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BMC Med Res Methodol ; 21(1): 28, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1079209


BACKGROUND: COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools. MAIN TEXT: Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures. To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended. CONCLUSION: Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.

/prevention & control , Global Health , Health Priorities , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , /epidemiology , Health Services Research , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Research Design , Resource Allocation , World Health Organization
Nature ; 590(7844): 134-139, 2021 02.
Article in English | MEDLINE | ID: covidwho-1065896


As countries in Europe gradually relaxed lockdown restrictions after the first wave, test-trace-isolate strategies became critical to maintain the incidence of coronavirus disease 2019 (COVID-19) at low levels1,2. Reviewing their shortcomings can provide elements to consider in light of the second wave that is currently underway in Europe. Here we estimate the rate of detection of symptomatic cases of COVID-19 in France after lockdown through the use of virological3 and participatory syndromic4 surveillance data coupled with mathematical transmission models calibrated to regional hospitalizations2. Our findings indicate that around 90,000 symptomatic infections, corresponding to 9 out 10 cases, were not ascertained by the surveillance system in the first 7 weeks after lockdown from 11 May to 28 June 2020, although the test positivity rate did not exceed the 5% recommendation of the World Health Organization (WHO)5. The median detection rate increased from 7% (95% confidence interval, 6-8%) to 38% (35-44%) over time, with large regional variations, owing to a strengthening of the system as well as a decrease in epidemic activity. According to participatory surveillance data, only 31% of individuals with COVID-19-like symptoms consulted a doctor in the study period. This suggests that large numbers of symptomatic cases of COVID-19 did not seek medical advice despite recommendations, as confirmed by serological studies6,7. Encouraging awareness and same-day healthcare-seeking behaviour of suspected cases of COVID-19 is critical to improve detection. However, the capacity of the system remained insufficient even at the low epidemic activity achieved after lockdown, and was predicted to deteriorate rapidly with increasing incidence of COVID-19 cases. Substantially more aggressive, targeted and efficient testing with easier access is required to act as a tool to control the COVID-19 pandemic. The testing strategy will be critical to enable partial lifting of the current restrictive measures in Europe and to avoid a third wave.

/statistics & numerical data , /prevention & control , Carrier State/epidemiology , Models, Biological , Age Distribution , /transmission , Carrier State/prevention & control , Carrier State/transmission , Female , France/epidemiology , Health Behavior , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Pandemics/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Time Factors , Treatment Refusal/statistics & numerical data , World Health Organization
J Infect Public Health ; 14(1): 61-65, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1065351


The concept of caseness in the COVID-19 virus is important for early case finding and reporting. These are essential steps for prevention and control. This review defines and differentiates between types of cases and specifies the elements of each case definition in general with their application to COVID-19, where appropriate. These terms and their application are useful for the surveillance team, epidemiologists, clinicians, policy makers as well as the public in general.

/epidemiology , Epidemiological Monitoring , Global Health , Humans , Pandemics , World Health Organization
Lancet ; 397(10273): 459, 2021 02 06.
Article in English | MEDLINE | ID: covidwho-1062669
Science ; 370(6523): 1385-1387, 2020 12 18.
Article in English | MEDLINE | ID: covidwho-1044974