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1.
JMIR Public Health Surveill ; 2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2065306

ABSTRACT

BACKGROUND: In late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. Our objective is to describe how SARI surveillance was digitised in Malta and describe the characteristics of people included in the surveillance system. We also compare different SARI case definitions including their advantages and disadvantages. OBJECTIVE: To describe the process of digitising and upgrading SARI surveillance in Malta, an island country with a centralized health system, during the Covid-19 pandemic from February to November 2021. This study discusses the process, output and future for SARI and other public health surveillance opportunities. METHODS: Malta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, while other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. RESULTS: From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onwards we mapped key stakeholders and digitised most surveillance processes. By 30 November 2021, 903 SARI cases were reported, with 380 (42.2%) positive for SARS-CoV-2. Of all SARI hospitalisations, 69 (7.6%) were admitted to ICU, 769 (85.2%) have been discharged, 27 (2.9%) are still being treated, and 107 (11.8%) have died. Among those who died, 96 (89.7%) had more than one underlying condition, the most common of which were hypertension (57; 53.3%) and chronic heart disease (49; 45.8%). CONCLUSIONS: The implementation of an enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes.

2.
Health Policy ; 126(4): 281-286, 2022 04.
Article in English | MEDLINE | ID: covidwho-1773338

ABSTRACT

The aim of this paper is to compare the impact of the COVID-19 pandemic on four small countries in the southern half of Europe with similar public health systems: San Marino, Montenegro, Malta and Cyprus, the latter two being island states. There are advantages and disadvantages in being a small nation amidst this crisis. The centralized public health administration means that small countries are faster at adapting as they learn and evolve on a weekly basis. However, small countries tend to be dependent on their bigger neighbours, and the networks they belong to, for trade, food, medical supplies as well as policies. The risk threshold taken by a small country for the transition strategy has to be less than that taken by a bigger country because if things go wrong in a border region, there is less resilience in a small country, with immediate impact on the whole country. The blow to the tourism industry, which plays a main role especially in small countries, negatively impacted the economy, and it has been a feat to reach a balance between allowing the flow of inbound tourists and keeping the local infection rates under control.


Subject(s)
COVID-19 , Cyprus/epidemiology , Humans , Malta/epidemiology , Montenegro/epidemiology , Pandemics , San Marino
3.
Eur J Public Health ; 31(Supplement_4): iv21-iv26, 2021 Nov 09.
Article in English | MEDLINE | ID: covidwho-1505632

ABSTRACT

BACKGROUND: The European Union has been criticized for responding to the COVID-19 pandemic in a reactive, rather than prosilient manner. For the EU bloc to be prosilient, it needs to have the right early warning indicators to allow short-term healthcare system preparedness and agile planning of the public health response. METHOD: The association of COVID-19 disease burden, as measured by mortality (COVID-19 and all-cause), hospital and ICU occupancy, with incidence rate (IR), total positivity rate (TPR) and adjusted TPR as proposed by Vong and Kakkar, was investigated using Poisson regression analysis. This was carried out using both real-time data and time lags of up to 8 weeks to identify potential for early warning of spikes in disease burden. ECDC weekly figures for these indicators were used, and the analysis was repeated for the subset of data after Week 42 of 2020, when the EU Council introduced minimum COVID-19 testing rates. RESULTS: TPR and IR were noted to be the most predictive of COVID-19 disease burden whilst adjusted TPR applied on weekly data was not associated. TPR behaved better at predicting all-cause mortality in both analyses. The TPR and IR were both best associated with hospital and ICU occupancy and COVID-19 mortality with a short time lag (2-3 weeks in the case of TPR with hospital occupancy and COVID-19 mortality). CONCLUSIONS: Monitoring TPR can provide a 2-3-week warning of a spike in hospital occupancy and COVID-19 mortality. This time, if well utilized, could help health systems save countless lives by mobilising resources.


Subject(s)
COVID-19 , Pandemics , COVID-19 Testing , Humans , Public Health , SARS-CoV-2
4.
BMC Public Health ; 21(1): 1827, 2021 10 09.
Article in English | MEDLINE | ID: covidwho-1463245

ABSTRACT

BACKGROUND: Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality, allowing for comprehensive comparisons of the population. The aim was to estimate the DALYs due to Covid-19 in Malta (March 2020-21) and investigate its impact in relation to other causes of disease at a population level. METHODS: Mortality and weekly hospital admission data were used to calculate DALYs, based on the European Burden of Disease Network consensus Covid-19 model. Covid-19 infection duration of 14 days was considered. Sensitivity analyses for different morbidity scenarios, including post-acute consequences were presented. RESULTS: An estimated 70,421 people were infected (with and without symptoms) by Covid-19 in Malta (March 2020-1), out of which 1636 required hospitalisation and 331 deaths, contributing to 5478 DALYs. These DALYs positioned Covid-19 as the fourth leading cause of disease in Malta. Mortality contributed to 95% of DALYs, while post-acute consequences contributed to 60% of morbidity. CONCLUSIONS: Covid-19 over 1 year has impacted substantially the population health in Malta. Post-acute consequences are the leading morbidity factors that require urgent targeted action to ensure timely multidisciplinary care. It is recommended that DALY estimations in 2021 and beyond are calculated to assess the impact of vaccine roll-out and emergence of new variants.


Subject(s)
COVID-19 , Disabled Persons , Cost of Illness , Humans , Malta/epidemiology , Quality-Adjusted Life Years , SARS-CoV-2
5.
JMIR Infodemiology ; 1(1): e30979, 2021.
Article in English | MEDLINE | ID: covidwho-1450773

ABSTRACT

BACKGROUND: An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. OBJECTIVE: The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. METHODS: As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. RESULTS: The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. CONCLUSIONS: Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.

6.
Euro Surveill ; 26(2)2021 01.
Article in English | MEDLINE | ID: covidwho-1067623

ABSTRACT

The European monitoring of excess mortality for public health action (EuroMOMO) network monitors weekly excess all-cause mortality in 27 European countries or subnational areas. During the first wave of the coronavirus disease (COVID-19) pandemic in Europe in spring 2020, several countries experienced extraordinarily high levels of excess mortality. Europe is currently seeing another upsurge in COVID-19 cases, and EuroMOMO is again witnessing a substantial excess all-cause mortality attributable to COVID-19.


Subject(s)
COVID-19/mortality , Mortality/trends , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cause of Death , Child , Child, Preschool , Computer Systems , Epidemiological Monitoring , Europe/epidemiology , Humans , Infant , Infant, Newborn , Middle Aged , SARS-CoV-2 , Young Adult
8.
J Med Internet Res ; 22(6): e19659, 2020 06 26.
Article in English | MEDLINE | ID: covidwho-607410

ABSTRACT

BACKGROUND: An infodemic is an overabundance of information-some accurate and some not-that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. OBJECTIVE: A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. METHODS: A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. RESULTS: The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. CONCLUSIONS: The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives.


Subject(s)
Betacoronavirus , Coronavirus Infections , Crowdsourcing , Health Education/methods , Health Education/standards , Pandemics , Pneumonia, Viral , Social Media/organization & administration , Social Media/standards , World Health Organization , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Coronavirus Infections/virology , Disease Outbreaks , Health Education/organization & administration , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Public Health/methods , Public Health/standards , SARS-CoV-2 , Social Media/supply & distribution
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