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1.
Chemosphere ; 335: 139065, 2023 Sep.
Article in English | MEDLINE | ID: covidwho-2327934

ABSTRACT

This study explores the dynamic transmission of infectious particles due to COVID-19 in the environment using a spatiotemporal epidemiological approach. We proposed a novel multi-agent model to simulate the spread of COVID-19 by considering several influencing factors. The model divides the population into susceptible and infected and analyzes the impact of different prevention and control measures, such as limiting the number of people and wearing masks on the spread of COVID-19. The findings suggest that reducing population density and wearing masks can significantly reduce the likelihood of virus transmission. Specifically, the research shows that if the population moves within a fixed range, almost everyone will eventually be infected within 1 h. When the population density is 50%, the infection rate is as high as 96%. If everyone does not wear a mask, nearly 72.33% of the people will be infected after 1 h. However, when people wear masks, the infection rate is consistently lower than when they do not wear masks. Even if only 25% of people wear masks, the infection rate with masks is 27.67% lower than without masks, which is strong evidence of the importance of wearing a mask. As people's daily activities are mostly carried out indoors, and many super-spreading events of the new crown epidemic also originated from indoor gatherings, the research on indoor epidemic prevention and control is essential. This study provides decision-making support for epidemic preventions and controls and the proposed methodology can be used in other regions and future epidemics.


Subject(s)
COVID-19 , Epidemics , Humans , COVID-19/epidemiology , Population Density , Probability
2.
Int J Environ Res Public Health ; 20(9)2023 05 08.
Article in English | MEDLINE | ID: covidwho-2313160

ABSTRACT

The article presents a study into the impact that the COVID-19 pandemic had on the daily mobility of those over 60 residing in small towns in the Lodz Province. The study determines the impact on the trip destination, trip frequency, preferred means of transport, distance and duration of trips, and length of the target activity. To achieve these objectives, a survey was conducted using the CATI technique (Computer Assisted Telephone Interviewing), which comprised 500 residents of small towns in the Lodz Province aged 60+, who were divided into three classes of small towns (by population size). In order to determine the impact of the COVID-19 pandemic on the daily mobility of those over 60, the tools the authors decided to use descriptive statistics and hypothesis testing. Overall, the pandemic was found to have had only a minor impact on the changes in transport behavior of those over 60 in small towns. Only 9% of respondents declared any effect on their daily mobility. The impact mainly involved a reduction in travel time and frequency, primarily among the oldest residents. Since a low level of daily mobility leads to low social activity, especially for the elderly-with a consequent sense of loneliness or even depression-towns should take measures to improve the already poor situation, one that has been further exacerbated by the pandemic.


Subject(s)
COVID-19 , Aged , Humans , Cities/epidemiology , COVID-19/epidemiology , Pandemics , Travel , Population Density
3.
PLoS One ; 18(4): e0284157, 2023.
Article in English | MEDLINE | ID: covidwho-2305781

ABSTRACT

Since November 2019, most countries across the globe have suffered from the disastrous consequences of the Covid-19 pandemic which redefined every aspect of human life. Given the inevitable spread and transmission of the virus, it is critical to acknowledge the factors that catalyse transmission of the disease. This research investigates the relation of the external demographic parameters such as total population, population density and weighted population density on the spread of Covid-19 in Malaysia. Pearson correlation and simple linear regression were utilized to identify the relation between the population-related variables and the spread of Covid-19 in Malaysia using data from 15th March 2020 to 31st March 2021. As a result, a strong positive significant correlation between the total population and Covid-19 cases was found. However, a weak positive relationship was found between the density variable (population density and weighted population density) and the spread of Covid-19. Our findings suggest that the transmission of Covid-19 during lockdown (Movement Control Order, MCO) in Malaysia was more readily explained by the demographic variable population size, than population density or weighted population density. Thus, this study could be helpful in intervention planning and managing future virus outbreaks in Malaysia.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Malaysia/epidemiology , Population Density , SARS-CoV-2 , Pandemics/prevention & control , Communicable Disease Control
4.
Int J Environ Res Public Health ; 18(18)2021 Sep 18.
Article in English | MEDLINE | ID: covidwho-2259963

ABSTRACT

The rapid transmission of highly contagious infectious diseases within communities can yield potential hotspots or clusters across geographies. For COVID-19, the impact of population density on transmission models demonstrates mixed findings. This study aims to determine the correlations between population density, clusters, and COVID-19 incidence across districts and regions in Malaysia. This countrywide ecological study was conducted between 22 January 2021 and 4 February 2021 involving 51,476 active COVID-19 cases during Malaysia's third wave of the pandemic, prior to the reimplementation of lockdowns. Population data from multiple sources was aggregated and spatial analytics were performed to visualize distributional choropleths of COVID-19 cases in relation to population density. Hierarchical cluster analysis was used to synthesize dendrograms to demarcate potential clusters against population density. Region-wise correlations and simple linear regression models were deduced to observe the strength of the correlations and the propagation effects of COVID-19 infections relative to population density. Distributional heats in choropleths and cluster analysis showed that districts with a high number of inhabitants and a high population density had a greater number of cases in proportion to the population in that area. The Central region had the strongest correlation between COVID-19 cases and population density (r = 0.912; 95% CI 0.911, 0.913; p < 0.001). The propagation effect and the spread of disease was greater in urbanized districts or cities. Population density is an important factor for the spread of COVID-19 in Malaysia.


Subject(s)
COVID-19 , Communicable Disease Control , Humans , Malaysia/epidemiology , Population Density , SARS-CoV-2
5.
BMC Public Health ; 23(1): 207, 2023 01 31.
Article in English | MEDLINE | ID: covidwho-2269151

ABSTRACT

BACKGROUND: In China, communicable diseases (CD) have a negative impact on public health and economic stability. The influx of migrants, who make up a substantial portion of China's population and continue to rapidly expand, has seriously hampered CD prevention and control, needing special care. This study aimed to identify key factors influencing the utilization of CD prevention and treatment education (CDPTE) among the floating population. We are confident that the findings will highlight obstacles facing CDPTE among the migrants, and guide future development prevention, treatment of CD, and health education services. METHODS: A sample of migrants aged 15 years and above in 32 provincial units nationwide in 2018 was recruited by stratified multi-stage proportional to population size sampling (PPS). A structured questionnaire survey was conducted via face-to-face interviews. Subsequently, the Anderson health service utilization model was used as the theoretical framework and SPSS 26.0 statistical software was applied to analyze the data. The statistical description of the current situation of CDPTE acceptance and the chi-square test were used to compare the differences in CDPTE acceptance by different characteristics. Multivariate logistic regression was used to analyze key factors affecting the use of CDPTE among migrants. RESULTS: A total of 40.1% of the recruited participants reported receiving education on CD prevention and treatment, primarily delivered through traditional transmission media. Multilevel logistic regression results revealed that male migrants, aged 30-49 years, unmarried, with higher educational attainment, an average monthly household income of CNY 7,500-9,999 (or US$1,176-1,568), working more than 40 h per week, flowing into the Central and Western regions, migrated in the province, self-rated health, contracted family doctors and those with health records were more likely to receive CDPTE (p < 0.05). CONCLUSION: Our findings revealed unsatisfactory acceptance of education on CD prevention and treatment among migrants, implying that health education should be strengthened further. Publicity of relevant policies and works should be strengthened and specific interventions should be developed for key regions as well as vulnerable groups to enhance CDPTE. More financial support should also be provided to improve the quality of health education.


Subject(s)
Health Education , Male , Humans , Cross-Sectional Studies , Educational Status , China , Population Density
6.
Vaccine ; 41(11): 1864-1874, 2023 03 10.
Article in English | MEDLINE | ID: covidwho-2264988

ABSTRACT

Vaccine allocation decisions during emerging pandemics have proven to be challenging due to competing ethical, practical, and political considerations. Complicating decision making, policy makers need to consider vaccine allocation strategies that balance needs both within and between populations. When vaccine stockpiles are limited, doses should be allocated in locations to maximize their impact. Using a susceptible-exposed-infectious-recovered (SEIR) model we examine optimal vaccine allocation decisions across two populations considering the impact of characteristics of the population (e.g., size, underlying immunity, heterogeneous risk structure, interaction), vaccine (e.g., vaccine efficacy), pathogen (e.g., transmissibility), and delivery (e.g., varying speed and timing of rollout). Across a wide range of characteristics considered, we find that vaccine allocation proportional to population size (i.e., pro-rata allocation) performs either better or comparably to nonproportional allocation strategies in minimizing the cumulative number of infections. These results may argue in favor of sharing of vaccines between locations in the context of an epidemic caused by an emerging pathogen, where many epidemiologic characteristics may not be known.


Subject(s)
Pandemics , Vaccines , Humans , Pandemics/prevention & control , Disease Susceptibility , Population Density , Administrative Personnel
7.
J Math Biol ; 85(4): 32, 2022 09 17.
Article in English | MEDLINE | ID: covidwho-2262297

ABSTRACT

The SIR (susceptible-infectious-recovered) model is a well known method for predicting the number of people (or animals) in a population who become infected by and then recover from a disease. Modifications can include categories such people who have been exposed to the disease but are not yet infectious or those who die from the disease. However, the model has nearly always been applied to the entire population of a country or state but there is considerable observational evidence that diseases can spread at different rates in densely populated urban regions and sparsely populated rural areas. This work presents a new approach that applies a SIR type model to a country or state that has been divided into a number of geographical regions, and uses different infection rates in each region which depend on the population density in that region. Further, the model contains a simple matrix based method for simulating the movement of people between different regions. The model is applied to the spread of disease in the United Kingdom and the state of Rio Grande do Sul in Brazil.


Subject(s)
Models, Theoretical , Animals , Brazil/epidemiology , Humans , Population Density , United Kingdom
8.
Int J Environ Res Public Health ; 19(22)2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2249182

ABSTRACT

Tracking the progress of an infectious disease is critical during a pandemic. However, the incubation period, diagnosis, and treatment most often cause uncertainties in the reporting of both cases and deaths, leading in turn to unreliable death rates. Moreover, even if the reported counts were accurate, the "crude" estimates of death rates which simply divide country-wise reported deaths by case numbers may still be poor or even non-computable in the presence of small (or zero) counts. We present a novel methodological contribution which describes the problem of analyzing COVID-19 data by two nested Poisson models: (i) an "upper model" for the cases infected by COVID-19 with an offset of population size, and (ii) a "lower" model for deaths of COVID-19 with the cases infected by COVID-19 as an offset, each equipped with their own random effect. This approach generates robustness in both the numerator as well as the denominator of the estimated death rates to the presence of small or zero counts, by "borrowing" information from other countries in the overall dataset, and guarantees positivity of both the numerator and denominator. The estimation will be carried out through non-parametric maximum likelihood which approximates the random effect distribution through a discrete mixture. An added advantage of this approach is that it allows for the detection of latent subpopulations or subgroups of countries sharing similar behavior in terms of their death rates.


Subject(s)
COVID-19 , Communicable Diseases , Humans , COVID-19/epidemiology , Population Density , Pandemics
9.
Int J Environ Res Public Health ; 20(4)2023 Feb 11.
Article in English | MEDLINE | ID: covidwho-2234597

ABSTRACT

Coronavirus Disease 2019 (COVID-19) spread quickly and reached epidemic levels worldwide. West Java is Indonesia's most populous province and has a high susceptibility to the transmission of the disease, resulting in a significant number of COVID-19 cases. Therefore, this research aimed to determine the influencing factors as well as the spatial and temporal distribution of COVID-19 in West Java. Data on COVID-19 cases in West Java obtained from PIKOBAR were used. Spatial distribution was described using a choropleth, while the influencing factors were evaluated with regression analysis. To determine whether COVID-19s policies and events affected its temporal distribution, the cases detected were graphed daily or biweekly with information on those two variables. Furthermore, the cumulative incidence was described in the linear regression analysis model as being significantly influenced by vaccinations and greatly elevated by population density. The biweekly chart had a random pattern with sharp decreases or spikes in cumulative incidence changes. Spatial and temporal analysis helps greatly in understanding distribution patterns and their influencing factors, specifically at the beginning of the pandemic. Plans and strategies for control and assessment programs may be supported by this study material.


Subject(s)
COVID-19 , Humans , Indonesia/epidemiology , Population Density
11.
P R Health Sci J ; 41(4): 192-196, 2022 12.
Article in English | MEDLINE | ID: covidwho-2156627

ABSTRACT

OBJECTIVE: The countries of the Community of Latin American and Caribbean States (CELAC, by its initials in Spanish) have been some of the most affected by COVID-19. This paper analyzes whether, in the 33 CELAC countries, population density, together with other economic variables, such as gross domestic product (GDP) at purchasing power parity (PPP) values or the Human Development Index (HDI), were significantly associated with the coronavirus mortality rate. METHODS: A correlation analysis and an ordinary least squares regression model were used to analyze the effects of different variables on the COVID-19 mortality rate. RESULTS: The results showed that countries with higher numbers of inhabitants per square kilometer had lower death rates. Gross domestic product was not associated with the number of deaths, while the HDI had a positive impact on that number. CONCLUSION: Countries with high population density are not more vulnerable to COVID-19, as population density allows for economic development and better-designed institutions.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Socioeconomic Factors , Population Density , Latin America/epidemiology , Caribbean People
12.
BMC Public Health ; 22(1): 2163, 2022 11 24.
Article in English | MEDLINE | ID: covidwho-2139225

ABSTRACT

BACKGROUND: Based on individual-level studies, previous literature suggested that conservatives and liberals in the United States had different perceptions and behaviors when facing the COVID-19 threat. From a state-level perspective, this study further explored the impact of personal political ideology disparity on COVID-19 transmission before and after the emergence of Omicron. METHODS: A new index was established, which depended on the daily cumulative number of confirmed cases in each state and the corresponding population size. Then, by using the 2020 United States presidential election results, the values of the built index were further divided into two groups concerning the political party affiliation of the winner in each state. In addition, each group was further separated into two parts, corresponding to the time before and after Omicron predominated. Three methods, i.e., functional principal component analysis, functional analysis of variance, and function-on-scalar linear regression, were implemented to statistically analyze and quantify the impact. RESULTS: Findings reveal that the disparity of personal political ideology has caused a significant discrepancy in the COVID-19 crisis in the United States. Specifically, the findings show that at the very early stage before the emergence of Omicron, Democratic-leaning states suffered from a much greater severity of the COVID-19 threat but, after July 2020, the severity of COVID-19 transmission in Republican-leaning states was much higher than that in Democratic-leaning states. Situations were reversed when the Omicron predominated. Most of the time, states with Democrat preferences were more vulnerable to the threat of COVID-19 than those with Republican preferences, even though the differences decreased over time. CONCLUSIONS: The individual-level disparity of political ideology has impacted the nationwide COVID-19 transmission and such findings are meaningful for the government and policymakers when taking action against the COVID-19 crisis in the United States.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Government , Population Density , Linear Models , Principal Component Analysis
13.
Int J Environ Res Public Health ; 19(23)2022 11 25.
Article in English | MEDLINE | ID: covidwho-2123668

ABSTRACT

Since its emergence, COVID-19 has caused a great impact in health and social terms. Governments and health authorities have attempted to minimize this impact by enforcing different mandates. Recent studies have addressed the relationship between various socioeconomic variables and compliance level to these interventions. However, little attention has been paid to what constitutes people's response and whether people behave differently when faced with different interventions. Data collected from different sources show very significant regional differences across the United States. In this paper, we attempt to shed light on the fact that a response may be different depending on the health system capacity and each individuals' social status. For that, we analyze the correlation between different societal (i.e., education, income levels, population density, etc.) and healthcare capacity-related variables (i.e., hospital occupancy rates, percentage of essential workers, etc.) in relation to people's level of compliance with three main governmental mandates in the United States: mobility restrictions, mask adoption, and vaccine participation. Our aim was to isolate the most influential variables impacting behavior in response to these policies. We found that there was a significant relationship between individuals' educational levels and political preferences with respect to compliance with each of these mandates.


Subject(s)
COVID-19 , United States/epidemiology , Humans , COVID-19/epidemiology , Social Factors , Social Behavior , Government , Population Density
14.
Environ Sci Pollut Res Int ; 28(30): 40424-40430, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-2115927

ABSTRACT

Currently, 2019-nCoV has spread to most countries of the world. Understanding the environmental factors that affect the spread of the disease COVID-19 infection is critical to stop the spread of the disease. The purpose of this study is to investigate whether population density is associated with the infection rate of the COVID-19. We collected data from official webpages of cities in China and in the USA. The data were organized on Excel spreadsheets for statistical analyses. We calculated the morbidity and population density of cities and regions in these two countries. We then examined the relationship between morbidity and other factors. Our analysis indicated that the population density in cities in Hubei province where the COVID-19 was severe was associated with a higher percentage of morbidity, with an r value of 0.62. Similarly, in the USA, the density of 51 states and territories is also associated with morbidity from COVID-19 with an r value of 0.55. In contrast, as a control group, there is no association between the morbidity and population density in 33 other regions of China, where the COVID-19 epidemic is well under control. Interestingly, our study also indicated that these associations were not influenced by the first case of COVID-19. The rate of morbidity and the number of days from the first case in the USA have no association, with an r value of - 0.1288. Population density is positively associated with the percentage of patients with COVID-19 infection in the population. Our data support the importance of such as social distancing and travel restriction in the prevention of COVID-19 spread.


Subject(s)
COVID-19 , Pandemics , China/epidemiology , Humans , Physical Distancing , Population Density , SARS-CoV-2
15.
J Environ Manage ; 326(Pt B): 116806, 2023 Jan 15.
Article in English | MEDLINE | ID: covidwho-2120406

ABSTRACT

Most studies have explored the Covid-19 outbreak by mainly focusing on restrictive public policies, human health, and behaviors at the macro level. However, the impacts of built and socio-economic environments, accounting for spatial effects on the spread at the local levels, have not been thoroughly studied. In this study, the relationships between the spatial spread of the virus and various indicators of the built and socio-economic environments are investigated, using Florida ZIP-code data on accumulated cases before large-scale vaccination campaigns began in 2021. Spatial regression models are used to account for the spatial dependencies and interactions that are core factors in Covid-19 spread. This study reveals both the spillover dynamics of the coronavirus spread at the ZIP code level and the existence of spatial dependencies among the unobserved variables represented by the error term. In addition, the findings show a positive association between the expected number of Covid-19 cases and specific land uses, such as education facilities and retail densities. Finally, the study highlights critical socio-economic characteristics causing a substantial increase in Covid-19 spread. Such results could help policymakers, public health experts, and urban planners design strategies to mitigate the spread of future Covid-19-like diseases.


Subject(s)
COVID-19 , Environment , Socioeconomic Factors , Humans , COVID-19/epidemiology , COVID-19/transmission , Florida/epidemiology , Spatial Analysis , Population Density
16.
Int J Environ Res Public Health ; 19(21)2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2099540

ABSTRACT

We evaluated the influence of population size (POP), HDI (Human Development Index) and GDP (gross domestic product) on the COVID-19 pandemic in the Southeast region of Brazil, between February 2020 and May 2021. METHODS: Cases, deaths, incidence coefficient, mortality rate and lethality rate were compared among states. The cities were divided into strata according to POP, GDP, and HDI. Data were compared by Welch's ANOVA, nonlinear polynomial regression, and Spearman's correlation test (rS). RESULTS: The highest incidence coefficient (p < 0.0001) and mortality rate (p < 0.05) were observed in the states of Espírito Santo and Rio de Janeiro, respectively. Until the 45th week, the higher the POP, the higher the mortality rate (p < 0.01), with no differences in the remaining period (p > 0.05). There was a strong positive correlation between POP size and the number of cases (rS = 0.92, p < 0.0001) and deaths (rS = 0.88, p < 0.0001). The incidence coefficient and mortality rate were lower (p < 0.0001) for low GDP cities. Both coefficients were higher in high- and very high HDI cities (p < 0.0001). The lethality rate was higher in the state of Rio de Janeiro (p < 0.0001), in large cities (p < 0.0001), in cities with medium GDP (p < 0.0001), and in those with high HDI (p < 0.05). CONCLUSIONS: Both incidence and mortality were affected by time, with minimal influence of POP, GDP and HDI.


Subject(s)
COVID-19 , Humans , Gross Domestic Product , COVID-19/epidemiology , Population Density , Brazil/epidemiology , Pandemics
17.
PLoS One ; 17(10): e0276741, 2022.
Article in English | MEDLINE | ID: covidwho-2098755

ABSTRACT

This study investigates the influence of infection cases of COVID-19 and two non-compulsory lockdowns on human mobility within the Tokyo metropolitan area. Using the data of hourly staying population in each 500m×500m cell and their city-level residency, we show that long-distance trips or trips to crowded places decrease significantly when infection cases increase. The same result holds for the two lockdowns, although the second lockdown was less effective. Hence, Japanese non-compulsory lockdowns influence mobility in a similar way to the increase in infection cases. This means that they are accepted as alarm triggers for people who are at risk of contracting COVID-19.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Population Density , Tokyo/epidemiology , Communicable Disease Control
18.
PLoS Comput Biol ; 18(10): e1010554, 2022 10.
Article in English | MEDLINE | ID: covidwho-2089312

ABSTRACT

The COVID-19 pandemic has had high mortality rates in the elderly and frail worldwide, particularly in care homes. This is driven by the difficulty of isolating care homes from the wider community, the large population sizes within care facilities (relative to typical households), and the age/frailty of the residents. To quantify the mortality risk posed by disease, the case fatality risk (CFR) is an important tool. This quantifies the proportion of cases that result in death. Throughout the pandemic, CFR amongst care home residents in England has been monitored closely. To estimate CFR, we apply both novel and existing methods to data on deaths in care homes, collected by Public Health England and the Care Quality Commission. We compare these different methods, evaluating their relative strengths and weaknesses. Using these methods, we estimate temporal trends in the instantaneous CFR (at both daily and weekly resolutions) and the overall CFR across the whole of England, and dis-aggregated at regional level. We also investigate how the CFR varies based on age and on the type of care required, dis-aggregating by whether care homes include nursing staff and by age of residents. This work has contributed to the summary of measures used for monitoring the UK epidemic.


Subject(s)
COVID-19 , Humans , Aged , COVID-19/epidemiology , Pandemics , Nursing Homes , Population Density , England/epidemiology
19.
PLoS Comput Biol ; 18(9): e1010472, 2022 09.
Article in English | MEDLINE | ID: covidwho-2054247

ABSTRACT

The metagenome embedded in urban sewage is an attractive new data source to understand urban ecology and assess human health status at scales beyond a single host. Analyzing the viral fraction of wastewater in the ongoing COVID-19 pandemic has shown the potential of wastewater as aggregated samples for early detection, prevalence monitoring, and variant identification of human diseases in large populations. However, using census-based population size instead of real-time population estimates can mislead the interpretation of data acquired from sewage, hindering assessment of representativeness, inference of prevalence, or comparisons of taxa across sites. Here, we show that taxon abundance and sub-species diversisty in gut-associated microbiomes are new feature space to utilize for human population estimation. Using a population-scale human gut microbiome sample of over 1,100 people, we found that taxon-abundance distributions of gut-associated multi-person microbiomes exhibited generalizable relationships with respect to human population size. Here and throughout this paper, the human population size is essentially the sample size from the wastewater sample. We present a new algorithm, MicrobiomeCensus, for estimating human population size from sewage samples. MicrobiomeCensus harnesses the inter-individual variability in human gut microbiomes and performs maximum likelihood estimation based on simultaneous deviation of multiple taxa's relative abundances from their population means. MicrobiomeCensus outperformed generic algorithms in data-driven simulation benchmarks and detected population size differences in field data. New theorems are provided to justify our approach. This research provides a mathematical framework for inferring population sizes in real time from sewage samples, paving the way for more accurate ecological and public health studies utilizing the sewage metagenome.


Subject(s)
COVID-19 , Gastrointestinal Microbiome , Gastrointestinal Microbiome/genetics , Humans , Pandemics , Population Density , Sewage , Wastewater
20.
Spat Spatiotemporal Epidemiol ; 43: 100539, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2042149

ABSTRACT

BACKGROUND: Many questions remain unanswered about how SARS-CoV-2 transmission is influenced by aspects of the economy, environment, and health. A better understanding of how these factors interact can help us to design early health prevention and control strategies, and develop better predictive models for public health risk management of SARS-CoV-2. This study examines the associations between COVID-19 epidemic growth and macro-level determinants of transmission such as demographic, socio-economic, climate and health factors, during the first wave of outbreaks in the United States. METHODS: A spatial-temporal data-set was created from a variety of relevant data sources. A unique data-driven study design was implemented to assess the relationship between COVID-19 infection and death epidemic doubling times and explanatory variables using a Generalized Additive Model (GAM). RESULTS: The main factors associated with infection doubling times are higher population density, home overcrowding, manufacturing, and recreation industries. Poverty was also an important predictor of faster epidemic growth perhaps because of factors associated with in-work poverty-related conditions, although poverty is also a predictor of poor population health which is likely driving infection and death reporting. Air pollution and diabetes were other important drivers of infection reporting. Warmer temperatures are associated with slower epidemic growth, which is most likely explained by human behaviors associated with warmer locations i.e. ventilating homes and workplaces, and socializing outdoors. The main factors associated with death doubling times were population density, poverty, older age, diabetes, and air pollution. Temperature was also slightly significant slowing death doubling times. CONCLUSIONS: Such findings help underpin current understanding of the disease epidemiology and also supports current policy and advice recommending ventilation of homes, work-spaces, and schools, along with social distancing and mask-wearing. Given the strong associations between doubling times and the stringency index, it is likely that those states that responded to the virus more quickly by implementing a range of measures such as school closing, workplace closing, restrictions on gatherings, close public transport, restrictions on internal movement, international travel controls, and public information campaigns, did have some success slowing the spread of the virus.


Subject(s)
COVID-19 , Epidemics , United States/epidemiology , Humans , SARS-CoV-2 , COVID-19/epidemiology , Disease Outbreaks , Population Density
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