surgery, University of Kentucky, 740 S Limestone, E300E, Lexington, KY, 40536, USA.
| | - Rebecca J Howell
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, USA
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Debra M Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington, USA
| | - Shumon I Dhar
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, USA
| | - Anais Rameau
- Department of Otolaryngology, Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Ashli K O'Rourke
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
| | - Maggie A Kuhn
- Department of Otolaryngology, Head and Neck Surgery, University of California-Davis Medical Center, Sacramento, USA
| |
Collapse
|
287
|
COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection 2020; 48:681-686. [PMID: 32394344 PMCID: PMC7211976 DOI: 10.1007/s15010-020-01438-z] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 01/28/2023]
Abstract
Introduction Data on people living with human immunodeficiency virus (PLWH) in the current SARS-CoV-2 pandemic are still scarce. This case series of 33 PLWH patients with COVID-19 reveals symptoms and outcome in this special population. Methods Retrospective analysis of anonymized data including age, gender, HIV-associated parameters, symptoms, and outcome. Results Three out of 32 patients with documented outcomes died (9%). 91% of the patients recovered and 76% have been classified as mild cases. All patients were on antiretroviral treatment, of them 22 on tenofovir-containing regimen and 4 on the protease inhibitor darunavir. Conclusions This preliminary case series does not support excess morbidity and mortality among symptomatic COVID-19 PLWH and with viral suppression on ART. SARS-CoV-2 infections may occur during boosted darunavir-based and/or on tenofovir-containing ART.
Collapse
|
288
|
Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol 2020; 20:355-362. [PMID: 32376901 PMCID: PMC7201395 DOI: 10.1038/s41577-020-0331-4] [Citation(s) in RCA: 1706] [Impact Index Per Article: 426.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic caused by infection with SARS-CoV-2 has led to more than 200,000 deaths worldwide. Several studies have now established that the hyperinflammatory response induced by SARS-CoV-2 is a major cause of disease severity and death in infected patients. Macrophages are a population of innate immune cells that sense and respond to microbial threats by producing inflammatory molecules that eliminate pathogens and promote tissue repair. However, a dysregulated macrophage response can be damaging to the host, as is seen in the macrophage activation syndrome induced by severe infections, including in infections with the related virus SARS-CoV. Here we describe the potentially pathological roles of macrophages during SARS-CoV-2 infection and discuss ongoing and prospective therapeutic strategies to modulate macrophage activation in patients with COVID-19. This Progress article from Merad and Martin examines our current understanding of the excessive inflammatory responses seen in patients with severe COVID-19. The authors focus on the emerging pathological roles of monocytes and macrophages and discuss the inflammatory pathways that are currently being targeted in the clinic.
Collapse
|
289
|
Abstract
During an epidemic, metrics such as R0, doubling time, and case fatality rates are important in understanding and predicting the course of an epidemic. However, if collected over country or regional scales, these metrics hide important smaller-scale, local dynamics. We examine how commonly used epidemiological metrics differ for each individual state within the United States during the initial COVID-19 outbreak. We found that the detected case number and trajectory of early detected cases differ considerably between states. We then test for correlations with testing protocols, interventions and population characteristics. We find that epidemic dynamics were most strongly associated with non-pharmaceutical government actions during the early phase of the epidemic. In particular, early social distancing restrictions, particularly on restaurant operations, was correlated with increased doubling times. Interestingly, we also found that states with little tolerance for deviance from enforced rules saw faster early epidemic growth. Together with other correlates such as population density, our results highlight the different factors involved in the heterogeneity in the early spread of COVID-19 throughout the United States. Although individual states are clearly not independent, they can serve as small, natural experiments in how different demographic patterns and government responses can impact the course of an epidemic.
Collapse
Affiliation(s)
- Easton R White
- Department of Biology, University of Vermont, Burlington, VT, United States of America
- Gund Institute for Environment, University of Vermont, Burlington, VT, United States of America
| | - Laurent Hébert-Dufresne
- Department of Computer Science, University of Vermont, Burlington, VT, United States of America
- Vermont Complex Systems Center, University of Vermont, Burlington, VT, United States of America
| |
Collapse
|