Population density and SARS-CoV-2 pandemic: Comparing the geography of different waves in the Netherlands

Residential mobility according to health status in South Korea's largest metropolitan city during the COVID-19 pandemic using generalized estimating equations for longitudinal data

This study examines whether residential mobility differed according to health status in Seoul, the largest metropolitan city in South Korea, during the COVID-19 pandemic. Before the COVID-19 pandemic, people who moved had better health status in the baseline year than those who did not. However, during the pandemic, the residential mobility of people with poor health status increased, particularly in 2019-2020. This pattern appeared to be driven by the 55-74 age group. The effect of health status on residential mobility was not attenuated, even after adjusting for covariates at multiple levels.

Bayesian hierarchical spatiotemporal models for prediction of (under)reporting rates and cases: COVID-19 infection among the older people in the United States during the 2020-2022 pandemic

The gap between the reported and actual COVID-19 infection cases has been an issue of concern. Here, we present Bayesian hierarchical spatiotemporal disease mapping models for state-level predictions of COVID-19 infection risks and (under)reporting rates among people aged 65 and above during the first two years of the pandemic in the United States. With prior elicitation based on recent prevalence studies, the study suggests that the median state-level reporting rate of COVID-19 infection was 90% (interquartile range: [78%, 96%]). Our study uncovers spatiotemporal variations and dynamics in state-level infection risks and (under)reporting rates, suggesting time-varying associations between higher population density, higher percentage of minorities, and higher percentage of vaccination and increased risks of COVID-19 infection, as well as an association between more easily accessible tests and higher reporting rates. With sensitivity analyses, we highlight the impact and importance of incorporating covariates information and objective prior references for evaluating the issue of underreporting.

Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany and Italy

PURPOSE

Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention.

METHODS

To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories.

FINDINGS

We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas.

CONCLUSIONS

Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.

From test to rest: evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands

INTRODUCTION

The COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands.

METHODOLOGY

This retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results.

RESULTS

Among the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result.

DISCUSSION

Our findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.

Conditioning factors in the spreading of Covid-19 - Does geography matter?

There is evidence in literature that the spread of COVID-19 can be influenced by various geographic factors, including territorial features, climate, population density, socioeconomic conditions, and mobility. The objective of the paper is to provide an updated literature review on geographical studies analysing the factors which influenced COVID-19 spreading. This literature review took into account not only the geographical aspects but also the COVID-19-related outcomes (infections and deaths) allowing to discern the potential influencing role of the geographic factors per type of outcome. A total of 112 scientific articles were selected, reviewed and categorized according to subject area, aim, country/region of study, considered geographic and COVID-19 variables, spatial and temporal units of analysis, methodologies, and main findings. Our literature review showed that territorial features may have played a role in determining the uneven geography of COVID-19; for instance, a certain agreement was found regarding the direct relationship between urbanization degree and COVID-19 infections. For what concerns climatic factors, temperature was the variable that correlated the best with COVID-19 infections. Together with climatic factors, socio-demographic ones were extensively taken into account. Most of the analysed studies agreed that population density and human mobility had a significant and direct relationship with COVID-19 infections and deaths. The analysis of the different approaches used to investigate the role of geographic factors in the spreading of the COVID-19 pandemic revealed that the significance/representativeness of the outputs is influenced by the scale considered due to the great spatial variability of geographic aspects. In fact, a more robust and significant association between geographic factors and COVID-19 was found by studies conducted at subnational or local scale rather than at country scale.

Compact living or policy inaction? Effects of urban density and lockdown on the COVID-19 outbreak in the US

The coronavirus pandemic has reignited the debate over urban density. Popular media has been quick to blame density as a key contributor to rapid disease transmission, questioning whether compact cities are still a desirable planning goal. Past research on the density-pandemic connection have produced mixed results. This article offers a critical perspective on this debate by unpacking the effects of alternative measures of urban density, and examining the impacts of mandatory lockdowns and the stringency of other government restrictions on cumulative Covid-19 infection and mortality rates during the early phase of the pandemic in the US. Our results show a consistent positive effect of density on Covid-19 outcomes across urban areas during the first six months of the outbreak. However, we find modest variations in the density-pandemic relationship depending on how densities are measured. We also find relatively longer duration mandatory lockdowns to be associated with lower infection and mortality rates, and lockdown duration's effect to be relatively more pronounced in high-density urban areas. Moreover, we find that the timing of lockdown imposition and the stringency of the government's response additionally influence Covid-19 outcomes, and that the effects vary by urban density. We argue that the adverse impact of density on pandemics could be mitigated by adopting strict lockdowns and other stringent human mobility and interaction restriction policies in a spatially targeted manner. Our study helps to inform current and future government policies to contain the virus, and to make our cities more resilient against future shocks and threats.

Urban public health emergencies and the COVID-19 pandemic. Part 2: Infrastructures, urban governance and civil society

COVID-19 had sudden and dramatic impacts on the organisation and governance of urban life. In Part 2 of this Special Issue on public health emergencies we question the extent to which the pandemic ushered in fundamentally new understandings of urban public health, noting that ideas of urban pathology and the relation of dirt, disease and danger in cities, have long informed practices of planning. Emphasising important continuities in the way pandemics are associated with minoritised and vulnerable groups, past and present, we note that public health initiatives can often exacerbate existing health divides, and actually deepen health crises. Against this, we document the emergence of participatory, community-led responses to the pandemic that offered the promise of more inclusive urban policy, often characterised by self-organisation. While we argue that any public health policy needs to be mindful of local contingencies, the promise of inclusive policies is that they will lead to healthier cities for all, not simply protect the health of the wealthy few.

Early-phase pandemic in Italy: Covid-19 spread determinant factors

Although the Covid-19 pandemic is still ongoing, the environmental factors beyond virus transmission are only partially known. This statistical study has the aim to identify the key factors that have affected the virus spread during the early phase of pandemic in Italy, among a wide set of potential determinants concerning demographics, environmental pollution and climate. Because of its heterogeneity in pollution levels and climate conditions, Italy provides an ideal scenario for an ecological study. Moreover, the selected period excludes important confounding factors, as different virus variants, restriction policies or vaccines. The short-term relationship between the infection maximum increase and demographic, pollution and meteo-climatic parameters was investigated, including both winter-spring and summer 2020 data, also focusing separately on the two seasonal periods and on North vs Centre-South. Among main results, the importance of population size confirmed social distancing as a key management option. The pollution hazardous role undoubtedly emerged, as NO2 affected infection increase in all the studied scenarios, PM2.5 manifested its impact in North of Italy, while O3 always showed a protective action. Whereas higher temperatures were beneficial, especially in the cold season with also wind and relative humidity, solar irradiance was always relevant, revealing several significant interactions with other co-factors. Presented findings address the importance of the environment in Sars-CoV-2 spread and indicated that special carefulness should be taken in crowded areas, especially if they are highly polluted and weakly exposed to sun. The results suggest that containment of future epidemics similar to Covid-19 could be supported by reducing environmental pollution, achieving safer social habits and promoting preventive health care for better immune system response, as an only comprehensive strategy.