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1.
BMC Infect Dis ; 21(1): 1119, 2021 Oct 30.
Article in English | MEDLINE | ID: covidwho-1561534

ABSTRACT

BACKGROUND: Diagnostic testing using PCR is a fundamental component of COVID-19 pandemic control. Criteria for determining who should be tested by PCR vary between countries, and ultimately depend on resource constraints and public health objectives. Decisions are often based on sets of symptoms in individuals presenting to health services, as well as demographic variables, such as age, and travel history. The objective of this study was to determine the sensitivity and specificity of sets of symptoms used for triaging individuals for confirmatory testing, with the aim of optimising public health decision making under different scenarios. METHODS: Data from the first wave of COVID-19 in New Zealand were analysed; comprising 1153 PCR-confirmed and 4750 symptomatic PCR negative individuals. Data were analysed using Multiple Correspondence Analysis (MCA), automated search algorithms, Bayesian Latent Class Analysis, Decision Tree Analysis and Random Forest (RF) machine learning. RESULTS: Clinical criteria used to guide who should be tested by PCR were based on a set of mostly respiratory symptoms: a new or worsening cough, sore throat, shortness of breath, coryza, anosmia, with or without fever. This set has relatively high sensitivity (> 90%) but low specificity (< 10%), using PCR as a quasi-gold standard. In contrast, a group of mostly non-respiratory symptoms, including weakness, muscle pain, joint pain, headache, anosmia and ageusia, explained more variance in the MCA and were associated with higher specificity, at the cost of reduced sensitivity. Using RF models, the incorporation of 15 common symptoms, age, sex and prioritised ethnicity provided algorithms that were both sensitive and specific (> 85% for both) for predicting PCR outcomes. CONCLUSIONS:  If predominantly respiratory symptoms are used for test-triaging,  a large proportion of the individuals being tested may not have COVID-19. This could overwhelm testing capacity and hinder attempts to trace and eliminate infection. Specificity can be increased using alternative rules based on sets of symptoms informed by multivariate analysis and automated search algorithms, albeit at the cost of sensitivity. Both sensitivity and specificity can be improved through machine learning algorithms, incorporating symptom and demographic data, and hence may provide an alternative approach to test-triaging that can be optimised according to prevailing conditions.


Subject(s)
COVID-19 , Pandemics , Bayes Theorem , Humans , Multivariate Analysis , New Zealand/epidemiology , SARS-CoV-2
2.
Int J Environ Res Public Health ; 18(24)2021 12 08.
Article in English | MEDLINE | ID: covidwho-1554807

ABSTRACT

Recent research investigating changes in gambling behaviors during periods of COVID-19 social restrictions, such as enforced lockdowns, are somewhat limited by methodology, being generally cross-sectional in nature and with participant samples recruited via online panels. The present study overcame these limitations via a secondary analysis of data collected in 2012 and 2015 from a New Zealand (NZ) longitudinal gambling study, with questions related to gambling behaviors due to COVID-19 lockdown periods included in an additional data collection, of participants who had previously scored as a risky gambler, during 2020/21. Almost one-quarter of online gamblers increased their gambling during lockdown with this most likely to be on overseas gambling sites, instant scratch card gambling and Lotto. The only sociodemographic risk factor for increased online gambling was higher education. Behavioral risk factors included being a current low risk/moderate risk/problem gambler, a previously hazardous alcohol drinker or past participation in free-to-play gambling-type games. These past behaviors could act as trigger points for health services or family and friends to monitor a person's gambling behaviors during lockdown, or future stressful periods when usual terrestrial gambling opportunities are curtailed or unavailable, and to support safer gambling practices.


Subject(s)
COVID-19 , Gambling , Communicable Disease Control , Cross-Sectional Studies , Gambling/epidemiology , Humans , Longitudinal Studies , New Zealand/epidemiology , Risk Factors , SARS-CoV-2
4.
Stud Health Technol Inform ; 285: 67-75, 2021 Oct 27.
Article in English | MEDLINE | ID: covidwho-1502263

ABSTRACT

The Coronavirus pandemic has surprised the world and social media was extremely used to express frustrations and development of the cases found. Social media tools, such as Twitter, show a comparable impact with the number of tweets related to COVID-19 indicating remarkable development in a limited ability to focus time. The purpose of this paper is to investigate the impact of Coronavirus on the United States of America (USA) and New Zealand (NZ), and how that is reflected in a sentiment analysis through the examination of American and New Zealand tweets. We have gathered tweets from a March 2020 - August 2020 and used sentiment extraction on the tweets. The major finding of this sentiment extraction is the fact that the overall average sentiment over the 5-month period stayed in a negative range in the USA and NZ. This paper aims to analyze these trends, identify patterns, and determine whether these trends were caused by the COVID-19 pandemic or outside sources. One trend that was analyzed was the spike of COVID-19 results in relation to the number of protests occurring in the USA.


Subject(s)
COVID-19 , Social Media , COVID-19/prevention & control , Humans , New Zealand/epidemiology , Pandemics/prevention & control , Public Opinion , United States/epidemiology
6.
J Infect Dis ; 221(2): 183-190, 2020 01 02.
Article in English | MEDLINE | ID: covidwho-1452713

ABSTRACT

BACKGROUND: Severe influenza illness is presumed more common in adults with chronic medical conditions (CMCs), but evidence is sparse and often combined into broad CMC categories. METHODS: Residents (aged 18-80 years) of Central and South Auckland hospitalized for World Health Organization-defined severe acute respiratory illness (SARI) (2012-2015) underwent influenza virus polymerase chain reaction testing. The CMC statuses for Auckland residents were modeled using hospitalization International Classification of Diseases, Tenth Revision codes, pharmaceutical claims, and laboratory results. Population-level influenza rates in adults with congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus (DM), and end-stage renal disease (ESRD) were calculated by Poisson regression stratified by age and adjusted for ethnicity. RESULTS: Among 891 276 adults, 2435 influenza-associated SARI hospitalizations occurred. Rates were significantly higher in those with CMCs compared with those without the respective CMC, except for older adults with DM or those aged <65 years with CVA. The largest effects occurred with CHF (incidence rate ratio [IRR] range, 4.84-13.4 across age strata), ESRD (IRR range, 3.30-9.02), CAD (IRR range, 2.77-10.7), and COPD (IRR range, 5.89-8.78) and tapered with age. CONCLUSIONS: Our findings support the increased risk of severe, laboratory-confirmed influenza disease among adults with specific CMCs compared with those without these conditions.


Subject(s)
Chronic Disease/epidemiology , Influenza, Human/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Case-Control Studies , Cross-Sectional Studies , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Influenza, Human/virology , Male , Middle Aged , New Zealand/epidemiology , Prospective Studies , Risk Assessment , Young Adult
7.
Crit Care Med ; 49(10): 1749-1756, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1475873

ABSTRACT

OBJECTIVES: Nonpharmaceutical interventions are implemented internationally to mitigate the spread of severe acute respiratory syndrome coronavirus 2 with the aim to reduce coronavirus disease 2019-related deaths and to protect the health system, particularly intensive care facilities from being overwhelmed. The aim of this study is to describe the impact of nonpharmaceutical interventions on ICU admissions of non-coronavirus disease 2019-related patients. DESIGN: Retrospective cohort study. SETTING: Analysis of all reported adult patient admissions to New Zealand ICUs during Level 3 and Level 4 lockdown restrictions from March 23, to May 13, 2020, in comparison with equivalent periods from 5 previous years (2015-2019). SUBJECTS: Twelve-thousand one-hundred ninety-two ICU admissions during the time periods of interest were identified. MEASUREMENTS: Patient data were obtained from the Australian and New Zealand Intensive Care Society Adult Patient Database, Australian and New Zealand Intensive Care Society critical care resources registry, and Statistics New Zealand. Study variables included patient baseline characteristics and ICU resource use. MAIN RESULTS: Nonpharmaceutical interventions in New Zealand were associated with a 39.1% decrease in ICU admission rates (p < 0.0001). Both elective (-44.2%) and acute (-36.5%) ICU admissions were significantly reduced when compared with the average of the previous 5 years (both p < 0.0001). ICU occupancy decreased from a mean of 64.3% (2015-2019) to 39.8% in 2020. Case mix, ICU resource use per patient, and ICU and hospital mortality remained unchanged. CONCLUSIONS: The institution of nonpharmaceutical interventions was associated with a significant decrease in elective and acute ICU admissions and ICU resource use. These findings may help hospitals and health authorities planning for surge capacities and elective surgery management in future pandemics.


Subject(s)
COVID-19/diagnosis , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Quarantine/statistics & numerical data , Adult , Aged , COVID-19/epidemiology , Cohort Studies , Female , Humans , Intensive Care Units/organization & administration , Male , Middle Aged , New Zealand/epidemiology , Retrospective Studies
10.
Med Law Rev ; 29(3): 468-496, 2021 Oct 08.
Article in English | MEDLINE | ID: covidwho-1437837

ABSTRACT

Beginning from the first reports of COVID-19 out of China, this article provides a commentary on the actions taken by the Government of New Zealand in terms of nine themes-a national response with an elimination goal, speed, and comprehensiveness of the initial response; an evidence-based, science-led approach, prioritised on protecting lives; effective communication; leadership style which appealed to collective responsibility and attempted to de-politicise the Government's response to the virus; flexibility of response characterised by 'learning as you go'; oversight of coercive state powers, including a pragmatic response which attempted to defuse conflict and reserved use of 'hard power' to a last resort; deployment of public health interventions, and health system adaptations; the impact on Maori and marginalised communities; and economic protection and stimulus-to identify factors that might help explain why New Zealand's pandemic response was successful and those which could have been managed better. The partially successful legal challenge brought to the four-and-a half week lockdown, the most stringent in the world, in Borrowdale v Director-General of Health, is also considered.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/legislation & jurisprudence , Communicable Disease Control/organization & administration , Government , Health Policy , Public Health/legislation & jurisprudence , Communication , Humans , Leadership , New Zealand/epidemiology , Politics , SARS-CoV-2
13.
Med J Aust ; 215(7): 320-324, 2021 10 04.
Article in English | MEDLINE | ID: covidwho-1389701

ABSTRACT

OBJECTIVES: To identify COVID-19 quarantine system failures in Australia and New Zealand. DESIGN, SETTING, PARTICIPANTS: Observational epidemiological study of travellers in managed quarantine in Australia and New Zealand, to 15 June 2021. MAIN OUTCOME MEASURES: Number of quarantine system failures, and failure with respect to numbers of travellers and SARS-CoV-2-positive travellers. RESULTS: We identified 22 quarantine system failures in Australia and ten in New Zealand to 15 June 2021. One failure initiated a COVID-19 outbreak that caused more than 800 deaths (the Victorian "second wave"); nine lockdowns were linked with quarantine system failures. The failure risk was estimated to be 5.0 failures per 100 000 travellers passing through quarantine and 6.1 (95% CI, 4.0-8.3) failures per 1000 SARS-CoV-2-positive travellers. The risk per 1000 SARS-CoV-2-positive travellers was higher in New Zealand than Australia (relative risk, 2.0; 95% CI, 1.0-4.2). CONCLUSIONS: Quarantine system failures can be costly in terms of lives and economic impact, including lockdowns. Our findings indicate that infection control in quarantine systems in Australia and New Zealand should be improved, including vaccination of quarantine workers and incoming travellers, or that alternatives to hotel-based quarantine should be developed.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Quarantine/organization & administration , Travel , Australia/epidemiology , COVID-19/diagnosis , Humans , New Zealand/epidemiology
14.
ANZ J Surg ; 91(11): 2389-2396, 2021 11.
Article in English | MEDLINE | ID: covidwho-1388174

ABSTRACT

BACKGROUND: Early government-mandated restrictions in Australia and New Zealand contributed to a successful public health outcome during the COVID-19 pandemic, including an unprecedented temporary cancellation of all non-urgent elective surgical procedures. This study describes the change in vascular surgery services across Australia and New Zealand before and during the COVID-19 restrictions. METHODS: De-identified data from the Australia and New Zealand Society for Vascular Surgery Australasian Vascular Audit from January 2015 to September 2020 was obtained. Vascular surgery procedure numbers from January to September of 2020 (study period) was compared to the corresponding months between 2015 and 2019 (pre-study period). The volume of procedures, both elective and emergency, were compared. Subgroup analyses included procedures categorized by operation type and location. RESULTS: There was a 11% decrease in total vascular procedures, 22% decrease in elective procedures, and a 14% increase in emergency procedures, comparing the study and pre-study periods. There was a large increase in all revascularization procedures for critical limb ischemia and no change in acute limb ischemia interventions, without a concomitant rise in major or minor all-cause amputation. There was a decrease in interventions for abdominal aortic aneurysm and carotid artery disease, driven by a fall in elective procedures, while volume for dialysis access remained the same. Change in procedural volume varied by state with the largest decrease noted in NSW and Victoria. CONCLUSIONS: The COVID-19 pandemic reduced vascular surgery procedures across Australia and New Zealand with a decrease in elective operations and an increase in emergency operations.


Subject(s)
COVID-19 , Pandemics , Elective Surgical Procedures , Humans , New Zealand/epidemiology , SARS-CoV-2 , Vascular Surgical Procedures , Victoria
16.
Emerg Infect Dis ; 27(9): 2361-2368, 2021 09.
Article in English | MEDLINE | ID: covidwho-1369634

ABSTRACT

Since severe acute respiratory syndrome coronavirus 2 was first eliminated in New Zealand in May 2020, a total of 13 known coronavirus disease (COVID-19) community outbreaks have occurred, 2 of which led health officials to issue stay-at-home orders. These outbreaks originated at the border via isolating returnees, airline workers, and cargo vessels. Because a public health system was informed by real-time viral genomic sequencing and complete genomes typically were available within 12 hours of community-based positive COVID-19 test results, every outbreak was well-contained. A total of 225 community cases resulted in 3 deaths. Real-time genomics were essential for establishing links between cases when epidemiologic data could not do so and for identifying when concurrent outbreaks had different origins.


Subject(s)
COVID-19 , Viruses , Genomics , Humans , New Zealand/epidemiology , SARS-CoV-2
18.
Intern Med J ; 51(8): 1321-1323, 2021 08.
Article in English | MEDLINE | ID: covidwho-1367321

ABSTRACT

Australia and New Zealand have achieved excellent community control of COVID-19 infection. In light of the imminent COVID-19 vaccination roll out in both countries, representatives of all adult and paediatric allogeneic bone marrow transplant and cellular therapy (TCT) centres as well as representatives from autologous transplant only centres in Australia and New Zealand collaborated with infectious diseases specialists with expertise in TCT on this consensus position statement regarding COVID-19 vaccination in TCT patients in Australia and New Zealand. It is our recommendation that TCT patients, should have expedited access to high-efficacy COVID-19 vaccines given that these patients are at high risk of morbidity and mortality from COVID-19 infection. We also recommend prioritising vaccination of TCT healthcare workers and household members of TCT patients. Vaccination should not replace other public health measures in TCT patients given the effectiveness of COVID-19 vaccination in TCT patients is unknown. Furthermore, given the limited available data, prospective collection of safety and efficacy data of COVID-19 vaccination in this patient group is a priority.


Subject(s)
COVID-19 Vaccines , COVID-19 , Transplant Recipients , Adult , Australia/epidemiology , COVID-19/prevention & control , Child , Consensus , Humans , New Zealand/epidemiology , Prospective Studies , Vaccination
19.
J Prim Health Care ; 13(3): 222-230, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1364633

ABSTRACT

INTRODUCTION The delivery of health care by primary care general practices rapidly changed in response to the coronavirus disease 2019 (COVID-19) pandemic in early 2020. AIM This study explores the experience of a large group of New Zealand general practice health-care professionals with changes to prescribing medication during the COVID-19 pandemic. METHODS We qualitatively analysed a subtheme on prescribing medication from the General Practice Pandemic Experience New Zealand (GPPENZ) study, where general practice team members nationwide were invited to participate in five surveys over 16 weeks from 8 May 2020. RESULTS Overall, 78 (48%) of 164 participants enrolled in the study completed all surveys. Five themes were identified: changes to prescribing medicines; benefits of electronic prescription; technical challenges; clinical and medication supply challenges; and opportunities for the future. There was a rapid adoption of electronic prescribing as an adjunct to use of telehealth, minimising in-person consultations and paper prescription handling. Many found electronic prescribing an efficient and streamlined processes, whereas others had technical barriers and transmission to pharmacies was unreliable with sometimes incompatible systems. There was initially increased demand for repeat medications, and at the same time, concern that vulnerable patients did not have usual access to medication. The benefits of innovation at a time of crisis were recognised and respondents were optimistic that e-prescribing technical challenges could be resolved. DISCUSSION Improving e-prescribing technology between prescribers and dispensers, initiatives to maintain access to medication, particularly for vulnerable populations, and permanent regulatory changes will help patients continue to access their medications through future pandemic disruption.


Subject(s)
COVID-19/epidemiology , General Practice/organization & administration , General Practice/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Prescriptions/statistics & numerical data , Electronic Prescribing/statistics & numerical data , Female , Humans , Male , Middle Aged , New Zealand/epidemiology , Pandemics , Prescription Drugs/supply & distribution , SARS-CoV-2 , Telemedicine/organization & administration
20.
PLoS One ; 16(8): e0253843, 2021.
Article in English | MEDLINE | ID: covidwho-1362082

ABSTRACT

BACKGROUND: Knowing the true infected and symptomatic case fatality ratios (IFR and CFR) for COVID-19 is of high importance for epidemiological model projections. Early in the pandemic many locations had limited testing and reporting, so that standard methods for determining IFR and CFR required large adjustments for missed cases. We present an alternate approach, based on results from the countries at the time that had a high test to positive case ratio to estimate symptomatic CFR. METHODS: We calculated age specific (0-69, 70-79, 80+ years old) time corrected crude symptomatic CFR values from 7 countries using two independent time to fatality correction methods. Data was obtained through May 7, 2020. We applied linear regression to determine whether the mean of these coefficients had converged to the true symptomatic CFR values. We then tested these coefficients against values derived in later studies as well as a large random serological study in NYC at that time. RESULTS: The age dependent symptomatic CFR values accurately predicted the percentage of the population infected as reported by two random testing studies in NYC. They also were in good agreement with later studies that estimated age specific IFR and CFR values from serological studies and more extensive data sets available later in the pandemic. CONCLUSIONS: We found that for regions with extensive testing it is possible to get early accurate symptomatic CFR coefficients. These values, in combination with an estimate of the age dependence of infection, allows symptomatic CFR values and percentage of the population that is infected to be determined in similar regions with limited testing.


Subject(s)
COVID-19/epidemiology , Disease Outbreaks/statistics & numerical data , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19/mortality , Cause of Death , Child , Child, Preschool , Europe/epidemiology , Female , Humans , Infant , Infant, Newborn , Israel/epidemiology , Linear Models , Male , Middle Aged , Models, Statistical , Mortality , New Zealand/epidemiology , Republic of Korea/epidemiology , Young Adult
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