Who Counts Where? COVID-19 Surveillance in Federal Countries

[Analysis Of Data Quality/Completeness In Covid-19 Cases: Why A Digital Integrated Data Collection Is Also Necessary For Pandemic Control]

BACKGROUND

Epidemiological data on the corona pandemic collected in the public health sector in Germany have been less useful in estimating vaccine effectiveness and clinical outcomes compared to other countries.

METHODS

In this retrospective observational study, we examined the completeness of selected own data collected during the pandemic. Information on the important parameters of hospitalization, vaccination status and risk factors for severe course and death over different periods were considered and evaluated descriptively. The data are discussed in the extended context of required digital strategies in Germany.

RESULTS

From January 1, 2022 to June 30, 2022, we found 126,920 administrative procedures related to COVID-19. With regard to the data on hospitalization, in 19,749 cases, it was stated "No", in 1,990 cases "Yes" and in 105,181 cases (83+%) "Not collected" or "Not ascertainable". Concerning vaccinations, only a small proportion of procedures contained information on the type of vaccine (11.1+%), number of vaccinations (4.4+%) and date of the last vaccination (2.1+%). The completeness of data on chronic conditions/risk factors in COVID-19-related deaths decreased over four consecutive periods between 2020 and 2022 as case numbers increased.

CONCLUSION

Future strategies taking into account meaningfulness and completeness of data must comprise modern technical solutions with digital data collection on infections without putting the principle of data protection at risk.

Regional geographies and public health lessons of the COVID-19 pandemic in the Arctic

Objectives

This study examines the COVID-19 pandemic's spatiotemporal dynamics in 52 sub-regions in eight Arctic states. This study further investigates the potential impact of early vaccination coverage on subsequent COVID-19 outcomes within these regions, potentially revealing public health insights of global significance.

Methods

We assessed the outcomes of the COVID-19 pandemic in Arctic sub-regions using three key epidemiological variables: confirmed cases, confirmed deaths, and case fatality ratio (CFR), along with vaccination rates to evaluate the effectiveness of the early vaccination campaign on the later dynamics of COVID-19 outcomes in these regions.

Results

From February 2020 to February 2023, the Arctic experienced five distinct waves of COVID-19 infections and fatalities. However, most Arctic regions consistently maintained Case Fatality Ratios (CFRs) below their respective national levels throughout these waves. Further, the regression analysis indicated that the impact of initial vaccination coverage on subsequent cumulative mortality rates and Case Fatality Ratio (CFR) was inverse and statistically significant. A common trend was the delayed onset of the pandemic in the Arctic due to its remoteness. A few regions, including Greenland, Iceland, the Faroe Islands, Northern Canada, Finland, and Norway, experienced isolated spikes in cases at the beginning of the pandemic with minimal or no fatalities. In contrast, Alaska, Northern Sweden, and Russia had generally high death rates, with surges in cases and fatalities.

Conclusion

Analyzing COVID-19 data from 52 Arctic subregions shows significant spatial and temporal variations in the pandemic's severity. Greenland, Iceland, the Faroe Islands, Northern Canada, Finland, and Norway exemplify successful pandemic management models characterized by low cases and deaths. These outcomes can be attributed to successful vaccination campaigns, and proactive public health initiatives along the delayed onset of the pandemic, which reduced the impact of COVID-19, given structural and population vulnerabilities. Thus, the Arctic experience of COVID-19 informs preparedness for future pandemic-like public health emergencies in remote regions and marginalized communities worldwide that share similar contexts.

COVID-19 and democracy: a scoping review

BACKGROUND

The resilience of democracy is tested under exogenous shocks such as crises. The COVID-19 pandemic has recently tested the resilience of democratic institutions and practices around the world.

AIM

The purpose of this article is to scope the early research literature that discusses democracy and the COVID-19 pandemic. We review scientific journal articles published during the first two years of the pandemic. We ask three research questions in scoping this body of literature: (1) what are the key topic areas of all published research that associates itself with both democracy and COVID-19, (2) what kinds of conceptual and theoretical contributions has research literature that more specifically discusses democracy under the pandemic produced, and (3) what are the impacts of democracy to the pandemic and vice versa according to empirical research?

METHODS

The scoping review methodology draws on systematic literature search strategies, computational methods, and manual coding. The systematic Web of Science search produced 586 articles for which we conducted a Correlated Topic Model. After technical and manual screening, we identified 94 journal articles that were manually coded.

RESULTS

The early research on democracy and the COVID-19 pandemic offers a versatile body of scholarship. The topic modeling shows that the scholarship discusses issues of crises, governance, rights, society, epidemiology, politics, electorate, technology, and media. The body of papers with conceptual and theoretical contributions has offered new insights on the difficulties, possibilities, and means to maintain democracy under a pandemic. Empirical research on democracy's impact on the COVID-19 pandemic and vice versa varies in terms of methodology, geographical scope, and scientific contributions according to the direction of influence studied. Democracy appears to have a significant impact on some aspects of policy responses and epidemiological characteristics of the pandemic. In most parts of the world, the scope, franchise, and authenticity of democracy narrowed down due to the pandemic, albeit in most cases only temporarily.

CONCLUSIONS

A significant number of papers show that the pandemic has accentuated democratic backsliding but is unlikely to have undermined established democracies that have proved resilient in face of the pandemic. But empirical research has also made visible some weak signals of antidemocratic tendencies that may become more accentuated in the longer run.

The Effects of Health Sector Fiscal Decentralisation on Availability, Accessibility, and Utilisation of Healthcare Services: A Panel Data Analysis

BACKGROUND

Fiscal decentralisation (FD) is a widely implemented decentralisation policy consisting of the allocation of pooling and spending responsibilities from the central government to lower levels of governance within a country. In 2001, The Italian National Health System (Servizio Sanitario Nazionale, SSN) has introduced a strong element of FD, making regions responsible for their own pooling of resources and for their budgets. Despite the relevance, only few studies exist on health sector-FD in Italy, mostly looking at the effects of FD on infant mortality.

METHODS

This study performs a fixed-effects panel data analysis of Italian Regions and Autonomous provinces between the years 2001 and 2017, to investigate the effects of health sector-FD on availability, accessibility, and utilisation of healthcare services in Italy.

RESULTS

FD decreases availability of staff and hospital beds, decreases utilisation of care, measured by hospitalisation rates, and increases interregional patients' mobility for healthcare purposes, a finding suggesting increased disparities in access to healthcare. These effects seem to be stronger for public - rather than private - services, and are more prominent in poorer areas.

CONCLUSION

This evidence suggest that FD has created a fragmented and unequal healthcare system, in which levels of availability, utilisation of, and accessibility to resources - as well as the extent of public sector's retrenchment - coincide with the wealth of the area.

Missing science: A scoping study of COVID-19 epidemiological data in the United States

Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.

Assessment of COVID-19 data reporting in 100+ websites and apps in India

India is among the top three countries in the world both in COVID-19 case and death counts. With the pandemic far from over, timely, transparent, and accessible reporting of COVID-19 data continues to be critical for India's pandemic efforts. We systematically analyze the quality of reporting of COVID-19 data in over one hundred government platforms (web and mobile) from India. Our analyses reveal a lack of granular data in the reporting of COVID-19 surveillance, vaccination, and vacant bed availability. As of 5 June 2021, age and gender distribution are available for less than 22% of cases and deaths, and comorbidity distribution is available for less than 30% of deaths. Amid rising concerns of undercounting cases and deaths in India, our results highlight a patchy reporting of granular data even among the reported cases and deaths. Furthermore, total vaccination stratified by healthcare workers, frontline workers, and age brackets is reported by only 14 out of India's 36 subnationals (states and union territories). There is no reporting of adverse events following immunization by vaccine and event type. By showing what, where, and how much data is missing, we highlight the need for a more responsible and transparent reporting of granular COVID-19 data in India.

Comparing the COVID-19 pandemic in space and over time in Europe, using numbers of deaths, crude rates and adjusted mortality trend ratios

Comparison of COVID-19 trends in space and over time is essential to monitor the pandemic and to indirectly evaluate non-pharmacological policies aimed at reducing the burden of disease. Given the specific age- and sex- distribution of COVID-19 mortality, the underlying sex- and age-distribution of populations need to be accounted for. The aim of this paper is to present a method for monitoring trends of COVID-19 using adjusted mortality trend ratios (AMTRs). Age- and sex-mortality distribution of a reference European population (N = 14,086) was used to calculate age- and sex-specific mortality rates. These were applied to each country to calculate the expected deaths. Adjusted Mortality Trend Ratios (AMTRs) with 95% confidence intervals (C.I.) were calculated for selected European countries on a daily basis from 17th March 2020 to 29th April 2021 by dividing observed cumulative mortality, by expected mortality, times the crude mortality of the reference population. These estimated the sex- and age-adjusted mortality for COVID-19 per million population in each country. United Kingdom experienced the highest number of COVID-19 related death in Europe. Crude mortality rates were highest Hungary, Czech Republic, and Luxembourg. Accounting for the age-and sex-distribution of the underlying populations with AMTRs for each European country, four different patterns were identified: countries which experienced a two-wave pandemic, countries with almost undetectable first wave, but with either a fast or a slow increase of mortality during the second wave; countries with consistently low rates throughout the period. AMTRs were highest in Eastern European countries (Hungary, Czech Republic, Slovakia, and Poland). Our methods allow a fair comparison of mortality in space and over time. These might be of use to indirectly estimating the efficacy of non-pharmacological health policies. The authors urge the World Health Organisation, given the absence of age and sex-specific mortality data for direct standardisation, to adopt this method to estimate the comparative mortality from COVID-19 pandemic worldwide.