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2.
Elife ; 92020 08 13.
Article in English | MEDLINE | ID: covidwho-2155738

ABSTRACT

As of 1 May 2020, there had been 6808 confirmed cases of COVID-19 in Australia. Of these, 98 had died from the disease. The epidemic had been in decline since mid-March, with 308 cases confirmed nationally since 14 April. This suggests that the collective actions of the Australian public and government authorities in response to COVID-19 were sufficiently early and assiduous to avert a public health crisis - for now. Analysing factors that contribute to individual country experiences of COVID-19, such as the intensity and timing of public health interventions, will assist in the next stage of response planning globally. We describe how the epidemic and public health response unfolded in Australia up to 13 April. We estimate that the effective reproduction number was likely below one in each Australian state since mid-March and forecast that clinical demand would remain below capacity thresholds over the forecast period (from mid-to-late April).


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Australia/epidemiology , COVID-19 , Child , Child, Preschool , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Communicable Disease Control/statistics & numerical data , Coronavirus Infections/prevention & control , Female , Forecasting , Geography, Medical , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health , Quarantine , SARS-CoV-2 , Travel , Young Adult
3.
JMIR Public Health Surveill ; 7(9): e30460, 2021 09 20.
Article in English | MEDLINE | ID: covidwho-2141344

ABSTRACT

BACKGROUND: The UK National Health Service (NHS) classified 2.2 million people as clinically extremely vulnerable (CEV) during the first wave of the 2020 COVID-19 pandemic, advising them to "shield" (to not leave home for any reason). OBJECTIVE: The aim of this study was to measure the determinants of shielding behavior and associations with well-being in a large NHS patient population for informing future health policy. METHODS: Patients contributing to an ongoing longitudinal participatory epidemiology study (Longitudinal Effects on Wellbeing of the COVID-19 Pandemic [LoC-19], n=42,924) received weekly email invitations to complete questionnaires (17-week shielding period starting April 9, 2020) within their NHS personal electronic health record. Question items focused on well-being. Participants were stratified into four groups by self-reported CEV status (qualifying condition) and adoption of shielding behavior (baselined at week 1 or 2). The distribution of CEV criteria was reported alongside situational variables and univariable and multivariable logistic regression. Longitudinal trends in physical and mental well-being were displayed graphically. Free-text responses reporting variables impacting well-being were semiquantified using natural language processing. In the lead up to a second national lockdown (October 23, 2020), a follow-up questionnaire evaluated subjective concern if further shielding was advised. RESULTS: The study included 7240 participants. In the CEV group (n=2391), 1133 (47.3%) assumed shielding behavior at baseline, compared with 633 (13.0%) in the non-CEV group (n=4849). CEV participants who shielded were more likely to be Asian (odds ratio [OR] 2.02, 95% CI 1.49-2.76), female (OR 1.24, 95% CI 1.05-1.45), older (OR per year increase 1.01, 95% CI 1.00-1.02), living in a home with an outdoor space (OR 1.34, 95% CI 1.06-1.70) or three to four other inhabitants (three: OR 1.49, 95% CI 1.15-1.94; four: OR 1.49, 95% CI 1.10-2.01), or solid organ transplant recipients (OR 2.85, 95% CI 2.18-3.77), or have severe chronic lung disease (OR 1.63, 95% CI 1.30-2.04). Receipt of a government letter advising shielding was reported in 1115 (46.6%) CEV participants and 180 (3.7%) non-CEV participants, and was associated with adopting shielding behavior (OR 3.34, 95% CI 2.82-3.95 and OR 2.88, 95% CI 2.04-3.99, respectively). In CEV participants, shielding at baseline was associated with a lower rating of mental well-being and physical well-being. Similar results were found for non-CEV participants. Concern for well-being if future shielding was required was most prevalent among CEV participants who had originally shielded. CONCLUSIONS: Future health policy must balance the potential protection from COVID-19 against our findings that shielding negatively impacted well-being and was adopted in many in whom it was not indicated and variably in whom it was indicated. This therefore also requires clearer public health messaging and support for well-being if shielding is to be advised in future pandemic scenarios.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Mental Health/trends , Public Health/trends , Quarantine/psychology , Adult , Female , Health Policy , Humans , Longitudinal Studies , Male , Mental Health/legislation & jurisprudence , Middle Aged , Public Health/legislation & jurisprudence , SARS-CoV-2 , State Medicine , Surveys and Questionnaires , United Kingdom
4.
JMIR Public Health Surveill ; 7(10): e26840, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-2141319

ABSTRACT

BACKGROUND: The outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break. OBJECTIVE: In this study, we investigated levels of COVID-19-related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19-related cognitive factors. METHODS: A cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70%). Multilevel multiple logistic regression analysis was performed. RESULTS: Only 28.0% of respondents (6684/23,863) had left home for >4 hours, and 49.3% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9% for >5 times/day); 72.4% (17,282/23,863) had frequently undertaken ≥2 of these 3 measures. COVID-19-related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying. CONCLUSIONS: University students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Disease Outbreaks/prevention & control , COVID-19/epidemiology , China/epidemiology , Cross-Sectional Studies , Female , Hand Disinfection , Humans , Male , Masks , Physical Distancing , Students , Surveys and Questionnaires , Universities
5.
Pan Afr Med J ; 42(Suppl 1): 6, 2022.
Article in English | MEDLINE | ID: covidwho-2110977

ABSTRACT

Introduction: South Sudan has been implementing the Integrated Disease Surveillance and Response (IDSR) strategy since 2006, along with Early Warning and Alert Response and Network (EWARN). The IDSR/EWARN stakeholders commissioned an independent evaluation to establish performance at national, state, county, health facility, and community levels in the first half of 2021. Methods: the evaluation was conducted between June and September 2021 (during the COVID-19 pandemic) and was based on the World Health Organization (WHO) protocols for monitoring and evaluating communicable disease surveillance and response systems and the guidelines for evaluating EWARN. Results: integrated disease surveillance and response/early warning and alert response and network indicator data showed improving timeliness and completeness from the beginning of 2021 to week 16 and then a slight depression of timeliness by week 32, while completeness remained high. Event-based surveillance was active at the beginning of 2021 and in week 32. However, there was inadequate sample collection to investigate acute watery diarrhea, bloody diarrhea, and acute jaundice syndrome alerts. Respondents in all cadres had substantial experience working in IDSR/EWARN. All respondents performed the various IDSR/EWARN tasks and duties as expected, but needed more resources and training. Conclusion: while IDSR/EWARN is performing relatively well, confirmation of priority diseases by the laboratories needs to be strengthened. Health facilities need more regular supervision from the higher levels. Community health workers need more training on IDSR/EWARN. The whole IDSR/EWARN system needs more resources, particularly for communication and transport and to confirm priority diseases. Staff at all levels requested more training in IDSR/EWARN.


Subject(s)
COVID-19 , Communicable Disease Control , COVID-19/epidemiology , Communicable Disease Control/methods , Diarrhea , Disease Outbreaks , Humans , Pandemics , Population Surveillance/methods , South Sudan/epidemiology
6.
PLoS One ; 17(11): e0274407, 2022.
Article in English | MEDLINE | ID: covidwho-2109309

ABSTRACT

Since early March 2020, government agencies have utilized a wide variety of non-pharmaceutical interventions to mitigate the spread of COVID-19 and have struggled to determine when it is appropriate to return to in-person activities after an outbreak is detected. At many universities, fundamental issues related to understanding the spread of the disease (e.g. the transmission rate), the ability of administrators to respond quickly enough by closing when there is a sudden rise in cases, and how to make a decision on when to reopen remains a concern. Surveillance testing strategies have been implemented in some places, and those test outcomes have dictated whether to reopen, to simultaneously monitor community spread, and/or to isolate discovered cases. However, the question remains as to when it is safe to reopen and how much testing is required to remain safely open while keeping infection numbers low. Here, we propose an extension of the classic SIR model to investigate reopening strategies for a fixed testing strategy, based on feedback from testing results. Specifically, we close when a predefined proportion of the population becomes infected, and later reopen when that infected proportion decreases below a predefined threshold. A valuable outcome of our approach is that our reopening strategies are robust to variation in almost all model parameters, including transmission rates, which can be extremely difficult to determine as they typically differ between variants, location, vaccination status, etc. Thus, these strategies can be, in theory, translated over to new variants in different regions of the world. Examples of robust feedback strategies for high disease transmission and a fixed testing capacity include (1) a single long lock down followed by a single long in-person period, and (2) multiple shorter lock downs followed by multiple shorter in-person periods. The utility of this approach of having multiple strategies is that administrators of universities, schools, business, etc. can use a strategy that is best adapted for their own functionality.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Schools , Disease Outbreaks/prevention & control , Universities
12.
Libyan J Med ; 17(1): 2140473, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2097169

ABSTRACT

Distancing is one of the barrier measures in mitigating epidemics. We aimed to investigate the typology, effectiveness, and side effects of distancing rules during epidemics. Electronic searches were conducted on MEDLINE, PubMed in April 2020, using Mesh-Terms representing various forms of distancing ('social isolation', 'social distancing', 'quarantine') combining with 'epidemics'. PRISMA-ScR statement was consulted to report this review. A total of 314 titles were identified and 93 were finally included. 2009 influenza A and SARS-CoV-2 epidemics were the most studied. Distancing measures were mostly classified as case-based and community-based interventions. The combination of distancing rules, like school closure, home working, isolation and quarantine, has proven to be effective in reducing R0 and flattening the epidemic curve, also when initiated early at a high rate and combined with other non-pharmaceutical interventions. Epidemiological and modeling studies showed that Isolation and quarantine in the 2009 Influenza pandemic were effective measures to decrease attack rate also with high level of compliance but there was an increased risk of household transmission. lockdown was also effective to reduce R0 from 2.6 to 0.6 and to increase doubling time from 2 to 4 days in the covid-19 pandemic. The evidence for school closure and workplace distancing was moderate as single intervention. Psychological disorder, unhealthy behaviors, disruption of economic activities, social discrimination, and stigmatization were the main side effects of distancing measures. Earlier implementation of combined distancing measures leads to greater effectiveness in containing outbreaks. Their indication must be relevant and based on evidence to avoid adverse effects on the community. These results would help decision-makers to develop response plans based on the required experience and strengthen the capacity of countries to fight against future epidemics. Mesh words: Physical Distancing, Quarantine, Epidemics, Public Health, Scoping Review.


Subject(s)
COVID-19 , Influenza, Human , Humans , Pandemics/prevention & control , SARS-CoV-2 , Influenza, Human/epidemiology , Influenza, Human/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods
13.
Int J Environ Res Public Health ; 19(21)2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2090155

ABSTRACT

The spread of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has raised major health policy questions. Direct transmission via respiratory droplets seems to be the dominant route of its transmission. However, indirect transmission via shared contact of contaminated objects may also occur. The contribution of each transmission route to epidemic spread might change during lock-down scenarios. Here, we simulate viral spread of an abstract epidemic considering both routes of transmission by use of a stochastic, agent-based SEIR model. We show that efficient contact tracing (CT) at a high level of incidence can stabilize daily cases independently of the transmission route long before effects of herd immunity become relevant. CT efficacy depends on the fraction of cases that do not show symptoms. Combining CT with lock-down scenarios that reduce agent mobility lowers the incidence for exclusive direct transmission scenarios and can even eradicate the epidemic. However, even for small fractions of indirect transmission, such lockdowns can impede CT efficacy and increase case numbers. These counterproductive effects can be reduced by applying measures that favor distancing over reduced mobility. In summary, we show that the efficacy of lock-downs depends on the transmission route. Our results point to the particular importance of hygiene measures during mobility lock-downs.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Fomites , COVID-19/prevention & control , Communicable Disease Control/methods , Contact Tracing/methods
14.
PLoS One ; 17(10): e0276311, 2022.
Article in English | MEDLINE | ID: covidwho-2089426

ABSTRACT

During the SARS-CoV-2 outbreak, several epidemiological measures, such as cumulative case-counts (CCC), incidence rates, effective reproduction numbers (Reff) and doubling times, have been used to inform the general public and to justify interventions such as lockdown. It has been very likely that not all infectious people have been identified during the course of the epidemic, which lead to incomplete case-detection. We compare CCC, incidence rates, Reff and doubling times in the presence of incomplete case-detection. For this, an infection-age-structured SIR model is used to simulate a SARS-CoV-2 outbreak followed by a lockdown in a hypothetical population. Different scenarios about temporal variations in case-detection are applied to the four measures during outbreak and lockdown. The biases resulting from incomplete case-detection on the four measures are compared in terms of relative errors. CCC is most prone to bias by incomplete case-detection in all of our settings. Reff is the least biased measure. The possibly biased CCC may lead to erroneous conclusions in cross-country comparisons. With a view to future reporting about this or other epidemics, we recommend including and placing an emphasis on Reff in those epidemiological measures used for informing the general public and policy makers.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , COVID-19/epidemiology , Communicable Disease Control/methods , Disease Outbreaks , Bias
15.
BMC Public Health ; 22(1): 488, 2022 03 12.
Article in English | MEDLINE | ID: covidwho-2089180

ABSTRACT

INTRODUCTION: In response to the ongoing COVID-19 pandemic, countries have adopted various degrees of restrictive measures on people to reduce COVID-19 transmission. These measures have had significant social and economic costs. In the absence of therapeutics, and low vaccination coverage, strategies for a safe exit plan from a lockdown are required to mitigate the transmission and simultaneously re-open societies. Most countries have outlined or have implemented lockdown exit plans. The objective of this scoping review is to (a) identify and map the different strategies for exit from lockdowns, (b) document the effects of these exit strategies, and (c) discuss features of successful exit strategies based on the evidence. METHODS: A five-step approach was used in this scoping review: (a) identifying the research question and inclusion/exclusion criteria; (b) searching the literature using keywords within PubMed and WHO databases; (c) study selection; (d) data extraction; (e) collating results and qualitative synthesis of findings. RESULTS: Of the 406 unique studies found, 107 were kept for full-text review. Studies suggest the post-peak period as optimal timing for an exit, supplemented by other triggers such as sufficient health system capacity, and increased testing rate. A controlled and step-wise exit plan which is flexible and guided by information from surveillance systems is optimal. Studies recommend continued use of non-pharmaceutical interventions such as physical distancing, use of facemasks, and hygiene measures, in different combinations when exiting from a lockdown, even after optimal vaccination coverage has been attained. CONCLUSION: Reviewed studies have suggested adopting a multi-pronged strategy consisting of different approaches depending on the context. Among the different exit strategies reviewed (phase-wise exit, hard exit, and constant cyclic patterns of lockdown), phase-wise exit appears to be the optimal exit strategy.


Subject(s)
COVID-19 , COVID-19/prevention & control , Communicable Disease Control/methods , Humans , Hygiene , Pandemics/prevention & control , Vaccination Coverage
16.
Soc Sci Med ; 314: 115430, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2069696

ABSTRACT

BACKGROUND: The COVID-19 outbreak early 2020 was followed by an unprecedented package of measures. The relative calmness of the pandemic early 2022 provides a momentum to prepare for various scenarios. OBJECTIVES: As acceptance of COVID-19 measures is key for public support we investigated citizens' preferences towards imposing measures in four scenarios: 1) spring/summer scenario with few hospitalizations; 2) autumn/winter scenario with many hospitalizations; 3) a new contagious variant, the impact on hospitalizations is unclear; 4) a new contagious variant, hospitalizations will substantially increase. METHODS: Study 1 comprised a Participatory Value Evaluation (PVE) in which 2011 respondents advised their government on which measures to impose in the four scenarios. Respondents received information regarding the impact of each measure on the risk that the health system would be overloaded. To triangulate the results, 2958 respondents in Study 2 evaluated the acceptability of the measures in each scenario. RESULTS: Measures were ranked similarly by respondents in Study 1 and 2: 1) the majority of respondents thought that hygiene measures should be upheld, even in the spring/summer; 2) the majority supported booster vaccination, working from home, encouraging self-testing, and mandatory face masks from scenario 2 onwards; 3) even in scenario 4, lockdown measures were not supported by the majority. Young respondents were willing to accept more risks for the health system than older respondents. CONCLUSION: The results suggest that policies that focus on prevention (through advising low-impact hygiene measures) and early response to moderate threats (by scaling up to moderately restrictive measures and boostering) can count on substantial support. There is low support for lockdown measures even under high-risk conditions, which further emphasizes the importance of prevention and a timely response to new threats. Our results imply that young citizens' concerns, in particular, should be addressed when restrictive COVID-19 measures are to be implemented.


Subject(s)
COVID-19 , Communicable Disease Control , Humans , Administrative Personnel , Communicable Disease Control/methods , COVID-19/prevention & control , SARS-CoV-2
17.
J Clin Psychiatry ; 82(3)2021 04 06.
Article in English | MEDLINE | ID: covidwho-2066783

ABSTRACT

OBJECTIVE: By forcing closure of schools, curtailing outpatient services, and imposing strict social distancing, the COVID-19 pandemic has abruptly affected the daily life of millions worldwide, with still unclear consequences for mental health. This study aimed to evaluate if and how child and adolescent psychiatric visits to hospital emergency departments (EDs) changed during the pandemic lockdown, which started in Italy on February 24, 2020. METHODS: We examined all ED visits by patients under 18 years of age in the 7 weeks prior to February 24, 2020, and in the subsequent 8 weeks of COVID-19 lockdown at two urban university hospitals, in Turin and Rome, Italy. ED visits during the corresponding periods of 2019 served as a comparison using Poisson regression modeling. The clinician's decision to hospitalize or discharge home the patient after the ED visit was examined as an index of clinical severity. RESULTS: During the COVID-19 lockdown, there was a 72.0% decrease in the number of all pediatric ED visits (3,395) compared with the corresponding period in 2019 (12,128), with a 46.2% decrease in psychiatric visits (50 vs 93). The mean age of psychiatric patients was higher in the COVID-19 period (15.7 vs 14.1 years). No significant changes were found in hospitalization rate or in the prevalence distribution of the primary reason for the psychiatric ED visit (suicidality, anxiety/mood disorders, agitation). CONCLUSIONS: In the first 8 weeks of the COVID-19-induced social lockdown, the number of child and adolescent psychiatric ED visits significantly decreased, with an increase in patient age. This decrease does not appear to be explained by severity-driven self-selection and might be due to a reduction in psychiatric emergencies or to the implementation of alternative ways of managing acute psychopathology.


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19 , Emergencies/epidemiology , Emergency Services, Psychiatric , Hospitalization/statistics & numerical data , Mental Disorders , Physical Distancing , Adolescent , Age Factors , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Child , Communicable Disease Control/methods , Education, Distance , Emergency Services, Psychiatric/organization & administration , Emergency Services, Psychiatric/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Mental Disorders/therapy , Mental Health/statistics & numerical data , Organizational Innovation , SARS-CoV-2
20.
Sci Rep ; 12(1): 15660, 2022 09 19.
Article in English | MEDLINE | ID: covidwho-2036883

ABSTRACT

As the UK, together with numerous countries in the world, moves towards a new phase of the COVID-19 pandemic, there is a need to be able to predict trends in sufficient time to limit the pressure faced by the National Health Service (NHS) and maintain low hospitalisation levels. In this study, we explore the use of an epidemiological compartmental model to devise a periodic adaptive suppression/intervention policy to alleviate the pressure on the NHS. The proposed model facilitates the understanding of the progression of the specific stages of COVID-19 in communities in the UK including: the susceptible population, the infected population, the hospitalised population, the recovered population, the deceased population, and the vaccinated population. We identify the parameters of the model by relying on past data within the period from 1 October 2020 to 1 June 2021. We use the total number of hospitalised patients and the fraction of those infected who are being admitted to hospital to develop adaptive policies: these modulate the recommended level of social restriction measures and realisable vaccination target adjustments. The analysis over the period 1 October 2020 to 1 June 2021 demonstrates our periodic adaptive policies have the potential to reduce the hospitalisation by 58% on average per month. In a further prospective analysis over the period August 2021 to May 2022, we analyse several future scenarios, characterised by the relaxation of restrictions, the vaccination ineffectiveness and the gradual decay of the vaccination-induced immunity within the population. In addition, we simulate the surge of plausible variants characterised by an higher transmission rate. In such scenarios, we show that our periodic intervention is effective and able to maintain the hospitalisation rate to a manageable level.


Subject(s)
COVID-19 , Communicable Disease Control , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Epidemiological Models , Health Policy , Humans , Pandemics/prevention & control , State Medicine , United Kingdom/epidemiology
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