Panel stacking is a threat to consensus statement validity.

Consensus statements can be very influential in medicine and public health. Some of these statements use systematic evidence synthesis but others fail on this front. Many consensus statements use panels of experts to deduce perceived consensus through Delphi processes. We argue that stacking of panel members towards one particular position or narrative is a major threat, especially in absence of systematic evidence review. Stacking may involve financial conflicts of interest, but non-financial conflicts of strong advocacy can also cause major bias. Given their emerging importance, we describe here how such consensus statements may be misleading, by analysing in depth a recent high-impact Delphi consensus statement on COVID-19 recommendations as a case example. We demonstrate that many of the selected panel members and at least 35% of the core panel members had advocated towards COVID-19 elimination (zero-COVID) during the pandemic and were leading members of aggressive advocacy groups. These advocacy conflicts were not declared in the Delphi consensus publication, with rare exceptions. Therefore, we propose that consensus statements should always require rigorous evidence synthesis and maximal transparency on potential biases towards advocacy or lobbyist groups to be valid. While advocacy can have many important functions, its biased impact on consensus panels should be carefully avoided.

Could high heat cooking and food processing promoting neo-formed contaminants partially explain the high prevalence of chronic kidney disease in South Asian populations? A hypothesis.

BACKGROUND AND AIMS: The occurrence of chronic heart and kidney diseases among the South Asian populations has been rising exponentially over the years. Research has been carried out in the past to explain the increased susceptibility with no resultant strong evidence. Various possible causes have been suggested with a previous hypothesis suggestive of high heat cooking techniques being responsible for increased production of neo-formed contaminants such as advanced glycation end products (AGEs) and trans-fatty acids (TFAs) leading to increased chronic heart diseases among the South Asian diaspora (India, Pakistan, Bangladesh, Sri Lanka in South Asia and overseas). The aim of this study proposes the high-heating cooking techniques and subsequent NFCs also to be responsible for the development of chronic kidney ailments among the South Asians. METHODS: Review of the literature was conducted to ascertain the burden of accumulation and actions of AGEs and TFAs on kidney structure and functions. The varied high-heat cooking techniques including reheating of oils, food processing and kinds of food sources and their association with increased NFCs production and kidney damage were explored. RESULTS: Higher NFCs content of AGEs/TFAs in reheated oils at elevated temperatures and TFAs among processed and fast foods of South Asians was associated with elevated diabetic complications and CKDs progression in few animal and human studies but the research on the actual burden of NFCs in the renal tissues of South Asians was lacking. CONCLUSION: We hypothesize the high heat cooked foods generating increased levels of NFCs to be responsible for the preponderance of higher risk of CKDs among South Asians. Scientific exploration of the hypothesis to obtain quantifiable evidence of NFCs is suggested.

Comparing the COVID-19 pandemic in space and over time in Europe, using numbers of deaths, crude rates and adjusted mortality trend ratios.

Comparison of COVID-19 trends in space and over time is essential to monitor the pandemic and to indirectly evaluate non-pharmacological policies aimed at reducing the burden of disease. Given the specific age- and sex- distribution of COVID-19 mortality, the underlying sex- and age-distribution of populations need to be accounted for. The aim of this paper is to present a method for monitoring trends of COVID-19 using adjusted mortality trend ratios (AMTRs). Age- and sex-mortality distribution of a reference European population (N = 14,086) was used to calculate age- and sex-specific mortality rates. These were applied to each country to calculate the expected deaths. Adjusted Mortality Trend Ratios (AMTRs) with 95% confidence intervals (C.I.) were calculated for selected European countries on a daily basis from 17th March 2020 to 29th April 2021 by dividing observed cumulative mortality, by expected mortality, times the crude mortality of the reference population. These estimated the sex- and age-adjusted mortality for COVID-19 per million population in each country. United Kingdom experienced the highest number of COVID-19 related death in Europe. Crude mortality rates were highest Hungary, Czech Republic, and Luxembourg. Accounting for the age-and sex-distribution of the underlying populations with AMTRs for each European country, four different patterns were identified: countries which experienced a two-wave pandemic, countries with almost undetectable first wave, but with either a fast or a slow increase of mortality during the second wave; countries with consistently low rates throughout the period. AMTRs were highest in Eastern European countries (Hungary, Czech Republic, Slovakia, and Poland). Our methods allow a fair comparison of mortality in space and over time. These might be of use to indirectly estimating the efficacy of non-pharmacological health policies. The authors urge the World Health Organisation, given the absence of age and sex-specific mortality data for direct standardisation, to adopt this method to estimate the comparative mortality from COVID-19 pandemic worldwide.

Review of infective dose, routes of transmission and outcome of COVID-19 caused by the SARS-COV-2: comparison with other respiratory viruses.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is pandemic. Prevention and control strategies require an improved understanding of SARS-CoV-2 dynamics. We did a rapid review of the literature on SARS-CoV-2 viral dynamics with a focus on infective dose. We sought comparisons of SARS-CoV-2 with other respiratory viruses including SARS-CoV-1 and Middle East respiratory syndrome coronavirus. We examined laboratory animal and human studies. The literature on infective dose, transmission and routes of exposure was limited specially in humans, and varying endpoints were used for measurement of infection. Despite variability in animal studies, there was some evidence that increased dose at exposure correlated with higher viral load clinically, and severe symptoms. Higher viral load measures did not reflect coronavirus disease 2019 severity. Aerosol transmission seemed to raise the risk of more severe respiratory complications in animals. An accurate quantitative estimate of the infective dose of SARS-CoV-2 in humans is not currently feasible and needs further research. Our review suggests that it is small, perhaps about 100 particles. Further work is also required on the relationship between routes of transmission, infective dose, co-infection and outcomes.

Migration, ethnicity, racism and the COVID-19 pandemic: A conference marking the launch of a new Global Society.

The inaugural conference of the Global Society on Migration, Ethnicity, Race and Health COVID-19 examined the impact of the COVID-19 pandemic on migrants and ethnic minorities and the role of racism. Migrants everywhere have faced tightening immigration restrictions, more obstacles to healthcare, increased racism and worsening poverty. Higher COVID-19 mortality rates have been otbserved in ethnic/racial minorities in the United Kingdom and the United States. Structural racism has been implicated, operating, for example, through more crowded living conditions and higher-risk occupations. In Brazil, good data are lacking but a seroprevalence survey suggested higher rates of infection among ethnic minorities and slum dwellers. Considerable disruption of services for migrants at the border with Venezuela have occurred. National policy responses to protect vulnerable groups have been lacking. In Australia, with strict COVID-19 control metrtrun 0asures and inclusive policies, there have been few cases and deaths reported in Indigenous communities so far. In most countries, the lack of COVID-19 data by ethnic/racial group or migrant status should be addressed. Otherwise, racism and consequent inequalities will go undetected.

Vaccines for COVID-19: learning from ten phase II trials to inform clinical and public health vaccination programmes.

Public health professionals and clinicians, in many countries, are immersed in the ongoing and upcoming vaccination programmes for COVID-19. Published information from vaccine trials is complex. There are important and helpful insights about the nature of the available and forthcoming vaccines, immune responses and side-effects from phase II trials. We have systematically summarised information from 10 such trials on the nature of the vaccines, exclusions from the trials, immunological effects and side-effects. Some important information within these trial reports is not available in the phase III trial articles, so a complete picture requires examination of phase II and phase III trials for each vaccine. We recommend our systematic approach for the examination of other upcoming COVID-19 vaccine phase II and III trials.