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1.
Front Microbiol ; 13: 829393, 2022.
Article in English | MEDLINE | ID: covidwho-1793004

ABSTRACT

Background: Identifying determinants of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission in settings of contagion is fundamental to inform containment strategies. We assessed SARS-CoV-2 cycle threshold value (Ct) from the first diagnostic nasal-pharyngeal swab of symptomatic index cases and which demographic or clinical characteristics among cases and contacts are associated with transmission risk within households. Methods: This is a retrospective prevalence study on secondary SARS-CoV-2 cases (SC) among the household contacts of symptomatic adult index cases randomly sampled from all the SARS-CoV-2-positive diagnostic nasopharyngeal swabs analyzed at our regional referral hospital (Amedeo di Savoia Hospital, Turin, Italy) in March, 2020. Index cases underwent a telephone survey to collect their demographic and clinical data and all their household contacts. The Ct value of RdRp gene from the first diagnostic swab of index cases was recorded and index cases were grouped according to Ct tertiles (A < first tertile, first ≤ B ≤ second tertile, C ≥ second tertile). Post hoc analysis was performed in SC as well as contacts that did not undergo SARS-CoV-2 testing but developed compatible signs and symptoms. Non-parametric tests and generalized linear models were run. Results: Index (n = 72) and contact (n = 164) median age was 54 (48-63) and 32 (20-56) years, respectively. A total of 60, 50, and 54 subjects were contacts of group A, B, and C index cases, respectively; 35.9% of contacts were SC. Twenty-four further subjects (14.6%) met the criteria for symptom-based likely positive SC. The secondary attack rate was 36.0% (28.6-43.4), assuming a mean incubation period of 5 days and a maximum infectious period of 20 days. SC prevalence differed between Ct groups (53.3% A, 32.0% B, 20.4% C; p < 0.001). No difference in SC was found according to sex, presence of signs/symptoms, and COVID-19 severity of index cases, or according to contacts' sex and number per household. The age of both index cases [aOR 4.52 (1.2-17.0) for 60 vs. ≤45 years old] and contacts [aOR 3.66 (1.3-10.6) for 60 vs. ≤45years old] and the Ct of the index [aOR 0.17 (0.07-0.4) for Ct ≥ 31.8 vs. Ct < 24.4] independently associated with SC risk. Sensitivity analysis including symptoms-based likely positive SC supported all the previous results. Conclusion: In confined transmission settings such as households, PCR Ct values may inform on the contagiousness of infected subjects and age may modulate transmission/contagion risk.

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308578

ABSTRACT

In 2020, countries affected by the COVID-19 pandemic implemented various non-pharmaceutical interventions to contrast the spread of the virus and its impact on their healthcare systems and economies. Using Italian data at different geographic scales, we investigate the relationship between human mobility, which subsumes many facets of the population's response to the changing situation, and the spread of COVID-19. Leveraging mobile phone data from February through September 2020, we find a striking relationship between the decrease in mobility flows and the net reproduction number. We find that the time needed to switch off mobility and bring the net reproduction number below the critical threshold of 1 is about one week. Moreover, we observe a strong relationship between the number of days spent above such threshold before the lockdown-induced drop in mobility flows and the total number of infections per 100k inhabitants. Estimating the statistical effect of mobility flows on the net reproduction number over time, we document a 2-week lag positive association, strong in March and April, and weaker but still significant in June. Our study demonstrates the value of big mobility data to monitor the epidemic and inform control interventions during its unfolding.

3.
Nat Commun ; 13(1): 482, 2022 01 25.
Article in English | MEDLINE | ID: covidwho-1655580

ABSTRACT

The impact of the COVID-19 pandemic on excess mortality from all causes in 2020 varied across and within European countries. Using data for 2015-2019, we applied Bayesian spatio-temporal models to quantify the expected weekly deaths at the regional level had the pandemic not occurred in England, Greece, Italy, Spain, and Switzerland. With around 30%, Madrid, Castile-La Mancha, Castile-Leon (Spain) and Lombardia (Italy) were the regions with the highest excess mortality. In England, Greece and Switzerland, the regions most affected were Outer London and the West Midlands (England), Eastern, Western and Central Macedonia (Greece), and Ticino (Switzerland), with 15-20% excess mortality in 2020. Our study highlights the importance of the large transportation hubs for establishing community transmission in the first stages of the pandemic. Here, we show that acting promptly to limit transmission around these hubs is essential to prevent spread to other regions and countries.


Subject(s)
Bayes Theorem , COVID-19/mortality , Pandemics/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Cause of Death , England/epidemiology , Female , Geography , Greece/epidemiology , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics/prevention & control , SARS-CoV-2/physiology , Spain/epidemiology , Survival Rate , Switzerland/epidemiology
4.
Recenti Prog Med ; 113(1): 21-23, 2022 01.
Article in Italian | MEDLINE | ID: covidwho-1638802

ABSTRACT

Alessandro Liberati has been a pioneer of methods for the transfer of research into practice. In the last years this key component of medical practice and decision-making in public health has made one step forward and two steps backward. One forward because the awareness of the need for rational criteria for decision making, based on scientific evidence and literature synthesis, has grown. Two backward because the problems we face have become much more complex. With covid-19 we have seen a rapid acceleration of technological responses and of decision-making, but this has not necessarily followed the recommendations from evidence-based medicine, as testified by the confused bundling up of opinions on the measures to be taken at the bed of patients and at the policy-making level. With the threat of climate change, equally, we face a weak and uncertain process of selection of the best scientific evidence that can guide towards rational policy choices. In both cases the seeds that Alessandro has planted need to be disseminated and reinforced.


Subject(s)
COVID-19 , Decision Making , Evidence-Based Medicine , Humans , Public Health , SARS-CoV-2
5.
European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1514497

ABSTRACT

Different determinants play a role in the health and wellbeing of people, population groups, communities, and the society as a whole. During the COVID-19 epidemic (and beyond) the direct and indirect impact of such determinants has become yet more evident. Individual proximal factors such as age, ethnicity, socioeconomic position, underlying comorbidities have concurred to increase individual risk of acquiring the infection as well as of developing severe disease complications, including death. The concept of COVID-19 as a syndemic has been proposed on this ground, whereby socioeconomic determinants of disease have catalyzed health worse outcomes.

6.
PLoS Med ; 18(7): e1003699, 2021 07.
Article in English | MEDLINE | ID: covidwho-1457769

ABSTRACT

Modern medicine makes it possible for many people to live with multiple chronic diseases for decades, but this has enormous social, financial, and environmental consequences. Preclinical, epidemiological, and clinical trial data have shown that many of the most common chronic diseases are largely preventable with nutritional and lifestyle interventions that are targeting well-characterized signaling pathways and the symbiotic relationship with our microbiome. Most of the research priorities and spending for health are focused on finding new molecular targets for the development of biotech and pharmaceutical products. Very little is invested in mechanism-based preventive science, medicine, and education. We believe that overly enthusiastic expectations regarding the benefits of pharmacological research for disease treatment have the potential to impact and distort not only medical research and practice but also environmental health and sustainable economic growth. Transitioning from a primarily disease-centered medical system to a balanced preventive and personalized treatment healthcare system is key to reduce social disparities in health and achieve financially sustainable, universal health coverage for all. In this Perspective article, we discuss a range of science-based strategies, policies, and structural reforms to design an entire new disease prevention-centered science, educational, and healthcare system that maximizes both human and environmental health.


Subject(s)
Chronic Disease/prevention & control , Health Promotion , Interdisciplinary Research , Life Style , Delivery of Health Care , Environmental Pollution , Farms , Humans , Investments , Science/economics
7.
Front Public Health ; 9: 763830, 2021.
Article in English | MEDLINE | ID: covidwho-1441164

Subject(s)
COVID-19 , Syndemic , Humans , SARS-CoV-2
8.
Front Public Health ; 9: 719914, 2021.
Article in English | MEDLINE | ID: covidwho-1441156
10.
Ann Work Expo Health ; 66(2): 224-232, 2022 02 18.
Article in English | MEDLINE | ID: covidwho-1345712

ABSTRACT

BACKGROUND: The spread of severe acute respiratory coronavirus 2 (SARS-CoV-2) among active workers is poor known. The aim of our study was to evaluate the seroprevalence of immunoglobulin G (IgG) among a convenience sample of workers and to identify high-risk job sectors during the first pandemic way. METHODS: We conducted a cross-sectional study among workers tested for SARS-CoV-2 between 28 March and 7 August 2020, recorded by a private healthcare center located in North-West Italy. Association among seroprevalence and demographic and occupational variables was evaluated using chi square test and the seroprevalence and 95% confidence intervals (CI) were calculated. RESULTS: We collected the results for 23568 serological tests from a sample of 22708 workers from about 1000 companies. Median age was 45 years and about 60% of subjects were male. The overall seroprevalence was 4.97% [95%CI 4.69-5.25]. No statistical difference was found among gender while seroprevalence was associated with subjects' age, geographical location, and occupational sector. Significantly higher values of positivity were observed for the logistics sector (31.3%), weaving factory (12.6%), nursing homes (9.8%), and chemical industry (6.9%) workers. However, we observed some clusters of cases in single companies independently from the sector.Then, a detailed focus on 940 food workers shown a seroprevalence of 5.21% [95%CI 3.79-6.63] and subjects who self-reported COVID-19 symptoms and who worked during lockdown had a higher probability of being infected (p < 0.001). CONCLUSIONS: Data obtained might be useful for future public health decision; more than occupation sector, it seems that failure on prevention system in single companies increase the SARS-CoV-2 transmission.


Subject(s)
COVID-19 , Occupational Exposure , Antibodies, Viral , Communicable Disease Control , Cross-Sectional Studies , Health Personnel , Humans , Male , Middle Aged , SARS-CoV-2 , Seroepidemiologic Studies
11.
Front Public Health ; 9: 651089, 2021.
Article in English | MEDLINE | ID: covidwho-1207795

ABSTRACT

The response of the scientific community to the COVID-19 pandemic has been unprecedented in size, speed and discovery output. Within months of virus emergence, the SARS-CoV-2 genomics, replication, evolution and dissemination dynamics as well as natural history, infection risk and prognostic factors and biology of the disease have been gradually deciphered. More than 250 articles on COVID-19 published in Frontiers in Public Health have contributed to these insights. We discuss here some of the key research themes and challenges that have been addressed. We provide our perspective on current research issues with surveillance data quality and limitations of epidemiological methods. We warn against the potential misuse or misleading interpretation of public data of variable quality and the use of inadequate study designs for the evaluation of effect of non-pharmaceutical interventions. We conclude by interrogating possible public health strategies for pandemic control as well as discuss the ethical responsibilities and democratic accountability of researchers in their role as experts and policy advisors.


Subject(s)
COVID-19 , Pandemics , Humans , Pandemics/prevention & control , Public Health , SARS-CoV-2
13.
Environ Int ; 146: 106272, 2021 01.
Article in English | MEDLINE | ID: covidwho-943095

ABSTRACT

The outbreak of COVID-19 raised numerous questions on the interactions between the occurrence of new infections, the environment, climate and health. The European Union requested the H2020 HERA project which aims at setting priorities in research on environment, climate and health, to identify relevant research needs regarding Covid-19. The emergence and spread of SARS-CoV-2 appears to be related to urbanization, habitat destruction, live animal trade, intensive livestock farming and global travel. The contribution of climate and air pollution requires additional studies. Importantly, the severity of COVID-19 depends on the interactions between the viral infection, ageing and chronic diseases such as metabolic, respiratory and cardiovascular diseases and obesity which are themselves influenced by environmental stressors. The mechanisms of these interactions deserve additional scrutiny. Both the pandemic and the social response to the disease have elicited an array of behavioural and societal changes that may remain long after the pandemic and that may have long term health effects including on mental health. Recovery plans are currently being discussed or implemented and the environmental and health impacts of those plans are not clearly foreseen. Clearly, COVID-19 will have a long-lasting impact on the environmental health field and will open new research perspectives and policy needs.


Subject(s)
Air Pollution , COVID-19 , Animals , Climate , Humans , Pandemics , SARS-CoV-2
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