SARS-CoV-2 EPIDEMIC FIRST WAVE: THE IMPACT OF PARTIAL AND COMPLETE LOCKDOWNS ON ROAD-DEPOSITED SEDIMENTS IN KUWAIT

This research aims to find the impact of the nationwide partial and complete lockdowns on the environmental quality of Kuwait. This objective was accomplished by collecting roadside deposited sediments (n=54) at three periods during the first wave of the SARS-CoV-2 epidemic (complete-lockdown, partial-lockdown, and re-opening) from different locations in Kuwait and then analyzing them via ICP-AES for the presence of heavy metals and later applying various pollution indices. Extensive analysis of 162 subsamples showed that virtually all the minimum values were associated with the complete lockdown period (9 out of 10 elements). Pearson's correlation coefficients indicate that all elements are positively correlated except for Cu-Cd, Cu-Cr, and Co-V, suggesting that the sediments share a common source. Except for cadmium and copper, almost all sediments showed low ecological risk potential (Eri < 40). The lowest risk index was during the complete lockdown (RI=162.2). The full lockdown period had marginally lower geo-accumulation indices and classes than the partial lockdown and re-opening periods. The improvement in sediment quality between the different periods was minimal due to low levels of commitment in the governmental curfew leave permissions, the continuity of Kuwait municipality manual and mechanical road cleanup processes during lockdowns, and the associated energy consumption with emissions resulting from extended indoor stay. © 2023, ALÖKI Kft., Budapest, Hungary.

Gold and the herd of Cryptos: Saving oil in blurry times

This paper assesses the effectiveness of a broad set of 1066 active and continuously traded cryptocurrencies as a safe haven instrument against extreme oil price movements, in comparison to the corresponding roles of gold. The uncertainty for the oil market during the COVID-19 pandemic and the subsequent Russia–Ukraine conflict set the tone for natural experiments for our study. We use a trail-blazing dynamic generalized autoregressive score model to estimate the tail riskiness of the potential safe haven assets from January 1, 2020, to September 30, 2022. By estimating the risk exposure of all cryptocurrency assets, we determine top ten safest assets for investment. Our results show the emergence of new safe haven cryptocurrencies, which have previously been ignored by the academic literature and policy makers alike. Intriguingly, our findings reveal that gold has been replaced by altcoins as the safest assets during both the COVID-19 pandemic and the Russia–Ukraine conflict. At this instance, our findings suggest that Bitcoin provides lengthier safe haven properties than gold for oil returns in both periods. However, the safe haven properties of gold and cryptocurrencies are time varying. Last but not least, we introduce a new Cryptocurrency Tail Risk Index (CTRI) that captures the risk exposure of cryptocurrency market, as a whole. Our results suggest that investment in numerous cryptocurrencies provides lengthier safe haven properties than investing in gold alone.

The effect of oil implied volatility and geopolitical risk on GCC stock sectors under various market conditions

The importance of crude oil volatility and geopolitical risk for stock pricing is well known in both developed and emerging economies, but is relatively understudied in major oil-exporting countries at the sectoral level of stock indices and under various market conditions. Using daily data on eight Gulf Cooperation Council (GCC) stock sector indices over the period February 2010–30 June 2022, we capture the effect of two global risk factors, namely oil implied volatility and geopolitical risk, on stock returns and volatility while accounting for bull/bear markets and low/high volatility regimes. The analysis indicates the following results. Firstly, the effect of oil implied volatility is stronger than that of geopolitical risk, notably for Consumer Discretionary and Staples. Secondly, the effect on both returns and volatility is generally positive during bull markets, but it is stronger for volatility;the response of the returns of Energy, Materials, Industrials, and Financials is negative in bear markets and positive during bull markets. Thirdly, the effect of oil implied volatility on stock sector volatility is slightly higher during the COVID-19 outbreak for some cases and is prominent during bull markets. Our findings matter for the predictability of GCC stock sector returns and volatility and for the design of hedging strategies under various market states. © 2023 Elsevier B.V.

The impact of geopolitical risk on cash holdings policy: evidence from an emerging market

Purpose: This study aims to examine whether geopolitical risk (GPR) impacts the cash holdings behavior of 210 Turkish firms between 2005 and 2019. The authors choose Turkey as a country of interest because Turkey has an important place in terms of geographical location and serves as a bridge between Europe and Asia. Considering the prominent role that can play in decision-making processes, the authors thought that analyzing the impact of GPR on the cash holdings determinants of Turkish firms would be important and interesting. A widely accepted view is that GPRs play an important role in the economic decisions of emerging countries, such as Turkey. Design/methodology/approach: The authors examine models with fixed effects (FE), random effects (RE) and pooled ordinary least squares (POLS), respectively. First, the authors analyzed whether POLS, FE or RE would be the most appropriate model. According to the F-test and the Breusch–Pagan LM test, the FE and the RE models are more suitable than POLS. Then, according to the Hausman test results, the authors found that FE is this study's most appropriate model. After determining the validity of FE, the diagnostics tests of heteroscedasticity, autocorrelation and serial correlation tests are examined. Due to the presence of these problems, Driscoll and Kraay's (1998) test, which is the robust standard error estimator, is used. Findings: The authors find a positive relationship between GPR and cash holdings after controlling firm-level control variables. Firms faced with uncertainty prefer to hoard cash as a precautionary measure. In keeping with real options theory, firms postpone the investments of firms under uncertain conditions. The use of alternative measurements for GPR and cash holdings ensures the validity of our results. The authors' research reveals that investors and politicians should pay more attention to the influence of GPR on the determinants of the cash holdings of firms. Research limitations/implications: There are limitations for this study, but this study may provide opportunities for further studies. First, this study has only data from Turkey. This situation mitigates cross-country effects. In future studies, the number of firms, countries of focus and time span can be expanded. Second, this study does not consider the period of coronavirus disease 2019 (COVID-19) that increased risk and uncertainty worldwide. Further studies may consider the impact of COVID-19 and geographical risks relating to cash holdings. Third, the authors try to choose more relied independent and control variables. Practical implications: The authors' results provide some insights that are relevant to practitioners and policymakers. Managers need to consider GPR in managers' financial decisions based on managers' firm-specific characteristics. Turkish policymakers should target improving policies to alleviate the negative effects of GPRs. Regulators should postulate more encouraging policies to firms in an environment of GPR. Regulators can give firms more time to understand and analyze the GPRs and the impacts of GPRs to adjust regulators' day-to-day activities. Originality/value: There are fewer studies in the literature that analyzed the relationship between GPR and cash holdings. This study aims to full this gap in the literature. © 2023, Emerald Publishing Limited.

A wastewater-based risk index for SARS-CoV-2 infections among three cities on the Canadian Prairie.

Wastewater surveillance (WWS) is useful to better understand the spreading of coronavirus disease 2019 (COVID-19) in communities, which can help design and implement suitable mitigation measures. The main objective of this study was to develop the Wastewater Viral Load Risk Index (WWVLRI) for three Saskatchewan cities to offer a simple metric to interpret WWS. The index was developed by considering relationships between reproduction number, clinical data, daily per capita concentrations of virus particles in wastewater, and weekly viral load change rate. Trends of daily per capita concentrations of SARS-CoV-2 in wastewater for Saskatoon, Prince Albert, and North Battleford were similar during the pandemic, suggesting that per capita viral load can be useful to quantitatively compare wastewater signals among cities and develop an effective and comprehensible WWVLRI. The effective reproduction number (Rt) and the daily per capita efficiency adjusted viral load thresholds of 85 × 106 and 200 × 106 N2 gene counts (gc)/population day (pd) were determined. These values with rates of change were used to categorize the potential for COVID-19 outbreaks and subsequent declines. The weekly average was considered 'low risk' when the per capita viral load was 85 × 106 N2 gc/pd. A 'medium risk' occurs when the per capita copies were between 85 × 106 and 200 × 106 N2 gc/pd. with a rate of change <100 %. The start of an outbreak is indicated by a 'medium-high' risk classification when the week-over-week rate of change was >100 %, and the absolute magnitude of concentrations of viral particles was >85 × 106 N2 gc/pd. Lastly, a 'high risk' occurs when the viral load exceeds 200 × 106 N2 gc/pd. This methodology provides a valuable resource for decision-makers and health authorities, specifically given the limitation of COVID-19 surveillance based on clinical data.

The link between reported cases of COVID-19 and the Infodemic Risk Index: A worldwide perspective.

In this brief report we followed the evolution of the COVID-19 Infodemic Risk Index during 2020 and clarified its connection with the epidemic waves, focusing specifically on their co-evolution in Europe, South America, and South-eastern Asia. Using 640 million tweets collected by the Infodemic Observatory and the open access dataset published by Our World in Data regarding COVID-19 worldwide reported cases, we analyze the COVID-19 infodemic vs. pandemic co-evolution from January 2020 to December 2020. We find that a characteristic pattern emerges at the global scale: a decrease in misinformation on Twitter as the number of COVID-19 confirmed cases increases. Similar local variations highlight how this pattern could be influenced both by the strong content moderation policy enforced by Twitter after the first pandemic wave and by the phenomenon of selective exposure that drives users to pick the most visible and reliable news sources available.

Clinical Features and Analysis of Survival in a Sample of Patients Infected with SARS-COV-2 in the Specialized Hospital for Geriatric and Palliative Medicine "November 13" - Skopje

BACKGROUND: New worldwide intensive studies of a new virus called severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) have shown that in its clinical manifestations, the virus has an extremely different expression in different population groups, with age being found to be one of the most common and significant variables. AIM: The objective of this study is to categorize the difference between clinical and laboratory parameters of a sample of patients infected with SARS-COV-2 in the Specialized Hospital for Geriatric and Palliative Medicine "November 13" - Skopje, between survived and deceased patients, impact on the number and severity of comorbidities on the severity of the clinical picture and the survival rate. MATERIALS AND METHODS: In our study, we analyzed data from a sample of 113 patients hospitalized in our institution. The study is cross-sectional and observational, and in the methodology, we analyzed demographic data by gender and age groups, analysis of comorbidities, functional and nutritional status of patients, and risk factors for mortality and survival rate. For this purpose, we used several geriatric scores: Cumulative Illness Rating Scale scale-Geriatric (CIRS-G), degree of functional ability (Bartel), and the Geriatric Nutritional Index (GNRI) score. RESULT(S): The deceased patients had a significantly higher CIRS-G score, while no significant difference in functional (Bartel) and GNRI scores was found. Multivariate regression analysis showed that lymphocytopenia and low saturation were high-risk factors for death in the geriatric population. CONCLUSION(S): Providing hospital-level care for the elderly with SARS-COV-2 contributes to a lower mortality rate. Copyright © 2022 Lidija Veterovska-Miljkovic, Salija Ljatif-Petrushovska, Lazo Jordanovski, Marika Ivanovska, Olivera Bundaleska, Elena Brezovska, Natasha Zdraveska, Emilija Velkova.

Simulating pandemic emergency scenarios considering mobility patterns through an agent-based model

One of the main policies to contain a pandemic spreading is to reduce people mobility. However, it is not easy to predict its actual impact, and this is a limitation for policy-makers who need to act effectively and timely to limit virus spreading. Data are fundamental for monitoring purposes;however, models are needed to predict the impact of different scenarios at a granular scale. Based on this premise, this paper presents the first results of an agent-based model (ABM) able to dynamically simulate a pandemic spreading under mobility restriction scenarios. The model is here used to reproduce the first wave of COVID-19 pandemic in Italy and considers factors that can be attributed to the diffusion and lethality of the virus and population mobility patterns. The model is calibrated with real data (considering the first wave), and it is based on a combination of static and dynamic parameters. First results show the ability of the model to reproduce the pandemic spreading considering the lockdown strategy adopted by the Italian Government and pave the way for scenario analysis of different mobility restrictions. This could be helpful to support policy-making by providing a strategic decision-tool to contrast pandemics. © 2021 Copyright for this paper by its authors.

Geriatric Nutritional Risk Index is related to the risk of stroke-associated pneumonia.

BACKGROUND: Stroke-associated pneumonia (SAP) occurs frequently after a stroke. Geriatric Nutritional Risk Index (GNRI) is a valuable indicator of elderly individuals' nutritional status. This research was designed to obtain insight into the link between GNRI and SAP. METHODS: Patients with acute ischemic stroke (AIS) were categorized into the SAP and non-SAP groups. GNRI scores were divided into four layers: Q1, GNRI < 82; Q2, 82≤ GNRI < 92; Q3, 92≤ GNRI ≤98; Q4, GNRI > 98. To identify the independent risk and protective factors of developing SAP, logistic regression analyses were conducted. Additionally, we utilized the restricted cubic spline (RCS) analysis to test the effect of GNRI on the SAP risk. RESULTS: The SAP group showed lower GNRI scores than the non-SAP group (96.88 ± 9.36 vs. 100.88 ± 8.25, p  <  0.001). According to the logistic regression model, the Q1 and Q2 layers showed a higher risk of SAP than the Q3 layer, while the Q4 layer showed a lower SAP risk (all p < 0.05). Besides, the RCS model found that the risk of SAP dropped dramatically as GNRI scores increased, which got stable when the GNRI score was more significant than 100. CONCLUSION: Lower GNRI scores were linked to a higher prevalence of SAP. In clinical practice, GNRI showed predictive value for SAP, which could be helpful in early SAP intervention and therapy.

COVID-19 NUTRITION AND DISEASE RISK ASSESSMENTS PREDICT MORTALITY IN VETERANS AFFAIRS MEDICAL CENTER ICU

Background: COVID-19 pandemic significantly increases morbidity and mortality in vulnerable veteran populations. This observation cohort study evaluates nutrition risk factors associated with mortality in COVID-19 patients admitted to VA Level 1A complexity ICU. Methods: 508 COVID-19 patients requiring VAMC ICU admission 02/2020-07/2021 were retrospectively reviewed. We hypothesized that Covid19 may cause significant malnutrition. Survivors and mortality cohorts were assessed with five nutrition and physiology risk assessment algorithms: APACHE II, SOFA, ASA, NRI and GNRI, and co-morbidities: age, gender, race, obesity, diabetes, hypertension, coronary disease, and malnutrition. Results: Mortality: 111 of 508 patients (21.85%). Low admission NRI (45.27±2.1) and GNRI (60.73) indicated malnutrition in all patients. Both scores lower in mortality vs. survivors (NRI:42.45±4.1 vs. 46.06±3.49, p≤0.004) (GNRI: 56.4±12.56vs 61.9±25.88, p≤0.003). Nutritional markers lower in mortality vs. survivors: Albumin (2.9±0.5 vs. 3.4±0.6, p≤0.001), total lymphocyte count (1.23±1.8 vs. 2.5±1.9, p≤0.005), Hematocrit (33.2±9.9 vs 38.9±7.4, p≤0.01.) Physiology risk assessment scores were higher in mortality vs survivors: SOFA (4.24±1.73 vs. 2.54±0.88, p≤0.0005), APACHE II (12.3±4.64 vs. 7.19±2.48, p≤0.0002), and ASA (3.86±0.53 vs. 2.9±0.75, p≤0.0003). Comorbidities were higher in mortality vs. survivor: age (72.3±9.5 vs 67.8±12.9y/o, p≤0.001), obesity (87.39% vs. 42.06%, p≤0.04), diabetes (58.5% vs. 47.6%, p≤0.05), Hypertension (34.2% vs 11.58%, p≤0.04), Coronary disease (61.26% vs. 32.74%, p<0.002). No mortality difference between genders: (21.86% male, 21.74% female, p=NS), or races:(21.48%AA, 22.08% W, 22.08 UNK. p=NS) Conclusion: All COVID-19 patients were malnourished on ICU admission. Malnutrition low NRI score, high risk assessment scores, with comorbidities directly predict COVID-19 mortality risk regardless of gender or race. Low NRI scores indicate need for nutritional support to critically ill COVID-19 patients.

Comparison of geriatric nutritional risk index and creatinine index in short-term mortality prediction in maintenance hemodialysis patients.

BACKGROUND: The aim of this study is to analyze and compare the predictive values of the Geriatric Nutritional Risk Index (GNRI) and Creatinine Index (CI) in the short-term mortality of maintenance hemodialysis patients and to determine their best cut-offs. METHODS: A total of 169 adult hemodialysis patients were included in this retrospective, cross-sectional, and single-center study. The demographic, clinical, and laboratory data of the month in which the patients were included in the study were obtained from their medical files and computer records. All-cause death was the primary outcome of the study during a 12-month follow-up after baseline GNRI and CI calculations. RESULTS: The mean age of the study population was 57 ± 16 years (49.7% were women, 15% were diabetic). During the one-year observation period, 19 (11.24%) of the cases died (8 CV deaths). The optimal cut-off value for GNRI was determined as 104.2 by ROC analysis [AUC = 0.682 ± 0.06, (95% CI, 0.549-0.815), p = 0.01]. The low GNRI group had a higher risk for all-cause and CV mortality compared to the higher GNRI group (p = 0.02 for both in log-rank test). The optimal sex-specific cut-off was 12.18 mg/kg/day for men [AUC = 0.723 ± 0.07, (95% CI, 0.574-0.875), p = 0.03] and was 12.08 mg/kg/day for females [AUC = 0.649 ± 0.13, (95% CI, 0.384- 0.914), p = 0.01]. Patients with lower sex-specific CI values had higher all-cause and CV mortality (p = 0.001 and p = 0.009 in log-rank test, respectively). In multivariate cox models, both GNRI [HR = 4.904 (% 95 CI, 1.77-13.56), p = 0.002] and sex-specific CI [HR = 5.1 (95% CI, 1.38-18.9), p = 0.01] predicted all-cause mortality. The association of GNRI with CV was lost [HR = 2.6 (CI 95%, 0.54-13.455), p = 0.22], but low CI had a very strong association with CV mortality [HR = 11.48 (CI 95%, 1.25 -104), p = 0.03]. DISCUSSION: In hemodialysis patients, GNRI and CI have similar powers in predicting all-cause short-term mortality. The association of CI with all-cause death depends on gender. On the other hand, sex-specific CI predicts CV mortality better than GNRI.

Revisiting the financial market interdependence during COVID-19 times: a study of green bonds, cryptocurrency, commodities and other financial markets

Purpose: The purpose of the present study is to contribute to the existing literature by examining the nexus and the connectedness between classes S&P Green Bond Index, S&P GSCI Crude Oil Index, S&P GSCI Gold, MSCI Emerging Markets Index, MSCI World Index and Bitcoin, during the pre-and post-Covid period beginning from August 2011 to July 2021 (10 years). Design/methodology/approach: The study employs time-varying parameter vector autoregression and Quantile regression methods to understand the impact of events on traditional and upcoming asset classes. To further understand the connectedness of assets under consideration, the study used Geo-Political Risk Index (GPR) and Global Economic Policy and Uncertainty index (GPEU). Findings: Findings show that these markets are strongly linked, which will only expand in the post-pandemic future. Before the pandemic, the MSCI World and Emerging Markets indices contributed the most shocks to the remaining market variables. Green bond index shows a greater correlation and shock transmission with gold. Bitcoin can no longer be used as a good hedging instrument, validating the fact that the 21st-century technology assets. The results further opine that under extreme economic consequences with high GPR and GPEU, even gold cannot be considered a safe investment asset. Originality/value: Financial markets and the players who administer and communicate their investment logics are heavily reliant on conventional asset classes such as oil, gas, coal, nuclear and allied groupings, but these emerging asset classes are attempting to diversify. © 2022, Emerald Publishing Limited.

COVID-19 in the perioperative setting: A review of the literature and the clinical landscape.

The COVID-19 pandemic has dramatically affected societies and healthcare systems around the globe. The perioperative care continuum has also been under significant strain due to the pandemic-tasked with simultaneously addressing surgical strains and backlogs, infection prevention strategies, and emerging data regarding significantly higher perioperative risk for COVID-19 patients and survivors. Many uncertainties persist regarding the perioperative risk, assessment, and management of COVID-19 survivors-and the energy to catch up on surgical backlogs must be tempered with strategies to continue to mitigate COVID-19 related perioperative risk. Here, we review the available data for COVID-19-related perioperative risk, discuss areas of persistent uncertainty, and empower the perioperative teams to pursue evidence-based strategies for high quality, patient-centered, team-based care as we enter the third year of the COVID-19 pandemic.

Geriatric Nutritional Risk Index assessment in elderly patients during the COVID-19 outbreak.

Background and Aims: Globally, coronavirus disease-2019 (COVID-19) is persistent in many countries and presents a major threat to public health. Critically, elderly individuals, especially those with underlying disease, poor nutritional and immune functions, are highly susceptible. Therefore, we analyzed the epidemiological features in elderly COVID-19 patients. Methods: In total, 126 patients were recruited in the Fifth Affiliated Hospital of Sun Yat-sen University, China from January 2020 to March 2020 (including 103 confirmed COVID-19 patients and 23 elderly suspected cases). Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. We assessed nutritional risks in elderly patients by calculating the Geriatric Nutritional Risk Index (GNRI). Results: When compared with young patients, elderly patients were more likely to have underlying comorbidities and received nutritional support and intensive care unit treatment. Elderly patients had significantly lower levels of the following: lymphocyte percentages, red blood cell counts, hemoglobin levels, and serum albumin values. When compared with suspected COVID-19 elderly cases, elderly patients had significantly lower red blood cell counts and hemoglobin levels. The average GNRI of suspected cases and confirmed patients indicated no nutritional risk. There were no marked differences in GNRI values between groups. Conclusion: Nutritional risk assessments may provide valuable information for predicting a COVID-19 prognosis, especially in elderly patients. Anemia prevention and management should be actively and timely provided. GNRI is a potentially prognostic factor for hospitalized elderly patients. Moreover, it is also important to follow up discharged patients for continuous nutritional observations.

An alternative approach to determination of Covid-19 personal risk index by using fuzzy logic.

COVID-19 disease is an outbreak that seriously affected the whole world, occurred in December 2019, and thus was declared a global epidemic by WHO (World Health Organization). To reduce the impact of the epidemic on humans, it is important to detect the symptoms of the disease in a timely and accurate manner. Recently, several new variants of COVID-19 have been identified in the United Kingdom (UK), South Africa, Brazil and India, and preliminary findings have been suggested that these mutations increase the transmissibility of the virus. Therefore, the aim of this study is to construct a support system based on fuzzy logic for experts to help detect of COVID-19 infection risk in a timely and accurate manner and to get a numerical output on symptoms of the virus from every person. The decision support system consists of three different sub and one main Mamdani type fuzzy inference systems (FIS). Subsystems are Common- Serious symptoms (First), Rare Symptoms (Second) and Personal Information (Third). The first FIS has five inputs, fever-time, cough-time, fatigue-time, shortness of breath and chest pain/dysfunction; the second FIS has four inputs, Loss of Taste/Smell, Body Aches, Conjuctivitis, and Nausea/Vomiting/Diarrhea; and the third FIS has three inputs, Age, Smoke, and Comorbidities. Then, we obtain personal risk index of individual by combining the outputs of these subsystems in a final FIS. The results can be used by health professionals and epidemiologists to make inferences about public health. Numerical output can also be useful for self-control of an individual.

Geriatric Nutritional Risk Index in a group of elderly patients hospitalized for SARS-CoV-2 pneumonia: A retrospective study about correlation with intra-hospital mortality rate and length of hospitalisation

Background and Aim: In medical literature, numerous anthropometric assessment methods and nutritional status assessment scales have been used to identify elderly patients at risk of malnutrition. The Geriatric Nutritional Risk Index (GNRI) is a relatively recent nutritional index used to estimate the risk of nutritionally related morbidity and mortality in hospitalized elderly patients. The purpose of this study is to assess the association between reduced GNRI (cutoff=98) and the basic functional status of the patient with intrahospital mortality rate for all causes or prolonged hospital stay in a group of elderly patients with SARS-CoV-2 pneumonia. Materials and Methods: Retrospective study of 77 elderly patients (>= 70 years old) hospitalized for SARS-CoV-2 pneumonia;for each patient GNRI was calculated and the basic functional level of the patient was considered, according to the Barthel index from the nursing card. Results: In elderly patients with SARS-CoV-2 moderate or severe pneumonia, mortality rate is higher in patients with reduced GNRI, though in our study this data doesn't reach the statistical significance. The average length of hospitalisation is slightly higher in patient with reduced GNRI. Conclusions: In this retrospective study, mortality rate is higher in elderly patients with SARS-CoV-2 pneumonia and reduced GNRI, a data in line with medical literature about GNRI.

WITHDRAWN: Urban citizen health risk assessment for epidemic pneumonia and research on innovation on economic development.

Ahead of Print article withdrawn by publisher.

Health Sentinel: A mobile crowdsourcing platform for self-reported surveys provides early detection of COVID-19 clusters in San Luis Potosí, Mexico.

BACKGROUND: The Health Sentinel (Centinela de la Salud, CDS), a mobile crowdsourcing platform that includes the CDS app, was deployed to assess its utility as a tool for COVID-19 surveillance in San Luis Potosí, Mexico. METHODS: The CDS app allowed anonymized individual surveys of demographic features and COVID-19 risk of transmission and exacerbation factors from users of the San Luis Potosí Metropolitan Area (SLPMA). The platform's data processing pipeline computed and geolocalized the risk index of each user and enabled the analysis of the variables and their association. Point process analysis identified geographic clustering patterns of users at risk and these were compared with the patterns of COVID-19 cases confirmed by the State Health Services. RESULTS: A total of 1554 COVID-19 surveys were administered through the CDS app. Among the respondents, 50.4 % were men and 49.6 % women, with an average age of 33.5 years. Overall risk index frequencies were, in descending order: no-risk 77.8 %, low risk 10.6 %, respiratory symptoms 6.7 %, medium risk 1.4 %, high risk 2.0 %, very high risk 1.5 %. Comorbidity was the most frequent vulnerability category (32.4 %), followed by the inability to keep home lockdown (19.2 %). Statistically significant risk clusters identified at a spatial scale between 5 and 730 m coincided with those in neighborhoods containing substantial numbers of confirmed COVID-19 cases. CONCLUSIONS: The CDS platform enables the analysis of the sociodemographic features and spatial distribution of individual risk indexes of COVID-19 transmission and exacerbation. It is a useful epidemiological surveillance and early detection tool because it identifies statistically significant and consistent risk clusters in neighborhoods with a substantial number of confirmed COVID-19 cases.

A conceptual framework for reopening our society during the Covid-19 pandemic.

Decisions about how to go about the necessary task of re-opening our society in the midst of the Covid-19 (CV19) have been paralyzed by our extremes. But we can neither afford to insist on a zero-risk response, nor can we pretend that the risk does not exist. What is needed are tools to rationally triage the risk. To this end, we propose a novel 'risk index', which is the intersection of two components of risk: 1) the risk of an individual becoming infected due to action 'X'; and 2) the likely probability of death (or serious harm) if that individual develops CV19. The risk index allows risk to be compared across different scenarios, and may reveal that seemingly very different situations constitute similar degrees of risk. With risk measured in this way, one can then contrast different levels of risk against the social benefits of absorbing that risk, allowing actions to be sorted into those that are tolerable, debatable, or acceptable. While these concepts are presented in abstract based on approximate estimates of risk and influenced by our judgements about social desirability, the concept itself can be refined as more accurate approximations of risk and broadly accepted values of social desirability are derived empirically. In short, this is a tool intended to provide a useful empirical framework for rationale decision making about CV19.

Observations on the Occurrence, Transmission and Management of the COVID-19 Pandemic Derived from Physics.

Three important observations derived from the ongoing COVID-19 pandemic could result in the development of novel approaches to deal with it and avoid or at least minimize the occurrence and impact of future outbreaks. First, the dramatic increase in pandemics in the past decade alone suggests that the current relationship of humans with the environment is quickly becoming unstable, with potentially catastrophic consequences. In order to reduce the toll in life and property, we would need to shift our emphasis from control of nature to a symbiosis with nature. This, then, can become the new framework for dealing effectively with environmental issues such as climate change, whereby properly applied medical science would provide the necessary impetus for action. Second, the existence of superspreaders of infection among populations in this pandemic requires that we develop objective tests, most likely of a genetic nature, to identify them rather than apply indiscriminate and draconian controls across the board. Not identifying superspreaders in a timely fashion could allow this pandemic to turn into a black swan event, with a catastrophic impact on society. Third, we need to refocus our efforts in dealing with this pandemic from the virus itself to the human hosts. An objective morbidity risk index can be developed such that most of us can go about our daily business without the fear of becoming seriously ill, while measures can be implemented to protect those who are most vulnerable to this virus. These observations point clearly to a need for a paradigm shift.