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Rev Bras Ginecol Obstet ; 43(10): 765-774, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1517657


OBJECTIVE: To investigate depression and sexual function among pregnant and non-pregnant women throughout the COVID-19 pandemic. METHODS: A total of 188 women, 96 pregnant and 92 non-pregnant were included. The Beck Depression Inventory (BDI) and the Arizona Sexual Experience Scale (ASEX) were applied to the participants after obtaining sociodemographic data. RESULTS: The depression scores of pregnant and non-pregnant women were similar (p = 0.846). We found that the depression scores were significantly higher among the group of participants who have lower economic status (p = 0.046). Moreover, the depression score was significantly higher among women who lost their income during the pandemic (p = 0.027). The score on the ASEX was significantly higher, and sexual dysfunction was more prevalent among women who have lower levels of schooling and income (p < 0.05). Likewise, the ASEX scores were significantly higher (p = 0.019) among the group who experienced greater income loss throughout the pandemic. Upon comparing the pregnant and non-pregnant groups, we detected that sexual dysfunction had a significantly higher rate among pregnant women (p < 0.001). CONCLUSION: In times of global crisis, such as the current pandemic, low-income families have an increased risk of experiencing depression and sexual dysfunction. When we compared pregnant women with non-pregnant women, depression scores were similar, but pregnant women were at a 6.2 times higher risk of developing sexual dysfunction.

Investigar a depressão e as funções sexuais de mulheres grávidas e não grávidas durante a pandemia de Covid-19. MéTODOS: Um total de 188 mulheres, 96 grávidas e 92 não grávidas, foram incluídas. O Inventário de Depressão de Beck (Beck Depression Inventory, BDI, em inglês) e a Escala de Experiências Sexuais do Arizona (Arizona Sexual Experience Scale, ASEX, em inglês) foram aplicados aos participantes após a obtenção dos dados sociodemográficos.As pontuações de depressão de mulheres grávidas e não grávidas foram semelhantes (p = 0,846). Verificou-se que as pontuações de depressão foram significativamente maiores no grupo de participantes de menor nível econômico (p = 0,046). Além disso, a pontuação de depressão foi significativamente maior em mulheres que perderam sua renda durante a pandemia (p = 0,027). A pontuação na ASEX foi significativamente maior, e a disfunção sexual foi mais prevalente em pessoas com menores escolaridade e nível de renda (p < 0,05). Da mesma forma, as pontuações na ASEX foram significativamente mais altas (p = 0,019) no grupo que experimentou maior perda de renda durante a pandemia. Ao comparar os grupos de gestantes e não gestantes, detectou-se que a disfunção sexual apresentava índice significativamente maior entre as gestantes (p <0,001). CONCLUSãO: Em tempos de crise global, como a atual pandemia, famílias de baixa renda têm um risco maior de sofrer depressão e disfunção sexual. Quando comparamos mulheres grávidas e mulheres não grávidas, as pontuações de depressão foram semelhantes, mas as mulheres grávidas apresentaram um risco 6,2 vezes maior de desenvolver disfunção sexual.

COVID-19/epidemiology , COVID-19/psychology , Depression/epidemiology , Pandemics , Pregnant Women/psychology , Sexual Dysfunctions, Psychological/epidemiology , Adolescent , Adult , Cross-Sectional Studies , Economic Factors , Female , Humans , Middle Aged , Pregnancy , SARS-CoV-2 , Sexual Behavior , Turkey/epidemiology , Unemployment/psychology , Young Adult
Trans R Soc Trop Med Hyg ; 115(11): 1282-1287, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1434512


BACKGROUND: Understanding differences in hospital case fatality rates (HCFRs) of coronavirus disease 2019 (COVID-19) may help evaluate its severity and the capacity of the healthcare system to reduce mortality. METHODS: We examined the variability in HCFRs of COVID-19 in relation to spatial inequalities in socio-economic factors, hospital health sector and patient medical condition across the city of São Paulo, Brazil. We obtained the standardized hospital case fatality ratio adjusted indirectly by age and sex, which is the ratio between the HCFR of a specific spatial unit and the HCFR for the entire study area. We modelled it using a generalized linear mixed model with spatial random effects in a Bayesian context. RESULTS: We found that HCFRs were higher for men and for individuals ≥60 y of age. Our models identified per capita income as a significant factor that is negatively associated with the HCFRs of COVID-19, even after adjusting for age, sex and presence of risk factors. CONCLUSIONS: Spatial analyses of the implementation of these methods and of disparities in COVID-19 outcomes may help in the development of policies for at-risk populations in geographically defined areas.

COVID-19 , Economic Factors , Bayes Theorem , Brazil/epidemiology , Hospitals , Humans , Male , SARS-CoV-2
Rev. gaúch. enferm ; 42(spe): e20200332, 2021.
Article in English | LILACS (Americas) | ID: covidwho-1410823


ABSTRACT Aim: To analyze the repercussions of Nursing, the structuring and resolution of National Health Systems in facing the new coronavirus (SARS-CoV-2) in selected countries. Method: Reflection article on the confrontation of COVID-19 by the National Health Systems of China, United States of America, Italy, United Kingdom, Portugal, Cuba and Brazil, from information disseminated in different media and in the literature. Results: The response of health systems depended more on political decisions than on their structuring and organization. Nursing, being the front line, was the profession most affected in number of cases and deaths. Final Considerations: The reflection shows that the countries' economic and political issues interfered in the response to COVID-19 and what the role played by Nursing is essential in the front line to face the pandemic.

RESUMEN Objectivo: Analizar las repercusiones para la Enfermería, la estructuración y resolución de Sistemas Nacionales de Salud ante el nuevo coronavirus (SARS-CoV-2) en países seleccionados. Método: Artículo de reflexión sobre el enfrentamiento del COVID-19 por parte de los Sistemas Nacionales de Salud de China, Estados Unidos de América, Italia, Reino Unido, Portugal, Cuba y Brasil, a partir de información difundida en diferentes medios y en la literatura. Resultados: La respuesta de los sistemas de salud dependió más de decisiones políticas que de su estruturación y organización. La enfermería, al ser la primera línea, fue la profesión más afectada en número de casos y muertes. Consideraciones Finales: La reflexión muestra que los problemas económicos y políticos de los países interfirieron en la respuesta a COVID-19 y cuál es el papel que juega la Enfermería en primera línea para enfrentar la pandemia.

RESUMO Objetivo: Analisar as repercussões para a Enfermagem, a estruturação e a resolutividade de Sistemas Nacionais de Saúde no enfrentamento do novo coronavírus (SARS-CoV-2) em países selecionados. Método: Artigo de reflexão sobre o enfrentamento da COVID-19 pelos Sistemas Nacionais de Saúde da China, Estados Unidos da América, Itália, Reino Unido, Portugal, Cuba e Brasil, a partir de informações divulgadas em diferentes meios e na literatura. Resultados: A resposta dos sistemas de saúde dependeu mais de decisões políticas do que da estruturação e organização dos mesmos. A Enfermagem, por ser linha de frente, foi a profissão mais atingida em número de casos e óbitos. Considerações Finais: A reflexão demonstra que questões econômicas e políticas dos países interferiram na resposta à COVID-19 e o que o papel exercido pela Enfermagem é essencial na linha de frente ao enfrentamento da pandemia.

Humans , Coronavirus Infections , National Health Systems/organization & administration , Pandemics , COVID-19 , Politics , Adaptation, Psychological , Nursing/organization & administration , Economic Factors
J Health Care Poor Underserved ; 32(3): 1265-1275, 2021.
Article in English | MEDLINE | ID: covidwho-1369551


Centers for Independent Living (CILs) are federally funded, community-based organizations designed and operated by people with disabilities that provide individual and systems advocacy, peer support, information and referral, independent living skills training, and transition services throughout the U.S. and its territories. Centers for Independent Living therefore offer a rich and detailed perspective on the needs of people with disabilities during the COVID-19 pandemic. In this brief report, we summarize COVID-19-related issues raised by 144 CIL administrators and staff in a national survey conducted in April and May 2020 and discuss their research and policy implications. Respondents voiced concerns about health and safety, long-term supportive services, social isolation, and economic insecurity. In the words of one center director, "The pandemic has pulled back the curtain on the depth of need in our local disability community."

Disabled Persons , Needs Assessment , COVID-19/epidemiology , COVID-19/prevention & control , Disabled Persons/legislation & jurisprudence , Economic Factors , Food Security , Humans , Independent Living , Nursing Homes , Pandemics , Social Isolation , Surveys and Questionnaires , United States
Glob Heart ; 16(1): 18, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1175699


The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.

COVID-19/physiopathology , Cardiovascular Diseases/physiopathology , Acute Coronary Syndrome/economics , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/physiopathology , Africa , Antimalarials/adverse effects , Arrhythmias, Cardiac/economics , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , COVID-19/complications , COVID-19/economics , Cardiovascular Diseases/economics , Cardiovascular Diseases/etiology , Chloroquine/adverse effects , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Delivery of Health Care/economics , Economic Factors , Economic Recession , Gross Domestic Product , Health Resources/economics , Health Resources/supply & distribution , Heart Failure/economics , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Hydroxychloroquine/adverse effects , Inflammation , Myocardial Ischemia/economics , Myocardial Ischemia/etiology , Myocardial Ischemia/physiopathology , Myocarditis/economics , Myocarditis/etiology , Myocarditis/physiopathology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/physiopathology , Socioeconomic Factors , Takotsubo Cardiomyopathy/economics , Takotsubo Cardiomyopathy/etiology , Takotsubo Cardiomyopathy/physiopathology
Sci Total Environ ; 778: 146394, 2021 Jul 15.
Article in English | MEDLINE | ID: covidwho-1129188


The rate of spread of the global pandemic calls for much attention from the empirical literature. The limitation of extant literature in assessing a comprehensive COVID-19 portfolio that accounts for complexities in the spread and containment of the virus underscores this study. We investigate the effect of city-to-city air pollutant species, meteorological conditions, underlying health conditions, socio-economic and demographic factors on COVID-19 health outcomes. We utilize a panel estimation of 615 cities in 6 continents from January 1 to June 11, 2020. While social distancing measures, movement restrictions and lockdown are reported to have improved environmental quality, we show that ambient PM2.5 remains unhealthy and above the acceptable threshold in several countries. Our empirical assessment shows that while ambient PM2.5, nitrogen dioxide, ozone, pressure, dew, Windgust, and windspeed increase the spread of COVID-19, high relative humidity and ambient temperature have mitigation effect on COVID-19, hence, decreases the number of confirmed cases. We report 66.3% of countries projected to experience a second wave of COVID-19 if government stringency and safety protocols are not enhanced. By extension, our assessments demonstrate that several factors namely underlying health conditions, meteorological, air pollution, health system quality, socio-economic and demographics spur the reproduction effect of COVID-19 across countries. Our study highlights the importance of government stringency in containing the spread of COVID-19 and its impacts.

Air Pollutants , Air Pollution , COVID-19 , Air Pollutants/analysis , Air Pollution/analysis , Cities , Communicable Disease Control , Economic Factors , Humans , Pandemics , Particulate Matter/analysis , SARS-CoV-2
PLoS Negl Trop Dis ; 15(3): e0009259, 2021 03.
Article in English | MEDLINE | ID: covidwho-1127761


Dengue, Zika and chikungunya are diseases of global health significance caused by arboviruses and transmitted by the mosquito Aedes aegypti, which is of worldwide circulation. The arrival of the Zika and chikungunya viruses to South America increased the complexity of transmission and morbidity caused by these viruses co-circulating in the same vector mosquito species. Here we present an integrated analysis of the reported arbovirus cases between 2007 and 2017 and local climate and socio-economic profiles of three distinct Colombian municipalities (Bello, Cúcuta and Moniquirá). These locations were confirmed as three different ecosystems given their contrasted geographic, climatic and socio-economic profiles. Correlational analyses were conducted with both generalised linear models and generalised additive models for the geographical data. Average temperature, minimum temperature and wind speed were strongly correlated with disease incidence. The transmission of Zika during the 2016 epidemic appeared to decrease circulation of dengue in Cúcuta, an area of sustained high incidence of dengue. Socio-economic factors such as barriers to health and childhood services, inadequate sanitation and poor water supply suggested an unfavourable impact on the transmission of dengue, Zika and chikungunya in all three ecosystems. Socio-demographic influencers were also discussed including the influx of people to Cúcuta, fleeing political and economic instability from neighbouring Venezuela. Aedes aegypti is expanding its range and increasing the global threat of these diseases. It is therefore vital that we learn from the epidemiology of these arboviruses and translate it into an actionable local knowledge base. This is even more acute given the recent historical high of dengue cases in the Americas in 2019, preceding the COVID-19 pandemic, which is itself hampering mosquito control efforts.

Chikungunya Fever/epidemiology , Dengue/epidemiology , Zika Virus Infection/epidemiology , Aedes/physiology , Aedes/virology , Animals , Chikungunya Fever/economics , Chikungunya Fever/virology , Chikungunya virus/physiology , Climate , Colombia/epidemiology , Dengue/economics , Dengue/virology , Dengue Virus/physiology , Economic Factors , Ecosystem , Humans , Mosquito Vectors/physiology , Mosquito Vectors/virology , South America , Temperature , Zika Virus/physiology , Zika Virus Infection/economics , Zika Virus Infection/virology
Environ Health ; 20(1): 17, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1090660


A report published in this journal showed an inversely significant association between ultraviolet radiation (UVR) before the pandemic and cumulative COVID-19 cases in Spain. The analyses employed several meteorological factors, but socio-economic factors were not included. We examined the associations of COVID-19 cases with selected factors and found a significance on gross domestic product per capita (p = 0.037 by Spearman's correlation). Hence, simple regression analyses of UVR would be confounded with regional difference in economic activities. In addition, we raised several questions for limitations due to the study design and analyses.

COVID-19 , Economic Factors , Humans , Incidence , SARS-CoV-2 , Spain , Ultraviolet Rays
Environ Health ; 20(1): 18, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1090659


Phosri et al., commented on our previous study about the influence of climate variables at the beginning of the SARS-CoV-2 pandemic in Spain. They showed the impact of the association of gross domestic product (GDP) with the cumulative COVID-19 incidence per 105 inhabitants in our country and the rise of several methodologic issues. Here we discussed the main advantages and disadvantages of ecological studies and we advocate to test the hypothesis created in this type of studies using individual-level research designs.

COVID-19 , Economic Factors , Humans , Incidence , SARS-CoV-2 , Spain
J Epidemiol Glob Health ; 11(1): 117-123, 2021 03.
Article in English | MEDLINE | ID: covidwho-1090441


OBJECTIVE: The Coronavirus Disease 2019 (COVID-19) pandemic is a public health emergency of international concern and poses a challenge to people's psychological resilience. Students are reported to have greater psychological impacts from COVID-19. This study aimed to survey international students to better understand their traumatic effects and psychological reactions from COVID-19, to develop evidence-driven strategies to reduce adverse psychological impact during the pandemic. METHOD: We conducted an online survey that collected information on the demographics, economic conditions, academic conditions, and health statuses of native Chinese students attending university in the U.S. Psychological impact was assessed by the Post-traumatic Stress Disorder (PTSD) Checklist Civilian Version (PCL-C) and mental health status was assessed by the Depression, Anxiety, and Stress Scale. RESULTS: This study included 261 Chinese international students. In total, 37.5% of respondents' PTSD PCL-C scores measured as moderate or severe. International students who were currently in China facing job-hunting or planning to continue studying abroad, severe economic pressure, and poor self-rated health status were significantly associated with greater PTSD PCL-C scores and higher levels of stress, anxiety, and depression. CONCLUSION: During the COVID-19 pandemic, more than one-third of the respondents rated their PTSD PCL-C score as moderate-to-severe and nearly half of them reported moderate-to-severe anxiety. Our findings identify factors such as future academic plan, economic pressure, and health status are associated with higher levels of psychological impact and worse mental health status. These should receive attention and psychological interventions should be implemented to improve the mental health of international students during the COVID-19 pandemic.

Anxiety , COVID-19 , Depression , Stress Disorders, Post-Traumatic , Stress, Psychological , Students , Adult , Anxiety/diagnosis , Anxiety/etiology , /statistics & numerical data , COVID-19/economics , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Depression/diagnosis , Depression/etiology , Economic Factors , Female , Humans , International Cooperation , Male , Mental Health/statistics & numerical data , Resilience, Psychological , SARS-CoV-2 , Self-Assessment , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Students/psychology , Students/statistics & numerical data , United States/epidemiology
S Afr Med J ; 111(1): 17-19, 2020 12 14.
Article in English | MEDLINE | ID: covidwho-1067957


Illuminating paraffin (kerosene) is the primary cooking fuel for approximately two million South Africans. The highly flammable and toxic fuel is burnt in poorly made stoves that are prone to malfunction and are associated with accidental fires, burns and household air pollution. However, the fuel continues to be used as it is easily decanted, widely available in neighbourhood outlets, perceived as affordable, and often the only available option for low-income urban settlements. It is anticipated that increased and enforced home congestion during COVID-19 lockdowns will exacerbate exposure of homebound families to unsafe energy, especially during the cold winter months. Based on an accumulation of evidence on the health and socioeconomic impacts of paraffin, this article advocates for its expedited phase-out and substitution with safer energy.

Air Pollution/statistics & numerical data , Burns/epidemiology , Fires/statistics & numerical data , Kerosene/adverse effects , Public Policy , Accidents, Home/economics , Accidents, Home/statistics & numerical data , Air Pollution/economics , Burns/economics , Burns/etiology , COVID-19/prevention & control , Communicable Disease Control , Cooking , Economic Factors , Electric Power Supplies , Fires/economics , Fuel Oils , Household Articles , Humans , Kerosene/poisoning , Paraffin , Poisoning , Poverty , SARS-CoV-2 , South Africa/epidemiology , Urban Population
PLoS One ; 16(2): e0244936, 2021.
Article in English | MEDLINE | ID: covidwho-1060091


OBJECTIVE: The experiences of frontline healthcare professionals are essential in identifying strategies to mitigate the disruption to healthcare services caused by the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of TB and HIV professionals in low and middle-income countries (LMIC). Between May 12 and August 6, 2020, we collected qualitative and quantitative data using an online survey in 11 languages. We used descriptive statistics and thematic analysis to analyse responses. FINDINGS: 669 respondents from 64 countries completed the survey. Over 40% stated that it was either impossible or much harder for TB and HIV patients to reach healthcare facilities since COVID-19. The most common barriers reported to affect patients were: fear of getting infected with SARS-CoV-2, transport disruptions and movement restrictions. 37% and 28% of responses about TB and HIV stated that healthcare provider access to facilities was also severely impacted. Strategies to address reduced transport needs and costs-including proactive coordination between the health and transport sector and cards that facilitate lower cost or easier travel-were presented in qualitative responses. Access to non-medical support for patients, such as food supplementation or counselling, was severely disrupted according to 36% and 31% of HIV and TB respondents respectively; qualitative data suggested that the need for such services was exacerbated. CONCLUSION: Patients and healthcare providers across numerous LMIC faced substantial challenges in accessing healthcare facilities, and non-medical support for patients was particularly impacted. Synthesising recommendations of frontline professionals should be prioritised for informing policymakers and healthcare service delivery organisations.

COVID-19/prevention & control , Communicable Disease Control , HIV Infections/therapy , Health Personnel , Health Services Accessibility , Tuberculosis/therapy , COVID-19/epidemiology , Cross-Sectional Studies , Economic Factors , Humans , Poverty , Surveys and Questionnaires
Diabetes Metab Syndr ; 14(6): 1809-1814, 2020.
Article in English | MEDLINE | ID: covidwho-1059534


BACKGROUND AND AIMS: The underestimation of the severity of COVID-19 by the South African government resulted in delayed action against the pandemic. Ever since WHO declared COVID-19 a pandemic preventive action was comprehensively upgraded worldwide. This prompted South African authorities to implement physical distancing, self-isolation, closure of non-essential services, schools, travelling restrictions and recursive national lockdowns to mitigate the impact of COVID-19. This explanatory study sought to review the effects of COVID-19 in the South African health system and society. METHODS: The study applied literature research of COVID-19 reports, policies from the National Department of Health, WHO, Africa CDC, and articles from Google Scholar, Science Direct, Web of Science, Scopus and PubMed. RESULTS: The South African health system is affected by the lack of PPEs, increased mortality rates, mental health problems, substance abuse, resurgent of NCDs. The closure of international borders, global demand meltdown, supply disruptions, dramatic scaling down of human and industrial activities during lockdown cause socio-economic problems. The prolonged effects of lockdown on psychosocial support services resulted in the outbursts of uncertainties, acute panic, fear, depression, obsessive behaviours, social unrests, stigmatization, anxiety, increased gender-based violence cases and discrimination in the distribution of relief food aid. CONCLUSION: To slow down the spread of COVID-19, massive testing must be adopted, contact tracing, isolation, and home quarantine guidelines for asymptomatic cases which promote behavioural change and reviewing of policy on food relief.

COVID-19/epidemiology , Mental Disorders/epidemiology , Personal Protective Equipment/supply & distribution , Poverty , Public Policy , Unemployment , COVID-19/mortality , Contact Tracing , Delivery of Health Care , Economic Factors , Food Assistance/statistics & numerical data , Gender-Based Violence/statistics & numerical data , Health Policy , Humans , Life Style , Physical Distancing , Psychosocial Support Systems , SARS-CoV-2 , Sedentary Behavior , Socioeconomic Factors , South Africa/epidemiology , Substance-Related Disorders/epidemiology
Front Public Health ; 8: 611325, 2020.
Article in English | MEDLINE | ID: covidwho-1000224


This paper introduces a health index for measuring the health level of societies during the lockdown era, i. e., for the period from March 21, 2020 to April 7, 2020. For this purpose, individual-level survey data from the Global Behaviors and Perceptions in the COVID-19 Pandemic dataset are considered. We focus on cases in the United States and the United Kingdom, and the data come from 11,270 and 11,459 respondents, respectively. We then use unit root tests with structural breaks to examine whether COVID-19-related economic shocks significantly affect the health levels of the United States and the United Kingdom. The empirical results indicate that the health levels in the United States and the United Kingdom are not significantly affected by the COVID-19-related economic shocks. The evidence shows that government directives (such as lockdowns) did not significantly change the health levels of these societies.

COVID-19/economics , Economic Factors , Health Status , Physical Distancing , Datasets as Topic/statistics & numerical data , Humans , SARS-CoV-2 , United Kingdom , United States
PLoS One ; 15(12): e0244535, 2020.
Article in English | MEDLINE | ID: covidwho-999846


BACKGROUND: COVID-19 rapidly escalated into a pandemic, threatening 213 countries, areas, and territories the world over. We aimed to identify potential province-level socioeconomic determinants of the virus's dissemination, and explain between-province differences in the speed of its spread, based on data from 36 provinces of Northern Italy. METHODS: This is an ecological study. We included all confirmed cases of SARS-CoV-2 reported between February 24th and March 30th, 2020. For each province, we calculated the trend of contagion as the relative increase in the number of individuals infected between two time endpoints, assuming an exponential growth. Pearson's test was used to correlate the trend of contagion with a set of healthcare-associated, economic, and demographic parameters by province. The virus's spread was input as a dependent variable in a stepwise OLS regression model to test the association between rate of spread and province-level indicators. RESULTS: Multivariate analysis showed that the spread of COVID-19 was correlated negatively with aging index (p-value = 0.003), and positively with public transportation per capita (p-value = 0.012), the % of private long-term care hospital beds and, to a lesser extent (p-value = 0.070), the % of private acute care hospital beds (p-value = 0.006). CONCLUSION: Demographic and socioeconomic factors, and healthcare organization variables were found associated with a significant difference in the rate of COVID-19 spread in 36 provinces of Northern Italy. An aging population seemed to naturally contain social contacts. The availability of healthcare resources and their coordination could play an important part in spreading infection.

COVID-19/epidemiology , Adolescent , Aged , Child , Child, Preschool , Delivery of Health Care , Demography/methods , Economic Factors , Female , Health Facilities , Health Resources , Humans , Infant , Infant, Newborn , Italy/epidemiology , Male , Pandemics/prevention & control , SARS-CoV-2/pathogenicity , Socioeconomic Factors