Estimating Excess Deaths in French and Spanish Regions During the First COVID-19 Wave with the Later/Earlier Method

Estimates of excess deaths have been widely used to measure the overall impact of the COVID-19 pandemic on mortality. We investigate the validity of a method-the later/earlier method- developed for forecasting the number of deaths one would expect if no shock occurred. We apply this method to estimate excess mortality during the first COVID-19 wave in France and Spain (February–June 2020), stratified by age, sex, and region. Although both countries recorded similar numbers of COVID-19 deaths, Spain had higher excess mortality. The results are informative about differences in COVID-19 vulnerability for population subgroups and spatial areas: adults aged 75–85 were the hardest hit;Île-de-France (Paris region) in France and Comunidad de Madrid in Spain had the highest excess mortality. Applicable to other demographic phenomena, the later/earlier method is simple, requires fewer assumptions than other forecasting methods, and is less biased and more accurate than the 5-year-average method.Alternate :Des estimations du surplus de décès ont été largement utilisées pour mesurer l'impact global de la pandémie sur la mortalité. Cet article examine la validité d'une nouvelle méthode (« méthode après/avant »), mise au point pour prévoir le nombre de décès qui seraient attendus en l'absence de choc. Cette méthode est appliquée pour estimer la surmortalité durant la première vague de Covid-19 (février-juin 2020) en France et en Espagne, par âge, sexe et région. Bien que les deux pays aient déclaré des nombres similaires de décès par Covid-19, la surmortalité de l'Espagne s'est avérée plus élevée. Les résultats sont riches d'enseignements sur les différences de vulnérabilité à la Covid-19 selon les sous-groupes de population et les zones géographiques considérés : les adultes de 75 à 85 ans ont été les plus durement touchés ;c'est en Île-de-France, pour la France, et dans la Comunidad de Madrid, pour l'Espagne, que la surmortalité a été la plus importante. Applicable à d'autres phénomènes démographiques, la méthode après/avant est simple, nécessite moins d'hypothèses que d'autres méthodes de prévision, et se révèle moins biaisée et plus précise que celle de la moyenne quinquennale.Alternate :Se han realizado numerosas estimaciones sobre el aumento de muertes para medir el efecto global de la pandemia sobre la mortalidad. Este artículo examina la validez de un nuevo método («método antes-después»), desarrollado para prever el número de fallecimientos que se esperarían en ausencia de impacto. El método se aplica para estimar el exceso de mortalidad durante la primera ola de Covid-19 (febrero-junio 2020) en Francia y en España, por edad, sexo y región. Aunque los dos países hayan declarado un número similar de muertes por Covid-19, la sobremortalidad en España resulta más elevada. Los resultados informan sobre las diferencias de vulnerabilidad frente a la Covid-19 según los subgrupos de población y las zonas geográficas consideradas: los adultos de 75 a 85 años han sido los más gravemente afectados;en Île-de-France, en el caso de Francia, y en la Comunidad de Madrid, en el caso de España, es donde el exceso de mortalidad ha sido más importante. Aplicable a otros fenómenos demográficos, el método antes-después es simple, necesita menos hipótesis que otros métodos de previsión y resulta menos sesgado y más preciso que el de promedios quinquenales.

Sex-differences in excess death risk during the COVID-19 pandemic: an analysis of the first wave across Italian regions. What have we learned?

In this commentary, we bring together knowledge on sex-differences in excess death during the first wave of the COVID-19 pandemic in Italy, one of the most hit European countries. We zoom into Italian regions to account for the spatial gradient of the spread of the virus. Analyses of excess death by sex during the COVID-19 pandemic have been possible thanks to weekly mortality data released by national statistical offices, mainly in developed countries. The general finding is that males up to 75 years old have been suffering more excess death compared to females. However, the picture is less clear-cut at older ages. During previous epidemics, such as SARS, Swine Flu, and MERS, studies are limited and produce scattered, non-conclusive evidence. Knowledge of the sex-pattern of susceptibility to mortality from virulent respiratory diseases and its interplay with age could improve crisis management during future epidemics and pandemics. National statistical offices should provide weekly mortality data with spatial granularity, disaggregated by sex and age groups, to allow for such analyses.

High excess deaths in Sweden during the first wave of COVID-19: Policy deficiencies or 'dry tinder'?

AIMS: During the first wave of the COVID-19 pandemic, Sweden registered a high level of excess deaths. Non-pharmaceutical interventions adopted by Sweden have been milder compared to those implemented in Denmark. Moreover, Sweden might have started the pandemic with a large proportion of vulnerable elderly with a high mortality risk. This study aimed to clarify whether excess mortality in Sweden can be explained by a large stock of 'dry tinder' instead of being attributed to faulty lockdown policies. METHODS: We analysed weekly death counts in Sweden and Denmark from July 2007 to June 2020. We used a novel method for short-term mortality forecasting to estimate expected and excess deaths during the first COVID-19 wave in Sweden and Denmark. RESULTS: In the first part of the epiyear 2019-2020, deaths were low in both Sweden and Denmark. In the absence of COVID-19, a relatively low level of death would be expected for the later part of the epiyear. The registered deaths were, however, way above the upper bound of the prediction interval in Sweden and within the range in Denmark. CONCLUSIONS: 'Dry tinder' can only account for a modest fraction of excess Swedish mortality. The risk of death during the first COVID-19 wave rose significantly for Swedish women aged >85 but only slightly for Danish women aged >85. The risk discrepancy seems more likely to result from differences between Sweden and Denmark in how care and housing for the elderly are organised, coupled with a less successful Swedish strategy of shielding the elderly.

Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study.

BACKGROUND: University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. OBJECTIVE: The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. METHODS: In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale-Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. RESULTS: Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. CONCLUSIONS: This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.

Short-term forecasts of expected deaths.

We introduce a method for making short-term mortality forecasts of a few months, illustrating it by estimating how many deaths might have happened if some major shock had not occurred. We apply the method to assess excess mortality from March to June 2020 in Denmark and Sweden as a result of the first wave of the coronavirus pandemic; associated policy interventions; and behavioral, healthcare, social, and economic changes. We chose to compare Denmark and Sweden because reliable data were available and because the two countries are similar but chose different responses to COVID-19: Denmark imposed a rather severe lockdown; Sweden did not. We make forecasts by age and sex to predict expected deaths if COVID-19 had not struck. Subtracting these forecasts from observed deaths gives the excess death count. Excess deaths were lower in Denmark than Sweden during the first wave of the pandemic. The later/earlier ratio we propose for shortcasting is easy to understand, requires less data than more elaborate approaches, and may be useful in many countries in making both predictions about the future and the past to study the impact on mortality of coronavirus and other epidemics. In the application to Denmark and Sweden, prediction intervals are narrower and bias is less than when forecasts are based on averages of the last 5 y, as is often done. More generally, later/earlier ratios may prove useful in short-term forecasting of illnesses and births as well as economic and other activity that varies seasonally or periodically.

Risk of pre-term births and major birth defects resulting from paternal intake of COVID-19 medications prior to conception.

OBJECTIVE: With the ongoing COVID-19 pandemic, large numbers of people will receive one of the several medications proposed to treat COVID-19, including patients of reproductive age. Given that some medications have shown adverse effects on sperm quality, there might be a transgenerational concern. We aim at examining the association between drugs proposed to treat COVID-19 when taken by the father around conception and any pre-term birth or major birth defects in offspring in a nation-wide cohort study using Danish registry data. Offspring whose father filled at least one prescription of the following medications in the 3 months preceding conception were considered exposed: chloroquine, hydroxychloroquine, losartan, azithromycin, naproxen, dexamethasone and prednisone. RESULTS: For azithromycin and naproxen, large numbers of offspring were exposed (> 1800 offspring), and we found no association with adverse birth outcomes. For chloroquine, losartan and dexamethasone, exposure was intermediate (~ 900 offspring), and there was no statistically significant association with birth defects. For hydroxychloroquine and prednisone, exposure was limited (< 300 offspring). Our evidence suggests that azithromycin and naproxen are safe with respect to pre-term birth and birth defects. For the other drugs investigated larger exposures are needed for conclusive statements.

Risk of pre-term births and major birth defects resulting from paternal intake of COVID-19 medications prior to conception.

OBJECTIVE: With the ongoing COVID-19 pandemic, large numbers of people will receive one of the several medications proposed to treat COVID-19, including patients of reproductive age. Given that some medications have shown adverse effects on sperm quality, there might be a transgenerational concern. We aim at examining the association between drugs proposed to treat COVID-19 when taken by the father around conception and any pre-term birth or major birth defects in offspring in a nation-wide cohort study using Danish registry data. Offspring whose father filled at least one prescription of the following medications in the three months preceding conception were considered exposed: chloroquine, hydroxychloroquine, losartan, azithromycin, naproxen, dexamethasone and prednisone. RESULTS: For azithromycin and naproxen, large numbers of offspring were exposed (> 1800 offspring), and we found no association with adverse birth outcomes. For chloroquine, losartan and dexamethasone, exposure was intermediate (~ 900 offspring), and there was no statistically significant association with birth defects. For hydroxychloroquine and prednisone, exposure was limited (< 300 offspring). There is strong evidence that azithromycin and naproxen are safe with respect to pre-term birth and birth defects. With some caution, the other drugs investigated can be considered safe.