The Economics of Pandemics: Exploring Globally Shared Experiences

This book offers a lively account of the humanitarian, economic, societal, and planetwide impacts of the pandemics, the COVID-19 pandemic included, which are traced back to as early as the 14th century plague pandemic. Placing the pandemics along with other globally shared resources, such as global warming, AI singularity, and high-risk physics experiments, each of the nine chapters of the book discusses the global health crises from a variety of unique standpoints, including infectious diseases, economics, governance, and public health. Based on the historical records of past pandemics and the rich data from the COVID-19 pandemic, a conceptual framework is presented for the economics of pandemics as a globally shared experience. This book aims to critically examine salient features in the global responses to the COVID-19 pandemic, including global governance, lockdowns, radical movements, and mRNA vaccines. The book will be a valuable resource to students, researchers, and policymakers who are working in the fields of environmental economics, global-scale public goods, and health economics. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.

Potential cost of not vaccinating against COVID19 in the United States

Introduction: As of April 2022, the COVID19 global pandemic has resulted in over six million deaths globally, and over 81 million cases of COVID19 in the United States. Objective(s): The objective of the presentation is to share estimated direct and indirect costs due to COVID19 infection juxtaposed with the costs of COVID19 vaccine administration in the United States. Method(s): A literature review was conducted to identify potential cost savings from being immunized against COVID19. The costs of COVID19 vaccinations, direct costs related to healthcare and types of indirect costs were noted. Result(s): After reviewing over 40 resources, several costs were identified. The cost of COVID19 vaccine series, as defined by the Centers of Medicare and Medicaid Services (CMS), is currently USD40 for single-dose and USD40 per dose in a multiple-dose series. It is estimated that the average hospitalisation stay of an uninsured inpatient was ~USD7000-USD10,000 per day. The average cost of 12 major metropolitan cities in the United States were estimated for primary care facilities, urgent care facilities, and emergency room visits at USD195, USD239, USD1,425, respectively. As of April 2, 2022, 77% of the US have received at least one dose of COVID19 vaccine and 66% are considered to be fully vaccinated against COVID19 primary series. Conclusion(s): According to the data, the cost reduction in healthcare is consequential and cost-effective in vaccinating the population. This analysis contributes to the limited reports of a national cost-benefit analysis.

Do lung ultrasound abnormalities change during hospitalization for COVID-19?

Background. While point-of-care ultrasound (POCUS) has been used to track disease resolution, temporal trends in lung ultrasound (LUS) findings among hospitalized patients with COVID-19 is not well-characterized. Methods. We studied 413 LUS scans in 244 participants >= 18 years of age hospitalized for COVID-19 pneumonia within 28 days of symptom onset from April, 2020 until September, 2021 at the Johns Hopkins Hospital, Baltimore Maryland. All patients were scanned using a 12-lung zone protocol and repeat scans were obtained in 3 days (N=114), 7 days (N=53), and weekly (N=9) from the initial scan. Participants were followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung artifacts, and the composite mean LUS score (ranging from 0 to 3) across lung zones was determined. Trends of mean LUS scores and%lung fields with A-lines (indicating proportion of normal lung fields) were plotted by peak severity (mild, moderate, and severe defined by the World Health Organization Ordinal Scale) over time from symptom onset. Differences in mean LUS score or % A-lines changes over time between peak severity levels were evaluated using a Kruskal-Wallis test and linear mixed-effected models with an exchangeable correlation structure. Results. Among 244 patients in our cohort (mean age of 58.2 (SD 15.0) years, and 55.7% female) (Table 1), there was no change in average mean LUS scores between the first two visits by severity groups (Figure 1;Kruskal-Wallis p=0.63). Mean LUS scores were elevated by 0.22 (p< 0.001) in a dose-response manner regardless of duration of illness, but there was no change over time associated with peak severity (p=0.73). Similarly, percentage of A-lines were in 13.9% less lung fields for each increase in peak severity (p< 0.001;Figure 2) regardless of duration of illness. However, a change in mean LUS score did not differ significantly among peak severity levels (p=0.36). Conclusion. Mean LUS scores correlated with clinical severity among hospitalized adults when assessed cross-sectionally, however mean LUS score did not change or differ between peak severity levels over the time course of hospitalization. These results do not support serial LUS scans to monitor disease progression.

The impact of the COVID-19 on the screening of breast and cervical cancer in Korea

Background: The COVID-19 pandemic has affected use of healthcare services, especially disrupting individual participation in cancer screening programs. The National Cancer Screening Program (NCSP) of Korea provides screening services for six common cancers - stomach, liver, colorectum, breast, cervix, and lung. As complete national lockdown measures were not implemented, the NCSP continued operation during the three major COVID-19 waves in Korea, which allowed us to assess the changes in health-seeking behavior. We examined the cancer screening rates for breast and cervical cancers among NCSP participants in different geographic regions and by age group, in association with the COVID-19 pandemic. Methods: From the National Health Insurance Service database, we obtained information on the number of eligible population and NCSP participants from January 2019 to December 2020. The target group for biennial mammography screening is women aged 40 years and over, and that for biennial pap smear is women aged 20 years and over. We compared monthly screening rates for breast and cervical cancer between 2020 vs 2019 and described them as a percentage change. Results: The overall cancer screening rate has decreased in both cancers in 2020 compared with that of 2019: breast (55.8% vs 63.8%), cervical (52.2% vs 57.8%). Screening rates for both cancers declined in all age groups in March and December of 2020, which corresponds to the first and third COVID-19 wave. The month of March 2020 had the sharpest drop in screening rates, by 57.9% for breast cancer and 43.7% for cervical cancer compared with March 2019. In June 2020, screening rates for both cancers rebounded compared with 2019 (breast, +29.2%;cervical, +26.3%), which remained higher compared with the same months in 2019 until November 2020. By December 2020, screening rates for both cancers have dropped, compared with December 2019 (breast, -19.5%;cervical, -21.0%). For breast cancer, the screening rate decreased in all age groups, and the largest decline was observed in women aged 80 years and over. Although the cervical cancer screening rate has been steadily increasing since 2010, it decreased in all age groups in 2020 compared with that of 2019, with the exception of the 20-29 age group. Considering social distancing measures that were implemented nationwide during each COVID-19 wave, we observed a similar pattern of cancer screening rates in major cities. Conclusions: It was observed that after the two major COVID-19 waves, mammography and pap smear rates declined compared with that of 2019. The largest decline in cancer screening rates was seen in elderly women. The pattern of screening rate changes was comparable according to geographic region. In contrast to reports showing a deficit in cancer screening in other countries, our results suggest a substantial recovery in cancer screening in Korea. Additional analyses are needed to assess the effect of the 6-month extension of NCSP.

Colorectal and gastric cancer screening rates in Korea during the COVID-19 pandemic

Background: The COVID-19 pandemic has disrupted healthcare delivery, which is widely discussed as the distraction effect. This study aimed to estimate the distraction effect of the COVID-19 pandemic in Korea by analyzing colorectal and gastric cancer screening rates in the years 2019 and 2020. Methods: Information of eligible population who had colorectal and gastric cancer screening provided by the National Cancer Screening Program in the years 2019 and 2020 was collected. Participation rates were analyzed by age group, sex, geographic region, and calendar month. Percentage change was calculated by dividing the percentage point difference by the screening rate of the reference period (2019). Results: Overall, the colorectal and gastric cancer screening rates had decreased in 2020, compared to the reference period. For colorectal cancer, the screening rate decreased from 68.3% in 2019 (5,886,319 participants/14,526,424 eligible population) to 54.6% in 2020 (5,135,218/9,410,525) For gastric cancer, the screening rates decreased from 61.9% in 2019 (7,194,489/11,625,627) to 54.6% in 2020 (6,244,491/11,439,246). In March, during the first wave, the screening rates declined sharply (percentage change: colorectal, 56.6%;gastric, 57.3%). Although the screening rates had rebounded aftermath, they declined again in December, during the third wave (percentage change: colorectal, 17.0%;gastric, 13.8%). According to specific-age group, we found a substantial decline in screening rates for older adults aged 80∼84, and those over 85 (percentage change: colorectal, 19.0% & 23.0%;gastric, 17.4% & 25.1% respectively). Conclusion: During the COVID-19 pandemic, the screening rates for both colorectal and gastric cancer decreased. There was a substantial decline during the first and the third waves of the epidemic, in March and in December. The older adults group showed the highest reduction in screening rates. However, comparing the screening rate by region and sex, we did not find a significant difference. Delayed cancer diagnosis or excess death due to distraction effect of the COVID-19 pandemic has not yet been detected in Korea, therefore, further studies are needed.

Short-Term Dermatology Medical Mission and Global Health: A Retrospective Analysis of Climate Change

Background: The coronavirus disease pandemic has directly impacted global health. In developing countries, health service problems are more serious because of the lack of healthcare infrastructure. In this situation, if medical needs could be predicted, it would be helpful to bridge the medical gap with the provision of appropriate medical support. Objective: The aim of this study was to evaluate the association between climate change and skin diseases in developing countries to better prepare for medical missions. Methods: From 2012 to 2016, except for 2014, we visited a mission site located in Luzon, Philippines, every July. We retrospectively reviewed 499 patient data as well as weather information. Results: The total number of patients decreased each year. The climate change analysis using Pearson correlation showed diat the temperature and ultraviolet index tended to increase every year (r2=0.99, 0.93, respectively;p< 0.05). Conversely, humidity and rainfall decreased (r2= - 0.99, - 0.96, respectively;p<0.05). The Cochran-Armitage test showed that the rate of infectious skin disease diagnoses decreased every year compared to that of eczematous diseases. Conclusion: The total number of patients decreased by approximately 50% during medical service. We believe that the improvement in living standards and hygiene through continuous medical support has influenced the change in the incidence of skin diseases. Climate change was also thought to have affected the rate of skin disease diagnoses;in fact, the rate of infectious disease diagnoses tended to decrease compared to that of eczematous diseases. This analysis would be helpful for preparing for medical support. © 2021 Korean Dermatological Association. All rights reserved.

Effect of Mask Mandates on the Intraocular Pressure Measured via Goldmann Applanation Tonometry

Purpose: The corona virus disease-19 (COVID-19) pandemic has resulted in mandatory masking of patients and physicians during outpatient visits. This study evaluated the changes in intraocular pressure (IOP) according to mask use. Methods: This prospective study enrolled 30 healthy volunteers (60 eyes). IOP was measured via Goldmann applanation tonometry (GAT) for the subjects wearing one of four commonly used masks: dental, bi-folding Korean Filter (KF)94, tri-folding KF94, and dust masks. Subjects with IOP measurement errors of more than 5 mmHg were rechecked with another GAT type. Results: The mean IOP measured via GAT before mask wearing was 13.7 +/- 1.7 mmHg. It was 13.5 +/- 2.1, 14.0 +/- 2.3, 14.3 +/- 2.5, and 13.8 +/- 1.6 mmHg with the dental, bi-folding KF94, tri-folding KF94, and dust masks, respectively. There were no significant differences in IOP according to mask type (p = 0.635). IOP errors above 5 mmHg were detected in three subjects who had contact between the GAT feeler arm and tri-folding KF94 mask during IOP measurement. Conclusions: The IOP as measured via GAT is artificially elevated by mechanical interference from the tri-fold KF94 mask. To minimize such mask-induced artifacts in GAT measurements, compress the patient's mask or change the mask type to prevent any contact during measurement.

Real-Time Low-Cost Personal Monitoring for Exposure to PM2.5 among Asthmatic Children: Opportunities and Challenges

This study aims to evaluate the accuracy and effectiveness of real-time personal monitoring of exposure to PM concentrations using low-cost sensors, in comparison to conventional data collection method based on fixed stations. PM2.5 data were measured every 5 min using a low-cost sensor attached to a bag carried by 47 asthmatic children living in the Seoul Metropolitan area between November 2019 and March 2020, along with the real-time GPS location, temperature, and humidity. The mobile sensor data were then matched with station-based hourly PM2.5 data using the time and location. Despite some uncertainty and inaccuracy of the sensor data, similar temporal patterns were found between the two sources of PM2.5 data on an aggregate level. However, average PM2.5 concentrations via personal monitoring tended to be lower than those from the fixed stations, particularly when the subjects were indoors, during nighttime, and located farther from the fixed station. On an individual level, a substantial discrepancy is observed between the two PM2.5 data sources while staying indoors. This study provides guidance to policymakers and researchers on improving the feasibility of personal monitoring via low-cost mobile sensors as an alternative or supplement to the conventional station-based monitoring.

Subretinal gene replacement rescues retinal phenotype in BBS10 mouse

Purpose : To assess toxicity and efficacy of subretinal gene replacement in BBS10 mice. Overexpression toxicity in BBS1 mice occurred with gene therapy;BBS1 is part of the BBSome, while BBS10 is part of the BBS/CCT chaperonin complex. Methods : A knock out mouse model of Bardet Biedl Syndrome type 10 (BBS10) was developed. AAV2/5-Bbs10FLAG and AAV2/Anc80-Bbs10FLAG vectors were created. Subretinal 2 ul injections of 1E12, 2E12 or 4E12VG/ml were performed in 62 Bbs10-/-and 12 WT mice. Immunoblotting and immunohistochemistry were utilized to assess protein production and restoration of Bbs10 gene function. ERG, OCT, and visually guided swim assay (VGSA) were used to assess efficacy. Due to COVID-19, long term data was collected only for 12 mice treated with 2E9 or 4E9 AAV2/Anc80-Bbs10FLAG and 3 controls. Results : Neither AAV2/5-Bbs10FLAG nor AAV2/Anc80-Bbs10FLAG were toxic in WT or Bbs10-/-. One month after injection, FLAG was detected in treated, but not untreated Bbs10-/-eyes, documenting presence of BBS10 protein.BBS7,undetectable or barely detectable within photoreceptor cilia in untreated Bbs10 eyes,was present in photoreceptor cilia in treated Bbs10 eyes.VGSA was partially rescued via either AAV2/5 or AAV2/Anc80 treated at P30-P60 when tested in the dark at age 3.5 months(p= 1.36E005)and in both light and dark at age 7 months (p=. <0.0001 light;p= 0.0094 dark). VGSA improvement endured in AAV2/Anc80 treated mice at 9-12 months old(p=0.0113). Treated eyes had higher amplitude ERG than untreated fellow eyes at 10-11.5 months old (highest p=0.0425). OCT at 11-14 months demonstrated presence of outer nuclear layer in 5/11 treated eyes compared to 0/11 untreated fellow eyes and 0/6 untreated control eyes. 5Hz flicker response was not present at any age in untreated Bbs10 (n=18 eyes), but developed in 9 of 12 eyes treated before 4 months old. 4 of 12 treated eyes still had recordable 5 Hz at 11-14 mos, all treated with 4E9. Histology at 11 months demonstrated robust ONL, inner and outer segments with numerous cones, and normal localization of STX3 adjacent to the injection site in 2 treated eyes. Conclusions : In the Bbs10 mouse subretinal gene therapy with AAV2/Anc80-Bbs10FLAG rescues retinal phenotype . Lack of 5 Hz flicker ERG response in untreated eyes was rescued with early high titer gene therapy suggesting that BBS10 plays an early role in cone development and/or function. Human BBS10 clinical trials are needed.

Reductions in NO2 concentrations in Seoul, South Korea detected from space and ground-based monitors prior to and during the COVID-19 pandemic

Nitrogen oxides detected in urban regions are primarily emitted by transportation methods and are crucial precursors for air pollutants and climate forcers such as ozone and fine particulate matter. We investigate the trends of nitrogen dioxide (NO2) obtained from a satellite instrument and surface monitors over the megacity, Seoul, South Korea, from 2005 to 2019. Both satellite Ozone Monitoring Instrument NO2 and surface in situ concentrations decreased by up to 30% between 2015 and 2019 while significant trends were not observed between 2005 and 2015. Further analysis shows the continual reduction of NO2 concentrations prior to and during the COVID-19 pandemic in 2020. This study highlights the efficacy of South Korean pollution control policies targeting vehicular emissions. However, this study also found inconsistencies between trends observed in the official bottom-up emission inventory and data collected from space and surface sites. Further research will be urgently needed to understand the causes for the discrepancies.