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Mueller V, Páez-Bernal C, Gray C, Grépin K. The Gendered Consequences of COVID-19 for Internal Migration. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:60. [PMID: 37397235 PMCID: PMC10307700 DOI: 10.1007/s11113-023-09809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
Scant evidence exists to identify the effects of the pandemic on migrant women and the unique barriers on employment they endure. We merge longitudinal data from mobile phone surveys with subnational data on COVID cases to examine whether women were left more immobile and vulnerable to health risks, relative to men, during the pandemic in Kenya and Nigeria. Each survey interviewed approximately 2000 men and women over three rounds (November 2020-January 2021, March-April 2021, November 2021-January 2022). Linear regression analysis reveals internal migrants are no more vulnerable to knowing someone in their network with COVID. Rather, rural migrant women in Kenya and Nigeria were less vulnerable to transmission through their network, perhaps related to the possible wealth accumulation from migration or acquired knowledge of averting health risks from previous destinations. Per capita exposure to COVID cases hinders the inter-regional migration of women in both countries. Exposure to an additional COVID case per 10,000 people resulted in a decline in women's interregional migration by 6 and 2 percentage points in Kenya and Nigeria, respectively.
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Affiliation(s)
- Valerie Mueller
- School of Politics and Global Studies, Arizona State University, Tempe, USA
- International Food Policy Research Institute, Washington, DC USA
| | - Camila Páez-Bernal
- School of Politics and Global Studies, Arizona State University, Tempe, USA
| | - Clark Gray
- Department of Geography, University of North Carolina, Chapel Hill, USA
| | - Karen Grépin
- School of Public Health, University of Hong Kong, Hong Kong, China
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2
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Paez A. Reproducibility of Research During COVID-19: Examining the Case of Population Density and the Basic Reproductive Rate from the Perspective of Spatial Analysis. GEOGRAPHICAL ANALYSIS 2021; 54:GEAN12307. [PMID: 34898693 PMCID: PMC8652856 DOI: 10.1111/gean.12307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 06/14/2023]
Abstract
The emergence of the novel SARS-CoV-2 coronavirus and the global COVID-19 pandemic in 2019 led to explosive growth in scientific research. Alas, much of the research in the literature lacks conditions to be reproducible, and recent publications on the association between population density and the basic reproductive number of SARS-CoV-2 are no exception. Relatively few papers share code and data sufficiently, which hinders not only verification but additional experimentation. In this article, an example of reproducible research shows the potential of spatial analysis for epidemiology research during COVID-19. Transparency and openness means that independent researchers can, with only modest efforts, verify findings and use different approaches as appropriate. Given the high stakes of the situation, it is essential that scientific findings, on which good policy depends, are as robust as possible; as the empirical example shows, reproducibility is one of the keys to ensure this.
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Affiliation(s)
- Antonio Paez
- School of EarthEnvironment and SocietyMcMaster UniversityHamiltonCanada
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Chung RYN, Chung GKK, Marmot M, Allen J, Chan D, Goldblatt P, Wong H, Lai E, Woo J, Yeoh EK, Wong SYS. COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong. J Epidemiol Community Health 2021; 75:616-623. [PMID: 33402396 DOI: 10.1136/jech-2020-215392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND We examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence. METHODS 752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factors, worry of COVID-19, general health, economic activity, and personal protective equipment (PPE) and related hygiene practice by deprivation status. The associations between deprivation and negative COVID-19 related issues were analysed using binary logistic regressions, while the associations of these issues with health were analysed using linear regressions. Path analysis was conducted to determine the direct effect of deprivation, and the indirect effects via COVID-19 related issues, on health. Interactions between deprivation and the mediators were also tested. RESULTS Deprived individuals were more likely to have job loss/instability, less reserves, less utilisation and more concerns of PPE. After adjustments for potential confounders, being deprived was associated with having greater risk of low reserve of face masks, being worried about the disease and job loss/instability. Being deprived had worse physical (β=-0.154, p<0.001) and mental health (β=-0.211, p<0.001) and had an indirect effect on mental health via worry and job loss/instability (total indirect effect: β=-0.027, p=0.017; proportion being mediated=11.46%). In addition, significant interaction between deprivation and change of economic activity status was observed on mental health-related quality of life. CONCLUSION Even if the COVID-19 incidence was relatively low, part of the observed health inequality can be explained by people's concerns over livelihood and economic activity, which were affected by the containment measures. We should look beyond the incidence to address COVID-19 related health inequalities.
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Affiliation(s)
- Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jessica Allen
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Dicken Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter Goldblatt
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Lai
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eng-Kiong Yeoh
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel Y S Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Montano L, Donato F, Bianco PM, Lettieri G, Guglielmino A, Motta O, Bonapace IM, Piscopo M. Air Pollution and COVID-19: A Possible Dangerous Synergy for Male Fertility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136846. [PMID: 34202243 PMCID: PMC8297116 DOI: 10.3390/ijerph18136846] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Abstract
Several studies indicate that semen quality has strongly declined in the last decades worldwide. Air pollution represents a significant co-factor with the COVID-19 impact and has negative effects on the male reproductive system, through pro-oxidant, inflammatory and immune-dysregulating mechanisms. It has recently been reported that chronic exposure to PM2.5 causes overexpression of the alveolar ACE2 receptor, the entry route of SARS-CoV-2 into the organism shared by the lungs and testis where expression is highest in the body. In the testis, the ACE2/Ang-(1-7)/MasR pathway plays an important role in the regulation of spermatogenesis and an indirect mechanism of testicular damage could be due to the blockade of the ACE2 receptor by SARS-CoV-2. This prevents the conversion of specific angiotensins, and their excess causes inflammation with the overproduction of cytokines. PM2.5-induced overexpression of the alveolar ACE2 receptor, in turn, could increase local viral load in patients exposed to pollutants, producing ACE2 receptor depletion and compromising host defenses. By presenting an overall view of epidemiological data and molecular mechanisms, this manuscript aims to interpret the possible synergistic effects of both air pollution and COVID-19 on male reproductive function, warning that the spread of SARS-CoV-2 in the fertile years may represent a significant threat to global reproductive health. All of this should be of great concern, especially for men of the age of maximum reproductive capacity, and an important topic of debate for policy makers. Altered environmental conditions, together with the direct and indirect short- and long-term effects of viral infection could cause a worsening of semen quality with important consequences for male fertility, especially in those areas with higher environmental impact.
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Affiliation(s)
- Luigi Montano
- Andrology Unit and Service of Lifestyle Medicine in UroAndrology, Local Health Authority (ASL) Salerno, Coordination Unit of the Network for Environmental and Reproductive Health (EcoFoodFertility Project), “Oliveto Citra Hospital”, 84020 Oliveto Citra, Italy
- PhD Program in Evolutionary Biology and Ecology, Department of Biology, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence: (L.M.); (I.M.B.); (M.P.); Tel.: +39-0331-339452 (I.M.B.); +39-0816-79081 (M.P.)
| | - Francesco Donato
- Unit of Hygiene, Epidemiology, and Public Health, Department of Medical and Surgical Specialties Radiological Sciences and Public Health, University of Brescia, 21100 Brescia, Italy;
| | - Pietro Massimiliano Bianco
- ISPRA, Italian Institute for Environmental Protection and Research, Via Vitaliano Brancati 60, 00144 Roma, Italy;
| | - Gennaro Lettieri
- Department of Biology, University of Naples Federico II, 80126 Napoli, Italy;
| | | | - Oriana Motta
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy;
| | - Ian Marc Bonapace
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
- Correspondence: (L.M.); (I.M.B.); (M.P.); Tel.: +39-0331-339452 (I.M.B.); +39-0816-79081 (M.P.)
| | - Marina Piscopo
- Department of Biology, University of Naples Federico II, 80126 Napoli, Italy;
- Correspondence: (L.M.); (I.M.B.); (M.P.); Tel.: +39-0331-339452 (I.M.B.); +39-0816-79081 (M.P.)
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Li C, Zhao S, Tang B, Zhu Y, Ran J, Li X, He D. Estimating the Instantaneous Asymptomatic Proportion With a Simple Approach: Exemplified With the Publicly Available COVID-19 Surveillance Data in Hong Kong. Front Public Health 2021; 9:604455. [PMID: 34012950 PMCID: PMC8126604 DOI: 10.3389/fpubh.2021.604455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The asymptomatic proportion is a critical epidemiological characteristic that modulates the pandemic potential of emerging respiratory virus, which may vary depending on the nature of the disease source, population characteristics, source-host interaction, and environmental factors. Methods: We developed a simple likelihood-based framework to estimate the instantaneous asymptomatic proportion of infectious diseases. Taking the COVID-19 epidemics in Hong Kong as a case study, we applied the estimation framework to estimate the reported asymptomatic proportion (rAP) using the publicly available surveillance data. We divided the time series of daily cases into four stages of epidemics in Hong Kong by examining the persistency of the epidemic and compared the rAPs of imported cases and local cases at different stages. Results: As of July 31, 2020, there were two intermittent epidemics in Hong Kong. The first one was dominated by imported cases, accounting for 63.2% of the total cases, and the second one was dominated by local cases, accounting for 86.5% of the total cases. The rAP was estimated at 23.1% (95% CI: 10.8-39.7%) from January 23 to July 31, and the rAPs were estimated at 22.6% (95% CI: 11.1-38.9%) among local cases and 38.7% (95% CI: 9.0-72.0%) among imported cases. Our results showed that the rAPs of local cases were not significantly different between the two epidemics, but increased gradually during the first epidemic period. In contrast, the rAPs of imported cases in the latter epidemic period were significantly higher than that in the previous epidemic period. Conclusion: Hong Kong has a high rAP of imported COVID-19 cases and should continue to strengthen the detection and isolation of imported individuals to prevent the resurgence of the disease.
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Affiliation(s)
- Chunyu Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.,Chinese University of Hong Kong (CUHK) Shenzhen Research Institute, Shenzhen, China
| | - Biao Tang
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China.,Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Yuchen Zhu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jinjun Ran
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Xiujun Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China
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Kulkarni H, Khandait H, Narlawar UW, Rathod P, Mamtani M. Independent association of meteorological characteristics with initial spread of Covid-19 in India. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 764:142801. [PMID: 33148430 PMCID: PMC7566664 DOI: 10.1016/j.scitotenv.2020.142801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 04/14/2023]
Abstract
Whether weather plays a part in the transmissibility of the novel Coronavirus Disease-19 (COVID-19) is still not established. We tested the hypothesis that meteorological factors (air temperature, relative humidity, air pressure, wind speed and rainfall) are independently associated with transmissibility of COVID-19 quantified using the basic reproduction rate (R0). We used publicly available datasets on daily COVID-19 case counts (total n = 108,308), three-hourly meteorological data and community mobility data over a three-month period. Estimated R0 varied between 1.15 and 1.28. Mean daily air temperature (inversely), wind speed (positively) and countrywide lockdown (inversely) were significantly associated with time dependent R0, but the contribution of countrywide lockdown to variability in R0 was over three times stronger as compared to that of temperature and wind speed combined. Thus, abating temperatures and easing lockdown may concur with increased transmissibility of COVID-19 in India.
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Affiliation(s)
- Hemant Kulkarni
- Lata Medical Research Foundation, Nagpur, India; M&H Research, LLC, San Antonio, TX, USA.
| | | | - Uday W Narlawar
- Lata Medical Research Foundation, Nagpur, India; Government Medical College, Nagpur, India
| | | | - Manju Mamtani
- Lata Medical Research Foundation, Nagpur, India; M&H Research, LLC, San Antonio, TX, USA
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7
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Public Perception of the First Major SARS-Cov-2 Outbreak in the Suceava County, Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041406. [PMID: 33546326 PMCID: PMC7913496 DOI: 10.3390/ijerph18041406] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022]
Abstract
The first months of 2020 were marked by the rapid spread of the acute respiratory disease, which swiftly reached the proportions of a pandemic. The city and county of Suceava, Romania, faced an unprecedented crisis in March and April 2020, triggered not only by the highest number of infections nationwide but also by the highest number of infected health professionals (47.1% of the infected medical staff nationwide, in April 2020). Why did Suceava reach the peak number of COVID-19 cases in Romania? What were the vulnerability factors that led to the outbreak, the closure of the city of Suceava and neighboring localities, and the impossibility of managing the crisis with local resources? What is the relationship between the population's lack of confidence in the authorities' ability to solve the crisis, and their attitude towards the imposed measures? The present article aims to provide answers to the above questions by examining the attitudes of the public towards the causes that have led to the outbreak of an epidemiological crisis, systemic health problems, and the capacity of decision makers to intervene both at local and national level. The research is based on an online survey, conducted between April and May 2020, resulting in a sample of 1231 people from Suceava County. The results highlight that the development of the largest COVID-19 outbreak in Romania is, without a doubt, the result of a combination of factors, related to the medical field, decision makers, and the particularities of the population's behavior.
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Sahoo PK, Mangla S, Pathak AK, Salãmao GN, Sarkar D. Pre-to-post lockdown impact on air quality and the role of environmental factors in spreading the COVID-19 cases - a study from a worst-hit state of India. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:205-222. [PMID: 33034718 PMCID: PMC7544766 DOI: 10.1007/s00484-020-02019-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/09/2020] [Indexed: 05/11/2023]
Abstract
The present study aims to examine the changes in air quality during different phases of the COVID-19 pandemic, including the lockdown (LD1-4) and unlock period (UL1-2) (post-lockdown) as compared to pre-lockdown (PL1-3) and to establish the relationships of the environmental and demographic variables with COVID-19 cases in the state of Maharashtra, the worst-hit state in India. Atmospheric pollutants such as PM2.5, PM10, NOx, and CO were substantially reduced during the lockdown and unlock phases with the greatest reduction in cities having larger traffic volumes. Compared with the immediate pre-lockdown period (PL3), the averaged PM2.5 and PM10 reduced by up to 51% and 47% respectively during the lockdown periods, which resulted in 'satisfactory' level of air quality index (AQI) as a result of reduced vehicular traffic and industrial closing. These parameters continued to reduce as much as 80% during the unlock periods due to the additive impact of weather (rainfall and temperature) combined with the lockdown conditions. Kendall's correlation matrix showed a significant negative correlation between temperature and air pollutants (r= - 0.35 to - 057). Conversely, SO2 and O3 did not improve, and in some cases, they increased during the lockdown and unlocking. COVID-19 spreading incidences were strongly and positively correlated with temperature (r < 0.62) and dew point (r < 0.73). Thus, this indicates that the increase in temperature and dew point cannot weaken the transmission of this virus. The number of COVID-19 cases relative to air pollutants was negatively correlated (r = - 0.33 to - 0.74), which may be a mere coincidence as a result of lockdown. However, based on pre-lockdown air quality data and demographic factors, it was found that particulate matter (PM2.5 and PM10) and population density are closely linked with higher morbidity and mortality although a more in-depth research is required in this direction to validate this finding. The onset of COVID-19 has allowed us to determine that 'immediate' changes in air quality within densely populated/industrialized areas can improve livelihood based on pollution mitigation. These findings could be used by policymakers to set new benchmarks for air pollution that would improve the quality of life for major sectors of the World's population. COVID-19 has shown us that we can make changes when necessary, and findings may pave the way for future research to inform policy on the tough choices we will have to make between quality of life and survival. Also, our results will enrich the ongoing discussion on the role of environmental factors on the transmission of COVID-19 and will help to take necessary steps for its control.
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Affiliation(s)
- Prafulla Kumar Sahoo
- Department of Environmental Science and Technology, Central University of Punjab, Bathinda, Punjab, 151001, India.
- Instituto Tecnológico Vale, Belém, PA, 66055-090, Brazil.
| | - Sherry Mangla
- Department of Mathematics and Statistics, Central University of Punjab, Bathinda, Punjab, 151001, India
| | - Ashok Kumar Pathak
- Department of Mathematics and Statistics, Central University of Punjab, Bathinda, Punjab, 151001, India
| | - Gabriel Negreiros Salãmao
- Programa de Pós-graduação em Geologia e Geoquímica (PPGG), Instituto de Geociências (IG), Universidade Federal do Pará (UFPA), Rua Augusto Corrêa, 1, Belém, PA, 66075-110, Brazil
| | - Dibyendu Sarkar
- Department of Civil, Environmental and Ocean Engineering, Stevens Institute of Technology, Castle Point on Hudson, Hoboken, NJ, 07030, USA
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Ngiam JN, Chew N, Tham SM, Beh DLL, Lim ZY, Li TYW, Cen S, Tambyah PA, Santosa A, Sia CH, Cross GB. Demographic shift in COVID-19 patients in Singapore from an aged, at-risk population to young migrant workers with reduced risk of severe disease. Int J Infect Dis 2020; 103:329-335. [PMID: 33220440 PMCID: PMC7674985 DOI: 10.1016/j.ijid.2020.11.157] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives The vast majority of COVID-19 cases in Singapore have occurred amongst migrant workers. This paper examined trends in the hospitalised cases and tested the assumption that the low severity of disease was related to the relatively young affected population. Methods All patients with PCR-positive SARS-CoV-2 admitted from February to April 2020 were divided into: (i) imported cases, (ii) locally-transmitted cases outside migrant worker dormitories and (iii) migrant worker dormitory cases. They were examined for underlying comorbidities, clinical progress and outcomes. Results Imported cases (n = 29) peaked in mid-March 2020, followed by local cases (n = 100) in mid-April 2020; migrant worker cases (n = 425) continued to increase in late April 2020. Migrant worker cases were younger, had few medical comorbidities and less severe disease. As the migrant worker cases increased, the proportion of patients with pneumonia decreased, whilst patients presenting earlier in their illness and asymptomatic disease became more common. Conclusion Singapore experienced a substantial shift in the population at risk of severe COVID-19. Successful control in the community protected an aging population. Large migrant worker dormitory outbreaks occurred, but the disease incurred was less severe, resulting in Singapore having one of the lowest case fatality rates in the world.
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Affiliation(s)
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Sai Meng Tham
- Division of Infectious Diseases, National University Health System, Singapore
| | | | - Zhen Yu Lim
- Department of Medicine, National University Health System, Singapore
| | - Tony Y W Li
- Department of Medicine, National University Health System, Singapore
| | - Shuyun Cen
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amelia Santosa
- Division of Rheumatology, National University Health System, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gail Brenda Cross
- Division of Infectious Diseases, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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