Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base

Sound mind, sound body, or vice versa? Mind-body beliefs shape health behaviors

The present research examines whether and how lay intuitive theory regarding the interconnectedness of the mind and body, which we term mind-body correspondence (MBC), predicts engagement in health behaviors. Specifically, we hypothesised that MBC would strengthen mind influences the body (MIB) and body influences the mind (BIM) beliefs, which would in turn increase mental and physical health behaviors, respectively. We tested associations among MBC (independent variable), MIB and BIM beliefs (proposed mediators), and mental and physical health behaviors (dependent variables) using correlational designs in Studies 1a to 1c. Results revealed positive associations between MBC and (1) MIB and BIM and (2) mental and physical health behaviors, as well as between MIB and mental health behaviors and between BIM and physical health behaviors. We then tested the full model in Study 2 with an experimental manipulation of MBC and in Study 3 with a two-wave longitudinal design. Both studies revealed significant indirect effects of MBC on mental health behaviors via MIB and on physical health behaviors via BIM. Together, our findings suggest that one can encourage mental health behaviors by emphasizing the mind-to-body connection and physical health behaviors by highlighting the body-to-mind connection.

Risk factors for diarrheal diseases among pilgrims during Arba'een mass gathering: a case-control study

BACKGROUND

A significant portion of the Muslim community participates in the Arba'een pilgrimage, with participant numbers increasing each year. There have been relatively few studies on the health of Arba'een Mass gathering (MG). Researching the prevalence and distribution of diseases among Arba'een pilgrims is essential to recognize any outbreaks and take timely responses to contain them. The current study aimed to identify exposures and risk factors for diarrheal disease in pilgrims who referred to the clinics located in Iraq among the Arba'een MG in 2023.

METHODS

This case-control study randomly selected 200 outpatients (100 cases and 100 controls) who were referred to Iraq clinics. Cases were patients with gastrointestinal symptoms (diarrhea), while controls were randomly selected from unaffected pilgrims at the same time for the cases. The study groups matched for age, and sex. Face-to-face interviews using a reliable field based checklist of the Center for Disease Control and Prevention of Iran's Ministry of Health to collect potential exposures and risk factors for diarrheal disease. Multiple logistic regression was used to estimate the crude and adjusted odds ratio (AOR) for the risk of diarrhea with a 95% confidence interval (CI).

RESULTS

The average age of the participants was 38.6 years. Diarrhea in 100% and fever in 81% were the most common clinical symptoms in patients. Having underlying diseases was not associated with an increased risk of diarrhea disease (P > 0.05). Regarding risk factors for diarrheal, the final analysis after adjusting for potential confounders indicated that consumption of insanitary (unpackaged) drinking water (AOR = 1.95; 95% CI: 1.05-3.6; P = 0.024), inappropriate hand washing (AOR = 3.82; 95% CI: 1.7-8.6; P = 0.001), ritual foods (AOR = 2.56; 95% CI: 1.3-5.2; P = 0.004), and public toilets (AOR = 1.46; 95% CI: 1.04-4.3; P = 0.038) were significantly increased the likelihood of diarrheal disease.

CONCLUSIONS

Contamination of water sources, food, inadequate and poor hand washing were the most common sources of diarrheal diseases among Arba'een pilgrims. The results indicate that the potential occurrence of outbreaks, especially water- and foodborne diseases, threatens participants in the Arba'een MG. It is recommended to provide risk assessment, improve pilgrims' awareness, pre-and post-screening, vaccination, compliance with personal hygiene, improvement of the environment, provision of sanitary water and food sources and hygienic disposal of sewage, laboratory diagnosis to identify the common types of pathogens in Arba'een MG.

Model analysis and data validation of structured prevention and control interruptions of emerging infectious diseases

The design of optimized non-pharmaceutical interventions (NPIs) is critical to the effective control of emergent outbreaks of infectious diseases such as SARS, A/H1N1 and COVID-19 and to ensure that numbers of hospitalized cases do not exceed the carrying capacity of medical resources. To address this issue, we formulated a classic SIR model to include a close contact tracing strategy and structured prevention and control interruptions (SPCIs). The impact of the timing of SPCIs on the maximum number of non-isolated infected individuals and on the duration of an infectious disease outside quarantined areas (i.e. implementing a dynamic zero-case policy) were analyzed numerically and theoretically. These analyses revealed that to minimize the maximum number of non-isolated infected individuals, the optimal time to initiate SPCIs is when they can control the peak value of a second rebound of the epidemic to be equal to the first peak value. More individuals may be infected at the peak of the second wave with a stronger intervention during SPCIs. The longer the duration of the intervention and the stronger the contact tracing intensity during SPCIs, the more effective they are in shortening the duration of an infectious disease outside quarantined areas. The dynamic evolution of the number of isolated and non-isolated individuals, including two peaks and long tail patterns, have been confirmed by various real data sets of multiple-wave COVID-19 epidemics in China. Our results provide important theoretical support for the adjustment of NPI strategies in relation to a given carrying capacity of medical resources.

How individuals' opinions influence society's resistance to epidemics: an agent-based model approach

BACKGROUND

Protecting public health from infectious diseases often relies on the cooperation of citizens, especially when self-care interventions are the only viable tools for disease mitigation. Accordingly, social aspects related to public opinion have been studied in the context of the recent COVID-19 pandemic. However, a comprehensive understanding of the effects of opinion-related factors on disease spread still requires further exploration.

METHODS

We propose an agent-based simulation framework incorporating opinion dynamics within an epidemic model based on the assumption that mass media channels play a leading role in opinion dynamics. The model simulates how opinions about preventive interventions change over time and how these changes affect the cumulative number of cases. We calibrated our simulation model using YouGov survey data and WHO COVID-19 new cases data from 15 different countries. Based on the calibrated models, we examine how different opinion-related factors change the consequences of the epidemic. We track the number of total new infections for analysis.

RESULTS

Our results reveal that the initial level of public opinion on preventive interventions has the greatest impact on the cumulative number of cases. Its normalized permutation importance varies between 69.67% and 96.65% in 15 models. The patterns shown in the partial dependence plots indicate that other factors, such as the usage of the pro-intervention channel and the response time of media channels, can also bring about substantial changes in disease dynamics, but only within specific ranges of the dominant factor.

CONCLUSIONS

Our results reveal the importance of public opinion on intervention during the early stage of the pandemic in protecting public health. The findings suggest that persuading the public to take actions they may be hesitant about in the early stages of epidemics is very costly because taking early action is critical for mitigating infectious diseases. Other opinion-related factors can also lead to significant changes in epidemics, depending on the average level of public opinion in the initial stage. These findings underscore the importance of media channels and authorities in delivering accurate information and persuading community members to cooperate with public health policies.

Evaluating the Effectiveness of Public Health Measures During Infectious Disease Outbreaks: A Systematic Review

Over the previous three decades, the incidence of infectious disease outbreaks has considerably increased and the trend is expected to increase further. Public health measures are essential for controlling and preventing emerging outbreaks of infectious illnesses. This study is aimed at evaluating the effectiveness of public health measures during infectious disease outbreaks by summarizing the outcomes from the available evidence in the literature. A systematic review was carried out through a detailed search strategy using specific keywords applied across different electronic databases, including the Science Direct, PubMed, and EMBASE databases. Studies published between 2015 and 2024 were included with a focus on cohorts, clinical trials, longitudinal studies, case-control, and quasi-experimental studies. Low-quality studies and those published before 2015 along with incorrect findings or measures were excluded. A standardized form was used for data extraction. The quality of included studies and the risk of bias were assessed through relevant techniques. The obtained data was narrative synthesized and findings were organized systematically. The reviewed studies revealed that public health measures are considerably effective against infectious disease outbreaks. The success of various measures such as social isolation, confinement measures, and public education on hygiene against different outbreaks of respiratory infectious diseases has been well-established in the literature. Moreover, the timing of intervention application plays a vital role in their success. The implementation in the early phase of an outbreak is highly effective, as it protects more people from infection and controls the overall burden of the disease. The systematic review provided valuable insights into the efficiency of public health measures in monitoring outbreaks of infectious illnesses. The main findings suggest that appropriate public health interventions are effective in controlling the incidence of contagious disease outbreaks. Ongoing research strives to investigate measures that are most effective from the perspective of public health against various transmittable diseases to prevent future outbreaks.

Using the Health Belief Model to assess COVID-19 perceptions and behaviours among a group of Egyptian adults: a cross-sectional study

BACKGROUND

It is crucial to study the public's perceptions and behaviour during a pandemic as this will be the driving force for practicing recommended precautions. The current study aimed to identify perceptions of a group of Egyptian adults to COVID-19 using the Health Belief Model (HBM), to measure self-reported practice of preventive behaviours and to identify influencing factors.

METHODS

Cross sectional study was used, including Egyptian adults aged 18 + years. A structured anonymous online questionnaire was used including: a demographic section, the modified MERS- CoV Health Belief Model scale after addition of questions related to COVID-19 and questions on preventive behaviours to COVID-19.

RESULTS

Of the 532 study participants, 28.6% were males, age ranges (18 to 74 years). There was a statistically significant positive correlation between total practice score and all COVID-19 Health Belief Model constructs total scores except for perceived barriers score showing negative correlation (P value < 0.05). Linear regression analysis showed that older age, male gender and living inside Cairo were associated with lower practice score (P value < 0.01).

CONCLUSIONS

Increased perceived susceptibility, perceived benefits, cues to action and perceived self-efficacy scores were associated with higher practice score in the current study. Additionally, results revealed that social media and websites can play an important role in shaping risk perception in the community. Stressing risk perception and efficacy beliefs prevention message can drive people to practice preventive behaviors.

Effects of non-compulsory and mandatory COVID-19 interventions on travel distance and time away from home, Norway, 2021

BackgroundGiven the societal, economic and health costs of COVID-19 non-pharmaceutical interventions (NPI), it is important to assess their effects. Human mobility serves as a surrogate measure for human contacts and compliance with NPI. In Nordic countries, NPI have mostly been advised and sometimes made mandatory. It is unclear if making NPI mandatory further reduced mobility.AimWe investigated the effect of non-compulsory and follow-up mandatory measures in major cities and rural regions on human mobility in Norway. We identified NPI categories that most affected mobility.MethodsWe used mobile phone mobility data from the largest Norwegian operator. We analysed non-compulsory and mandatory measures with before-after and synthetic difference-in-differences approaches. By regression, we investigated the impact of different NPI on mobility.ResultsNationally and in less populated regions, time travelled, but not distance, decreased after follow-up mandatory measures. In urban areas, however, distance decreased after follow-up mandates, and the reduction exceeded the decrease after initial non-compulsory measures. Stricter metre rules, gyms reopening, and restaurants and shops reopening were significantly associated with changes in mobility.ConclusionOverall, distance travelled from home decreased after non-compulsory measures, and in urban areas, distance further decreased after follow-up mandates. Time travelled reduced more after mandates than after non-compulsory measures for all regions and interventions. Stricter distancing and reopening of gyms, restaurants and shops were associated with changes in mobility.

Response to COVID-19 recommended preventive behavioral messages among Guraghe zone communities, South Ethiopia: using constructs of the Extended Parallel Process Model (EPPM)

INTRODUCTION

The World Health Organization declared COVID-19 is a pandemic disease. Countries should take standard measures and responses to battle the effects of the viruses. However, little is known in Ethiopia regarding the recommended preventive behavioral messages responses. Therefore, the study aimed to assess the response to COVID-19 recommended preventive behavioral messages.

METHODS

Community-based cross-sectional study design was carried out from 1 to 20, July 2020. We recruited 634 respondents by using a systematic sampling method. Data were analyzed using Statistical Package Software for Social Sciences version 23. Association between variables were explored using a bivariable and multi variable logistic regression model. The strength of the association is presented using odds ratio and regression coefficient with 95% confidence interval. A p-value of less than 0.05 was declared statistically significant.

RESULTS

Three hundred thirty-six (53.1%) of respondents had good response to recommended preventive behavioral messages. The general precise rate of the knowledge questionnaire was 92.21%. The study showed that merchant was 1.86 (p ≈ 0.01) times more likely respond to COVID-19 recommended preventive behavioral messages than government-employed. Respondents who scored one unit increase for self-efficacy and response-efficacy, the odds of responding to COVID-19 recommended preventive behavioral messages were increased by 1.22 (p < 0.001), and 1.05 times (p = 0.002) respectively. Respondents who scored one unit increase to cues to action, the odds of responding to COVID-19 recommended preventive behavioral messages were 43% (p < 0.001) less likely.

CONCLUSION

Even though respondents were highly knowledgeable about COVID-19, there is a lower level of applying response to recommended preventive behavioral messages. Merchant, self-efficacy, response efficacy, and cues to action were significantly associated with response to recommended preventive behavioral messages. Like merchants, government employer should be applying preventive behavioral messages and also, participants' self and response efficacy should be strengthened to improve the response. In addition, we should be changed or modified the way how-to deliver relevant information, promoting awareness, and also using appropriate reminder systems to preventive behavioral messages.

An Old Acquaintance: Could Adenoviruses Be Our Next Pandemic Threat?

Human adenoviruses (HAdV) are one of the most important pathogens detected in acute respiratory diseases in pediatrics and immunocompromised patients. In 1953, Wallace Rowe described it for the first time in oropharyngeal lymphatic tissue. To date, more than 110 types of HAdV have been described, with different cellular tropisms. They can cause respiratory and gastrointestinal symptoms, even urinary tract inflammation, although most infections are asymptomatic. However, there is a population at risk that can develop serious and even lethal conditions. These viruses have a double-stranded DNA genome, 25-48 kbp, 90 nm in diameter, without a mantle, are stable in the environment, and resistant to fat-soluble detergents. Currently the diagnosis is made with lateral flow immunochromatography or molecular biology through a polymerase chain reaction. This review aimed to highlight the HAdV variability and the pandemic potential that a HAdV3 and 7 recombinant could have considering the aggressive outbreaks produced in health facilities. Herein, we described the characteristics of HAdV, from the infection to treatment, vaccine development, and the evaluation of the social determinants of health associated with HAdV, suggesting the necessary measures for future sanitary control to prevent disasters such as the SARS-CoV-2 pandemic, with an emphasis on the use of recombinant AdV vaccines to control other potential pandemics.

Americans' Trust in COVID-19 Information from Governmental Sources in the Trump Era: Individuals' Adoption of Preventive Measures, and Health Implications

This study analyzes differences among Americans in their trust in COVID-19 information from governmental sources and how trust is associated with personal adoption of preventative measures under the Trump administration. Based on our analysis of data from a nationally representative survey conducted in October 2020 (effective sample size after weighting = 2615), we find that Americans in general have more trust in COVID-19 information from state/local governments than from the federal government. Variables such as age, party affiliation, religiosity, and race are significantly associated with Americans' trust or lack of trust in COVID-19 information from governmental sources. During the study period, Republicans had more trust in the federal government as a COVID-19 information source than Democrats did, while Democrats had more trust in state/local governments. African Americans had the least trust in the federal and state/local governments as COVID-19 information sources, while Asian Americans had the most trust in both institutions. Trust in the state/local governments as COVID-19 information sources was positively associated with physical distancing and mask-wearing while trust in the federal government as a COVID-19 information source was negatively associated with physical distancing and mask-wearing, suggesting the distinctive roles that state/local governments and the federal government played in mobilizing Americans to adopt preventive measures.

Lockdown measures during the COVID-19 pandemic strongly impacted the circulation of respiratory pathogens in Southern China

A range of public health measures have been implemented to suppress local transmission of coronavirus disease 2019 (COVID-19) in Shenzhen. We examined the effect of these measures on the prevalence of respiratory pathogens in children. Clinical and respiratory pathogen data were collected for routine care from hospitalized children with acute respiratory infections in Shenzhen Children's Hospital from July 2018 to January 2022. Nasopharyngeal swabs were collected and respiratory pathogens were detected using standardized clinical diagnostics as part of routine care. Data were analyzed to describe the effects of COVID-19 prevention procedures on other common pathogens. A total of 56,325 children under 14 years of age were hospitalized with an acute respiratory infection during the study period, 33,909 were tested from July 2018 to January 2020 (pre-lockdown), 1168 from February 2020 to May 2020 (lockdown) and 21,248 from July 2020 to January 2022 (post-lockdown). We observed a 37.3% decline of routine care in respiratory infection associated hospital admission in the 19 months' post-lockdown vs. the 19 months' pre-lockdown. There were 99.4%, 16.0% and 1.26% reductions measured for Mycoplasma pneumoniae, influenza virus A and adenovirus, respectively. However, a 118.7% and 75.8% rise was found for respiratory syncytial virus (RSV) and human para-influenza virus (HPIV) during the 19 months' post-lockdown in comparison to the pre-pandemic period. The detection of RSV especially increased in toddlers after the lockdown. Lockdown measures during the COVID-19 pandemic led to a significant reduction of Mycoplasma pneumoniae, influenza virus A and adenovirus infection. In contrast, RSV and HPIV infection increased.

Evidence in decision-making in the context of COVID-19 in Latin America

Background

The pace of the COVID-19 pandemic poses an unprecedented challenge to the evidence-to-decision process. Latin American countries have responded to COVID-19 by introducing interventions to both mitigate the risk of infection and to treat cases. Understanding how evidence is used to inform government-level decision-making at a national scale is crucial for informing country and regional actors in ongoing response efforts.

Objectives

This study was undertaken between February-May 2021 and aims to characterise the best available evidence (BAE) and assess the extent to which it was used to inform decision-making in 21 Latin American countries, in relation to pharmaceutical (PI) and non-pharmaceutical interventions (NPI) related to COVID-19, including the use of therapeutics (corticosteroids, hydroxychloroquine/chloroquine and ivermectin), facemask use in the community setting and the use of diagnostic tests as a requirement for international travel.

Method

A three-phase methodology was used to; (i) characterise the BAE for each intervention using an umbrella review, (ii) identify government-level decisions for each intervention through a document review and (iii) assess the use of evidence to inform decisions using a novel adapted framework analysis.

Findings

The BAE is characterized by 17 living and non-living systematic reviews as evolving, and particularly uncertain for NPIs. 107 country-level documents show variation in both content and timing of decision outcomes across intervention types, with the majority of decisions taken at a time of evidence uncertainty, with only 5 documents including BAE. Seven out of eight key indicators of an evidence-to-decision process were identified more frequently among PIs than either NPI of facemask use or testing prior to travel. Overall evidence use was reported more frequently among PIs than either NPI of facemask use or travel testing (92%, 28% and 29%, respectively).

Interpretation

There are limitations in the extent to which evidence use in decision-making is reported across the Latin America region. Institutionalising this process and grounding it in existing and emerging methodologies can facilitate the rapid response in an emergency setting.

Funding

No funding was sourced for this work.

Adherence to and enforcement of non-pharmaceutical interventions (NPIs) for COVID-19 prevention in Nigeria, Rwanda, and Zambia: A mixed-methods analysis

INTRODUCTION

In the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, including in sub-Saharan Africa, to prevent and control SARS-CoV-2 transmission. This mixed-methods study examines adherence to and enforcement of NPIs implemented to curb COVID-19 in Nigeria, Rwanda, and Zambia, leading up to the 10,000th case of laboratory-confirmed COVID-19 in each country. Additionally, we aim to evaluate the relationship between levels and changes of NPIs over time and changes in COVID-19 cases and deaths.

METHODS

This mixed-methods analysis utilized semi-structured interviews and a quantitative dataset constructed using multiple open data sources, including the Oxford COVID-19 Government Response Tracker. To understand potential barriers and facilitators in implementing and enforcing NPIs qualitative data were collected from those involved in the COVID-19 response and analyzed using NVivo. Quantitative results were analyzed using descriptive statistics, plots, ANOVA, and post hoc Tukey.

RESULTS

Individual indicator scores varied with the COVID-19 response in all three countries. Nigeria had sustained levels of strict measures for containment and closure NPIs, while in Rwanda there was substantial variation in NPI score as it transitioned through the different case windows for the same measures. Zambia implemented moderate stringency throughout the pandemic using gathering restrictions and business/school closure measures but maintained low levels of strictness for other containment and closure measures. Rwanda had far more consistent and stringent measures compared to Nigeria and Zambia. Rwanda's success in implementing COVID-related measures was partly due to strong enforcement and having a population that generally follow the recommendations of their government.

CONCLUSION

Various forces either facilitated or hindered adherence and compliance to COVID-19 control measures. The lessons learned and recommendations gleaned through interviews with experts involved in the COVID-19 pandemic and quantitative analysis of NPI implementation can be applied to future outbreaks, epidemics, and pandemics. Recommendations include engaging communities, using a risk-based approach to implement containment and closure NPIs, and providing social and economic support to citizens during periods of lockdowns and other measures that interrupt the ability to make a living.

Aggressive measures, rising inequalities, and mass formation during the COVID-19 crisis: An overview and proposed way forward

A series of aggressive restrictive measures were adopted around the world in 2020-2022 to attempt to prevent SARS-CoV-2 from spreading. However, it has become increasingly clear the most aggressive (lockdown) response strategies may involve negative side-effects such as a steep increase in poverty, hunger, and inequalities. Several economic, educational, and health repercussions have fallen disproportionately on children, students, young workers, and especially on groups with pre-existing inequalities such as low-income families, ethnic minorities, and women. This has led to a vicious cycle of rising inequalities and health issues. For example, educational and financial security decreased along with rising unemployment and loss of life purpose. Domestic violence surged due to dysfunctional families being forced to spend more time with each other. In the current narrative and scoping review, we describe macro-dynamics that are taking place because of aggressive public health policies and psychological tactics to influence public behavior, such as mass formation and crowd behavior. Coupled with the effect of inequalities, we describe how these factors can interact toward aggravating ripple effects. In light of evidence regarding the health, economic and social costs, that likely far outweigh potential benefits, the authors suggest that, first, where applicable, aggressive lockdown policies should be reversed and their re-adoption in the future should be avoided. If measures are needed, these should be non-disruptive. Second, it is important to assess dispassionately the damage done by aggressive measures and offer ways to alleviate the burden and long-term effects. Third, the structures in place that have led to counterproductive policies should be assessed and ways should be sought to optimize decision-making, such as counteracting groupthink and increasing the level of reflexivity. Finally, a package of scalable positive psychology interventions is suggested to counteract the damage done and improve humanity's prospects.

Unintended beneficial effects of COVID-19 on influenza-associated emergency department use in Korea

BACKGROUND

Non-pharmaceutical interventions, including hand hygiene, wearing masks, and cough etiquette, and public health measures such as social distancing, used to prevent the spread of coronavirus disease 2019 (COVID-19), could reduce the incidence rate of respiratory viral infections such as influenza. We evaluated the effect of COVID-19 on the incidence of influenza in Korea.

METHODS

This retrospective study included all patients who visited five urban emergency departments (EDs) during the influenza epidemic seasons of 2017-18, 2018-19, and 2019-20. Influenza was defined as ICD-10 codes J09, J10, and J11, determined from ED discharge records. The weekly incidence rates of influenza per 1000 ED visits during the 2019-20 season, when COVID-19 became a pandemic, were compared with those of 2017-18 and 2018-19. The actual incidence rate of the 2019-20 season was compared with the predicted value using a generalized estimation equation model based on 2017-18 and 2018-19 data.

RESULTS

The weekly influenza incidence rate decreased from 101.6 to 56.6 between week 4 and week 5 in 2020 when the first COVID-19 patient was diagnosed and public health measures were implemented. The weekly incidence rate during week 10 and week 22 of the 2019-20 season decreased most steeply compared to 2017-18 and 2018-19. The actual influenza incidence rate observed in the 2019-20 season was lower than the rate predicted in the 2017-18 and 2018-19 seasons starting from week 7 when a COVID-19 outbreak occurred in Korea.

CONCLUSIONS

The implementation of non-pharmaceutical interventions and public health measures for the COVID-19 epidemic effectively reduced the transmission of influenza and associated ED use in Korea. Implementing appropriate public health measures could reduce outbreaks and lessen the burden of influenza during future influenza epidemics.

Analytical estimation of maximum fraction of infected individuals with one-shot non-pharmaceutical intervention in a hybrid epidemic model

BACKGROUND

Facing a global epidemic of new infectious diseases such as COVID-19, non-pharmaceutical interventions (NPIs), which reduce transmission rates without medical actions, are being implemented around the world to mitigate spreads. One of the problems in assessing the effects of NPIs is that different NPIs have been implemented at different times based on the situation of each country; therefore, few assumptions can be shared about how the introduction of policies affects the patient population. Mathematical models can contribute to further understanding these phenomena by obtaining analytical solutions as well as numerical simulations.

METHODS AND RESULTS

In this study, an NPI was introduced into the SIR model for a conceptual study of infectious diseases under the condition that the transmission rate was reduced to a fixed value only once within a finite time duration, and its effect was analyzed numerically and theoretically. It was analytically shown that the maximum fraction of infected individuals and the final size could be larger if the intervention starts too early. The analytical results also suggested that more individuals may be infected at the peak of the second wave with a stronger intervention.

CONCLUSIONS

This study provides quantitative relationship between the strength of a one-shot intervention and the reduction in the number of patients with no approximation. This suggests the importance of the strength and time of NPIs, although detailed studies are necessary for the implementation of NPIs in complicated real-world environments as the model used in this study is based on various simplifications.

The Role of Social Media in Public Forest Management Policies during COVID-19: Implications for Stakeholder Engagement

Social networks have become increasingly popular lately, being a complementary method of expression and communication. With the adoption of quarantine and social distancing imposed by the authorities as measures to limit the spread of the COVID-19 pandemic, society has used the opportunity offered by digital technology to continue its concern related to the protection and conservation of the environment, especially the forest. The purpose of this study was to highlight the public interest regarding the forests in the context of COVID-19, especially the extent to which public opinion expressed on social networks has determined public forest management policies. The results revealed a major interest in preserving biodiversity and forestry, in reducing legal logging and stopping illegal logging, and monitoring of timber shipments as measures to combat illegal logging. During the analyzed period (i.e., 1 February 2020 to 31 July 2020), several legislative acts were adopted that overlap with the requests and needs identified by environmental organizations, acts that address the issue of illegal logging, conservation, and protection of the forest, monitoring the traceability of wood. The legislation adopted in the analyzed timeframe and shortly after responded to several major topics related to the licensing and withdrawal of the logging license for illegal logging, amending the legislation for the conservation of biodiversity and the classification of areas with virgin forests as strictly protected forests. An IT system has also been implemented by the government environmental authority that allows the supervision of timber transport, offering the possibility of active involvement of civil society.

Effectiveness of Mask-Wearing on Respiratory Illness Transmission in Community Settings: A Rapid Review

OBJECTIVE

Respiratory illnesses, including coronavirus disease 2019 (COVID-19), have resulted in millions of deaths globally. Guidance on mask-wearing in community settings has been inconsistent. This review examined the effectiveness of mask-wearing on respiratory virus transmission in community settings.

METHODS

A search was conducted for English language reports of randomized controlled trials of mask-wearing in the community and effect on laboratory-confirmed respiratory infections or influenza-like illness. Investigators abstracted study characteristics and assessed bias. Meta-analysis was conducted to calculate pooled risk estimates.

RESULTS

Eleven studies were included. In 7 studies that evaluated influenza-like illness symptoms as an outcome (3029 participants), this study found mask-wearing associated with a decreased risk of influenza-like illness (overall risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.96). Studies examining laboratory-confirmed respiratory infections as an outcome (10,531 participants) showed no statistically significant association between mask-wearing and infections (RR, 1.04; 95% CI, 0.60-1.80). However, masking combined with enhanced hand hygiene was associated with a decreased risk for both influenza-like illness symptoms (RR, 0.88; 95% CI, 0.51-1.51) and laboratory-confirmed respiratory infection (RR, 0.79; 95% CI, 0.52-1.18).

CONCLUSIONS

Masking in community settings decreases transmission of influenza-like illness. Mask-wearing combined with enhanced hand hygiene reduces transmission of influenza-like illness and laboratory-confirmed respiratory infection.

Taiwan's Response to Influenza: A Seroepidemiological Evaluation of Policies and Implications for Pandemic Preparedness

OBJECTIVES

To evaluate class suspension and mass vaccination implemented among Taipei schoolchildren during the 2009 influenza pandemic and investigate factors affecting antibody responses.

METHODS

We conducted 2 cohort studies on: (1) 972 schoolchildren from November 2009-March 2010 to evaluate pandemic policies and (2) 935 schoolchildren from November 2011-March 2012 to verify factors in antibody waning. Anti-influenza H1N1pdm09 hemagglutination inhibition antibodies (HI-Ab) were measured from serum samples collected before vaccination, and at 1 and 4 months after vaccination. Factors affecting HI-Ab responses were investigated through logistic regression and generalized estimating equation.

RESULTS

Seroprevalence of H1N1pdm09 before vaccination was significantly higher among schoolchildren who experienced class suspensions than those who did not (59.6% vs 47.5%, p<0.05). Participating in after-school activities (adjusted odds ratio [aOR]=2.47, p=0.047) and having ≥3 hours per week of exercise (aOR=2.86, p=0.019) were significantly correlated with H1N1pdm09 infection. Two doses of the H1N1pdm09 vaccine demonstrated significantly better antibody persistence than 1 dose (HI-Ab geometric mean titer: 132.5 vs 88.6, p=0.047). Vaccine effectiveness after controlling for preexisting immunity was 86% (32%-97%). Exercise ≥3 hours per week and preexisting immunity were significantly associated with antibody waning/maintenance.

CONCLUSIONS

This study is the first to show that exercise and preexisting immunity may affect antibody waning. Further investigation is needed to identify immune correlates of protection.

Downstream health impacts of employment losses during the COVID-19 pandemic

OBJECTIVES

The Canadian workforce has experienced significant employment losses during the COVID-19 pandemic, in part as a result of non-pharmaceutical interventions to slow COVID-19 transmission. Health consequences are likely to result from these job losses, but without historical precedent for the current economic shutdown they are challenging to plan for. Our study aimed to use population risk models to quantify potential downstream health impacts of the COVID-19 pandemic and inform public health planning to minimize future health burden.

METHODS

The impact of COVID-19 job losses on future premature mortality and high-resource health care utilization (HRU) was estimated using an economic model of Canadian COVID-19 lockdowns and validated population risk models. Five-year excess premature mortality and HRU were estimated by age and sex to describe employment-related health consequences of COVID-19 lockdowns in the Canadian population.

RESULTS

With federal income supplementation like the Canadian Emergency Response Benefit, we estimate that each month of economic lockdown will result in 5.6 new high-resource health care system users (HRUs), and 4.1 excess premature deaths, per 100,000, over the next 5 years. These effects were concentrated in ages 45-64, and among males 18-34. Without income supplementation, the health consequences were approximately twice as great in terms of both HRUs and premature deaths.

CONCLUSION

Employment losses associated with COVID-19 countermeasures may have downstream implications for health. Public health responses should consider financially vulnerable populations at high risk of downstream health outcomes.

Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review

Background

Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements.

Methods

We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality.

Results

Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness.

Conclusions

Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-00935-7.

Wastewater Surveillance for SARS-CoV-2 RNA in Canada

Wastewater surveillance for SARS-CoV-2 RNA is a relatively recent adaptation of long-standing wastewater surveillance for infectious and other harmful agents. Individuals infected with COVID-19 were found to shed SARS-CoV-2 in their faeces. Researchers around the world confirmed that SARS-CoV-2 RNA fragments could be detected and quantified in community wastewater. Canadian academic researchers, largely as volunteer initiatives, reported proof-of-concept by April 2020. National collaboration was initially facilitated by the Canadian Water Network.

Many public health officials were initially skeptical about actionable information being provided by wastewater surveillance even though experience has shown that public health surveillance for a pandemic has no single, perfect approach. Rather, different approaches provide different insights, each with its own strengths and limitations. Public health science must triangulate among different forms of evidence to maximize understanding of what is happening or may be expected. Well-conceived, resourced, and implemented wastewater-based platforms can provide a cost-effective approach to support other conventional lines of evidence. Sustaining wastewater monitoring platforms for future surveillance of other disease targets and health states is a challenge. Canada can benefit from taking lessons learned from the COVID-19 pandemic to develop forward-looking interpretive frameworks and capacity to implement, adapt, and expand such public health surveillance capabilities.

The SARS-CoV-2 Pandemic in High Income Countries Such as Canada: A Better Way Forward Without Lockdowns

The SARS-CoV-2 pandemic has caused tragic morbidity and mortality. In attempt to reduce this morbidity and mortality, most countries implemented population-wide lockdowns. Here we show that the lockdowns were based on several flawed assumptions, including "no one is protected until everyone is protected," "lockdowns are highly effective to reduce transmission," "lockdowns have a favorable cost-benefit balance," and "lockdowns are the only effective option." Focusing on the latter, we discuss that Emergency Management principles provide a better way forward to manage the public emergency of the pandemic. Specifically, there are three priorities including the following: first, protect those most at risk by separating them from the threat (mitigation); second, ensure critical infrastructure is ready for people who get sick (preparation and response); and third, shift the response from fear to confidence (recovery). We argue that, based on Emergency Management principles, the age-dependent risk from SARS-CoV-2, the minimal (at best) efficacy of lockdowns, and the terrible cost-benefit trade-offs of lockdowns, we need to reset the pandemic response. We can manage risk and save more lives from both COVID-19 and lockdowns, thus achieving far better outcomes in both the short- and long-term.

Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis

OBJECTIVE

To review the evidence on the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline, Embase, CINAHL, Biosis, Joanna Briggs, Global Health, and World Health Organization COVID-19 database (preprints).

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Observational and interventional studies that assessed the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality.

MAIN OUTCOME MEASURES

The main outcome measure was incidence of covid-19. Secondary outcomes included SARS-CoV-2 transmission and covid-19 mortality.

DATA SYNTHESIS

DerSimonian Laird random effects meta-analysis was performed to investigate the effect of mask wearing, handwashing, and physical distancing measures on incidence of covid-19. Pooled effect estimates with corresponding 95% confidence intervals were computed, and heterogeneity among studies was assessed using Cochran's Q test and the I2 metrics, with two tailed P values.

RESULTS

72 studies met the inclusion criteria, of which 35 evaluated individual public health measures and 37 assessed multiple public health measures as a "package of interventions." Eight of 35 studies were included in the meta-analysis, which indicated a reduction in incidence of covid-19 associated with handwashing (relative risk 0.47, 95% confidence interval 0.19 to 1.12, I2=12%), mask wearing (0.47, 0.29 to 0.75, I2=84%), and physical distancing (0.75, 0.59 to 0.95, I2=87%). Owing to heterogeneity of the studies, meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces. The effects of these interventions were synthesised descriptively.

CONCLUSIONS

This systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020178692.

Have the Diagnoses of Patients Transported by Ambulances Changed in the Early Stage of the COVID-19 Pandemic?

Introduction:

Since December 2019, emergency services and Emergency Medical Service (EMS) systems have been at the forefront of the fight against the coronavirus disease 2019 (COVID-19) pandemic world-wide.

Objective:

The objective of this study was to examine the reasons and the necessity of transportation to the emergency department (ED) by ambulance and the outcomes of these cases with the admissions during the COVID-19 pandemic period and during the same period in 2019.

Methods:

A retrospective descriptive study was conducted in which patients transported to the ED by ambulance in April 2019 and April 2020 were compared. The primary outcomes were the changes in the number and diagnoses of patients who were transferred to the ED by ambulance during the COVID-19 period. The secondary outcome was the need for patients to be transferred to the hospital by ambulance.

Results:

A total of 4,466 patients were included in the study. During the COVID-19 period, there was a 41.6% decrease in ED visits and a 31.5% decrease in ambulance calls. The number of critically ill patients transported by ambulance (with diagnoses such as decompensated heart failure [P <.001], chronic obstructive pulmonary disease [COPD] attack (P = .001), renal failure [acute-chronic; P = .008], angina pectoris [P <.001], and syncope [P <.001]) decreased statistically significantly in 2020. Despite this decrease in critical patient calls, non-emergency patient calls continued and 52.2% of the patients transported by ambulance in 2020 were discharged from the ED.

Conclusions:

Understanding how the COVID-19 pandemic is affecting EMS use is important for evaluating the current state of emergency health care and planning to manage possible future outbreaks.

Unmasking the mask studies: why the effectiveness of surgical masks in preventing respiratory infections has been underestimated

BACKGROUND

Pre-pandemic empirical studies have produced mixed statistical results on the effectiveness of masks against respiratory viruses, leading to confusion that may have contributed to organizations such as the WHO and CDC initially not recommending that the general public wear masks during the coronavirus disease 2019 pandemic.

METHODS

A threshold-based dose-response curve framework is used to analyse the effects of interventions on infection probabilities for both single and repeated exposure events. Empirical studies on mask effectiveness are evaluated with a statistical power analysis that includes the effect of adherence to mask usage protocols.

RESULTS

When the adherence to mask usage guidelines is taken into account, the empirical evidence indicates that masks prevent disease transmission: all studies we analysed that did not find surgical masks to be effective were under-powered to such an extent that even if masks were 100% effective, the studies in question would still have been unlikely to find a statistically significant effect. We also provide a framework for understanding the effect of masks on the probability of infection for single and repeated exposures. The framework demonstrates that masks can have a disproportionately large protective effect and that more frequently wearing a mask provides super-linearly compounding protection.

CONCLUSIONS

This work shows (1) that both theoretical and empirical evidence is consistent with masks protecting against respiratory infections and (2) that non-linear effects and statistical considerations regarding the percentage of exposures for which masks are worn must be taken into account when designing empirical studies and interpreting their results.

Non-Pharmaceutical Interventions and COVID-19 Burden in the United States

BACKGROUND

Non-pharmaceutical interventions (NPIs) are mitigation strategies used to reduce the spread of transmissible diseases. The relative effectiveness of specific NPIs remains uncertain.

METHODS

We used state-level Coronavirus disease 2019 (COVID-19) case and mortality data between January 19, 2020 and March 7, 2021 to model NPI policy effectiveness. Empirically derived breakpoints in case and mortality velocities were used to identify periods of stable, decreasing, or increasing COVID-19 burden. The associations between NPI adoption and subsequent decreases in case or death velocities were estimated using generalized linear models accounting for weekly variability shared across states. State-level NPI policies included: stay at home order, indoor public gathering ban (mild >10 or severe ≤10), indoor restaurant dining ban, and public mask mandate.

RESULTS

28,602,830 cases and 511,899 deaths were recorded. The odds of a decrease in COVID-19 case velocity were significantly elevated for stay at home (OR 2.02, 95% CI 1.63-2.52), indoor dining ban (OR 1.62, 95% CI 1.25-2.10), public mask mandate (OR 2.18, 95% CI 1.47-3.23), and severe gathering ban (OR 1.68, 95% CI 1.31-2.16). In mutually adjusted models, odds remained elevated for stay at home (AOR 1.47, 95% CI 1.04-2.07) and public mask mandate (AOR = 2.27, 95% CI 1.51-3.41). Stay at home (OR 2.00, 95% CI 1.53-2.62; AOR 1.89, 95% CI 1.25-2.87) was also associated with greater likelihood of decrease in death velocity in unadjusted and adjusted models.

CONCLUSIONS

NPIs employed in the U.S. during the COVID-19 pandemic, most significantly stay at home orders, were associated with decreased COVID-19 burden.

Preventive effects of tea and tea catechins against influenza and acute upper respiratory tract infections: a systematic review and meta-analysis

Purpose

Gargling with tea has protective effects against influenza infection and upper respiratory tract infection (URTI). To evaluate if tea and tea catechin consumption has the same protective effects as gargling with tea, we performed a systematic review and meta-analysis.

Methods

We performed a comprehensive literature search using the PubMed, Cochrane Library, Web of Science, and Ichu-shi Web databases. The search provided six randomized controlled trials (RCTs) and four prospective cohort studies (n = 3748). The quality of each trial or study was evaluated according to the Cochrane risk-of-bias tool or Newcastle–Ottawa Scale. We collected data from publications meeting the search criteria and conducted a meta-analysis of the effect of tea gargling and tea catechin consumption for preventing URTI using a random effects model.

Results

Tea gargling and tea catechin consumption had significant preventive effects against URTI (risk ratio [RR] = 0.74, 95% confidence interval [CI] 0.64–0.87). In sub-analyses, a significant preventive effect was observed by study type (prospective cohort study: RR = 0.67, 95% CI 0.50–0.91; RCT: RR = 0.79, 95% CI 0.66–0.94) and disease type (influenza: RR = 0.69, 95% CI 0.58–0.84; acute URTI: RR = 0.78, 95% CI 0.62–0.98). Both gargling with tea and consuming tea catechins effectively protected against URTI (tea and tea catechins consumption: RR = 0.68, 95% CI 0.52–0.87; tea gargling: RR = 0.83, 95% CI 0.72–0.96).

Conclusion

Our findings suggest that tea gargling and tea catechin consumption may have preventive effects against influenza infection and URTI. The potential effectiveness of these actions as non-pharmaceutical interventions, however, requires further investigation.

A solution scan of societal options to reduce transmission and spread of respiratory viruses: SARS-CoV-2 as a case study

Societal biosecurity – measures built into everyday society to minimize risks from pests and diseases – is an important aspect of managing epidemics and pandemics. We aimed to identify societal options for reducing the transmission and spread of respiratory viruses. We used SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) as a case study to meet the immediate need to manage the COVID-19 pandemic and eventually transition to more normal societal conditions, and to catalog options for managing similar pandemics in the future. We used a ‘solution scanning’ approach. We read the literature; consulted psychology, public health, medical, and solution scanning experts; crowd-sourced options using social media; and collated comments on a preprint. Here, we present a list of 519 possible measures to reduce SARS-CoV-2 transmission and spread. We provide a long list of options for policymakers and businesses to consider when designing biosecurity plans to combat SARS-CoV-2 and similar pathogens in the future. We also developed an online application to help with this process. We encourage testing of actions, documentation of outcomes, revisions to the current list, and the addition of further options.

Efficacy of face masks against respiratory infectious diseases: a systematic review and network analysis of randomized-controlled trials

During the ongoing COVID-19 pandemic, face masks are among the most common and practical control measures used globally in reducing the risk of infection and disease transmission. Although several studies have investigated the efficacy of various face masks and respirators in preventing infection, the results have been inconsistent. Therefore, we performed a systematic review and network meta-analysis (NMA) of the randomized-controlled trials (RCTs) to assess the actual efficacy of face masks in preventing respiratory infections. We searched nine electronic databases up to July 2020 to find potential articles. We accepted trials reporting the protective efficacy of face masks against respiratory infections, of which the primary endpoint was the presence of respiratory infections. We used the ROB-2 Cochrane tool to grade the trial quality. We initially registered the protocol for this study in PROSPERO (CRD42020178516). Sixteen RCTs involving 17 048 individuals were included for NMA. Overall, evidence was weak, lacking statistical power due to the small number of participants, and there was substantial inconsistency in our findings. In comparison to those without face masks, participants with fit-tested N95 respirators were likely to have lesser infection risk (RR 0.67, 95% CI 0.38-1.19,P-score 0.80), followed by those with non-fit-tested N95 and non-fit-tested FFP2 respirators that shared the similar risk, (RR 0.73, 95% CI 0.12-4.36,P-score 0.63) and (RR 0.80, 95% CI 0.38-1.71,P-score 0.63), respectively. Next, participants who donned face masks with and without hand hygiene practices showed modest risk improvement alike (RR 0.89, 95% CI 0.67-1.17,P-score 0.55) and (RR 0.92, 95% CI 0.70-1.22,P-score 0.51). Otherwise, participants donning double-layered cloth masks were prone to infection (RR 4.80, 95% CI 1.42-16.27,P-score 0.01). Eleven out of 16 RCTs that underwent a pairwise meta-analysis revealed a substantially lower infection risk in those donning medical face masks (MFMs) than those without face masks (RR 0.83 95% CI 0.71-0.96). Given the body of evidence through a systematic review and meta-analyses, our findings supported the protective benefits of MFMs in reducing respiratory transmissions, and the universal mask-wearing should be applied-especially during the COVID-19 pandemic. More clinical data is required to conclude the efficiency of cloth masks; in the short term, users should not use cloth face masks in the outbreak hot spots and places where social distancing is impossible.

The impact of crisis and disasters risk management in COVID-19 times: Insights and lessons learned from Saudi Arabia

Background

All countries all over the world strive to fight the outbreak of COVID-19 pandemic and their governments are facing unprecedented strains and challenges. Since COVID-19 has engendered socioeconomic recession and the deterioration of health systems, Insights and lessons from some countries can illustrate various approaches designing their people-centric health and socioeconomic policies. The kingdom of Saudi Arabia has implemented various measures and strategies to mitigate the spread of pandemic and to save the lives of people. Therefore, we investigate the role of the Saudi disaster risk reduction system (DRRS) to fight the virus outbreak and provide a safe environment for the well-being of its inhabitants.

Methodology

We use a qualitative case study methodology to document and analyze the crisis and disasters risk management framework within the hazard management process. The case study methodology is suitable in investigating a phenomenon in its real-life settings and contexts. Thus, we outline lessons learned from Saudi disaster risk management experience in combating COVID-19 pandemic.

Results

During COVID-19 disaster, we found that the Saudi disaster risk reduction system (DRRS) is structured into three main levels: strategic, operational and tactical. The strategic level represents the strategic planning division and runs audit and monitoring of overall decentralized units of crisis management at operational and tactical levels. The findings show that there are three policy implications: keep vigilance at the public national level, remaining flexible in a national management structure and good governance at local administration level.

Conclusion

The application of disaster risk reduction framework in COVID-19 times requires the use of multi-level strategies to protect vulnerable peoples during the four stages of mitigation (readiness), preparedness, response (implementation) and recovery (post-COVID).

Health belief model and behavioural practice of urban poor towards COVID-19 in Nigeria

Poor adherence to promoting health behaviours is a significant challenge for prevention and management of infectious respiratory diseases. Non-pharmaceutical Interventions (NPIs) remain a proven behavioural practice for reducing the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently ravaging the world. Studies on Covid-19 have primarily focused on epidemiology, virology, and potential drug treatments to the neglect of behavioural practice of low-income settings. This study examines the extent health belief model predicts the behavior of 405 urban poor residents of Ogun State, which recorded the first index case in Nigeria, towards adoption Covid-19 NPIs. A cross-sectional study was conducted to find out the relationship between study participant characteristics, HBM constructs and unhealthy behavior. Study constructs were assessed on a four point Likert scale and were mean aggregated such that higher scores indicated stronger feelings about a construct. Findings shows that urban poor in the age group 30-40 years were more likely to feel susceptible to contracting Covid-19 (mean score: 2.59 and std. dev. 0.54), they also had a higher perception of the benefit of Covid-19 preventive behaviours than participants in other age groups (mean score: 2.95 and std. dev. 0.71). Also, the most prevalent unhealthy behaviour amongst urban poor residents was the indiscriminate use of facemasks as shown by almost half (47.6%) of participants who agreed that they use facemasks all the time even when alone. The study concludes that though urban poor residents feel threatened by Covid-19, nexus of factors such as low financial earnings, inadequate knowledge, and limited access to basic medical needs hamper the effective adoption of NPIs.

Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia

OBJECTIVES

To understand the impact of COVID-19 and public health measures on different social groups, we conducted a mixed-methods study in five countries ('SEBCOV-social, ethical and behavioural aspects of COVID-19'). Here, we report the results of the online survey.

STUDY DESIGN AND STATISTICAL ANALYSIS

Overall, 5058 respondents from Thailand, Malaysia, the UK, Italy and Slovenia completed the self-administered survey between May and June 2020. Poststratification weighting was applied, and associations between categorical variables assessed. Frequency counts and percentages were used to summarise categorical data. Associations between categorical variables were assessed using Pearson's χ2 test. Data were analysed in Stata 15.0 RESULTS: Among the five countries, Thai respondents reported having been most, and Slovenian respondents least, affected economically. The following factors were associated with greater negative economic impacts: being 18-24 years or 65 years or older; lower education levels; larger households; having children under 18 in the household and and having flexible/no income. Regarding social impact, respondents expressed most concern about their social life, physical health, mental health and well-being.There were large differences between countries in terms of voluntary behavioural change, and in compliance and agreement with COVID-19 restrictions. Overall, self-reported compliance was higher among respondents who self-reported a high understanding of COVID-19. UK respondents felt able to cope the longest and Thai respondents the shortest with only going out for essential needs or work. Many respondents reported seeing news perceived to be fake, the proportion varying between countries, with education level and self-reported levels of understanding of COVID-19.

CONCLUSIONS

Our data showed that COVID-19 and public health measures have uneven economic and social impacts on people from different countries and social groups. Understanding the factors associated with these impacts can help to inform future public health interventions and mitigate their negative consequences.

TRIAL REGISTRATION NUMBER

TCTR20200401002.

The effectiveness of mobility control, shortening of restaurants' opening hours, and working from home on control of COVID-19 spread in Japan

Since the first outbreak of COVID-19, various interventions have been implemented to prevent the global spread of the virus. Using an agent-based model that describes the attributes and mobility of the Japanese population, the present research evaluates the effectiveness of mobility control, shortening of restaurants' opening hours, and working from home. Results show that early and severe mobility control that restricts 90% of domestic travel decreases the peak cases by 40%, compared to no intervention implementation. Mobility control that only limits movement to and from highly populated regions is as effective as nationwide travel restrictions. Furthermore, shortening of restaurants’ opening hours is the most effective intervention in a state of emergency; it should be utilized even after the emergency. However, working from home has comparatively limited effects.

The hidden potential of call detail records in The Gambia

Aggregated data from mobile network operators (MNOs) can provide snapshots of population mobility patterns in real time, generating valuable insights when other more traditional data sources are unavailable or out-of-date. The COVID-19 pandemic has highlighted the value of remotely-collected, high-frequency, localized data in inferring the economic impact of shocks to inform decision-making. However, proper protocols must be put in place to ensure end-to-end user-confidentiality and compliance with international best practice. We demonstrate how to build such a data pipeline, channeling data from MNOs through the national regulator to the analytical users, who in turn produce policy-relevant insights. The aggregated indicators analyzed offer a detailed snapshot of the decrease in mobility and increased out-migration from urban to rural areas during the COVID-19 lockdown. Recommendations based on lessons learned from this process can inform engagements with other regulators in creating data pipelines to inform policy-making.

Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort

Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study.  Participants ( n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

An Examination of COVID-19 Mitigation Efficiency among 23 Countries

The purpose of this paper was to compare the relative efficiency of COVID-19 transmission mitigation among 23 selected countries, including 19 countries in the G20, two heavily infected countries (Iran and Spain), and two highly populous countries (Pakistan and Nigeria). The mitigation efficiency for each country was evaluated at each stage by using data envelopment analysis (DEA) tools and changes in mitigation efficiency were analyzed across stages. Pearson correlation tests were conducted between each change to examine the impact of efficiency ranks in the previous stage on subsequent stages. An indicator was developed to judge epidemic stability and was applied to practical cases involving lifting travel restrictions and restarting the economy in some countries. The results showed that Korea and Australia performed with the highest efficiency in preventing the diffusion of COVID-19 for the whole period covering 105 days since the first confirmed case, while the USA ranked at the bottom. China, Japan, Korea, and Australia were judged to have recovered from the attack of COVID-19 due to higher epidemic stability.

Containing pandemics through targeted testing of households

Background

While invasive social distancing measures have proven efficient to control the spread of pandemics failing wide-scale deployment of vaccines, they carry vast societal costs. The development of a diagnostic methodology for identifying COVID-19 infection through simple testing was a reality only a few weeks after the novel virus was officially announced. Thus, we were interested in exploring the ability of regular testing of non-symptomatic people to reduce cases and thereby offer a non-pharmaceutical tool for controlling the spread of a pandemic.

Methods

We developed a data-driven individual-based epidemiological network model in order to investigate epidemic countermeasures. This models is based on high-resolution demographic data for each municipality in Norway, and each person in the model is subject to Susceptible-Exposed-Infectious-Recovered (SEIR) dynamics. The model was calibrated against hospitalization data in Oslo, Norway, a city with a population of 700k which we have used as the simulations focus.

Results

Finding that large households function as hubs for the propagation of COVID-19, we assess the intervention efficiency of targeted pooled household testing (TPHT) repeatedly. For an outbreak with reproductive number R=1.4, we find that weekly TPHT of the 25% largest households brings R below unity. For the case of R=1.2, our results suggest that TPHT with the largest 25% of households every three days in an urban area is as effective as a lockdown in curbing the outbreak. Our investigations of different disease parameters suggest that these results are markedly improved for disease variants that more easily infect young people, and when compliance with self-isolation rules is less than perfect among suspected symptomatic cases. These results are quite robust to changes in the testing frequency, city size, and the household-size distribution. Our results are robust even with only 50% of households willing to participate in TPHT, provided the total number of tests stay unchanged.

Conclusions

Pooled and targeted household testing appears to be a powerful non-pharmaceutical alternative to more invasive social-distancing and lock-down measures as a localized early response to contain epidemic outbreaks.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12879-021-06256-8).

Impact of Nonpharmacological Public Health Interventions on Epidemiological Parameters of COVID-19 Pandemic in India

Background Public health interventions are epidemiologically sound and cost-effective methods to control disease burden. Non-pharmacological public health interventions are the only mode to control diseases in the absence of medication. Objective To find the impact of public health interventions on the epidemiological indicators of disease progression. Methods This is a secondary data analysis done on COVID-19 data. The median doubling time and R0 were calculated for a rolling period of seven days. Interventions were scored from zero to three with an increasing level of stringency. Multivariate linear regression was performed to find the role of individual interventions on R0 and the median doubling time. Results The highest intervention score was reported in the lockdown phase, which gradually decreased to the lowest level of 22. The R0 values settled to a level of 1.25, and the median doubling time increased to 20 days at the end of the study. Public awareness and public health laws were found to be related to both R0 and the median doubling time in the pre-lockdown phase only. Conclusion The implementation of interventions at the ground level is one of the key factors in the success of public health interventions. Post implementation, poor effectiveness of many interventions is evident from the study. Further, studies related to the sequence of interventions are required to further analyze the poor effect of the interventions.

The impact of labour market disruptions and transport choice on the environment during COVID-19

Since late 2019, COVID-19 has devastated the global economy, with indirect implications for the environment. As governments' prioritized health and implemented measures such as the closure of non-essential businesses and social distancing, many workers have lost their jobs, been furloughed, or started working from home. Consequently, the world of work has drastically transformed and this period is likely to have major implications for mobility, transportation and the environment. This paper estimates the potential for people to engage in remote work and social distancing using O*NET data and Irish Census data and calculates the potential emission savings, by commuter type from a switch to remote working and occupational social distancing. The results show that while those who commute by car have a relatively high potential for remote work, they are less likely to be able to engage in social distancing in their workplace. While this may be negative for employment prospects in the short run, our analysis indicates that this pattern has the potential for positive environmental implications in the short and long run.

Evolution of emergency medical calls during a pandemic - An emergency medical service during the COVID-19 outbreak

INTRODUCTION

Emergency Medical Services (EMS) are expected to be affected by a pandemic outbreak. However, the available data about trends and extents of these effects is limited.

METHODS

We analyzed numbers of ambulance calls for all 136 diagnosis codes used by Magen David Adom (MDA), Israel's national EMS during 121 days between January 01 and April 30, 2020.

RESULTS

There was an increase in calls for COVID-19 symptoms (cough, fever, throat pain). This trend followed the same shape as the curve for confirmed COVID-19 patients. Trends were found to increase for calls not followed by transport to the hospital as well as in calls for mental or psychiatric causes. Simultaneously, there was a decrease in calls for cardiovascular issues, pneumonia, and all injuries.

CONCLUSION

Understanding these correlations may allow better preparedness of the EMS and a better response towards the public needs in the period of an epidemic or a pandemic.

Machine Learning-Based Prediction of Growth in Confirmed COVID-19 Infection Cases in 114 Countries Using Metrics of Nonpharmaceutical Interventions and Cultural Dimensions: Model Development and Validation

BACKGROUND

National governments worldwide have implemented nonpharmaceutical interventions to control the COVID-19 pandemic and mitigate its effects.

OBJECTIVE

The aim of this study was to investigate the prediction of future daily national confirmed COVID-19 infection growth-the percentage change in total cumulative cases-across 14 days for 114 countries using nonpharmaceutical intervention metrics and cultural dimension metrics, which are indicative of specific national sociocultural norms.

METHODS

We combined the Oxford COVID-19 Government Response Tracker data set, Hofstede cultural dimensions, and daily reported COVID-19 infection case numbers to train and evaluate five non-time series machine learning models in predicting confirmed infection growth. We used three validation methods-in-distribution, out-of-distribution, and country-based cross-validation-for the evaluation, each of which was applicable to a different use case of the models.

RESULTS

Our results demonstrate high R2 values between the labels and predictions for the in-distribution method (0.959) and moderate R2 values for the out-of-distribution and country-based cross-validation methods (0.513 and 0.574, respectively) using random forest and adaptive boosting (AdaBoost) regression. Although these models may be used to predict confirmed infection growth, the differing accuracies obtained from the three tasks suggest a strong influence of the use case.

CONCLUSIONS

This work provides new considerations in using machine learning techniques with nonpharmaceutical interventions and cultural dimensions as metrics to predict the national growth of confirmed COVID-19 infections.

Quarantine acceptance and adherence: qualitative evidence synthesis and conceptual framework

Aim

Emergent infectious diseases often lack medical treatment or preventive vaccines, thus requiring non-pharmaceutical interventions such as quarantine to reduce disease transmission. Quarantine, defined as the separation and restriction of movement of healthy people who have potentially been exposed to the disease, remains contentious especially when the risks and benefits are not fully discussed and not effectively communicated to the people by the organizations who impose this public health measure.

Subject and methods

A qualitative evidence synthesis was conducted to examine the phenomenon of adherence to quarantine focused on the following questions: What strategies affect adherence to quarantine? What are the barriers and facilitators to quarantine acceptance? What benefits and harms of quarantine have been described or measured?

Results

The evidence synthesis produced 18 findings assessed with high confidence. The findings were used to construct a conceptual framework for inter- and within-organization coordination and public communication that includes the following topics for consideration: desired orientation for implementation; population demographics; perceptions of messages; prior acceptance of quarantine; likelihood of impacts of quarantine; perceptions of health infrastructure; and perceptions of policy importance.

Conclusion

The findings and conceptual framework can guide development of effective non-pharmaceutical interventions and as such have direct relevance to public health policy and decision-making for intervening in emergent infectious diseases outbreak such as the ongoing COVID-19 pandemic.

Population Health Rounds: A Novel Vehicle for Training in Population Medicine and Clinical Preventive Medicine

CONTEXT

Preventive medicine residents must train in population medicine (including analytics and population health) and clinical preventive medicine (including screening, behavioral counseling, and chemoprophylaxis). Yet, opportunities to perform both functions concurrently for the same population are scarce. Residents must also master the art of preventive medicine, but they often lack an established community of practice that provides a continuous forum to do so. This project explored Population Health Rounds as a novel vehicle to optimize preventive medicine residency training.

PROGRAM DESCRIPTION

Modeled after traditional medical rounds, Population Health Rounds consist of a 1-hour weekly meeting engaging preventive medicine residents and supervising attendings at Stony Brook Medicine in both population medicine and clinical preventive medicine concurrently, including patient case discussions and targeted population health analytics.

EVALUATION AND RESULTS

Because of the pandemic, the rounds have predominantly focused on COVID-19 and its effects on the hospital employee population. In addition to providing direct patient care to COVID-19-positive and exposed employees, residents have analyzed data on this population and made recommendations to hospital leadership based on COVID-19's institutional epidemiology, including incidence, prevalence, and predictive factors. A formative qualitative survey of resident perceptions offers insights on the value and learning outcomes of this new model.

DISCUSSION AND CONCLUSION

Factors that may impact the implementation, sustainability, and feasibility of this model are discussed. The preventive medicine residency program is commissioned to address gaps in clinical preventive services for the patient-centered medical home tied to the sponsoring institution's family medicine practice. Additional plans are underway to expand the rounds to other clinical contexts, such as lifestyle medicine in the occupational setting, and for targeted populations, such as the underserved. Replication of the Population Health Rounds model is recommended to determine its effectiveness.

Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore

Introduction: As part of infection control measures for COVID-19, individuals have been encouraged to adopt both preventive (such as handwashing) and avoidant behavioural changes (e.g. avoiding crowds). In this study, we examined whether demographics predicted the likelihood that a person would adopt these behaviours in Singapore. Methods: A total of 1,145 participants responded to an online survey conducted between 7 March and 21 April 2020. We collected demographic information and asked participants to report which of 17 behaviour changes they had undertaken because of the COVID-19 outbreak. Regression analyses were performed to predict the number of behavioural changes (preventive, avoidant, and total) as a function of demographics. Finally, we sought to identify predictors of persons who declared that they had not undertaken any of these measures following the outbreak. Results: Most participants (97%) reported at least one behavioural change on account of the pandemic, with changes increasing with the number of local COVID-19 cases (P<0.001). Additionally, women and those who were younger adopted more preventive behaviours (gender: P<0.001; age: P=0.001). Women were more likely to increase handwashing frequency, and younger individuals were more likely to wear face masks prior to legislation. Finally, women and those who were married adopted more avoidant behaviours (gender: P<0.001; marital status: P<0.001), with both groups avoiding crowded areas and staying home more than usual. Women also voluntarily reduced physical contact, whereas those who were married preferentially chose outdoor venues and relied on online shopping. Conclusion: Our characterisation of behavioural changes provides a baseline for public health advisories. Moving forward, health authorities can focus their efforts on encouraging segments of the population who do not readily adopt infection control measures against COVID-19.

Prevalence of Influenza Among Hajj Pilgrims: A Systematic Review and Meta-Analysis

OBJECTIVES

Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims.

METHODS

In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg's test.

RESULTS

Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively.

CONCLUSIONS

In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.