Digital Epidemiology after COVID-19: impact and prospects (preprint)

Epidemiology and Public Health have increasingly relied on structured and unstructured data, collected inside and outside of typical health systems, to study, identify, and mitigate diseases at the population level. Focusing on infectious disease, we review how Digital Epidemiology (DE) was at the beginning of 2020 and how it was changed by the COVID-19 pandemic, in both nature and breadth. We argue that DE will become a progressively useful tool as long as its potential is recognized and its risks are minimized. Therefore, we expand on the current views and present a new definition of DE that, by highlighting the statistical nature of the datasets, helps in identifying possible biases. We offer some recommendations to reduce inequity and threats to privacy and argue in favour of complex multidisciplinary approaches to tackling infectious diseases.

Integrated environmental and clinical surveillance for the prevention of acute respiratory infections (ARIs) in indoor environments and vulnerable communities (Stell-ARI) (preprint)

Background The epidemiological relevance of viral acute respiratory infections (ARIs) has been dramatically highlighted by COVID-19. However, other viruses cannot be neglected, such as the influenza virus, respiratory syncytial virus, human adenovirus. These viruses thrive in closed spaces, influenced by human and environmental factors. High-risk closed communities are the most vulnerable settings, where the real extent of viral ARIs is often difficult to evaluate, due to the natural disease progression and case identification complexities. During the COVID-19 pandemic, wastewater-based epidemiology has demonstrated its great potential for monitoring the circulation and evolution of the virus in the environment. The “Prevention of ARIs in indoor environments and vulnerable communities” study (Stell-ARI) addresses the urgent need for integrated surveillance and early detection of ARIs within enclosed and vulnerable communities such as Long-Term Care Facilities (LTCFs), prisons and primary schools. The rapid transmission of ARIs in such environments underscores the importance of comprehensive surveillance strategies to minimise the risk of outbreaks and safeguard community health, enabling proactive prevention and control strategies to protect the health of vulnerable populations.Methods The Stell-ARI study consists of designing and validating tools for integrated clinical and environmental-based surveillance for each setting, coupled with analytical methods for environmental matrices. The study design encompasses the development of specialised clinical surveillance involving pseudonymized questionnaires and nasopharyngeal swabs for virus identification, while the environmental surveillance includes air and surface microbiological and chemical monitoring, and virological analysis of wastewater. Integrating this information and the collection of behavioural and environmental risk factors into predictive and risk assessment models will provide a useful tool for early warning, risk assessment and informed decision-making.Discussion This study seeks to integrate clinical, behavioural, and environmental data to establish and validate a predictive model and risk assessment tool for the early warning and risk management of viral ARIs in closed and vulnerable communities prior to the onset of an outbreak.

Political Context of the European Vaccine Debate on Twitter (preprint)

At the beginning of the COVID-19 pandemic, fears grew that making vaccination a political (instead of public health) issue may impact the efficacy of this life-saving intervention, spurring the spread of vaccine-hesitant content. In this study, we examine whether there is a relationship between the political interest of social media users and their exposure to vaccine-hesitant content on Twitter. We focus on 17 European countries using a multilingual, longitudinal dataset of tweets spanning the period before COVID, up to the vaccine roll-out. We find that, in most countries, users' endorsement of vaccine-hesitant content is the highest in the early months of the pandemic, around the time of greatest scientific uncertainty. Further, users who follow politicians from right-wing parties, and those associated with authoritarian or anti-EU stances are more likely to endorse vaccine-hesitant content, whereas those following left-wing politicians, more pro-EU or liberal parties, are less likely. Somewhat surprisingly, politicians did not play an outsized role in the vaccine debates of their countries, receiving a similar number of retweets as other similarly popular users. This systematic, multi-country, longitudinal investigation of the connection of politics with vaccine hesitancy has important implications for public health policy and communication.

Attitudes towards booster, testing and isolation, and their impact on COVID-19 response in winter 2022/2023 in France, Belgium, and Italy (preprint)

European countries are focusing on testing, isolation, and boosting strategies to counter the 2022/2023 winter surge due to Omicron subvariants. However, widespread pandemic fatigue and limited compliance potentially undermine mitigation efforts. To establish a baseline for interventions, we ran a multicountry survey to assess respondents' willingness to receive booster vaccination and comply with testing and isolation mandates. The vast majority of survey participants (N=4,594) was willing to adhere to testing (>91%) and rapid isolation (>88%) across the three countries. Pronounced differences emerged in the declared senior adherence to booster vaccination (73% in France, 94% in Belgium, 86% in Italy). Next, we inferred the vaccine-induced population immunity profile at the winter start from prior vaccination data, immunity waning, and declared booster uptake. Integrating survey and estimated immunity data in a branching process epidemic spreading model, we evaluated the effectiveness and costs of current protocols in France, Belgium, and Italy to manage the winter wave. Model results estimate that testing and isolation protocols would confer significant benefit in reducing transmission (17-24%) with declared adherence. Achieving a mitigating level similar tothe French protocol, the Belgian protocol would require 30% fewer tests and avoid the long isolation periods of the Italian protocol (average of 6 days vs. 11). A cost barrier to test would significantly decrease adherence in France and Belgium, undermining protocols' effectiveness. Simpler mandates for isolation may increase awareness and actual compliance, reducing testing costs, without compromising mitigation. High booster vaccination uptake remains key for the control of the winter wave.

Global misinformation spillovers in the online vaccination debate before and during COVID-19 (preprint)

Anti-vaccination views pervade online social media, fueling distrust in scientific expertise and increasing vaccine-hesitant individuals. While previous studies focused on specific countries, the COVID-19 pandemic brought the vaccination discourse worldwide, underpinning the need to tackle low-credible information flows on a global scale to design effective countermeasures. Here, we leverage 316 million vaccine-related Twitter messages in 18 languages, from October 2019 to March 2021, to quantify misinformation flows between users exposed to anti-vaccination (no-vax) content. We find that, during the pandemic, no-vax communities became more central in the country-specific debates and their cross-border connections strengthened, revealing a global Twitter anti-vaccination network. U.S. users are central in this network, while Russian users also become net exporters of misinformation during vaccination roll-out. Interestingly, we find that Twitter's content moderation efforts, and in particular the suspension of users following the January 6th U.S. Capitol attack, had a worldwide impact in reducing misinformation spread about vaccines. These findings may help public health institutions and social media platforms to mitigate the spread of health-related, low-credible information by revealing vulnerable online communities.

Impact of tiered measures on social contact and mixing patterns in Italy during the second wave of COVID-19 (preprint)

Background: The COVID-19 pandemic has significantly affected social contact patterns worldwide. Particularly during the first epidemic wave, because of the lack of specific treatment or vaccine, most countries around the world enforced non-pharmaceutical interventions. Italy was one of the first countries to be strongly affected by the pandemic, imposing in the first epidemic wave a hard lockdown. During the second wave, the country implemented color-coded, progressively restrictive tiers at the regional level according to weekly epidemiological risk assessments. Methods: We analyze longitudinal surveys of a representative sample of the Italian population by age, gender, and region of residence, collected during the second epidemic wave. After presenting a statistical description of the sample, we compare variations in contact patterns according to a color-coded tier of interventions experienced by the participants. In particular, we use contact matrices to quantify the reduction in the number of contacts by age group and contact settings, focusing on the adult population. We also compare the results with the pre-pandemic baseline assessing the impact of tiered restrictions on contacts. Finally, we compute the reproduction number to evaluate the impact of the restrictions on the spreading of the disease.Results: The comparison with the pre-pandemic baseline, shows a significant decrease in the number of contacts, independently from the age group or contact settings. Moreover, we show that the decrease in the number of contacts significantly depends on the strictness of the non-pharmaceutical interventions. For all levels of strictness considered, the reduction in social mixing results in a reproduction number smaller than one. In particular, the impact of the restriction on the number of contacts decreases with the severity of the interventions. Conclusions: We showed that the progressive restriction tiers implemented in Italy reduced overall the reproduction number, with stricter interventions associated with higher reductions. Readily collected contact data can promptly inform the implementation of mitigation measures at the national level in epidemic emergencies to come.

Echoes through Time: Evolution of the Italian COVID-19 Vaccination Debate (preprint)

Twitter is one of the most popular social media platforms in the country, but pre-pandemic vaccination debate has been shown to be polarized and siloed into echo chambers. It is thus imperative to understand the nature of this discourse, with a specific focus on the vaccination hesitant individuals, whose healthcare decisions may affect their communities and the country at large. In this study we ask, how has the Italian discussion around vaccination changed during the COVID-19 pandemic, and have the unprecedented events of 2020-2021 been able to break the echo chamber around this topic? We use a Twitter dataset spanning September 2019 - November 2021 to examine the state of polarization around vaccination. We propose a hierarchical clustering approach to find the largest communities in the endorsement networks of different time periods, and manually illustrate that it produces communities of users sharing a stance. Examining the structure of these networks, as well as textual content of their interactions, we find the stark division between supporters and hesitant individuals to continue throughout the vaccination campaign. However, we find an increasing commonality in the topical focus of the vaccine supporters and vaccine hesitant, pointing to a possible common set of facts the two sides may agree on. Still, we discover a series of concerns voiced by the hesitant community, ranging from unfounded conspiracies (microchips in vaccines) to public health policy discussion (vaccine passport limitations). We recommend an ongoing surveillance of this debate, especially to uncover concerns around vaccination before the public health decisions and official messaging are made public.

Participatory surveillance for COVID-19 trends detection in Brazil (preprint)

The ongoing COVID-19 pandemic has emphasized the necessity of a well-functioning surveillance system to detect and mitigate disease outbreaks. Traditional surveillance (TS) usually relies on healthcare providers and generally suffers from reporting lags that prevent immediate response plans. Participatory surveillance (PS), an innovative digital approach whereby individuals voluntarily monitor and report on their own health status via Web-based surveys, has emerged in the past decade to complement traditional data collections approaches. This study compares novel PS data on COVID-19 infection rates across nine Brazilian cities with official TS data to examine the opportunities and challenges of using the former, and the potential advantages of combining the two approaches. We find that high participation rates are key for PS data to adequately mirror TS infection rates. Where participation was high, we document a significant trend correlation between lagged PS data and TS infection rates, suggesting that the former could be used for early detection. In our data, forecasting models integrating both approaches increased accuracy up to 3% relative to a 14-day forecast horizon model based exclusively on TS data. Furthermore, we show that the PS data captures a population that significantly differs from the traditional observation. These results corroborate previous studies when it comes to the benefits of an integrated and comprehensive surveillance system, but also shed lights on its limitations, and on the need for additional research to improve future implementations of PS platforms.

Integrating digital and field surveillance to complement efforts to manage epidemic diseases of livestock: African swine fever as a case study (preprint)

The SARS-CoV-2 pandemic has unveiled the importance of stakeholders and ordinary citizens in managing infectious disease emergencies. Efficient management of infectious diseases requires a top-down approach which must be complemented with a bottom-up response to be effective. Here we investigate a novel approach to surveillance for transboundary animal diseases using African Swine fever as a model. We were able to collect data at a population level on information-seeking behavior and at a local level through a targeted questionnaire-based survey to relevant stakeholders such as farmers and veterinary authorities. Our study shows how information-seeking behavior and resulting public attention during an epidemic, can be addressed through novel data streams from digital platforms such as Wikipedia. We also bring evidence on how field surveys aimed at local workers (e.g. farmers) and public authorities remain a crucial tool to assess more in-depth preparedness and awareness among front-line actors. We conclude that they should be used in combination to maximize the outcome of surveillance and prevention activities for selected transboundary animal diseases.

Collective response to the media coverage of COVID-19 Pandemic on Reddit and Wikipedia (preprint)

The exposure and consumption of information during epidemic outbreaks may alter risk perception, trigger behavioural changes, and ultimately affect the evolution of the disease. It is thus of the uttermost importance to map information dissemination by mainstream media outlets and public response. However, our understanding of this exposure-response dynamic during COVID-19 pandemic is still limited. In this paper, we provide a characterization of media coverage and online collective attention to COVID-19 pandemic in four countries: Italy, United Kingdom, United States, and Canada. For this purpose, we collect an heterogeneous dataset including 227,768 online news articles and 13,448 Youtube videos published by mainstream media, 107,898 users posts and 3,829,309 comments on the social media platform Reddit, and 278,456,892 views to COVID-19 related Wikipedia pages. Our results show that public attention, quantified as users activity on Reddit and active searches on Wikipedia pages, is mainly driven by media coverage and declines rapidly, while news exposure and COVID-19 incidence remain high. Furthermore, by using an unsupervised, dynamical topic modeling approach, we show that while the attention dedicated to different topics by media and online users are in good accordance, interesting deviations emerge in their temporal patterns. Overall, our findings offer an additional key to interpret public perception/response to the current global health emergency and raise questions about the effects of attention saturation on collective awareness, risk perception and thus on tendencies towards behavioural changes.

Are people excessively pessimistic about the risk of coronavirus infection? (preprint)

The recent emergence of the SARS-CoV-2 in China has raised the spectre of a novel, potentially catastrophic pandemic in both scientific and lay communities throughout the world. In this particular context, people have been accused of being excessively pessimistic regarding the future consequences of this emerging health threat. However, consistent with previous research in social psychology, a large survey conducted in Europe in the early stage of the COVID-19 epidemic shows that the majority of respondents was actually overly optimistic about the risk of infection.