Concordance between COVID-19 mortality statistics derived from clinical audit and death certificates in Östergötland county, Sweden.

OBJECTIVES: Despite early notions that correct attribution of deaths caused by SARS-CoV-2 infection is critical to the understanding of the COVID-19 pandemic, three years later, the accuracy of COVID-19 death counts is still contested. We aimed to compare official death statistics with cause-of-death assessments made in a clinical audit routine by experienced physicians having access to the full medical record. STUDY DESIGN: Health service quality evaluation. METHODS: In Östergötland county (pop. 465,000), Sweden, a clinical audit team assessed from the start of the pandemic the cause of death in individuals having deceased after testing positive for SARS-CoV-2. We estimated the concordance between official data on COVID-19 deaths and data from the clinical audit using correlations (r) between the cause-of-death categories and discrepancies between the absolute numbers of categorised deaths. RESULTS: The concordance between the data sources was poor regarding whether COVID-19 was the underlying or a contributing cause of death. Grouping of the causes increased the correlations to acceptable strength. Also including deaths implicated by a positive SARS-CoV-2 test in the clinical categorisation of COVID-19 deaths reduced the difference in absolute number of deaths; with these modifications, the concordance was acceptable before the COVID-19 vaccination program was initiated (r = 0.97; symmetric mean absolute percentage error (SMAPE) = 19%), while a difference in the absolute numbers of deaths remained in the vaccination period (r = 0.94; SMAPE = 35%). CONCLUSIONS: This study highlights that carefulness is warranted when COVID-19 death statistics are used in health service planning and resonates a need for further research on cause-of-death recording methodologies.

The influence of sociodemographic factors on COVID-19 vaccine certificate acceptance: A cross-sectional study.

Vaccine certificates have been implemented worldwide, aiming to promote vaccination rates and to reduce the spread of COVID-19. However, their use during the COVID-19 pandemic was controversial and has been criticized for infringing upon medical autonomy and individual rights. We administered a national online survey exploring social and demographic factors predicting the degree of public approval of vaccine certificates in Canada. We conducted a multivariate linear regression which revealed which factors were predictive of vaccine certificate acceptance in Canada. Self-reported minority status (p < .001), rurality (p < .001), political ideology (p < .001), age (p < .001), having children under 18 in the household (p < .001), education (p = .014), and income status (p = .034) were significant predictors of attitudes toward COVID-19 vaccine certificates. We observed the lowest vaccine-certificate approval among participants who: self-identify as a visible minority; live in rural areas; are politically conservative; are 18-34 years of age; have children under age 18 living in the household; have completed an apprenticeship or trades education; and those with an annual income between $100,000-$159,999. The present findings are valuable for their ability to inform the implementation of vaccine certificates during future pandemic scenarios which may require targeted communication between public health agencies and under-vaccinated populations.

[Places of death of COVID-19 patients: an observational study based on evaluated death certificates from the city of Muenster, Germany (2021)]. / Sterbeorte von COVID-19-Patienten: eine Observationsstudie auf Grundlage ausgewerteter Todesbescheinigungen der Stadt Münster (2021).

INTRODUCTION: The places of death of COVID-19 patients have so far hardly been investigated in Germany. METHODS: In a places of death study in Westphalia (Germany), statistical evaluations were carried out in the city of Muenster on the basis of all death certificates from 2021. Persons who had died with or from a COVID-19 infection were identified by medical information on cause of death and analyzed with descriptive statistical methods using SPSS. RESULTS: A total of 4044 death certificates were evaluated, and 182 deceased COVID-19 patients were identified (4.5%). In 159 infected patients (3.9%), the viral infection was fatal, whereby the distribution of places of death was as follows: 88.1% in hospital (57.2% in the intensive care unit; 0.0% in the palliative care unit), 0.0% in hospice, 10.7% in nursing homes, 1.3% at home, and 0.0% in other places. All infected patients < 60 years and 75.4% of elderly patients ≥ 80 years died in hospital. Only two COVID-19 patients, both over 80 years old, died at home. COVID-19 deaths in nursing homes (17) affected mostly elderly female residents. Ten of these residents had received end-of-life care from a specialized outpatient palliative care team. DISCUSSION: The majority of COVID-19 patients died in hospital. This can be explained by the rapid course of the disease with a high symptom burden and the frequent young age of the patients. Inpatient nursing facilities played a certain role as a place of death in local outbreaks. COVID-19 patients rarely died at home. Infection control measures may be one reason why no patients died in hospices or palliative care units.

The distribution of fake Australian vaccine digital certificates on an alt-tech platform.

This paper provides the first exploration of the online distribution of fake Australian COVID-19 vaccine certificates. Drawing on a collection of 2589 posts between five distributors and their community members on the alt-tech platform Gab, this study gathers key insights into the mechanics of illicit vaccine certificate distribution. The qualitative findings in this research demonstrate the various motivations and binding ideologies that underpinned this illicit distribution (e.g. anti-vaccine and anti-surveillance motivations); the unique cybercultural aspects of this online illicit network (e.g. 'crowdsourcing' the creation of fake vaccine passes); and how the online community was used to share information on the risks of engaging in this illicit service, setting the appropriate contexts of using fake vaccine passes, and the evasion of guardians in offline settings. Implications for future research in cybercrime, illicit networks, and organised crime in digital spaces are discussed.

The ethical, legal and social issues of pandemics: An analysis from the EU perspective

This book proposes an ethical and legal framework to improve the responses to social issues related not only to the current SARS-CoV-2 pandemic, but also to future pandemics. Its contents cover the issues that are likely to be most controversial in any public health crisis. It starts by discussing non-pharmacological measures, such as the appropriateness of confinement, how to control compliance with public health measures and the ethical, legal and social acceptability of health certificates. Then it turns to issues related to the production, distribution and administration of vaccines, with a particular focus on the design and implementation of vaccination policies. Finally, it analyses the most appropriate criteria to develop a triage, when the situation brings us to this terrible scenario. The analyses presented in this book are based on the ethical and legal frameworks, as well as the social context, of the European Union, and aims to address the main dilemmas faced by any liberal democracy dealing with a pandemic: how to reconcile the defense against a public health crisis together with a respect for fundamental rights and freedoms. The European legal systems have developed a number of conceptual tools designed to ensure that there is no room for arbitrariness in the restrictions introduced by the political power in emergency situations, and this book builds upon these tools. The Ethical, Legal and Social Issues of Pandemics: An Analysis from the EU Perspective is a predominantly practice-oriented book, which will help policy makers to adopt policies that effectively combine public health needs with individual rights and freedoms. It will also help health care givers to understand better the ethical and legal issues involved in their work and citizens, in general, to participate in public decision making in an informed manner. Finally, it will help to design tools that faithfully comply with existing fundamental rights standards. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Blockchain-based vaccination certificates management

With the explosion of COVID-19 cases and the government's needs to control virus spreading, the development of effective and robust systems for managing vaccination certificates to restrict citizens' activities has been in the centre of many governments. This paper proposes a system that allows for the update of the status of certificates and bases its function on a specific form of logs stored on Blockchains and a set of rules for the interpretation of these logs. Also an outline of a proof of concept implementation of the system in Ethereum together with a cost and security analysis are provided in the paper. The proposed architecture provides several benefits with the most prominent one being the suspension of certificates in case an already vaccinated individual is found positive. In existing certificate management systems a vaccinated individual that is tested positive still holds a valid vaccination certificate during the self-isolation period. This vulnerability allows infected individuals to commute freely and thus facilitates the spread of the pandemic. The proposed solution is not limited to COVID-19 related certificates, but rather it could be deployed in any kind of digital certificate. © 2022 ACM.

Bank funding costs during the COVID-19 pandemic: Evidence from China

This paper investigates whether and how the COVID-19 pandemic affects bank funding costs in China. We find a significantly positive relationship between the offering yield spreads of negotiable certificates of deposit and banks' pandemic exposure. The surge in bank funding costs is alleviated by banks' asset quality, financial flexibility, operational resilience, and government support, indicating that pandemic-induced risks are priced in the interbank market. The alternative explanations of monetary policy interventions, investors' flight-to-liquidity effect, bank liquidity hoarding, and banks' mispricing are further excluded. We contribute to the literature on the pandemic effects on financial markets, and bank funding during crises. © 2023 Elsevier B.V.

Individual Factors Influencing the Public's Perceptions About the Importance of COVID-19 Immunity Certificates in the United Kingdom: Cross-sectional Web-based Questionnaire Survey.

BACKGROUND: Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification. OBJECTIVE: This study aimed to assess what were the main individual factors influencing people's perception of the importance of using COVID-19 immunity certificates, including health beliefs about COVID-19, vaccination views, sociodemographics, and lifestyle factors. METHODS: A cross-sectional web-based survey with a nationally representative sample in the United Kingdom was conducted on August 3, 2021. Responses were collected and analyzed from 534 participants, aged 18 years and older, who were residents of the United Kingdom. The primary outcome measure (dependent variable) was the participants' perceived importance of using immunity certificates, computed as an index of 6 items. The following individual drivers were used as the independent variables: (1) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), (2) personal views on vaccination, (3) willingness to share immunity status with service providers, and (4) variables related to respondents' lifestyle and sociodemographic characteristics. RESULTS: The perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (ß=0.2564; P<.001) and felt safer if vaccinated (ß=0.1552; P<.001). The prospect of future economic recovery positively influenced the perceived importance of immunity certificates. Respondents who were employed or self-employed (ß=-0.2412; P=.001) or experienced an increase in income after the COVID-19 pandemic (ß=-0.1287; P=.002) perceived the use of immunity certificates as less important compared to those who were unemployed or had retired or those who had experienced a reduction in their income during the pandemic. CONCLUSIONS: The findings of our survey suggest that more vulnerable members in our society (those unemployed or retired and those who believe that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher.

Flaws and uncertainties in pandemic global excess death calculations.

Several teams have been publishing global estimates of excess deaths during the COVID-19 pandemic. Here, we examine potential flaws and underappreciated sources of uncertainty in global excess death calculations. Adjusting for changing population age structure is essential. Otherwise, excess deaths are markedly overestimated in countries with increasingly aging populations. Adjusting for changes in other high-risk indicators, such as residence in long-term facilities, may also make a difference. Death registration is highly incomplete in most countries; completeness corrections should allow for substantial uncertainty and consider that completeness may have changed during pandemic years. Excess death estimates have high sensitivity to modelling choice. Therefore different options should be considered and the full range of results should be shown for different choices of pre-pandemic reference periods and imposed models. Any post-modelling corrections in specific countries should be guided by pre-specified rules. Modelling of all-cause mortality (ACM) in countries that have ACM data and extrapolating these models to other countries is precarious; models may lack transportability. Existing global excess death estimates underestimate the overall uncertainty that is multiplicative across diverse sources of uncertainty. Informative excess death estimates require risk stratification, including age groups and ethnic/racial strata. Data to-date suggest a death deficit among children during the pandemic and marked socioeconomic differences in deaths, widening inequalities. Finally, causal explanations require great caution in disentangling SARS-CoV-2 deaths, indirect pandemic effects and effects from measures taken. We conclude that excess deaths have many uncertainties, but globally deaths from SARS-CoV-2 may be the minority of calculated excess deaths.

Towards Decentralized Autonomous Digital Signatures Using Smart Contracts

Owing to the spread of COVID-19, the digitalization of various services is rapidly being promoted. In particular, online services such as obtaining a digital certificate (e.g., digital signature) from an authority are becoming increasingly important. Therefore, systems that can autonomously generate digital signatures are urgently required. However, the autonomous generation of signatures is difficult because the secret key for signatures must be strictly managed. Moreover, a decentralized autonomous systems should be publicly verifiable. Thus, schemes that preclude strict control of the secret key are desirable. In this study, we propose a new decentralized scheme that autonomously generates a digital signature without a secret key, using blockchain-based smart contracts. The fundamental concept behind our scheme is to eliminate secret keys by leveraging the closed nature of the processing operations of smart contracts within the blockchain;thus, the process of generating signatures and their output values satisfies the condition of immutability. Finally, we perform a security evaluation and feasibility study of our proposed scheme and show that it works securely on the Ethereum blockchain. © 2023 IEEE.

COVID-19, travel restrictions and environmental consequences.

The component of human life that has been most significantly altered by the COVID-19 epidemic is travel. Due to the upheaval produced by the pandemic breakout, countries are becoming increasingly avaricious and are scrambling to stockpile vaccines. The world has been locked down to reduce/control the pandemic outbreak, driving countries to shut their doors to other people from countries. The recent pandemic has had a short-term, positive effect on the environment, but travel restrictions have caused problems for the common person and are expected to deteriorate more soon, necessitating longer quarantines, vaccination requirements, vaccine passports, and immunization certificates required by countries for safe travel. Thus, this study has three objectives. First, we investigate the impact of COVID-19 on travel and the environment, as well as the role that tourists play in the transmission of the virus. Second, we examine how countries are handling COVID-19 vaccines. Finally, we pinpoint differences in vaccination coverage.

Profiling the vendors of COVID-19 related product on the Darknet: An observational study.

Background: In a time of unprecedented global change, the COVID-19 pandemic has led to a surge in demand of COVID-19 vaccines and related certifications. Mainly due to supply shortages, counterfeit vaccines, fake documentation, and alleged cures to illegal portfolios, have been offered on darkweb marketplaces (DWMs) with important public health consequences. We aimed to profile key DWMs and vendors by presenting some in-depth case studies. Methods: A non-systematic search for COVID-19 products was performed across 118 DWMs. Levels of activity, credibility, content, COVID-19 product listings, privacy protocols were among the features retrieved. Open web fora and other open web sources were also considered for further analysis of both functional and non functional DWMs. Collected data refers to the period between January 2020 and October 2021. Results: A total of 42 relevant listings sold by 24 vendors across eight DWMs were identified. Four of these markets were active and well-established at the time of the study with good levels of credibility. COVID-19 products were listed alongside other marketplace content. Vendors had a trusted profile, communicated in English language and accepted payments in cryptocurrencies (Monero or Bitcoin). Their geographical location included the USA, Asia and Europe. While COVID-19 related goods were mostly available for regional supply, other listings were also shipped worldwide. Interpretation: Findings emerging from this study rise important questions about the health safety of certain DWMs activities and encourage the development of targeted interventions to overcome such new and rapidly expanding public health threats. Funding: CovSaf, National Research centre on Privacy, Harm Reduction and Adversarial Influence Online (REPHRAIN), Commonwealth Fund.

COVID-19 Health Passes: Practical and Ethical Issues.

Several countries have implemented COVID-19 health passes or certificates to promote a safer return to in-person social activities. These passes have been proposed as a way to prove that someone has been vaccinated, has recovered from the disease, or has negative results on a diagnostic test. However, many people have questioned their ethical justification. This article presents some practical and ethical problems to consider in the event of wishing to implement these passes. Among the former, it is questioned how accurate diagnostic tests are as a means of ensuring that a person is not contagious, whether vaccination guarantees immunity, the fact that health passes can be forged, whether they encourage vaccination, and the problem that there is no universally recognized health pass. Among the ethical issues, it is discussed whether health passes promote discrimination and inequality and whether they violate rights to privacy and freedom. It is concluded that health passes have enough ethical justification to be implemented.

BLOCOVID: A blockchain-based COVID-19 digital vaccination certificate verification system

The global impact of the COVID-19 pandemic has been felt in diverse ways. Although the death rate in Africa has not been as devastating as predicted by the World Health Organization (WHO), its economic and social impact has been fully felt by the African continent. As the world goes through the vaccination process to achieve herd immunity, Africa has not only faced problems like the inability to produce and procure vaccines, but some countries in the west are doubting the authenticity of the vaccination process and even vaccine certificates coming from various countries on the continent. The approach of using centralized systems to validate COVID-19 vaccine certificates makes these systems susceptible to Denial of Service (DoS), modification, and Man-in-The-Middle (MiTM) attacks. To curb this problem, we proposed a blockchain-based digital COVID-19 vaccination certificate verification system called BLOCOVID. The proposed system uses the decentralized approach of distributed ledgers to ensure that vaccine certificates are secured, immutable, and verifiable. Our proposed system stores vaccine serial numbers and their corresponding certificates as hash values. These hash values are stored on the blockchain network as transaction values. The authenticity of a vaccine certificate is determined by the availability of the hash values of the certificate and its corresponding vaccine serial number on the blockchain network. The proposed system was simulated using the BlockSim simulator. To begin with, the simulation results show that the proposed system can ensure system availability, thereby minimizing DoS attacks. Secondly, the proposed system can ensure the integrity of vaccine certificates by allowing third parties to verify the authenticity of these certificates. The simulation results show that even with 10240 nodes, the average transaction time was 137.2ms, with a total transaction rate of 9911.034 transactions per second. © 2022 IEEE.

Increased deaths from fungal infections during the COVID-19 pandemic-National Vital Statistics System, United States, January 2020-December 2021.

BACKGROUND: COVID-19-associated fungal infections cause severe illness, but comprehensive data on disease burden are lacking. We analyzed US National Vital Statistics System (NVSS) data to characterize disease burden, temporal trends, and demographic characteristics of persons dying from fungal infections during the COVID-19 pandemic. METHODS: Using NVSS's January 2018-December 2021 Multiple Cause of Death Database, we examined numbers and age-adjusted rates (per 100,000 population) of fungal deaths by fungal pathogen, COVID-19 association, demographic characteristics, and year. RESULTS: Numbers and age-adjusted rates of fungal deaths increased from 2019 (n = 4,833, rate 1.2, 95% confidence interval [CI] 1.2-1.3) to 2021 (n = 7,199, rate: 1.8, 95% CI = 1.8-1.8); of 13,121 fungal deaths during 2020-2021, 2,868 (21.9%) were COVID-19-associated. Compared with non-COVID-19-associated fungal deaths (n = 10,253), COVID-19-associated fungal deaths more frequently involved Candida (n = 776 [27.1%] versus n = 2,432 [23.7%]) and Aspergillus (n = 668 [23.3%] versus n = 1,486 [14.5%]) and less frequently involved other specific fungal pathogens. Fungal death rates were generally highest in non-White and non-Asian populations. Death rates from Aspergillus infections were approximately two times higher in the Pacific US census division compared with most other divisions. CONCLUSIONS: Fungal deaths increased during 2020-2021 compared with previous years, primarily driven by COVID-19-associated fungal deaths, particularly those involving Aspergillus and Candida. Our findings may inform efforts to prevent, identify, and treat severe fungal infections in COVID-19 patients, especially in certain racial/ethnic groups and geographic areas.

Hayyakum (حيَّاكم) - COVID-19 Vaccine Digital Certificate: A Blockchain Approach

As a consequence of the global pandemic, many restrictions and rules were enforced. One predicament was the travel restrictions and requirements put into place with regard to vaccinations. Countries worldwide now require people to be vaccinated upon entry. The process of validating vaccine doses requires lots of paperwork and is inefficient. Blockchain is an uprising technology that is secure and fast at carrying out transactions. We propose implementing vaccine dose verifications between countries through vaccine certificates using Blockchain as an effective solution. The need for a common shared database, avoiding a trusted third party to administrate the network, having several countries involved, ensuring privacy and security, and accountability logs make Blockchain needed in this scenario. Digital vaccine certificates are very sensitive information that must be kept private and secure but accessible to several entities. Blockchain ensures the aforementioned requirements are met while preserving the integrity of the VDCs. This paper describes blockchain technology and its application in digital vaccine certificates. © 2022 IEEE.

Economic Sustainability of Direct Energy Efficiency Investments for Gas and Energy Distributors to Comply with the PAEE (Italian National Plan for Energy Efficiency)

Energy Efficiency Certificates (TEE, also called white certificates) are negotiable securities that certify the achievement of energy savings in energy end-use through measures and projects to improve energy efficiency. Electricity and natural gas distributors may achieve their energy efficiency improvement targets both by implementing energy efficiency projects (and gaining TEE) and by purchasing TEE from other parties. Despite all these incentives and goals for energy utilities, investments in 2020 are decreasing. The causes of this regression are the extreme slowness of certifying procedures and the impossibility of accumulating energy efficiency investments with other public state aids. To ensure the industrial sector to achieve the objectives established by the PNIEC in terms of decreasing consumption, a global reform that is able to relaunch the mechanism would therefore be important, mostly in the post-COVID-19 crisis. The article shows the convenience for a medium-sized gas distributor, but could be applicable for energy distributors, of investing in direct projects of energy efficiency or financing these projects to achieve the goals imposed by the PAEE (Energy Efficiency Action Plan). © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Demo: VaxPass-A Scalable and Verifiable Platform for COVID-19 Records

COVID-19 has altered the landscape of medical record issuing and verification. Multiple challenges have arisen in this new era as individuals are now required to prove their health status for traveling, working, or simply eating at a restaurant. Record verification across country borders is particularly hard to achieve as it requires collaboration at an international level, sharing potentially sensitive medical data. In this work, we propose VaxPass, a scalable system for COVID-19 record issuing and verification that facilitates this collaboration with minimal data leakage. At the core of our design lies a 2-tier blockchain architecture that allows individual issuing authorities to maintain their own 1st-level blockchain and only upload a small digest of their records, periodically, on the 2nd-level. Crucially, a verifier can check the validity of a certificate without having access to the 1st-level blockchain where the records actually reside. Our system also includes a mobile application and a web client. As we demonstrate, its performance scales well with the number of participants, making this the first solution able to support real-life inspired needs for such a system, while maintaining confidentiality of the medical data solely to privy entities. © 2022 Owner/Author.

Post-pandemic comeback and breakthroughs for electric flight

Miller discusses post-pandemic comeback and breakthroughs for electric flight. In May, Federal Aviation Administration (FAA) released its Air Traffic by the Numbers with updated data for 2021. The covid-19 pandemic continued to suppress the general aviation community, but there were signs of improvement. In 2020, there were 204,100 active general aviation aircraft across the US. In 2021, active pilot certificates increased by 4.2% in 2021 to 720,603;drone pilot certificates increased by 23.4% to 254,587. There are 5,184 public-use airports and 14,539 private-use airports across the country. General aviation is the manufacturing and operation of aircraft that have been issued an airworthiness certificate by the FAA--other than aircraft used for scheduled commercial air service or operated by the military--and includes on-demand Federal Aviation Regulations Part 135 operations.

Blockchain in Healthcare: A Decentralized Platform for Digital Health Passport of COVID-19 Based on Vaccination and Immunity Certificates.

COVID-19 has become a very transmissible disease that has had a worldwide impact, resulting in a huge number of infections and fatalities. Testing is critical to the pandemic's successful response because it helps detect illnesses and so attenuate (isolate/cure) them and now vaccination is a life-safer innovation against the pandemic which helps to make the immunity system stronger and fight against this infection. Patient-sensitive information, on the other hand, is now held in a centralized or third-party storage paradigm, according to COVID-19. One of the most difficult aspects of using a centralized storage strategy is maintaining patient privacy and system transparency. The application of blockchain technology to support health initiatives that can minimize the spread of COVID-19 infections in the context of accessibility of the system and for verification of digital passports. Only by combining blockchain technology with advanced cryptographic algorithms can a secure and privacy-preserving solution to COVID-19 be provided. In this article, we investigate the issue and propose a blockchain-based solution incorporating conscience identity, encryption, and decentralized storage via interplanetary file systems (IPFS). For COVID-19 test takers and vaccination takers, our solution includes digital health passports (DHP) as a certification of test or vaccination. We explain smart contracts constructed and tested with Ethereum to preserve a DHP for test and vaccine takers, allowing for a prompt and trustworthy response from the necessary medical authorities. We use an immutable trustworthy blockchain to minimize medical facility response times, relieve the transmission of incorrect information, and stop the illness from spreading via DHP. We give a detailed explanation of the proposed solution's system model, development, and assessment in terms of cost and security. Finally, we put the suggested framework to the test by deploying a smart contract prototype on the Ethereum TESTNET network in a Windows environment. The study's findings revealed that the suggested method is effective and feasible.