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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 DOI: 10.1128/cmr.00124-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Musa SS, Zhao S, Abdulrashid I, Qureshi S, Colubri A, He D. Evaluating the spike in the symptomatic proportion of SARS-CoV-2 in China in 2022 with variolation effects: a modeling analysis. Infect Dis Model 2024; 9:601-617. [PMID: 38558958 PMCID: PMC10978539 DOI: 10.1016/j.idm.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
Despite most COVID-19 infections being asymptomatic, mainland China had a high increase in symptomatic cases at the end of 2022. In this study, we examine China's sudden COVID-19 symptomatic surge using a conceptual SIR-based model. Our model considers the epidemiological characteristics of SARS-CoV-2, particularly variolation, from non-pharmaceutical intervention (facial masking and social distance), demography, and disease mortality in mainland China. The increase in symptomatic proportions in China may be attributable to (1) higher sensitivity and vulnerability during winter and (2) enhanced viral inhalation due to spikes in SARS-CoV-2 infections (high transmissibility). These two reasons could explain China's high symptomatic proportion of COVID-19 in December 2022. Our study, therefore, can serve as a decision-support tool to enhance SARS-CoV-2 prevention and control efforts. Thus, we highlight that facemask-induced variolation could potentially reduces transmissibility rather than severity in infected individuals. However, further investigation is required to understand the variolation effect on disease severity.
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Affiliation(s)
- Salihu S. Musa
- Department of Genomics and Computational Biology, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Mathematics, Aliko Dangote University of Science and Technology, Kano, Nigeria
| | - Shi Zhao
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Ismail Abdulrashid
- School of Finance and Operations Management, The University of Tulsa, 800 South Tucker Dr., Tulsa, OK, 74104, USA
| | - Sania Qureshi
- Department of Basic Sciences and Related Studies, Mehran University of Engineering and Tech., Jamshoro, Pakistan
- Department of Computer Science and Mathematics, Lebanese American University, Beirut, Lebanon
| | - Andrés Colubri
- Department of Genomics and Computational Biology, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong SAR, China
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Mølbak K, Sørensen TIA, Bhatt S, Lyngse FP, Simonsen L, Aaby P. Severity of respiratory tract infections depends on the infectious dose. Perspectives for the next pandemic. Front Public Health 2024; 12:1391719. [PMID: 38746005 PMCID: PMC11091249 DOI: 10.3389/fpubh.2024.1391719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Kåre Mølbak
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Statens Serum Institut, Copenhagen, Denmark
| | - Thorkild I. A. Sørensen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Samir Bhatt
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Plesner Lyngse
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Simonsen
- PandemiX Center, Roskilde University, Roskilde, Denmark
| | - Peter Aaby
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, Bissau, Guinea-Bissau
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Castonguay FM, Barnes A, Jeon S, Fornoff J, Adhikari BB, Fischer LS, Greening B, Hassan AO, Kahn EB, Kang GJ, Kauerauf J, Patrick S, Vohra S, Meltzer MI. Estimated public health impact of concurrent mask mandate and vaccinate-or-test requirement in Illinois, October to December 2021. BMC Public Health 2024; 24:1013. [PMID: 38609903 PMCID: PMC11010411 DOI: 10.1186/s12889-024-18203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/24/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Facing a surge of COVID-19 cases in late August 2021, the U.S. state of Illinois re-enacted its COVID-19 mask mandate for the general public and issued a requirement for workers in certain professions to be vaccinated against COVID-19 or undergo weekly testing. The mask mandate required any individual, regardless of their vaccination status, to wear a well-fitting mask in an indoor setting. METHODS We used Illinois Department of Public Health's COVID-19 confirmed case and vaccination data and investigated scenarios where masking and vaccination would have been reduced to mimic what would have happened had the mask mandate or vaccine requirement not been put in place. The study examined a range of potential reductions in masking and vaccination mimicking potential scenarios had the mask mandate or vaccine requirement not been enacted. We estimated COVID-19 cases and hospitalizations averted by changes in masking and vaccination during the period covering October 20 to December 20, 2021. RESULTS We find that the announcement and implementation of a mask mandate are likely to correlate with a strong protective effect at reducing COVID-19 burden and the announcement of a vaccinate-or-test requirement among frontline professionals is likely to correlate with a more modest protective effect at reducing COVID-19 burden. In our most conservative scenario, we estimated that from the period of October 20 to December 20, 2021, the mask mandate likely prevented approximately 58,000 cases and 1,175 hospitalizations, while the vaccinate-or-test requirement may have prevented at most approximately 24,000 cases and 475 hospitalizations. CONCLUSION Our results indicate that mask mandates and vaccine-or-test requirements are vital in mitigating the burden of COVID-19 during surges of the virus.
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Affiliation(s)
- François M Castonguay
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia.
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia.
- Department of Health Management, Evaluation and Policy, University of Montreal School of Public Health, and Centre for Public Health Research - CReSP, 7101 Av du Parc, 3E Étage, Montréal, QC, H3N 1X9, Canada.
| | - Arti Barnes
- Illinois Department of Public Health, Springfield, IL, USA
| | - Seonghye Jeon
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia
| | - Jane Fornoff
- Illinois Department of Public Health, Springfield, IL, USA
| | - Bishwa B Adhikari
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia
| | - Leah S Fischer
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia
| | - Bradford Greening
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia
| | | | - Emily B Kahn
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia
| | - Gloria J Kang
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia
| | - Judy Kauerauf
- Illinois Department of Public Health, Springfield, IL, USA
| | - Sarah Patrick
- Illinois Department of Public Health, Springfield, IL, USA
| | - Sameer Vohra
- Illinois Department of Public Health, Springfield, IL, USA
| | - Martin I Meltzer
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Health Economics and Modeling Unit, U.S. Department of Health and Human Services, 7101 Avenue du Parc, Local 3180, QC H3N 1X9, Atlanta, Georgia
- Contact Tracing and Innovation Section (CTIS), State Tribal Local and Territorial (STLT) Task Force, CDC COVID-19 Response; Centers for Disease Control and Prevention, Modeling Support Team, U.S. Department of Health and Human Services, Atlanta, Georgia
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Constantin AM, Noertjojo K, Sommer I, Pizarro AB, Persad E, Durao S, Nussbaumer-Streit B, McElvenny DM, Rhodes S, Martin C, Sampson O, Jørgensen KJ, Bruschettini M. Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings. Cochrane Database Syst Rev 2024; 4:CD015112. [PMID: 38597249 PMCID: PMC11005086 DOI: 10.1002/14651858.cd015112.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment. This is the first update of a Cochrane review published 6 May 2022, with one new study added. OBJECTIVES To assess the benefits and harms of interventions in non-healthcare-related workplaces aimed at reducing the risk of SARS-CoV-2 infection compared to other interventions or no intervention. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science Core Collections, Cochrane COVID-19 Study Register, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and medRxiv to 13 April 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by coworkers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls (i.e. elimination; engineering controls; administrative controls; personal protective equipment). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess risk of bias, and GRADE methods to evaluate the certainty of evidence for each outcome. MAIN RESULTS We identified 2 studies including a total of 16,014 participants. Elimination-of-exposure interventions We included one study examining an intervention that focused on elimination of hazards, which was an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) working at 86 schools were assigned to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic polymerase chain reaction (PCR)-positive SARS-CoV-2 infection (rate ratio (RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study; very low-certainty evidence). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-CoV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study; very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 working days) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 working days) in the intervention group (RR 0.83, 95% CI 0.55 to 1.25). We downgraded the certainty of the evidence to low due to imprecision. Uptake of the intervention was 71% in the intervention group, but not reported for the control intervention. The trial did not measure our other outcomes of SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, or hospitalisation. We found seven ongoing studies using elimination-of-hazard strategies, six RCTs and one non-randomised trial. Administrative control interventions We found one ongoing RCT that aims to evaluate the efficacy of the Bacillus Calmette-Guérin (BCG) vaccine in preventing COVID-19 infection and reducing disease severity. Combinations of eligible interventions We included one non-randomised study examining a combination of elimination of hazards, administrative controls, and personal protective equipment. The study was conducted in two large retail companies in Italy in 2020. The study compared a safety operating protocol, measurement of body temperature and oxygen saturation upon entry, and a SARS-CoV-2 test strategy with a minimum activity protocol. Both groups received protective equipment. All employees working at the companies during the study period were included: 1987 in the intervention company and 1798 in the control company. The study did not report an outcome of interest for this systematic review. Other intervention categories We did not find any studies in this category. AUTHORS' CONCLUSIONS We are uncertain whether a test-based attendance policy affects rates of PCR-positive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. A test-based attendance policy may result in little to no difference in absenteeism rates compared to standard 10-day self-isolation. The non-randomised study included in our updated search did not report any outcome of interest for this Cochrane review. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus become an important absolute effect from the enterprise or societal perspective. The included RCT did not report on any of our other primary outcomes (i.e. SARS-CoV-2-related mortality and adverse events). We identified no completed studies on any other interventions specified in this review; however, eight eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.
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Affiliation(s)
- Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | | | - Isolde Sommer
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | | | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | - Damien M McElvenny
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
- Institute of Occupational Medicine, Edinburgh, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | | | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Kawungezi P, Migisha R, Zavuga R, Simbwa BN, Zalwango JF, Ninsiima M, Kiggundu T, Agaba B, Kyamwine I, Kadobera D, Kwesiga B, Bulage L, Majwala RK, Ario AR. Investigation of COVID-19 outbreak at a refugee transit centre, Kisoro District, Uganda, June-July 2022. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002428. [PMID: 38446829 PMCID: PMC10917256 DOI: 10.1371/journal.pgph.0002428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
Due to conflict in the Democratic Republic of Congo (DRC), approximately 34,000 persons arrived at Nyakabande Transit Centre (NTC) between March and June 2022. On June 12, 2022, Kisoro District reported >330 cases of COVID-19 among NTC residents. We investigated the outbreak to assess its magnitude, identify risk factors, and recommend control measures. We defined a confirmed case as a positive SARS-CoV-2 antigen test in an NTC resident during March 1-June 30, 2022. We generated a line list through medical record reviews and interviews with residents and health workers. We assessed the setting to understand possible infection mechanisms. In a case-control study, we compared exposures between cases (persons staying ≥5 days at NTC between June 26 and July 16, 2022, with a negative COVID-19 test at NTC entry and a positive test at exit) and unmatched controls (persons with a negative COVID-19 test at both entry and exit who stayed ≥5 days at NTC during the same period). We used multivariable logistic regression to identify factors associated with contracting COVID-19. Among 380 case-persons, 206 (54.2%) were male, with a mean age of 19.3 years (SD = 12.6); none died. The attack rate was higher among exiting persons (3.8%) than entering persons (0.6%) (p<0.01). Among 42 cases and 127 controls, close contact with symptomatic persons (aOR = 9.6; 95%CI = 3.1-30) increased the odds of infection; using a facemask (aOR = 0.06; 95% CI = 0.02-0.17) was protective. We observed overcrowding in shelters, poor ventilation, and most refugees not wearing face masks. The COVID-19 outbreak at NTC was facilitated by overcrowding and suboptimal use of facemasks. Enforcing facemask use and expanding shelter space could reduce the risk of future outbreaks. The collaborative efforts resulted in successful health sensitization and expanding the distribution of facemasks and shelter space. Promoting facemask use through refugee-led efforts is a viable strategy.
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Affiliation(s)
- Peter Kawungezi
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Richard Migisha
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Robert Zavuga
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Brenda Nakafeero Simbwa
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Jane Frances Zalwango
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Mackline Ninsiima
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Thomas Kiggundu
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Brian Agaba
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Irene Kyamwine
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Daniel Kadobera
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Benon Kwesiga
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Lilian Bulage
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Robert Kaos Majwala
- Ministry of Health, Kampala, Uganda
- Department of Global Health Security, Baylor Uganda, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda National Institute of Public Health, Uganda Public Health Fellowship Program, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
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7
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Enright C, Gilbourne C, Kiersey R, Parlour R, Flanagan P, McGowan E, Boland M, Mulholland D. Efficacy of facemasks in preventing transmission of COVID-19 in non-healthcare settings: A scoping review. J Infect Prev 2024; 25:24-32. [PMID: 38362115 PMCID: PMC10866118 DOI: 10.1177/17571774231203387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/14/2023] [Indexed: 02/17/2024] Open
Abstract
Background During the COVID-19 pandemic, an abundance of literature relating to the efficacy of face masks on reducing transmission of COVID-19 in non-healthcare settings emerged. Aim/objective The aim of this scoping review was to allow the identification of: types of evidence conducted in this area; knowledge gaps and common concepts relating to mask efficacy in non-healthcare settings. Methods A comprehensive literature search was conducted in PubMed, CINAHL, MEDLINE, Embase and the Irish Management Institute bibliographic database on December 15th, 2021. All types of face masks were included. Of 722 records, 16 were included after full text screening. Findings/results Themes from an adapted model of Howard et al. framework were used to group results and identify common concepts. The grouped thematic results were then applied to the socio-ecological model. This illustrated the multifactorial elements determining the efficacy of masks themselves while also illustrating how other factors such as individual behaviours, social interactions, settings and national policy can influence the degree of the protective effect. Discussion The findings from this scoping review indicate that an abundance of experimental literature is available indicating that masks are effective at preventing COVID-19 transmission but their degree of efficacy is impacted by external factors. This review highlights that the quality of the evidence available is low.
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Barosa M, Jamrozik E, Prasad V. The Ethical Obligation for Research During Public Health Emergencies: Insights From the COVID-19 Pandemic. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:49-70. [PMID: 38153559 PMCID: PMC10904511 DOI: 10.1007/s11019-023-10184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/29/2023]
Abstract
In times of crises, public health leaders may claim that trials of public health interventions are unethical. One reason for this claim can be that equipoise-i.e. a situation of uncertainty and/or disagreement among experts about the evidence regarding an intervention-has been disturbed by a change of collective expert views. Some might claim that equipoise is disturbed if the majority of experts believe that emergency public health interventions are likely to be more beneficial than harmful. However, such beliefs are not always justified: where high quality research has not been conducted, there is often considerable residual uncertainty about whether interventions offer net benefits. In this essay we argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies (PHEs). We contend that this standard applies to both pharmaceutical and non-pharmaceutical interventions, and we elaborate an account of equipoise that captures key features of debates in the recent pandemic. We build our case by analyzing research strategies employed during the COVID-19 pandemic regarding drugs, vaccines, and non-pharmaceutical interventions; and by providing responses to possible objections. Finally, we propose a public health policy reform: whenever a policy implemented during a PHE is not grounded in high-quality evidence that expected benefits outweigh harms, there should be a planned approach to generate high-quality evidence, with review of emerging data at preset time points. These preset timepoints guarantee that policymakers pause to review emerging evidence and consider ceasing ineffective or even harmful policies, thereby improving transparency and accountability, as well as permitting the redirection of resources to more effective or beneficial interventions.
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Affiliation(s)
- Mariana Barosa
- Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Science and Technologies Studies (MSc student), University College London, London, UK
| | - Euzebiusz Jamrozik
- Ethox and Pandemic Sciences Institute, University of Oxford, Oxford, UK
- Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, Australia
- Monash Bioethics Centre, Monash University, Melbourne, Australia
| | - Vinay Prasad
- University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA.
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Liu M, Shi L, Yang M, Jiao J, Yang J, Ma M, Xie W, Sun G. Ecological comparison of six countries in two waves of COVID-19. Front Public Health 2024; 12:1277457. [PMID: 38481850 PMCID: PMC10933017 DOI: 10.3389/fpubh.2024.1277457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/16/2024] [Indexed: 04/30/2024] Open
Abstract
Objective The purpose of this study is to provide experience and evidence support for countries to deal with similar public health emergencies such as COVID-19 by comparing and analyzing the measures taken by six countries in epidemic prevention and control. Methods This study extracted public data on COVID-19 from the official website of various countries and used ecological comparative research methods to compare the specific situation of indicators such as daily tests per thousand people, stringency index, and total vaccinations per hundred people in countries. Results The cumulative death toll in China, Germany and Australia was significantly lower than that in the United States, South Africa and Italy. Expanding the scale of testing has helped control the spread of the epidemic to some extent. When the epidemic situation is severe, the stringency index increases, and when the epidemic situation tends to ease, the stringency index decreases. Increased vaccination rates, while helping to build an immune barrier, still need to be used in conjunction with non-drug interventions. Conclusion The implementation of non-drug interventions and vaccine measures greatly affected the epidemic prevention and control effect. In responding to public health emergencies such as the COVID-19 epidemic, countries should draw on international experience, closely align with their national conditions, follow the laws of epidemiology, actively take non-drug intervention measures, and vigorously promote vaccine research and development and vaccination.
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Affiliation(s)
- Meiheng Liu
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Manfei Yang
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Jun Jiao
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Junyan Yang
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Mengyuan Ma
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Wanzhen Xie
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Gang Sun
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Sandlund J, Duriseti R, Ladhani SN, Stuart K, Noble J, Høeg TB. Child mask mandates for COVID-19: a systematic review. Arch Dis Child 2024; 109:e2. [PMID: 38050026 PMCID: PMC10894839 DOI: 10.1136/archdischild-2023-326215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Mask mandates for children during the COVID-19 pandemic varied in different locations. A risk-benefit analysis of this intervention has not yet been performed. In this study, we performed a systematic review to assess research on the effectiveness of mask wearing in children. METHODS We performed database searches up to February 2023. The studies were screened by title and abstract, and included studies were further screened as full-text references. A risk-of-bias analysis was performed by two independent reviewers and adjudicated by a third reviewer. RESULTS We screened 597 studies and included 22 in the final analysis. There were no randomised controlled trials in children assessing the benefits of mask wearing to reduce SARS-CoV-2 infection or transmission. The six observational studies reporting an association between child masking and lower infection rate or antibody seropositivity had critical (n=5) or serious (n=1) risk of bias; all six were potentially confounded by important differences between masked and unmasked groups and two were shown to have non-significant results when reanalysed. Sixteen other observational studies found no association between mask wearing and infection or transmission. CONCLUSIONS Real-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19.
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Affiliation(s)
- Johanna Sandlund
- Board-Certified Clinical Microbiologist and Independent Scholar, Alameda, California, USA
| | - Ram Duriseti
- Stanford University School of Medicine, Stanford, California, USA
| | - Shamez N Ladhani
- Immunisation Department, UK Health Security Agency, London, UK
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
| | - Kelly Stuart
- SmallTalk Pediatric Therapy, San Diego, California, USA
| | - Jeanne Noble
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tracy Beth Høeg
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Clinical Research, University of Southern Denmark, Odense, Denmark
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Wang CW, de Jong EP, Faure JA, Ellington JL, Chen CHS, Chan CC. Exploring the Barriers and Facilitators of Mask-Wearing Behavior During the COVID-19 Pandemic in Taiwan, the United States, the Netherlands, and Haiti: A Qualitative Study. Disaster Med Public Health Prep 2024; 18:e23. [PMID: 38351541 DOI: 10.1017/dmp.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti. METHODS Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti. RESULTS In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior. CONCLUSIONS These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.
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Affiliation(s)
- Chia-Wen Wang
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Lloyd's Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore
| | - Erik Pieter de Jong
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Josemyrne Ashley Faure
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Chi-Hsin Sally Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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Nanque LM, Jensen AM, Diness A, Nielsen S, Cabral C, Cawthorne D, Martins JSD, Ca EJC, Jensen K, Martins CL, Rodrigues A, Fisker AB. Effect of distributing locally produced cloth facemasks on COVID-19-like illness and all-cause mortality-a cluster-randomised controlled trial in urban Guinea-Bissau. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002901. [PMID: 38349910 PMCID: PMC10863890 DOI: 10.1371/journal.pgph.0002901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
Facemasks have been employed to mitigate the spread of SARS-CoV-2. The community effect of providing cloth facemasks on COVID-19 morbidity and mortality is unknown. In a cluster randomised trial in urban Bissau, Guinea-Bissau, clusters (geographical areas with an average of 19 houses), were randomised to an intervention or control arm using computer-generated random numbers. Between 20 July 2020 and 22 January 2021, trial participants (aged 10+ years) living in intervention clusters (n = 90) received two 2-layer cloth facemasks, while facemasks were only distributed later in control clusters (n = 91). All participants received information on COVID-19 prevention. Trial participants were followed through a telephone interview for COVID-19-like illness (3+ symptoms), care seeking, and mortality for 4 months. End-of-study home visits ensured full mortality information and distribution of facemasks to the control group. Individual level information on outcomes by trial arm was compared in logistic regression models with generalised estimating equation-based correction for cluster. Facemasks use was mandated. Facemask use in public areas was assessed by direct observation. We enrolled 39,574 trial participants among whom 95% reported exposure to groups of >20 persons and 99% reported facemasks use, with no difference between trial arms. Observed use was substantially lower (~40%) with a 3%, 95%CI: 0-6% absolute difference between control and intervention clusters. Half of those wearing a facemask wore it correctly. Few participants (532, 1.6%) reported COVID-19-like illness; proportions did not differ by trial arm: Odds Ratio (OR) = 0.81, 95%CI: 0.57-1.15. 177 (0.6%) participants reported consultations and COVID-19-like illness (OR = 0.83, 95%CI: 0.56-1.24); 89 participants (0.2%) died (OR = 1.34, 95%CI: 0.89-2.02). Hence, though trial participants were exposed to many people, facemasks were mostly not worn or not worn correctly. Providing facemasks and messages about correct use did not substantially increase their use and had limited impact on morbidity and mortality. Trial registration: clinicaltrials.gov: NCT04471766.
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Affiliation(s)
- Line M. Nanque
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Andreas M. Jensen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Arthur Diness
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Carlos Cabral
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Dylan Cawthorne
- The Maersk Mc-Kinney Moller Institute, SDU Drone Center, University of Southern Denmark, Odense, Denmark
- Engineers Without Borders Denmark, Copenhagen, Denmark
| | | | - Elsi J. C. Ca
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Kjeld Jensen
- The Maersk Mc-Kinney Moller Institute, SDU Drone Center, University of Southern Denmark, Odense, Denmark
- Engineers Without Borders Denmark, Copenhagen, Denmark
| | | | | | - Ane B. Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
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Smith LE, West R, Potts HWW, Amlôt R, Fear NT, Rubin GJ, Michie S. Factors associated with wearing a facemask in shops in England following removal of a legal requirement to do so during the COVID-19 pandemic. Br J Health Psychol 2024; 29:3-19. [PMID: 37537895 DOI: 10.1111/bjhp.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/30/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES We aimed to identify psychological factors associated with the use of facemasks in shops in England following removal of legal requirements to do so, and to compare associations with and without legal restrictions. DESIGN Repeated cross-sectional online surveys (n ≈ 2000 adults) between August 2020 and April 2022 (68,716 responses from 45,682 participants) using quota sampling. METHODS The outcome measure was whether those who had visited a shop for essentials in the previous seven days reported always having worn a facemask versus sometimes or not at all. Psychological predictor variables included worry, perceived risk and severity of COVID-19 and the perceived effectiveness of facemasks. Socio-demographic variables and measures of clinical vulnerability were also measured. For the period following removal of legal restrictions, multivariable regression was used to assess associations between the primary outcome variable and predictors adjusting for socio-demographic and clinical vulnerability measures. The analysis was repeated including interactions between psychological predictors and presence versus absence of legal restrictions. RESULTS Worry about COVID-19, beliefs about risks and severity of COVID-19 and effectiveness of facemasks were substantially and independently associated with the use of facemasks. Removal of legal obligations to wear facemasks was associated with a 25% decrease in wearing facemasks and stronger associations between psychological predictors and wearing facemasks. CONCLUSIONS Legal obligations increase rates of wearing a facemask. Psychological factors associated with wearing a facemask could be targets for interventions aiming to alter rates of wearing a facemask. These interventions may be more effective when there are no legal obligations to wear a face covering in place.
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Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
- Behavioural Science and Insights Unit, UK Health Security Agency, London, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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Peng A, Bosco S, Simmons AE, Tuite AR, Fisman DN. Impact of community mask mandates on SARS-CoV-2 transmission in Ontario after adjustment for differential testing by age and sex. PNAS NEXUS 2024; 3:pgae065. [PMID: 38463611 PMCID: PMC10923507 DOI: 10.1093/pnasnexus/pgae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024]
Abstract
Mask use for prevention of respiratory infectious disease transmission is not new but has proven controversial during the SARS-CoV-2 pandemic. In Ontario, Canada, irregular regional introduction of community mask mandates in 2020 created a quasi-experiment useful for evaluating the impact of such mandates; however, Ontario SARS-CoV-2 case counts were likely biased by testing focused on long-term care facilities and healthcare workers. We developed a regression-based method that allowed us to adjust cases for under-testing by age and gender. We evaluated mask mandate effects using count-based regression models with either unadjusted cases, or testing-adjusted case counts, as dependent variables. Models were used to estimate mask mandate effectiveness, and the fraction of SARS-CoV-2 cases, severe outcomes, and costs, averted by mask mandates. Models using unadjusted cases as dependent variables identified modest protective effects of mask mandates (range 31-42%), with variable statistical significance. Mask mandate effectiveness in models predicting test-adjusted case counts was higher, ranging from 49% (95% CI 44-53%) to 76% (95% CI 57-86%). The prevented fraction associated with mask mandates was 46% (95% CI 41-51%), with 290,000 clinical cases, 3,008 deaths, and loss of 29,038 quality-adjusted life years averted from 2020 June to December, representing $CDN 610 million in economic wealth. Under-testing in younger individuals biases estimates of SARS-CoV-2 infection risk and obscures the impact of public health preventive measures. After adjustment for under-testing, mask mandates emerged as highly effective. Community masking saved substantial numbers of lives, and prevented economic costs, during the SARS-CoV-2 pandemic in Ontario, Canada.
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Affiliation(s)
- Amy Peng
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Savana Bosco
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Alison E Simmons
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
- Centre for Immunization Programs, Public Health Agency of Canada, 130 Colonnade Road, Ottawa, ON K1A 0K9, Canada
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
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15
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Kivelä JM. Unpacked Cochrane Review on Masks: A Further Look. Am J Public Health 2024; 114:251-252. [PMID: 38335492 PMCID: PMC10862200 DOI: 10.2105/ajph.2023.307526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Jesper M Kivelä
- Jesper M. Kivelä is with the HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Finland
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16
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Kato T, Suzuki J, Kobayashi Y, Oishi T, Ikushima H, Yamauchi Y, Katori Y. Effect of wearing masks on odor detection and recognition. Acta Otolaryngol 2024; 144:142-146. [PMID: 38469861 DOI: 10.1080/00016489.2024.2325047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The effect of wearing masks on olfaction remains unclear. OBJECTIVES This study aimed to clarify the differences between the effects of no masks, surgical masks, and N95 respirator masks by conducting both identification and threshold olfaction tests. METHODS Young, healthy volunteers aged ≥ 18 years and < 30 years without awareness of apparent olfactory disorder were included. All participants filled out a questionnaire on olfaction and completed an acuity smell identification test (Open Essence test) and an olfactory threshold test (T&T olfactometry) while wearing no masks, surgical masks, or N95 respirator masks. RESULTS In the Open Essence tests, the no-mask group score was significantly higher than those of the surgical- and N95-mask groups. Using T&T olfactometry, the median-detection threshold of the no-mask group was significantly lower than that of the surgical-mask group, and the surgical-mask group threshold was significantly lower than that of the N95-mask group. Similar patterns were observed for the median-recognition threshold. CONCLUSIONS Wearing masks, especially an N95 mask, reduces the ability to detect and identify odors. This disadvantage should be considered by professionals such as healthcare workers, who require proper olfaction to perform appropriate tasks.
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Affiliation(s)
- Taiga Kato
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Oishi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Ikushima
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasunari Yamauchi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Gurbaxani BM, Hill AN, Patel P. Gurbaxani et al. Respond. Am J Public Health 2024; 114:252-253. [PMID: 38335493 PMCID: PMC10862214 DOI: 10.2105/ajph.2023.307527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Brian M Gurbaxani
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. B. M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the National Center for Emerging and Zoonotic Infectious Diseases, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta. P. Patel is also with the Department of Medicine, Emory University
| | - Andrew N Hill
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. B. M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the National Center for Emerging and Zoonotic Infectious Diseases, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta. P. Patel is also with the Department of Medicine, Emory University
| | - Pragna Patel
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. B. M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the National Center for Emerging and Zoonotic Infectious Diseases, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta. P. Patel is also with the Department of Medicine, Emory University
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Hoffman SA, Maldonado YA. Emerging and re-emerging pediatric viral diseases: a continuing global challenge. Pediatr Res 2024; 95:480-487. [PMID: 37940663 PMCID: PMC10837080 DOI: 10.1038/s41390-023-02878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
The twenty-first century has been marked by a surge in viral epidemics and pandemics, highlighting the global health challenge posed by emerging and re-emerging pediatric viral diseases. This review article explores the complex dynamics contributing to this challenge, including climate change, globalization, socio-economic interconnectedness, geopolitical tensions, vaccine hesitancy, misinformation, and disparities in access to healthcare resources. Understanding the interactions between the environment, socioeconomics, and health is crucial for effectively addressing current and future outbreaks. This scoping review focuses on emerging and re-emerging viral infectious diseases, with an emphasis on pediatric vulnerability. It highlights the urgent need for prevention, preparedness, and response efforts, particularly in resource-limited communities disproportionately affected by climate change and spillover events. Adopting a One Health/Planetary Health approach, which integrates human, animal, and ecosystem health, can enhance equity and resilience in global communities. IMPACT: We provide a scoping review of emerging and re-emerging viral threats to global pediatric populations This review provides an update on current pediatric viral threats in the context of the COVID-19 pandemic This review aims to sensitize clinicians, epidemiologists, public health practitioners, and policy stakeholders/decision-makers to the role these viral diseases have in persistent pediatric morbidity and mortality.
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Affiliation(s)
- Seth A Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yvonne A Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Scholfield S, Kavembe GD, Duncan RR, Ragama BO, Mecha J, Orwa A, Otomu G, Wanga E, Astleford J, Gutto J, Kibwage I, Ogato J, Verma A, Brennan K, Huck J, Mitlin D, Nirmalan M. A cross-sectional survey on the effectiveness of public health campaigns for changing knowledge, attitudes, and practices in Kenyan informal settlements during the COVID-19 pandemic. PLoS One 2023; 18:e0294202. [PMID: 38134188 PMCID: PMC10745220 DOI: 10.1371/journal.pone.0294202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/26/2023] [Indexed: 12/24/2023] Open
Abstract
We performed two cross-sectional surveys across three informal settlements in Kenya (within Kisii county, Nairobi, and Nakuru county) to study the effectiveness of public health interventions during the COVID-19 pandemic. A total of 720 participants were surveyed from 120 randomly selected geographical locations (240 participants/settlement/survey), and a coordinated health promotion campaign was delivered between the two surveys by trained staff. Information relating to knowledge, attitudes, and practices (KAP) were collected by trained field workers using a validated questionnaire. The main outcomes showed improvements in: (i) mask-wearing (% of participants 'Always' using their mask increased from 71 to 74%, and the percentage using their masks 'Sometimes' decreased from 15% to 6%; p<0.001); (ii) practices related to face mask usage (% of subjects covering the mouth and nose increased from 91 to 95%, and those covering only part of their face decreased from around 2.5% to <1%; p<0.001). Significant improvements were also seen in the attitudes and expectations relating to mask wearing, and in the understanding of government directives. Over 50% of subjects in the post-campaign survey reported that social distancing was not possible in their communities and fears associated with COVID-19 testing were resistant to change (unchanged at 10%). Access to COVID-19 testing facilities was limited, leaving a large proportion of people unable to test. As willingness to take a COVID-19 test did not change between surveys (69 vs 70%; p = 0.57), despite increased availability, we recommend that policy level interventions are needed, aimed at mitigating adverse consequences of a positive test. Improvements of KAPs in the more crowded urban environment (Nairobi) were less than at settlements in rural or semi-urban settings (Nakuru and Kisii). We conclude that coordinated public health campaigns are effective in facilitating the change of KAPs amongst people living amidst challenging socio-economic conditions in informal settlements.
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Affiliation(s)
- Steven Scholfield
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
| | | | - Rodney R. Duncan
- Department of Monitoring and Evaluation, Central Kenya Conference of SDA, Nairobi, Kenya
| | - Bernhards O. Ragama
- Centre for Research and Therapeutic Sciences, Strathmore University and Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Jared Mecha
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Albert Orwa
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Geoffrey Otomu
- Department of Medicine, Kisii Teaching and Referral Hospital, Kisii, Kenya
| | - Erick Wanga
- Adventist Development and Relief Agency (ADRA), Nairobi, Kenya
| | - James Astleford
- Adventist Development and Relief Agency (ADRA), Nairobi, Kenya
| | - John Gutto
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
| | | | - Julius Ogato
- Division of Health Systems Strengthening, Ministry of Health, Nairobi, Kenya
| | - Arpana Verma
- Division of Population Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Keith Brennan
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
| | - Jonathan Huck
- MCGIS, Department of Geography, Faculty of Humanities, University of Manchester, Manchester, United Kingdom
| | - Diana Mitlin
- Global Development Institute, Faculty of Humanities, University of Manchester, Manchester, United Kingdom
| | - Mahesh Nirmalan
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
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20
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Mody A, Filiatreau LM, Goss CW, Powell BJ, Geng EH. Instrumental variables for implementation science: exploring context-dependent causal pathways between implementation strategies and evidence-based interventions. Implement Sci Commun 2023; 4:157. [PMID: 38124203 PMCID: PMC10731809 DOI: 10.1186/s43058-023-00536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The impact of both implementation strategies (IS) and evidence-based interventions (EBI) can vary across contexts, and a better understanding of how and why this occurs presents fundamental but challenging questions that implementation science as a field will need to grapple with. We use causal epidemiologic methods to explore the mechanisms of why sharp distinctions between implementation strategies (IS) and efficacy of an evidence-based intervention (EBI) may fail to recognize that the effect of an EBI can be deeply intertwined and dependent on the context of the IS leading to its uptake. METHODS We explore the use of instrumental variable (IV) analyses as a critical tool for implementation science methods to isolate three relevant quantities within the same intervention context when exposure to an implementation strategy is random: (1) the effect of an IS on implementation outcomes (e.g., uptake), (2) effect of EBI uptake on patient outcomes, and (3) overall effectiveness of the IS (i.e., ~ implementation*efficacy). We discuss the mechanisms by which an implementation strategy can alter the context, and therefore effect, of an EBI using the underlying IV assumptions. We illustrate these concepts using examples of the implementation of new ART initiation guidelines in Zambia and community-based masking programs in Bangladesh. RESULTS Causal questions relevant to implementation science are answered at each stage of an IV analysis. The first stage assesses the effect of the IS (e.g., new guidelines) on EBI uptake (e.g., same-day treatment initiation). The second stage leverages the IS as an IV to estimate the complier average causal effect (CACE) of the EBI on patient outcomes (e.g., effect of same-day treatment initiation on viral suppression). The underlying assumptions of CACE formalize that the causal effect of EBI may differ in the context of a different IS because (1) the mechanisms by which individuals uptake an intervention may differ and (2) the subgroup of individuals who take up an EBI may differ. IV methods thus provide a conceptual framework for how IS and EBIs are linked and that the IS itself needs to be considered a critical contextual determinant. Moreover, it also provides rigorous methodologic tools to isolate the effect of an IS, EBI, and combined effect of the IS and EBI. DISCUSSION Leveraging IV methods when exposure to an implementation strategy is random helps to conceptualize the context-dependent nature of implementation strategies, EBIs, and patient outcomes. IV methods formalize that the causal effect of an EBI may be specific to the context of the implementation strategy used to promote uptake. This integration of implementation science concepts and theory with rigorous causal epidemiologic methods yields novel insights and provides important tools for exploring the next generation of questions related to mechanisms and context in implementation science.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA.
| | - Lindsey M Filiatreau
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA
| | - Charles W Goss
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Byron J Powell
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA
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21
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Wilson D. HIV and COVID-19: convergence, divergence and lessons for future health emergencies. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:253-256. [PMID: 38117743 DOI: 10.2989/16085906.2023.2271452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
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22
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Grieve R, Yang Y, Abbott S, Babu GR, Bhattacharyya M, Dean N, Evans S, Jewell N, Langan SM, Lee W, Molenberghs G, Smeeth L, Williamson E, Mukherjee B. The importance of investing in data, models, experiments, team science, and public trust to help policymakers prepare for the next pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002601. [PMID: 38032861 PMCID: PMC10688710 DOI: 10.1371/journal.pgph.0002601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The COVID-19 pandemic has brought about valuable insights regarding models, data, and experiments. In this narrative review, we summarised the existing literature on these three themes, exploring the challenges of providing forecasts, the requirement for real-time linkage of health-related datasets, and the role of 'experimentation' in evaluating interventions. This literature review encourages us to broaden our perspective for the future, acknowledging the significance of investing in models, data, and experimentation, but also to invest in areas that are conceptually more abstract: the value of 'team science', the need for public trust in science, and in establishing processes for using science in policy. Policy-makers rely on model forecasts early in a pandemic when there is little data, and it is vital to communicate the assumptions, limitations, and uncertainties (theme 1). Linked routine data can provide critical information, for example, in establishing risk factors for adverse outcomes but are often not available quickly enough to make a real-time impact. The interoperability of data resources internationally is required to facilitate sharing across jurisdictions (theme 2). Randomised controlled trials (RCTs) provided timely evidence on the efficacy and safety of vaccinations and pharmaceuticals but were largely conducted in higher income countries, restricting generalisability to low- and middle-income countries (LMIC). Trials for non-pharmaceutical interventions (NPIs) were almost non-existent which was a missed opportunity (theme 3). Building on these themes from the narrative review, we underscore the importance of three other areas that need investment for effective evidence-driven policy-making. The COVID-19 response relied on strong multidisciplinary research infrastructures, but funders and academic institutions need to do more to incentivise team science (4). To enhance public trust in the use of scientific evidence for policy, researchers and policy-makers must work together to clearly communicate uncertainties in current evidence and any need to change policy as evidence evolves (5). Timely policy decisions require an established two-way process between scientists and policy makers to make the best use of evidence (6). For effective preparedness against future pandemics, it is essential to establish models, data, and experiments as fundamental pillars, complemented by efforts in planning and investment towards team science, public trust, and evidence-based policy-making across international communities. The paper concludes with a 'call to actions' for both policy-makers and researchers.
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Affiliation(s)
- Richard Grieve
- Centre for Data and Statistical Science for Health (DASH), London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Youqi Yang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sam Abbott
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giridhara R. Babu
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, India
| | | | - Natalie Dean
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Stephen Evans
- Centre for Data and Statistical Science for Health (DASH), London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas Jewell
- Centre for Data and Statistical Science for Health (DASH), London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sinéad M. Langan
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Woojoo Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Universiteit Hasselt & KU Leuven, Hasselt, Belgium
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth Williamson
- Centre for Data and Statistical Science for Health (DASH), London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
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23
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Li T, Fujimoto M, Hayashi K, Anzai A, Nishiura H. Habitual Mask Wearing as Part of COVID-19 Control in Japan: An Assessment Using the Self-Report Habit Index. Behav Sci (Basel) 2023; 13:951. [PMID: 37998697 PMCID: PMC10669277 DOI: 10.3390/bs13110951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
Although the Japanese government removed mask-wearing requirements in 2023, relatively high rates of mask wearing have continued in Japan. We aimed to assess psychological reasons and the strength of habitual mask wearing in Japan. An Internet-based cross-sectional survey was conducted with non-random participant recruitment. We explored the frequency of mask usage, investigating psychological reasons for wearing masks. A regression analysis examined the association between psychological reasons and the frequency of mask wearing. The habitual use of masks was assessed in the participant's most frequently visited indoor space and public transport using the self-report habit index. The principal component analysis with varimax rotation revealed distinct habitual characteristics. Among the 2640 participants surveyed from 6 to 9 February 2023, only 4.9% reported not wearing masks at all. Conformity to social norms was the most important reason for masks. Participants exhibited a slightly higher degree of habituation towards mask wearing on public transport compared to indoor spaces. The mask-wearing rate was higher in females than in males, and no significant difference was identified by age group. Daily mask wearing in indoor spaces was characterized by two traits (automaticity and behavioral frequency). A high mask-wearing frequency has been maintained in Japan during the social reopening transition period. Mask wearing has become a part of daily habit, especially on public transport, largely driven by automatic and frequent practice.
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Affiliation(s)
| | | | | | | | - Hiroshi Nishiura
- Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; (T.L.); (M.F.); (K.H.); (A.A.)
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Dudley L, Couper I, Kannangarage NW, Naidoo S, Ribas CR, Koller TS, Young T. COVID-19 preparedness and response in rural and remote areas: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002602. [PMID: 37967067 PMCID: PMC10651055 DOI: 10.1371/journal.pgph.0002602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
This scoping review used the Arksey and O'Malley approach to explore COVID-19 preparedness and response in rural and remote areas to identify lessons to inform future health preparedness and response planning. A search of scientific and grey literature for rural COVID-19 preparedness and responses identified 5 668 articles published between 2019 and early 2022. A total of 293 articles were included, of which 160 (54.5%) were from high income countries and 106 (36.2%) from middle income countries. Studies focused mostly on the Maintenance of Essential Health Services (63; 21.5%), Surveillance, epidemiological investigation, contact tracing and adjustment of public health and social measures (60; 20.5%), Coordination and Planning (32; 10.9%); Case Management (30; 10.2%), Social Determinants of Health (29; 10%) and Risk Communication (22; 7.5%). Rural health systems were less prepared and national COVID-19 responses were often not adequately tailored to rural areas. Promising COVID-19 responses involved local leaders and communities, were collaborative and multisectoral, and engaged local cultures. Non-pharmaceutical interventions were applied less, support for access to water and sanitation at scale was weak, and more targeted approaches to the isolation of cases and quarantine of contacts were preferable to blanket lockdowns. Rural pharmacists, community health workers and agricultural extension workers assisted in overcoming shortages of health professionals. Vaccination coverage was hindered by weaker rural health systems. Digital technology enabled better coordination, communication, and access to health services, yet for some was inaccessible. Rural livelihoods and food security were affected through disruptions to local labour markets, farm produce markets and input supply chains. Important lessons include the need for rural proofing national health preparedness and response and optimizing synergies between top-down planning with localised planning and coordination. Equity-oriented rural health systems strengthening and action on rural social determinants is essential to better prepare for and respond to future outbreaks.
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Affiliation(s)
- Lilian Dudley
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Selvan Naidoo
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Clara Rodriguez Ribas
- Health Emergencies Program, World Health Organisation, Headquarters, Geneva, Switzerland
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Theadora Swift Koller
- Department for Gender, Equity and Human Rights, Director General’s Office, World Health Organization, Headquarters, Geneva, Switzerland
| | - Taryn Young
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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25
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Barsch F, Peters V, Morath O, Krumnau O, Maier P, Huzly D, Prettin S, Deibert P. Trends in the numbers of SARS-CoV-2 infections among students: a prospective cohort study comparing students in sports boarding schools with students in day schools during early COVID-19 pandemic. Front Public Health 2023; 11:1223748. [PMID: 38035288 PMCID: PMC10682161 DOI: 10.3389/fpubh.2023.1223748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction During the first months of the COVID pandemic it emerged that facilities where people gather or live together in cohorts, such as nursing homes or schools, were particularly at high risk for becoming hotspots of virus transmission. German political and health institutions responded with far-reaching interventions and preventive strategies to protect the population from infection with SARS-CoV-2. In this context, it remains unclear whether boarding schools for sports particularly pose a risk of infection to their residents. Methods In a single-center prospective cohort study, numbers of SARS-CoV-2 infections of students in sports boarding schools (n = 11) vs. students attending regular day schools (n = 22) in the region Freiburg/Hochschwarzwald in Germany were investigated over a period from October 2020 to January 2021 via regular virus and antibody screening (German Clinical Trials Register; Study ID: DRKS00021909). In addition, individual and behavioral risk factors for infection were stratified via questionnaire, which provide an indication of cohort specific risk factors for infection and the success of the implementation of hygiene concepts, as well as other infection prevention strategies, within the respective facilities. Results Regarding SARS-CoV-2 infection numbers, the screening detected no significant group difference between sports boarding schools vs. day schools. Discussion The study results provide indications that sports boarding schools did not pose an increased risk of infection, assuming that the facilities prevent virus transmissions with appropriate preventive strategies and hygiene measures. In future pandemic scenarios larger-scale and multicenter studies are necessary to achieve more comprehensive epidemiological data in this field.
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Affiliation(s)
- Friedrich Barsch
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Vera Peters
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Morath
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Krumnau
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Philipp Maier
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniela Huzly
- Freiburg University Medical Center, Faculty of Medicine, Institute of Virology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephan Prettin
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter Deibert
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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26
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Elgersma IH, Fretheim A, Elstrøm P, Aavitsland P. Association between face mask use and risk of SARS-CoV-2 infection: Cross-sectional study. Epidemiol Infect 2023; 151:e194. [PMID: 37952983 PMCID: PMC10728967 DOI: 10.1017/s0950268823001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
We examined the association between face masks and risk of infection with SARS-CoV-2 using cross-sectional data from 3,209 participants in a randomized trial exploring the effectiveness of glasses in reducing the risk of SARS-CoV-2 infection. Face mask use was based on participants' response to the end-of-follow-up survey. We found that the incidence of self-reported COVID-19 was 33% (aRR 1.33; 95% CI 1.03-1.72) higher in those wearing face masks often or sometimes, and 40% (aRR 1.40; 95% CI 1.08-1.82) higher in those wearing face masks almost always or always, compared to participants who reported wearing face masks never or almost never. We believe the observed increase in the incidence of infection associated with wearing a face mask is likely due to unobservable and hence nonadjustable differences between those wearing and not wearing a mask. Observational studies reporting on the relationship between face mask use and risk of respiratory infections should be interpreted cautiously, and more randomized trials are needed.
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Affiliation(s)
- Ingeborg Hess Elgersma
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Petter Elstrøm
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Preben Aavitsland
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
- Pandemic Centre, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Agrawal V, Cantor J, Sood N, Whaley C. The impact of COVID-19 shelter-in-place policy responses on excess mortality. HEALTH ECONOMICS 2023; 32:2499-2515. [PMID: 37464737 DOI: 10.1002/hec.4737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/24/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023]
Abstract
As a way of slowing COVID-19 transmission, many countries and U.S. states implemented shelter-in-place (SIP) policies. However, the effects of SIP policies on public health are a priori ambiguous. Using an event study approach and data from 43 countries and all U.S. states, we measure changes in excess deaths following the implementation of COVID-19 shelter-in-place (SIP) policies. We do not find that countries or U.S. states that implemented SIP policies earlier had lower excess deaths. We do not observe differences in excess deaths before and after the implementation of SIP policies, even when accounting for pre-SIP COVID-19 death rates.
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Affiliation(s)
- Virat Agrawal
- University of Southern California, Los Angeles, California, USA
| | | | - Neeraj Sood
- University of Southern California, Los Angeles, California, USA
- National Bureau for Economic Research, Cambridge, Massachusetts, USA
| | - Christopher Whaley
- RAND Corporation, Santa Monica, California, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Miyazaki Y, Kamatani M, Tsurumi S, Suda T, Wakasugi K, Matsunaga K, Kawahara JI. Effects of wearing an opaque or transparent face mask on the perception of facial expressions: A comparative study between Japanese school-aged children and adults. Perception 2023; 52:782-798. [PMID: 37728164 DOI: 10.1177/03010066231200693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
The negative side effects of mask-wearing on reading facial emotional cues have been investigated in several studies with adults post-2020. However, little is known about children. This study aimed to determine the negative influence of mask-wearing on reading emotions of adult faces by Japanese school-aged children, compared to Japanese adults. We also examined whether this negative influence could be alleviated by using a transparent face mask instead of an opaque one (surgical mask). The performance on reading emotions was measured using emotion categorization and emotion intensity rating tasks for adult faces. As per the findings, the accuracy of emotion recognition in children was impaired for various facial expressions (disgust, fear, happy, neutral, sad, and surprise faces), except for angry faces. Conversely, in adults, it was impaired for a few facial expressions. The perceived intensity for happy faces with a surgical mask was weaker in both children and adults than in those without the mask. A negative influence of wearing surgical masks was generally not observed for faces wearing a transparent mask in both children and adults. Thus, negative side effects of mask-wearing on reading emotions are observed for more facial expressions in children than in adults; transparent masks can help remedy these.
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Drouin JR, Rojas JA. Influence of face masks on recalibration of phonetic categories. Atten Percept Psychophys 2023; 85:2700-2717. [PMID: 37188863 PMCID: PMC10185375 DOI: 10.3758/s13414-023-02715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
Previous research demonstrates listeners dynamically adjust phonetic categories in line with lexical context. While listeners show flexibility in adapting speech categories, recalibration may be constrained when variability can be attributed externally. It has been hypothesized that when listeners attribute atypical speech input to a causal factor, phonetic recalibration is attenuated. The current study investigated this theory directly by examining the influence of face masks, an external factor that affects both visual and articulatory cues, on the magnitude of phonetic recalibration. Across four experiments, listeners completed a lexical decision exposure phase in which they heard an ambiguous sound in either /s/-biasing or /ʃ/-biasing lexical contexts, while simultaneously viewing a speaker with a mask off, mask on the chin, or mask over the mouth. Following exposure, all listeners completed an auditory phonetic categorization test along an /ʃ/-/s/ continuum. In Experiment 1 (when no face mask was present during exposure trials), Experiment 2 (when the face mask was on the chin), Experiment 3 (when the face mask was on the mouth during ambiguous items), and Experiment 4 (when the face mask was on the mouth during the entire exposure phase), listeners showed a robust and equivalent phonetic recalibration effect. Recalibration manifested as greater proportion /s/ responses for listeners in the /s/-biased exposure group, relative to listeners in the /ʃ/-biased exposure group. Results support the notion that listeners do not causally attribute face masks with speech idiosyncrasies, which may reflect a general speech learning adjustment during the COVID-19 pandemic.
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Affiliation(s)
- Julia R Drouin
- Division of Speech and Hearing Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
- Department of Communication Sciences and Disorders, California State University Fullerton, Fullerton, CA, USA.
| | - Jose A Rojas
- Department of Communication Sciences and Disorders, California State University Fullerton, Fullerton, CA, USA
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Li X, Han F, Fan S, Liu Y, Zhang J, Li J. Recycling of discarded face masks for modification and use in SBS-modified bitumen. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:115152-115163. [PMID: 37880400 DOI: 10.1007/s11356-023-30570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
Since the outbreak of the COVID-19 pandemic, the discarded face masks have attracted widespread attention in society. In line with sustainable development, a physicochemical treatment method was used to recycle discarded face masks into styrene-butadiene-styrene (SBS) modified bitumen. Utilizing the highly adhesive polydopamine-polyethyleneimine (PDA-PEI) coating, it has improved the surface damage of the discarded face mask fibers (DFMF) caused by natural aging and mechanical fragmentation, simultaneously strengthening the connection between the fibers and bitumen. At 46 °C, the 2% embellish-face mask fiber (E-FMF)/SBS modified bitumen, compared to the 2%DFMF/SBS modified bitumen, exhibited improvements in complex modulus (G*), elastic modulus (G'), and loss modulus (G″) by 12.27%, 16.39%, and 13.35%, respectively. Furthermore, at 0.1 kPa and 3.2 kPa, the creep recovery rate (R) increased by 23.3% and 32%, and the average creep compliance (Jnr) decreased by 54.7% and 64%. It was demonstrated that DFMF adhered with the coating, were more effective in improving the mechanical properties, deformation resistance, and shear resistance of the bitumen. This approach enriches the application scenarios of discarded single-use face masks and supports environmental protection and road construction.
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Affiliation(s)
- Xinyu Li
- College of Chemistry and Chemical Engineering, Guangxi University, Nanning, 530004, China
| | - Fuhu Han
- College of Chemistry and Chemical Engineering, Guangxi University, Nanning, 530004, China
| | - Shencheng Fan
- College of Chemistry and Chemical Engineering, Guangxi University, Nanning, 530004, China
| | - Yu Liu
- Guangxi Communications Investment Technology Co., Ltd., Nanning, China
| | - Jieyu Zhang
- College of Chemistry and Chemical Engineering, Guangxi University, Nanning, 530004, China
| | - Jing Li
- College of Chemistry and Chemical Engineering, Guangxi University, Nanning, 530004, China.
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Talhelm T, Lee CS, English AS, Wang S. How Rice Fights Pandemics: Nature-Crop-Human Interactions Shaped COVID-19 Outcomes. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2023; 49:1567-1586. [PMID: 35856451 DOI: 10.1177/01461672221107209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wealthy nations led health preparedness rankings in 2019, yet many poor nations controlled COVID-19 better. We argue that a history of rice farming explains why some societies did better. We outline how traditional rice farming led to tight social norms and low-mobility social networks. These social structures helped coordinate societies against COVID-19. Study 1 compares rice- and wheat-farming prefectures within China. Comparing within China allows for controlled comparisons of regions with the same national government, language family, and other potential confounds. Study 2 tests whether the findings generalize to cultures globally. The data show rice-farming nations have tighter social norms and less-mobile relationships, which predict better COVID outcomes. Rice-farming nations suffered just 3% of the COVID deaths of nonrice nations. These findings suggest that long-run cultural differences influence how rice societies-with over 50% of the world's population-controlled COVID-19. The culture was critical, yet the preparedness rankings mostly ignored it.
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Affiliation(s)
| | - Cheol-Sung Lee
- University of Chicago, IL, USA
- Sogang University, Seoul, South Korea
| | | | - Shuang Wang
- Shanghai International Studies University, China
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Boulos L, Curran JA, Gallant A, Wong H, Johnson C, Delahunty-Pike A, Saxinger L, Chu D, Comeau J, Flynn T, Clegg J, Dye C. Effectiveness of face masks for reducing transmission of SARS-CoV-2: a rapid systematic review. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2023; 381:20230133. [PMID: 37611625 PMCID: PMC10446908 DOI: 10.1098/rsta.2023.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023]
Abstract
This rapid systematic review of evidence asks whether (i) wearing a face mask, (ii) one type of mask over another and (iii) mandatory mask policies can reduce the transmission of SARS-CoV-2 infection, either in community-based or healthcare settings. A search of studies published 1 January 2020-27 January 2023 yielded 5185 unique records. Due to a paucity of randomized controlled trials (RCTs), observational studies were included in the analysis. We analysed 35 studies in community settings (three RCTs and 32 observational) and 40 in healthcare settings (one RCT and 39 observational). Ninety-five per cent of studies included were conducted before highly transmissible Omicron variants emerged. Ninety-one per cent of observational studies were at 'critical' risk of bias (ROB) in at least one domain, often failing to separate the effects of masks from concurrent interventions. More studies found that masks (n = 39/47; 83%) and mask mandates (n = 16/18; 89%) reduced infection than found no effect (n = 8/65; 12%) or favoured controls (n = 1/65; 2%). Seven observational studies found that respirators were more protective than surgical masks, while five found no statistically significant difference between the two mask types. Despite the ROB, and allowing for uncertain and variable efficacy, we conclude that wearing masks, wearing higher quality masks (respirators), and mask mandates generally reduced SARS-CoV-2 transmission in these study populations. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
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Affiliation(s)
- Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, 5790 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
| | - Janet A. Curran
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- School of Nursing, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Allyson Gallant
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- Faculty of Health, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Helen Wong
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- Faculty of Health, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Catherine Johnson
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- Department of Health and Rehabilitation Services, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | | | - Lynora Saxinger
- Division of Infectious Diseases, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta, 116 Street & 85 Avenue, Edmonton, Alberta T6G 2R3, Canada
| | - Derek Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
- The Research Institute of St Joe's Hamilton, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N A46, Canada
| | - Jeannette Comeau
- Division of Infectious Diseases, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Trudy Flynn
- Patient/Public Partner, University of Oxford, 11A Mansfield Road, Oxford OX1 3SZ, UK
| | - Julie Clegg
- Patient/Public Partner, University of Oxford, 11A Mansfield Road, Oxford OX1 3SZ, UK
| | - Christopher Dye
- Department of Biology, University of Oxford, 11A Mansfield Road, Oxford OX1 3SZ, UK
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Cash-Goldwasser S, Reingold AL, Luby SP, Jackson LA, Frieden TR. Masks During Pandemics Caused by Respiratory Pathogens-Evidence and Implications for Action. JAMA Netw Open 2023; 6:e2339443. [PMID: 37906187 DOI: 10.1001/jamanetworkopen.2023.39443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Importance As demonstrated by the influenza virus and SARS-CoV-2, viruses spread by the respiratory route can cause deadly pandemics, and face masks can reduce the spread of these pathogens. The effectiveness of responses to future epidemics and pandemics will depend at least in part on whether evidence on masks, including from the COVID-19 pandemic, is utilized. Observations Well-designed observational studies have demonstrated the association of mask use with reduced transmission of SARS-CoV-2 in community settings, and rigorous evaluations of mask mandates have found substantial protection. Disagreement about whether face masks reduce the spread of SARS-CoV-2 has been exacerbated by a focus on randomized trials, which are limited in number, scope, and statistical power. Many effective public health policies have never been assessed in randomized clinical trials; such trials are not the gold standard of evidence for the efficacy of all interventions. Masking in the community to reduce the spread of SARS-CoV-2 is supported by robust evidence from diverse settings and populations. Data on the epidemiologic, environmental, and mask design parameters that influence the effectiveness of masking provide insights on when and how masks should be used to prevent transmission. Conclusions and Relevance During the next epidemic or pandemic caused by a respiratory pathogen, decision-makers will need to rely on existing evidence as they implement interventions. High-quality studies have shown that use of face masks in the community is associated with reduced transmission of SARS-CoV-2 and is likely to be an important component of an effective response to a future respiratory threat.
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Affiliation(s)
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle
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Tancredi S, Chiolero A, Wagner C, Haller ML, Chocano-Bedoya P, Ortega N, Rodondi N, Kaufmann L, Lorthe E, Baysson H, Stringhini S, Michel G, Lüdi C, Harju E, Frank I, Imboden M, Witzig M, Keidel D, Probst-Hensch N, Amati R, Albanese E, Corna L, Crivelli L, Vincentini J, Gonseth Nusslé S, Bochud M, D'Acremont V, Kohler P, Kahlert CR, Cusini A, Frei A, Puhan MA, Geigges M, Kaufmann M, Fehr J, Cullati S. Seroprevalence trends of anti-SARS-CoV-2 antibodies and associated risk factors: a population-based study. Infection 2023; 51:1453-1465. [PMID: 36870034 PMCID: PMC9985433 DOI: 10.1007/s15010-023-02011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE We aimed to assess the seroprevalence trends of SARS-CoV-2 antibodies in several Swiss cantons between May 2020 and September 2021 and investigate risk factors for seropositivity and their changes over time. METHODS We conducted repeated population-based serological studies in different Swiss regions using a common methodology. We defined three study periods: May-October 2020 (period 1, prior to vaccination), November 2020-mid-May 2021 (period 2, first months of the vaccination campaign), and mid-May-September 2021 (period 3, a large share of the population vaccinated). We measured anti-spike IgG. Participants provided information on sociodemographic and socioeconomic characteristics, health status, and adherence to preventive measures. We estimated seroprevalence with a Bayesian logistic regression model and the association between risk factors and seropositivity with Poisson models. RESULTS We included 13,291 participants aged 20 and older from 11 Swiss cantons. Seroprevalence was 3.7% (95% CI 2.1-4.9) in period 1, 16.2% (95% CI 14.4-17.5) in period 2, and 72.0% (95% CI 70.3-73.8) in period 3, with regional variations. In period 1, younger age (20-64) was the only factor associated with higher seropositivity. In period 3, being aged ≥ 65 years, with a high income, retired, overweight or obese or with other comorbidities, was associated with higher seropositivity. These associations disappeared after adjusting for vaccination status. Seropositivity was lower in participants with lower adherence to preventive measures, due to a lower vaccination uptake. CONCLUSIONS Seroprevalence sharply increased over time, also thanks to vaccination, with some regional variations. After the vaccination campaign, no differences between subgroups were observed.
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Affiliation(s)
- Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland.
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- School of Population and Global Health, McGill University, Montreal, Canada
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cornelia Wagner
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
| | - Moa Lina Haller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patricia Chocano-Bedoya
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Natalia Ortega
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Kaufmann
- Cantonal Public Health Service of the Canton of Neuchâtel, Neuchâtel, Switzerland
| | - Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Gisela Michel
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Chantal Lüdi
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Erika Harju
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Clinical Trial Unit, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Irene Frank
- Clinical Trial Unit, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Melissa Witzig
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Laurie Corna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Luca Crivelli
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Julia Vincentini
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Semira Gonseth Nusslé
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Alexia Cusini
- Division of Infectious Diseases, Cantonal Hospital of Grisons, Chur, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Geigges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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Judson TJ, Zhang S, Lindan CP, Boothroyd D, Grumbach K, Bollyky JB, Sample HA, Huang B, Desai M, Gonzales R, Maldonado Y, Rutherford G. Association of protective behaviors with SARS-CoV-2 infection: results from a longitudinal cohort study of adults in the San Francisco Bay Area. Ann Epidemiol 2023; 86:1-7. [PMID: 37524216 DOI: 10.1016/j.annepidem.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE In an effort to decrease transmission during the first years of the COVID-19 pandemic, public health officials encouraged masking, social distancing, and working from home, and restricted travel. However, many studies of the effectiveness of these measures had significant methodologic limitations. In this analysis, we used data from the TrackCOVID study, a longitudinal cohort study of a population-based sample of 3846 adults in the San Francisco Bay Area, to evaluate the association between self-reported protective behaviors and incidence of SARS-CoV-2 infection. METHODS Participants without SARS-CoV2 infection were enrolled from August to December 2020 and followed monthly with testing and surveys (median of four visits). RESULTS A total of 118 incident infections occurred (3.0% of participants). At baseline, 80.0% reported always wearing a mask; 56.0% avoided contact with nonhousehold members some/most of the time; 9.6% traveled outside the state; and 16.0% worked 20 or more hours per week outside the home. Factors associated with incident infection included being Black or Latinx, having less than a college education, and having more household residents. The only behavioral factor associated with incident infection was working outside the home (adjusted hazard ratio 1.62, 95% confidence interval 1.02-2.59). CONCLUSIONS Focusing on protecting people who cannot work from home could help prevent infections during future waves of COVID-19, or future pandemics from respiratory viruses. This focus must be balanced with the known importance of directing resources toward those at risk of severe infections.
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Affiliation(s)
- Timothy J Judson
- Department of Medicine, University of California San Francisco, San Francisco.
| | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Christina P Lindan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
| | - Derek Boothroyd
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Kevin Grumbach
- Department of Family and Community Medicine, University of California San Francisco, San Francisco
| | - Jennifer B Bollyky
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA
| | - Hannah A Sample
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Beatrice Huang
- Department of Medicine, University of California San Francisco, San Francisco
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Ralph Gonzales
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco
| | - Yvonne Maldonado
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA; Department of Medicine, School of Medicine, Stanford University, Stanford, CA
| | - George Rutherford
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
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Gurbaxani BM, Hill AN, Patel P. Unpacking Cochrane's Update on Masks and COVID-19. Am J Public Health 2023; 113:1074-1078. [PMID: 37672741 PMCID: PMC10484132 DOI: 10.2105/ajph.2023.307377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Brian M Gurbaxani
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Brian M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the Global Health Center, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics Department, Rollins School of Public Health, Emory University, Atlanta, GA. Pragna Patel is also with the Department of Medicine, Emory University
| | - Andrew N Hill
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Brian M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the Global Health Center, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics Department, Rollins School of Public Health, Emory University, Atlanta, GA. Pragna Patel is also with the Department of Medicine, Emory University
| | - Pragna Patel
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Brian M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the Global Health Center, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics Department, Rollins School of Public Health, Emory University, Atlanta, GA. Pragna Patel is also with the Department of Medicine, Emory University
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Schott W, Tao S, Shea L. Prevalence of high-risk conditions for severe COVID-19 among Medicaid-enrolled children with autism and mental health diagnoses in the United States. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2145-2157. [PMID: 36799305 PMCID: PMC9941459 DOI: 10.1177/13623613231155265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
LAY ABSTRACT Children are at risk of varying severity of illness and even death from COVID-19. We aim to determine whether autistic children or children with mental health conditions have more underlying health conditions that put people at risk of severe illness from COVID-19. We use data from a national sample of Medicaid-enrolled children for the years 2008-2016. These data include children across the 50 states and the District of Columbia. We compare the prevalence of underlying conditions among autistic children and children with mental health condition to that of other children in Medicaid. This study included 888,487 autistic children, 423,397 with any mental health condition (but not autism), and 932,625 children without any of these diagnoses. We found 29.5% of autistic children and 25.2% of children with mental health conditions had an underlying condition with high risk for severe illness from COVID, compared to 14.1% of children without these diagnoses. Autistic children had over twice the odds of having any underlying conditions, when accounting for age, race, sex, and other characteristics. Children with mental health conditions had 70% higher odds of having these underlying conditions. Mitigation measures in schools and other areas could minimize risk of short- and long-term impacts from COVID for autistic and all children.
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Abstract
COVID-19, the illness caused by SARS-CoV-2, became a worldwide pandemic in 2020. Initial clinical manifestations range from asymptomatic infection to mild upper respiratory illness but may progress to pulmonary involvement with hypoxemia and, in some cases, multiorgan involvement, shock, and death. Older adults, pregnant persons, those with common comorbidities, and those with immunosuppression are at greatest risk for progression. Vaccination is effective in preventing symptomatic infection and reducing risk for severe disease, hospitalization, and death. Antiviral treatment and immunomodulators have been shown to benefit certain patients. This article summarizes current recommendations on prevention, diagnosis, management, and treatment of COVID-19.
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Affiliation(s)
| | - Roy M Gulick
- Weill Cornell Medicine, New York, New York (K.M.M., R.M.G.)
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39
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Kriebel D. Advancing global public health with occupational epidemiology. Occup Environ Med 2023; 80:485-488. [PMID: 37567765 DOI: 10.1136/oemed-2023-108939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023]
Affiliation(s)
- David Kriebel
- Public Health, University of Massachusetts, Lowell, Massachusetts, USA
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40
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Atherstone CJ, Guagliardo SAJ, Hawksworth A, O'Laughlin K, Wong K, Sloan ML, Henao O, Rao CY, McElroy PD, Bennett SD. COVID-19 Epidemiology during Delta Variant Dominance Period in 45 High-Income Countries, 2020-2021. Emerg Infect Dis 2023; 29:1757-1764. [PMID: 37494699 PMCID: PMC10461680 DOI: 10.3201/eid2909.230142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
The SARS-CoV-2 Delta variant, first identified in October 2020, quickly became the dominant variant worldwide. We used publicly available data to explore the relationship between illness and death (peak case rates, death rates, case-fatality rates) and selected predictors (percentage vaccinated, percentage of the population >65 years, population density, testing volume, index of mitigation policies) in 45 high-income countries during the Delta wave using rank-order correlation and ordinal regression. During the Delta-dominant period, most countries reported higher peak case rates (57%) and lower peak case-fatality rates (98%). Higher vaccination coverage was protective against peak case rates (odds ratio 0.95, 95% CI 0.91-0.99) and against peak death rates (odds ratio 0.96, 95% CI 0.91-0.99). Vaccination coverage was vital to preventing infection and death from COVID-19 during the Delta wave. As new variants emerge, public health authorities should encourage the uptake of COVID-19 vaccination and boosters.
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Wallace J, Goldsmith-Pinkham P, Schwartz JL. Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic. JAMA Intern Med 2023; 183:916-923. [PMID: 37486680 PMCID: PMC10366951 DOI: 10.1001/jamainternmed.2023.1154] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/04/2023] [Indexed: 07/25/2023]
Abstract
Importance There is evidence that Republican-leaning counties have had higher COVID-19 death rates than Democratic-leaning counties and similar evidence of an association between political party affiliation and attitudes regarding COVID-19 vaccination; further data on these rates may be useful. Objective To assess political party affiliation and mortality rates for individuals during the initial 22 months of the COVID-19 pandemic. Design, Setting, and Participants A cross-sectional comparison of excess mortality between registered Republican and Democratic voters between March 2020 and December 2021 adjusted for age and state of voter registration was conducted. Voter and mortality data from Florida and Ohio in 2017 linked to mortality records for January 1, 2018, to December 31, 2021, were used in data analysis. Exposures Political party affiliation. Main Outcomes and Measures Excess weekly deaths during the COVID-19 pandemic adjusted for age, county, party affiliation, and seasonality. Results Between January 1, 2018, and December 31, 2021, there were 538 159 individuals in Ohio and Florida who died at age 25 years or older in the study sample. The median age at death was 78 years (IQR, 71-89 years). Overall, the excess death rate for Republican voters was 2.8 percentage points, or 15%, higher than the excess death rate for Democratic voters (95% prediction interval [PI], 1.6-3.7 percentage points). After May 1, 2021, when vaccines were available to all adults, the excess death rate gap between Republican and Democratic voters widened from -0.9 percentage point (95% PI, -2.5 to 0.3 percentage points) to 7.7 percentage points (95% PI, 6.0-9.3 percentage points) in the adjusted analysis; the excess death rate among Republican voters was 43% higher than the excess death rate among Democratic voters. The gap in excess death rates between Republican and Democratic voters was larger in counties with lower vaccination rates and was primarily noted in voters residing in Ohio. Conclusions and Relevance In this cross-sectional study, an association was observed between political party affiliation and excess deaths in Ohio and Florida after COVID-19 vaccines were available to all adults. These findings suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been factors in the severity and trajectory of the pandemic in the US.
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Affiliation(s)
- Jacob Wallace
- Yale School of Public Health, New Haven, Connecticut
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Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med 2023; 11:20503121231194400. [PMID: 37655303 PMCID: PMC10467233 DOI: 10.1177/20503121231194400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - April Elliott
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Branch-Elliman W, Elwy AR, Chambers DA. Embracing dynamic public health policy impacts in infectious diseases responses: leveraging implementation science to improve practice. Front Public Health 2023; 11:1207679. [PMID: 37663826 PMCID: PMC10469790 DOI: 10.3389/fpubh.2023.1207679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Rationale The host-pathogen relationship is inherently dynamic and constantly evolving. Applying an implementation science lens to policy evaluation suggests that policy impacts are variable depending upon key implementation outcomes (feasibility, acceptability, appropriateness costs) and conditions and contexts. COVID-19 case study Experiences with non-pharmaceutical interventions (NPIs) including masking, testing, and social distancing/business and school closures during the COVID-19 pandemic response highlight the importance of considering public health policy impacts through an implementation science lens of constantly evolving contexts, conditions, evidence, and public perceptions. As implementation outcomes (feasibility, acceptability) changed, the effectiveness of these interventions changed thereby altering public health policy impact. Sustainment of behavioral change may be a key factor determining the duration of effectiveness and ultimate impact of pandemic policy recommendations, particularly for interventions that require ongoing compliance at the level of the individual. Practical framework for assessing and evaluating pandemic policy Updating public health policy recommendations as more data and alternative interventions become available is the evidence-based policy approach and grounded in principles of implementation science and dynamic sustainability. Achieving the ideal of real-time policy updates requires improvements in public health data collection and analysis infrastructure and a shift in public health messaging to incorporate uncertainty and the necessity of ongoing changes. In this review, the Dynamic Infectious Diseases Public Health Response Framework is presented as a model with a practical tool for iteratively incorporating implementation outcomes into public health policy design with the aim of sustaining benefits and identifying when policies are no longer functioning as intended and need to be adapted or de-implemented. Conclusions and implications Real-time decision making requires sensitivity to conditions on the ground and adaptation of interventions at all levels. When asking about the public health effectiveness and impact of non-pharmaceutical interventions, the focus should be on when, how, and for how long they can achieve public health impact. In the future, rather than focusing on models of public health intervention effectiveness that assume static impacts, policy impacts should be considered as dynamic with ongoing re-evaluation as conditions change to meet the ongoing needs of the ultimate end-user of the intervention: the public.
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Affiliation(s)
- Westyn Branch-Elliman
- VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, Boston, MA, United States
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - A. Rani Elwy
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - David A. Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
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Merenstein C, Fitzgerald AS, Khatib LA, Graham-Wooten J, Bushman FD, Collman RG. Effects of Mask Reuse on the Oropharyngeal, Skin, and Mask Microbiome. J Infect Dis 2023; 228:479-486. [PMID: 37217829 PMCID: PMC10428194 DOI: 10.1093/infdis/jiad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Face masks have been critical in the coronavirus disease 2019 (COVID-19) pandemic, but supplies were sometimes limited and disposable masks contribute greatly to environmental waste. Studies suggest that filtration capacity is retained with repeated use, and surveys indicate many people reuse surgical masks. However, the impact of mask reuse on the host is understudied. METHODS We applied 16S rRNA gene sequencing to investigate the bacterial microbiome of the facial skin and oropharynx of individuals randomized to wearing fresh surgical masks daily versus masks reused for 1 week. RESULTS Compared to daily fresh masks, reuse was associated with increased richness (number of taxa) of the skin microbiome and trend towards greater diversity, but no difference in the oropharyngeal microbiome. Used masks had either skin-dominant or oropharynx-dominant bacterial sequences, and reused masks had >100-fold higher bacterial content but no change in composition compared to those used for 1 day. CONCLUSIONS One week of mask reuse increased the number of low-abundance taxa on the face but did not impact the upper respiratory microbiome. Thus, face mask reuse has little impact on the host microbiome, although whether minor changes to the skin microbiome might relate to reported skin sequelae of masking (maskne) remains to be determined.
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Affiliation(s)
- Carter Merenstein
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ayannah S Fitzgerald
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Layla A Khatib
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jevon Graham-Wooten
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frederic D Bushman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronald G Collman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Haslam A, Prasad V. Evidence Base for Health Care Strategies to Protect Vulnerable Patients During the COVID-19 Pandemic. JAMA Oncol 2023; 9:1150. [PMID: 37261802 DOI: 10.1001/jamaoncol.2023.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Soriano-Arandes A, Brett A, Buonsenso D, Emilsson L, de la Fuente Garcia I, Gkentzi D, Helve O, Kepp KP, Mossberg M, Muka T, Munro A, Papan C, Perramon-Malavez A, Schaltz-Buchholzer F, Smeesters PR, Zimmermann P. Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe. Front Public Health 2023; 11:1175444. [PMID: 37564427 PMCID: PMC10411527 DOI: 10.3389/fpubh.2023.1175444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.
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Affiliation(s)
- Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Brett
- Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Milan, Italy
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Isabel de la Fuente Garcia
- Pediatric Infectious Diseases, National Pediatric Center, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, Patras, Greece
| | - Otto Helve
- Department of Health Security, Institute for Health and Welfare, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kasper P. Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Mossberg
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Alasdair Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, Institute of Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Aida Perramon-Malavez
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Department of Physics, Universitat Politècnica de Catalunya (UPC·BarcelonaTech), Barcelona, Spain
| | | | - Pierre R. Smeesters
- Department of Pediatrics, University Hospital Brussels, Academic Children’s Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
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Maciejko LA, Fox JM, Steffens MT, Patten CA, Newman HR, Decker PA, Wheeler P, Juhn YJ, Wi CI, Gorfine M, Brewer L, Sinicrope PS. Rural and urban residents' attitudes and preferences toward COVID-19 prevention behaviors in a midwestern community. PLoS One 2023; 18:e0286953. [PMID: 37352298 PMCID: PMC10289401 DOI: 10.1371/journal.pone.0286953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/30/2023] [Indexed: 06/25/2023] Open
Abstract
Rural populations are more vulnerable to the impacts of COVID-19 compared to their urban counterparts as they are more likely to be older, uninsured, to have more underlying medical conditions, and live further from medical care facilities. We engaged the Southeastern MN (SEMN) community (N = 7,781, 51% rural) to conduct a survey of motivators and barriers to masking to prevent COVID-19. We also assessed preferences for types of and modalities to receive education/intervention, exploring both individual and environmental factors primarily consistent with Social Cognitive Theory. Our results indicated rural compared to urban residents performed fewer COVID-19 prevention behaviors (e.g. 62% rural vs. 77% urban residents reported wearing a mask all of the time in public, p<0.001), had more negative outcome expectations for wearing a mask (e.g. 50% rural vs. 66% urban residents thought wearing a mask would help businesses stay open, p<0.001), more concerns about wearing a mask (e.g. 23% rural vs. 14% urban were very concerned about being 'too hot', p<0.001) and lower levels of self-efficacy for masking (e.g. 13.9±3.4 vs. 14.9±2.8, p<0.001). It appears that masking has not become a social norm in rural SEMN, with almost 50% (vs. 24% in urban residents) disagreeing with the expectation 'others in my community will wear a mask to stop the spread of Coronavirus'. Except for people (both rural and urban) who reported not being at all willing to wear a mask (7%), all others expressed interest in future education/interventions to help reduce masking barriers that utilized email and social media for delivery. Creative public health messaging consistent with SCT tailored to rural culture and norms is needed, using emails and social media with pictures and videos from role models they trust, and emphasizing education about when masks are necessary.
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Affiliation(s)
- Laura A. Maciejko
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States of America
| | - Jean M. Fox
- Department of Gastroenterology, Mayo Clinic, Rochester, MN, United States of America
| | | | - Christi A. Patten
- Community Engagement Program, Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States of America
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Hana R. Newman
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States of America
| | - Paul A. Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Phil Wheeler
- Precision Population Science Lab, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, United States of America
| | - Young J. Juhn
- Precision Population Science Lab, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, United States of America
| | - Chung-Il Wi
- Precision Population Science Lab, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, United States of America
| | - Mary Gorfine
- Community Engagement Program, Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States of America
| | - LaPrincess Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States of America
| | - Pamela S. Sinicrope
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
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Hua L, Wang Y, Mo B, Guo Z, Wang Y, Su Z, Huang M, Chen H, Ma X, Xie J, Luo M. The hidden inequality: the disparities in the quality of daily use masks associated with family economic status. Front Public Health 2023; 11:1163428. [PMID: 37397746 PMCID: PMC10313325 DOI: 10.3389/fpubh.2023.1163428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Wearing high-quality masks plays a critical role in reducing COVID-19 transmission. However, no study has investigated socioeconomic inequality in the quality of masks. Addressing this gap, this paper explored the relationships between mask's quality and family economic status. The cross-sectional survey was conducted in two Chinese universities by distributing structured questionnaires to assess participants' characteristics including family economic status, and meanwhile collecting their masks to evaluate the quality by measuring particle filtration efficiency. The valid responses were obtained from 912 students with mean age of 19.556 ± 1.453 years and were analyzed by using fractional or binary logistic regression. Three main findings were presented. First, inequality existed in the quality of masks. 36.07% of students were using unqualified masks with average filtration efficiency of 0.795 ± 0.119, which was much lower than China's national standard (0.9). Of those masks with identified production date, 11.43% were manufactured during COVID-19 outbreak when market was flooded with counterfeit production, and thus were of poor quality with average filtration efficiency of 0.819 ± 0.152. Second, better family economic status was associated with better masks' filtration efficiency and greater probability of using qualified masks. Third, students with better family economic status tend to use masks with individual packaging, and unique patterns and special designs, which may lead to inequality on a psychological level. Our analysis reveals the hidden socioeconomic inequality that exist behind cheap masks. In facing the challenges of future emerging infectious diseases, it is important to address the inequity to ensure equal access to affordable qualified personal protection equipment.
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Affiliation(s)
- Lei Hua
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
- School of Government, Sun Yat-sen University, Guangzhou, China
| | - Ying Wang
- School of Public Policy and Administration, Chongqing University, Chongqing, China
| | - Bijuan Mo
- School of Foreign Language, Hunan University of Technology and Business, Changsha, Hunan, China
| | - Zuqi Guo
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Yulei Wang
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Zexuan Su
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Minqi Huang
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Han Chen
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Xiaowen Ma
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Jiaxin Xie
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Mengxian Luo
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
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Gibson GC, Woody S, James E, Weldon M, Fox SJ, Meyers LA, Bhavnani D. Real time monitoring of COVID-19 intervention effectiveness through contact tracing data. Sci Rep 2023; 13:9371. [PMID: 37296143 PMCID: PMC10250864 DOI: 10.1038/s41598-023-35892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Communities worldwide have used vaccines and facemasks to mitigate the COVID-19 pandemic. When an individual opts to vaccinate or wear a mask, they may lower their own risk of becoming infected as well as the risk that they pose to others while infected. The first benefit-reducing susceptibility-has been established across multiple studies, while the second-reducing infectivity-is less well understood. Using a new statistical method, we estimate the efficacy of vaccines and facemasks at reducing both types of risks from contact tracing data collected in an urban setting. We find that vaccination reduced the risk of onward transmission by 40.7% [95% CI 25.8-53.2%] during the Delta wave and 31.0% [95% CI 19.4-40.9%] during the Omicron wave and that mask wearing reduced the risk of infection by 64.2% [95% CI 5.8-77.3%] during the Omicron wave. By harnessing commonly-collected contact tracing data, the approach can broadly provide timely and actionable estimates of intervention efficacy against a rapidly evolving pathogen.
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Affiliation(s)
| | - Spencer Woody
- Department of Integrative Biology, University of Texas at Austin, Austin, USA
| | - Emily James
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, USA
| | - Minda Weldon
- Epidemiology and Disease Surveillance Unit, Austin Public Health, Austin, USA
| | - Spencer J Fox
- Department of Integrative Biology, University of Texas at Austin, Austin, USA
| | - Lauren Ancel Meyers
- Department of Integrative Biology, University of Texas at Austin, Austin, USA
| | - Darlene Bhavnani
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, USA
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Ali RN, Sarkar S. Impact of opinion dynamics on the public health damage inflicted by COVID-19 in the presence of societal heterogeneities. Front Digit Health 2023; 5:1146178. [PMID: 37363273 PMCID: PMC10285391 DOI: 10.3389/fdgth.2023.1146178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Certain behavioral practices, such as wearing masks, practicing social distancing, and accepting vaccines, play a crucial role in impeding the spread of COVID-19 and reducing the severity of symptoms. Opinions regarding whether to observe such behavioral practices evolve over time through interactions via networks that overlap with but are not identical to the physical interaction networks over which the disease progresses. This necessitates the joint study of the dynamics of COVID-19 and opinion evolution. Methods We develop a mathematical model that can be easily adapted to a wide range of behavioral practices and captures in a computationally tractable manner the joint evolution of the disease and relevant opinions in populations of large sizes. Populations of large sizes are typically heterogeneous in that they comprise individuals of different age groups, genders, races, and underlying health conditions. Such groups have different propensities to imbibe severe forms of the disease, different physical contact, and social interaction patterns and rates. These lead to different disease and opinion dynamics in them. Our model is designed to effectively capture such diversities. Results Computations using our model reveal that opinion dynamics have a strong impact on fatality and hospitalization counts and the number of man-days lost due to symptoms both in the regular form of the disease and the extended forms, more commonly known as long COVID. We show that opinion dynamics in certain groups have a disproportionate impact on the overall public health attributes because they have high physical interaction rates, even when they have the lowest propensity to imbibe severe forms of the disease. This identifies a social vulnerability that malactors can utilize to inflict heavy public health damages through opinion campaigns targeting specific segments. Once such vulnerabilities are identified, which we accomplish, adequate precautions may be designed to enhance resilience to such targeted attacks and better protect public health. Discussion By recognizing and understanding the vulnerabilities, appropriate precautions can be developed to enhance resilience against targeted attacks and safeguard public health. Our study underscores the importance of considering opinion evolution alongside disease dynamics, providing insights into the interplay between behavioral practices, opinions, and disease outcomes. We believe that our model is a valuable tool for understanding the joint dynamics of COVID-19 and opinions. We hope that our findings will help to inform public health policy and facilitate evidence-based decision-making for public health interventions.
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