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Kokkorakis M, Folkertsma P, van Dam S, Sirotin N, Taheri S, Chagoury O, Idaghdour Y, Henning RH, Forte JC, Mantzoros CS, de Vries DH, Wolffenbuttel BH. Effective questionnaire-based prediction models for type 2 diabetes across several ethnicities: a model development and validation study. EClinicalMedicine 2023; 64:102235. [PMID: 37936659 PMCID: PMC10626169 DOI: 10.1016/j.eclinm.2023.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 11/09/2023] Open
Abstract
Background Type 2 diabetes disproportionately affects individuals of non-White ethnicity through a complex interaction of multiple factors. Therefore, early disease detection and prediction are essential and require tools that can be deployed on a large scale. We aimed to tackle this problem by developing questionnaire-based prediction models for type 2 diabetes prevalence and incidence for multiple ethnicities. Methods In this proof of principle analysis, logistic regression models to predict type 2 diabetes prevalence and incidence, using questionnaire-only variables reflecting health state and lifestyle, were trained on the White population of the UK Biobank (n = 472,696 total, aged 37-73 years, data collected 2006-2010) and validated in five other ethnicities (n = 29,811 total) and externally in Lifelines (n = 168,205 total, aged 0-93 years, collected between 2006 and 2013). In total, 631,748 individuals were included for prevalence prediction and 67,083 individuals for the eight-year incidence prediction. Type 2 diabetes prevalence in the UK Biobank ranged between 6% in the White population to 23.3% in the South Asian population, while in Lifelines, the prevalence was 1.9%. Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC), and a detailed sensitivity analysis was conducted to assess potential clinical utility. We compared the questionnaire-only models to models containing physical measurements and biomarkers as well as to clinical non-laboratory type 2 diabetes risk tools and conducted a reclassification analysis. Findings Our algorithms accurately predicted type 2 diabetes prevalence (AUC = 0.901) and eight-year incidence (AUC = 0.873) in the White UK Biobank population. Both models replicated well in the Lifelines external validation, with AUCs of 0.917 and 0.817 for prevalence and incidence, respectively. Both models performed consistently well across different ethnicities, with AUCs of 0.855-0.894 for prevalence and 0.819-0.883 for incidence. These models generally outperformed two clinically validated non-laboratory tools and correctly reclassified >3,000 additional cases. Model performance improved with the addition of blood biomarkers but not with the addition of physical measurements. Interpretation Our findings suggest that easy-to-implement, questionnaire-based models could be used to predict prevalent and incident type 2 diabetes with high accuracy across several ethnicities, providing a highly scalable solution for population-wide risk stratification. Future work should determine the effectiveness of these models in identifying undiagnosed type 2 diabetes, validated in cohorts of different populations and ethnic representation. Funding University Medical Center Groningen.
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Affiliation(s)
- Michail Kokkorakis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Pytrik Folkertsma
- Ancora Health B.V., Groningen, Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sipko van Dam
- Ancora Health B.V., Groningen, Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nicole Sirotin
- Department of Preventive Medicine, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Shahrad Taheri
- National Obesity Treatment Centre, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Odette Chagoury
- National Obesity Treatment Centre, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Youssef Idaghdour
- Program in Biology, Division of Science and Mathematics, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Robert H. Henning
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Ancora Health B.V., Groningen, Netherlands
| | - Christos S. Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston VA Healthcare System, Boston, MA, USA
| | - Dylan H. de Vries
- Ancora Health B.V., Groningen, Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Zahra A, Luijken K, Abbink EJ, van den Berg JM, Blom MT, Elders P, Festen J, Gussekloo J, Joling KJ, Melis R, Mooijaart S, Peters JB, Polinder-Bos HA, van Raaij BFM, Smorenberg A, la Roi-Teeuw HM, Moons KGM, van Smeden M. A study protocol of external validation of eight COVID-19 prognostic models for predicting mortality risk in older populations in a hospital, primary care, and nursing home setting. Diagn Progn Res 2023; 7:8. [PMID: 37013651 PMCID: PMC10069944 DOI: 10.1186/s41512-023-00144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has a large impact worldwide and is known to particularly affect the older population. This paper outlines the protocol for external validation of prognostic models predicting mortality risk after presentation with COVID-19 in the older population. These prognostic models were originally developed in an adult population and will be validated in an older population (≥ 70 years of age) in three healthcare settings: the hospital setting, the primary care setting, and the nursing home setting. METHODS Based on a living systematic review of COVID-19 prediction models, we identified eight prognostic models predicting the risk of mortality in adults with a COVID-19 infection (five COVID-19 specific models: GAL-COVID-19 mortality, 4C Mortality Score, NEWS2 + model, Xie model, and Wang clinical model and three pre-existing prognostic scores: APACHE-II, CURB65, SOFA). These eight models will be validated in six different cohorts of the Dutch older population (three hospital cohorts, two primary care cohorts, and a nursing home cohort). All prognostic models will be validated in a hospital setting while the GAL-COVID-19 mortality model will be validated in hospital, primary care, and nursing home settings. The study will include individuals ≥ 70 years of age with a highly suspected or PCR-confirmed COVID-19 infection from March 2020 to December 2020 (and up to December 2021 in a sensitivity analysis). The predictive performance will be evaluated in terms of discrimination, calibration, and decision curves for each of the prognostic models in each cohort individually. For prognostic models with indications of miscalibration, an intercept update will be performed after which predictive performance will be re-evaluated. DISCUSSION Insight into the performance of existing prognostic models in one of the most vulnerable populations clarifies the extent to which tailoring of COVID-19 prognostic models is needed when models are applied to the older population. Such insight will be important for possible future waves of the COVID-19 pandemic or future pandemics.
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Affiliation(s)
- Anum Zahra
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands.
| | - Kim Luijken
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Evertine J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jesse M van den Berg
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Petra Elders
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Jacobijn Gussekloo
- Department of Public Health and Primary Care & Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | - René Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simon Mooijaart
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeannette B Peters
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bas F M van Raaij
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemieke Smorenberg
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hannah M la Roi-Teeuw
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
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Cowley A, Booth V, Di Lorito C, Chandria P, Chadwick O, Stanislas C, Dunlop M, Howe L, Harwood RH, Logan PA. A Qualitative Study on the Experiences of Therapists Delivering the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) Intervention During the COVID-19 Pandemic. J Alzheimers Dis 2023; 91:203-214. [PMID: 36404541 PMCID: PMC9881024 DOI: 10.3233/jad-220424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a programme of physical activity and exercise designed to maintain participation in activities of daily living, mobility, and quality of life for people living with dementia. During the COVID-19 pandemic first national lockdown in England, the PrAISED physiotherapists, occupational therapists, and rehabilitation support workers adapted to delivering the intervention remotely via telephone or video conferencing. OBJECTIVE The aim of this study was to explore therapists' experience of delivering the PrAISED intervention during the COVID-19 pandemic and derive implications for clinical practice. METHODS Qualitative semi-structured interviews were conducted with 16 therapists using purposive sampling. Thematic analysis was used to analyze the transcripts. RESULTS Therapists reported a change in the relationship between themselves, the person with dementia and the caregiver, with an increased reliance on the caregiver and a loss of autonomy for the person living with dementia. There was concern that this would increase the burden on the caregiver. The therapists reported using creativity to adapt to different modes of delivery. They felt their sessions were mostly focused on providing social and emotional support, and that assessing, progressing, and tailoring the intervention was difficult. CONCLUSION It is possible to deliver some elements of a physical intervention using remote delivery, but a dual modal approach including remote and face-to-face delivery would optimize treatment efficacy. Educational support would be required to enable people living with dementia and their caregivers to overcome barriers relating to digital literacy.
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Affiliation(s)
- Alison Cowley
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,Correspondence to: Alison Cowley, Research & Innovation, Nottingham University Hospitals NHS Trust, QMC Campus, Derby Road, Nottingham NG2 7UH, UK. Tel.: +0115 9691169 Ext. 77148; E-mail:
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Claudio Di Lorito
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Pooja Chandria
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Olivia Chadwick
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - Marianne Dunlop
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Louise Howe
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,
School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Pip A. Logan
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, United Kingdom,Nottingham CityCare Partnership CIC, Nottingham, United Kingdom
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4
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Batty GD, Deary IJ, Altschul D. Pre-pandemic mental and physical health as predictors of COVID-19 vaccine hesitancy: evidence from a UK-wide cohort study. Ann Med 2022; 54:274-282. [PMID: 35067149 PMCID: PMC8788379 DOI: 10.1080/07853890.2022.2027007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health and, particularly, mental health, is poorly understood. METHODS We used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (Oxford University/AstraZeneca, November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16-95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, including the completion of the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression). Peri-pandemic, individuals indicated whether they or someone in their household was shielding; that is, people judged by the UK National Health Service as being particularly clinically vulnerable who were therefore requested to remain at home. Intention to take up vaccination for COVID-19 was also self-reported. RESULTS In an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine-hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to vaccine-hesitancy. CONCLUSIONS People with a physical condition were more likely to take up the potential offer of a COVID-19 vaccination. These effects were not apparent for indices of mental health.Key messagesIn understanding predictors of COVID-19 vaccine hesitancy, the role of physical and mental health has not been well-examined despite both groups seemingly experiencing an elevated risk of the disease.In a large UK cohort study, people with a pre-pandemic physical condition were more likely to take up the theoretical offer of vaccination.There were no apparent effects for indices of pre-pandemic mental health.
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Affiliation(s)
- G. David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ian J. Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Drew Altschul
- Department of Psychology, University of Edinburgh, Edinburgh, UK
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Lasseter G, Compston P, Robin C, Lambert H, Hickman M, Denford S, Reynolds R, Zhang J, Cai S, Zhang T, Smith LE, Rubin GJ, Yardley L, Amlôt R, Oliver I. Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation. BMC Public Health 2022; 22:2145. [PMID: 36418978 PMCID: PMC9685010 DOI: 10.1186/s12889-022-14368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of "shielding" on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown. METHODS A two-stage mixed methods study, including a structured survey (7 August-23 October 2020) and semi-structured telephone interviews (26 August-30 September 2020) with a sample of individuals who had been identified as CEV and advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). RESULTS The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of 'official' communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety. CONCLUSIONS This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.
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Affiliation(s)
- Gemma Lasseter
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Polly Compston
- grid.515304.60000 0005 0421 4601Field Epidemiology Service, UK Health Security Agency, Cambridge, UK
| | - Charlotte Robin
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Field Epidemiology, Field Service, National Infection Service, UK Health Security Agency, Liverpool, UK ,grid.10025.360000 0004 1936 8470NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK ,grid.10025.360000 0004 1936 8470NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Helen Lambert
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Matthew Hickman
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Sarah Denford
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK
| | - Rosy Reynolds
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Juan Zhang
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shenghan Cai
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tingting Zhang
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise E. Smith
- grid.13097.3c0000 0001 2322 6764NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, King’s College London, London, UK
| | - G James Rubin
- grid.13097.3c0000 0001 2322 6764NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, King’s College London, London, UK
| | - Lucy Yardley
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK ,grid.5491.90000 0004 1936 9297Psychology Department, University of Southampton, Southampton, UK
| | - Richard Amlôt
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, UK
| | - Isabel Oliver
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Field Epidemiology Service, UK Health Security Agency, Cambridge, UK
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Evans BA, Akbari A, Bailey R, Bethell L, Bufton S, Carson-Stevens A, Dixon L, Edwards A, John A, Jolles S, Kingston MR, Lyons J, Lyons R, Porter A, Sewell B, Thornton CA, Watkins A, Whiffen T, Snooks H. Evaluation of the shielding initiative in Wales (EVITE Immunity): protocol for a quasiexperimental study. BMJ Open 2022; 12:e059813. [PMID: 36691218 PMCID: PMC9461087 DOI: 10.1136/bmjopen-2021-059813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/23/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the COVID-19 pandemic. Clinically extremely vulnerable people identified through algorithms and screening of routine National Health Service (NHS) data were individually and strongly advised to stay at home and strictly self-isolate even from others in their household. This study will generate a logic model of the intervention and evaluate the effects and costs of shielding to inform policy development and delivery during future pandemics. METHODS AND ANALYSIS This is a quasiexperimental study undertaken in Wales where records for people who were identified for shielding were already anonymously linked into integrated data systems for public health decision-making. We will: interview policy-makers to understand rationale for shielding advice to inform analysis and interpretation of results; use anonymised individual-level data to select people identified for shielding advice in March 2020 and a matched cohort, from routine electronic health data sources, to compare outcomes; survey a stratified random sample of each group about activities and quality of life at 12 months; use routine and newly collected blood data to assess immunity; interview people who were identified for shielding and their carers and NHS staff who delivered healthcare during shielding, to explore compliance and experiences; collect healthcare resource use data to calculate implementation costs and cost-consequences. Our team includes people who were shielding, who used their experience to help design and deliver this study. ETHICS AND DISSEMINATION The study has received approval from the Newcastle North Tyneside 2 Research Ethics Committee (IRAS 295050). We will disseminate results directly to UK government policy-makers, publish in peer-reviewed journals, present at scientific and policy conferences and share accessible summaries of results online and through public and patient networks.
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Affiliation(s)
- Bridie Angela Evans
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
| | | | | | | | - Samantha Bufton
- Knowledge and Analytical Services, Welsh Government, Cardiff, UK
| | | | - Lucy Dixon
- Swansea University Medical School, Swansea, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Ann John
- Swansea University Medical School, Swansea, UK
| | | | - Mark Rhys Kingston
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Swansea University Medical School, Swansea, UK
| | - Ronan Lyons
- Swansea University Medical School, Swansea, UK
| | - Alison Porter
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, West Glamorgan, UK
| | | | | | - Tony Whiffen
- Knowledge and Analytical Services, Welsh Government, Cardiff, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
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de Jong VMT, Rousset RZ, Antonio-Villa NE, Buenen AG, Van Calster B, Bello-Chavolla OY, Brunskill NJ, Curcin V, Damen JAA, Fermín-Martínez CA, Fernández-Chirino L, Ferrari D, Free RC, Gupta RK, Haldar P, Hedberg P, Korang SK, Kurstjens S, Kusters R, Major RW, Maxwell L, Nair R, Naucler P, Nguyen TL, Noursadeghi M, Rosa R, Soares F, Takada T, van Royen FS, van Smeden M, Wynants L, Modrák M, Asselbergs FW, Linschoten M, Moons KGM, Debray TPA. Clinical prediction models for mortality in patients with covid-19: external validation and individual participant data meta-analysis. BMJ 2022; 378:e069881. [PMID: 35820692 PMCID: PMC9273913 DOI: 10.1136/bmj-2021-069881] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To externally validate various prognostic models and scoring rules for predicting short term mortality in patients admitted to hospital for covid-19. DESIGN Two stage individual participant data meta-analysis. SETTING Secondary and tertiary care. PARTICIPANTS 46 914 patients across 18 countries, admitted to a hospital with polymerase chain reaction confirmed covid-19 from November 2019 to April 2021. DATA SOURCES Multiple (clustered) cohorts in Brazil, Belgium, China, Czech Republic, Egypt, France, Iran, Israel, Italy, Mexico, Netherlands, Portugal, Russia, Saudi Arabia, Spain, Sweden, United Kingdom, and United States previously identified by a living systematic review of covid-19 prediction models published in The BMJ, and through PROSPERO, reference checking, and expert knowledge. MODEL SELECTION AND ELIGIBILITY CRITERIA Prognostic models identified by the living systematic review and through contacting experts. A priori models were excluded that had a high risk of bias in the participant domain of PROBAST (prediction model study risk of bias assessment tool) or for which the applicability was deemed poor. METHODS Eight prognostic models with diverse predictors were identified and validated. A two stage individual participant data meta-analysis was performed of the estimated model concordance (C) statistic, calibration slope, calibration-in-the-large, and observed to expected ratio (O:E) across the included clusters. MAIN OUTCOME MEASURES 30 day mortality or in-hospital mortality. RESULTS Datasets included 27 clusters from 18 different countries and contained data on 46 914patients. The pooled estimates ranged from 0.67 to 0.80 (C statistic), 0.22 to 1.22 (calibration slope), and 0.18 to 2.59 (O:E ratio) and were prone to substantial between study heterogeneity. The 4C Mortality Score by Knight et al (pooled C statistic 0.80, 95% confidence interval 0.75 to 0.84, 95% prediction interval 0.72 to 0.86) and clinical model by Wang et al (0.77, 0.73 to 0.80, 0.63 to 0.87) had the highest discriminative ability. On average, 29% fewer deaths were observed than predicted by the 4C Mortality Score (pooled O:E 0.71, 95% confidence interval 0.45 to 1.11, 95% prediction interval 0.21 to 2.39), 35% fewer than predicted by the Wang clinical model (0.65, 0.52 to 0.82, 0.23 to 1.89), and 4% fewer than predicted by Xie et al's model (0.96, 0.59 to 1.55, 0.21 to 4.28). CONCLUSION The prognostic value of the included models varied greatly between the data sources. Although the Knight 4C Mortality Score and Wang clinical model appeared most promising, recalibration (intercept and slope updates) is needed before implementation in routine care.
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Affiliation(s)
- Valentijn M T de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Rebecca Z Rousset
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Neftalí Eduardo Antonio-Villa
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
- EPI-centre, KU Leuven, Leuven, Belgium
| | | | - Nigel J Brunskill
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
| | - Carlos A Fermín-Martínez
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- Faculty of Chemistry, Universidad Nacional Autónoma de México, México City, Mexico
| | - Davide Ferrari
- School of Population Health and Environmental Sciences, King's College London, London, UK
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Robert C Free
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | - Pranabashis Haldar
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pontus Hedberg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steef Kurstjens
- Laboratory of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Ron Kusters
- Laboratory of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Den Bosch, Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Rupert W Major
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Lauren Maxwell
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Germany
| | - Rajeshwari Nair
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Centre for Access and Delivery Research Evaluation Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Tri-Long Nguyen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Pharmacy, University Hospital Centre of Nîmes, Nîmes, France
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Rossana Rosa
- Infectious Diseases Service, UnityPoint Health-Des Moines, Des Moines, IA, USA
| | - Felipe Soares
- Industrial Engineering Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Florien S van Royen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Laure Wynants
- Bernhoven, Uden, Netherlands
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Martin Modrák
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Marijke Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
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Abstract
OBJECTIVE The Great Barrington Declaration (GBD) and the John Snow Memorandum (JSM), each signed by numerous scientists, have proposed hotly debated strategies for handling the COVID-19 pandemic. The current analysis aimed to examine whether the prevailing narrative that GBD is a minority view among experts is true. METHODS The citation impact and social media presence of the key GBD and JSM signatories was assessed. Citation data were obtained from Scopus using a previously validated composite citation indicator that incorporated also coauthorship and author order and ranking was against all authors in the same Science-Metrix scientific field with at least five full papers. Random samples of scientists from the longer lists of signatories were also assessed. The number of Twitter followers for all key signatories was also tracked. RESULTS Among the 47 key GBD signatories, 20, 19 and 21, respectively, were top-cited authors for career impact, recent single-year (2019) impact or either. For comparison, among the 34 key JSM signatories, 11, 14 and 15, respectively, were top cited. Key signatories represented 30 different scientific fields (9 represented in both documents, 17 only in GBD and 4 only in JSM). In a random sample of n=30 scientists among the longer lists of signatories, five in GBD and three in JSM were top cited. By April 2021, only 19/47 key GBD signatories had personal Twitter accounts versus 34/34 of key JSM signatories; 3 key GBD signatories versus 10 key JSM signatories had >50 000 Twitter followers and extraordinary Kardashian K-indices (363-2569). By November 2021, four key GBD signatories versus 13 key JSM signatories had >50 000 Twitter followers. CONCLUSIONS Both GBD and JSM include many stellar scientists, but JSM has far more powerful social media presence and this may have shaped the impression that it is the dominant narrative.
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Affiliation(s)
- John P Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, California, USA
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9
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Herrick C. 'We thank you for your sacrifice': Clinical vulnerability, shielding and biosociality in the UK's Covid-19 response. BIOSOCIETIES 2022; 18:218-240. [PMID: 35096124 PMCID: PMC8783156 DOI: 10.1057/s41292-021-00266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 01/08/2023]
Abstract
The UK response to Covid-19 has been unusually complex in its ever-shifting classifications of clinical vulnerability. By May 2020, 2.2 million people had been identified as 'clinically extremely vulnerable' (CEV) and were asked to 'shield' at home for over four months. To adhere to this strict guidance, they were enfolded within the patchy infrastructure of the 'shielding programme'. However, membership of the 'shielded list' has changed-often without warning or explanation-through time and across space. Drawing on policy and evidentiary documents, government speeches, reports, press conferences and media analysis of Covid-19 coverage between March 2020 and April 1, 2021, this paper traces the shifting delineations of clinical vulnerability in the UK response across three lockdowns. It argues that the complexities and confusions generated by the transience of the CEV category have fed into forms of biosociality that have been as much about making practical sense of government guidance as a form of mutual support amid crisis. This uncertainty has not eased as restrictions have been relaxed and vaccines rolled out. Instead, tracing individual immune response has become a burgeoning industry as 'the shielded' navigate the uneasy demands of taking 'personal responsibility' rather than being protected by 'the rules'.
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Affiliation(s)
- Clare Herrick
- grid.13097.3c0000 0001 2322 6764Department of Geography, King’s College London, London, UK
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10
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Tao S, Bragazzi NL, Wu J, Mellado B, Kong JD. Harnessing Artificial Intelligence to assess the impact of nonpharmaceutical interventions on the second wave of the Coronavirus Disease 2019 pandemic across the world. Sci Rep 2022; 12:944. [PMID: 35042945 PMCID: PMC8766477 DOI: 10.1038/s41598-021-04731-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/23/2021] [Indexed: 02/07/2023] Open
Abstract
In the present paper, we aimed to determine the influence of various non-pharmaceutical interventions (NPIs) enforced during the first wave of COVID-19 across countries on the spreading rate of COVID-19 during the second wave. For this purpose, we took into account national-level climatic, environmental, clinical, health, economic, pollution, social, and demographic factors. We estimated the growth of the first and second wave across countries by fitting a logistic model to daily-reported case numbers, up to the first and second epidemic peaks. We estimated the basic and effective (second wave) reproduction numbers across countries. Next, we used a random forest algorithm to study the association between the growth rate of the second wave and NPIs as well as pre-existing country-specific characteristics. Lastly, we compared the growth rate of the first and second waves of COVID-19. The top three factors associated with the growth of the second wave were body mass index, the number of days that the government sets restrictions on requiring facial coverings outside the home at all times, and restrictions on gatherings of 10 people or less. Artificial intelligence techniques can help scholars as well as decision and policy-makers estimate the effectiveness of public health policies, and implement "smart" interventions, which are as efficacious as stringent ones.
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Affiliation(s)
| | - Nicola Luigi Bragazzi
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, Department of Mathematics and Statistics, York University, Toronto, ON, M3J 1P3, Canada
| | - Jianhong Wu
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, Department of Mathematics and Statistics, York University, Toronto, ON, M3J 1P3, Canada
| | - Bruce Mellado
- School of Physics, Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa
- iThemba LABS, National Research Foundation, Somerset West, South Africa
| | - Jude Dzevela Kong
- Africa-Canada Artificial Intelligence and Data Innovation Consortium, Department of Mathematics and Statistics, York University, Toronto, ON, M3J 1P3, Canada.
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11
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Banerjee A, Pasea L, Manohar S, Lai AG, Hemingway E, Sofer I, Katsoulis M, Sood H, Morris A, Cake C, Fitzpatrick NK, Williams B, Denaxas S, Hemingway H. 'What is the risk to me from COVID-19?': Public involvement in providing mortality risk information for people with 'high-risk' conditions for COVID-19 (OurRisk.CoV). Clin Med (Lond) 2021; 21:e620-e628. [PMID: 34862222 DOI: 10.7861/clinmed.2021-0386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients and public have sought mortality risk information throughout the pandemic, but their needs may not be served by current risk prediction tools. Our mixed methods study involved: (1) systematic review of published risk tools for prognosis, (2) provision and patient testing of new mortality risk estimates for people with high-risk conditions and (3) iterative patient and public involvement and engagement with qualitative analysis. Only one of 53 (2%) previously published risk tools involved patients or the public, while 11/53 (21%) had publicly accessible portals, but all for use by clinicians and researchers.Among people with a wide range of underlying conditions, there has been sustained interest and engagement in accessible and tailored, pre- and postpandemic mortality information. Informed by patient feedback, we provide such information in 'five clicks' (https://covid19-phenomics.org/OurRiskCoV.html), as context for decision making and discussions with health professionals and family members. Further development requires curation and regular updating of NHS data and wider patient and public engagement.
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Affiliation(s)
- Amitava Banerjee
- University College London, London, UK, honorary consultant cardiologist, University College London Hospitals NHS Trust, London, UK, and honorary consultant cardiologist, Barts Health NHS Trust, London, UK
| | | | | | - Alvina G Lai
- University College London, London, UK, and associate, Health Data Research UK, London, UK
| | | | | | | | - Harpreet Sood
- Health Education England, London, UK, and general practitioner, Hurley Group Practice, London, UK
| | | | | | - Natalie K Fitzpatrick
- University College London, London, UK, and associate, Health Data Research UK, London, UK
| | - Bryan Williams
- University College London Hospitals NHS Trust, London, UK, professor of medicine, University College London, London, UK, and director, UCL Hospitals NIHR Biomedical Research Centre
| | - Spiros Denaxas
- University College London, London, UK, associate, Health Data Research UK, and research fellow, Alan Turing Institute, London, UK
| | - Harry Hemingway
- University College London, London, UK, research director, Health Data Research UK, London, UK, and director of healthcare informatics, genomics/omics, data science, UCL Hospitals NIHR Biomedical Research Centre, London, UK
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12
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Wignall L, Portch E, McCormack M, Owens R, Cascalheira CJ, Attard-Johnson J, Cole T. Changes in Sexual Desire and Behaviors among UK Young Adults During Social Lockdown Due to COVID-19. JOURNAL OF SEX RESEARCH 2021; 58:976-985. [PMID: 33780311 DOI: 10.1080/00224499.2021.1897067] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study examined self-reported changes in young adults' sexual desire and behaviors during the most significant social restrictions imposed to deal with COVID-19. Drawing on a survey of 565 British adults aged 18-32 collected at the peak of social lockdown restrictions, we document an overall decrease in sexual behaviors consistent with abiding by social restrictions. We found that the levels of sexual desire reported by women (but not men) decreased compared with reports of pre-lockdown levels. Participants in serious relationships reported more increases in sexual activity than people who were single or dating casually, and there were significant differences according to gender and sexual orientation. The perceived impact of subjective wellbeing of people with high sociosexuality scores was disproportionately associated with social lockdown but there was no effect for general health. Thus, the impact on sexuality and general wellbeing should be considered by policymakers when considering future social restrictions related to COVID-19 or other public health emergencies.
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Affiliation(s)
- Liam Wignall
- Department of Psychology, Bournemouth University
| | - Emma Portch
- Department of Psychology, Bournemouth University
| | | | | | - Cory J Cascalheira
- Department of Counseling & Educational Psychology, New Mexico State University
| | | | - Terri Cole
- Department of Psychology, Bournemouth University
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Govender R, Behenna K, Brady G, Coffey M, Babb M, Patterson JM. Shielding, hospital admission and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic: A cross-sectional survey from the first national lockdown. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1064-1073. [PMID: 34351676 PMCID: PMC8441848 DOI: 10.1111/1460-6984.12656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 05/15/2023]
Abstract
BACKGROUND People with a total laryngectomy (PTL) rely on a permanent opening in their neck (stoma) to breathe. This altered anatomy may increase susceptibility to contracting and transmitting SARS-CoV-2. AIMS To report on (1) the frequency and characteristics of PTL who tested positive for COVID-19, (2) the receipt of advice regarding shielding and patient self-reports of shielding, (3) hospital admissions and length of stay, and (4) mortality rates in this group during the first UK national lockdown. METHODS & PROCEDURES This is a cross-sectional survey and case note review. National Health Service (NHS) centres providing care to PTL were invited to participate via the Royal College of Speech and Language Therapists' (RCSLT) Head & Neck Clinical Excellence Networks and through social media. PTL were reviewed by their speech and language therapist either in person or via telehealth between 30 March and 30 September 2020. Data were collected within the time frame covered by the Control of Patient Information (COPI) notice issued for COVID-19 and included information on COVID-19 testing, shielding, hospital admissions, length of stay and deaths. Information was submitted to the lead NHS site using a custom designed data-capture worksheet. Analysis was performed using descriptive statistics, including proportions and frequency counts. Pearson's Chi squared tests were used to compare categorical data using a 5% significance level. OUTCOMES & RESULTS Data were obtained from 1216 PTL from 26 centres across the UK. A total of 81% were male; mean age was 70 years (28-97 years). Of the total group, 12% received a COVID-19 test. A total of 24 (2% of total sample) tested positive for COVID-19. Almost one-third of PTL (32%) received a government letter or were advised to shield by a healthcare professional. During the data collection time frame, 12% had a hospital admission (n = 151) with a median length of stay of 1 day (1-133 days), interquartile range (IQR) = 17 days. A total of 20 of these admissions (13%) had tested positive for COVID-19 with a median length of stay of 26 days, IQR = 49 days. The overall mortality was 4% (41 patients), with eight deaths occurring within 28 days of testing positive for COVID-19. CONCLUSIONS & IMPLICATIONS This study highlighted the lack of routine national data for neck-breathers with which to compare the current findings. Greater testing in the community is necessary to understand the prevalence of COVID-19 in PTL and if this group is indeed more susceptible. The potential for nasopharyngeal and tracheal aspirates to show differing results when testing for COVID-19 in neck-breathers requires further investigation. WHAT THIS PAPER ADDS What is already known on the subject? People with total laryngectomy (PTL) have an altered anatomy for breathing and speaking. The presence of a neck stoma poses an additional virus entry point aside from the nose, mouth and conjunctiva. This could increase the susceptibility to COVID-19 for PTL. What this paper adds? This is the first national audit to provide data on shielding, hospital admissions and mortality for patients with total laryngectomy in the UK over the pandemic. The overall mortality in PTL over the first lockdown did not appear to be higher than the "best case" estimates from previous years. However, one in three PTL who acquired COVID-19 and were admitted to hospital, died within 28 days of testing positive. These findings are relevant to the current care and management of PTL over the pandemic but also highlights important knowledge gaps. What are the potential or actual clinical implications of this work? This study highlights gaps in the collection of baseline information on hospital admissions, length of stay and mortality for people with laryngectomy in the UK, restricting comparisons between the current data and historical data. The need for further research on whether neck-breathers should be tested via both nasopharyngeal and tracheal aspirates is important not just currently, but also in case of any future respiratory epidemics.
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Affiliation(s)
- Roganie Govender
- University College London HospitalHead & Neck Academic CentreLondonUK
- Department of Applied Health ResearchInstitute of Epidemiology & HealthcareUniversity College LondonLondonUK
| | - Katherine Behenna
- ENT/HNC SLT DepartmentNottingham University Hospitals Healthcare TrustNottinghamUK
| | - Grainne Brady
- Department of SpeechVoice and Swallowing, The Royal Marsden NHS Foundation TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Margaret Coffey
- Department of Surgery and CancerImperial College LondonLondonUK
- Imperial College Healthcare Trust, SLT DepartmentCharing Cross HospitalLondonUK
| | - Malcolm Babb
- National Association of Laryngectomee ClubsLondonUK
| | - Joanne M. Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck CentreUniversity of LiverpoolLiverpoolUK
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Watanabe T, Yabu T. Japan's voluntary lockdown: further evidence based on age-specific mobile location data. JAPANESE ECONOMIC REVIEW (OXFORD, ENGLAND) 2021; 72:333-370. [PMID: 34177343 PMCID: PMC8214931 DOI: 10.1007/s42973-021-00077-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 05/21/2023]
Abstract
Changes in people's behavior during the COVID-19 pandemic can be regarded as the result of two types of effects: the "intervention effect" (changes resulting from government orders for people to change their behavior) and the "information effect" (voluntary changes in people's behavior based on information about the pandemic). Using age-specific mobile location data, we examine how the intervention and information effects differ across age groups. Our main findings are as follows. First, the age profile of the intervention effect shows that the degree to which people refrained from going out was smaller for older age groups, who are at a higher risk of serious illness and death, than for younger age groups. Second, the age profile of the information effect shows that the degree to which people stayed at home tended to increase with age for weekends and holidays. Thus, while Acemoglu et al. (2020) proposed targeted lockdowns requiring stricter lockdown policies for the oldest group in order to protect those at a high risk of serious illness and death, our findings suggest that Japan's government intervention had a very different effect in that it primarily reduced outings by the young, and what led to the quarantining of older groups at higher risk instead was people's voluntary response to information about the pandemic. Third, the information effect has been on a downward trend since the summer of 2020. It is relatively more pronounced among the young, so that the age profile of the information effect remains upward sloping.
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Affiliation(s)
| | - Tomoyoshi Yabu
- Faculty of Business and Commerce, Keio University, Tokyo, Japan
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The impact of primary care supported shielding on the risk of mortality in people vulnerable to COVID-19: English sentinel network matched cohort study. J Infect 2021; 83:228-236. [PMID: 34004222 PMCID: PMC8123406 DOI: 10.1016/j.jinf.2021.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022]
Abstract
Objectives To mitigate risk of mortality from coronavirus 2019 infection (COVID-19), the UK government recommended ‘shielding’ of vulnerable people through self-isolation for 12 weeks. Methods A retrospective cohort study using a nationally representative English primary care database comparing people aged >= 40 years who were recorded as being advised to shield using a fixed ratio of 1:1, matching to people with the same diagnoses not advised to shield (n = 77,360 per group). Time-to-death was compared using Cox regression, reporting the hazard ratio (HR) of mortality between groups. A sensitivity analysis compared exact matched cohorts (n = 24,752 shielded, n = 61,566 exact matches). Results We found a time-varying HR of mortality between groups. In the first 21 days, the mortality risk in people shielding was half those not (HR = 0.50, 95%CI:0.41–0.59. p < 0.0001). Over the remaining nine weeks, mortality risk was 54% higher in the shielded group (HR=1.54, 95%CI:1.41–1.70, p < 0.0001). Beyond the shielding period, mortality risk was over two-and-a-half times higher in the shielded group (HR=2.61, 95%CI:2.38–2.87, p < 0.0001). Conclusions Shielding halved the risk of mortality for 21 days. Mortality risk became higher across the remainder of the shielding period, rising to two-and-a-half times greater post-shielding. Shielding may be beneficial in the next wave of COVID-19.
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Beckwith H, Nimmo A, Savino M, Selvaskandan H, Graham-Brown M, Medcalf J, Cockwell P. Impact of the COVID-19 Pandemic on Training, Morale and Well-Being Among the UK Renal Workforce. Kidney Int Rep 2021; 6:1433-1436. [PMID: 34013121 PMCID: PMC8116903 DOI: 10.1016/j.ekir.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Ailish Nimmo
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | | | - Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - James Medcalf
- UK Renal Registry, The Renal Association, Bristol, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - UK Renal SpR Club and Renal Association
- Department of Renal Medicine, Imperial College London, UK
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
- UK Renal Registry, The Renal Association, Bristol, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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17
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Batty GD, Deary IJ, Altschul D. Pre-pandemic mental and physical health as predictors of COVID-19 vaccine hesitancy: evidence from a UK-wide cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.27.21256185. [PMID: 34013297 PMCID: PMC8132272 DOI: 10.1101/2021.04.27.21256185] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Although several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health has not been well-examined, and the association with mental health is unknown. OBJECTIVE To examine the association of pre-pandemic mental health, physical health, and shielding with vaccine hesitancy after the announcement of the successful testing of the Oxford University/AstraZeneca vaccine. DESIGN SETTING AND PARTICIPANTS We used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16-95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, completed the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression), and indicated whether they or someone in their household was shielding. MAIN OUTCOME MEASURES Self-reported intention to take up a vaccination for COVID-19. To summarise our results, we computed odds ratios with accompanying 95% confidence intervals for indices of health and shielding adjusted for selected covariates. RESULTS In an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to take up a vaccine. CONCLUSIONS AND RELEVANCE People who have been prioritised for COVID-19 vaccination owing to a physical condition are more likely to take it up. These effects were not apparent for indices of mental health.
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Affiliation(s)
- G David Batty
- Department of Epidemiology and Public Health, University College London, UK
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, UK
| | - Drew Altschul
- Department of Psychology, University of Edinburgh, UK
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18
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Ioannidis JPA, Axfors C, Contopoulos-Ioannidis DG. Second versus first wave of COVID-19 deaths: Shifts in age distribution and in nursing home fatalities. ENVIRONMENTAL RESEARCH 2021; 195:110856. [PMID: 33581086 PMCID: PMC7875012 DOI: 10.1016/j.envres.2021.110856] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To examine whether the age distribution of COVID-19 deaths and the share of deaths in nursing homes changed in the second versus the first pandemic wave. ELIGIBLE DATA We considered all countries that had at least 4000 COVID-19 deaths occurring as of January 14, 2021, at least 200 COVID-19 deaths occurring in each of the two epidemic wave periods; and which had sufficiently detailed information available on the age distribution of these deaths. We also considered countries with data available on COVID-19 deaths of nursing home residents for the two waves. MAIN OUTCOME MEASURES Change in the second wave versus the first wave in the proportion of COVID-19 deaths occurring in people <50 years ("young deaths") among all COVID-19 deaths and among COVID-19 deaths in people <70 years old; and change in the proportion of COVID-19 deaths in nursing home residents among all COVID-19 deaths. RESULTS Data on age distribution were available for 14 eligible countries. Individuals <50 years old had small absolute difference in their share of the total COVID-19 deaths in the two waves across 13 high-income countries (absolute differences 0.0-0.4%). Their proportion was higher in Ukraine, but it decreased markedly in the second wave. The proportion of young deaths was lower in the second versus the first wave (summary prevalence ratio 0.81, 95% CI 0.71-0.92) with large between-country heterogeneity. The proportion of young deaths among deaths <70 years did not differ significantly across the two waves (summary prevalence ratio 0.96, 95% CI 0.86-1.06). Eligible data on nursing home COVID-19 deaths were available for 11 countries. The share of COVID-19 deaths that were accounted by nursing home residents decreased in the second wave significantly and substantially in 8 countries (prevalence ratio estimates: 0.36 to 0.78), remained the same in Denmark and Norway and markedly increased in Australia. CONCLUSIONS In the examined countries, age distribution of COVID-19 deaths has been fairly similar in the second versus the first wave, but the contribution of COVID-19 deaths in nursing home residents to total fatalities has decreased in most countries in the second wave.
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA.
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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19
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Hothorn T, Bopp M, Günthard H, Keiser O, Roelens M, Weibull CE, Crowther M. Assessing relative COVID-19 mortality: a Swiss population-based study. BMJ Open 2021; 11:e042387. [PMID: 34006026 PMCID: PMC7941676 DOI: 10.1136/bmjopen-2020-042387] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/27/2021] [Accepted: 02/07/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Severity of the COVID-19 has been previously reported in terms of absolute mortality in SARS-CoV-2 positive cohorts. An assessment of mortality relative to mortality in the general population is presented. DESIGN Retrospective population-based study. SETTING Individual information on symptomatic confirmed SARS-CoV-2 patients and subsequent deaths from any cause were compared with the all-cause mortality in the Swiss population of 2018. Starting 23 February 2020, mortality in COVID-19 patients was monitored for 80 days and compared with the population mortality observed in the same time of year starting 23 February 2018. PARTICIPANTS 5 102 300 inhabitants of Switzerland aged 35-95 without COVID-19 (general population in spring 2018) and 20 769 persons tested positively for COVID-19 during the first wave in spring 2020. MEASUREMENTS Sex-specific and age-specific mortality rates were estimated using Cox proportional hazards models. Absolute probabilities of death were predicted and risk was assessed in terms of relative mortality by taking the ratio between the sex-specific and age-specific absolute mortality in COVID-19 patients and the corresponding mortality in the 2018 general population. RESULTS Absolute mortalities increased with age and were higher for males compared with females, both in the general population and in positively tested persons. A confirmed SARS-CoV-2 infection substantially increased the probability of death across all patient groups at least eightfold. The highest relative mortality risks were observed among males and younger patients. Male COVID-19 patients exceeded the population hazard for males (HR 1.21, 95% CI 1.02 to 1.44). An additional year of age increased the population hazard in COVID-19 patients only marginally (HR 1.00, 95% CI 1.00 to 1.01). CONCLUSIONS Healthcare professionals, decision-makers and societies are provided with an additional population-adjusted assessment of COVID-19 mortality risk. In combination with absolute measures of risk, the relative risks presented here help to develop a more comprehensive understanding of the actual impact of COVID-19.
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Affiliation(s)
- Torsten Hothorn
- Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich, Zürich, Switzerland
| | - Matthias Bopp
- Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich, Zürich, Switzerland
| | - Huldrych Günthard
- Institut für Medizinische Virologie, Universität Zürich, Zürich, Switzerland
- Klinik für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich, Zurich, Switzerland
| | - Olivia Keiser
- Institut de santé globale, Université de Genève, Geneva, Switzerland
| | - Maroussia Roelens
- Institut de santé globale, Université de Genève, Geneva, Switzerland
| | | | - Michael Crowther
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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20
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Ioannidis JPA. Precision shielding for COVID-19: metrics of assessment and feasibility of deployment. BMJ Glob Health 2021; 6:e004614. [PMID: 33514595 PMCID: PMC7849322 DOI: 10.1136/bmjgh-2020-004614] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
The ability to preferentially protect high-risk groups in COVID-19 is hotly debated. Here, the aim is to present simple metrics of such precision shielding of people at high risk of death after infection by SARS-CoV-2; demonstrate how they can estimated; and examine whether precision shielding was successfully achieved in the first COVID-19 wave. The shielding ratio, S, is defined as the ratio of prevalence of infection among people in a high-risk group versus among people in a low-risk group. The contrasted risk groups examined here are according to age (≥70 vs <70 years), and institutionalised (nursing home) setting. For age-related precision shielding, data were used from large seroprevalence studies with separate prevalence data for elderly versus non-elderly and with at least 1000 assessed people≥70 years old. For setting-related precision shielding, data were analysed from 10 countries where information was available on numbers of nursing home residents, proportion of nursing home residents among COVID-19 deaths and overall population infection fatality rate (IFR). Across 17 seroprevalence studies, the shielding ratio S for elderly versus non-elderly varied between 0.4 (substantial shielding) and 1.6 (substantial inverse protection, that is, low-risk people being protected more than high-risk people). Five studies in the USA all yielded S=0.4-0.8, consistent with some shielding being achieved, while two studies in China yielded S=1.5-1.6, consistent with inverse protection. Assuming 25% IFR among nursing home residents, S values for nursing home residents ranged from 0.07 to 3.1. The best shielding was seen in South Korea (S=0.07) and modest shielding was achieved in Israel, Slovenia, Germany and Denmark. No shielding was achieved in Hungary and Sweden. In Belgium (S=1.9), the UK (S=2.2) and Spain (S=3.1), nursing home residents were far more frequently infected than the rest of the population. In conclusion, the experience from the first wave of COVID-19 suggests that different locations and settings varied markedly in the extent to which they protected high-risk groups. Both effective precision shielding and detrimental inverse protection can happen in real-life circumstances. COVID-19 interventions should seek to achieve maximal precision shielding.
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Affiliation(s)
- John P A Ioannidis
- Department of Medicine and Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
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21
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Keeling MJ, Hill EM, Gorsich EE, Penman B, Guyver-Fletcher G, Holmes A, Leng T, McKimm H, Tamborrino M, Dyson L, Tildesley MJ. Predictions of COVID-19 dynamics in the UK: Short-term forecasting and analysis of potential exit strategies. PLoS Comput Biol 2021; 17:e1008619. [PMID: 33481773 PMCID: PMC7857604 DOI: 10.1371/journal.pcbi.1008619] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 02/03/2021] [Accepted: 12/08/2020] [Indexed: 01/08/2023] Open
Abstract
Efforts to suppress transmission of SARS-CoV-2 in the UK have seen non-pharmaceutical interventions being invoked. The most severe measures to date include all restaurants, pubs and cafes being ordered to close on 20th March, followed by a "stay at home" order on the 23rd March and the closure of all non-essential retail outlets for an indefinite period. Government agencies are presently analysing how best to develop an exit strategy from these measures and to determine how the epidemic may progress once measures are lifted. Mathematical models are currently providing short and long term forecasts regarding the future course of the COVID-19 outbreak in the UK to support evidence-based policymaking. We present a deterministic, age-structured transmission model that uses real-time data on confirmed cases requiring hospital care and mortality to provide up-to-date predictions on epidemic spread in ten regions of the UK. The model captures a range of age-dependent heterogeneities, reduced transmission from asymptomatic infections and produces a good fit to the key epidemic features over time. We simulated a suite of scenarios to assess the impact of differing approaches to relaxing social distancing measures from 7th May 2020 on the estimated number of patients requiring inpatient and critical care treatment, and deaths. With regard to future epidemic outcomes, we investigated the impact of reducing compliance, ongoing shielding of elder age groups, reapplying stringent social distancing measures using region based triggers and the role of asymptomatic transmission. We find that significant relaxation of social distancing measures from 7th May onwards can lead to a rapid resurgence of COVID-19 disease and the health system being quickly overwhelmed by a sizeable, second epidemic wave. In all considered age-shielding based strategies, we projected serious demand on critical care resources during the course of the pandemic. The reintroduction and release of strict measures on a regional basis, based on ICU bed occupancy, results in a long epidemic tail, until the second half of 2021, but ensures that the health service is protected by reintroducing social distancing measures for all individuals in a region when required. Our work confirms the effectiveness of stringent non-pharmaceutical measures in March 2020 to suppress the epidemic. It also provides strong evidence to support the need for a cautious, measured approach to relaxation of lockdown measures, to protect the most vulnerable members of society and support the health service through subduing demand on hospital beds, in particular bed occupancy in intensive care units.
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Affiliation(s)
- Matt J. Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Edward M. Hill
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Erin E. Gorsich
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Bridget Penman
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Glen Guyver-Fletcher
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
- Midlands Integrative Biosciences Training Partnership, School of Life Sciences, University of Warwick, Coventry, United Kingdom
| | - Alex Holmes
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
- Mathematics for Real World Systems Centre for Doctoral Training, Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Trystan Leng
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
- Mathematics for Real World Systems Centre for Doctoral Training, Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Hector McKimm
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Massimiliano Tamborrino
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Louise Dyson
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Michael J. Tildesley
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
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22
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COVID-19 zugzwang: Potential public health moves towards population (herd) immunity. PUBLIC HEALTH IN PRACTICE 2020; 1:100031. [PMID: 34173570 PMCID: PMC7361085 DOI: 10.1016/j.puhip.2020.100031] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023] Open
Abstract
COVID-19 is pandemic, and likely to become endemic, possibly returning with greater virulence. Outlining potential public health actions, including hygiene measures, social distancing and face masks, and realistic future advances, this paper focuses on the consequences of taking no public health action; the role of natural changes such as weather; the adverse public health consequences of lockdowns; testing for surveillance and research purposes; testing to identify cases and contacts, including the role of antibody tests; the public health value of treatments; mobilising people who have recovered; population (a synonym for herd) immunity through vaccination and through natural infection; involving the entire population; and the need for public debate. Until there is a vaccine, population immunity is going to occur only from infection. Allowing infection in those at very low risk while making it safer for them and wider society needs consideration but is currently taboo. About 40–50% population immunity is sufficient to suppress an infection with a reproduction number of about 1 or slightly more. Importantly, in children and young people COVID-19 is currently rarely fatal, roughly comparable with influenza. The balance between the damage caused by COVID-19 and that caused by lockdowns needs quantifying. Public debate, including on population immunity, informed by epidemiological data, is now urgent. The long-term solution to the COVID-19 pandemic is population immunity through natural infection or vaccination. 40-50% population immunity is sufficient to suppress and eliminate this pandemic. New vaccines may not work well in the older age groups and those with underlying conditions and may not be safer than the infection for children and youth. Immunity is currently being acquired by infection and we need safer strategies for managing this. Open, honest, factual and sensitively conducted public dialogue is now urgent.
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23
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Individual and community-level risk for COVID-19 mortality in the United States. Nat Med 2020; 27:264-269. [PMID: 33311702 DOI: 10.1038/s41591-020-01191-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
Reducing COVID-19 burden for populations will require equitable and effective risk-based allocations of scarce preventive resources, including vaccinations1. To aid in this effort, we developed a general population risk calculator for COVID-19 mortality based on various sociodemographic factors and pre-existing conditions for the US population, combining information from the UK-based OpenSAFELY study with mortality rates by age and ethnicity across US states. We tailored the tool to produce absolute risk estimates in future time frames by incorporating information on pandemic dynamics at the community level. We applied the model to data on risk factor distribution from a variety of sources to project risk for the general adult population across 477 US cities and for the Medicare population aged 65 years and older across 3,113 US counties, respectively. Validation analyses using 54,444 deaths from 7 June to 1 October 2020 show that the model is well calibrated for the US population. Projections show that the model can identify relatively small fractions of the population (for example 4.3%) that might experience a disproportionately large number of deaths (for example 48.7%), but there is wide variation in risk across communities. We provide a web-based risk calculator and interactive maps for viewing community-level risks.
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24
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Kavaliunas A, Ocaya P, Mumper J, Lindfeldt I, Kyhlstedt M. Swedish policy analysis for Covid-19. HEALTH POLICY AND TECHNOLOGY 2020; 9:598-612. [PMID: 32904437 PMCID: PMC7455549 DOI: 10.1016/j.hlpt.2020.08.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health care systems and put societies to the test in the world beyond expectations. OBJECTIVE Our aim is to describe and analyze the Swedish approach in combating the pandemic. METHODS We present and discuss data collated from various sources - published scientific studies, pre-print material, agency reports, media communication, public surveys, etc. - with specific focus on the approach itself, Covid-19 trends, healthcare system response, policy and measures overview, and implications. RESULTS The main intervention to manage the curve has been the general recommendations to adhere to good hand hygiene, beware of physical distance to others, to refrain from large gatherings and restrain from non-essential travel. Persons with suspected Covid-19 infection were recommended to stay at home and avoid social contacts. Additionally, visits to the elderly care homes and meetings with more than 50 people were forbidden. As a result, the healthcare system in the country has so far, never been overwhelmed. However, the relatively high mortality among the elderly, together with the vulnerability of some migrants, points out the drawbacks. CONCLUSIONS Many countries have both marvelled and criticized the Swedish strategy that is formed in a close partnership between the government and the society based on a mutual trust giving the responsibility to individuals. It already highlights how much can be achieved with voluntary measures (recommendations) - something that was noticed and proposed as a future model by the World Health Organization.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Pauline Ocaya
- Department of Clinical Microbiology, Section of Infection and Immunology, University Hospital of Umeå, Umeå, Sweden
| | - Jim Mumper
- Independent Consultant, Norrköping, Sweden
| | - Isis Lindfeldt
- Department of Sociology and Uppsala Antibiotic Center, Uppsala University, Uppsala, Sweden
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25
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Khan SS, Marshall CL, Stylianou KA, McMullen E, Griffiths CEM, Warren RB, Hunter HJA. An evaluation of dermatology patients shielding during the COVID-19 outbreak. Clin Exp Dermatol 2020; 46:193-194. [PMID: 33098712 PMCID: PMC9213949 DOI: 10.1111/ced.14489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- S S Khan
- The Dermatology Centre, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK
| | - C L Marshall
- The Dermatology Centre, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK
| | - K A Stylianou
- The Dermatology Centre, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK
| | - E McMullen
- The Dermatology Centre, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK
| | - C E M Griffiths
- The Dermatology Centre, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK.,Department of Dermatological Sciences, The University of Manchester, Manchester, UK
| | - R B Warren
- The Dermatology Centre, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK.,Department of Dermatological Sciences, The University of Manchester, Manchester, UK
| | - H J A Hunter
- The Dermatology Centre, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK.,Department of Dermatological Sciences, The University of Manchester, Manchester, UK
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26
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Kipps S, Paul A, Vasireddy S. Incidence of COVID-19 in patients with rheumatic disease: is prior health education more important than shielding advice during the pandemic? Clin Rheumatol 2020; 40:1575-1579. [PMID: 33174109 PMCID: PMC7655460 DOI: 10.1007/s10067-020-05494-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has led to major changes in clinical practice on a global scale in order to protect patients. This includes the identification of vulnerable patients who should "shield" in order to reduce the likelihood of contracting SARS-CoV2. We used national specialty guidance and an adapted screening tool to risk stratify patients identified from our prescribing and monitoring databases, and identify those needing to shield (score ≥ 3) using information from departmental letters, online general practice records and recent laboratory investigations. We collated underlying rheumatological conditions and risk factors. Two months into the shielding process, we examined the COVID-19 status of these patients using hospital laboratory records and compared to population level data. Of 887 patients assessed, 248 (28%) scored ≥ 3 and were sent a standard shielding letter. The most common risk factor in the shielding letter group was age ≥ 70 years and/or presence of a listed co-morbidity (199 patients). The most common rheumatology conditions were rheumatoid arthritis (69.4%), polymyalgia rheumatica (8.5%) and giant cell arteritis (8.5%). Coronavirus incidence rates were similar in the shielding letter group (0.403%) and in the UK population (0.397%). However, we found a trend towards lower incidence (0.113%) in our whole cohort (RR 0.28, 95%CI 0.04-2.01 for the whole cohort compared to UK population). The trend towards lower incidence in this cohort could be because of prior education regarding general infection risk and response to public health messages. While risk stratification and shielding could be effective, prior education regarding general infection risk and public health messages to enhance health protection behaviours during a pandemic may have equal or more important roles. Key Points • Patients on treatment for rheumatic disorders showed a trend for lower incidence of COVID-19 transmission irrespective of shielding letter status • This could potentially be because of prior education regarding infection risk received when starting on disease-modifying medication • Health education influencing health protection behaviours may be of equal or more importance than shielding information in reducing transmission of SARS-CoV-2.
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Affiliation(s)
- Sarah Kipps
- Department of Rheumatology, Bolton One Health Centre, Bolton NHS FT, Moor Lane, Bolton, BL3 5BN, UK
| | - Anindita Paul
- Department of Rheumatology, Bolton One Health Centre, Bolton NHS FT, Moor Lane, Bolton, BL3 5BN, UK
| | - Sreekanth Vasireddy
- Department of Rheumatology, Bolton One Health Centre, Bolton NHS FT, Moor Lane, Bolton, BL3 5BN, UK.
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27
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Affiliation(s)
- A Lee
- University of Sheffield, UK.
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28
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Cook TM, El-Boghdadly K. COVID-19 risk tools should incorporate assessment of working environment risk and its mitigation. EClinicalMedicine 2020; 28:100613. [PMID: 33173855 PMCID: PMC7646368 DOI: 10.1016/j.eclinm.2020.100613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tim M Cook
- Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Blakes Farm, Englishcombe, Bath BA2 9DT, United Kingdom
- Honorary Professor, School of Medicine, University of Bristol, United Kingdom
| | - Kariem El-Boghdadly
- Consultant, Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Honorary Senior Lecturer, King's College London, United Kingdom
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Clift AK, Coupland CAC, Keogh RH, Diaz-Ordaz K, Williamson E, Harrison EM, Hayward A, Hemingway H, Horby P, Mehta N, Benger J, Khunti K, Spiegelhalter D, Sheikh A, Valabhji J, Lyons RA, Robson J, Semple MG, Kee F, Johnson P, Jebb S, Williams T, Hippisley-Cox J. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study. BMJ 2020; 371:m3731. [PMID: 33082154 PMCID: PMC7574532 DOI: 10.1136/bmj.m3731] [Citation(s) in RCA: 341] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To derive and validate a risk prediction algorithm to estimate hospital admission and mortality outcomes from coronavirus disease 2019 (covid-19) in adults. DESIGN Population based cohort study. SETTING AND PARTICIPANTS QResearch database, comprising 1205 general practices in England with linkage to covid-19 test results, Hospital Episode Statistics, and death registry data. 6.08 million adults aged 19-100 years were included in the derivation dataset and 2.17 million in the validation dataset. The derivation and first validation cohort period was 24 January 2020 to 30 April 2020. The second temporal validation cohort covered the period 1 May 2020 to 30 June 2020. MAIN OUTCOME MEASURES The primary outcome was time to death from covid-19, defined as death due to confirmed or suspected covid-19 as per the death certification or death occurring in a person with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the period 24 January to 30 April 2020. The secondary outcome was time to hospital admission with confirmed SARS-CoV-2 infection. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance, including measures of discrimination and calibration, was evaluated in each validation time period. RESULTS 4384 deaths from covid-19 occurred in the derivation cohort during follow-up and 1722 in the first validation cohort period and 621 in the second validation cohort period. The final risk algorithms included age, ethnicity, deprivation, body mass index, and a range of comorbidities. The algorithm had good calibration in the first validation cohort. For deaths from covid-19 in men, it explained 73.1% (95% confidence interval 71.9% to 74.3%) of the variation in time to death (R2); the D statistic was 3.37 (95% confidence interval 3.27 to 3.47), and Harrell's C was 0.928 (0.919 to 0.938). Similar results were obtained for women, for both outcomes, and in both time periods. In the top 5% of patients with the highest predicted risks of death, the sensitivity for identifying deaths within 97 days was 75.7%. People in the top 20% of predicted risk of death accounted for 94% of all deaths from covid-19. CONCLUSION The QCOVID population based risk algorithm performed well, showing very high levels of discrimination for deaths and hospital admissions due to covid-19. The absolute risks presented, however, will change over time in line with the prevailing SARS-C0V-2 infection rate and the extent of social distancing measures in place, so they should be interpreted with caution. The model can be recalibrated for different time periods, however, and has the potential to be dynamically updated as the pandemic evolves.
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Affiliation(s)
- Ash K Clift
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Carol A C Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth H Keogh
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karla Diaz-Ordaz
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Williamson
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Andrew Hayward
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Harry Hemingway
- UCL Institute for Health Informatics, University College London, London, UK
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nisha Mehta
- Office of the Chief Medical Officer, Department of Health and Social Care, London, UK
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David Spiegelhalter
- Winton Centre for Risk and Evidence Communication, Faculty of Mathematics, University of Cambridge, Cambridge, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Malcolm G Semple
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Tony Williams
- Association of Local Authority Medical Advisors, London, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
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30
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Affiliation(s)
- Ewan Macdonald
- Institute of Health and Wellbeing University of Glasgow, Glasgow, UK
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31
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Bhopal RS. To achieve "zero covid" we need to include the controlled, careful acquisition of population (herd) immunity. BMJ 2020; 370:m3487. [PMID: 32907816 DOI: 10.1136/bmj.m3487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Raj S Bhopal
- Edinburgh Migration, Ethnicity, and Health Research Group, Usher Institute, Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK
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32
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Affiliation(s)
- David Spiegelhalter
- Winton Centre for Risk and Evidence Communication, Statistical Laboratory Centre for Mathematical Sciences, Cambridge, UK
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33
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Dick L, Green J, Brown J, Kennedy E, Cassidy R, Othman S, Berlansky M. Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study. World J Surg 2020; 44:3590-3594. [PMID: 32860140 PMCID: PMC7454130 DOI: 10.1007/s00268-020-05760-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 01/08/2023]
Abstract
Introduction Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. Methods A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. Results A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. Conclusion Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.
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Affiliation(s)
- Lachlan Dick
- Department of General Surgery, Borders General Hospital, Melrose, TD6 9BS, UK.
| | - James Green
- Department of General Surgery, Borders General Hospital, Melrose, TD6 9BS, UK
| | - Jasmine Brown
- Department of General Surgery, Borders General Hospital, Melrose, TD6 9BS, UK
| | - Ewan Kennedy
- Department of General Surgery, Borders General Hospital, Melrose, TD6 9BS, UK
| | - Richard Cassidy
- Department of General Surgery, Borders General Hospital, Melrose, TD6 9BS, UK
| | - Salasiah Othman
- Department of General Surgery, Borders General Hospital, Melrose, TD6 9BS, UK
| | - Martin Berlansky
- Department of General Surgery, Borders General Hospital, Melrose, TD6 9BS, UK
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Chirico F, Sacco A, Bragazzi NL, Magnavita N. Can Air-Conditioning Systems Contribute to the Spread of SARS/MERS/COVID-19 Infection? Insights from a Rapid Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6052. [PMID: 32825303 PMCID: PMC7503634 DOI: 10.3390/ijerph17176052] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022]
Abstract
The airborne transmission of SARS-CoV-2 is still debated. The aim of this rapid review is to evaluate the COVID-19 risk associated with the presence of air-conditioning systems. Original studies (both observational and experimental researches) written in English and with no limit on time, on the airborne transmission of SARS-CoV, MERS-CoV, and SARS-CoV-2 coronaviruses that were associated with outbreaks, were included. Searches were made on PubMed/MEDLINE, PubMed Central (PMC), Google Scholar databases, and medRxiv. A snowball strategy was adopted to extend the search. Fourteen studies reporting outbreaks of coronavirus infection associated with the air-conditioning systems were included. All studies were carried out in the Far East. In six out the seven studies on SARS, the role of Heating, Ventilation, and Air Conditioning (HVAC) in the outbreak was indirectly proven by the spatial and temporal pattern of cases, or by airflow-dynamics models. In one report on MERS, the contamination of HVAC by viral particles was demonstrated. In four out of the six studies on SARS-CoV-2, the diffusion of viral particles through HVAC was suspected or supported by computer simulation. In conclusion, there is sufficient evidence of the airborne transmission of coronaviruses in previous Asian outbreaks, and this has been taken into account in the guidelines released by organizations and international agencies for controlling the spread of SARS-CoV-2 in indoor environments. However, the technological differences in HVAC systems prevent the generalization of the results on a worldwide basis. The few COVID-19 investigations available do not provide sufficient evidence that the SARS-CoV-2 virus can be transmitted by HVAC systems.
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Affiliation(s)
- Francesco Chirico
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
- Health Service Department, State Police, Ministry of Interior, 20125 Milan, Italy
| | - Angelo Sacco
- Local Healthcare Unit Roma 2, 00155 Roma, Italy;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Nicola Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
- Department of Woman/Child & Public Health, Fondazione Policlinico A. Gemelli IRCCS, 00168 Roma, Italy
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35
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Cook TM. Risk to health from COVID-19 for anaesthetists and intensivists - a narrative review. Anaesthesia 2020; 75:1494-1508. [PMID: 32677708 PMCID: PMC7405109 DOI: 10.1111/anae.15220] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
Healthcare workers are at an increased risk of infection, harm and death from COVID‐19. Close and prolonged exposure to individuals infectious with SARS‐CoV‐2 leads to infection. A person’s individual characteristics (age, sex, ethnicity and comorbidities) then influence the subsequent risk of COVID‐19 leading to hospitalisation, critical care admission or death. While relative risk is often reported as a measure of individual danger, absolute risk is more important and dynamic, particularly in the healthcare setting. Individual risk interacts with exposure and environmental risk‐factors, and the extent of mitigation to determine overall risk. Hospitals are a unique environment in which there is a significantly increased risk of infection for all healthcare workers. Anaesthetists and intensivists particularly are at high risk of exposure to SARS‐CoV‐2 infected patients due to their working environments and exposure to certain patient groups. However, the available evidence suggests that the risk for this group of individuals is not currently increased. This review examines factors associated with increased risk of infection with SARS‐CoV‐2, increasing severity of COVID‐19 and death. A risk tool is proposed that includes personal, environmental and mitigating factors, and enables an individualised dynamic ‘point‐of‐time’ risk assessment.
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Affiliation(s)
- T M Cook
- Royal United Hospital, Bath, UK.,University of Bristol, UK
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36
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Affiliation(s)
- Irene Petersen
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
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37
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Seifu Estifanos A, Alemu G, Negussie S, Ero D, Mengistu Y, Addissie A, Gebrehiwot Y, Yifter H, Melkie A, Gebrekiros DH, Gebremariam Kotecho M, Soklaridis S, Cartmill C, Whitehead CR, Wondimagegn D. 'I exist because of we': shielding as a communal ethic of maintaining social bonds during the COVID-19 response in Ethiopia. BMJ Glob Health 2020; 5:e003204. [PMID: 32709704 PMCID: PMC7387313 DOI: 10.1136/bmjgh-2020-003204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Alemu
- Development Economics, Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Negussie
- College of Law and Governance Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Debebe Ero
- College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yirgu Gebrehiwot
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen Yifter
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Addisu Melkie
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sophie Soklaridis
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carrie Cartmill
- Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Cynthia Ruth Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre, University Health Network, Toronto, Ontario, Canada
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