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1.
Innovation in Aging ; 5:521-521, 2021.
Article in English | Web of Science | ID: covidwho-2012380
2.
BMJ Global Health ; 7:A35, 2022.
Article in English | EMBASE | ID: covidwho-1968281

ABSTRACT

Objective The health systems costs of COVID-19 are high in many countries, including Pakistan. Without increases in fiscal space, COVID-19 interventions are likely to displace other activities within the health system. We reflect on the inclusion of COVID-19 interventions in Pakistan's Essential Package of Health Services (EPHS) and, from a financial optimisation perspective, propose which interventions should be displaced to ensure the highest possible overall health utility within budgetary constraints. Methods We estimated the costs of all 88 interventions currently included in the EPHS and collected published data on their cost-effectiveness. We also estimated total costs and costeffectiveness of COVID-19 vaccination in Pakistan. We ranked all EPHS interventions and COVID-19 vaccination by costeffectiveness, determining which interventions are comparatively least cost-effective and, in the absence of additional funding, no longer affordable. Results The EPHS assumes a spending per capita of US $12.96, averting 40.36 million disability-adjusted life years (DALYs). From a financial optimisation perspective, and assuming no additional funds, the introduction of a COVID-19 vaccine (US$3 per dose) should displace 8 interventions out of the EPHS, making the EPHS more cost-effective by averting 40.62 million DALYs. A US$6 dose should displace a further intervention and avert 40.56 million DALYs. A US$10 dose would partially fall out of the package, displacing four additional interventions. If health spending per capita decreased to US$8, a US$3 dose would still be affordable, but not US$6 or US$10 doses. Discussion Cost-effectiveness is only one criterion considered when deciding which interventions are included in (or removed from) a health benefits package. While displacing certain interventions to create fiscal space for the COVID-19 vaccine may lead to a financially optimal scenario, doing so may be politically unfeasible or socially undesirable. We highlight the difficult trade-offs that health systems face in the era of COVID-19.

3.
Social Policy and Society ; : 16, 2022.
Article in English | Web of Science | ID: covidwho-1799615

ABSTRACT

Governments across the world have been slow in reacting to meeting the needs of disabled people during the pandemic. This has exposed existing inequalities in social policies, as well as new support barriers. Debates over social care have focused on Covid-19's impact on those living in residential care. Little is known about the experiences of disabled people who rely on daily support in their homes. This article reports on a year-long study examining the experiences of disabled people during the pandemic in England and Scotland. It focuses on the crisis in social care and offers evidence of how lives have been disrupted. For many, this resulted in a sudden loss of services, delayed assessments and break down of routines and communities. Findings underline the weakness of social care in its wider relationship with the NHS and show how the social care crisis has challenged the goal of independent living.

4.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-327021

ABSTRACT

The recent emergence of the SARS-CoV-2 Omicron variant is raising concerns because of its increased transmissibility and by its numerous spike mutations with potential to evade neutralizing antibodies elicited by COVID-19 vaccines. The Dominican Republic was among the first countries in recommending the administration of a third dose COVID-19 vaccine to address potential waning immunity and reduced effectiveness against variants. Here, we evaluated the effects of a heterologous BNT162b2 mRNA vaccine booster on the humoral immunity of participants that had received a two-dose regimen of CoronaVac, an inactivated vaccine used globally. We found that heterologous CoronaVac prime followed by BNT162b2 booster regimen induces elevated virus-specific antibody levels and potent neutralization activity against the ancestral virus and Delta variant, resembling the titers obtained after two doses of mRNA vaccines. While neutralization of Omicron was undetectable in participants that had received a two-dose regimen of CoronaVac vaccine, BNT162b2 booster resulted in a 1.4-fold increase in neutralization activity against Omicron, compared to two-dose mRNA vaccine. Despite this increase, neutralizing antibody titers were reduced by 6.3-fold and 2.7-fold for Omicron compared to ancestral and Delta variant, respectively. Surprisingly, previous SARS-CoV-2 infection did not affect the neutralizing titers for Omicron in participants that received the heterologous regimen. Our findings have immediate implications for multiples countries that previously used a two-dose regimen of CoronaVac and reinforce the notion that the Omicron variant is associated with immune escape from vaccines or infection-induced immunity, highlighting the global need for vaccine boosters to combat the impact of emerging variants.

5.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326899

ABSTRACT

A new SARS-CoV-2 variant of concern, Omicron (B.1.1.529), has been identified based on genomic sequencing and epidemiological data in South Africa. Presumptive Omicron cases in South Africa have grown extremely rapidly, despite high prior exposure and moderate vaccination coverage. The available evidence suggests that Omicron spread is at least in part due to evasion of this immune protection, though Omicron may also exhibit higher intrinsic transmissibility. Using detailed laboratory and epidemiological data from South Africa, we estimate the constraints on these two characteristics of the new variant and their relationship. Our estimates and associated uncertainties provide essential information to inform projection and scenario modeling analyses, which are crucial planning tools for governments around the world.

6.
Galbiati, C.; Abba, A.; Agnes, P.; Amaudruz, P.; Arba, M.; Ardellier-Desages, F.; Badia, C.; Batignani, G.; Bellani, G.; Bianchi, G.; Bishop, D.; Bocci, V.; Bonivento, W.; Bottino, B.; Bouchard, M.; Brice, S.; Buccino, G.; Bussino, S.; Caminata, A.; Capra, A.; Caravati, M.; Carlini, M.; Carrozzi, L.; Cela, J. M.; Celano, B.; Charette, C.; Coelli, S.; Constable, M.; Cocco, V.; Croci, G.; Cudmore, S.; Molin, Dal, D'Auria, S.; D'Avenio, G.; DeRuiter, J.; Cecco, De, Lauretis, De, Tutto, Del, Devoto, A.; Dinon, T.; Druszkiewicz, E.; Fabbri, A.; Ferroni, F.; Fiorillo, G.; Ford, R.; Foti, G.; Franco, D.; Gabriele, F.; Abia, Garcia, Giarratana, L. S.; Givoletti, J.; Givoletti, Mi, Gorini, G.; Gramellini, E.; Grosso, G.; Guescini, F.; Guetre, E.; Hadden, T.; Hall, J.; Heavey, A.; Hersak, G.; Hessey, N.; Ianni, An, Ienzi, C.; Ippolito, V.; Kendziora, C. L.; King, M.; Kittmer, A.; Kochanek, I.; Kruecken, R.; Commara, La, Leblond, G.; Li, X.; Lim, C.; Lindner, T.; Lombardi, T.; Long, T.; Lu, P.; Lukhanin, G.; Magni, G.; Maharaj, R.; Malosio, M.; Mapelli, C.; Maqueo, P.; Margetak, P.; Mari, S. M.; Martin, L.; Massacret, N.; McDonald, A.; Minuzzo, D.; Mohayai, T. A.; Tosatti, Molinari, Moretti, C.; Muraro, A.; Nati, F.; Noble, A. J.; Norrick, A.; Olchanski, K.; Palumbo, I.; Paoletti, R.; Paoli, N.; Pearson, C.; Pellegrino, C.; Pesudo, V.; Pocar, A.; Pontesilli, M.; Pordes, R.; Pordes, S.; Prini, A.; Putignano, O.; Raaf, J. L.; Razeti, M.; Razeto, A.; Reed, D.; Renshaw, A.; Rescigno, M.; Retiere, F.; Rignanese, L. P.; Rode, J.; Romualdez, L. J.; Santorelli, R.; Sablone, D.; Scapparone, E.; Schaubel, T.; Shaw, B.; Slutsky, A. S.; Smith, B.; Smith, N. J. T.; Spagnolo, P.; Spinella, F.; Stenzler, A.; Steri, A.; Stiaccini, L.; Stoughton, C.; Stringari, P.; Tardocchi, M.; Tartaglia, R.; Testera, G.; Tintori, C.; Tonazzo, A.; Tseng, J.; Viscione, E.; Vivaldi, F.; Wada, M.; Wang, H.; Westerdale, S.; Yue, S.; Zardoni, A..
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-310788

ABSTRACT

Presented here is the design of the Mechanical Ventilator Milano (MVM), a novel mechanical ventilator designed for rapid mass production in response to the COVID-19 pandemic to address the urgent shortage of intensive therapy ventilators in many countries, and the growing difficulty in procuring these devices through normal supply chains across borders. This ventilator is an electro-mechanical equivalent of the old and reliable Manley Ventilator, and is able to operate in both pressure-controlled and pressure-supported ventilation modes. MVM is optimized for the COVID-19 emergency, thanks to the collaboration with medical doctors in the front line. MVM is designed for large-scale production in a short amount of time and at a limited cost, as it relays on off-the-shelf components, readily available worldwide. Operation of the MVM requires only a source of compressed oxygen (or compressed medical air) and electrical power. Initial tests of a prototype device with a breathing simulator are also presented. Further tests and developments are underway. At this stage the MVM is not yet a certified medical device but certification is in progress.

7.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-296807

ABSTRACT

Background: Countries in the World Health Organization (WHO) European Region differ in terms of the COVID-19 vaccine roll-out speed. We evaluated the health and economic impact of different age-based vaccine prioritisation strategies across this demographically and socio-economically diverse region. Methods: We fitted country-specific age-stratified compartmental transmission models to reported COVID-19 mortality in the WHO European Region to inform the immunity level before vaccine roll-out. Building upon broad recommendations from the WHO Strategic Advisory Group of Experts on Immunisation (SAGE), we examined four strategies that prioritise: all adults (V+), younger (20-59 year-olds) followed by older adults (60+) (V20), older followed by younger adults (V60), and the oldest adults (75+) (V75) followed by incremental expansion to successively younger five-year age groups. We explored four roll-out scenarios based on projections or recent observations (R1-4) - the slowest scenario (R1) covers 30% of the total population by December 2022 and the fastest (R4) 80% by December 2021. Five decision-making metrics were summarised over 2021-22: mortality, morbidity, and losses in comorbidity-adjusted life expectancy (cLE), comorbidity- and quality-adjusted life years (cQALY), and the value of human capital (HC). Six sets of infection-blocking and disease-reducing vaccine efficacies were considered. Findings: The optimal age-based vaccine prioritisation strategies were sensitive to country characteristics, decision-making metrics and roll-out speeds. Overall, V60 consistently performed better than or comparably to V75. There were greater benefits in prioritising older adults when roll-out is slow and when VE is low. Under faster roll-out, V+ was the most desirable option. Interpretation: A prioritisation strategy involving more age-based stages (V75) does not necessarily lead to better health and economic outcomes than targeting broad age groups (V60). Countries expecting a slow vaccine roll-out may particularly benefit from prioritising older adults. Funding: World Health Organization, Bill and Melinda Gates Foundation, the Medical Research Council (United Kingdom), the National Institute of Health Research (United Kingdom), the European Commission, the Foreign, Commonwealth and Development Office (United Kingdom), Wellcome Trust. Research in Context: Evidence before this study: We searched PubMed and medRxiv for articles published in English from inception to 9 Jun 2021, with the search terms: ("COVID-19" OR "SARS-CoV-2") AND ("priorit*) AND ("model*") AND ("vaccin*") and identified 66 studies on vaccine prioritization strategies. Of the 25 studies that compared two or more age-based prioritisation strategies, 12 found that targeting younger adults minimised infections while targeting older adults minimised mortality;an additional handful of studies found similar outcomes between different age-based prioritisation strategies where large outbreaks had already occurred. However, only two studies have explored age-based vaccine prioritisation using models calibrated to observed outbreaks in more than one country, and no study has explored the effectiveness of vaccine prioritisation strategies across settings with different population structures, contact patterns, and outbreak history. Added-value of this study: We evaluated various age-based vaccine prioritisation strategies for 38 countries in the WHO European Region using various health and economic outcomes for decision-making, by parameterising models using observed outbreak history, known epidemiologic and vaccine characteristics, and a range of realistic vaccine roll-out scenarios. We showed that while targeting older adults was generally advantageous, broadly targeting everyone above 60 years might perform better than or comparably to a more detailed strategy that targeted the oldest age group above 75 years followed by those in the next younger five-year age band. Rapid vaccine roll-out has only been observed in a small number of countries. If vaccine coverage can reach 80% by the end of 2021, prioritising older adults may not be optimal in terms of health and economic impact. Lower vaccine efficacy was associated with greater relative benefits only under relatively slow roll-out scenarios considered. Implication of all the available evidence: COVID-19 vaccine prioritization strategies that require more precise targeting of individuals of a specific and narrow age range may not necessarily lead to better outcomes compared to strategies that prioritise populations across broader age ranges. In the WHO European Region, prioritising all adults equally or younger adults first will only optimise health and economic impact when roll-out is rapid, which may raise between-country equity issues given the global demand for COVID-19 vaccines.

8.
Under Pressure: Essays on Urban Housing ; : 105-116, 2021.
Article in English | Scopus | ID: covidwho-1528976

ABSTRACT

Domestic arrangements are changing accordingly, with seniors moving in with their adult children or their siblings or unrelated caregivers. While homeownership for the population as a whole has held steady at about 65 percent for many decades, only about 33 percent of Millennials owned their own homes in 2017. The rise of the sharing economy in the past ten years has disrupted our relationship to cars, apartments, even jobs. Inter-generational, non-family, non-traditional, and multi-cultural are all housing options readily available online. While the COVID-19 pandemic has turned social distancing into a new habit, it’s unclear if it will change long-term attitudes to sharing rides, living arrangements, and other such things. As society becomes more fluid in terms of its definitions of “household” and “family, " new forms of housing will continue to evolve. Some of these models will focus on particular needs-such as micro-dwellings for young professionals without a lot of money to spend on rent. © 2022 Taylor & Francis.

9.
J Hosp Infect ; 119: 175-181, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1415561

ABSTRACT

Increases in hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia rates in England were observed between August 2020 and February 2021 to the highest levels recorded since the start of mandatory surveillance in April 2017. Cases were extracted from England's mandatory surveillance database for key Gram-negative bloodstream infections. Incidence rates for hospital-onset bacteraemia cases increased from 8.9 (N=255) to 14.9 (N=394) per 100,000 bed-days for Klebsiella spp. [incidence rate ratio (IRR) 1.7, P<0.001], and from 4.9 (N=139) to 6.2 (N=164) per 100,000 bed-days for P. aeruginosa (IRR 1.3, P<0.001) (August 2020-February 2021). These incidence rates were higher than the average rates observed during the same period in the previous 3 years. These trends coincided with an increase in the percentage of hospital-onset bacteraemia cases that were also positive for severe acute respiratory syndrome coronavirus-2.


Subject(s)
Bacteremia , COVID-19 , Bacteremia/epidemiology , England/epidemiology , Hospitals , Humans , Klebsiella , Pseudomonas aeruginosa , SARS-CoV-2 , State Medicine
11.
Annals of Emergency Medicine ; 78(2):S41-S42, 2021.
Article in English | Web of Science | ID: covidwho-1353233
12.
Annals of Emergency Medicine ; 78(2):S41-S42, 2021.
Article in English | EMBASE | ID: covidwho-1351526

ABSTRACT

Study Objectives: Emergency physicians (EPs) are always on the frontlines and many EPs thrive on the unpredictable. Despite this, the COVID-19 pandemic posed unprecedented challenges to all EPs, including the challenge of how to prepare for and cope with a pandemic. This subset analysis aimed to evaluate the impact of the COVID-19 pandemic specifically on the lives of EP fathers. Methods: From May 2 through June 16, 2020, a convenience sample of physician fathers was surveyed on their personal and professional preparedness for COVID-19. Surveys were distributed via the Physician Dads Group (PDG), an international Facebook group covering all medical specialties, LinkedIn, via personal contacts and professional organizations. Results: 260 surveys were completed by EP fathers (Table 1). Of the respondents, 77% were between 30-49 years, 84% were White, 9% Asian, 1% Black;31 U.S. states were represented. 98% reported they had a partner. At the time of the survey, 63% felt they were in a high-density area with 88% having cared for a COVID+ patient. About half had taken steps to prepare personally or professionally for the local impact of COVID-19 (46% and 67%, respectively). EP fathers’ top two concerns were exposing their partner or their child(ren) to COVID-19, followed by personally acquiring COVID-19. 44% of fathers didn’t have to change their schedule to care for children, while 37% did;other fathers did not have school-aged children or already had care in the home. In terms of preparation, about 67% made sure they had adequate food, 60% made sure they were financially prepared, while 46% and 41% obtained PPE for self or family, respectively. To prepare professionally, almost all (97%) educated themselves about COVID-19, 68% self-educated about pandemics, and 72% reviewed critical care literature. The three biggest professional concerns were morale of staff (48%), financial challenges (45%), and health of staff (43%). 37% of fathers felt that the balance between their professional and personal responsibilities worsened, while 17% felt the balance improved. When EP fathers were asked if they wished they did not go into medicine, 67% disagreed/strongly disagreed. When asked if they wished they had not gone into their specialty, 89% disagreed/strongly disagreed. Conclusions: EP fathers felt more prepared professionally than personally for the pandemic. The findings highlight that EP fathers were concerned about their family becoming sick but also concerned with the health and morale of staff at work. [Formula presented]

13.
Annals of Emergency Medicine ; 78(2):S36, 2021.
Article in English | EMBASE | ID: covidwho-1351515

ABSTRACT

Study Objectives: The ongoing COVID-19 pandemic has affected frontline health care workers significantly at work and at home, with recent studies suggesting the pandemic negatively affecting physicians in both spheres. Only a few studies have examined the attitudes and conflicts faced by physician fathers, the majority of current practitioners. This work is a subset analysis of responses to qualitative questions on the impact of the COVID-19 pandemic on the lives of emergency physician (EP) fathers. Methods: A convenience sample of physician fathers was obtained from May 2 to June 16, 2020, via social media and email. The survey contained questions on personal and professional struggles during the start of the pandemic and including several free test questions. Free responses were analyzed and coded. Several themes emerged related to experiences described: (1) self;(2) social;(3) home life;(4) work life;(5) financial;(6) immediate family. Under each main theme were subthemes that provided a more detailed match for each comment. Results: There were 260 surveys completed by EP fathers from 31 states. 84% were White, 9% Asian, 1% Black, 5% other. 78% were between 30-49 years;98% reported having a partner. Most fathers had younger children (infants through middle-school aged) living in the household with them at the time of the survey. The three most common themes were “work life” (38%), “immediate family” (20%), and “social” (15%). In “work life” the most common subthemes were “general change in responsibilities” (29%), “decrease in workload/unemployed” (21%), and “concerns/negative feelings towards work” (18%). In “immediate family” both “positive change in family life” (45%) and “negative change in family life” (19%) predominated. Under “social,” “missing/lacking social interaction” (49%) and “missed/cancelled events” (33%) were most common. Of note in other themes in “self,” the two most common subthemes were “negative mental state” (45%) and “decreased productivity” (12%). In “home life,” “change in usual routine/structure/schedule” was the most common (42%) followed by “difficulty caring/assisting children” (28%). The “financial” theme was dominated by the subtheme “financial issues/loss” (94%). Conclusions: This study examined reported concerns and attitudes of EP fathers during the COVID-19 pandemic. EP fathers reported a variety challenges affecting both their personal and professional lives with positive and negative changes. Further research is needed to better understand how to support EP fathers during future pandemics.

14.
Annals of Emergency Medicine ; 78(2):S34-S35, 2021.
Article in English | EMBASE | ID: covidwho-1351511

ABSTRACT

Study Objectives: The new coronavirus that emerged in Wuhan, China was declared a global pandemic in March 2020 sparking a worldwide effort to find a vaccine that could effectively prevent continued spread of the virus. The Gallup’s tracking poll findings from 9/16/2020 to 9/29/2020 showed that 63% of Americans would be agreeable to being vaccinated if an FDA-approved vaccine were available to them at no cost. A survey conducted in France from March to July 2020 to determine COVID-19 vaccine acceptance specifically amongst health care workers (HCW) revealed that 75% of their HCWs intended to be vaccinated. Our literature search however did not yield studies assessing the acceptability of a COVID-19 vaccine amongst HCWs, specifically in the United States. The aim of this study was to determine COVID-19 vaccination rates amongst HCWs within a single hospital, any differences between HCWs acceptability of the vaccine, and which factors were most important in their decision-making. Methods: A prospective cross-sectional study of HCWs at Ascension Macomb-Oakland Hospital was conducted in February 2021 – March 2021 soon after vaccines became available at the hospital. A SurveyMonkey was mass-distributed by email to HCWs including doctors, nurses, administrators, pharmacists, technicians, and secretaries. Any HCW that was over the age of 18 years of age was eligible to participate. A series of 15 questions were asked in a multiple choice and scale format. Result: A total of 574 out of the ∼2900 HCWs completed the survey. Of these, 487 (84.8%) either accepted or intended to get vaccinated within the next 3 months. 62 (10.8%) would decline the vaccine over the next 3 months and 25 (4.4%) remained undecided. The mean age of respondents was 45. The majority of surveys were completed by females (75.7%). The mean age of HCWs willing to accept the vaccine was greater compared to those who declined the vaccine (40 years of age vs 46 years of age). There was a higher proportion of Democrats willing to accept the vaccine than those who declined the vaccine (27% vs 9.8%). The most important factors for those that decided to take the vaccine were protection of their own health;protection of health of patients, family, or friends;and trust in the science. The most important factors in those that either declined or were undecided about the vaccine were concern for safety profile and side effects of vaccine, uncertainty regarding the effectiveness of the vaccine, and the accelerated development of the vaccine. Conclusions: As one of the nation’s hotspots for the highest rates of positive COVID-19 cases and deaths, a survey to assess acceptability of a COVID-19 vaccine showed that a majority of HCWs had either taken or planned to take the vaccine. HCWs background in science and the proximity and frequency in which they work with COVID-19+ patients were felt to account for the difference in vaccination rates between the general public and HCWs.

15.
International Journal of Public Theology ; 15(2):153-156, 2021.
Article in English | Scopus | ID: covidwho-1346125
16.
Scandinavian Journal of Disability Research ; 22(1):285-295, 2020.
Article in English | EMBASE | ID: covidwho-994696

ABSTRACT

Personalisation has dominated social care across OECD countries over the past 20 years. UK policy evolved from the efforts of disabled peoples’ organisations (DPOs) to secure the availability of cash payments as part of a wider drive to enable independent living. Implementation of personalisation across the UK has seen significant divergence in how governments have developed their own responses, but in each country the DPOs’ role and impact has shifted from campaigning and promoting the voices of disabled people to a more muted focus on service provision and limited policy engagement. This article draws on a series of interviews with DPOs and leading disabled activists. It highlights concerns raised related to themes around austerity, changing relationships with local government and the role of co-production in developing policy. We conclude the article by discussing the future directions for personalisation and developments in light of the COVID-19 pandemic.

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