ABSTRACT
The severity of the COVID-19 pandemic on overall welfare depends on the resilience of microeconomic units, particularly households, to cope and recover from the shocks created by the pandemic. In Sub-Saharan Africa, where the pandemic has been less pervasive, the pandemic is expected to increase food insecurity, vulnerability, and ultimately poverty. To accurately measure the welfare impact of the pandemic on the macroeconomy, it is important to account for the distributional impact on households and the ability of households to cope with it, which reflects their microeconomic resilience. In this paper, we seek to determine the differential impacts of the COVID-19 pandemic on household microeconomic resilience in Sub-Saharan Africa. We use direct measurements of economic indicators to measure the impact of the pandemic on 6249 households across Ethiopia and Nigeria. Given that resilience is a latent variable, the FAO's Resilience Index Measure Analysis (RIMA) framework is utilized to construct the resilience index. We hypothesize that the pandemic created differential economic impacts among households and ultimately household microeconomic resilience. Study findings show that government containment measures improved household microeconomic resilience, while self-containment measures lowered microeconomic resilience. Additionally, households that relied on wage employment and non-farm businesses as their main source of livelihood were found to be more microeconomic resilient.
ABSTRACT
ABSTRACT Objective To assess left atrial appendage (LAA) thrombus detection using a novel cardiac computed tomography (CT) protocol specifically prior to direct current cardioversion (DCCV). Background Transesophageal echocardiography (TEE) is the gold standard in evaluating the LAA prior to DCCV for atrial fibrillation (AF) or flutter (AFL). The COVID-19 pandemic has restricted availability of TEE and anesthesia support. Methods Prospective cohort of consecutive patients with uncontrolled AF/AFL referred for DCCV from March 2020 to March 2021 were enrolled. CT evaluation of LAA was performed with an initial arterial and subsequent 30-second delayed acquisition to exclude thrombus prior to DCCV. Primary end points were to assess safety and outcomes. Results A total of 161 patients were included; mean age 69.8 ± 11.1 years; mean CHA 2 DS 2 -VASc 3.4 ± 1.7; and HAS-BLED 1.8 ± 0.9. Median follow-up 175 (105-267) days with zero cardiac-related deaths, and no episodes of TIA or embolic stroke. There was no statistically significant change in mean glomerular filtration rate (GFR) in the study population between the pre- and post-GFR measurements (73.9 ± 21.0 vs 72.7 ± 20.3; p=0.104). Overall mean total dose length product (DLP) was 1042.8 ± 447.5 mGy*cm. Modifying the CT protocol to a narrower 8-cm axial coverage had a statistically significant decrease in total DLP (from 1130.6 ± 464.1 mGy*cm to 802.1 ± 286.4 mGy*cm; P<0.0001). Conclusion Cardiac CT is both a safe and feasible alternative imaging to TEE for patients prior to DCCV. Perspectives Competency in Medical Knowledge Cardiac CT is a powerful tool for the evaluation of left atrial appendage and detection of thrombus prior to direct current cardioversion. Translational Outlook Our protocol was implemented with the restrictions during COVID-19 in mind, yet CT can be a viable tool beyond the pandemic; future randomized clinical trials can bridge the gap between CT and TEE in the setting of cardioversion and help elucidate its safety profile further.