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1.
The Great Health Dilemma: Is Prevention Better than Cure? ; : 1-206, 2021.
Article in English | Scopus | ID: covidwho-1901224

ABSTRACT

The proverbial benefits of prevention over cure are self-evident-and yet we are reluctant to invest in staying healthy. Resolution of this age-old dilemma begins with a timeless truth: The benefits of good health come at a cost: Prevention is not better than cure at any price. That logic leads to a testable-and refutable-proposition: That prevention should be favoured when an imminent, high-risk, high-impact hazard can be averted at relatively low cost. Application of this idea helps to explain why cigarette smoking is still commonplace, why the world was not ready for the COVID-19 pandemic, why the idea of a ‘sin tax’ is misconceived, why billions still do not have access to safe sanitation, why the response to climate change has been so slow, and why public health advice often falls on deaf ears. Much more money and effort are invested in health promotion and prevention today than is commonly thought, but the enormous avoidable burden of illness is reason to seek incentives for investing still more. The principles, together with a series of case studies in diverse settings, offer 12 lessons for prevention. These are methods and motives for shifting the balance away from reactive medical treatment, bypassing illness and injury, to promote better health and well-being. © Oxford University Press 2021.

2.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-334727

ABSTRACT

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. NOTE: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . ONE SENTENCE SUMMARY: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

3.
Science ; 372(6544):815-821, 2021.
Article in English | EMBASE | ID: covidwho-1735994

ABSTRACT

Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Manaus, Brazil, resurged in late 2020 despite previously high levels of infection. Genome sequencing of viruses sampled in Manaus between November 2020 and January 2021 revealed the emergence and circulation of a novel SARS-CoV-2 variant of concern. Lineage P.1 acquired 17 mutations, including a trio in the spike protein (K417T, E484K, and N501Y) associated with increased binding to the human ACE2 (angiotensin-converting enzyme 2) receptor. Molecular clock analysis shows that P.1 emergence occurred around mid-November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.7- to 2.4-fold more transmissible and that previous (non-P.1) infection provides 54 to 79% of the protection against infection with P.1 that it provides against non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness.

4.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326624

ABSTRACT

Cases of SARS-CoV-2 infection in Manaus, Brazil, resurged in late 2020, despite high levels of previous infection there. Through genome sequencing of viruses sampled in Manaus between November 2020 and January 2021, we identified the emergence and circulation of a novel SARS-CoV-2 variant of concern, lineage P.1, that acquired 17 mutations, including a trio in the spike protein (K417T, E484K and N501Y) associated with increased binding to the human ACE2 receptor. Molecular clock analysis shows that P.1 emergence occurred around early November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.4-2.2 times more transmissible and 25-61% more likely to evade protective immunity elicited by previous infection with non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness. One-Sentence Summary: We report the evolution and emergence of a SARS-CoV-2 lineage of concern associated with rapid transmission in Manaus.

5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-296567

ABSTRACT

The COVID-19 pandemic has revealed the importance of virus genome sequencing to guide public health interventions to control virus transmission and understand SARS-CoV-2 evolution. As of July 20th, 2021, >2 million SARS-CoV-2 genomes have been submitted to GISAID, 94% from high income and 6% from low and middle income countries. Here, we analyse the spatial and temporal heterogeneity in SARS-CoV-2 global genomic surveillance efforts. We report a comprehensive analysis of virus lineage diversity and genomic surveillance strategies adopted globally, and investigate their impact on the detection of known SARS-CoV-2 virus lineages and variants of concern. Our study provides a perspective on the global disparities surrounding SARS-CoV-2 genomic surveillance, their causes and consequences, and possible solutions to maximize the impact of pathogen genome sequencing for efforts on public health.

6.
PUBMED; 2021.
Preprint in English | PUBMED | ID: ppcovidwho-292866

ABSTRACT

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. Note: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . One sentence summary: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

7.
10th Operational Research Society Simulation Workshop, SW 2021 ; : 221-230, 2021.
Article in English | Scopus | ID: covidwho-1239364

ABSTRACT

This paper considers SEPIR, an extension of the well-known SEIR continuous simulation compartment model. Both models can be fitted to real data as they include parameters that can be estimated from the data. SEPIR deploys an additional pre-symptomatic (also called asymptomatic) infectious stage not in SEIR but known to exist in COVID-19. This stage can also be fitted to data. We focus on how to fit SEPIR to a first wave. Both SEPIR and the existing SEIR model assume a homogeneous mixing population with parameters fixed. Moreover neither includes dynamically varying control strategies deployed against the virus. If either model is to represent more than just a single wave of the epidemic, then the parameters of the model would have to be time dependent. In view of this we also consider how reproduction numbers can be calculated to investigate the longer term overall result of an epidemic. © 2021 SW 2021. All rights reserved.

8.
American Journal of Gastroenterology ; 115(SUPPL):S490-S491, 2020.
Article in English | EMBASE | ID: covidwho-994361

ABSTRACT

INTRODUCTION: Large polyps >20 mm make up 5% of all polyps removed and are considered high-risk precancerous lesions. Endoscopic mucosal resection (EMR) is a technique used to remove these polyps, but has a local recurrence rate of 10-30% at first follow up. Recurrence is thought to be due to residual microscopic disease at the edge or base of the resected polyp. Hybrid argon plasma coagulation (APC) is an innovative technique which can be used to ablate the remaining microscopic disease at the base and edge of the polyp thereby reducing local recurrence. The aim of this study was to assess recurrence at 6 months following hybrid APC assisted EMR. Secondary endpoints including post polypectomy bleeding and post polypectomy syndrome were also assessed. METHODS: Patients in this single-center, prospective data collection study were referred to our institution for resection of polyps >20 mm. After obtaining consent, eligible patients underwent endoscopy using the hybrid APC assisted EMR technique. Participants were contacted 30 days after their procedure to assess adverse events. At 6 months, patients were brought back in for a surveillance colonoscopy, and rate of polyp recurrence was calculated. This study was approved by the Penn State Institutional Review Board. RESULTS: At the time of this report, 25 (62.5%) of the 40 treated patients had completed the 6-month follow-up colonoscopy. Three patients were lost to follow up, one patient withdrew for personal reasons, and 11 patients are currently awaiting rescheduling due to the COVID-19 pandemic. Demographics of the included patients and characteristics of the study polyps are displayed in Table 1 and Table 2, respectively. Post polypectomy bleeding was reported by 3 (7.5%) patients, and post polypectomy syndrome was reported by 1 (2.5%) patient. None of the 25 patients who have completed the study showed recurrence at 6 months. CONCLUSION: This prospective data collection study assessing 6-month recurrence rate using hybrid APC assisted EMR preliminarily resulted in a 0% local recurrence rate. Secondary end points assessing post polypectomy syndrome and post polypectomy bleeding revealed an incidence of 2.5% and 7.5%, respectively. This suggests that hybrid APC assisted EMR may be more effective at reducing the rate of polyp recurrence. Additional studies assessing a larger population of patients in a randomized control trial would be recommended to ensure this data is generalizable to the general population.

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