Islands, remoteness and effective policy making: Aotearoa New Zealand during the COVID-19 pandemic

Aotearoa New Zealand has been identified, by several measures, as being one of a few developed countries that have weathered the COVID-19 pandemic in the best possible way. This outcome is generally attributed to strict but effective public health measures that included – besides very high vaccination rates – national and regional lockdowns, as well as total closure of the border except for returning citizens (who were subject to mandatory quarantining). Concurrent fiscal and monetary policies contributed to economic outcomes that remained remarkably buoyant. In this paper we assess the importance of public interventions in New Zealand triggered by the pandemic relative to the mitigating effects of the country being an island nation with a small population scale, low population density and remote location. We summarize the recent international literature, estimate simple but representative cross-country regression models, and provide a qualitative evaluation of the public policy response. We find that the favourable effects of low average population density, remoteness and the absence of land borders have indeed been of great benefit. Geography assisted in the effectiveness of the elimination strategy which was only abandoned in favour of a mitigation strategy once the less severe but highly contagious Omicron variants arrived in early 2022. Hence, while a remote and peripheral location is generally seen as economically disadvantageous, during a pandemic it delays the spread of a viral disease and provides the opportunity to focus on interventions to maintain economic activity, develop effective public health responses and learn from the experience of less remote nations. © 2023 The Authors. Regional Science Policy & Practice published by John Wiley & Sons Ltd on behalf of Regional Science Association International.

A large outbreak of the Kappa mutation of COVID-19 in Cork, Ireland, April-May 2021.

BACKGROUND: In May 2021, the B.1.617 variant of SARS-CoV-2 emerged in Ireland, and both Delta and Kappa sub-lineages were initially deemed variants of concern (VOCs) on a precautionary basis. We describe a large outbreak of SARS-CoV-2 B.1.617.1 (Kappa mutation) linked to a private gathering among third level students in Cork, Ireland. METHODS: Surveillance data were available from the Health Service Executive COVID Care Tracker. The epidemiological sequence of infection for each new case in this outbreak was tracked and whole genome sequencing was requested on all linked cases. Enhanced public health control measures were implemented by the Department of Public Health HSE-South to contain onward spread of VOCs, including retrospective contact tracing, lengthy isolation and quarantine periods for cases and close contacts. Extensive surveillance efforts were used to describe and control onward transmission. RESULTS: There were 146 confirmed SARS-CoV-2 cases linked to the outbreak. All sequenced cases (53/146; 36%) confirmed Kappa mutation. The median age was 21 years (range 17-65). The majority (88%) had symptoms of SARS-CoV-2 infection. There were 407 close contacts; the median was 3 per case (range 0-14). There were no known hospitalisations, ICU admissions or deaths. Vaccination data was unavailable, but the outbreak pre-dated routine availability of COVID-19 vaccines among younger adults in Ireland. CONCLUSION: Enhanced public health control measures for new and emerging variants of SARS-CoV-2 may be burdensome for cases and close contacts. The overall public health benefit of enhanced controls may only become apparent when evidence on disease transmissibility and severity becomes more complete.

A Tale of Two Cities During the COVID-19 Pandemic: Evaluating Food Insecurity in Chicago and New York City.

BACKGROUND: COVID-19 revealed and broadened existing disparities in large cities. This article interprets the early impacts of COVID-19 on food insecurity (FI) in the Chicago and New York City (NYC) metropolitan areas for Black, Indigenous, and People of Color (BIPOC) and provides a study using a Social Determinants of Health (SDOH) framework. METHODS: A cross-sectional survey adapted from the National Food Access and COVID Research Team (NFACT) was deployed in Chicago (N = 680) and in NYC (N = 525) during summer 2020 and oversampled for race, ethnicity, and socioeconomic status. Multivariate binary logistic regression generated adjusted odds ratios (aOR) and 95% CIs for FI and select SDOH variables, which was conducted on each dataset. RESULTS: The prevalence of FI in NYC increased to 66.8% (from 57.8%) and in Chicago to 44.8% (from 41.0%). While higher income protected against FI before, protection was diminished or eliminated since COVID-19. FI declined for households with children in NYC while odds increased and became significant in Chicago. Respondents with chronic health conditions experienced increased odds of FI since COVID. In Chicago, this variable had the highest odds of FI. Respondents with depression or anxiety had increased odds of FI. In NYC, depression had the highest odds of FI. Females in NYC were protected against FI. Hispanics in NYC lost protection against FI from before to since COVID-19. CONCLUSIONS: Results support the observed rise of FI for BIPOC and its association with health status. The analysis has multifaceted, structural policy implications for reducing FI in urban centers.

Covid-19 presentation among symptomatic healthcare workers in Ireland:a case control study

Introduction: It is recognized that healthcare workers are at high risk of contracting Covid-19. The aims of the study were to describe the presenting symptoms of healthcare workers who developed Covid-19 in Ireland, & to estimate the odds of specific symptoms being associated with a positive Covid-19 polymerase chain reaction result. Methods: A retrospective chart review of symptomatic healthcare workers who self-presented for Covid-19 testing in Cork from March-May 2020 was conducted. A sex-matched case–control study was carried out to compare presenting features among those who tested positive compared to those who tested negative. Univariate & multivariable-adjusted conditional logistic regression models were run using Stata 15.0 to identify the symptoms associated with positive Covid-19 swab results. Results: 306 healthcare workers were included in the study;102 cases & 204 controls. Common presenting features among cases were fever/chills (55%), cough (44%) & headache (35%). The symptoms which were significantly associated with a positive Covid-19 swab result were loss of taste/smell (adjusted odds ratio [aOR] 12.15, 95% confidence interval [CI] 1.36–108.79), myalgia (aOR 2.36, 95% 1.27–4.38), fatigue (aOR 2.31, 95% CI 1.12–4.74), headache (aOR 2.11, 95% CI 1.19–3.74) & fever/chills (aOR 1.88, 95% CI 1.12–3.15). Conclusions: Fever, fatigue, myalgia, loss of taste/smell & headache were associated with increased odds of a Covid-19 diagnosis among symptomatic self-referred healthcare workers compared with those had negative swab results. Testing criteria should reflect the broad range of possible symptoms of Covid-19.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Factors affecting aerosol SARS-CoV-2 transmission via HVAC systems; a modeling study.

The role of heating, ventilation, and air-conditioning (HVAC) systems in the transmission of SARS-CoV-2 is unclear. To address this gap, we simulated the release of SARS-CoV-2 in a multistory office building and three social gathering settings (bar/restaurant, nightclub, wedding venue) using a well-mixed, multi-zone building model similar to those used by Wells, Riley, and others. We varied key factors of HVAC systems, such as the Air Changes Per Hour rate (ACH), Fraction of Outside Air (FOA), and Minimum Efficiency Reporting Values (MERV) to examine their effect on viral transmission, and additionally simulated the protective effects of in-unit ultraviolet light decontamination (UVC) and separate in-room air filtration. In all building types, increasing the ACH reduced simulated infections, and the effects were seen even with low aerosol emission rates. However, the benefits of increasing the fraction of outside air and filter efficiency rating were greatest when the aerosol emission rate was high. UVC filtration improved the performance of typical HVAC systems. In-room filtration in an office setting similarly reduced overall infections but worked better when placed in every room. Overall, we found little evidence that HVAC systems facilitate SARS-CoV-2 transmission; most infections in the simulated office occurred near the emission source, with some infections in individuals temporarily visiting the release zone. HVAC systems only increased infections in one scenario involving a marginal increase in airflow in a poorly ventilated space, which slightly increased the likelihood of transmission outside the release zone. We found that improving air circulation rates, increasing filter MERV rating, increasing the fraction of outside air, and applying UVC radiation and in-room filtration may reduce SARS-CoV-2 transmission indoors. However, these mitigation measures are unlikely to provide a protective benefit unless SARS-CoV-2 aerosol emission rates are high (>1,000 Plaque-forming units (PFU) / min).

A Multi-Site Analysis of the Prevalence of Food Security in the United States, before and during the COVID-19 Pandemic (preprint)

Background. The COVID-19 pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support, and identify long-term impacts and needs. Objective. Our team- the National Food Access and COVID research Team (NFACT) was formed to assess food security over different U.S. study sites throughout the pandemic, using common instruments and measurements. Here we present results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. Methods. A validated survey instrument was developed and implemented in whole or part across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA six-item module. Food security prevalence was analyzed using analysis of variance by sampling method to statistically significant differences. Results. In total, more than 27,000 people responded to the surveys. We find higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, as compared to before the pandemic. In nearly all study sites, we find higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. We also demonstrate lingering food insecurity, with high or increased prevalence over time in sites with repeat surveys. We find no statistically significant differences between convenience and representative surveys, but statistically higher prevalence of food insecurity among high-risk compared to convenience surveys. Conclusions. This comprehensive multi-study site effort demonstrates higher prevalence of food insecurity since the beginning of the COVID-19 pandemic, which in multiple survey sites continues throughout the first year of the pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations.

Covid-19 presentation among symptomatic healthcare workers in Ireland.

BACKGROUND: It is recognized that healthcare workers (HCWs) are at high risk of contracting Covid-19. It is incumbent on occupational health staff to recognize potential symptoms of Covid-19 among HCWs. AIMS: The aims of the study were to describe the presenting symptoms of HCWs who developed Covid-19 in Ireland, and to estimate the odds of specific symptoms being associated with a positive Covid-19 polymerase chain reaction (PCR) result. METHODS: A retrospective chart review of all symptomatic HCWs who self-presented for Covid-19 testing in Cork from March to May 2020 was conducted. A sex-matched case-control study was carried out to compare presenting features among those who tested positive compared to those who tested negative. Univariate and multivariable-adjusted conditional logistic regression models were run using Stata 15.0 to identify the symptoms associated with positive Covid-19 swab results. RESULTS: Three hundred and six HCWs were included in the study; 102 cases and 204 controls. Common presenting features among cases were fever/chills (55%), cough (44%) and headache (35%). The symptoms which were significantly associated with a positive Covid-19 swab result were loss of taste/smell (adjusted odds ratio [aOR] 12.15, 95% confidence interval [CI] 1.36-108.79), myalgia (aOR 2.36, 95% 1.27-4.38), fatigue (aOR 2.31, 95% CI 1.12-4.74), headache (aOR 2.11, 95% CI 1.19-3.74) and fever/chills (aOR 1.88, 95% CI 1.12-3.15). CONCLUSIONS: Fever, fatigue, myalgia, loss of taste/smell and headache were associated with increased odds of a Covid-19 diagnosis among symptomatic self-referred HCWs compared with those had negative swab results. Testing criteria for HCWs should reflect the broad range of possible symptoms of Covid-19.

Mobile ECMO for Covid-19 Does Not Pose Extra Risk to Transport Team

Transporting patients on ECMO is a proven safe and effective mode of transferring critically ill patients requiring maximum mechanical ventilator support to a regional quaternary care center. Prior to the COVID-19 pandemic, mobile ECMO teams were able to be transported without suffering adverse events. With the COVID-19, the safety of the staff and transport team adds a new layer of challenges. We conducted a retrospective study of 79 patients (median age 36 years old, 41% male) who were cannulated at an outside hospital and transported on Venovenous or Venoarterial ECMO to one of five quaternary care centers. The average distance travelled was 27 miles (SD 23 miles) and the duration of the transport was 56 minutes (SD 36 minutes) from ambulance bay to ambulance bay. The teams consisted of 1-2 physicians for cannulation and patient management, 2 critical care transport nurses and a driver or pilot. Mobile ECMO team members practiced strict ACE precautions while caring for the patient and were in standard PPE at other times. The primary mode of transportation was ground. Six patients were transported by air. There were no instances of transport related adverse events including pump failures, cannulation complications at the OSH or decannulations in transit. There were no instances of the transport team members contracting COVID-19 at 30 days after transport. By adhering to best practices and ACE precautions, patients with COVID-19 can be safely cannulated at an outside hospital and transported to a quaternary care center without increased risk to the transport team.