COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns.

BACKGROUND: COVID-19 has affected the African region in many ways. We aimed to generate robust information on the transmission dynamics of COVID-19 in this region since the beginning of the pandemic and throughout 2022. METHODS: For each of the 47 countries of the WHO African region, we consolidated COVID-19 data from reported infections and deaths (from WHO statistics); published literature on socioecological, biophysical, and public health interventions; and immunity status and variants of concern, to build a dynamic and comprehensive picture of COVID-19 burden. The model is consolidated through a partially observed Markov decision process, with a Fourier series to produce observed patterns over time based on the SEIRD (denoting susceptible, exposed, infected, recovered, and dead) modelling framework. The model was set up to run weekly, by country, from the date the first infection was reported in each country until Dec 31, 2021. New variants were introduced into the model based on sequenced data reported by countries. The models were then extrapolated until the end of 2022 and included three scenarios based on possible new variants with varying transmissibility, severity, or immunogenicity. FINDINGS: Between Jan 1, 2020, and Dec 31, 2021, our model estimates the number of SARS-CoV-2 infections in the African region to be 505·6 million (95% CI 476·0-536·2), inferring that only 1·4% (one in 71) of SARS-CoV-2 infections in the region were reported. Deaths are estimated at 439 500 (95% CI 344 374-574 785), with 35·3% (one in three) of these reported as COVID-19-related deaths. Although the number of infections were similar between 2020 and 2021, 81% of the deaths were in 2021. 52·3% (95% CI 43·5-95·2) of the region's population is estimated to have some SARS-CoV-2 immunity, given vaccination coverage of 14·7% as of Dec 31, 2021. By the end of 2022, we estimate that infections will remain high, at around 166·2 million (95% CI 157·5-174·9) infections, but deaths will substantially reduce to 22 563 (14 970-38 831). INTERPRETATION: The African region is estimated to have had a similar number of COVID-19 infections to that of the rest of the world, but with fewer deaths. Our model suggests that the current approach to SARS-CoV-2 testing is missing most infections. These results are consistent with findings from representative seroprevalence studies. There is, therefore, a need for surveillance of hospitalisations, comorbidities, and the emergence of new variants of concern, and scale-up of representative seroprevalence studies, as core response strategies. FUNDING: None.

Early assessment of the relationship between the COVID-19 pandemic and births in high-income countries.

Drawing on past pandemics, scholars have suggested that the COVID-19 pandemic will bring about fertility decline. Evidence from actual birth data has so far been scarce. This brief report uses data on vital statistics from a selection of high-income countries, including the United States. The pandemic has been accompanied by a significant drop in crude birth rates beyond that predicted by past trends in 7 out of the 22 countries considered, with particularly strong declines in southern Europe: Italy (-9.1%), Spain (-8.4%), and Portugal (-6.6%). Substantial heterogeneities are, however, observed.

Impact of Population Growth and Aging on Estimates of Excess U.S. Deaths During the COVID-19 Pandemic, March to August 2020.

BACKGROUND: Excess death estimates quantify the full impact of the coronavirus disease 2019 (COVID-19) pandemic. Widely reported U.S. excess death estimates have not accounted for recent population changes, especially increases in the population older than 65 years. OBJECTIVE: To estimate excess deaths in the United States in 2020, after accounting for population changes. DESIGN: Surveillance study. SETTING: United States, March to August 2020. PARTICIPANTS: All decedents. MEASUREMENTS: Age-specific excess deaths in the United States from 1 March to 31 August 2020 compared with 2015 to 2019 were estimated, after changes in population size and age were taken into account, by using Centers for Disease Control and Prevention provisional death data and U.S. Census Bureau population estimates. Cause-specific excess deaths were estimated by month and age. RESULTS: From March through August 2020, 1 671 400 deaths were registered in the United States, including 173 300 COVID-19 deaths. An average of 1 370 000 deaths were reported over the same months during 2015 to 2019, for a crude excess of 301 400 deaths (128 100 non-COVID-19 deaths). However, the 2020 U.S. population includes 5.04 million more persons aged 65 years and older than the average population in 2015 to 2019 (a 10% increase). After population changes were taken into account, an estimated 217 900 excess deaths occurred from March through August 2020 (173 300 COVID-19 and 44 600 non-COVID-19 deaths). Most excess non-COVID-19 deaths occurred in April, July, and August, and 34 900 (78%) were in persons aged 25 to 64 years. Diabetes, Alzheimer disease, and heart disease caused the most non-COVID-19 excess deaths. LIMITATION: Provisional death data are underestimated because of reporting delays. CONCLUSION: The COVID-19 pandemic resulted in an estimated 218 000 excess deaths in the United States between March and August 2020, and 80% of those deaths had COVID-19 as the underlying cause. Accounting for population changes substantially reduced the excess non-COVID-19 death estimates, providing important information for guiding future clinical and public health interventions. PRIMARY FUNDING SOURCE: National Cancer Institute.

A scoping review of the nursing workforce's changing demography: Supporting Baby-Boomer nurses.

AIMS: This scoping review discusses two telecommuting options to advance scholarship regarding Baby-Boomer nurses' delayed retirement and to extend their contribution to bedside nursing. BACKGROUND: Peer-reviewed studies published in the 15 years before COVID-19 indicate that Baby-Boomer nurses' retirement will increase the global nursing shortage. However, three international trends have affected Baby-Boomer nurses' decision to delay their retirement. EVALUATION: This review observed the scoping review framework. KEY ISSUES: COVID-19 further disrupts the current understanding of Baby-Boomer nurses' retirement as they recognize COVID-19's impact on health care systems and younger nurses. Technological advancements and the changing needs of health care delivery have made telecommuting a practical possibility. CONCLUSION: Baby-Boomer nurses can leverage alternative work arrangements to meet their needs and to contribute to clinical practice through telecommuting. This approach extends Baby-Boomer nurses' careers and creates a resource for bedside nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Clinical experience matters at the bedside. Telecommuting maximizes the retention of Baby-Boomer nurses' clinical expertise to benefit patients and to socialize bedside nurses. Baby-Boomer nurses can contribute to patient monitoring as well as patient education and counselling through telehealth. They can also provide asynchronous and synchronous telementoring to bedside nurses.

On the evolutionary epidemiology of SARS-CoV-2.

There is no doubt that the novel coronavirus SARS-CoV-2 that causes COVID-19 is mutating and thus has the potential to adapt during the current pandemic. Whether this evolution will lead to changes in the transmission, the duration, or the severity of the disease is not clear. This has led to considerable scientific and media debate, from raising alarms about evolutionary change to dismissing it. Here we review what little is currently known about the evolution of SARS-CoV-2 and extend existing evolutionary theory to consider how selection might be acting upon the virus during the COVID-19 pandemic. Although there is currently no definitive evidence that SARS-CoV-2 is undergoing further adaptation, continued evidence-based analysis of evolutionary change is important so that public health measures can be adjusted in response to substantive changes in the infectivity or severity of COVID-19.