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1.
Sustain Cities Soc ; 81: 103840, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1740174

ABSTRACT

COVID-19 is deemed as the most critical world health calamity of the 21st century, leading to dramatic life loss. There is a pressing need to understand the multi-stage dynamics, including transmission routes of the virus and environmental conditions due to the possibility of multiple waves of COVID-19 in the future. In this paper, a systematic examination of the literature is conducted associating the virus-laden-aerosol and transmission of these microparticles into the multimedia environment, including built environments. Particularly, this paper provides a critical review of state-of-the-art modelling tools apt for COVID-19 spread and transmission pathways. GIS-based, risk-based, and artificial intelligence-based tools are discussed for their application in the surveillance and forecasting of COVID-19. Primary environmental factors that act as simulators for the spread of the virus include meteorological variation, low air quality, pollen abundance, and spatial-temporal variation. However, the influence of these environmental factors on COVID-19 spread is still equivocal because of other non-pharmaceutical factors. The limitations of different modelling methods suggest the need for a multidisciplinary approach, including the 'One-Health' concept. Extended One-Health-based decision tools would assist policymakers in making informed decisions such as social gatherings, indoor environment improvement, and COVID-19 risk mitigation by adapting the control measurements.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-318771

ABSTRACT

There is much discussion among clinicians, epidemiologists, and public health experts about why case fatality rate from COVID-19 in Italy (at 13.3% as of April 20, 2020, versus a global case fatality rate of 6.9%) is considerably higher than estimates from other countries (especially China, South Korea, and Germany). In this article, we propose several potential explanations for these differences. We suggest that Italy’s overall and relative case fatality rate, as reported by public health authorities, is likely to be inflated by such factors as heterogeneous reporting of coronavirus-related fatalities across countries and the iceberg effect of under-testing, yielding a distorted view of the global severity of the COVID-19 pandemic. We also acknowledge that deaths from COVID-19 in Italy are still likely to be higher than in other equally affected nations due to its unique demographic and socio-economic profile. Lastly, we discuss the important role of the stress imparted by the epidemic on the Italian healthcare system, which weakened its capacity to adequately respond to the sudden influx of COVID-19 patients in the most affected areas of the country, especially in the Lombardy region.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-305816

ABSTRACT

Background: To provide an overview of the worldwide association between hospital beds, the burden of non-communicable diseases (NCDs), and COVID-19 mortality. Methods: : Data was extracted regarding COVID-19 deaths and cases from the Our World in Data as of March 23, 2021. The following data was obtained:1) NCDs disability-adjusted life years (DALYs), health-adjusted life expectancy, and the health access and quality index from the Global Burden of Disease study;2) the number of hospital beds, physicians, nurses and midwives per population, and out-of-pocket payments from the WHO website. Using the multilevel generalized linear model, these variables’ independent associations with COVID-19 mortality rate ratio (MRR) was examined. Results: : Hospital beds were associated with reduced COVID-19 mortality (MRR=0.47;95% CI: 0.44 to 0.5) globally. During COVID-19 peak periods, despite a decreasing trend in COVID-19 MRR with increasing beds in high-income countries, the odds of mortality remained high even within the highest percentile of hospital beds (MRR=1.54 for 20 th -40 th and 1.06 for >60 th bed percentile, respectively). On the contrary, in middle-income countries, an inverse association was observed between the number of hospital beds and COVID-19 mortality in both periods. NCD DALYs were associated with increased COVID-19 deaths, particularly during peak mortality periods in high-income countries. Death-to-case ratio increased by approximately two times during the peak vs non-peak mortality periods. Conclusions: : COVID-19 is a syndemic interacting with non-communicable diseases and not only a pandemic. A comprehensive national healthcare plan against COVID-19 spread should include adequate measures to protect vulnerable patients with pre-existing chronic conditions.

5.
Int J Public Health ; 66: 1604312, 2021.
Article in English | MEDLINE | ID: covidwho-1686586

ABSTRACT

Objectives: With vaccination shortage persisting in many countries, adopting an optimal vaccination program is of crucial importance. Given the slow pace of vaccination campaigns globally, a very relevant and burning public health question is whether it is better to delay the second COVID-19 vaccine shot until all priority group people have received at least one shot. Currently, many countries are looking to administer a third dose (booster shot), which raises the question of how to distribute the available daily doses to maximize the effectively vaccinated population. Methods: We formulate a generalized optimization problem with a total of u T = ∑ i = 1 n u i vaccine doses, that have to be optimally distributed between n different sub-populations, where sub-population u i represents people receiving the ith dose of the vaccine with efficacy α i . The particular case where n = 2 is solved first, followed by the general case of n dose regimen. Results: In the case of a two dose regimen, if the efficacy of the second dose is less than (or equal to) twice the efficacy of the first dose, the optimal strategy to maximize the number of effectively vaccinated people is to delay the second vaccine as much as possible. Otherwise, the optimal strategy would consist of administering the second dose as quickly as possible. In the general case, the optimal vaccination strategy would be to administer the k - th dose corresponding to the index providing the maximum inter-dose efficacy difference (α i - α i-1) for all possible values of i ∈ {1, … , n}, with α 0 = 0. Conclusion: Our results suggest that although extending the interval between doses beyond 12 weeks was likely optimal earlier in the pandemic, the reduced single dose efficacy of vaccines against the delta variant make this approach no longer viable.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , SARS-CoV-2 , Vaccination
6.
Br J Sports Med ; 2022 Feb 09.
Article in English | MEDLINE | ID: covidwho-1685524

ABSTRACT

OBJECTIVE: To determine the association between directly measured physical activity and hospitalisation, intensive care unit (ICU) admission, ventilation and mortality rates in patients with a confirmed diagnosis of COVID-19. METHODS: Directly measured physical activity data from 65 361 adult patients with a COVID-19 diagnosis from 19 March 2020 to 30 June 2021, were grouped by activity level: low (<60 min/week), moderate (60-149 min/week) and high activity (≥150 min/week). The association of physical activity levels and the risk of adverse outcomes was analysed using modified Poisson regression. We accounted for demographics and comorbidities including conditions known to influence COVID-19 outcomes, as well as patient complexity as measured by the Johns Hopkins Adjusted Clinical Group system. The regression approach was further validated with a Bayesian network model built off a directed acyclic graph. RESULTS: High physical activity was associated with lower rates of hospitalisation (risk ratio, RR 0.66, 95% CI 0.63 to 0.70), ICU admission (RR 0.59, 95% CI 0.52 to 0.66), ventilation (RR 0.55, 95% CI 0.47 to 0.64) and death (RR 0.58, 95% CI 0.50 to 0.68) due to COVID-19 than those who engaged in low physical activity. Moderate physical activity also was associated with lower rates of hospitalisation (RR 0.87, 95% CI 0.82 to 0.91), admission to ICU (RR 0.80, 95% CI 0.71 to 0.89), ventilation (RR 0.73, 95% CI 0.62 to 0.84) and death (RR 0.79, 95% CI 0.69 to 0.91). CONCLUSIONS: Adults with high and moderate physical activity levels had significantly better outcomes than those with low activity when contracting COVID-19. The apparent protective effects of regular physical activity extended to those with concomitant chronic medical conditions.

8.
BMJ Open ; 11(10): e053962, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1495474

ABSTRACT

INTRODUCTION: Infectious diseases pose a risk to public health, requiring efficient strategies for disease prevention. Digital health surveillance technologies provide new opportunities to enhance disease prevention, detection, tracking, reporting and analysis. However, in addition to concerns regarding the effectiveness of these technologies in meeting public health goals, there are also concerns regarding the ethics, legality, safety and sustainability of digital surveillance technologies. This scoping review examines the literature on digital surveillance for public health purposes during the COVID-19 pandemic to identify health-related applications of digital surveillance technologies, and to highlight discussions of the implications of these technologies. METHODS AND ANALYSIS: The scoping review will be guided by the framework proposed by Arksey and O'Malley and the guidelines outlined by Colquhoun et al and Levac et al. We will search Medline (Ovid), PsycInfo, PubMed, Scopus, CINAHL (EBSCOhost), ACM Digital Library, Google Scholar and IEEE Explore for relevant studies published between December 2019 and December 2020. The review will also include grey literature. Data will be managed and analysed through an extraction table and thematic analysis. ETHICS AND DISSEMINATION: Findings will be disseminated through traditional academic channels, as well as social media channels and research briefs and infographics. We will target our dissemination to provincial and federal public health organisations, as well as technology companies and community-based organisations managing the public response to the COVID-19 pandemic.


Subject(s)
COVID-19 , Delivery of Health Care , Digital Technology , Humans , Pandemics/prevention & control , Research Design , Review Literature as Topic , SARS-CoV-2
10.
Scand J Public Health ; 49(1): 69-78, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1207568

ABSTRACT

Aims: To compare the early impact of COVID-19 infections and mortality from February to July 2020 across the Nordic nations of Sweden, Norway, Denmark, and Finland through available public data sources and conduct a descriptive analysis of the potential factors that drove different epidemiological outcomes, with a focus on Sweden's response. Methods: COVID-19 cases, deaths, tests, case age distribution, and the difference between 2020 all-cause mortality and the average mortality of the previous 5 years were compared across nations. Patterns in cell phone mobility data, testing strategies, and seniors' care home deaths were also compared. Data for each nation were based on publicly available sources as of July 31, 2020. Results: Compared with its Nordic peers, Sweden had a higher incidence rate across all ages, a higher COVID-19-related death rate only partially explained by population demographics, a higher death rate in seniors' care, and higher all-cause mortality. Sweden had approximately half as much mobility change as its Nordic neighbours until April and followed similar rates as its neighbours from April to July. Denmark led its Nordic peers in testing rates, while Sweden had the highest cumulative test-positivity rate continuously from mid-March. Conclusions: COVID-19 pushed Sweden's health system to its capacity, exposed systemic weaknesses in the seniors' care system, and revealed challenges with implementing effective contact tracing and testing strategies while experiencing a high case burden. Looser government restrictions at the beginning of the outbreak are likely to have played a role in the impact of COVID-19 in Sweden. In an effort to improve epidemic control, Sweden has increased testing rates, implemented more restrictive prevention measures, and increased their intensive care unit bed capacity.


Subject(s)
COVID-19/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19 Testing/statistics & numerical data , Cause of Death/trends , Child , Child, Preschool , Denmark/epidemiology , Finland/epidemiology , Humans , Infant , Infant, Newborn , Middle Aged , Mortality/trends , Norway/epidemiology , Sweden/epidemiology , Young Adult
11.
Int J Health Policy Manag ; 9(10): 436-438, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-1068314

ABSTRACT

Differences in public health approaches to control the coronavirus disease 2019 (COVID-19) pandemic could largely explain substantial variations in epidemiological indicators (such as incidence and mortality) between the West and the East. COVID-19 revealed vulnerabilities of most western countries' healthcare systems in their response to the ongoing public health crisis. Hence, western countries can possibly learn from practices from several East Asian countries regarding infrastructures, epidemiological surveillance and control strategies to mitigate the public health impact of the pandemic. In this paper, we discuss that the lack of rapid and timely community-centered approaches, and most importantly weak public health infrastructures, might have resulted in a high number of infected cases and fatalities in many western countries.


Subject(s)
COVID-19/prevention & control , COVID-19/therapy , Communicable Disease Control/methods , Internationality , Public Health/methods , Humans , Pandemics , SARS-CoV-2
12.
Epidemiol Prev ; 44(5-6 Suppl 2): 51-59, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068124

ABSTRACT

BACKGROUND: the Covid-19 pandemic has provoked a huge of clinical and epidemiological research initiatives, especially in the most involved countries. However, this very large effort was characterized by several methodological weaknesses, both in the field of discovering effective treatments (with too many small and uncontrolled trials) and in the field of identifying preventable risks and prognostic factors (with too few large, representative and well-designed cohorts or case-control studies). OBJECTIVES: in response to the fragmented and uncoordinated research production on Covid-19, the   italian Association of Epidemiology (AIE) stimulated the formation of a working group (WG) with the aims of identifying the most important gaps in knowledge and to propose a structured research agenda of clinical and epidemiological studies considered at high priority on Covid-19, including recommendations on the preferable methodology. METHODS: the WG was composed by 25 subjects, mainly epidemiologists, statisticians, and other experts in specific fields, who have voluntarily agreed to the proposal. The agreement on a list of main research questions and on the structure of the specific documents to be produced were defined through few meetings and cycles of document exchanges. RESULTS: twelve main research questions on Covid-19 were identified, covering aetiology, prognosis, interventions, follow-up and impact on general and specific populations (children, pregnant women). For each of them, a two-page form was developed, structured in: background, main topics, methods (with recommendations on preferred study design and warnings for bias prevention) and an essential bibliography. CONCLUSIONS: this research agenda represents an initial contribution to direct clinical and epidemiological research efforts on high priority topics with a focus on methodological aspects. Further development and refinements of this agenda by Public Health Authorities are encouraged.


Subject(s)
COVID-19/epidemiology , Epidemiologic Research Design , Pandemics , Research , SARS-CoV-2 , Adult , Aged , COVID-19/drug therapy , COVID-19/therapy , Child , Epidemiology/organization & administration , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Prognosis , Societies, Scientific , Therapeutic Equipoise
16.
J Stroke Cerebrovasc Dis ; 29(12): 105321, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-872317

ABSTRACT

BACKGROUND: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. METHODS: This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. RESULTS: During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). CONCLUSION: In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic.


Subject(s)
Brain Ischemia/therapy , COVID-19 , Hospitalization/trends , Intracranial Hemorrhages/therapy , Outcome and Process Assessment, Health Care/trends , Stroke/therapy , Thrombolytic Therapy/trends , Time-to-Treatment/trends , Aged , Aged, 80 and over , Bayes Theorem , Brain Ischemia/diagnosis , Brain Ischemia/mortality , COVID-19/epidemiology , Female , Hospital Mortality/trends , Humans , Interrupted Time Series Analysis , Intracranial Hemorrhages/diagnosis , Intracranial Hemorrhages/mortality , Iran/epidemiology , Length of Stay/trends , Male , Middle Aged , Recovery of Function , Stroke/diagnosis , Stroke/mortality , Time Factors , Treatment Outcome
17.
Can J Public Health ; 111(4): 462-465, 2020 08.
Article in English | MEDLINE | ID: covidwho-696704

ABSTRACT

COVID-19 mitigation strategies have led to widespread school closures around the world. Initially, these were undertaken based on data from influenza outbreaks in which children were highly susceptible and important in community-wide transmission. An argument was made that school closures were necessary to prevent harm to vulnerable adults, especially the elderly. Although data are still accumulating, the recently described complication, pediatric multisystem inflammatory syndrome, is extremely rare and children remain remarkably unaffected by COVID-19. We also do not have evidence that children are epidemiologically important in community-wide viral spread. Previous studies have shown long-term educational, social, and medical harms from school exclusion, with very young children and those from marginalized groups such as immigrants and racialized minorities most affected. The policy and ethical implications of ongoing mandatory school closures, in order to protect others, need urgent reassessment in light of the very limited data of public health benefit.


Subject(s)
Coronavirus Infections/prevention & control , Health Policy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health Practice/ethics , Schools/organization & administration , COVID-19 , Canada/epidemiology , Child , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/epidemiology
18.
J Neurol Sci ; 416: 117013, 2020 09 15.
Article in English | MEDLINE | ID: covidwho-629733

ABSTRACT

INTRODUCTION: Current evidence on the association between COVID-19 and dementia is sparse. This study aims to investigate the associations between COVID-19 caseload and the burden of dementia. METHODS: We gathered data regarding burden of dementia (disability-adjusted life years [DALYs] per 100,000), life expectancy, and healthy life expectancy (HALE) from the Global Burden of Disease (GBD) 2017 study. We obtained COVID-19 data from Our World in Data database. We analyzed the association of COVID-19 cases and deaths with the burden of dementia using Spearman's rank correlation coefficient. RESULTS: Globally, we found significant positive (p < .001) correlations between life expectancy (r = 0.60), HALE (r = 0.58), and dementia DALYs (r = 0.46) with COVID-19 caseloads. Likewise, we found similar correlations between life expectancy (r = 0.60), HALE (r = 0.58) and dementia DALYs (r = 0.54) with COVID-19 mortality. CONCLUSION: Health policymakers should clarify a targeted model of disease surveillance in order to reduce the dual burden of dementia and COVID-19.


Subject(s)
COVID-19/epidemiology , Dementia/epidemiology , Age Distribution , Cause of Death , Comorbidity , Databases, Factual , Global Burden of Disease , Humans , Pandemics
19.
J Stroke Cerebrovasc Dis ; 29(9): 105089, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-614222

ABSTRACT

BACKGROUND: The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases. METHODS: We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis. FINDINGS: High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model. INTERPRETATION: Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.


Subject(s)
Coronavirus Infections/epidemiology , Global Health , Noncommunicable Diseases/epidemiology , Pneumonia, Viral/epidemiology , Age Factors , Aged , Aged, 80 and over , Betacoronavirus/pathogenicity , COVID-19 , Cause of Death , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Cost of Illness , Databases, Factual , Female , Health Services Needs and Demand , Health Status Disparities , Healthcare Disparities , Host-Pathogen Interactions , Humans , Incidence , Infection Control , Male , Middle Aged , Needs Assessment , Noncommunicable Diseases/mortality , Noncommunicable Diseases/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , Prognosis , Risk Factors , SARS-CoV-2 , Time Factors
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