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Naidoo R, Lambert B, Voysey M, Shretta R, Keene CM, Wanat M, Andersen-Waine B, Dahal P, Stepniewska K, Hounsell R, Molyneux S, Pinto-Duschinsky S, Rowe E, Yenidogan G, Fowler T, White L, Consortium EOHA. An evaluation of the national testing response during the COVID-19 pandemic in England: a multistage mixed-methods study protocol. BMJ Open 2024; 14:e077271. [PMID: 38885988 PMCID: PMC11184184 DOI: 10.1136/bmjopen-2023-077271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/03/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION In 2020, the UK government established a large-scale testing programme to rapidly identify individuals in England who were infected with SARS-CoV-2 and had COVID-19. This comprised part of the UK government's COVID-19 response strategy, to protect those at risk of severe COVID-19 disease and death and to reduce the burden on the health system. To assess the success of this approach, the UK Health Security Agency (UKHSA) commissioned an independent evaluation of the activities delivered by the National Health System testing programme in England. The primary purpose of this evaluation will be to capture key learnings from the roll-out of testing to different target populations via various testing services between October 2020 and March 2022 and to use these insights to formulate recommendations for future pandemic preparedness strategy. In this protocol, we detail the rationale, approach and study design. METHODS AND ANALYSIS The proposed study involves a stepwise mixed-methods approach, aligned with established methods for the evaluation of complex interventions in health, to retrospectively assess the combined impact of key asymptomatic and symptomatic testing services nationally. The research team will first develop a theory of change, formulated in collaboration with testing service stakeholders, to understand the causal pathways and intended and unintended outcomes of each testing service and explore contextual impacts on each testing service's intended outcomes. Insights gained will help identify indicators to evaluate how the combined aims of the testing programme were achieved, using a mixed-methods approach. ETHICS AND DISSEMINATION The study protocol was granted ethics approval by the UKHSA Research Ethics and Governance Group (reference NR0347). All relevant ethics guidelines will be followed throughout. Findings arising from this evaluation will be used to inform lessons learnt and recommendations for UKHSA on appropriate pandemic preparedness testing programme designs; findings will also be disseminated in peer-reviewed journals, a publicly available report to be published online and at academic conferences. The final report of findings from the evaluation will be used as part of a portfolio of evidence produced for the independent COVID-19 government inquiry in the UK. TRANSPARENCY DECLARATION The lead author (the manuscript's guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; no important aspects of the study have been omitted, and any discrepancies from the study as planned have been explained.
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Affiliation(s)
- Reshania Naidoo
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Ernst & Young, London, UK
| | - Ben Lambert
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, Oxford University, Oxford, UK
| | - Rima Shretta
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Claire Marriott Keene
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Rachel Hounsell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | | | - Lisa White
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Shi X, Ling GHT, Leng PC, Rusli N, Matusin AMRA. Associations between institutional-social-ecological factors and COVID -19 case-fatality: Evidence from 134 countries using multiscale geographically weighted regression (MGWR). One Health 2023; 16:100551. [PMID: 37153369 PMCID: PMC10141798 DOI: 10.1016/j.onehlt.2023.100551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/25/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023] Open
Abstract
During the period in which the Omicron coronavirus variant was rapidly spreading, the impact of the institutional-social-ecological dimensions on the case-fatality rate was rarely afforded attention. By adopting the diagnostic social-ecological system (SES) framework, the present paper aims to identify the impact of institutional-social-ecological factors on the case-fatality rate of COVID-19 in 134 countries and regions and test their spatial heterogeneity. Using statistical data from the Our World In Data website, the present study collected the cumulative case-fatality rate from 9 November 2021 to 23 June 2022, along with 11 country-level institutional-social-ecological factors. By comparing the goodness of fit of the multiple linear regression model and the multiscale geographically weighted regression (MGWR) model, the study demonstrated that the effects of SES factors exhibit significant spatial heterogeneity in relation to the case-fatality rate of COVID-19. After substituting the data into the MGWR model, six SES factors were identified with an R square of 0.470 based on the ascending effect size: COVID-19 vaccination policy, age dependency ratio, press freedom, gross domestic product (GDP), COVID-19 testing policy, and population density. The GWR model was used to test and confirm the robustness of the research results. Based on the analysis results, it is suggested that the world needs to meet four conditions to restore normal economic activity in the wake of the COVID-19 pandemic: (i) Countries should increase their COVID-19 vaccination coverage and maximize COVID-19 testing expansion. (ii) Countries should increase public health facilities available to provide COVID-19 treatment and subsidize the medical costs of COVID-19 patients. (iii) Countries should strictly review COVID-19 news reports and actively publicize COVID-19 pandemic prevention knowledge to the public through a range of media. (iv) Countries should adopt an internationalist spirit of cooperation and help each other to navigate the COVID-19 pandemic. The study further tests the applicability of the SES framework to the field of COVID-19 prevention and control based on the existing research, offering novel policy insights to cope with the COVID-19 pandemic that coexists with long-term human production and life for a long time.
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Affiliation(s)
- Xuerui Shi
- Department of Urban and Regional Planning, Faculty of Built Environment & Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia
| | - Gabriel Hoh Teck Ling
- Department of Urban and Regional Planning, Faculty of Built Environment & Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia
| | - Pau Chung Leng
- Department of Architecture, Faculty of Built Environment & Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia
| | - Noradila Rusli
- Department of Urban and Regional Planning, Faculty of Built Environment & Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia
- Centre for Innovative Planning and Development (CIPD), Faculty of Built Environment & Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia
| | - Ak Mohd Rafiq Ak Matusin
- Department of Urban and Regional Planning, Faculty of Built Environment & Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia
- Centre for Innovative Planning and Development (CIPD), Faculty of Built Environment & Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia
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Kevrekidis GA, Rapti Z, Drossinos Y, Kevrekidis PG, Barmann MA, Chen QY, Cuevas-Maraver J. Backcasting COVID-19: a physics-informed estimate for early case incidence. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220329. [PMID: 36533196 PMCID: PMC9748501 DOI: 10.1098/rsos.220329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
It is widely accepted that the number of reported cases during the first stages of the COVID-19 pandemic severely underestimates the number of actual cases. We leverage delay embedding theorems of Whitney and Takens and use Gaussian process regression to estimate the number of cases during the first 2020 wave based on the second wave of the epidemic in several European countries, South Korea and Brazil. We assume that the second wave was more accurately monitored, even though we acknowledge that behavioural changes occurred during the pandemic and region- (or country-) specific monitoring protocols evolved. We then construct a manifold diffeomorphic to that of the implied original dynamical system, using fatalities or hospitalizations only. Finally, we restrict the diffeomorphism to the reported cases coordinate of the dynamical system. Our main finding is that in the European countries studied, the actual cases are under-reported by as much as 50%. On the other hand, in South Korea-which had a proactive mitigation approach-a far smaller discrepancy between the actual and reported cases is predicted, with an approximately 18% predicted underestimation. We believe that our backcasting framework is applicable to other epidemic outbreaks where (due to limited or poor quality data) there is uncertainty around the actual cases.
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Affiliation(s)
- G. A. Kevrekidis
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Z. Rapti
- Department of Mathematics and Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61820, USA
| | - Y. Drossinos
- European Commission, Joint Research Centre, I-21027 Ispra (VA), Italy
| | - P. G. Kevrekidis
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - M. A. Barmann
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Q. Y. Chen
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - J. Cuevas-Maraver
- Grupo de Física No Lineal, Departamento de Física Aplicada I, Universidad de Sevilla. Escuela Politécnica Superior, C/ Virgen de África, 7, 41012 Sevilla, Spain
- Instituto de Matemáticas de la Universidad de Sevilla (IMUS). Edificio Celestino Mutis. Avda. Reina Mercedes s/n, 41012 Sevilla, Spain
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Slim MA, Appelman B, Peters-Sengers H, Dongelmans DA, de Keizer NF, Schade RP, de Boer MGJ, Müller MCA, Vlaar APJ, Wiersinga WJ, van Vught LA. Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands. Open Forum Infect Dis 2022; 9:ofac632. [PMID: 36519114 PMCID: PMC9745783 DOI: 10.1093/ofid/ofac632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/20/2022] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive. METHODS We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used: unadjusted, adjusted, propensity matched, and propensity weighted. RESULTS Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67-64 years; P < .001), in in-hospital mortality on the ward (21%-15%; P < .001), and a trend in the ICU (24%-16%; P = .148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22-1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03-1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69-0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality. CONCLUSIONS Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
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Affiliation(s)
- Marleen A Slim
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam—Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Rogier P Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marcella C A Müller
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Division of Infectious Diseases, Department of Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lonneke A van Vught
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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Park MB, Ranabhat CL. COVID-19 trends, public restrictions policies and vaccination status by economic ranking of countries: a longitudinal study from 110 countries. Arch Public Health 2022; 80:197. [PMID: 35999620 PMCID: PMC9398898 DOI: 10.1186/s13690-022-00936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has transitioned to a third phase and many variants have been originated. There has been millions of lives loss as well as billions in economic loss. The morbidity and mortality for COVID-19 varies by country. There were different preventive approaches and public restrictions policies have been applied to control the COVID-19 impacts and usually measured by Stringency Index. This study aimed to explore the COVID-19 trend, public restriction policies and vaccination status with economic ranking of countries. Methods We received open access data from Our World in Data. Data from 210 countries were available. Countries (n = 110) data related to testing, which is a key variable in the present study, were included for the analysis and remaining 100 countries were excluded due to incomplete data. The analysis period was set between January 22, 2020 (when COVID-19 was first officially reported) and December 28, 2021. All analyses were stratified by year and the World Bank income group. To analyze the associations among the major variables, we used a longitudinal fixed-effects model. Results Out of the 110 countries included in our analysis, there were 9 (8.18%), 25 (22.72%), 31 (28.18%), and 45 (40.90%) countries from low income countries (LIC), low and middle income countries (LMIC), upper middle income countries (UMIC) and high income countries (HIC) respectively. New case per million was similar in LMIC, UMIC and HIC but lower in LIC. The number of new COVID-19 test were reduced in HIC and LMIC but similar in UMIC and LIC. Stringency Index was negligible in LIC and similar in LMIC, UMIC and HIC. New positivity rate increased in LMIC and UMIC. The daily incidence rate was positively correlated with the daily mortality rate in both 2020 and 2021. In 2020, Stringency Index was positive in LIC and HIC but a negative association in LMIC and in 2021 there was a positive association between UMIC and HIC. Vaccination coverage did not appear to change with mortality in 2021. Conclusion New COVID-19 cases, tests, vaccinations, positivity rates, and Stringency indices were low in LIC and highest in UMIC. Our findings suggest that the available resources of COVID-19 pandemic would be allocated by need of countries; LIC and UMIC.
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The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study. Sci Rep 2022; 12:11758. [PMID: 35817818 PMCID: PMC9272878 DOI: 10.1038/s41598-022-15647-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04–3.04]), primary schooling or less (RR 2.16 [1.21–3.87]), being overweight (RR 4.34 [1.04–19.01]) or obese (RR 6.55 [1.57–27.37]), having public prenatal care (RR 2.16 [1.01–4.68]), planned pregnancies (RR 2.09 [1.15–3.78]), onset of infection in postpartum period (RR 6.00 [1.37–26.26]), chronic hypertension (RR 2.15 [1.37–4.10]), pre-existing diabetes (RR 3.20 [1.37–7.46]), asthma (RR 2.22 [1.14–4.34]), and anaemia (RR 3.15 [1.14–8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.
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Haber NA, Clarke-Deelder E, Feller A, Smith ER, Salomon JA, MacCormack-Gelles B, Stone EM, Bolster-Foucault C, Daw JR, Hatfield LA, Fry CE, Boyer CB, Ben-Michael E, Joyce CM, Linas BS, Schmid I, Au EH, Wieten SE, Jarrett B, Axfors C, Nguyen VT, Griffin BA, Bilinski A, Stuart EA. Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength. BMJ Open 2022; 12:e053820. [PMID: 35017250 PMCID: PMC8753111 DOI: 10.1136/bmjopen-2021-053820] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. METHODS We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on 26 November 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation. RESULTS After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-sectional), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes. DISCUSSION The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigour to be actionable by policy-makers. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
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Affiliation(s)
- Noah A Haber
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Emma Clarke-Deelder
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Avi Feller
- Department of Statistics, Goldman School of Public Policy, University of California Berkeley, Berkeley, California, USA
| | - Emily R Smith
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Benjamin MacCormack-Gelles
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Clara Bolster-Foucault
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Jamie R Daw
- Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Laura Anne Hatfield
- Department of Biostatistics, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie E Fry
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA
| | - Christopher B Boyer
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Eli Ben-Michael
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Caroline M Joyce
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Beth S Linas
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Applied Public Health and Research, RTI International, Washington, DC, USA
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric H Au
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah E Wieten
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Brooke Jarrett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cathrine Axfors
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Van Thu Nguyen
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | | | - Alyssa Bilinski
- Interfaculty Initiative in Health Policy, Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Martinelli D, Fortunato F, Mazzilli S, Bisceglia L, Lopalco PL, Prato R. Estimating the Proportion of Asymptomatic COVID-19 Cases in an Italian Region with Intermediate Incidence during the First Pandemic Wave: An Observational Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3401566. [PMID: 35005026 PMCID: PMC8733711 DOI: 10.1155/2022/3401566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 12/31/2022]
Abstract
Early in the COVID-19 pandemic, asymptomatic transmission represented an important challenge for controlling the spread of SARS-CoV-2 through the traditional public health strategies. Further understanding of the contribution of asymptomatic infections to SARS-CoV-2 transmission has been of crucial importance for pandemic control. We conducted a retrospective epidemiological study to characterize asymptomatic COVID-19 cases occurred in the Apulia region, Italy, during the first epidemic wave of COVID-19 outbreak (February 29-July 7, 2020). We analyzed data collected in a regional platform developed to manage surveillance activities, namely, investigation and follow-up of cases and contacts, contact tracing, and laboratory and clinical data collection. We included all asymptomatic cases that were laboratory-confirmed during the appropriate follow-up, defined as persons infected with SARS-CoV-2 who did not develop symptoms/clinical signs of the disease. Between February 29 and July 7, 2020, a total of 4,536 cases were diagnosed with COVID-19 among 193,757 tests performed. The group of persons with asymptomatic SARS-CoV-2 infection consisted of 903 cases; the asymptomatic proportion was 19.9% (95% CI: 18.8-21.1%); this decreased with increasing age (OR: 0.89, 95% CI: 0.83-0.96; p = 0.001), in individuals with underlying comorbidities (OR: 0.55, 95% CI: 0.41-0.73; p < 0.001), and in males (OR: 0.69, 95% CI: 0.54-0.87; p = 0.002). The median asymptomatic SARS-CoV-2 RNA positive period was 19 days (IQR: 14-31) and the cumulative proportion of persons with resolution of infection 14 days after the first positive PCR test was 74%. As the public health community is debating the question of whether asymptomatic and late spreaders could sustain virus transmission in the communities, such cases present unique opportunities to gain insight into SARS-CoV-2 adaptation to human host. This has important implications for future COVID-19 surveillance and prevention.
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Affiliation(s)
- Domenico Martinelli
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Fortunato
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sara Mazzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Scuola Normale Superiore, Pisa, Italy
| | - Lucia Bisceglia
- Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Rosa Prato
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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James N, Menzies M. Estimating a continuously varying offset between multivariate time series with application to COVID-19 in the United States. THE EUROPEAN PHYSICAL JOURNAL. SPECIAL TOPICS 2022; 231:3419-3426. [PMID: 35035778 PMCID: PMC8749119 DOI: 10.1140/epjs/s11734-022-00430-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/18/2021] [Indexed: 05/04/2023]
Abstract
This paper introduces new methods to track the offset between two multivariate time series on a continuous basis. We then apply this framework to COVID-19 counts on a state-by-state basis in the United States to determine the progression from cases to deaths as a function of time. Across multiple approaches, we reveal an "up-down-up" pattern in the estimated offset between reported cases and deaths as the pandemic progresses. This analysis could be used to predict imminent increased load on a healthcare system and aid the allocation of additional resources in advance.
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Affiliation(s)
- Nick James
- School of Mathematics and Statistics, University of Melbourne, Parkville, VIC 3010 Australia
| | - Max Menzies
- Beijing Institute of Mathematical Sciences and Applications, Tsinghua University, Beijing, 101408 China
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Haber NA, Clarke-Deelder E, Salomon JA, Feller A, Stuart EA. Impact Evaluation of Coronavirus Disease 2019 Policy: A Guide to Common Design Issues. Am J Epidemiol 2021; 190:2474-2486. [PMID: 34180960 PMCID: PMC8344590 DOI: 10.1093/aje/kwab185] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Policy responses to COVID-19, particularly those related to non-pharmaceutical interventions, are unprecedented in scale and scope. However, policy impact evaluations require a complex combination of circumstance, study design, data, statistics, and analysis. Beyond the issues that are faced for any policy, evaluation of COVID-19 policies is complicated by additional challenges related to infectious disease dynamics and a multiplicity of interventions. The methods needed for policy-level impact evaluation are not often used or taught in epidemiology, and differ in important ways that may not be obvious. Methodological complications of policy evaluations can make it difficult for decision-makers and researchers to synthesize and evaluate strength of evidence in COVID-19 health policy papers. We (1) introduce the basic suite of policy impact evaluation designs for observational data, including cross-sectional analyses, pre/post, interrupted time-series, and difference-in-differences analysis, (2) demonstrate key ways in which the requirements and assumptions underlying these designs are often violated in the context of COVID-19, and (3) provide decision-makers and reviewers a conceptual and graphical guide to identifying these key violations. The overall goal of this paper is to help epidemiologists, policy-makers, journal editors, journalists, researchers, and other research consumers understand and weigh the strengths and limitations of evidence.
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Affiliation(s)
- Noah A Haber
- Meta-Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, CA, USA
- Correspondence to Dr. Noah A Haber, Meta Research Innovation Center at Stanford University, Stanford University, 1265 Welch Rd, Palo Alto, CA 94305 (e-mail: , phone +1 (650) 497-0811, fax: +1 (650) 725-6247)
| | - Emma Clarke-Deelder
- Department of Global Health & Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joshua A Salomon
- Department of Medicine, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford, CA, USA
| | - Avi Feller
- Goldman School of Public Policy, University of California, Berkeley, CA, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Völkel G, Fürstberger A, Schwab JD, Werle SD, Ikonomi N, Gscheidmeier T, Kraus JM, Groß A, Holderried M, Balig J, Jobst F, Kuhn P, Kuhn KA, Kohlbacher O, Kaisers UX, Seufferlein T, Kestler HA. Patient Empowerment During the COVID-19 Pandemic by Ensuring Safe and Fast Communication of Test Results: Implementation and Performance of a Tracking System. J Med Internet Res 2021; 23:e27348. [PMID: 33999836 PMCID: PMC8189287 DOI: 10.2196/27348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Overcoming the COVID-19 crisis requires new ideas and strategies for online communication of personal medical information and patient empowerment. Rapid testing of a large number of subjects is essential for monitoring and delaying the spread of SARS-CoV-2 in order to mitigate the pandemic’s consequences. People who do not know that they are infected may not stay in quarantine and, thus, risk infecting others. Unfortunately, the massive number of COVID-19 tests performed is challenging for both laboratories and the units that conduct throat swabs and communicate the results. Objective The goal of this study was to reduce the communication burden for health care professionals. We developed a secure and easy-to-use tracking system to report COVID-19 test results online that is simple to understand for the tested subjects as soon as these results become available. Instead of personal calls, the system updates the status and the results of the tests automatically. This aims to reduce the delay when informing testees about their results and, consequently, to slow down the virus spread. Methods The application in this study draws on an existing tracking tool. With this open-source and browser-based online tracking system, we aim to minimize the time required to inform the tested person and the testing units (eg, hospitals or the public health care system). The system can be integrated into the clinical workflow with very modest effort and avoids excessive load to telephone hotlines. Results The test statuses and results are published on a secured webpage, enabling regular status checks by patients; status checks are performed without the use of smartphones, which has some importance, as smartphone usage diminishes with age. Stress tests and statistics show the performance of our software. CTest is currently running at two university hospitals in Germany—University Hospital Ulm and University Hospital Tübingen—with thousands of tests being performed each week. Results show a mean number of 10 (SD 2.8) views per testee. Conclusions CTest runs independently of existing infrastructures, aims at straightforward integration, and aims for the safe transmission of information. The system is easy to use for testees. QR (Quick Response) code links allow for quick access to the test results. The mean number of views per entry indicates a reduced amount of time for both health care professionals and testees. The system is quite generic and can be extended and adapted to other communication tasks.
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Affiliation(s)
- Gunnar Völkel
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Axel Fürstberger
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Julian D Schwab
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Silke D Werle
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Nensi Ikonomi
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | | | - Johann M Kraus
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Alexander Groß
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Martin Holderried
- Department of Medical Development and Quality Management, University Hospital Tübingen, Tübingen, Germany
| | - Julien Balig
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | | | - Peter Kuhn
- Comprehensive Cancer Center, University Hospital Ulm, Ulm, Germany
| | - Klaus A Kuhn
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Ulm, Germany
| | - Oliver Kohlbacher
- Institute for Translational Bioinformatics, University Hospital Tübingen, Tübingen, Germany
| | | | - Thomas Seufferlein
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Hans A Kestler
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
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Haber NA, Clarke-Deelder E, Feller A, Smith ER, Salomon J, MacCormack-Gelles B, Stone EM, Bolster-Foucault C, Daw JR, Hatfield LA, Fry CE, Boyer CB, Ben-Michael E, Joyce CM, Linas BS, Schmid I, Au EH, Wieten SE, Jarrett BA, Axfors C, Nguyen VT, Griffin BA, Bilinski A, Stuart EA. Problems with Evidence Assessment in COVID-19 Health Policy Impact Evaluation (PEACHPIE): A systematic review of study design and evidence strength. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501457 PMCID: PMC7836129 DOI: 10.1101/2021.01.21.21250243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. This study systematically reviewed the strength of evidence in the published COVID-19 policy impact evaluation literature. Methods: We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on November 26, 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation, assessing what impact evaluation method was used, graphical display of outcomes data, functional form for the outcomes, timing between policy and impact, concurrent changes to the outcomes, and an overall rating. Results: After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. The majority (n=23/36) of studies in our sample examined the impact of stay-at-home requirements. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-section), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 1/27 studies passed all of the above checks, and 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes. Discussion: The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigor to be actionable by policymakers. This was largely driven by the circumstances under which policies were passed making it difficult to attribute changes in COVID-19 outcomes to particular policies. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
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Affiliation(s)
- Noah A Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Emma Clarke-Deelder
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Avi Feller
- Goldman School of Public Policy, UC Berkeley, Berkeley, CA, USA
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C, USA
| | - Joshua Salomon
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Clara Bolster-Foucault
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Jamie R Daw
- Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Carrie E Fry
- Department of Health Policy, Vanderbilt University, Nashville, TN, USA
| | - Christopher B Boyer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eli Ben-Michael
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Caroline M Joyce
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Beth S Linas
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Clinical Quality and Informatics, MITRE Corp, McLean, VA, USA
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric H Au
- School of Public Health, University of Sydney, Sydney, Australia
| | - Sarah E Wieten
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Brooke A Jarrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Van Thu Nguyen
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | | | - Alyssa Bilinski
- Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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James N, Menzies M, Radchenko P. COVID-19 second wave mortality in Europe and the United States. CHAOS (WOODBURY, N.Y.) 2021; 31:031105. [PMID: 33810707 DOI: 10.1063/5.0041569] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/09/2021] [Indexed: 05/19/2023]
Abstract
This paper introduces new methods to analyze the changing progression of COVID-19 cases to deaths in different waves of the pandemic. First, an algorithmic approach partitions each country or state's COVID-19 time series into a first wave and subsequent period. Next, offsets between case and death time series are learned for each country via a normalized inner product. Combining these with additional calculations, we can determine which countries have most substantially reduced the mortality rate of COVID-19. Finally, our paper identifies similarities in the trajectories of cases and deaths for European countries and U.S. states. Our analysis refines the popular conception that the mortality rate has greatly decreased throughout Europe during its second wave of COVID-19; instead, we demonstrate substantial heterogeneity throughout Europe and the U.S. The Netherlands exhibited the largest reduction of mortality, a factor of 16, followed by Denmark, France, Belgium, and other Western European countries, greater than both Eastern European countries and U.S. states. Some structural similarity is observed between Europe and the United States, in which Northeastern states have been the most successful in the country. Such analysis may help European countries learn from each other's experiences and differing successes to develop the best policies to combat COVID-19 as a collective unit.
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Affiliation(s)
- Nick James
- School of Mathematics and Statistics, University of Sydney, NSW 2006, Australia
| | - Max Menzies
- Yau Mathematical Sciences Center, Tsinghua University, Beijing 100084, China
| | - Peter Radchenko
- School of Business, University of Sydney, NSW 2006, Australia
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Pana TA, Bhattacharya S, Gamble DT, Pasdar Z, Szlachetka WA, Perdomo-Lampignano JA, Ewers KD, McLernon DJ, Myint PK. Country-level determinants of the severity of the first global wave of the COVID-19 pandemic: an ecological study. BMJ Open 2021; 11:e042034. [PMID: 33536319 PMCID: PMC7868125 DOI: 10.1136/bmjopen-2020-042034] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We aimed to identify the country-level determinants of the severity of the first wave of the COVID-19 pandemic. DESIGN Ecological study of publicly available data. Countries reporting >25 COVID-19 related deaths until 8 June 2020 were included. The outcome was log mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential determinants assessed were most recently published demographic parameters (population and population density, percentage population living in urban areas, population >65 years, average body mass index and smoking prevalence); economic parameters (gross domestic product per capita); environmental parameters (pollution levels and mean temperature (January-May); comorbidities (prevalence of diabetes, hypertension and cancer); health system parameters (WHO Health Index and hospital beds per 10 000 population); international arrivals; the stringency index, as a measure of country-level response to COVID-19; BCG vaccination coverage; UV radiation exposure; and testing capacity. Multivariable linear regression was used to analyse the data. PRIMARY OUTCOME Country-level mean mortality rate: the mean slope of the COVID-19 mortality curve during its ascending phase. PARTICIPANTS Thirty-seven countries were included: Algeria, Argentina, Austria, Belgium, Brazil, Canada, Chile, Colombia, the Dominican Republic, Ecuador, Egypt, Finland, France, Germany, Hungary, India, Indonesia, Ireland, Italy, Japan, Mexico, the Netherlands, Peru, the Philippines, Poland, Portugal, Romania, the Russian Federation, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the UK and the USA. RESULTS Of all country-level determinants included in the multivariable model, total number of international arrivals (beta 0.033 (95% CI 0.012 to 0.054)) and BCG vaccination coverage (-0.018 (95% CI -0.034 to -0.002)), were significantly associated with the natural logarithm of the mean death rate. CONCLUSIONS International travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Very early restrictions on international travel should be considered to control COVID-19 outbreaks and prevent related deaths.
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Affiliation(s)
- Tiberiu A Pana
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Sohinee Bhattacharya
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - David T Gamble
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Zahra Pasdar
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Weronika A Szlachetka
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jesus A Perdomo-Lampignano
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kai D Ewers
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - David J McLernon
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Phyo K Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Gombos K, Földi M, Kiss S, Herczeg R, Gyenesei A, Geiger L, Csabai D, Futács K, Nagy T, Miseta A, Somogyi BA, Hegyi P, Szentesi A. Analysis of COVID-19-Related RT-qPCR Test Results in Hungary: Epidemiology, Diagnostics, and Clinical Outcome. Front Med (Lausanne) 2021; 7:625673. [PMID: 33575263 PMCID: PMC7870862 DOI: 10.3389/fmed.2020.625673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/31/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Effective testing is an essential tool for controlling COVID-19. We aimed to analyse the data from first-wave PCR test results in Hungary's Southern Transdanubian region to improve testing strategies. Methods: We performed a retrospective analysis of all suspected COVID-19 cases between 17 March and 8 May 2020, collecting epidemiological, demographic, clinical and outcome data (ICU admission and mortality) with RT-qPCR test results. Descriptive and comparative statistical analyses were conducted. Results: Eighty-six infections were confirmed among 3,657 tested patients. There was no difference between the positive and negative cases in age and sex distribution; however, ICU admission (8.1 vs. 3.1%, p = 0.006) and in-hospital mortality (4.7 vs. 1.6%, p = 0.062) were more frequent among positive cases. Importantly, none of the initially asymptomatic patients (n = 20) required ICU admission, and all survived. In almost all cases, if the first test was negative, second and third tests were performed with a 48-h delay for careful monitoring of disease development. However, the positive hit rate decreased dramatically with the second and third tests compared to the first (0.3 vs. 2.1%, OR = 0.155 [0.053-0.350]). Higher E-gene copy numbers were associated with a longer period of PCR positivity. Conclusion: In our immunologically naïve suspected COVID-19 population, coronavirus infection increased the need for intensive care and mortality by 3-4 times. In the event of the exponential phase of the pandemic involving a bottleneck in testing capacity, a second or third test should be reconsidered to diagnose more coronavirus infections.
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Affiliation(s)
- Katalin Gombos
- Department of Laboratory Medicine, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Mária Földi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Róbert Herczeg
- Bioinformatics Research Group, Genomics and Bioinformatics Core Facility, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Attila Gyenesei
- Bioinformatics Research Group, Genomics and Bioinformatics Core Facility, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Lili Geiger
- Department of Laboratory Medicine, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
- Neurobiology of Stress Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Dávid Csabai
- Department of Laboratory Medicine, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
- Neurobiology of Stress Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Krisztina Futács
- Department of Laboratory Medicine, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Nagy
- Department of Laboratory Medicine, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Attila Miseta
- Department of Laboratory Medicine, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Balázs Antal Somogyi
- National Virology Laboratory, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
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16
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An alternate prospect in detecting presymptomatic and asymptomatic COVID-19 carriers through odor differentiation by HeroRATs. J Vet Behav 2020; 42:26-29. [PMID: 33519319 PMCID: PMC7832940 DOI: 10.1016/j.jveb.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022]
Abstract
The need for a cheap, ubiquitous, sensitive, rapid, noninvasive means of screening large numbers of presymptomatic and asymptomatic samples at departure or arrival into ports of countries, high-risk areas, and within communities forms the subject of this review. The widely used diagnostic test for the SARS-CoV 2 is the real-time reverse transcription–polymerase chain reaction assay while antibody-based techniques are being introduced as supplemental tools, but the lack of specialized nucleic acid extraction and amplification laboratories hampers/slows down timely large-scale testing. The use of animals with sensitive olfactory cue as an alternate testing model could serve as an alternative to detect COVID-19 in the saliva of carriers. The African giant rats are highly versatile and detect odorant molecules from carriers of pathogens with high percentage success after few months of training, hence can be taught to detect odor differences of COVID-19 in asymptomatic and presymptomatic individuals. If these are trained, they could help to curtail further spread of COVID infections.
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17
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Odone A, Delmonte D, Gaetti G, Signorelli C. Doubled mortality rate during the COVID-19 pandemic in Italy: quantifying what is not captured by surveillance. Public Health 2020; 190:108-115. [PMID: 33412438 PMCID: PMC7703200 DOI: 10.1016/j.puhe.2020.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
Objectives It is important to quantify the true burden of coronavirus disease 2019 (COVID-19) in different countries, to enable informed decisions about imposing and relaxing control measures. COVID-19 surveillance data fails in this respect, as it is influenced by different definitions, control policies and capacities. This article aims to quantify excess mortality and estimate the distribution between COVID-19 and non-COVID-19 causes of death. Study design Observational study and mathematical modelling. Methods Publicly available data from multiple institutional sources were used and an in-depth analysis was carried out of deaths from all causes between 2015 and 2020 in Italy at the national, regional and local level. Excess mortality over time and space was first explored, followed by an assessment of how this related to COVID-19 surveillance and, ultimately, assuming a fixed male:female ratio, a model was developed and applied to estimate the proportions of COVID-19 and non-COVID-19 excess mortality in 2020. Results In Italy, the mortality rate doubled in March and April 2020 compared with data from 2015 to 2019 (+109%, when considering municipalites with >10.000 inhabitants), with excess mortality reaching >600% in large municipalities in northern areas. Notified COVID-19 deaths accounted for only 43.5% (regional range: 43–62%) of excess mortality. It is estimated that more than two-thirds of excess deaths that were not captured by surveillance are non-COVID-19 deaths, which could be a result of the excess burden on the health systems, in addition to reduced demand and supply of other non-COVID healthcare services. Conclusions The impact of COVID-19 during the early stages of the pandemic is much larger than official figures have reported. Monitoring excess mortality helps to capture the full effect of the COVID-19 pandemic, which differs between regions in Italy and which might have resulted in significant indirect effects on the well-being of the population. In addition, the COVID-19 pandemic has also resulted in significant indirect effects on the well-being of the population.
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Affiliation(s)
- A Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
| | - D Delmonte
- Italian National Research Council - IMEM, Parma, Italy
| | - G Gaetti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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