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1.
JMIR Public Health Surveill ; 7(6): e28265, 2021 06 03.
Article in English | MEDLINE | ID: covidwho-2197911

ABSTRACT

BACKGROUND: Despite the limitations in the use of cycle threshold (CT) values for individual patient care, population distributions of CT values may be useful indicators of local outbreaks. OBJECTIVE: We aimed to conduct an exploratory analysis of potential correlations between the population distribution of cycle threshold (CT) values and COVID-19 dynamics, which were operationalized as percent positivity, transmission rate (Rt), and COVID-19 hospitalization count. METHODS: In total, 148,410 specimens collected between September 15, 2020, and January 11, 2021, from the greater El Paso area were processed in the Dascena COVID-19 Laboratory. The daily median CT value, daily Rt, daily count of COVID-19 hospitalizations, daily change in percent positivity, and rolling averages of these features were plotted over time. Two-way scatterplots and linear regression were used to evaluate possible associations between daily median CT values and outbreak measures. Cross-correlation plots were used to determine whether a time delay existed between changes in daily median CT values and measures of community disease dynamics. RESULTS: Daily median CT values negatively correlated with the daily Rt values (P<.001), the daily COVID-19 hospitalization counts (with a 33-day time delay; P<.001), and the daily changes in percent positivity among testing samples (P<.001). Despite visual trends suggesting time delays in the plots for median CT values and outbreak measures, a statistically significant delay was only detected between changes in median CT values and COVID-19 hospitalization counts (P<.001). CONCLUSIONS: This study adds to the literature by analyzing samples collected from an entire geographical area and contextualizing the results with other research investigating population CT values.


Subject(s)
COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Adult , COVID-19/transmission , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Texas , Time Factors
2.
JMIR Public Health Surveill ; 7(6): e27917, 2021 06 02.
Article in English | MEDLINE | ID: covidwho-2197909

ABSTRACT

BACKGROUND: The United States of America has the highest global number of COVID-19 cases and deaths, which may be due in part to delays and inconsistencies in implementing public health and social measures (PHSMs). OBJECTIVE: In this descriptive analysis, we analyzed the epidemiological evidence for the impact of PHSMs on COVID-19 transmission in the United States and compared these data to those for 10 other countries of varying income levels, population sizes, and geographies. METHODS: We compared PHSM implementation timing and stringency against COVID-19 daily case counts in the United States and against those in Canada, China, Ethiopia, Japan, Kazakhstan, New Zealand, Singapore, South Korea, Vietnam, and Zimbabwe from January 1 to November 25, 2020. We descriptively analyzed the impact of border closures, contact tracing, household confinement, mandated face masks, quarantine and isolation, school closures, limited gatherings, and states of emergency on COVID-19 case counts. We also compared the relationship between global socioeconomic indicators and national pandemic trajectories across the 11 countries. PHSMs and case count data were derived from various surveillance systems, including the Health Intervention Tracking for COVID-19 database, the World Health Organization PHSM database, and the European Centre for Disease Prevention and Control. RESULTS: Implementing a specific package of 4 PHSMs (quarantine and isolation, school closures, household confinement, and the limiting of social gatherings) early and stringently was observed to coincide with lower case counts and transmission durations in Vietnam, Zimbabwe, New Zealand, South Korea, Ethiopia, and Kazakhstan. In contrast, the United States implemented few PHSMs stringently or early and did not use this successful package. Across the 11 countries, national income positively correlated (r=0.624) with cumulative COVID-19 incidence. CONCLUSIONS: Our findings suggest that early implementation, consistent execution, adequate duration, and high adherence to PHSMs represent key factors of reducing the spread of COVID-19. Although national income may be related to COVID-19 progression, a country's wealth appears to be less important in controlling the pandemic and more important in taking rapid, centralized, and consistent public health action.


Subject(s)
COVID-19/prevention & control , Global Health/statistics & numerical data , Public Health/legislation & jurisprudence , COVID-19/epidemiology , COVID-19/transmission , Databases, Factual , Humans , Physical Distancing , Quarantine , Schools/organization & administration , United States/epidemiology , Workplace/organization & administration
3.
JMIR Public Health Surveill ; 7(6): e27189, 2021 06 03.
Article in English | MEDLINE | ID: covidwho-2197904

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, swab tests proved to be effective in containing the infection and served as a means for early diagnosis and contact tracing. However, little evidence exists regarding the correct timing for the execution of the swab test, especially for asymptomatic individuals and health care workers. OBJECTIVE: The objective of this study was to analyze changes in the positive findings over time in individual SARS-CoV-2 swab tests during a health surveillance program. METHODS: The study was conducted with 2071 health care workers at the University Hospital of Verona, with a known date of close contact with a patient with COVID-19, between February 29 and April 17, 2020. The health care workers underwent a health surveillance program with repeated swab tests to track their virological status. A generalized additive mixed model was used to investigate how the probability of a positive test result changes over time since the last known date of close contact, in an overall sample of individuals who tested positive for COVID-19 and in a subset of individuals with an initial negative swab test finding before being proven positive, to assess different surveillance time intervals. RESULTS: Among the 2071 health care workers in this study, 191 (9.2%) tested positive for COVID-19, and 103 (54%) were asymptomatic with no differences based on sex or age. Among 49 (25.7%) cases, the initial swab test yielded negative findings after close contact with a patient with COVID-19. Sex, age, symptoms, and the time of sampling were not different between individuals with an initial negative swab test finding and those who initially tested positive after close contact. In the overall sample, the estimated probability of testing positive was 0.74 on day 1 after close contact, which increased to 0.77 between days 5 and 8. In the 3 different scenarios for scheduled repeated testing intervals (3, 5, and 7 days) in the subgroup of individuals with an initially negative swab test finding, the probability peaked on the sixth, ninth and tenth, and 13th and 14th days, respectively. CONCLUSIONS: Swab tests can initially yield false-negative outcomes. The probability of testing positive increases from day 1, peaking between days 5 and 8 after close contact with a patient with COVID-19. Early testing, especially in this final time window, is recommended together with a health surveillance program scheduled in close intervals.


Subject(s)
COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19/diagnosis , Health Personnel/statistics & numerical data , Adult , COVID-19/epidemiology , COVID-19/transmission , Contact Tracing/methods , False Negative Reactions , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Italy/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Time Factors
4.
JMIR Public Health Surveill ; 7(6): e26784, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-2197902

ABSTRACT

BACKGROUND: Despite recent achievements in vaccines, antiviral drugs, and medical infrastructure, the emergence of COVID-19 has posed a serious threat to humans worldwide. Most countries are well connected on a global scale, making it nearly impossible to implement perfect and prompt mitigation strategies for infectious disease outbreaks. In particular, due to the explosive growth of international travel, the complex network of human mobility enabled the rapid spread of COVID-19 globally. OBJECTIVE: South Korea was one of the earliest countries to be affected by COVID-19. In the absence of vaccines and treatments, South Korea has implemented and maintained stringent interventions, such as large-scale epidemiological investigations, rapid diagnosis, social distancing, and prompt clinical classification of severely ill patients with appropriate medical measures. In particular, South Korea has implemented effective airport screenings and quarantine measures. In this study, we aimed to assess the country-specific importation risk of COVID-19 and investigate its impact on the local transmission of COVID-19. METHODS: The country-specific importation risk of COVID-19 in South Korea was assessed. We investigated the relationships between country-specific imported cases, passenger numbers, and the severity of country-specific COVID-19 prevalence from January to October 2020. We assessed the country-specific risk by incorporating country-specific information. A renewal mathematical model was employed, considering both imported and local cases of COVID-19 in South Korea. Furthermore, we estimated the basic and effective reproduction numbers. RESULTS: The risk of importation from China was highest between January and February 2020, while that from North America (the United States and Canada) was high from April to October 2020. The R0 was estimated at 1.87 (95% CI 1.47-2.34), using the rate of α=0.07 for secondary transmission caused by imported cases. The Rt was estimated in South Korea and in both Seoul and Gyeonggi. CONCLUSIONS: A statistical model accounting for imported and locally transmitted cases was employed to estimate R0 and Rt. Our results indicated that the prompt implementation of airport screening measures (contact tracing with case isolation and quarantine) successfully reduced local transmission caused by imported cases despite passengers arriving from high-risk countries throughout the year. Moreover, various mitigation interventions, including social distancing and travel restrictions within South Korea, have been effectively implemented to reduce the spread of local cases in South Korea.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Communicable Diseases, Imported/epidemiology , Humans , Models, Statistical , Republic of Korea/epidemiology , Risk Assessment
5.
Medicine (Baltimore) ; 100(21): e26102, 2021 May 28.
Article in English | MEDLINE | ID: covidwho-2191016

ABSTRACT

ABSTRACT: Healthcare workers (HWs) perform a critical role not only in the clinical management of patients but also in providing adequate infection control and prevention measures and waste management procedures to be implemented in healthcare facilities. The aim of this study was to evaluate the awareness and knowledge of COVID-19 infection control precautions and waste management procedures among HWs in Saudi Arabian hospitals.This was a descriptive, cross-sectional study. Information on knowledge, awareness, and practice of infection control and waste management procedures were obtained from the HWs using a structured questionnaire. A thematic analysis was used to analyze the data.Our findings indicated that most of the study participants were knowledgeable, with a mean score of 78.3%. In total, 92.5%, 90.3%, and 91.7% of the participants were aware of the infection control precautions, COVID-19 waste management procedures, the availability of infection control supplies, respectively. HWs' Knowledge regarding waste management and infection control procedures correlated significantly with sex (P ≤ .001 and <.001), education (P = .024 and .043), and working experience (P = .029 and .009), respectively.Most participants appreciated the importance of their role in infection control, surveillance, and monitoring of the ongoing safety practices in their patients as well as their facilities and communities.


Subject(s)
Attitude of Health Personnel , COVID-19/prevention & control , Health Knowledge, Attitudes, Practice , Infection Control/standards , Medical Waste Disposal/standards , Adult , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Cross-Sectional Studies , Female , Health Facilities/standards , Health Personnel/statistics & numerical data , Humans , Infection Control/organization & administration , Infection Control/statistics & numerical data , Male , Middle Aged , Pandemics/prevention & control , Practice Guidelines as Topic , SARS-CoV-2/pathogenicity , Saudi Arabia/epidemiology , Surveys and Questionnaires/statistics & numerical data , Young Adult
6.
Medicine (Baltimore) ; 100(21): e25945, 2021 May 28.
Article in English | MEDLINE | ID: covidwho-2191011

ABSTRACT

ABSTRACT: To investigate the prevalence of anxiety and depressive symptoms and the associated risk factors among first-line medical staff in Wuhan during the coronavirus disease 2019 (COVID-19) epidemic.From March 5 to 15, 2020, the Hamilton Anxiety Scale and Hamilton Depression scale were used to investigate the anxiety and depression status of medical staff in Wuhan Cabin Hospital (a Hospital). Two hundred seventy-six questionnaires were received from 96 doctors and 180 nurses, including 79 males and 197 females.During the COVID-19 epidemic, the prevalence rate of anxiety and depression was 27.9% and 18.1%, respectively, among 276 front-line medical staff in Wuhan. The prevalence rate of anxiety and depression among doctors was 19.8% and 11.5%, respectively, and the prevalence rate of anxiety and depression among nurses was 32.2% and 21.7%, respectively. Females recorded higher total scores for anxiety and depression than males, and nurses recorded higher scores for anxiety and depression than doctors.During the COVID-19 epidemic, some first-line medical staff experienced mental health problems such as depression and anxiety. Nurses were more prone to anxiety and depression than doctors. Effective strategies toward to improving the mental health should be provided to first-line medical staff, especially female medical staff and nurses.


Subject(s)
Anxiety/epidemiology , COVID-19/epidemiology , Depression/epidemiology , Medical Staff/psychology , Mobile Health Units/statistics & numerical data , Adult , Anxiety/psychology , COVID-19/diagnosis , COVID-19/therapy , COVID-19/transmission , China/epidemiology , Cross-Sectional Studies , Depression/psychology , Fear , Female , Humans , Infectious Disease Transmission, Patient-to-Professional , Male , Medical Staff/statistics & numerical data , Middle Aged , Pandemics , Prevalence , Risk Factors , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Self Report/statistics & numerical data , Sex Factors , Workload/psychology
7.
JMIR Public Health Surveill ; 7(9): e30406, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-2141343

ABSTRACT

BACKGROUND: Data on how SARS-CoV-2 enters and spreads in a population are essential for guiding public policies. OBJECTIVE: This study seeks to understand the transmission dynamics of SARS-CoV-2 in small Brazilian towns during the early phase of the epidemic and to identify core groups that can serve as the initial source of infection as well as factors associated with a higher risk of COVID-19. METHODS: Two population-based seroprevalence studies, one household survey, and a case-control study were conducted in two small towns in southeastern Brazil between May and June 2020. In the population-based studies, 400 people were evaluated in each town; there were 40 homes in the household survey, and 95 cases and 393 controls in the case-control study. SARS-CoV-2 serology testing was performed on participants, and a questionnaire was applied. Prevalence, household secondary infection rate, and factors associated with infection were assessed. Odds ratios (ORs) were calculated by logistic regression. Logistics worker was defined as an individual with an occupation focused on the transportation of people or goods and whose job involves traveling outside the town of residence at least once a week. RESULTS: Higher seroprevalence of SARS-CoV-2 was observed in the town with a greater proportion of logistics workers. The secondary household infection rate was 49.1% (55/112), and it was observed that in most households (28/40, 70%) the index case was a logistics worker. The case-control study revealed that being a logistics worker (OR 18.0, 95% CI 8.4-38.7) or living with one (OR 6.9, 95% CI 3.3-14.5) increases the risk of infection. In addition, having close contact with a confirmed case (OR 13.4, 95% CI 6.6-27.3) and living with more than four people (OR 2.7, 95% CI 1.1-7.1) were also risk factors. CONCLUSIONS: Our study shows a strong association between logistics workers and the risk of SARS-CoV-2 infection and highlights the key role of these workers in the viral spread in small towns. These findings indicate the need to focus on this population to determine COVID-19 prevention and control strategies, including vaccination and sentinel genomic surveillance.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Communicable Diseases, Imported/epidemiology , Occupations/statistics & numerical data , Transportation/statistics & numerical data , Adolescent , Adult , Brazil/epidemiology , Case-Control Studies , Child , Child, Preschool , Cities/epidemiology , Family Characteristics , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Risk Factors , Seroepidemiologic Studies , Young Adult
8.
JMIR Public Health Surveill ; 7(8): e29957, 2021 Aug 30.
Article in English | MEDLINE | ID: covidwho-2141339

ABSTRACT

BACKGROUND: Association between human mobility and disease transmission has been established for COVID-19, but quantifying the levels of mobility over large geographical areas is difficult. Google has released Community Mobility Reports (CMRs) containing data about the movement of people, collated from mobile devices. OBJECTIVE: The aim of this study is to explore the use of CMRs to assess the role of mobility in spreading COVID-19 infection in India. METHODS: In this ecological study, we analyzed CMRs to determine human mobility between March and October 2020. The data were compared for the phases before the lockdown (between March 14 and 25, 2020), during lockdown (March 25-June 7, 2020), and after the lockdown (June 8-October 15, 2020) with the reference periods (ie, January 3-February 6, 2020). Another data set depicting the burden of COVID-19 as per various disease severity indicators was derived from a crowdsourced API. The relationship between the two data sets was investigated using the Kendall tau correlation to depict the correlation between mobility and disease severity. RESULTS: At the national level, mobility decreased from -38% to -77% for all areas but residential (which showed an increase of 24.6%) during the lockdown compared to the reference period. At the beginning of the unlock phase, the state of Sikkim (minimum cases: 7) with a -60% reduction in mobility depicted more mobility compared to -82% in Maharashtra (maximum cases: 1.59 million). Residential mobility was negatively correlated (-0.05 to -0.91) with all other measures of mobility. The magnitude of the correlations for intramobility indicators was comparatively low for the lockdown phase (correlation ≥0.5 for 12 indicators) compared to the other phases (correlation ≥0.5 for 45 and 18 indicators in the prelockdown and unlock phases, respectively). A high correlation coefficient between epidemiological and mobility indicators was observed for the lockdown and unlock phases compared to the prelockdown phase. CONCLUSIONS: Mobile-based open-source mobility data can be used to assess the effectiveness of social distancing in mitigating disease spread. CMR data depicted an association between mobility and disease severity, and we suggest using this technique to supplement future COVID-19 surveillance.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Cell Phone , Geographic Information Systems , Pandemics , Travel/statistics & numerical data , Humans , India/epidemiology
9.
JMIR Public Health Surveill ; 7(1): e25241, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-2141298

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in changes to normal life and disrupted social and economic function worldwide. However, little is known about the impact of social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women during the COVID-19 pandemic. OBJECTIVE: This study aims to assess the association between social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women in the early stage of the COVID-19 pandemic in China. METHODS: In this prospective cohort study, 456 singleton pregnant women in mainland China were recruited during January and February 2020. Sociodemographic characteristics, history of previous health, social media use, and current lifestyles were collected at baseline, and we followed up about the occurrence of miscarriage. Log-binomial regression models were used to estimate the risk ratios (RRs) of miscarriage for women with different exposures to COVID-19-specific information. RESULTS: Among all the 456 pregnant women, there were 82 (18.0%) who did no physical activities, 82 (18.0%) with inadequate dietary diversity, 174 (38.2%) with poor sleep quality, and 54 (11.8%) spending >3 hours on reading COVID-19 news per day. Women with excessive media use (>3 hours) were more likely to be previously pregnant (P=.03), have no physical activity (P=.003), have inadequate dietary diversity (P=.03), and have poor sleep quality (P<.001). The prevalence of miscarriage was 16.0% (n=73; 95% CI 12.6%-19.4%). Compared with women who spent 0.5-2 hours (25/247, 10.1%) on reading COVID-19 news per day, miscarriage prevalence in women who spent <0.5 hours (5/23, 21.7%), 2-3 hours (26/132, 19.7%), and >3 hours (17/54, 31.5%) was higher (P<.001). Miscarriage prevalence was also higher in pregnant women with poor sleep quality (39/174, 22.4% vs 34/282, 12.1%; P=.003) and a high education level (66/368, 17.9% vs 7/88, 8.0%; P=.02). In the multivariable model, poor sleep quality (adjusted RR 2.06, 95% CI 1.24-3.44; P=.006), 2-3 hours of media use daily (adjusted RR 1.74, 95% CI 1.02-2.97; P=.04), and >3 hours of media use daily (adjusted RR 2.56, 95% CI 1.43-4.59; P=.002) were associated with miscarriage. In the sensitivity analysis, results were still stable. CONCLUSIONS: Pregnant women with excessive media use were more likely to have no physical activity, inadequate dietary diversity, and poor sleep quality. Excessive media use and poor sleep quality were associated with a higher risk of miscarriage. Our findings highlight the importance of healthy lifestyles during the COVID-19 pandemic.


Subject(s)
Abortion, Spontaneous/etiology , Life Style , Pregnant Women/psychology , Social Media/trends , Abortion, Spontaneous/epidemiology , Abortion, Spontaneous/psychology , Adult , COVID-19/complications , COVID-19/psychology , COVID-19/transmission , China/epidemiology , Female , Humans , Pandemics/prevention & control , Pregnancy , Prospective Studies , Risk Factors , Social Media/statistics & numerical data
10.
JMIR Public Health Surveill ; 7(1): e24859, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-2141296

ABSTRACT

BACKGROUND: Previous studies have shown that electronic cigarette (e-cigarette) users might be more vulnerable to COVID-19 infection and could develop more severe symptoms if they contract the disease owing to their impaired immune responses to viral infections. Social media platforms such as Twitter have been widely used by individuals worldwide to express their responses to the current COVID-19 pandemic. OBJECTIVE: In this study, we aimed to examine the longitudinal changes in the attitudes of Twitter users who used e-cigarettes toward the COVID-19 pandemic, as well as compare differences in attitudes between e-cigarette users and nonusers based on Twitter data. METHODS: The study dataset containing COVID-19-related Twitter posts (tweets) posted between March 5 and April 3, 2020, was collected using a Twitter streaming application programming interface with COVID-19-related keywords. Twitter users were classified into two groups: Ecig group, including users who did not have commercial accounts but posted e-cigarette-related tweets between May 2019 and August 2019, and non-Ecig group, including users who did not post any e-cigarette-related tweets. Sentiment analysis was performed to compare sentiment scores towards the COVID-19 pandemic between both groups and determine whether the sentiment expressed was positive, negative, or neutral. Topic modeling was performed to compare the main topics discussed between the groups. RESULTS: The US COVID-19 dataset consisted of 4,500,248 COVID-19-related tweets collected from 187,399 unique Twitter users in the Ecig group and 11,479,773 COVID-19-related tweets collected from 2,511,659 unique Twitter users in the non-Ecig group. Sentiment analysis showed that Ecig group users had more negative sentiment scores than non-Ecig group users. Results from topic modeling indicated that Ecig group users had more concerns about deaths due to COVID-19, whereas non-Ecig group users cared more about the government's responses to the COVID-19 pandemic. CONCLUSIONS: Our findings show that Twitter users who tweeted about e-cigarettes had more concerns about the COVID-19 pandemic. These findings can inform public health practitioners to use social media platforms such as Twitter for timely monitoring of public responses to the COVID-19 pandemic and educating and encouraging current e-cigarette users to quit vaping to minimize the risks associated with COVID-19.


Subject(s)
Electronic Nicotine Delivery Systems/standards , Pandemics , Perception , Smokers/psychology , Social Media/instrumentation , COVID-19/complications , COVID-19/psychology , COVID-19/transmission , Electronic Nicotine Delivery Systems/statistics & numerical data , Humans , Social Media/trends
11.
JMIR Public Health Surveill ; 7(4): e24292, 2021 04 07.
Article in English | MEDLINE | ID: covidwho-2141292

ABSTRACT

BACKGROUND: Significant uncertainty has existed about the safety of reopening college and university campuses before the COVID-19 pandemic is better controlled. Moreover, little is known about the effects that on-campus students may have on local higher-risk communities. OBJECTIVE: We aimed to estimate the range of potential community and campus COVID-19 exposures, infections, and mortality under various university reopening plans and uncertainties. METHODS: We developed campus-only, community-only, and campus × community epidemic differential equations and agent-based models, with inputs estimated via published and grey literature, expert opinion, and parameter search algorithms. Campus opening plans (spanning fully open, hybrid, and fully virtual approaches) were identified from websites and publications. Additional student and community exposures, infections, and mortality over 16-week semesters were estimated under each scenario, with 10% trimmed medians, standard deviations, and probability intervals computed to omit extreme outliers. Sensitivity analyses were conducted to inform potential effective interventions. RESULTS: Predicted 16-week campus and additional community exposures, infections, and mortality for the base case with no precautions (or negligible compliance) varied significantly from their medians (4- to 10-fold). Over 5% of on-campus students were infected after a mean of 76 (SD 17) days, with the greatest increase (first inflection point) occurring on average on day 84 (SD 10.2 days) of the semester and with total additional community exposures, infections, and mortality ranging from 1-187, 13-820, and 1-21 per 10,000 residents, respectively. Reopening precautions reduced infections by 24%-26% and mortality by 36%-50% in both populations. Beyond campus and community reproductive numbers, sensitivity analysis indicated no dominant factors that interventions could primarily target to reduce the magnitude and variability in outcomes, suggesting the importance of comprehensive public health measures and surveillance. CONCLUSIONS: Community and campus COVID-19 exposures, infections, and mortality resulting from reopening campuses are highly unpredictable regardless of precautions. Public health implications include the need for effective surveillance and flexible campus operations.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Universities/organization & administration , COVID-19/mortality , Community-Acquired Infections/epidemiology , Humans , Models, Theoretical , Risk Assessment , Uncertainty , United States/epidemiology
12.
JMIR Public Health Surveill ; 7(4): e21468, 2021 04 19.
Article in English | MEDLINE | ID: covidwho-2141284

ABSTRACT

BACKGROUND: The major medical and social challenge of the 21st century is COVID-19, caused by the novel coronavirus SARS-CoV-2. Critical issues include the rate at which the coronavirus spreads and the effect of quarantine measures and population vaccination on this rate. Knowledge of the laws of the spread of COVID-19 will enable assessment of the effectiveness and reasonableness of the quarantine measures used, as well as determination of the necessary level of vaccination needed to overcome this crisis. OBJECTIVE: This study aims to establish the laws of the spread of COVID-19 and to use them to develop a mathematical model to predict changes in the number of active cases over time, possible human losses, and the rate of recovery of patients, to make informed decisions about the number of necessary beds in hospitals, the introduction and type of quarantine measures, and the required threshold of vaccination of the population. METHODS: This study analyzed the onset of COVID-19 spread in countries such as China, Italy, Spain, the United States, the United Kingdom, Japan, France, and Germany based on publicly available statistical data. The change in the number of COVID-19 cases, deaths, and recovered persons over time was examined, considering the possible introduction of quarantine measures and isolation of infected people in these countries. Based on the data, the virus transmissibility and the average duration of the disease at different stages were evaluated, and a model based on the principle of recursion was developed. Its key features are the separation of active (nonisolated) infected persons into a distinct category and the prediction of their number based on the average duration of the disease in the inactive phase and the concentration of these persons in the population in the preceding days. RESULTS: Specific values for SARS-CoV-2 transmissibility and COVID-19 duration were estimated for different countries. In China, the viral transmissibility was 3.12 before quarantine measures were implemented and 0.36 after these measures were lifted. For the other countries, the viral transmissibility was 2.28-2.76 initially, and it then decreased to 0.87-1.29 as a result of quarantine measures. Therefore, it can be expected that the spread of SARS-CoV-2 will be suppressed if 56%-64% of the total population becomes vaccinated or survives COVID-19. CONCLUSIONS: The quarantine measures adopted in most countries are too weak compared to those previously used in China. Therefore, it is not expected that the spread of COVID-19 will stop and the disease will cease to exist naturally or owing to quarantine measures. Active vaccination of the population is needed to prevent the spread of COVID-19. Furthermore, the required specific percentage of vaccinated individuals depends on the magnitude of viral transmissibility, which can be evaluated using the proposed model and statistical data for the country of interest.


Subject(s)
COVID-19/transmission , Models, Theoretical , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Global Health , Humans , Quarantine/legislation & jurisprudence
13.
JMIR Public Health Surveill ; 7(1): e21327, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-2141283

ABSTRACT

BACKGROUND: The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital-based outpatient clinic in one of the worst-hit areas in the world. OBJECTIVE: Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. METHODS: We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. RESULTS: During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. CONCLUSIONS: There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.


Subject(s)
Pandemics/prevention & control , Telemedicine/methods , Ambulatory Care/methods , COVID-19/complications , COVID-19/transmission , Humans , Michigan , Pandemics/statistics & numerical data , Patient Satisfaction , Prospective Studies , Retrospective Studies , Telemedicine/trends , Tertiary Care Centers/organization & administration , Tertiary Care Centers/trends
14.
JMIR Public Health Surveill ; 7(4): e20699, 2021 04 21.
Article in English | MEDLINE | ID: covidwho-2141282

ABSTRACT

BACKGROUND: Daily new COVID-19 cases from January to April 2020 demonstrate varying patterns of SARS-CoV-2 transmission across different geographical regions. Constant infection rates were observed in some countries, whereas China and South Korea had a very low number of daily new cases. In fact, China and South Korea successfully and quickly flattened their COVID-19 curve. To understand why this was the case, this paper investigated possible aerosol-forming patterns in the atmosphere and their relationship to the policy measures adopted by select countries. OBJECTIVE: The main research objective was to compare the outcomes of policies adopted by countries between January and April 2020. Policies included physical distancing measures that in some cases were associated with mask use and city disinfection. We investigated whether the type of social distancing framework adopted by some countries (ie, without mask use and city disinfection) led to the continual dissemination of SARS-CoV-2 (daily new cases) in the community during the study period. METHODS: We examined the policies used as a preventive framework for virus community transmission in some countries and compared them to the policies adopted by China and South Korea. Countries that used a policy of social distancing by 1-2 m were divided into two groups. The first group consisted of countries that implemented social distancing (1-2 m) only, and the second comprised China and South Korea, which implemented distancing with additional transmission/isolation measures using masks and city disinfection. Global daily case maps from Johns Hopkins University were used to provide time-series data for the analysis. RESULTS: The results showed that virus transmission was reduced due to policies affecting SARS-CoV-2 propagation over time. Remarkably, China and South Korea obtained substantially better results than other countries at the beginning of the epidemic due to their adoption of social distancing (1-2 m) with the additional use of masks and sanitization (city disinfection). These measures proved to be effective due to the atmosphere carrier potential of SARS-CoV-2 transmission. CONCLUSIONS: Our findings confirm that social distancing by 1-2 m with mask use and city disinfection yields positive outcomes. These strategies should be incorporated into prevention and control policies and be adopted both globally and by individuals as a method to fight the COVID-19 pandemic.


Subject(s)
Air Microbiology , COVID-19/prevention & control , COVID-19/transmission , Policy , COVID-19/epidemiology , China/epidemiology , Cities/epidemiology , Disinfection , Global Health , Humans , Masks , Physical Distancing , Policy Making , Republic of Korea/epidemiology , SARS-CoV-2
15.
Anesth Analg ; 132(1): 2-14, 2021 01.
Article in English | MEDLINE | ID: covidwho-2140282

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remains unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.


Subject(s)
COVID-19/prevention & control , Decontamination , Equipment Contamination , Equipment Reuse , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Inhalation Exposure/prevention & control , N95 Respirators/virology , Occupational Exposure/prevention & control , COVID-19/transmission , Humans , Inhalation Exposure/adverse effects , Occupational Exposure/adverse effects , Occupational Health , Risk Assessment , Risk Factors
16.
Science ; 378(6620): 611, 2022 11 11.
Article in English | MEDLINE | ID: covidwho-2137363

ABSTRACT

Mathematical models help predict and manage the course of pandemics.


Subject(s)
COVID-19 , Models, Theoretical , Pandemics , Pandemics/prevention & control , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission
17.
Epidemiol Infect ; 150: e171, 2022 Sep 27.
Article in English | MEDLINE | ID: covidwho-2133093

ABSTRACT

Coronavirus disease 2019 (COVID-19) asymptomatic cases are hard to identify, impeding transmissibility estimation. The value of COVID-19 transmissibility is worth further elucidation for key assumptions in further modelling studies. Through a population-based surveillance network, we collected data on 1342 confirmed cases with a 90-days follow-up for all asymptomatic cases. An age-stratified compartmental model containing contact information was built to estimate the transmissibility of symptomatic and asymptomatic COVID-19 cases. The difference in transmissibility of a symptomatic and asymptomatic case depended on age and was most distinct for the middle-age groups. The asymptomatic cases had a 66.7% lower transmissibility rate than symptomatic cases, and 74.1% (95% CI 65.9-80.7) of all asymptomatic cases were missed in detection. The average proportion of asymptomatic cases was 28.2% (95% CI 23.0-34.6). Simulation demonstrated that the burden of asymptomatic transmission increased as the epidemic continued and could potentially dominate total transmission. The transmissibility of asymptomatic COVID-19 cases is high and asymptomatic COVID-19 cases play a significant role in outbreaks.


Subject(s)
COVID-19 , Epidemics , Humans , Middle Aged , Computer Simulation , COVID-19/epidemiology , COVID-19/transmission , Disease Outbreaks , SARS-CoV-2 , Asymptomatic Infections
18.
Global Health ; 17(1): 93, 2021 Aug 21.
Article in English | MEDLINE | ID: covidwho-2098356

ABSTRACT

International air travel has been highlighted as a concern since the beginning of the COVID-19 pandemic with respect to importation of cases. We summarise the available evidence for in-flight transmission of wild type SARS-CoV-2 during 2020, and for imported COVID-19 clusters to cause outbreaks. This paper provides a data baseline prior to the emergence of new mutations causing SARS-CoV-2 variants of concern, whose characteristics may increase the potential risk of in-flight transmission and imported outbreaks. The evidence on in-flight transmission of wild-type SARS-CoV-2 is limited, and is described in a small number of published reports. Most of the available evidence pertains to the early phase of the COVID-19 pandemic, during a period without non-pharmaceutical interventions such as distancing and in-flight mask wearing. There is considerable potential for outbreaks of COVID-19 from imported cases or clusters when public health guidance around quarantine of travellers and self-isolation of cases is not adhered to. Risks can be mitigated by measures such as: avoiding non-essential travel, targeted testing and quarantine of travellers from high incidence regions or regions of concern, managed quarantine processes, and protocols for rapid investigation and control of transmission from a possible variant of concern. Measures should be dynamically assessed and proportionate to the level of risk.


Subject(s)
Air Travel , COVID-19/transmission , COVID-19/virology , Communicable Diseases, Imported/epidemiology , Disease Outbreaks , COVID-19/epidemiology , Humans , SARS-CoV-2/genetics
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