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1.
Neurol Neuroimmunol Neuroinflamm ; 9(6)2022 11.
Article in English | MEDLINE | ID: covidwho-2021402

ABSTRACT

BACKGROUND AND OBJECTIVES: Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is needed. METHODS: Clinician-reported demographic/clinical data from 27 countries were aggregated into a data set of 5,648 patients with suspected/confirmed coronavirus disease 2019 (COVID-19). COVID-19 severity outcomes (hospitalization, admission to intensive care unit [ICU], requiring artificial ventilation, and death) were assessed using multilevel mixed-effects ordered probit and logistic regression, adjusted for age, sex, disability, and MS phenotype. DMTs were individually compared with glatiramer acetate, and anti-CD20 DMTs with pooled other DMTs and with natalizumab. RESULTS: Of 5,648 patients, 922 (16.6%) with suspected and 4,646 (83.4%) with confirmed COVID-19 were included. Male sex, older age, progressive MS, and higher disability were associated with more severe COVID-19. Compared with glatiramer acetate, ocrelizumab and rituximab were associated with higher probabilities of hospitalization (4% [95% CI 1-7] and 7% [95% CI 4-11]), ICU/artificial ventilation (2% [95% CI 0-4] and 4% [95% CI 2-6]), and death (1% [95% CI 0-2] and 2% [95% CI 1-4]) (predicted marginal effects). Untreated patients had 5% (95% CI 2-8), 3% (95% CI 1-5), and 1% (95% CI 0-3) higher probabilities of the 3 respective levels of COVID-19 severity than glatiramer acetate. Compared with pooled other DMTs and with natalizumab, the associations of ocrelizumab and rituximab with COVID-19 severity were also more pronounced. All associations persisted/enhanced on restriction to confirmed COVID-19. DISCUSSION: Analyzing the largest international real-world data set of people with MS with suspected/confirmed COVID-19 confirms that the use of anti-CD20 medication (both ocrelizumab and rituximab), as well as male sex, older age, progressive MS, and higher disability are associated with more severe course of COVID-19.


Subject(s)
COVID-19 , Multiple Sclerosis, Chronic Progressive , Multiple Sclerosis , Antigens, CD20 , Glatiramer Acetate/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Information Dissemination , Male , Multiple Sclerosis/drug therapy , Multiple Sclerosis/epidemiology , Multiple Sclerosis, Chronic Progressive/drug therapy , Natalizumab/therapeutic use , Risk Factors , Rituximab/therapeutic use
2.
Mult Scler Relat Disord ; 66: 104072, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2015867

ABSTRACT

BACKGROUND: Interferon-ß, a disease-modifying therapy (DMT) for MS, may be associated with less severe COVID-19 in people with MS. RESULTS: Among 5,568 patients (83.4% confirmed COVID-19), interferon-treated patients had lower risk of severe COVID-19 compared to untreated, but not to glatiramer-acetate, dimethyl-fumarate, or pooled other DMTs. CONCLUSIONS: In comparison to other DMTs, we did not find evidence of protective effects of interferon-ß on the severity of COVID-19, though compared to the untreated, the course of COVID19 was milder among those on interferon-ß. This study does not support the use of interferon-ß as a treatment to reduce COVID-19 severity in MS.


Subject(s)
COVID-19 , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Acetates , Dimethyl Fumarate/therapeutic use , Glatiramer Acetate/therapeutic use , Humans , Immunosuppressive Agents/adverse effects , Interferon-beta/therapeutic use , Multiple Sclerosis/chemically induced , Multiple Sclerosis/complications , Multiple Sclerosis/drug therapy , Multiple Sclerosis, Relapsing-Remitting/chemically induced
3.
BMC Infect Dis ; 22(1): 514, 2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-1874998

ABSTRACT

BACKGROUND: The city of Melbourne, Australia experienced two waves of the COVID-19 epidemic peaking, the first in March and a more substantial wave in July 2020. During the second wave, a series of control measure were progressively introduced that initially slowed the growth of the epidemic then resulted in decreasing cases until there was no detectable local transmission. METHODS: To determine the relative efficacy of the progressively introduced intervention measures, we modelled the second wave as a series of exponential growth and decay curves. We used a linear regression of the log of daily cases vs time, using a four-segment linear spline model corresponding to implementation of the three successive major public health measures. The primary model used all reported cases between 14 June and 15 September 2020 then compared the projection of the model with observed cases predicting future case trajectory up until the 31 October 2020 to assess the use of exponential models in projecting the future course and planning future interventions. The main outcome measures were the exponential daily growth constants, analysis of residuals and estimates of the 95% confidence intervals for the expected case distributions, comparison of predicted daily cases. RESULTS: The exponential growth/decay constants in the primary analysis were: 0.122 (s.e. 0.004), 0.035 (s.e. 0.005), - 0.037 (s.e. 0.011), and - 0.069 (s.e. 0.003) for the initial growth rate, Stage 3, Stage 3 + compulsory masks and Stage 4, respectively. Extrapolation of the regression model from the 14 September to the 31 October matched the decline in observed cases over this period. CONCLUSIONS: The four-segment exponential model provided an excellent fit of the observed reported case data and predicted the day-to-day range of expected cases. The extrapolated regression accurately predicted the decline leading to epidemic control in Melbourne.


Subject(s)
COVID-19 , Epidemics , Australia/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Forecasting , Humans , Public Health
4.
Mult Scler ; 28(7): 1051-1059, 2022 06.
Article in English | MEDLINE | ID: covidwho-1861983

ABSTRACT

BACKGROUND: The primary objective of this study was to analyse the association between multiple sclerosis (MS) disease-modifying therapy (DMT) exposure and hospitalisation in patients infected with COVID-19. METHODS: Associations between MS DMT exposure and COVID-19 hospitalisation were analysed using univariable and multi-variable-clustered propensity score weighted logistic regression, where the models were clustered on the individual patients to control for patients contributing multiple COVID-19 episodes. FINDINGS: As of 18 January 2021, a total of 476 reported COVID-19 cases had been recorded in MS patients in the Swedish MS registry. Of these, 292 (61.3%) had confirmed COVID-19. The mean value (standard deviation (SD)) age at infection was 44.0 years (11.6). Of the 292 confirmed infections, 68 (23.2%) required hospitalisation. A total of 49 of the 164 confirmed COVID-19 patients on rituximab at baseline (29.9%) required hospitalisation, compared to a rate of 12.7% for all other DMTs combined. Rituximab in confirmed COVID-19 patients was associated with 2.95 times the odds of hospitalisation relative to any other DMT combined (odds ratio = 2.95; 95% confidence interval (CI) = 1.48-5.87). INTERPRETATION: Rituximab treatment, known to increase the risk of severe infections in general, also confers such a risk for MS patients with COVID-19, in comparison with other MS DMTs.


Subject(s)
COVID-19 , Multiple Sclerosis , Hospitalization , Humans , Multiple Sclerosis/chemically induced , Multiple Sclerosis/drug therapy , Multiple Sclerosis/epidemiology , Registries , Rituximab/adverse effects , Sweden/epidemiology
5.
Blood Adv ; 6(7): 2014-2034, 2022 04 12.
Article in English | MEDLINE | ID: covidwho-1765426

ABSTRACT

The objectives of this study were to assess the immunogenicity and safety of COVID-19 vaccines in patients with hematologic malignancies. A systematic review and meta-analysis of clinical studies of immune responses to COVID-19 vaccination stratified by underlying malignancy and published from January 1, 2021, to August 31, 2021, was conducted using MEDLINE, EMBASE, and Cochrane CENTRAL. Primary outcome was the rate of seropositivity after 2 doses of COVID-19 vaccine with rates of seropositivity after 1 dose, rates of positive neutralizing antibodies, cellular responses, and adverse events as secondary outcomes. Rates were pooled from single-arm studies while rates of seropositivity were compared against the rate in healthy controls for comparator studies using a random effects model and expressed as a pooled odds ratios with 95% confidence intervals. Forty-four studies (16 mixed group, 28 disease specific) with 7064 patients were included in the analysis (2331 after first dose, 4733 after second dose). Overall seropositivity rates were 62% to 66% after 2 doses of COVID-19 vaccine and 37% to 51% after 1 dose. The lowest seropositivity rate was 51% in patients with chronic lymphocytic leukemia and was highest in patients with acute leukemia (93%). After 2 doses, neutralizing antibody response rates were 57% to 60%, and cellular response rates were 40% to 75%. Active treatment, ongoing or recent treatment with targeted and CD-20 monoclonal antibody therapies within 12 months were associated with poor immune responses to COVID-19 vaccine. New approaches to prevention are urgently required to reduce COVID-19 infection morbidity and mortality in high-risk patient groups that respond poorly to COVID-19 vaccination.


Subject(s)
COVID-19 , Hematologic Neoplasms , Antibodies, Neutralizing , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Hematologic Neoplasms/complications , Hematologic Neoplasms/therapy , Humans , SARS-CoV-2
6.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-321966

ABSTRACT

Background: The primary objective of this study was to analyse the association between multiple sclerosis (MS) disease modifying therapy (DMT) exposure and subsequent hospitalisation in patients infected with COVID-19.Methods: Data were extracted on the 18th January 2021 from the Swedish MS Registry, which collates nationwide, prospectively-collected clinical, demographic and, from March 2020 onwards, Covid-19-related information (including diagnostics and need of health care including needs of hospitalization, intensive care and ventilation) among persons with MS. Associations between MS DMT exposure and COVID-19 hospitalisation were analysed using univariable and multivariable clustered logistic regression, where the models were clustered on the individual patients to control for patients contributing multiple COVID-19 episodes. Propensity score based inverse probability of treatment weighting (IPTW) approach was used to adjust for confounders.Findings: As of 18th January 2021, a total of 476 reported COVID-19 cases had been recorded in MS patients in the Swedish MS registry. Of these, 292 (61.3%) had confirmed COVID-19. The mean (SD) age at infection was 44.0 years (11.6). Of the 292 confirmed infections 68 (23.2%) required hospitalisation. A total of 49 of the 164 confirmed COVID-19 patients on rituximab at baseline (29.9%) required hospitalisation, compared to a rate of 12.7% for all other DMTs combined. Rituximab in confirmed COVID-19 patients was associated with 2.95 times the weighted odds of hospitalisation relative to treatment with any other alternate DMT combined (Odds Ratio 2.95;95% CI 1.48-5.87). The risk of severe COVID-19 increased with duration of rituximab treatment with a yearly Odds Ratio of 1.24 (95% CI 1.04-1.48).Interpretation: Rituximab treatment, known to increase the risk of severe infections in general, also confers such a risk for MS patients with COVID-19, in comparison with other MS DMTs.Funding: This study was supported by the Swedish Research Council and the Swedish Brain Foundation.Declaration of Interest: TS has received compensation for serving on scientific advisory boards, honoraria for consultancy and funding for travel from Biogen Inc;speaker honoraria from NovartisLF declared no competing interestsKAM receives postdoctoral research funding from the Swedish Research Council for Health, Working Life and Welfare.AG has received research support from Novartis.JH has received honoraria for serving on advisory boards for Biogen, Celgene, Sanofi, Merck KGaA, Novartis and Sandoz and speaker’s fees from Biogen, Novartis, Merck KGaA, Teva and Sanofi. He has served as P.I. for projects, or received unrestricted research support from, Biogen, Celgene, Merck KGaA, Novartis, Roche and Sanofi. His MS research was funded by the Swedish Research Council and the Swedish Brain foundation.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-321606

ABSTRACT

Background: People with multiple sclerosis (MS) may be a vulnerable group for severe COVID-19, particularly those taking immunosuppressive disease-modifying therapies (DMTs).Objectives: To examine characteristics of COVID-19 severity in an international sample of people with MS.Methods: Clinician and patient-reported data from 82 countries were aggregated into two datasets of 1,625 and 7,365 patients, respectively. Characteristics of hospitalisation, admission to Intensive Care Unit (ICU), requiring artificial ventilation, and death were assessed in patients with suspected/confirmed COVID-19 using log-binomial regression.Findings: Only clinician-reported data were used for all analyses. Of 1,625 patients, 481 (29·6%) with suspected and 811 (49·9%) with confirmed COVID-19 were included. Older age, progressive MS, and higher disability were positively associated with worse COVID-19 outcomes. Anti-CD20 DMTs (ocrelizumab/rituximab) were positively associated with hospitalisation (aPR=1·31, 95%CI=0·88-1·95;aPR=1·63, 95%CI=1·08-2·46), ICU admission (aPR=3·38, 95%CI=1·01-11·32;aPR=3·85, 95%CI=1·13-13·11), and ventilation (aPR=2·78, 95%CI=0·61-12·65;aPR=6·73, 95%CI=1·57-28·84) vs dimethyl fumarate, as well as pooled anti-CD20 DMTs vs all other DMTs (hospitalisation aPR=1·59, 95%CI=1·24-2·03;ICU aPR=2·63, 95%CI=1·48-4·68;ventilation aPR=3·18, 95%CI=1·54-6·58) and vs natalizumab (hospitalisation aPR=1·79, 95%CI=1·07-3·01;ICU aPR=2·03, 95%CI=0·66-6·24;ventilation aPR=2·34, 95%CI=0·57-9·63). Importantly, associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death.Interpretation: Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of anti-CD20 DMTs with increased risk of hospitalisation, ICU admission, and need for artificial ventilation, suggesting their use may be a risk factor for more severe COVID-19.Funding: Operational costs were funded by the Multiple Sclerosis International Federation (MSIF) and the Multiple Sclerosis Data Alliance (MSDA), acting under the European Charcot Foundation. MSDA and MSIF receive income from a range of corporate sponsors. This research received funding from the Flemish Government under the Onderzoeksprogramma Artificiële Intelligentie Vlaanderen programme. The central platform was provided by QMENTA and computational resources were provided by Amazon.Declaration of Interests: TK has served on scientific advisory boards for Roche, Sanofi-Genzyme, Novartis, Merck and Biogen, steering committee for Brain Atrophy Initiative by Sanofi-Genzyme, received conference travel support and/or speaker honoraria from WebMD Global, Novartis, Biogen, Sanofi-Genzyme, Teva, BioCSL and Merck and received research support from Biogen. NR & CW have no personal pecuniary interests to disclose, other than being an employee of MSIF, which receives income from a range of corporate sponsors, recently including: Biogen, BristolMyersSquibb (formerly Celgene), Genzyme, Med-Day, Merck, Mylan, Novartis, Roche. JH has received honoraria for serving on advisory boards for Biogen, Celgene, Sanofi-Genzyme, Merck KGaA, Novartis and Sandoz and speaker’s fees from Biogen, Novartis, Merck KGaA, Teva and Sanofi-Genzyme, has served as principal investigator for projects, or received unrestricted research support from Biogen, Celgene, Merck KGaA, Novartis, Roche and Sanofi-Genzyme, and his MS research was funded by the Swedish Research Council and the Swedish Brain foundation. GE has received consulting/speaking fees and research support from Bayer, Novartis, Teva, Sanofi Genzyme, Merck Serono, Biogen Idec, and Roche. TS has served on scientific advisory boards for Biogen. RMcB & HS, work for the Accelerated Cure Project for MS (ACP), which has received grants, collaboration funding, payments for use of assets, or in-kind contributions from the following companies: EMD Serono, Sanofi/Genzyme, Biogen, Genentech, AbbVie, Octave, GlycoMind , Pfizer, MedDay, AstraZeneca, Teva, Mallinckrodt, MSDx, Regeneron Genetics Center, BC Platforms, and Celgene. ACP has also received funding from the Patient-Centered Outcomes Research Institute (PCORI) and the National MS Society (NMSS). RMcB. has received consulting payments from EMD Serono, which have been donated to ACP. AB has received consulting fees from and is an advisory board/speaker/other activities for NeuroTransData, and has worked on project management/clinical studies for and received travel expenses from Novartis and Servier. AS has no personal pecuniary interests to disclose, other than being the lead of the German MSRegistry, which receives funding from a range of public and corporate sponsors, recently including The German Innovation Fund (G-BA), The German MS Trust, Biogen, German MS Society, Celgene (BMS), Merck and Novartis. RM has received no personal funding from any sources, but works for the UK MS Register which is funded by the UK MS Society and has received funding for specific projects from Novartis, Sanofi-Genzyme and Merck KGaA. RJF has received personal consulting fees from Actelion, Biogen, Celgene, EMD Serono, Genentech, Immunic, Novartis, Sanofi, Teva, and TG Therapeutics, and has served on advisory committees for Actelion, Biogen, Immunic, and Novartis, and received clinical trial contract and research grant funding from Biogen and Novartis. AvdW has received honoraria and unrestricted research funding from Novartis, Biogen, Roche, Merck and Sanofi. JIR has received honoraria from Novartis as a scientific advisor, and has received travel grants and attended courses and conferences on behalf of Merck-Serono Argentina, Novartis Argentina. GSdO has received honoraria for lecturing and support for congress participation from Biogen, Merck, Novartis, Sanofi/Genzyme, EMS and Roche. MM has served on scientific advisory board for Biogen, Sanofi, Roche, Novartis, Merck, Abbvie, has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi, Genzyme, and has received research support and support for congress participation from Biogen, Genzyme, Roche, Merck, Novartis. RA has received honoraria from Novartis as a scientific advisor, travel grants and attended courses and conferences on behalf of Merck-Serono Argentina, Biogen Argentina, Genzyme Argentina, Roche Argentina and Novartis Argentina. RN has received honoraria from Novartis, Roche and Biogen for advisory boards. AZ has received travel expenses for scientific meetings from Biogen, Novartis, and Genzyme, speaking honoraria from Eisai, and a study grant from Novartis. GA has received compensation for consulting services or participation in advisory boards from Sanofi, Merck and Roche;research support from Novartis;travel expenses for scientific meetings from Novartis, Roche, Stendhal, and ECTRIMS;speaking honoraria from Sanofi and Merck;and is a member of the International Women in Multiple Sclerosis (iWiMS) network executive committee. GC has received consulting and speaking fees from Novartis, Teva Pharmaceutical Industries Ltd, Teva Italia Srl, Sanofi Genzyme, Genzyme Corporation, Genzyme Europe, Merck KGgA, Merck Serono SpA, Celgene Group, Biogen Idec, Biogen Italia Srl, F. Hoffman-La Roche, Roche SpA, Almirall SpA, Forward Pharma, Medday and Excemed. LMP has no personal pecuniary interests to disclose, other than being the chair of The MS Data Alliance (MSDA), which receives income from a range of corporate sponsors, recently including Biogen, BristolMyersSquibb (formerly Celgene), Canopy Growth Corporation, Genzyme, Icometrix, Merck, Mylan, Novartis, QMENTA, Quanterix, Roche. SSY, EDB, YM, LG, TP, CG, NL, AP, AA, LEF, AG, SB, AS, IvDM, NN, RI, AED, DG, MFM, JB, AF, and AC have no conflicts of interests to disclose.Ethics Approval Statement: This study was approved by the ethical committee of Hasselt University [CME2020/025]. Individual data sources obtained additional ethics approval as required.

8.
Neurology ; 97(19): e1870-e1885, 2021 11 09.
Article in English | MEDLINE | ID: covidwho-1523377

ABSTRACT

BACKGROUND AND OBJECTIVES: People with multiple sclerosis (MS) are a vulnerable group for severe coronavirus disease 2019 (COVID-19), particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS. METHODS: Data from 12 data sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl fumarate, glatiramer acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other DMTs) covariates were queried, along with COVID-19 severity outcomes, hospitalization, intensive care unit (ICU) admission, need for artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression adjusted for age, sex, MS phenotype, and Expanded Disability Status Scale (EDSS) score. RESULTS: Six hundred fifty-seven (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analyzed. Among suspected plus confirmed and confirmed-only COVID-19, 20.9% and 26.9% were hospitalized, 5.4% and 7.2% were admitted to ICU, 4.1% and 5.4% required artificial ventilation, and 3.2% and 3.9% died. Older age, progressive MS phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl fumarate, ocrelizumab and rituximab were associated with hospitalization (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.01-2.41; aOR 2.43, 95% CI 1.48-4.02) and ICU admission (aOR 2.30, 95% CI 0.98-5.39; aOR 3.93, 95% CI 1.56-9.89), although only rituximab was associated with higher risk of artificial ventilation (aOR 4.00, 95% CI 1.54-10.39). Compared to pooled other DMTs, ocrelizumab and rituximab were associated with hospitalization (aOR 1.75, 95% CI 1.29-2.38; aOR 2.76, 95% CI 1.87-4.07) and ICU admission (aOR 2.55, 95% CI 1.49-4.36; aOR 4.32, 95% CI 2.27-8.23), but only rituximab was associated with artificial ventilation (aOR 6.15, 95% CI 3.09-12.27). Compared to natalizumab, ocrelizumab and rituximab were associated with hospitalization (aOR 1.86, 95% CI 1.13-3.07; aOR 2.88, 95% CI 1.68-4.92) and ICU admission (aOR 2.13, 95% CI 0.85-5.35; aOR 3.23, 95% CI 1.17-8.91), but only rituximab was associated with ventilation (aOR 5.52, 95% CI 1.71-17.84). Associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death. Stratification by age, MS phenotype, and EDSS score found no indications that DMT associations with COVID-19 severity reflected differential DMT allocation by underlying COVID-19 severity. DISCUSSION: Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of rituximab with increased risk of hospitalization, ICU admission, and need for artificial ventilation and of ocrelizumab with hospitalization and ICU admission. Despite the cross-sectional design of the study, the internal and external consistency of these results with prior studies suggests that rituximab/ocrelizumab use may be a risk factor for more severe COVID-19.


Subject(s)
COVID-19/complications , Hospitalization/statistics & numerical data , Multiple Sclerosis/complications , Multiple Sclerosis/drug therapy , Adolescent , Adult , Aged , Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/pathology , COVID-19/physiopathology , Cross-Sectional Studies , Dimethyl Fumarate/adverse effects , Dimethyl Fumarate/therapeutic use , Female , Humans , Male , Middle Aged , Natalizumab/adverse effects , Natalizumab/therapeutic use , Respiration, Artificial/statistics & numerical data , Rituximab/adverse effects , Rituximab/therapeutic use , SARS-CoV-2 , Young Adult
10.
PLoS One ; 16(7): e0253510, 2021.
Article in English | MEDLINE | ID: covidwho-1319515

ABSTRACT

BACKGROUND: Whilst evidence of use of face masks in reducing COVID-19 cases is increasing, the impact of mandatory use across a large population has been difficult to assess. Introduction of mandatory mask use on July 22, 2020 during a resurgence of COVID-19 in Melbourne, Australia created a situation that facilitated an assessment of the impact of the policy on the epidemic growth rate as its introduction occurred in the absence of other changes to restrictions. METHODS AND FINDINGS: Exponential epidemic growth or decay rates in daily COVID-19 diagnoses were estimated using a non-weighted linear regression of the natural logarithm of the daily cases against time, using a linear spline model with one knot (lspline package in R v 3.6.3). The model's two linear segments pivot around the hinge day, on which the mask policy began to take effect, 8 days following the introduction of the policy. We used two forms of data to assess change in mask usage: images of people wearing masks in public places obtained from a major media outlet and population-based survey data. Potential confounding factors (including daily COVID-19 tests, number of COVID-19 cases among population subsets affected differentially by the mask policy-e.g., healthcare workers) were examined for their impact on the results. Daily cases fitted an exponential growth in the first log-linear segment (k = +0.042, s.e. = 0.007), and fitted an exponential decay in the second (k = -0.023, s.e. = 0.017) log-linear segment. Over a range of reported serial intervals for SARS-CoV-2 infection, these growth rates correspond to a 22-33% reduction in an effective reproduction ratio before and after mandatory mask use. Analysis of images of people in public spaces showed mask usage rose from approximately 43% to 97%. Analysis of survey data found that on the third day before policy introduction, 44% of participants reported "often" or "always" wearing a mask; on the fourth day after, 100% reported "always" doing so. No potentially confounding factors were associated with the observed change in growth rates. CONCLUSIONS: The mandatory mask use policy substantially increased public use of masks and was associated with a significant decline in new COVID-19 cases after introduction of the policy. This study strongly supports the use of masks for controlling epidemics in the broader community.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Masks/statistics & numerical data , Policy , Australia/epidemiology , Cities/epidemiology , Health Behavior , Humans , Multivariate Analysis , Pandemics/prevention & control
12.
Mult Scler ; 26(10): 1157-1162, 2020 09.
Article in English | MEDLINE | ID: covidwho-646806

ABSTRACT

BACKGROUND: We need high-quality data to assess the determinants for COVID-19 severity in people with MS (PwMS). Several studies have recently emerged but there is great benefit in aligning data collection efforts at a global scale. OBJECTIVES: Our mission is to scale-up COVID-19 data collection efforts and provide the MS community with data-driven insights as soon as possible. METHODS: Numerous stakeholders were brought together. Small dedicated interdisciplinary task forces were created to speed-up the formulation of the study design and work plan. First step was to agree upon a COVID-19 MS core data set. Second, we worked on providing a user-friendly and rapid pipeline to share COVID-19 data at a global scale. RESULTS: The COVID-19 MS core data set was agreed within 48 hours. To date, 23 data collection partners are involved and the first data imports have been performed successfully. Data processing and analysis is an on-going process. CONCLUSIONS: We reached a consensus on a core data set and established data sharing processes with multiple partners to address an urgent need for information to guide clinical practice. First results show that partners are motivated to share data to attain the ultimate joint goal: better understand the effect of COVID-19 in PwMS.


Subject(s)
Coronavirus Infections/physiopathology , Multiple Sclerosis/therapy , Pneumonia, Viral/physiopathology , Registries , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/therapy , Data Collection , Humans , Information Dissemination , International Cooperation , Multiple Sclerosis/complications , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Risk Factors , SARS-CoV-2 , Treatment Outcome
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