Public misunderstanding of pivotal COVID-19 vaccine trials may contribute to New Zealand's adoption of a costly and economically inefficient vaccine mandate

New Zealand adopted a policy of mandatory COVID-19 vaccination for workers in many sectors. Existing analysis suggests expected costs of this mandate policy far outweigh benefits. This paper discusses an issue potentially contributing to adoption of this costly vaccine mandate policy. There is a widespread public misunderstanding about the testing the vaccines underwent in the pivotal trials underpinning their approval, with over 95% of New Zealand's voting-age public believing that the vaccines were tested against more demanding criteria than was actually the case. Consequently, public expectations about performance of these vaccines were likely inflated, and expected benefits of vaccine mandates may have been overstated. The ambiguous evidence on effects of COVID-19 vaccination on mortality risk also highlights the importance of these informational problems. If the public misunderstanding described here persists, a continuation of inefficient vaccine mandates whose costs exceed benefits is likely.

The epidemiology, healthcare and societal burden of basal cell carcinoma in Wales 2000-2018: a retrospective nationwide analysis.

BACKGROUND: Basal cell carcinoma (BCC) represents the most commonly occurring cancer worldwide within the white population. Reports predict 298 308 cases of BCC in the UK by 2025, at a cost of £265-366 million to the National Health Service (NHS). Despite the morbidity, societal and healthcare pressures brought about by BCC, routinely collected healthcare data and global registration remain limited. OBJECTIVES: To calculate the incidence of BCC in Wales between 2000 and 2018 and to establish the related healthcare utilization and estimated cost of care. METHODS: The Secure Anonymised Information Linkage (SAIL) databank is one of the largest and most robust health and social care data repositories in the UK. Cancer registry data were linked to routinely collected healthcare databases between 2000 and 2018. Pathological data from Swansea Bay University Health Board (SBUHB) were used for internal validation. RESULTS: A total of 61 404 histologically proven BCCs were identified within the SAIL Databank during the study period. The European age-standardized incidence for BCC in 2018 was 224.6 per 100 000 person-years. Based on validated regional data, a 45% greater incidence was noted within SBUHB pathology vs. matched regions within SAIL between 2016 and 2018. A negative association between deprivation and incidence was noted with a higher incidence in the least socially deprived and rural dwellers. Approximately 2% travelled 25-50 miles for dermatological services compared with 37% for plastic surgery. Estimated NHS costs of surgically managed lesions for 2002-2019 equated to £119.2-164.4 million. CONCLUSIONS: Robust epidemiological data that are internationally comparable and representative are scarce for nonmelanoma skin cancer. The rising global incidence coupled with struggling healthcare systems in the post-COVID-19 recovery period serve to intensify the societal and healthcare impact. This study is the first to demonstrate the incidence of BCC in Wales and is one of a small number in the UK using internally validated large cohort datasets. Furthermore, our findings demonstrate one of the highest published incidences within the UK and Europe.

A synthetic control analysis of U.S. state level COVID-19 stay-at-home orders on new jobless claims

There is an ongoing debate regarding the economic consequences of public policies designed to curb public health crises, such as the COVID-19 pandemic. Many opponents of such policies claim that their economic costs may outweigh their health benefits. In this paper, we use synthetic control analysis to determine the impact of stay-at-home orders on weekly new jobless claims during the initial phase of the COVID-19 pandemic. Our analysis reveals that while new jobless claims spike following the stay-at-home orders, similar spikes are observed within our synthetic control. Specifically, we find that stay-at-home orders account for only 32 percent of the increase in new jobless claims, with the majority of the increase being driven by factors outside of the policy, such as the general spread of the virus and waning consumer confidence.

Jabbing the economy back to life?

The pace and scope of Covid-19 vaccination has varied greatly across OECD countries. In this paper, monthly data on vaccination rates for the 32 OECD countries with high-frequency all-cause mortality rates available are related to seven monthly economic activity indicators: night-time lights and Google Mobility reports for six types of locations. Vaccination rates are also related to Covid response stringency, to Covid cases and deaths, and to all-cause mortality. A standard deviation higher fully vaccinated rate is associated with up to an 0.5 standard deviation larger rise in economic activity over the same month in 2020;an effect due to relaxed response stringency. The partial vaccination rate has no relationship with the economic rebound. These associations with changes in economic activity occur despite no apparent relationship between vaccination rates and changes in Covid-19 cases or changes in mortality.

Generalized Kubelka's theory for light transmission in multilayer materials and its application for UV light penetration in filtering facepiece respirators.

The spread of SARS-CoV-2 has resulted in the shortage of filtering facepiece respirators (FFRs). As a result, the use of ultraviolet (UV) irradiation for disinfection and reuse of FFRs has been the topic of much investigation. In this article, a mathematical model is developed based on Kubelka's theory to determine light transmission in multilayer materials, such as N95 masks. Using this model, the predicted UV transmittance and absorbance of a N95 mask layers were found to be in close agreement with the experimental values. In addition, when the mask was exposed to UV equally from both surfaces, the estimated minimum UV irradiance inside the N95 mask was 14.5% of the incident irradiance, suggesting a significant degree of light penetration. The proposed model provides a simple and practical methodology for the design and use of UV decontamination equipment for FFRs and other multilayer materials.

Government mandated lockdowns do not reduce Covid-19 deaths: implications for evaluating the stringent New Zealand response

The New Zealand policy response to Coronavirus was the most stringent in the world during the Level 4 lockdown. Up to 10 billion dollars of output (≈3.3% of GDP) was lost in moving to Level 4 rather than staying at Level 2, according to Treasury calculations. For lockdown to be optimal requires large health benefits to offset this output loss. Forecast deaths from epidemiological models are not valid counterfactuals, due to poor identification. Instead, I use empirical data, based on variation amongst United States counties, over one-fifth of which just had social distancing rather than lockdown. Political drivers of lockdown provide identification. Lockdowns do not reduce Covid-19 deaths. This pattern is visible on each date that key lockdown decisions were made in New Zealand. The apparent ineffectiveness of lockdowns suggests that New Zealand suffered large economic costs for little benefit in terms of lives saved.

Hard, not early: putting the New Zealand Covid-19 response in context

A popular narrative that New Zealand’s policy response to Coronavirus was ‘go hard, go early’ is misleading. While restrictions were the most stringent in the world during the Level 4 lockdown in March and April, these were imposed after the likely peak in new infections. I use the time path of Covid-19 deaths for each OECD country to estimate inflection points. Allowing for the typical lag from infection to death, new infections peaked before the most stringent policy responses were applied in many countries, including New Zealand. The cross-country evidence shows that restrictions imposed after the inflection point in infections is reached are ineffective in reducing total deaths. Even restrictions imposed earlier have just a modest effect;if Sweden’s more relaxed restrictions had been used, an extra 310 Covid-19 deaths are predicted for New Zealand – far fewer than the thousands of deaths in some widely reported mathematical simulations.

Kinetics and Monte Carlo simulation of UV disinfection of B. subtilis spores and SARS-CoV-2 in dried saliva droplets.

Surfaces can be contaminated by droplets produced through coughing or sneezing. In this exploratory work, the UV disinfection results of Bacillus subtilis spores in dried saliva droplets were fitted to a three-parameter kinetic model (R2 ≥ 0.97). This model has a disinfection rate constant for single organisms and a smaller one for aggregates found in droplets. The fraction of organisms found in aggregates (ß) could account for the effects of different-sized droplets in the experimental work. Since a wide spectrum of droplet sizes can be produced, and some of the rate constants were uncertain, Monte Carlo simulation was used to estimate the UV inactivation performance in dried saliva droplets in a variety of conditions. Using conservative distribution for ß, the model was applied to the UV disinfection of SARS-CoV-2 in dried saliva droplets. It was shown that a one-log reduction of SARS-CoV-2 was very likely (p>99.9%) and a two-log reduction was probable (p=75%) at a dose of 60 mJ/cm2. Aggregates tend to be variable and limit the log reductions that can be achieved at high UV doses.

Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study.

BACKGROUND: A significant proportion of healthcare resource has been diverted to the care of those with COVID-19. This study reports the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic. METHODS: We used hospital episode statistics for all adult patients undergoing surgery between January 1, 2020 and December 31, 2020 in England and Wales. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from 2016 to 2019 with the actual number of procedures in 2020. Using a linear regression model, we calculated the expected cumulative number of cancelled procedures by December 31, 2021. RESULTS: The total number of surgical procedures carried out in England and Wales in 2020 was 3 102 674 compared with the predicted number of 4 671 338 (95% confidence interval [CI]: 4 218 740-5 123 932). This represents a 33.6% reduction in the national volume of surgical activity. There were 763 730 emergency surgical procedures (13.4% reduction) compared with 2 338 944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1 568 664 (95% CI: 1 116 066-2 021 258). We estimate that this will increase to 2 358 420 (95% CI: 1 667 587-3 100 808) up to December 31, 2021. CONCLUSIONS: The volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in more than 1.5 million cancelled operations. This deficit will continue to grow in 2021.

Evaluation of a primary care-based collaborative care model (PARTNERS2) for people with diagnoses of schizophrenia, bipolar, or other psychoses: study protocol for a cluster randomised controlled trial.

BACKGROUND: Current NHS policy encourages an integrated approach to provision of mental and physical care for individuals with long term mental health problems. The 'PARTNERS2' complex intervention is designed to support individuals with psychosis in a primary care setting. AIM: The trial will evaluate the clinical and cost-effectiveness of the PARTNERS2 intervention. DESIGN & SETTING: This is a cluster randomised controlled superiority trial comparing collaborative care (PARTNERS2) with usual care, with an internal pilot to assess feasibility. The setting will be primary care within four trial recruitment areas: Birmingham & Solihull, Cornwall, Plymouth, and Somerset. GP practices are randomised 1:1 to either (a) the PARTNERS2 intervention plus modified standard care ('intervention'); or (b) standard care only ('control'). METHOD: PARTNERS2 is a flexible, general practice-based, person-centred, coaching-based intervention aimed at addressing mental health, physical health, and social care needs. Two hundred eligible individuals from 39 GP practices are taking part. They were recruited through identification from secondary and primary care databases. The primary hypothesis is quality of life (QOL). Secondary outcomes include: mental wellbeing, time use, recovery, and process of physical care. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action, and look for unintended consequences. An economic evaluation will estimate its cost-effectiveness. Intervention delivery and follow-up have been modified during the COVID-19 pandemic. CONCLUSION: The overarching aim is to establish the clinical and cost-effectiveness of the model for adults with a diagnosis of schizophrenia, bipolar, or other types of psychoses.

Direct and Indirect Effects of Covid-19 On Life Expectancy and Poverty in Indonesia

The spread and threat of Covid-19 have resulted in unprecedented economic and public health responses in Indonesia and elsewhere. We analyse the direct and indirect effects of Covid-19 on life expectancy and poverty in Indonesia, and the responses to the virus. We view life expectancy and poverty as indicators of quantity and quality of life. Our analysis shows that the indirect effects on life expectancy, which operate through lower future income, exceed the direct effects of Covid-19-related deaths by at least five orders of magnitude. The reduction in long-run real income due to the Covid-19 shock may reduce life expectancy by up to 1.7 years, compared with what could otherwise be expected. In contrast, even if the Covid-19 death toll to date were 40 times worse, life expectancy would fall by just two days. Given this imbalance between direct and indirect effects, any interventions to reduce the risk of Covid-19 must be finely targeted and must consider indirect effects. Our analysis of the geographic pattern of poverty effects, which is based on near real-time mobility data, discusses how targeted interventions that are less fiscally costly could be developed. Such interventions should pose less of a threat to future growth and may help to reduce the indirect effects of the Covid-19 shock.

Fatal central nervous system co-infection with SARS-CoV-2 and tuberculosis in a healthy child.

BACKGROUND: Central and peripheral nervous system symptoms and complications are being increasingly recognized among individuals with pandemic SARS-CoV-2 infections, but actual detection of the virus or its RNA in the central nervous system has rarely been sought or demonstrated. Severe or fatal illnesses are attributed to SARS-CoV-2, generally without attempting to evaluate for alternative causes or co-pathogens. CASE PRESENTATION: A five-year-old girl with fever and headache was diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis, and magnetic resonance imaging findings. Serial serologic tests for SARS-CoV-2 IgG and IgA showed seroconversion, consistent with an acute infection. Mental status and brain imaging findings gradually worsened despite antiviral therapy and intravenous dexamethasone. Decompressive suboccipital craniectomy for brain herniation with cerebellar biopsy on day 30 of illness, shortly before death, revealed SARS-CoV-2 RNA in cerebellar tissue using the Centers for Disease Control and Prevention 2019-nCoV Real-Time Reverse Transcriptase-PCR Diagnostic Panel. On histopathology, necrotizing granulomas with numerous acid-fast bacilli were visualized, and Mycobacterium tuberculosis complex DNA was detected by PCR. Ventricular cerebrospinal fluid that day was negative for mycobacterial DNA. Tracheal aspirate samples for mycobacterial DNA and culture from days 22 and 27 of illness were negative by PCR but grew Mycobacterium tuberculosis after 8 weeks, long after the child's passing. She had no known exposures to tuberculosis and no chest radiographic findings to suggest it. All 6 family members had normal chest radiographs and negative interferon-γ release assay results. The source of her tuberculous infection was not identified, and further investigations by the local health department were not possible because of the State of Michigan-mandated lockdown for control of SARS-CoV-2 spread. CONCLUSION: The detection of SARS-CoV-2 RNA in cerebellar tissue and the demonstration of seroconversion in IgG and IgA assays was consistent with acute SARS-CoV-2 infection of the central nervous infection. However, the cause of death was brain herniation from her rapidly progressive central nervous system tuberculosis. SARS-CoV-2 may mask or worsen occult tuberculous infection with severe or fatal consequences.

Indonesia in the Time of Covid-19

The Covid-19 virus has spread across the world with alarming speed, infecting millions and causing economic disruption on an unprecedented scale. In this survey, we examine the impact of the outbreak on the Indonesian economy, as well as the government's response to the public health crisis and its provisions for the emerging economic crisis. Indonesia's delay in responding to the health crisis while Covid-19 spread in neighbouring countries in January-February 2020 has been costly for the health of the population. The government's policy responses have so far been aimed at steadying the ship, addressing both the needs of the poor and the potentially poor (vulnerable) groups. At the time of writing, Covid-19 had not been tamed in Indonesia by any means. Hence, its implications for economic growth, jobs and welfare remained uncertain, as policy discussions were all about opening up the economy from virus-imposed restrictions across the country, under what has been termed the 'new normal'.