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1.
Br J Psychiatry ; 217(4): 540-542, 2020 10.
Article in English | MEDLINE | ID: covidwho-853428

ABSTRACT

The effects of the COVID-19 pandemic on population mental health are unknown. We need to understand the scale of any such impact in different sections of the population, who is most affected and how best to mitigate, prevent and treat any excess morbidity. We propose a coordinated and interdisciplinary mental health science response.


Subject(s)
Coronavirus Infections , Mental Disorders , Pandemics , Pneumonia, Viral , Preventive Psychiatry/methods , Psychosocial Support Systems , Public Health/methods , Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Humans , Mental Disorders/epidemiology , Mental Disorders/prevention & control , Mental Disorders/virology , Mental Health , Mental Health Services/organization & administration , Mental Health Services/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Quality Improvement , Research Design , Risk Assessment/methods
2.
BMJ Open ; 10(10): e043763, 2020 10 05.
Article in English | MEDLINE | ID: covidwho-835490

ABSTRACT

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Subject(s)
Ambulatory Care/statistics & numerical data , Coronavirus Infections/epidemiology , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Pneumonia, Viral/epidemiology , Primary Health Care , Public Health , Adult , Age Factors , Betacoronavirus , Family Planning Services/statistics & numerical data , Female , HIV Infections/epidemiology , Humans , Male , Pandemics , Pediatrics/statistics & numerical data , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Public Health/methods , Public Health/statistics & numerical data , Rural Population
3.
Aust J Gen Pract ; 49(10): 625-629, 2020 10.
Article in English | MEDLINE | ID: covidwho-813234

ABSTRACT

BACKGROUND: The availability of a COVID-19 vaccine is being heralded as the solution to control the current COVID-19 pandemic, reduce the number of infections and deaths and facilitate resumption of our previous way of life. OBJECTIVE: The aim of this article is to provide a framework for primary care of what will be needed to optimise COVID-19 vaccine confidence and uptake in Australia once the vaccine prioritisation schedule and key target groups are known. DISCUSSION: While a number of vaccines are currently under development, with at least seven undergoing phase III trials (28 August 2020), it is hoped that an effective COVID-19 vaccine will become available to the public in 2021. Ensuring public confidence in vaccine safety and effectiveness will be crucial to facilitate uptake. General practitioners are at the forefront of public health, and one of the most trusted sources for patients. In this article, the authors discuss the expedited vaccine development process for COVID-19 vaccines; the likely vaccine prioritisation schedule and anticipated key target groups; the behavioural and social drivers of vaccination acceptance, including the work required to facilitate this; and the implications for general practice.


Subject(s)
Coronavirus Infections , General Practitioners/psychology , Immunization Programs/organization & administration , Pandemics , Pneumonia, Viral , Public Health/methods , Vaccination , Viral Vaccines/pharmacology , Australia , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Focus Groups , Health Services Accessibility/organization & administration , Humans , Pandemics/prevention & control , Patient Acceptance of Health Care , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Primary Health Care/methods , Self Concept , Vaccination/methods , Vaccination/psychology
4.
BMC Nephrol ; 21(1): 419, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-810425

ABSTRACT

BACKGROUND: Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland. METHODS: Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed. RESULTS: During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients. CONCLUSION: The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.


Subject(s)
Betacoronavirus/isolation & purification , Communicable Disease Control/organization & administration , Coronavirus Infections , Kidney Failure, Chronic , Kidney Transplantation/statistics & numerical data , Pandemics , Pneumonia, Viral , Renal Replacement Therapy , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Humans , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/therapy , Male , Middle Aged , Mortality , Outcome and Process Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Public Health/methods , Registries/statistics & numerical data , Renal Replacement Therapy/methods , Renal Replacement Therapy/statistics & numerical data , Scotland/epidemiology
6.
BMJ Open ; 10(9): e040569, 2020 09 29.
Article in English | MEDLINE | ID: covidwho-809101

ABSTRACT

INTRODUCTION: This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. METHODS AND ANALYSIS: Over a 3-month period we aim to recruit a minimum of 500 patients across 10 hospital sites, collecting baseline data including: patient demographics; presence of comorbidities; relevant blood tests on admission; prescription of ACE inhibitors/angiotensin receptor blockers/non-steroidal anti-inflammatory drugs/immunosuppressants; smoking status; Clinical Frailty Score (CFS); length of hospital stay; mortality and readmission. All patients receiving inpatient hospital care >18 years who receive a diagnosis of COVID-19 are eligible for inclusion. Long-term follow-up at 6 and 12 months is planned. This will assess frailty, quality of life and medical complications.Our primary analysis will be short-term and long-term mortality by CFS, adjusted for age (18-64, 65-80 and >80) and gender. We will carry out a secondary analysis of the primary outcome by including additional clinical mediators which are determined statistically important using a likelihood ratio test. All analyses will be presented as crude and adjusted HR and OR with associated 95% CIs and p values. ETHICS AND DISSEMINATION: This study has been registered, reviewed and approved by the following: Health Research Authority (20/HRA1898); Ethics Committee of Hospital Policlinico Modena, Italy (369/2020/OSS/AOUMO); Health and Care Research Permissions Service, Wales; and NHS Research Scotland Permissions Co-ordinating Centre, Scotland. All participating units obtained approval from their local Research and Development department consistent with the guidance from their relevant national organisation.Data will be reported as a whole cohort. This project will be submitted for presentation at a national or international surgical and geriatric conference. Manuscript(s) will be prepared following the close of the project.


Subject(s)
Coronavirus Infections , Frail Elderly , Frailty , Multimorbidity , Pandemics , Pneumonia, Viral , Public Health/methods , Quality of Life , Adult , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Correlation of Data , Europe/epidemiology , Female , Frail Elderly/psychology , Frail Elderly/statistics & numerical data , Frailty/diagnosis , Frailty/epidemiology , Geriatric Assessment/methods , Hospitalization/statistics & numerical data , Humans , Male , Multicenter Studies as Topic , Observational Studies as Topic , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Survival Analysis
7.
Ethn Dis ; 30(4): 695-700, 2020.
Article in English | MEDLINE | ID: covidwho-808403

ABSTRACT

The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to everyday life for millions of Americans due to job loss, school closures, stay-at-home orders and health and mortality consequences. In turn, physicians, academics, and policymakers have turned their attention to the public mental health toll of COVID-19. This commentary reporting from the field integrates perceptions of academic, community, health system, and policy leaders from state, county, and local levels in commenting on community mental health needs in the COVID-19 pandemic. Stakeholders noted the broad public health scope of mental health challenges while expressing concern about exacerbation of existing disparities in access and adverse social determinants, including for communities with high COVID-19 infection rates, such as African Americans and Latinos. They noted rapid changes toward telehealth and remote care, and the importance of understanding impacts of changes, including who may benefit or have limited access, with implications for future services delivery. Needs for expanded workforce and training in mental health were noted, as well as potential public health value of expanding digital resources tailored to local populations for enhancing resilience to stressors. The COVID-19 pandemic has led to changes in delivery of health care services across populations and systems. Concerns over the mental health impact of COVID-19 has enhanced interest in remote mental care delivery and preventive services, while being mindful of potential for enhanced disparities and needs to address social determinants of health. Ongoing quality improvement across systems can integrate lessons learned to enhance a public mental well-being.


Subject(s)
Coronavirus Infections , Delivery of Health Care , Health Services Needs and Demand/organization & administration , Mental Health/trends , Pandemics , Pneumonia, Viral , Public Health , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Humans , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Public Health/methods , Public Health/trends , Quality Improvement , United States/epidemiology
8.
BMJ Open ; 10(9): e039749, 2020 09 29.
Article in English | MEDLINE | ID: covidwho-808388

ABSTRACT

OBJECTIVES: The growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics. DESIGN: We combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability. SETTING: 91 Clinical Commissioning Groups (CCGs) in England. MAIN OUTCOME MEASURES: We merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities. RESULTS: We find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments. CONCLUSIONS: Evidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.


Subject(s)
Communicable Disease Control , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Health Resources/supply & distribution , Health Services Accessibility/standards , Pandemics , Pneumonia, Viral , Betacoronavirus , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , England/epidemiology , Health Status Disparities , Humans , Needs Assessment , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Prevalence , Public Health/methods , Public Health/trends , Quality Improvement/organization & administration , Risk Factors , Spatial Analysis
9.
J Med Internet Res ; 22(9): e22142, 2020 09 25.
Article in English | MEDLINE | ID: covidwho-802070

ABSTRACT

BACKGROUND: In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. OBJECTIVE: In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. METHODS: Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government's WhatsApp channel; and (3) their demographics. RESULTS: Within the sample, 7.9% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=-0.07, t[863]=-2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government's WhatsApp messages (b=-0.05, t[863]=-2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. CONCLUSIONS: Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an "infodemic." TRIAL REGISTRATION: ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574.


Subject(s)
Anxiety/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Depression/epidemiology , Health Surveys , Mental Health/statistics & numerical data , Mobile Applications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Public Health/methods , Public Health/statistics & numerical data , Adult , Cross-Sectional Studies , Disease Outbreaks , Female , Humans , Male , Pandemics
11.
BMJ Open ; 10(9): e039338, 2020 09 24.
Article in English | MEDLINE | ID: covidwho-794755

ABSTRACT

OBJECTIVES: A number of studies have shown that the airborne transmission route could spread some viruses over a distance of 2 meters from an infected person. An epidemic model based only on respiratory droplets and close contact could not fully explain the regional differences in the spread of COVID-19 in Italy. On March 16th 2020, we presented a position paper proposing a research hypothesis concerning the association between higher mortality rates due to COVID-19 observed in Northern Italy and average concentrations of PM10 exceeding a daily limit of 50 µg/m3. METHODS: To monitor the spreading of COVID-19 in Italy from February 24th to March 13th (the date of the Italian lockdown), official daily data for PM10 levels were collected from all Italian provinces between February 9th and February 29th, taking into account the maximum lag period (14 days) between the infection and diagnosis. In addition to the number of exceedances of the daily limit value of PM10, we also considered population data and daily travelling information for each province. RESULTS: Exceedance of the daily limit value of PM10 appears to be a significant predictor of infection in univariate analyses (p<0.001). Less polluted provinces had a median of 0.03 infections over 1000 residents, while the most polluted provinces showed a median of 0.26 cases. Thirty-nine out of 41 Northern Italian provinces resulted in the category with the highest PM10 levels, while 62 out of 66 Southern provinces presented low PM10 concentrations (p<0.001). In Milan, the average growth rate before the lockdown was significantly higher than in Rome (0.34 vs 0.27 per day, with a doubling time of 2.0 days vs 2.6, respectively), thus suggesting a basic reproductive number R0>6.0, comparable with the highest values estimated for China. CONCLUSION: A significant association has been found between the geographical distribution of daily PM10 exceedances and the initial spreading of COVID-19 in the 110 Italian provinces.


Subject(s)
Air Pollution , Betacoronavirus/isolation & purification , Coronavirus Infections , Disease Transmission, Infectious , Pandemics , Particulate Matter/analysis , Pneumonia, Viral , Air Pollution/analysis , Air Pollution/statistics & numerical data , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Correlation of Data , Disease Transmission, Infectious/prevention & control , Disease Transmission, Infectious/statistics & numerical data , Humans , Italy/epidemiology , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Public Health/methods , Public Health/statistics & numerical data , Risk Assessment/methods
13.
Prev Chronic Dis ; 17: E109, 2020 09 17.
Article in English | MEDLINE | ID: covidwho-782358

ABSTRACT

INTRODUCTION: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York City closed all nonessential businesses and restricted the out-of-home activities of residents as of March 22, 2020. This order affected different neighborhoods differently, as stores and workplaces are not randomly distributed across the city, and different populations may have responded differently to the out-of-home restrictions. This study examines how the business closures and activity restrictions affected COVID-19 testing results. An evaluation of whether such actions slowed the spread of the pandemic is a crucial step in designing effective public health policies. METHODS: Daily data on the fraction of COVID-19 tests yielding a positive result at the zip code level were analyzed in relation to the number of visits to local businesses (based on smartphone location) and the number of smartphones that stayed fixed at their home location. The regression model also included vectors of fixed effects for the day of the week, the calendar date, and the zip code of residence. RESULTS: A large number of visits to local businesses increased the positivity rate of COVID-19 tests, while a large number of smartphones that stayed at home decreased it. A doubling in the relative number of visits increases the positivity rate by about 12.4 percentage points (95% CI, 5.3 to 19.6). A doubling in the relative number of stay-at-home devices lowered it by 2.0 percentage points (95% CI, -2.9 to -1.2). The business closures and out-of-home activity restrictions decreased the positivity rate, accounting for approximately 25% of the decline observed in April and May 2020. CONCLUSION: Policy measures decreased the likelihood of positive results in COVID-19 tests. These specific policy tools may be successfully used when comparable health crises arise in the future.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Commerce/legislation & jurisprudence , Communicable Disease Control , Coronavirus Infections , Disease Transmission, Infectious , Pandemics , Pneumonia, Viral , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Communicable Disease Control/instrumentation , Communicable Disease Control/methods , Communicable Disease Control/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Disease Transmission, Infectious/statistics & numerical data , Humans , New York City/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Policy Making , Population Health Management , Public Health/methods , Public Health/statistics & numerical data , Risk Assessment/methods , Smartphone/statistics & numerical data , Social Distance
16.
BMJ Open ; 10(9): e040951, 2020 09 09.
Article in English | MEDLINE | ID: covidwho-760257

ABSTRACT

OBJECTIVES: To assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19. DESIGN: Analysis of data (n=9515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1 and 8 April 2020. SETTING: Community. PARTICIPANTS: 9515 people with self-reported long-term respiratory conditions. 81% female, age ranges from ≤17 years to 80 years and above, from all nations of the UK. Long-term respiratory conditions reported included asthma (83%), chronic obstructive pulmonary disease (10%), bronchiectasis (4%), interstitial lung disease (2%) and 'other' (<1%) (eg, lung cancer and pulmonary endometriosis). OUTCOME MEASURES: Study responses related to impacts on key elements of healthcare, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures. RESULTS: 45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues and getting basic necessities such as food were also common. 36% did not use online prescriptions, and 54% had not accessed online inhaler technique videos. Psychosocial impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19. CONCLUSIONS: COVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group.


Subject(s)
Coronavirus Infections , Exercise , Pandemics , Pneumonia, Viral , Public Health , Respiratory Tract Diseases , Self-Management , Social Isolation/psychology , Adolescent , Adult , Aged, 80 and over , Anxiety/prevention & control , Betacoronavirus , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Cross-Sectional Studies , Exercise/physiology , Exercise/psychology , Female , Health Services Needs and Demand , Humans , Loneliness/psychology , Male , Pandemics/prevention & control , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Public Health/methods , Public Health/standards , Respiratory Tract Diseases/epidemiology , Respiratory Tract Diseases/physiopathology , Respiratory Tract Diseases/psychology , Risk Reduction Behavior , Self-Management/methods , Self-Management/psychology , Self-Management/trends , United Kingdom
18.
Sensors (Basel) ; 20(17)2020 Sep 02.
Article in English | MEDLINE | ID: covidwho-742835

ABSTRACT

COVID-19 has shown a relatively low case fatality rate in young healthy individuals, with the majority of this group being asymptomatic or having mild symptoms. However, the severity of the disease among the elderly as well as in individuals with underlying health conditions has caused significant mortality rates worldwide. Understanding this variance amongst different sectors of society and modelling this will enable the different levels of risk to be determined to enable strategies to be applied to different groups. Long-established compartmental epidemiological models like SIR and SEIR do not account for the variability encountered in the severity of the SARS-CoV-2 disease across different population groups. The objective of this study is to investigate how a reduction in the exposure of vulnerable individuals to COVID-19 can minimise the number of deaths caused by the disease, using the UK as a case study. To overcome the limitation of long-established compartmental epidemiological models, it is proposed that a modified model, namely SEIR-v, through which the population is separated into two groups regarding their vulnerability to SARS-CoV-2 is applied. This enables the analysis of the spread of the epidemic when different contention measures are applied to different groups in society regarding their vulnerability to the disease. A Monte Carlo simulation (100,000 runs) along the proposed SEIR-v model is used to study the number of deaths which could be avoided as a function of the decrease in the exposure of vulnerable individuals to the disease. The results indicate a large number of deaths could be avoided by a slight realistic decrease in the exposure of vulnerable groups to the disease. The mean values across the simulations indicate 3681 and 7460 lives could be saved when such exposure is reduced by 10% and 20% respectively. From the encouraging results of the modelling a number of mechanisms are proposed to limit the exposure of vulnerable individuals to the disease. One option could be the provision of a wristband to vulnerable people and those without a smartphone and contact-tracing app, filling the gap created by systems relying on smartphone apps only. By combining very dense contact tracing data from smartphone apps and wristband signals with information about infection status and symptoms, vulnerable people can be protected and kept safer.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Transmission, Infectious/statistics & numerical data , Models, Theoretical , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Public Health/methods , Quarantine/organization & administration , Vulnerable Populations , Contact Tracing/methods , Coronavirus Infections/epidemiology , Disease Outbreaks/prevention & control , Health Planning Guidelines , Health Services Needs and Demand , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/statistics & numerical data , Inventions/statistics & numerical data , Pneumonia, Viral/epidemiology , Preventive Health Services/methods , Preventive Health Services/organization & administration , Preventive Health Services/standards , Public Health/statistics & numerical data , Public Health Administration/methods , Quarantine/methods , Quarantine/statistics & numerical data , United Kingdom/epidemiology , Vulnerable Populations/statistics & numerical data
20.
J Med Internet Res ; 22(9): e22142, 2020 09 25.
Article in English | MEDLINE | ID: covidwho-740481

ABSTRACT

BACKGROUND: In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. OBJECTIVE: In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. METHODS: Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government's WhatsApp channel; and (3) their demographics. RESULTS: Within the sample, 7.9% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=-0.07, t[863]=-2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government's WhatsApp messages (b=-0.05, t[863]=-2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. CONCLUSIONS: Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an "infodemic." TRIAL REGISTRATION: ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574.


Subject(s)
Anxiety/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Depression/epidemiology , Health Surveys , Mental Health/statistics & numerical data , Mobile Applications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Public Health/methods , Public Health/statistics & numerical data , Adult , Cross-Sectional Studies , Disease Outbreaks , Female , Humans , Male , Pandemics
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