The study of spatial autocorrelation for infectious disease epidemiology decision-making: a systematized literature review

In recent years, the global spread of communicable diseases such as Ebola and COVID-19 has stressed the need for clear, geographically targeted, and actionable public health recommendations at appropriate spatial scales. Country-level stakeholders are increasingly utilizing spatial data and spatial decision support systems to optimize resource allocation, and researchers have access to a growing library of spatial data, tools, and software. Application of spatial methods, however, varies widely between researchers, resulting in often unstandardized results, which may be difficult to compare across geographical settings. This literature review aims to compare epidemiological studies, which applies methods including spatial autocorrelation to describe, explain, or predict spatial patterns underlying infectious disease health outcomes, and to describe whether those studies provide clear recommendations.The results of our analysis show an increasing trend in the number of publications applying spatial analysis in epidemiological research per year, with COVID-19, tuberculosis and dengue predominantly studied (43% of n = 98 total articles), and a majority of publication coming from Asia (62%). Spatial autocorrelation was quantified in the majority of studies (72%), and 57 (58%) of articles include some form of statistical modeling of which 11 (19%) accounted for spatial autocorrelation in the model. Most studies (68%) provided some level of recommendation regarding how results should be interpreted for future research or policy development, however often using vague, cautious terms. We recommend the development of standards for spatial epidemiological methods and reporting, and for spatial epidemiological studies to more clearly propose how their findings support or challenge current public health practice. © CAB International 2022 (Online ISSN 1749-8848)

Ethical principles compromised during the COVID-19 pandemic? [Dutch]

In the late 1970s, the American bioethicists Tom Beauchamp and James Childress described the four ethical principles that should guide a physician's actions in individual patient care. These principles are: (a) respect for autonomy;(b) doing well (beneficence);(c) not harming (non-maleficence);and (d) justice. In many countries, the global outbreak of SARS-CoV-2 has led to overloaded healthcare systems due to large numbers of COVID-19 patients. In order to provide care to this high volume of patients, far-reaching measures are taken that affect everyone. These measures are not taken from an individual patient's perspective but in the interest of public health;nonetheless, they can directly affect the individual patient's interests. This article examines the extent to which Beauchamp and Childress' ethical principles may be compromised during the COVID-19 pandemic.

Patient information in times of crisis: Lessons learned from COVID-19 communication in rheumatology

Background: The rapid global spread of COVID-19 required swift action to provide people with rheumatic and musculoskeletal diseases (RMDs) with reliable information. Important issues included the risk of infection and severe illness, (continued) use of medication, temporary closure of clinics, and organization of (semi-) virtual care. People with limited health literacy are a particularly vulnerable group that might have difficulty accessing, understanding, and applying health information. Objectives: To evaluate (a) key aspects of crisis communication and (b) explicit consideration of people's health literacy needs in communication to people with RMDs during the first wave of COVID-19 in the Netherlands. Methods: We conducted an explorative qualitative study including seven interviews in May and June 2020 with representatives of organisations (a mixed regional/academic hospital, the association for RMD professionals and two patient organisations) responsible for information provision to people with RMDs in the Netherlands. Interviewees were asked about preparedness (1) and strategy (2) for crisis communication, and content (3) and reach (4) of communication, considering principles of good crisis communication and health literacy. In addition, through systematic screening of websites, social media and emails, we identified and analysed 13 written communications provided to people with RMDs by these organisations during the first three months of the COVID-19 pandemic. We assessed comprehensibility and applicability with the Dutch adapted version of the Patient Education Materials Assessment tool (PEMAT), the outcome being a percentage of adherence to 24 criteria. We assessed difficulty level using an online assessment application (Figure 1), with Common European Framework of Reference for Languages (CEFR) level B1 being the highest acceptable level. Results: While admittedly being underprepared, respondents generally perceived their crisis communication as adequate. They quickly adapted to people's needs and changing circumstances and attempted to adapt written and verbal communication to people with limited health literacy. Respondents reported challenges related to the scientific uncertainty, lack of reach, difficulty simplifying information, and being unsure if their communication approach was adequate. Textual assessment showed great variation in applicability (range 60-100%) and comprehensibility (range 58-100%) of these texts, and 69% of communications were more difficult than B1-level. Considering principles of crisis communication and health literacy, we propose several lessons to be learned for future crises (Table 1). Conclusion: The rheumatology organisations mostly adhered to principles of crisis communication, and made efforts to adapt information to their audience's needs, including health literacy needs. Nevertheless, important recommendations were drawn which are potentially also relevant for other clinical fields.

Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia.

The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.

La pandémie de COVID-19 et les mesures de riposte incluant des confinements et une réorientation des services de santé ont perturbé les services de santé essentiels destinés aux autres maladies comme la TB, le VIH et le paludisme. En ce qui concerne la TB, les réductions de la détection des cas dues à la pandémie de COVID-19 devrait entraîner une augmentation de la transmission, morbidité et mortalité de la TB. La recherche active des cas (ACF) de TB grâce à des approches communautaires est une stratégie potentielle visant à compenser pour les réductions de détection de la TB en écartant le besoin pour les patients de solliciter des soins dans un structure de santé. Plusieurs approches peuvent être utilisées pour réaliser l'ACF TB de façon sûre et de dépister des populations cibles désignées tout en gérant les risques de transmission du SARS-CoV-2 pour le personnel, les individus et la communauté. Nous présentons un cadre d'options et d'expériences d'adaptation des services TB ACF en réponse aux défis du COVID-19 dans notre programme à Yogyakarta, Indonésie. Les changements majeurs ont inclus une révision des priorités des populations cibles focalisée sur les contacts domiciliaires ; une réduction de la cadence de la recherche de cas ; la mise en œuvre de mesures supplémentaires de lutte contre l'infection et de précautions ; et l'intégration du dépistage de COVID-19 parmi ceux dépistés pour la TB. Notre approche pourrait informer d'autres programmes voulant adapter les services TB ACF afin d'atténuer l'impact négatif du COVID-19 sur la détection des cas de TB.

[Coercive measures for covid-19: application of which law?]

Since the end of January 2020, covid-19 is a group A infectious disease according to the Public Health Act (in Dutch: Wet publiekegezondheid or Wpg). To avert the risk of infection with covid-19, coercive measures can be imposed under this law. Almost at the same time, since January 1 2020, two new Dutch laws regulate the mandatory care for people with intellectual disability and dementia (the Care and Compulsion Act (in Dutch: Wet zorgendwang or Wzd) and for people with a mental disorder (the Mandatory Mental Health Care Act (in Dutch: Wet verplichte GGZ or Wvggz). Just like the Wpg, the Wzd and Wvggz allow coercion for the benefit of third parties. In this clinical lesson we describe the use of the Wpg, Wzd and Wvggz in order to avert covid-19 infection risk.