ABSTRACT
Background: . This paper presents, for the first time, the Epidemic Volatility Index (EVI), a conceptually simple, early warning tool for emerging epidemic waves. Methods: . EVI is based on the volatility of the newly reported cases per unit of time, ideally per day, and issues an early warning when the rate of the volatility change exceeds a threshold. Results: . Results from the COVID-19 epidemic in Italy and New York are presented here, while daily updated predictions for all world countries and each of the United States are available online. Interpretation . EVI’s application to data from the current COVID-19 pandemic revealed a consistent and stable performance in terms of detecting oncoming waves. The application of EVI to other epidemics and syndromic surveillance tasks in combination with existing early warning systems will enhance our ability to act fast and optimize containment of outbreaks.
Subject(s)
COVID-19 , Encephalitis, Arbovirus , SyndromeABSTRACT
Background: As the COVID-19 pandemic unfolded, rapid case increase was observed in multiple cities in Iran. However, in the absence of seroprevalence surveys, the true infection rate remains unknown. In this population-based study we assessed the seroprevalence of SARS-CoV-2 antibodies in eighteen cities of Iran.Methods: We randomly selected and invited study participants from the general population (N = 3,547) and occupations with high risk of COVID-19 exposure, defined as high-risk population (e.g., supermarket employees) (N = 5,391), in eighteen cities of Iran. SARS-CoV-2 ELISA kits were used to detect antibody against COVID-19. Crude, population weight adjusted, and test performance adjusted seroprevalence rates were estimated.Findings: The population weight adjusted and test performance adjusted prevalence rates of antibody seropositivity in general population were 13·1% (95% CI 11·6-14·8%) and 18·5% (95% CI 16·1-21·3%), respectively. The population-weighted seroprevalence estimate implies that 3,290,633 (95% CI 2,907185-3,709,167) individuals, from the eighteen included cities in this study, were infected by end of April 2020.The overall prevalence rate was higher among individuals aged ≥ 60 years (32·0%, 95% CI 23·9-40·8%) and with comorbidity condition (23·7%, 95% CI 18·5-28·8%). The estimated seroprevalence of SARS-CoV-2 antibodies varied greatly by city and the highest population test-adjusted prevalence rates were in Rasht 78·1% (95% CI 58·3-98·3%) and Qom (66·5%, 95% CI 39·9-95·4%) cities. The test-adjusted prevalence did not differ between low and high-risk populations and was about 20.0%.Interpretations: The findings of this study imply that prevalence of seropositivity is likely much higher than the reported prevalence rates based on confirmed COVID-19 cases in Iran. Despite the high seroprevalence rates in a few cities, the low overall prevalence estimates indicate that a large proportion of population is still susceptible to the virus. The similar seroprevalence estimates between low and high-risk occupations might be an indicator of inadequate or low adherence to infection control measures among general population.Funding Statement: Iranian Ministry of Health and Medical Education COVID-19 Grant (number 99-1-97-47964).Declaration of Interests: None to disclose.Ethics Approval Statement: Ethics approval for this study was granted by Vice-Chancellor in Research Affairs-Tehran University of Medical Sciences (IR. TUMS.VCR.REC.1399.308)
Subject(s)
COVID-19ABSTRACT
Periodical daily variation in the number of reported COVID-19 cases within weeks is a common observation in global and national statistics. This variation may imply that the day of week has a significant role in the number of reported cases. We compared the pattern in some countries with an acceptable surveillance system. Data of 18 European and North American countries between 6 Mar and 8 Nov 2020 were extracts. Harmonic regression models were used to quantify the peak day, the absolute intensity and the average of coefficient of variation within weeks (ACVW) classified by country. In eight countries, the within week variation was statistically significant, the maximum and minimum number reported cases were in Saturday and Monday respectively, however, this pattern varied among countries. The maximum of ACVW was observed in Belgium and France, while it was minimum in Russia. The level of intensity of infection had a positive association with the ACVW (r = 0.54, p-value = 0.021). The observed variation and its pattern may show that the coverage or the tidiness of COVID-19 surveillance system fluctuates in different days of week. In addition, we suggest that the level of this fluctuation might be used as an accuracy indicator of the surveillance system.
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COVID-19ABSTRACT
Background During the first months of the COVID-19 pandemic, Iran reported high numbers of infections and deaths in the Middle East region. In the following months, the burden of this infection decreased significantly, possibly due to the impact of a package of interventions. We modeled the dynamics of COVID-19 infection in Iran to quantify the impacts of these interventions.Methods We used a modified susceptible–exposed–infected–recovered (SEIR) model to model the COVID-19 epidemic in Iran, from 21 January to 21 September 2020, using Markov chain Monte Carlo simulation to calculate 95% uncertainty intervals (UI). We used the model to assess the effectiveness of physical distancing measures and self-isolation under different scenarios. We also estimated the control reproductive number (Rc), using our mathematical model and epidemiologic data.Results If no non-pharmaceutical interventions (NPIs) were applied, there could have been a cumulative number of 51,800,000 (95% UI: 19,100,000–77,600,000) COVID-19 infections and 266,000 (95% UI: 119,000–476,000) deaths by September 21 2020. If physical distancing interventions, such as school/border closures and self-isolation interventions, had been introduced a week earlier than they were actually launched, a 30% reduction in the number of infections and deaths could have been achieved by September 21 2020. The observed daily number of deaths showed that the Rc was one or more than one almost every day during the analysis period.Conclusions Our models suggest that the NPIs implemented in Iran between 21 January and 21 September 2020 had significant effects on the spread of the COVID-19 epidemic. Therefore, we recommend that these interventions are considered when designing future control programs, while simultaneously considering innovative approaches that can minimize harmful economic impacts on the community and the state. Our study also showed that the timely implementation of NPIs showed a profound effect on further reductions in the numbers of infections and deaths. This highlights the importance of forecasting and early detection of future waves of infection and of the need for effective preparedness and response capabilities.
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COVID-19 , DeathABSTRACT
Background & aimsHepatic manifestations of coronavirus disease 2019 (COVID-19) are common among people infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). This systematic review aimed to summarize the evidence on COVID-19 patients with HBV or HCV co-infections. MethodsWe searched multiple electronic databases and preprint servers from December 1, 2019 to August 9, 2020. Studies were included if they reported quantitative empirical data on COVID-19 patients with HBV or HCV co-infections. Descriptive analyses were reported and data were narratively synthesized. Quality assessments was completed using the Joanna Briggs Institute critical appraisal tools. ResultsOut of the 941 identified records, 28 studies were included. Of the eligible studies, 235 patients with COVID-19 were infected with HBV and 22 patients with HCV. Most patients were male and mean age was 49.8 and 62.8 in patients with HBV and HCV, respectively. Death proportion was 6% among COVID-19-HBV and 13% among COVID-19-HCV co-infected patients. Among COVID-19 patients, 34.1% and 76.2% reported at least one comorbidity besides HBV and HCV infections, mainly hypertension and diabetes mellites type 2. The most common COVID-19-related symptoms in both HBV and HCV groups were fever, cough and dyspnea. ICU admission was reported in 14.1% and 21.4% of individuals with HBV and HCV, respectively. ConclusionsOur findings suggest a considerable risk of morbidity and mortality among COVID-19 patients with HBV and HCV. Careful assessment of hepatic manifestations upon admission of patients could help improve health outcomes among COVID-19 patients with HBV or HCV co-infections. Key PointsO_LIHepatic manifestations of COVID-19 are common among people infected with HBV and HCV. C_LIO_LIAmong COVID-19 patients, 34.1% and 76.2% reported at least one comorbidity besides HBV and HCV infections. C_LIO_LIThe most common COVID-19-related symptoms in both HBV and HCV groups were fever, cough and dyspnea. C_LIO_LIThere is a considerable risk of mortality among COVID-19 patients with HBV and HCV. C_LI
Subject(s)
COVID-19ABSTRACT
Background The novel Coronavirus disease 2019 (COVID-19) rapidly became the world’s largest threat to health and the economy in recent times. Prediction of the COVID-19 pandemic’s full impact is a necessary gauge for future policy making, including resource allocation for prevention, mitigation, and control preparedness.Methods We used the extended form of the Susceptible-Exposed-Infected/Infectious-Recovered/Removed (SEIR) model to predict new cases and number of deaths associated to COVID-19. Data from the Ministry of Health and Medical Education of Iran provided relevant parameters for predicting disability-adjusted life years (DALYs). We conducted a review of the literature on COVID-19-like diseases to develop disability weights (DWs) and convened an expert panel to verify their applicability. Beta-PERT distributions were used to calculate DWs for age groups. The minimum and maximum values were 0 and 0.14 for mild to severe disability, respectively.Results The total DALYs for COVID-19 in Iran predicted by our model will be 973 per 100,000 populations from January, 2020 to January, 2021. Overall, 957 years per 100,000 will be from YLLs (98.4% of DALYs) and 16 will be from YLDs (1.6% of DALY). The total DALYs in men will be 1,082 years per 100,000 and 861 per 100,000 in women.Conclusions Our predictions of COVID-19 burden will be useful in determining health priorities and to appropriately allocate resources to prepare for future outbreaks of COVID-19 and similar diseases. We hope this study will contribute to evidence-based health policy making in Iran.
Subject(s)
COVID-19 , Weight LossABSTRACT
This systematic review summarizes the evidence on the earliest patients with COVID-19-HIV co-infection. We searched PubMed, Scopus, Web of Science, Embase, preprint databases, and Google Scholar from December 01, 2019 to June 1, 2020. From an initial 547 publications and 75 reports, 25 studies provided specific information on COVID-19 patients living with HIV. Studies described 252 patients, 80.9% were male, mean age was 52.7 years, and 98% were on ART. Co-morbidities in addition to HIV and COVID-19 (multimorbidity) included hypertension (39.3%), obesity or hyperlipidemia (19.3%), chronic obstructive pulmonary disease (18.0%), and diabetes (17.2%). Two-thirds (66.5%) had mild to moderate symptoms, the most common being fever (74.0%) and cough (58.3%). Among patients who died, the majority (90.5%) were over 50 years old, male (85.7%), and had multimorbidity (64.3%). Our findings highlight the importance of identifying co-infections, addressing co-morbidities, and ensuring a secure supply of ART for PLHIV during the COVID-19 pandemic.
Subject(s)
Coinfection , HIV Infections , Pulmonary Disease, Chronic Obstructive , Fever , Diabetes Mellitus , Obesity , Hypertension , COVID-19ABSTRACT
Background: Iran is one of the countries that has been overwhelmed with COVID-19. We aimed to estimate the total number of COVID-19 related infections, deaths, and hospitalizations in Iran under different physical distancing and isolation scenarios. Methods: We developed a Susceptible-Exposed-Infected-Removed (SEIR) model, parameterized to the COVID-19 pandemic in Iran. We used the model to quantify the magnitude of the outbreak in Iran and assess the effectiveness of isolation and physical distancing under five different scenarios (A: 0% isolation, through E: 40% isolation of all infected cases). We used Monte-Carlo simulation to calculate the 95% uncertainty intervals (UI). Findings: Under scenario A, we estimated 5,196,000 (UI 1,753,000 - 10,220,000) infections to happen till mid-June with 966,000 (UI 467,800 - 1,702,000) hospitalizations and 111,000 (UI 53,400 - 200,000) deaths. Successful implantation of scenario E would reduce the number of infections by 90% (i.e. 550,000) and change the epidemic peak from 66,000 on June 9th to 9,400 on March 1st. Scenario E also reduces the hospitalizations by 92% (i.e. 74,500), and deaths by 93% (i.e. 7,800). Interpretation: With no approved vaccination or therapy, we found physical distancing and isolation that includes public awareness and case-finding/isolation of 40% of infected people can reduce the burden of COVID-19 in Iran by 90% by mid-June.
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COVID-19ABSTRACT
Background: Our understanding of the corona virus disease 2019 (COVID-19) continues to evolve. However, there are many unknowns about its epidemiology. Purpose: To synthesize the number of deaths from confirmed COVID-19 cases, incubation period, as well as time from onset of COVID-19 symptoms to first medical visit, ICU admission, recovery and death of COVID-19. Data Sources: MEDLINE, Embase, and Google Scholar from December 01, 2019 through to March 11, 2020 without language restrictions as well as bibliographies of relevant articles. Study Selection: Quantitative studies that recruited people living with or died due to COVID-19. Data Extraction: Two independent reviewers extracted the data. Conflicts were resolved through discussion with a senior author. Data Synthesis: Out of 1675 non-duplicate studies identified, 57 were included. Pooled mean incubation period was 5.84 (99% CI: 4.83, 6.85) days. Pooled mean number of days from the onset of COVID-19 symptoms to first clinical visit was 4.82 (95% CI: 3.48, 6.15), ICU admission was 10.48 (95% CI: 9.80, 11.16), recovery was 17.76 (95% CI: 12.64, 22.87), and until death was 15.93 (95% CI: 13.07, 18.79). Pooled probability of COVID-19-related death was 0.02 (95% CI: 0.02, 0.03). Limitations: Studies are observational and findings are mainly based on studies that recruited patient from clinics and hospitals and so may be biased toward more severe cases. Conclusion: We found that the incubation period and lag between the onset of symptoms and diagnosis of COVID-19 is longer than other respiratory viral infections including MERS and SARS; however, the current policy of 14 days of mandatory quarantine for everyone might be too conservative. Longer quarantine periods might be more justified for extreme cases.