ABSTRACT
The SARS-CoV-2 pandemic has had a significant impact on the healthcare field that resulted in changes to the way safe and effective medical care is delivered. The effects range from service disruption including ambulatory clinic closure due to both patient and provider concerns, to lack of capacity in hospital services. In rheumatology, there were other effects including viral infection-related autoantibody production, concerns about the use of systemic immunosuppression in the presence of an infectious pandemic and even concerns for viral infection-induced flares of rheumatic disease. Coronavirus disease 2019 (COVID-19) led to the rapid adoption of innovative technologies that permitted the introduction and increased use of telemedicine via a number of platforms. Rapid discoveries and innovations led to the development of diagnostic and therapeutic agents in the management of COVID-19. Scientific advancement and discoveries around COVID-19 infection, symptoms, autoantibody production, chronic sequela and the repurposing of rheumatic immunosuppressive agents led to improved survival and an expanded role for the rheumatologist. Rheumatologists may sometimes be involved in the diagnosis and management of the hospitalized COVID-19 patient. In the ambulatory clinic, a rheumatologist also helps to differentiate between symptoms of long COVID and those of systemic autoimmune rheumatic disease (SARD). Rheumatologists must also grapple with the concerns related to immunosuppressive therapy and the risk of COVID-19 infections. In addition, there are concerns around vaccine effectiveness in people with SARD and those on immunosuppressive medications. Although the SARS-CoV-2 pandemic and the effects on healthcare resulted in difficulties, both patients and providers have risen to the challenge. The long-term outcome of COVID-19 for the medical system and rheumatologists in particular is not yet fully understood and will need further study. This review concentrates on the changing role of the rheumatologists, improved understanding of rheumatic disease and immunosuppressive therapies in the wake of the pandemic and how this has led to an improvement in the care of patients with COVID-19.
ABSTRACT
The Covid-19 pandemic has documented an unprecedented series of biased, distorted, or sub-optimal decisions and behaviours by ‘expert’ decision-makers such as: health policy-makers;leaders of national and regional health systems and public health organisations;managers of territorial health agencies and hospitals;managers of hospital units and public health departments;and other experienced professionals with decision-making responsibilities in terms of public health. Some of these biased decisions and behaviours have had dramatic cascade effects on population health and behaviours. We list, name, and describe some of the biases and behavioural distortions by ‘expert’ decision-makers that emerged during the Covid-19 pandemic. Many of these behavioural biases have not been previously categorized as such, or may have been discussed under different names. © 2022, Sistemi Intelligenti. All Rights Reserved.
ABSTRACT
"Follow the science" became the mantra for responding to COVID-19 pandemic. However, for the public this also meant "follow the scientists", and this led to uneasiness as some viewed scientists as not credible. We investigate how beliefs about the way scientists develop their findings affect pandemic-related views. Our analysis shows that beliefs about scientists' objectivity predict views regrading coronavirus-related risks, behavioral changes, and policy priorities. While political party identity also predicts views about COVID-19-related concerns, these vary by political leaders whose approaches embraced versus dismissed science-based strategies, highlighting the importance of perceptions of scientists in shaping pandemic-related attitudes and beliefs.
ABSTRACT
BACKGROUND: In the era of evidence-based policy-making (EBPM), scientific outputs and public policy should engage with each other in a more interactive and coherent way. Notably, this is becoming increasingly critical in preparing for public health emergencies. METHODS: To explore the coevolution dynamics between science and policy (SAP), this study explored the changes in, and development of, COVID-19 research in the early period of the COVID-19 outbreak in China, from 30 December 2019 to 26 June 2020. In this study, VOSviewer was adopted to calculate the link strength of items extracted from scientific publications, and machine learning clustering analysis of scientific publications was carried out to explore dynamic trends in scientific research. Trends in relevant policies that corresponded to changing trends in scientific research were then traced. RESULTS: The study observes a salient change in research content as follows: an earlier focus on "children and pregnant patients", "common symptoms", "nucleic acid test", and "non-Chinese medicine" was gradually replaced with a focus on "aged patients", "pregnant patients", "severe symptoms and asymptomatic infection", "antibody assay", and "Chinese medicine". "Mental health" is persistent throughout China's COVID-19 research. Further, our research reveals a correlation between the evolution of COVID-19 policies and the dynamic development of COVID-19 research. The average issuance time of relevant COVID-19 policies in China is 8.36 days after the launching of related research. CONCLUSIONS: In the early stage of the outbreak in China, the formulation of research-driven-COVID-19 policies and related scientific research followed a similar dynamic trend, which is clearly a manifestation of a coevolution model (CEM). The results of this study apply more broadly to the formulation of policies during public health emergencies, and provide the foundation for future EBPM research.
Subject(s)
COVID-19 , Aged , China , Humans , Public Health , Public Policy , SARS-CoV-2ABSTRACT
Drawing on the SAGE minutes and other documents, I consider the wider lessons for norms of scientific advising that can be learned from the UK's initial response to coronavirus in the period January-March 2020, when an initial strategy that planned to avoid total suppression of transmission was abruptly replaced by an aggressive suppression strategy. I introduce a distinction between "normatively light advice", in which no specific policy option is recommended, and "normatively heavy advice" that does make an explicit recommendation. I argue that, although scientific advisers should avoid normatively heavy advice in normal times in order to facilitate democratic accountability, this norm can be permissibly overridden in situations of grave emergency. SAGE's major mistake in early 2020 was not that of endorsing a particular strategy, nor that of being insufficiently precautionary, but that of relying too heavily on a specific set of "reasonable worst-case" planning assumptions. I formulate some proposals that assign a more circumscribed role to "worst-case" thinking in emergency planning. In an epilogue, I consider what the implications of my proposals would have been for the UK's response to the "second wave" of late 2020.
ABSTRACT
Coronavirus disease (COVID-19) has reached millions of people worldwide and is responsible for millions of deaths around the world. Research on fatalities in rural communities remains limited. In addition, the scientific literature has not yet reported on the distribution of vaccines in Canada and compared the findings to the age distribution of COVID-19 fatalities in Canada to see whether the vaccines have been distributed to the highest age category populations. This research article used data from the Government of Ontario and Statistics Canada to analyze the number of cases, fatalities, case fatality rates (CFRs) by demographic factors, such as age, gender, urban-rural status, and compared the findings to national vaccination rates by age. As of June 11, 2021, this study found that among the 528,819 cases among 14.8 million people. Among this population, there were 8875 fatalities in Ontario with 82.208% (n=7296) of fatalities occurred in people over 70 years, and 93.183% in people over 60 years (n=8,270). Additionally, the odds ratio of a fatal event was 9,652 times higher in people over 90 years (95% CI: 4418, 31124, p<0.001) as compared with less than 20 years. Men had a higher number of fatalities (n=4,490, CFR=1.721%) compared with women (n=4,385, CFR=1.692%), and a higher odd of fatal events only when adjusted for age and gender (OR=1.66, 95% CI: 1.57, 1.74, p<0.001). Urban areas had 92.034% of fatalities (n=8,168) and had a CFR of 1.632%. In contrast, rural areas comprised 4.451% of total fatalities (n=395) and had the highest CFR (2.267%). The unadjusted odds of a fatality were 1.41 (95% CI: 1.27, 1.56) in rural areas compared with urban areas. Across Canada as of May 29, 2021, people over 80 years old received 1,530,318 vaccines with 91.98% of this population age group receiving at least one and 457,664 being fully vaccinated (27.51%). In Ontario, as the number of people with at least one vaccine increased for people over 90 years, the number of fatalities was reduced from about 8 per day prior to vaccines to approximately two per day. Furthermore, once the vaccination rates exceeded 75% in ages 60 years and over 50% in the younger age groups, the number of fatalities per day among all age groups was approximately one per day. In summary, age was found to be a significant factor for COVID-19 mortality in Ontario and vaccine uptake in Ontario was followed by decreases in COVID-19 mortality.
ABSTRACT
This note introduces a framework incorporating multiple sources of evidence into the response to COVID-19 to overcome the neglect of social and psychological causes of illness. By using the example of psychological research on loneliness and its effects on physical and mental health with particular focus on aging and disability, I seek to open further inquiry into how relevant psychological and social aspects of health can be addressed at policy level.