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1.
Nurs Adm Q ; 45(2): 102-108, 2021.
Article in English | MEDLINE | ID: covidwho-1165558

ABSTRACT

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.


Subject(s)
/epidemiology , Capacity Building/organization & administration , Hospital Design and Construction/methods , Mobile Health Units/organization & administration , Boston , Female , Humans , Leadership , Male , Mobile Health Units/statistics & numerical data , Pandemics , Uncertainty
2.
Nat Hum Behav ; 5(3): 295, 2021 03.
Article in English | MEDLINE | ID: covidwho-1164856
4.
Front Public Health ; 9: 661482, 2021.
Article in English | MEDLINE | ID: covidwho-1155198

ABSTRACT

This paper examines the effects of pandemic uncertainty on socially responsible investments. We use the overall corporate sustainability performance index in the Global-100 Most Sustainable Corporations in the World dataset to measure socially responsible investments. The global pandemic uncertainty is also measured by the World Pandemic Uncertainty Index. We focus on the panel dataset from 2012 to 2020, and the results show that the World Pandemic Uncertainty Index is positively related to socially responsible investments. The main findings remain significant when we utilize various panel estimation techniques.


Subject(s)
/economics , Investments/economics , Investments/statistics & numerical data , Models, Economic , Pandemics/statistics & numerical data , Social Responsibility , Uncertainty , Humans
5.
Health Sociol Rev ; 29(2): 113-121, 2020 07.
Article in English | MEDLINE | ID: covidwho-1153013

ABSTRACT

On 19 March 2020, I last met with a group of women from a neighbourhood of Monterrey, Mexico where I have spent the past year conducting ethnographic research. They had scheduled a meeting to decide whether to continue our weekly talks on health-related topics. 'Is this coronavirus real?' was the question guiding the meeting. Women shared their thoughts on their feelings on the threat that predominates in biomedical discourse. An air of resignation pervaded their speech. Nearly all of them suffer from chronic diseases and they clearly perceive the risk of their own death. However, the material conditions of their lives limit the scope of their strategies to protect themselves. A dialogue emerged between the women's request for clarity regarding the pandemic and me, a researcher called on as a physician. This article seeks to reflect on the political and moral aspects of everyday life that configure risk perception in the context of the WHO-declared pandemic. I analyse the dialogue sustained in the meeting as part of an ethnographic research I am conducting in this neighbourhood. Most of its residents live under precarious circumstances, which is a fundamental element in understanding their responses to the current COVID-19 crisis.


Subject(s)
Anthropology, Cultural , Quarantine/psychology , Risk Assessment , Female , Humans , Mexico/epidemiology , Poverty , Uncertainty
7.
Proc Biol Sci ; 288(1947): 20201556, 2021 03 31.
Article in English | MEDLINE | ID: covidwho-1148017

ABSTRACT

An epidemic can be characterized by its strength (i.e., the reproductive number [Formula: see text]) and speed (i.e., the exponential growth rate r). Disease modellers have historically placed much more emphasis on strength, in part because the effectiveness of an intervention strategy is typically evaluated on this scale. Here, we develop a mathematical framework for the classic, strength-based paradigm and show that there is a dual speed-based paradigm which can provide complementary insights. In particular, we note that r = 0 is a threshold for disease spread, just like [Formula: see text] [ 1], and show that we can measure the strength and speed of an intervention on the same scale as the strength and speed of an epidemic, respectively. We argue that, while the strength-based paradigm provides the clearest insight into certain questions, the speed-based paradigm provides the clearest view in other cases. As an example, we show that evaluating the prospects of 'test-and-treat' interventions against the human immunodeficiency virus (HIV) can be done more clearly on the speed than strength scale, given uncertainty in the proportion of HIV spread that happens early in the course of infection. We also discuss evaluating the effects of the importance of pre-symptomatic transmission of the SARS-CoV-2 virus. We suggest that disease modellers should avoid over-emphasizing the reproductive number at the expense of the exponential growth rate, but instead look at these as complementary measures.


Subject(s)
Epidemics , HIV Infections , /epidemiology , HIV Infections/epidemiology , Humans , Uncertainty
8.
Health Res Policy Syst ; 19(1): 40, 2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1147268

ABSTRACT

BACKGROUND: This paper critically discusses the use and merits of global indices, in particular, the Global Health Security Index (GHSI; Cameron et al. https://www.ghsindex.org/#l-section--map ) in times of an imminent crisis, such as the current pandemic. This index ranked 195 countries according to their expected preparedness in the case of a pandemic or other biological threat. The coronavirus disease 2019 (Covid-19) pandemic provides the background to compare each country's predicted performance from the GHSI with the actual performance. In general, there is an inverted relation between predicted versus actual performance, i.e. the predicted top performers are among those that are the worst hit. Obviously, this reflects poorly on the potential policy uses of this index in imminent crisis management. METHODS: The paper analyses the GHSI and identifies why it may have struggled to predict actual pandemic preparedness as evidenced by the Covid-19 pandemic. The paper also uses two different data sets, one from the Worldmeter on the spread of the Covid-19 pandemics, and the other from the International Network for Government Science Advice (INGSA) Evidence-to-Policy Tracker, to draw comparisons between the actual introduction of pandemic response policies and the corresponding death rate in 29 selected countries. RESULTS: This paper analyses the reasons for the poor match between prediction and reality in the index, and mentions six general observations applying to global indices in this respect. These observations are based on methodological and conceptual analyses. The level of abstraction in these global indices builds uncertainties upon uncertainties and hides implicit value assumptions, which potentially removes them from the policy needs on the ground. CONCLUSIONS: From the analysis, the question is raised if the policy community might have better tools for decision-making in a pandemic. On the basis of data from the INGSA Evidence-to-Policy Tracker, and with backing in studies from social psychology and philosophy of science, some simple heuristics are suggested, which may be more useful than a global index.


Subject(s)
Decision Making , Disaster Planning , Global Health , Health Policy , Pandemics , Policy Making , Administrative Personnel , Forecasting , Humans , Social Values , Trust , Uncertainty
12.
Int J Environ Res Public Health ; 18(6)2021 03 11.
Article in English | MEDLINE | ID: covidwho-1125818

ABSTRACT

The uncertainty caused by the COVID-19 pandemic has exacerbated negative emotions, especially among adolescents, who feel unable to tolerate the uncertainty of the epidemic. However, the mechanism by which the intolerance of COVID-19-related uncertainty (COVID-19 IU) affects negative emotions in adolescents remains unclear. This study explored the underlying mechanism from COVID-19 IU to negative emotions using a moderated mediation model in adolescents. In total, 3037 teenagers completed a cross-sectional survey including measures of COVID-19 IU, risk perception, social exclusion, perceived efficacy, and negative emotions. The results showed that COVID-19 IU positively predicted negative emotions and that risk perception and social exclusion mediated this relationship. In addition, both the direct effect of COVID-19 IU on negative emotions and the mediating effect of risk perception on this relationship were moderated by perceived efficacy; in particular, COVID-19 IU had a greater impact on negative emotions among adolescents with lower levels of perceived efficacy. These findings suggest that COVID-19 IU is closely associated with negative emotions among adolescents and that effective measures should be taken to enable adolescents to improve their perceived efficacy and develop a reasonable perception of risk, help them eliminate the stigma of the disease, and strengthen their connections with society.


Subject(s)
Pandemics , Adolescent , China/epidemiology , Cross-Sectional Studies , Emotions , Humans , Social Isolation , Social Perception , Uncertainty
13.
Recenti Prog Med ; 112(3): 195-206, 2021 03.
Article in Italian | MEDLINE | ID: covidwho-1123708

ABSTRACT

BACKGROUND: SARS-CoV-2 is a coronavirus that causes a disease which can leads to a severe form of fatal pneumonia. At december 2020 in Italy, more than 2 million people have contracted the virus and 78,755 people have died. The scientific community is studying and testing numerous compounds that can be effective and safe for treating people with covid-19. AIM: To synthesize and evaluate the quality of evidence of efficacy and safety for the treatment. The available evidence is summarized in a living systematic review, a review that is constantly updated on the basis of the results of the new clinical studies. METHODS: A bibliographic search is launched weekly on the electronic databases and on the main clinical trial registers. Two researchers independently select the articles and assess the quality of the studies using the criteria developed by the Cochrane Collaboration, the certainty of the overall quality of the evidence is assessed using the GRADE criteria. RESULTS: At 31/12/2020, 101 randomized controlled studies were included that consider 72 different comparisons and include a total of 55,281 patients. 37 drugs are tested with respect to the standard treatment, 6 are evaluated against placebo and finally 29 compare different drugs with each other. By selecting studies that evaluate the efficacy and safety of a drug compared to standard treatment, which include at least 2 studies and which have low to high certainty of evidence, results show that corticosteroids, remdesivir, favipiravir, immunoglobulins, colchicine, and umbilical cord mesenchymal stem cell infusion could reduce overall mortality. No differences for the risk of any adverse events are observed between convalescent plasma and remdesivir compared to standard treatment. Remdesivir probably reduces the risk of serious adverse events; a similar effect, although less strong, is also noted for tocilizumab and the lopinavir-ritonavir combination. In contrast, hydroxychloroquine, corticosteroids and convalescent plasma transfusion are associated with safety concerns with respect to the risk of serious adverse events. CONCLUSIONS: The 101 studies included consider 72 comparisons and numerous outcomes, the results often coming from single studies and of small dimensions, and for 61% with a very low certainty of evidence, are difficult to summarize and the final result is to increase the uncertainty rather than providing useful information to the clinic and research. From all the work carried out it seems to us that the pandemic has highlighted the many shadows of scientific literature as tool to improve knowledge.


Subject(s)
Antiviral Agents/therapeutic use , /drug therapy , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Alanine/adverse effects , Alanine/analogs & derivatives , Alanine/therapeutic use , Amides/adverse effects , Amides/therapeutic use , Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/adverse effects , Antiviral Agents/pharmacology , /therapy , Combined Modality Therapy , Drug Combinations , Drug Repositioning , Humans , Hydroxychloroquine/adverse effects , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunoglobulins, Intravenous/therapeutic use , Lopinavir/adverse effects , Lopinavir/therapeutic use , Mesenchymal Stem Cell Transplantation , Pandemics , Pyrazines/adverse effects , Pyrazines/therapeutic use , Randomized Controlled Trials as Topic , Ritonavir/adverse effects , Ritonavir/therapeutic use , Treatment Outcome , Uncertainty
14.
JMIR Public Health Surveill ; 7(4): e24292, 2021 04 07.
Article in English | MEDLINE | ID: covidwho-1120374

ABSTRACT

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


Subject(s)
/epidemiology , Universities/organization & administration , /mortality , Community-Acquired Infections/epidemiology , Humans , Models, Theoretical , Risk Assessment , Uncertainty , United States/epidemiology
15.
Elife ; 102021 03 05.
Article in English | MEDLINE | ID: covidwho-1119624

ABSTRACT

Establishing how many people have been infected by SARS-CoV-2 remains an urgent priority for controlling the COVID-19 pandemic. Serological tests that identify past infection can be used to estimate cumulative incidence, but the relative accuracy and robustness of various sampling strategies have been unclear. We developed a flexible framework that integrates uncertainty from test characteristics, sample size, and heterogeneity in seroprevalence across subpopulations to compare estimates from sampling schemes. Using the same framework and making the assumption that seropositivity indicates immune protection, we propagated estimates and uncertainty through dynamical models to assess uncertainty in the epidemiological parameters needed to evaluate public health interventions and found that sampling schemes informed by demographics and contact networks outperform uniform sampling. The framework can be adapted to optimize serosurvey design given test characteristics and capacity, population demography, sampling strategy, and modeling approach, and can be tailored to support decision-making around introducing or removing interventions.


Subject(s)
/epidemiology , Adolescent , Adult , Age Factors , Aged , Bayes Theorem , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Middle Aged , Pandemics , Seroepidemiologic Studies , Uncertainty , Young Adult
16.
Int J Environ Res Public Health ; 18(4)2021 02 09.
Article in English | MEDLINE | ID: covidwho-1112715

ABSTRACT

The management of a controllable production in the manufacturing system is essential to achieve viable advantages, particularly during emergency conditions. Disasters, either man-made or natural, affect production and supply chains negatively with perilous effects. On the other hand, flexibility and resilience to manage the perpetuated risks in a manufacturing system are vital for achieving a controllable production rate. Still, these performances are strongly dependent on the multi-criteria decision making in the working environment with the policies launched during the crisis. Undoubtedly, health stability in a society generates ripple effects in the supply chain due to high demand fluctuation, likewise due to the Coronavirus disease-2019 (COVID-19) pandemic. Incorporation of dependent demand factors to manage the risk from uncertainty during this pandemic has been a challenge to achieve a viable profit for the supply chain partners. A non-linear supply chain management model is developed with a controllable production rate to provide an economic benefit to the manufacturing firm in terms of the optimized total cost of production and to deal with the different situations under variable demand. The costs in the model are set as fuzzy to cope up with the uncertain conditions created by lasting pandemic. A numerical experiment is performed by utilizing the data set of the multi-stage manufacturing firm. The optimal results provide support for the industrial managers based on the proactive plan by the optimal utilization of the resources and controllable production rate to cope with the emergencies in a pandemic.


Subject(s)
Commerce/organization & administration , Industry/organization & administration , Pandemics , Humans , Uncertainty
17.
BMJ ; 372: n526, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1112324

ABSTRACT

CLINICAL QUESTION: What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. RECOMMENDATION: The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). HOW THIS GUIDELINE WAS CREATED: This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. UNDERSTANDING THE NEW RECOMMENDATION: The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. UPDATES: This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. READERS NOTE: This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.


Subject(s)
/prevention & control , Chemoprevention , Hydroxychloroquine/pharmacology , Risk Assessment , /epidemiology , Chemoprevention/methods , Chemoprevention/standards , Clinical Decision-Making/methods , Humans , Immunologic Factors/pharmacology , Uncertainty , World Health Organization
20.
Int J Environ Res Public Health ; 18(5)2021 02 25.
Article in English | MEDLINE | ID: covidwho-1110427

ABSTRACT

(1) Background: Prior studies have documented that access to testing has not been equitable across all communities in the US, with less testing availability and lower testing rates documented in rural counties and lower income communities. However, there is limited understanding of the perceived barriers to coronavirus disease 2019 (COVID-19) testing. The purpose of this study was to document the perceived barriers to COVID-19 testing. (2) Methods: Arkansas residents were recruited using a volunteer research participant registry. Participants were asked an open-ended question regarding their perceived barriers to testing. A qualitative descriptive analytical approach was used. (3) Results: Overall, 1221 people responded to the open-ended question. The primary barriers to testing described by participants were confusion and uncertainty regarding testing guidelines and where to go for testing, lack of accessible testing locations, perceptions that the nasal swab method was too painful, and long wait times for testing results. (4) Conclusions: This study documents participant reported barriers to COVID-19 testing. Through the use of a qualitative descriptive method, participants were able to discuss their concerns in their own words. This work provides important insights that can help public health leaders and healthcare providers with understanding and mitigating barriers to COVID-19 testing.


Subject(s)
/diagnosis , Health Services Accessibility , Mass Screening , Arkansas , Humans , Qualitative Research , Rural Population , Uncertainty
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