Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US

Intersectionality and the Association Between State-Level Structural Racism, Binge Alcohol Consumption, and Smoking Status Among Black Americans

BACKGROUND

Structural racism is associated with alcohol and tobacco use among Black Americans. There is a need to understand how this relationship differs within varying groups of Black Americans. This study assessed the moderating roles of age, gender, and income in the association between structural racism and binge alcohol consumption and tobacco smoking status among Black Americans.

METHODS

A state-level index of structural racism was merged with data from a national probability sample of 1946 Black Americans. Hierarchical linear and logistic regression models tested associations between structural racism (measured by residential segregation, and economic, incarceration, and educational inequities) and binge alcohol use and smoking status among Black Americans by stratified by age, gender, and income. Moderating effects of age, gender, and income were tested using slope estimate comparisons.

RESULTS

Results indicated statistically significant positive associations between incarceration disparities and binge drinking and smoking status among Black Americans below age 65. An inverse association was detected between education disparities and smoking status among Black Americans below age 65 and among higher-income Black Americans. Age, gender, and income were not significant moderators of these associations.

CONCLUSIONS

Age, gender, and income do not moderate the association between state-level structural racism and binge alcohol or tobacco use behaviors among the current sample of Black Americans.

IMPACT

Addressing structural racism may have implications for reducing participation in binge drinking and tobacco use behaviors among Black Americans, regardless of their age, gender, or income. This has implications for healthy equity and cancer prevention and control.

Automated local lockdowns for SARS-CoV-2 epidemic control-assessment of effect by controlled interrupted time series analysis

Objectives

During the COVID-19 pandemic, broad non-pharmaceutical interventions such as national lockdowns were effective but had significant drawbacks, prompting targeted approaches, such as Denmark's localized lockdowns, based on specific epidemiological criteria. This study evaluates the effect of Denmark's automated local lockdown strategy on epidemic control to inform future response.

Methods

This was a register-based controlled interrupted time series analysis, examining SARS-CoV-2 infection rates in Danish parishes from March to September 2021. The matching of control parishes was based on location, time, and pre-lockdown infection trends, with the lockdown's start defined as the day after a parish exceeded the lockdown criteria. Follow-up included 3-week pre-lockdown and 2-week post-lockdown.

Results

A total of 30 parishes were mandated to lockdown, approximately 3.5% of the population of Denmark. A total of 94 control parishes were used as 109 controls. The decrease in the incidence during the 2-week follow-up period after the initiation of the lockdown was 13% points higher in case parishes: in case parishes, the incidence was reduced by 78% compared with 65% in control parishes.

Conclusions

Our findings demonstrate that local lockdowns did have a positive effect in mitigating the spread of the SARS-CoV-2 virus, making them valuable in the fight against the COVID-19 pandemic and an important alternative to national lockdowns.

COVID-19 School Closures Were Associated With A Decline In Employment For Female Nurses With Young Children

COVID-19-related school closures may have had unintended consequences affecting the ability of health professionals with school-age children to work-particularly female professionals, who often have disproportionate child care responsibilities. We combined labor-force participation data from the Current Population Survey with measures of school closures based on cell phone mobility data to examine the association between local school closures and labor supply among female nurses during the COVID-19 pandemic. During the six months after large-scale closure of schools at the end of the 2019-20 school year (March-August 2020), among counties with above-median school closure rates, the employment rate of female nurses with young children declined by 12.5 percentage points versus the rate during the prior four months (November 2019-February 2020); the change in the employment rate in below-median counties was not statistically significant. No statistically significant changes were observed among female nurses who had only older children or among male nurses. During public health emergencies, policies should consider how disruptions to schooling may affect the labor supply of health care professionals. Strategies might include direct provision of child care by health care facilities, subsidies and other aid to child care centers, or subsidies to health care workers for affordable child care.

A data-driven analysis on the mediation effect of compartment models between control measures and COVID-19 epidemics

By collecting various control policies taken by 127 countries/territories during the first wave of COVID-19 pandemic until July 2nd, 2020, we evaluate their impacts on the epidemic dynamics quantitatively through a combination of the multiple linear regression, neural-network-based nonlinear regression and sensitivity analysis. Remarkable differences in the public health policies are observed across these countries, which affect the spreading rate and infected population size to a great extent. Several key dynamical features, like the normalized cumulative numbers of confirmed/cured/death cases on the 100th day and the half time, show statistically significant linear correlations with the control measures, which thereby confirms their dramatic impacts. Most importantly, we perform the mediation analysis on the SEIR-QD model, a representative of general compartment models, by using the structure equation modeling for multiple mediators operating in parallel. This, to the best of our knowledge, is the first of its kind in the field of epidemiology. The infection rate and the protection rate of the SEIR-QD model are confirmed to exhibit a statistically significant mediation effect between the control measures and dynamical features of epidemics. The mediation effect along the pathway from control measures in Category 2 to four dynamical features through the infection rate, highlights the crucial role of nucleic acid testing and suspected cases tracing in containing the spread of the epidemic. Our data-driven analysis offers a deeper insight into the inherent correlations between the effectiveness of public health policies and the dynamic features of COVID-19 epidemics.

Geography versus sociodemographics as predictors of changes in daily mobility across the USA during the COVID-19 pandemic: a two-stage regression analysis across 26 metropolitan areas

OBJECTIVE

We investigated whether a zip code's location or demographics are most predictive of changes in daily mobility throughout the course of the COVID-19 pandemic.

DESIGN

We used a population-level study to examine the predictability of daily mobility during the COVID-19 pandemic using a two-stage regression approach, where generalised additive models (GAM) predicted mobility trends over time at a large spatial level, then the residuals were used to determine which factors (location, zip code-level features or number of non-pharmaceutical interventions (NPIs) in place) best predict the difference between a zip code's measured mobility and the average trend on a given date.

SETTING

We analyse zip code-level mobile phone records from 26 metropolitan areas in the USA on 15 March-31 September 2020, relative to October 2020.

RESULTS

While relative mobility had a general trend, a zip code's city-level location significantly helped to predict its daily mobility patterns. This effect was time-dependent, with a city's deviation from general mobility trends differing in both direction and magnitude throughout the course of 2020. The characteristics of a zip code further increased predictive power, with the densest zip codes closest to a city centre tended to have the largest decrease in mobility. However, the effect on mobility change varied by city and became less important over the course of the pandemic.

CONCLUSIONS

The location and characteristics of a zip code are important for determining changes in daily mobility patterns throughout the course of the COVID-19 pandemic. These results can determine the efficacy of NPI implementation on multiple spatial scales and inform policy makers on whether certain NPIs should be implemented or lifted during the ongoing COVID-19 pandemic and when preparing for future public health emergencies.

The Effect of Peer Relationships on Adolescent Loneliness: The Role of Psychological Resilience and the OXTR Gene

Background

Based on the gene-environment interaction paradigm, this study explored the effect of peer relationships on adolescent loneliness and the role of psychological resilience and the oxytocin receptor gene (OXTR).

Methods

A survey was conducted in a sample of 619 adolescents, and their oral cells were collected for DNA extraction and genotyping.

Results

The results showed that (1) both peer relationships and psychological resilience significantly affected adolescent loneliness; (2) psychological resilience partially mediated the relationship between peer relationships and loneliness in adolescents; (3) OXTR gene rs53576 polymorphism moderated both the first and second half of the indirect pathway of the mediation model. Specifically, carriers of the rs53576 polymorphism A/A genotype showed a significantly enhanced effect of peer relationships on adolescent psychological resilience, while carriers of the rs53576 polymorphism G/G genotype showed a significantly enhanced effect of psychological resilience on adolescent loneliness.

Conclusion

These findings helped elucidate the developmental mechanisms of adolescent loneliness in terms of peer relationships, psychological resilience, and OXTR gene polymorphisms.

Limited impact of lifting universal masks on SARS-CoV-2 transmission in schools: The crucial role of outcome measurements

Amid the COVID-19 pandemic, education systems globally implemented protective measures, notably mandatory mask wearing. As the pandemic's dynamics changed, many municipalities lifted these mandates, warranting a critical examination of these policy changes' implications. This study examines the effects of lifting mask mandates on COVID-19 transmission within Massachusetts school districts. We first replicated previous research that utilized a difference-in-difference (DID) model for COVID-19 incidence. We then repeated the DID analysis by replacing the outcome measurement with the reproductive number (Rt ), reflecting the transmissibility. Due to the data availability, the Rt we estimated only measures the within school transmission. We found a similar result in the replication using incidence with an average treatment effect on treated (ATT) of 39.1 (95% CI: 20.4 to 57.4) COVID-19 cases per 1,000 students associated with lifting masking mandates. However, when replacing the outcome measurement to Rt , our findings suggest that no significant association between lifting mask mandates and reduced Rt (ATT: 0.04, 95% CI: -0.09 to 0.18), except for the first 2 weeks postintervention. Moreover, we estimated Rt below 1 at 4 weeks before lifting mask mandates across all school types, suggesting nonsustainable transmission before the implementation. Our reanalysis suggested no evidence of lifting mask mandates in schools impacted the COVID-19 transmission in the long term. Our study highlights the importance of examining the transmissibility outcome when evaluating interventions against transmission.

COVID-19 testing, incidence, and positivity trends among school age children during the academic years 2020-2022 in the State of Qatar: special focus on using CDC indicators for community transmission to evaluate school attendance policies and public health response

BACKGROUND

There exists a gap in our understanding of the age-dependent epidemiological dynamics of SARS-CoV-2 among school-age children in comparison to adults within the State of Qatar. Additionally, there has been limited assessment of the timely implementation of physical distancing interventions, notably national school closures, and their impact on infection trends.

METHODS

We used the national database to capture all records of polymerase-chain-reaction (PCR) testing, and rapid antigen tests (RAT) conducted at all health care venues in Qatar and administered between August 26, 2020, and August 21, 2022, across all age groups (≥ 5 years old). Study participants under 18 years old were categorized into two age brackets: (5-11) and (12-17), aligning with the Primary and Preparatory/Secondary grade levels in Qatar, respectively. We assessed age group testing rates, incidence rates, and positivity rates in relation to adults. These epidemiological metrics were compared with the CDC's thresholds for COVID-19 community transmission.

RESULTS

Throughout the school years of 2020-2021 and 2021-2022, a total of 5,063,405 and 6,130,531 tests were respectively conducted. In the 2020-2021 school year, 89.6% of the tests were administered to adults, while 13.7% were conducted on children in the following year. The overall test positivity rates for the 2020-2021 and 2021-2022 school years were 5.8% and 8.1%, respectively. Adolescents underwent the fewest tests during the full study period compared to both adults and young children. Using the CDC indicators, we found that children and adolescents can significantly contribute to elevated infection rates, potentially driving community transmission upon relaxation of social restrictions.

CONCLUSION

It is crucial to acknowledge the potential for higher transmission among youth and adolescents when formulating transmission control strategies and making decisions regarding school closures. Employing data-driven indicators and thresholds to monitor COVID-19 community levels is important for informing decision-making. These approaches also enable the prompt implementation of infection control transmission mitigation measures in future pandemics.

Association of School Instructional Mode with Community COVID-19 Incidence during August-December 2020 in Cuyahoga County, Ohio

Remote and hybrid modes of instruction were employed as alternatives to in-person instruction as part of early mitigation efforts in response to the COVID-19 pandemic. We investigated the impact of a public school district's instructional mode on cumulative incidence and transmission in the surrounding community by employing a generalized estimating equations approach to estimate the association with weekly COVID-19 case counts by zip code in Cuyahoga County, Ohio, from August to December 2020. Remote instruction only (RI) was employed by 7 of 20 school districts; 13 used some non-remote instruction (NRI) (2-15 weeks). Weekly incidence increased in all zip codes from August to peak in late fall before declining. The zip code cumulative incidence within NRI school districts was higher than in those offering only RI (risk ratio = 1.12, p = 0.01; risk difference = 519 per 100,000, 95% confidence interval (123-519)). The mean effect for NRI on emergent cases 2 weeks after mode exposure, controlling for Social Vulnerability Index (SVI), was significant only for high SVI zip codes 1.30, p < 0.001. NRI may be associated with increased community COVID-19 incidence, particularly in communities with high SVI. Vulnerable communities may need more resources to open schools safely.

Quantification of multiple respiratory viruses in wastewater in the Kathmandu Valley, Nepal: Potential implications of wastewater-based epidemiology for community disease surveillance in developing countries

Despite being the major cause of death, clinical surveillance of respiratory viruses at the community level is very passive, especially in developing countries. This study focused on the surveillance of three respiratory viruses [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A virus (IFV-A), and respiratory syncytial virus (RSV)] in the Kathmandu Valley, Nepal, by implication of wastewater-based epidemiology (WBE). Fifty-one untreated wastewater samples were from two wastewater treatment plants (WWTPs) between April and October 2022. Among eight combinations of the pre-evaluated methods, the combination of concentration by simple centrifugation, pretreatment by DNA/RNA Shield (Zymo Research), and extraction by the QIAamp Viral RNA Mini Kit (QIAGEN) showed the best performance for detecting respiratory viruses. Using this method with a one-step reverse transcription-quantitative polymerase chain reaction (RT-qPCR), SARS-CoV-2 RNA was successfully detected from both WWTPs (positive ratio, 100 % and 81 %) at concentrations of 5.6 ± 0.6 log10 copies/L from each WWTP. Forty-six SARS-CoV-2 RNA-positive samples were further tested for three mutation site-specific one-step RT-qPCR (L452R, T478K, and E484A/G339D), where G339D/E484A mutations were frequently detected in both WWTPs (96 %). IFV-A RNA was more frequently detected in WWTP A (84 %) compared to WWTP B (38 %). RSV RNA was also detected in both WWTPs (28 % and 8 %, respectively). This is the first study on detecting IFV-A and RSV in wastewater in Nepal, showing the applicability and importance of WBE for respiratory viruses in developing countries where clinical data are lacking.

Impact of Covid -19 incidence rate and government-initiated risk communication measures on individual's NPI practices

BACKGROUND

Non-pharmaceutical interventions (NPI) are the most widely recognized public health measures recognized globally to prevent the spread of Covid-19. NPIs' effectiveness may depend on the type, combination of applied interventions, and the level of proper public compliance with the NPIs. The expected outcome of behavioural practices varies relative to the intervention duration.

OBJECTIVES

This study aimed to assess the trend of community compliance to NPI with Covid-19 incidence and government-initiated interventions, and its variation by residence and sociodemographic characteristics of people.

METHODS

A weekly non-participatory field survey on individuals' NPI practices was observed from the 41st epidemiological week of October 5th, 2020, to the 26th epidemiological week of July 4th, 2021, a total of 39 weeks. The survey covered all 14 regional and national capital cities in Ethiopia. Data collection for the three NPI behaviours (i.e., respiratory hygiene, hand hygiene, and physical distance) was managed weekly at eight public service locations using the Open Data Kit (ODK) tool. The Covid- 19 incidence data and public health measures information from August 3rd, 2020 to July 4th, 2021 were obtained from the Ethiopian Public Health Institute (EPHI).

RESULTS

More than 180,000 individuals were observed for their NPI practice, with an average of 5,000 observations in a week. About 43% of the observations were made in Addis Ababa, 56% were male and 75% were middle age group (18-50 years). The overall level of NPI compliance was high at the beginning of the observation then peaked around the 13th- 15th epidemiological weeks then declined during the rest of the weeks. The peak NPI compliance periods followed the high Covid-19 death incidence and government-initiated intensive public health measures weeks. Respiratory hygiene had the highest compliance above 41% whereas hand hygiene was the lowest (4%). There was a significant difference between residents of the capital city and regional cities in their level of compliance with NPI. Females comply more than males, and individuals had increased NPI compliance at the bank service and workplaces compared to those in the transport services at P = 0.000.

CONCLUSION

An increased level of compliance with NPI was observed following intensive government-initiated Covid-19 prevention measures and an increased Covid-19 death incidence. Therefore, the intensity of government-initiated risk communication and public advocacy programs should be strengthened, possibly for similar respiratory disease pandemics in the future.

Modeling the impact of distancing measures on infectious disease spread: a case study of COVID-19 in the Moroccan population

This paper explores the impact of various distancing measures on the spread of infectious diseases, focusing on the spread of COVID-19 in the Moroccan population as a case study. Contact matrices, generated through a social force model, capture population interactions within distinct activity locations and age groups. These matrices, tailored for each distancing scenario, have been incorporated into an SEIR model. The study models the region as a network of interconnected activity locations, enabling flexible analysis of the effects of different distancing measures within social contexts and between age groups. Additionally, the method assesses the influence of measures targeting potential superspreaders (i.e., agents with a very high contact rate) and explores the impact of inter-activity location flows, providing insights beyond scalar contact rates or survey-based contact matrices. The results suggest that implementing intra-activity location distancing measures significantly reduces in the number of infected individuals relative to the act of imposing restrictions on individuals with a high contact rate in each activity location. The combination of both measures proves more advantageous. On a regional scale, characterized as a network of interconnected activity locations, restrictions on the movement of individuals with high contact rates was found to result in a $ 2 \% $ reduction, while intra-activity location-based distancing measures was found to achieve a $ 44 \% $ reduction. The combination of these two measures yielded a $ 48\% $ reduction.

Impact of alternative Non-Pharmaceutical Interventions strategies for controlling COVID-19 outbreak in Bangladesh: A modeling study

The COVID-19 pandemic has been a major health concern in Bangladesh until very recently. Although the Bangladesh government has employed various infection control strategies, more targeted Non-Pharmaceutical interventions (NPIs), including school closure, mask-wearing, hand washing, and social distancing have gained special attention. Despite significant long-term adverse effects of school closures, authorities have opted to keep schools closed to curb the spread of COVID-19 infection. However, there is limited knowledge about the impact of reopening schools alongside other NPI measures on the course of the epidemic. In this study, we implemented a mathematical modeling framework developed by the CoMo Consortium to explore the impact of NPIs on the dynamics of the COVID-19 outbreak and deaths for Bangladesh. For robustness, the results of prediction models are then validated through model calibration with incidence and mortality data and using external sources. Hypothetical projections are made under alternative NPIs where we compare the impact of current NPIs with school closures versus enhanced NPIs with school openings. Results suggest that enhanced NPIs with schools opened may have lower COVID-19 related prevalence and deaths. This finding indicates that enhanced NPIs and school openings may mitigate the long-term negative impacts of COVID-19 in low- and middle-income countries. Potential shortcomings and ways to improve the research are also discussed.

The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans

BACKGROUND

Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans.

METHODS

An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates.

RESULTS

Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status.

CONCLUSIONS

Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans.

IMPACT

Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.

Unlocking the importance of perceived governance: The impact on COVID-19 in NUTS-2 European regions

In the immediate aftermath of the pandemic, governments implemented non-pharmaceutical interventions (NPIs). Previous literature suggests that NPI effectiveness is influenced by governance quality. The acceptance and perceived necessity of these measures by the public are crucial to their success, as NPIs cannot be easily enforced without public support. Does regional governance also play a role? This study examines the correlation between the quality of governance in European NUTS-2 regions and the spread of COVID-19. The findings indicate that overall perceived governance, and its perceived quality and corruption pillars, significantly impact the effectiveness of these interventions. This effect was pronounced during the first wave and then diminished in importance, disappearing before vaccines were available, suggesting that regional governance matters especially in the immediate aftermath of an exogenous shock.

Prolonged School Closure and Pediatric Respiratory Hospitalization: The Silver Lining of the COVID-19 Pandemic

Objective. This is a single-center retrospective cohort study that aimed to quantitatively assess the association between prolonged school closure (>2 weeks) and pediatric respiratory hospitalization during the COVID-19 pandemic. Methods. Subjects included 1243 patients presenting to Children's Hospital of Michigan during the winters of 2019, 2020, and 2021. The primary outcome measures were total respiratory hospitalizations and respiratory diagnoses. Results. Data was analyzed using a 2-sample z-test for proportions. We found that pediatric patients in the setting of prolonged school closure had significantly fewer hospitalizations in 2020 compared to 2019 (9% vs 47%; P < .001) and 2021 (9% vs 45%; P < .001). There were decreases in bronchiolitis, asthma/reactive airway disease (RAD), and pneumonia hospitalizations compared to 2019 and 2021. Conclusions. Our study showed that during prolonged school closure, there was a significant decrease in pediatric respiratory hospitalization. As such, it should be considered when creating a pandemic response strategy.

COVID-19 impact on facial trauma: Insights from Mississippi's only level 1 trauma center

PURPOSE

Our primary aim was to understand and describe the impact of COVID-19 on the incidence and etiology of facial trauma in the state of Mississippi.

METHODS

Retrospective review of facial trauma-related Emergency Department encounters in Mississippi from March 11, 2019 to March 10, 2021, divided into three time periods using the state of Mississippi's Governor's Office Executive Orders. Chi-square tests and segmented linear regressions were used for analysis.

RESULTS

Patients presenting with facial trauma were typically male, 18-44 years old, and lived in urban zip codes. Insurance payors significantly differed across time periods. There were no significant differences in self-inflicted assault or accidental injury between the 3 time periods, with pre- and pandemic patients more likely to be self-pay while patients during recovery being more likely to have private insurance. During the pandemic, facial trauma from a family member, partner or spouse, or other person in the household significantly increased.

CONCLUSION

Similar accidental facial trauma trends may reflect lower adherence to social distancing guidelines. The increase in facial trauma perpetrated by family members is consistent with reported increases in domestic violence during the pandemic. While overall facial trauma demographic patterns did not change significantly during the COVID-19 pandemic, there were notable changes in the etiology and insurance payor of facial trauma cases.

LAY SUMMARY

The COVID-19 pandemic impacted healthcare systems worldwide, and our study seeks to understand how the pandemic affected incidence of facial trauma.

LEVEL OF EVIDENCE: 2

The emotion prediction of college students with attention LSTM during the COVID19 epidemic

During the COVID19 pandemic, there is a pronounced collective mental health issue among college students. Forecasting the trend of emotional changes in on-campus students is crucial to effectively address this issue. This study proposes an Attention-LSTM neural network model that performs deep learning on key input sequence information, so as to predict the distribution of emotional states in college students. By testing 60 consecutive days of emotional data, the model successfully predicts students' emotional distribution, triggers and resolution strategies, with an accuracy rate of no less than 99%. Compared with models such as ARIMA, SARIMA and VAR, this model shows significant advantages in accuracy, operational efficiency, and data collection requirements. The integration of deep learning technology with student management in this study offers a novel approach to address emotional issues among students under exceptional circumstances.

Evaluating the Effectiveness of School Closure in COVID-19-Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study

BACKGROUND

During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries.

OBJECTIVE

This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19-related syndromes in an outpatient syndromic surveillance system.

METHODS

We calculated the incidence of COVID-19-related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19-related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals.

RESULTS

School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19-related syndromes in 2021 for 2 weeks after the intervention (coefficient -1.24, 95% CI -2.40 to -0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ≥65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups.

CONCLUSIONS

Overall, school closure effectively suppresses COVID-19-related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home.

Potential determinants of parental hesitancy to vaccinate their children against COVID-19 infection: a cross-sectional investigation

Coronavirus disease 2019 (COVID-19) vaccination hesitancy has emerged as a substantial concern among the adult population globally. However, limited evidence is available about parental hesitancy to vaccinate their children against COVID-19 within the Pakistani context. Thus, the present investigation aimed to assess parental attitudes, perceptions, and willingness regarding vaccination hesitancy and associated predictors of getting their children vaccinated against COVID-19. We conducted a cross-sectional population-based, self-administered online questionnaire in Punjab, Pakistan, on randomly selected parents between October 2022 and February 2023. The data were collected based on socio-demographics, attitudes, perceptions, and willingness of parents regarding COVID-19 vaccine hesitancy for their children. Adjusted odds ratios with 95% confidence intervals were estimated to identify the predictors of vaccine hesitancy. The findings demonstrated that among 1,478 participants, a total of 40% believed that the COVID-19 vaccine may pose a greater risk to children than adults, while 38% exhibited no concerns. Around 13% of children were not vaccinated in our study sample. More than half expressed hesitancy toward vaccination, and only 35.25% were inclined to get their children vaccinated in our study sample. In addition, only 16% of the parents believed that the COVID-19 vaccination may cause an alteration in their children's DNA. A similar proportion of parents were aware of the significance of getting their children vaccinated and expressed their willingness to vaccinate their children to prevent the COVID-19 infection. However, a higher odds ratio was observed in females with a higher educational background and those in the healthcare profession. In conclusion, healthcare awareness-supporting programs for educating parents should be designed and implemented. These insights might aid in the development of strategies to eradicate barriers in existing coronavirus vaccination programs and may vaccinate a larger child population to reduce the adverse consequences of the pandemic.

The Relationship Between Lockdowns and Video Game Playtime: Multilevel Time-Series Analysis Using Massive-Scale Data Telemetry

BACKGROUND

COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide.

OBJECTIVE

The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games.

METHODS

Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19-related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country.

RESULTS

No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001).

CONCLUSIONS

Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure ("lockdown") procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness.

Effectiveness of social distancing measures and lockdowns for reducing transmission of COVID-19 in non-healthcare, community-based settings

Social distancing measures (SDMs) are community-level interventions that aim to reduce person-to-person contacts in the community. SDMs were a major part of the responses first to contain, then to mitigate, the spread of SARS-CoV-2 in the community. Common SDMs included limiting the size of gatherings, closing schools and/or workplaces, implementing work-from-home arrangements, or more stringent restrictions such as lockdowns. This systematic review summarized the evidence for the effectiveness of nine SDMs. Almost all of the studies included were observational in nature, which meant that there were intrinsic risks of bias that could have been avoided were conditions randomly assigned to study participants. There were no instances where only one form of SDM had been in place in a particular setting during the study period, making it challenging to estimate the separate effect of each intervention. The more stringent SDMs such as stay-at-home orders, restrictions on mass gatherings and closures were estimated to be most effective at reducing SARS-CoV-2 transmission. Most studies included in this review suggested that combinations of SDMs successfully slowed or even stopped SARS-CoV-2 transmission in the community. However, individual effects and optimal combinations of interventions, as well as the optimal timing for particular measures, require further investigation. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Governmental anti-pandemic policies, vaccination, population mobility, Twitter narratives, and the spread of COVID-19: Evidence from the European Union countries

We provide large-scale empirical evidence on the effects of multiple governmental regulatory and health policies, vaccination, population mobility, and COVID-19-related Twitter narratives on the spread of a new coronavirus infection. Using multiple-level fixed effects panel data model with weekly data for 27 European Union countries in the period of March 2020-June 2021, we show that governmental response policies were effective both in reducing the number of COVID-19 infection cases and deaths from it, particularly, in the countries with higher level of rule of law. Vaccination expectedly helped to decrease the number of virus cases. Reductions in population mobility in public places and workplaces were also powerful in fighting the pandemic. Next, we identify four core pandemic-related Twitter narratives: governmental response policies, people's sad feelings during the pandemic, vaccination, and pandemic-related international politics. We find that sad feelings' narrative helped to combat the virus spread in EU countries. Our findings also reveal that while in countries with high rule of law international politics' narrative helped to reduce the virus spread, in countries with low rule of law the effect was strictly the opposite. The latter finding suggests that trust in politicians played an important role in confronting the pandemic.

Effects of School-Based Preventive Measures on COVID-19 Incidence, Hong Kong, 2022

We show that school closures reduced COVID-19 incidence rates in children by 31%-46% in Hong Kong in 2022. After school reopening accompanied by mask mandates, daily rapid testing, and vaccination requirements, school-reported cases correlated with community incidence rates. Safe school reopening is possible when appropriate preventive measures are used.

Systematic review: Impact of parental decision on paediatric COVID-19 vaccination

OBJECTIVE

The objective was to carry out a systematic review on the acceptance of parents to vaccinate their children against COVID-19 and the factors that contribute for vaccination hesitancy.

METHODS

The Preferred Reporting Items for Systematic Re- views and Meta-Analyses (PRISMA) guidelines and the Patient, Intervention, Comparison and Outcome (PICO) strategy were followed. A search was carried out in the VHL Regional Portal, PubMed, Scielo, Web of Science, Embase and Scopus databases. We included articles that assessed the rate of acceptance and/or hesitation of parents and the factors that affect the decision about vaccination against COVID-19 for their children in cross-sectional studies. Laboratory studies, animal models, tests and case reports that elected other aspects related to COVID-19 were excluded. The methodological quality of the studies was based on the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data, developed by the Joanna Briggs Institute.

RESULTS

From the 708 articles found, 237 studies remained after removal of duplicates. Titles and abstracts of these publications were evaluated and, applying the exclusion criteria, 56 articles were selected. Inclusion criteria were employed and 28 studies were eligible. Overall average vaccination acceptance rate was 55.81%, and the main reasons for vaccine hesitancy were uncertainty of vaccine efficacy and safety, concerns about side effects, and lack of access to relevant information.

CONCLUSION

The research results can be useful for the development of health education and parental awareness strategies in order to promote greater adherence to vaccination against COVID-19.

Participatory Mathematical Modeling Approach for Policymaking during the First Year of the COVID-19 Crisis, Jordan

We engaged in a participatory modeling approach with health sector stakeholders in Jordan to support government decision-making regarding implementing public health measures to mitigate COVID-19 disease burden. We considered the effect of 4 physical distancing strategies on reducing COVID-19 transmission and mortality in Jordan during March 2020-January 2021: no physical distancing; intermittent physical distancing where all but essential services are closed once a week; intermittent physical distancing where all but essential services are closed twice a week; and a permanent physical distancing intervention. Modeling showed that the fourth strategy would be most effective in reducing cases and deaths; however, this approach was only marginally beneficial to reducing COVID-19 disease compared with an intermittently enforced physical distancing intervention. Scenario-based model influenced policy-making and the evolution of the pandemic in Jordan confirmed the forecasting provided by the modeling exercise and helped confirm the effectiveness of the policy adopted by the government of Jordan.

Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study

BACKGROUND

The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period.

OBJECTIVE

We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period.

METHODS

Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google's Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison.

RESULTS

Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (n=42; week of April 15, 2020) to 70.9% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (ρ=0.90, P<.001) and March 2020 to May 2022 (ρ=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: ρ=0.90; P<.001; 18-20 years: ρ=0.87; P<.001; 21-24 years: ρ=0.88; P<.001), racial or ethnic minorities (ρ=0.86, P<.001), and respondents with lower socioeconomic status (ρ=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (ρ=0.92, P<.001) and retail and recreation (ρ=0.89, P<.001), and moderate significant correlations for grocery and pharmacy (ρ=0.68, P<.001) and parks (ρ=0.62, P<.001). A strong negative correlation was observed for places of residence (ρ=-0.78, P<.001), and a weak but significant positive correlation was found for workplaces (ρ=0.24, P<.001).

CONCLUSIONS

The Transportation Security Administration's travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States.

Risk factors for transmission in a COVID-19 cluster infection in a high school in the Republic of Korea

BACKGROUND

This study aimed to examine the scale, characteristics, risk factors, and modes of transmission in a coronavirus disease 2019 (COVID-19) outbreak at a high school in Seoul, Republic of Korea.

METHODS

An epidemiological survey was conducted of 1,118 confirmed cases and close contacts from a COVID-19 outbreak at an educational facility starting on May 31, 2021. In-depth interviews, online questionnaires, flow evaluations, and CCTV analyses were used to devise infection prevention measures. Behavioral and spatial risk factors were identified, and statistical significance was tested.

RESULTS

Among 3rd-year students, there were 33 confirmed COVID-19 cases (9.6%). Students who used a study room in the annex building showed a statistically significant 4.3-fold elevation in their relative risk for infection compared to those who did not use the study room. Moreover, CCTV facial recognition analysis confirmed that 17.8% of 3rd-year students did not wear masks and had the lowest percentage of mask-wearers by grade. The air epidemiological survey conducted in the study room in the annex, which met the 3 criteria for a closed space, confirmed that there was only 10% natural ventilation due to the poor ventilation system.

CONCLUSION

To prevent and manage the spread of COVID-19 in educational facilities, advance measures that consider the size, operation, and resources of each school are crucial. In addition, various survey methodologies should be used in future studies to quickly analyze a wider range of data that can inform an evidence-based quarantine response.

Fine scale human mobility changes within 26 US cities in 2020 in response to the COVID-19 pandemic were associated with distance and income

Human mobility patterns changed greatly due to the COVID-19 pandemic. Despite many analyses investigating general mobility trends, there has been less work characterising changes in mobility on a fine spatial scale and developing frameworks to model these changes. We analyse zip code-level within-city mobility data from 26 US cities between February 2 -August 31, 2020. We use Bayesian models to characterise the initial decrease in mobility and mobility patterns between June-August at this fine spatial scale. There were similar temporal trends across cities but large variations in the magnitude of mobility reductions. Long-distance routes and higher-income subscribers, but not age, were associated with greater mobility reductions. At the city level, mobility rates around early April, when mobility was lowest, and over summer showed little association with non-pharmaceutical interventions or case rates. Changes in mobility patterns lasted until the end of the study period, despite overall numbers of trips recovering to near baseline levels in many cities.

Trends in Depressive Symptoms and Suicidality of South Korean Adolescents: Comparison of Expected and Observed Prevalence During the COVID-19 Pandemic

PURPOSE

Depressive symptoms and suicidality of adolescents during the COVID-19 pandemic are emerging public health issues. However, there is a lack of representative studies on adolescents' mental health that considers the preceding secular trends.

METHODS

This descriptive study used nationally representative cross-sectional data of Korean adolescents from the Korea Youth Risk Behavior Survey from 2005 to 2020 (N = 1,035,382). We utilized joinpoint regression analysis to explore the temporal prevalence trends of depressive symptoms, suicidal ideation, and suicide attempts. Based on the annual percentage change until 2019, the expected and actual prevalence in 2020 (N = 54,948) was compared to describe departures of prevalence from the trend line. These trends between sex, school level, ethnic status, and socioeconomic status were also compared.

RESULTS

Considering the recent increase in secular trends until 2019, the actual observed values in 2020 were lower than expected by 13% in depressive symptoms, 20% in suicidal ideation, and 40% in suicide attempts. The gap between sexes, school levels, ethnic status, and socioeconomic groups was similar or narrowed in 2020 compared to previous trends.

DISCUSSION

We observed a lower prevalence of depressive symptoms and suicidality among Korean adolescents than expected about 9 months from the beginning of the COVID-19 pandemic despite the recent increase in secular trends.

The Effects of Non-Pharmaceutical Interventions on COVID-19 Cases, Hospitalizations, and Mortality: A Systematic Literature Review and Meta-Analysis

Introduction

To assess the effects of various non-pharmaceutical interventions (NPI) on cases, hospitalizations, and mortality during the first wave of the COVID-19 pandemic.

Methods

To empirically investigate the impacts of different NPIs on COVID-19-related health outcomes, a systematic literature review was conducted. We studied the effects of 10 NPIs on cases, hospitalizations, and mortality across three periodic lags (2, 3, and 4 weeks-or-more following implementation). Articles measuring the impact of NPIs were sourced from three databases by May 10, 2022, and risk of bias was assessed using the Newcastle-Ottawa scale.

Results

Across the 44 papers, we found that mask wearing corresponded to decreased per capita cases across all lags (up to -2.71 per 100,000). All NPIs studied except business and bar/restaurant closures corresponded to reduced case growth rates in the two weeks following implementation, while policy stringency and travelling restrictions were most effective after four. While we did not find evidence of reduced deaths in our per capita estimates, policy stringency, masks, SIPOs, limited gatherings, school and business closures were associated with decreased mortality growth rates. Moreover, the two NPIs studied in hospitalizations (SIPOs and mask wearing) showed negative estimates.

Conclusions

When assessing the impact of NPIs, considering the duration of effectiveness following implementation has paramount significance. While some NPIs may reduce the COVID-19 impact, others can disrupt the mitigative progression of containing the virus. Policymakers should be aware of both the scale of their effectiveness and duration of impact when adopting these measures for future COVID-19 waves.

A critical assessment of SARS-CoV-2 in aqueous environment: Existence, detection, survival, wastewater-based surveillance, inactivation methods, and effective management of COVID-19

In early January 2020, the causal agent of unspecified pneumonia cases detected in China and elsewhere was identified as a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was the major cause of the COVID-19 outbreak. Later, the World Health Organization (WHO) proclaimed the COVID-19 pandemic a worldwide public health emergency on January 30, 2020. Since then, many studies have been published on this topic. In the present study, bibliometric analysis has been performed to analyze the research hotspots of the coronavirus. Coronavirus transmission, detection methods, potential risks of infection, and effective management practices have been discussed in the present review. Identification and quantification of SARS-CoV-2 viral loads in various water matrices have been reviewed. It was observed that the viral shedding through urine and feces of COVID-19-infected patients might be a primary mode of SARS-CoV-2 transmission in water and wastewater. In this context, the present review highlights wastewater-based epidemiology (WBE)/sewage surveillance, which can be utilized as an effective tool for tracking the transmission of COVID-19. This review also emphasizes the role of different disinfection techniques, such as chlorination, ultraviolet irradiation, and ozonation, for the inactivation of coronavirus. In addition, the application of computational modeling methods has been discussed for the effective management of COVID-19.

Saliva and wastewater surveillance for SARS-CoV-2 during school reopening amid COVID-19 pandemic in Thailand

Objectives

School closure during the coronavirus disease 2019 (COVID-19) pandemic resulted in a negative impact on children. Serial testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proposed as a measure for safety school reopening. We aimed to study the usefulness of SARS-CoV-2 surveillance by saliva testing and performing wastewater surveillance for SARS-CoV-2 in a day school in a resource-limited setting.

Methods

We conducted a cluster randomized study to investigate the potential use of saliva antigen testing compared to saliva pooling for nucleic acid detection in a primary school in Thailand from December 2021 to March 2022. Wastewater surveillance in the school was also performed.

Results

A total of 484 participants attended the study. SARS-CoV-2 was detected in two participants from the tests provided by the study (one in the pool nucleic acid test arm, and another in the quantitative antigen test arm). Additional ten participants reported positive results on an additional rapid antigen test (RAT) performed by nasal swab when they had symptoms or household contact. There was no difference among arms in viral detection by intention-to-treat and per protocol analysis (p = 0.304 and 0.894, respectively). We also investigated the feasibility of wastewater surveillance to detect the virus in this setting. However, wastewater surveillance could not detect the virus.

Conclusions

In a low COVID-19 prevalence, serial saliva testing and wastewater surveillance for SARS-CoV-2 rarely detected the virus in a day school setting. Performing RAT on nasal swabs when students, teachers or staff have symptoms or household contact might be more reasonable.

Disproportionate impacts of COVID-19 in a large US city

COVID-19 has disproportionately impacted individuals depending on where they live and work, and based on their race, ethnicity, and socioeconomic status. Studies have documented catastrophic disparities at critical points throughout the pandemic, but have not yet systematically tracked their severity through time. Using anonymized hospitalization data from March 11, 2020 to June 1, 2021 and fine-grain infection hospitalization rates, we estimate the time-varying burden of COVID-19 by age group and ZIP code in Austin, Texas. During this 15-month period, we estimate an overall 23.7% (95% CrI: 22.5-24.8%) infection rate and 29.4% (95% CrI: 28.0-31.0%) case reporting rate. Individuals over 65 were less likely to be infected than younger age groups (11.2% [95% CrI: 10.3-12.0%] vs 25.1% [95% CrI: 23.7-26.4%]), but more likely to be hospitalized (1,965 per 100,000 vs 376 per 100,000) and have their infections reported (53% [95% CrI: 49-57%] vs 28% [95% CrI: 27-30%]). We used a mixed effect poisson regression model to estimate disparities in infection and reporting rates as a function of social vulnerability. We compared ZIP codes ranking in the 75th percentile of vulnerability to those in the 25th percentile, and found that the more vulnerable communities had 2.5 (95% CrI: 2.0-3.0) times the infection rate and only 70% (95% CrI: 60%-82%) the reporting rate compared to the less vulnerable communities. Inequality persisted but declined significantly over the 15-month study period. Our results suggest that further public health efforts are needed to mitigate local COVID-19 disparities and that the CDC's social vulnerability index may serve as a reliable predictor of risk on a local scale when surveillance data are limited.

Well-being implications of immobility during COVID-19: evidence from a student sample in Bangladesh using the satisfaction with life scale

Immobility is known to impact health and well-being by reducing social contact, activity participation, and changing time use patterns. These unfortunate effects mostly affect specific demographic segments, including older adults, low income families, people who face disabilities, and those living in conflict zones. Emergency measures taken during the COVID-19 pandemic mandated or strongly recommended limitations to mobility, thereby causing this condition for segments of the public not usually characterized by high levels of immobility. In the context of the pandemic, reduced mobility was the non-pharmaceutical intervention of choice, and the evidence suggests that it helped to keep incidences of the disease from exploding. On the other hand, there is also a need to understand how mobility restrictions may have had incidental impacts, including to well-being, in population groups that have not been studied from this perspective before. In this spirit, the present paper uses the items of the Satisfaction with Life Scale to investigate how aspects of well-being changed during the pandemic, using a sample of 400 college and university students in Dhaka, Bangladesh. Analysis is based on multivariate ordered models and the results suggest that being less mobile, less active, and changes in activity time use due COVID-19 had an impact on the satisfaction with life of students. The detrimental effect was more marked for males and students from low-income households. Additionally, perceptions of residential characteristics and sense of belonging also correlate with satisfaction with life in the period under study.

Seeing the forest and the trees: Holistic view of social distancing on the spread of COVID-19 in China

The human social and behavioral activities play significant roles in the spread of COVID-19. Social-distancing centered non-pharmaceutical interventions (NPIs) are the best strategies to curb the spread of COVID-19 prior to an effective pharmaceutical or vaccine solution. This study investigates various social-distancing measures' impact on the spread of COVID-19 using advanced global and novel local geospatial techniques. Social distancing measures are acquired through website analysis, document text analysis, and other big data extraction strategies. A spatial panel regression model and a newly proposed geographically weighted panel regression model are applied to investigate the global and local relationships between the spread of COVID-19 and the various social distancing measures. Results from the combined global and local analyses confirm the effectiveness of NPI strategies to curb the spread of COVID-19. While global level strategies allow a nation to implement social distancing measures immediately at the beginning to minimize the impact of the disease, local level strategies fine tune such measures based on different times and places to provide targeted implementation to balance conflicting demands during the pandemic. The local level analysis further suggests that implementing different NPI strategies in different locations might allow us to battle unknown global pandemic more efficiently.

Nonpharmaceutical Interventions in Georgia: Public Health Implications

OBJECTIVES

As coronavirus disease 2019 (COVID-19) spread, many states implemented nonpharmaceutical interventions in the absence of effective therapies with varying degrees of success. Our aim was to evaluate restrictions comparing two regions of Georgia and their impact on outcomes as measured by confirmed illness and deaths.

METHODS

Using The New York Times COVID-19 incidence data and mandate information from various web sites, we examined trends in cases and deaths using joinpoint analysis at the region and county level before and after the implementation of a mandate.

RESULTS

We found that rates of cases and deaths showed the greatest decrease in acceleration after the simultaneous implementation of a statewide shelter-in-place for vulnerable populations combined with social distancing for businesses and limiting gatherings to <10 people. County-level shelters-in-place, business closures, limits on gatherings to <10, and mask mandates showed significant case rate decreases after a county implemented them. School closures had no consistent effect on either outcome.

CONCLUSIONS

Our findings indicate that protecting vulnerable populations, implementing social distancing, and mandating masks may be effective countermeasures to containment while mitigating the economic and psychosocial effects of strict shelters-in-place and business closures. In addition, states should consider allowing local municipalities the flexibility to enact nonpharmaceutical interventions that are more or less restrictive than the state-level mandates under some conditions in which the data indicate it is necessary to protect communities from disease or undue economic burden.

Improving Environmental Health in Schools

School environmental conditions have immediate and long-term effects on student health and learning. Relying on disconnected, inconsistent, voluntary, or unenforced environmental standards has not resulted in sufficient protection of students from toxic insults. Furthermore, the United States public school system was not prepared to navigate a potentially deadly infectious disease like COVID-19. Although Department of Education agencies have policies to establish clean and safe learning spaces, deficiencies are evident. This article highlights common environmental challenges in schools and opportunities for improvement. Voluntary adoption of rigorous environmental policies by grassroots efforts alone is unlikely to occur in all school systems. In the absence of a legally enforced requirement, the dedication of sufficient resources to update infrastructure and build the environmental health workforce capacity is equally unlikely to occur. Environmental health standards in schools should not be voluntary. Science-based standards should be comprehensive, and part of an actionable, integrated strategy that includes preventive measures and addresses environmental health issues sustainably. Establishing an Integrated Environmental Management approach for schools will require a coordinated capacity-building effort, community-based implementation efforts, and enforcement of minimal standards. Schools will need ongoing technical support and training for staff, faculty, and teachers sufficient to enable them to assume greater oversight and responsibility for environmental management of their schools. Ideally, a holistic approach will include all environmental health components, including IAQ, IPM, green cleaning, pesticide and chemical safety, food safety, fire prevention, building legacy pollutant management, and drinking water quality. Thus, creating a comprehensive management system with continuous monitoring and maintenance. Clinicians who care for children can serve as advocates for children's health beyond their clinic walls by advising parents and guardians to be aware of school conditions and management practices. Medical professionals have always been valued and influential members of communities and school boards. In these roles they can greatly assist in identifying and providing solutions to reduce environmental hazards in schools.

Effects of school-level and area-level socio-economic factors on elementary school student COVID-19 infections: a population-based observational study

OBJECTIVES

To estimate the variability of the cumulative incidence of SARS-CoV-2 infections among elementary school students attributable to individual schools and/or their geographic areas, and to ascertain whether socio-economic characteristics of school populations and/or geographic areas may be predictive of this variability.

DESIGN

Population-based observational study of SARS-CoV-2 infections among elementary school children.

SETTING

3994 publicly funded elementary schools in 491 forward sortation areas (designated geographic unit based on first three characters of Canadian postal code), Ontario, Canada, September 2020 to April 2021.

PARTICIPANTS

All students attending publicly funded elementary schools with a positive molecular test for SARS-CoV-2 reported by the Ontario Ministry of Education.

MAIN OUTCOME MEASURES

Cumulative incidence of laboratory-confirmed elementary school student SARS-CoV-2 infections in Ontario, 2020-21 school year.

RESULTS

A multilevel modelling approach was used to estimate the effects of socio-economic factors at the school and area levels on the cumulative incidence of elementary school student SARS-CoV-2 infections. At the school level (level 1), the proportion of the student body from low-income households was positively associated with cumulative incidence (β=0.083, p<0.001). At the area level (level 2), all dimensions of marginalisation were significantly related to cumulative incidence. Ethnic concentration (β=0.454, p<0.001), residential instability (β=0.356, p<0.001) and material deprivation (β=0.212, p<0.001) were positively related, while dependency (β=-0.204, p<0.001) was negatively related. Area-related marginalisation variables explained 57.6% of area variability in cumulative incidence. School-related variables explained 1.2% of school variability in cumulative incidence.

CONCLUSIONS

The socio-economic characteristics of the geographic area of schools were more important in accounting for the cumulative incidence of SARS-CoV-2 elementary school student infections than individual school characteristics. Schools in marginalised areas should be prioritised for infection prevention measures and education continuity and recovery plans.

Risk factors for SARS-CoV-2 infection in primary and secondary school students and staff in England in the 2020/2021 school year: a longitudinal study

OBJECTIVES

Investigate risk factors for SARS-CoV-2 infections in school students and staff.

METHODS

In the 2020/2021 school year, we administered polymerase chain reaction, antibody tests, and questionnaires to a sample of primary and secondary school students and staff, with data linkage to COVID-19 surveillance. We fitted logistic regression models to identify the factors associated with infection.

RESULTS

We included 6799 students and 5090 staff in the autumn and 11,952 students and 4569 staff in the spring/summer terms. Infections in students in autumn 2020 were related to the percentage of students eligible for free school meals. We found no statistical association between infection risk in primary and secondary schools and reported contact patterns between students and staff in either period in our study. Using public transports was associated with increased risk in autumn in students (adjusted odds ratio = 1.72; 95% confidence interval 1.31-2.25) and staff. One or more infections in the same household during either period was the strongest risk factor for infection in students and more so among staff.

CONCLUSION

Deprivation, community, and household factors were more strongly associated with infection than contacts patterns at school; this suggests that the additional school-based mitigation measures in England in 2020/2021 likely helped reduce transmission risk in schools.

COVID-19 Policies, Pandemic Disruptions, and Changes in Child Mental Health and Sleep in the United States

IMPORTANCE

The adverse effects of COVID-19 containment policies disrupting child mental health and sleep have been debated. However, few current estimates correct biases of these potential effects.

OBJECTIVES

To determine whether financial and school disruptions related to COVID-19 containment policies and unemployment rates were separately associated with perceived stress, sadness, positive affect, COVID-19-related worry, and sleep.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was based on the Adolescent Brain Cognitive Development Study COVID-19 Rapid Response Release and used data collected 5 times between May and December 2020. Indexes of state-level COVID-19 policies (restrictive, supportive) and county-level unemployment rates were used to plausibly address confounding biases through 2-stage limited information maximum likelihood instrumental variables analyses. Data from 6030 US children aged 10 to 13 years were included. Data analysis was conducted from May 2021 to January 2023.

EXPOSURES

Policy-induced financial disruptions (lost wages or work due to COVID-19 economic impact); policy-induced school disruptions (switches to online or partial in-person schooling).

MAIN OUTCOMES AND MEASURES

Perceived stress scale, National Institutes of Health (NIH)-Toolbox sadness, NIH-Toolbox positive affect, COVID-19-related worry, and sleep (latency, inertia, duration).

RESULTS

In this study, 6030 children were included in the mental health sample (weighted median [IQR] age, 13 [12-13] years; 2947 [48.9%] females, 273 [4.5%] Asian children, 461 [7.6%] Black children, 1167 [19.4%] Hispanic children, 3783 [62.7%] White children, 347 [5.7%] children of other or multiracial ethnicity). After imputing missing data, experiencing financial disruption was associated with a 205.2% [95% CI, 52.9%-509.0%] increase in stress, a 112.1% [95% CI, 22.2%-268.1%] increase in sadness, 32.9% [95% CI, 3.5%-53.4%] decrease in positive affect, and a 73.9 [95% CI, 13.2-134.7] percentage-point increase in moderate-to-extreme COVID-19-related worry. There was no association between school disruption and mental health. Neither school disruption nor financial disruption were associated with sleep.

CONCLUSIONS AND RELEVANCE

To our knowledge, this study presents the first bias-corrected estimates linking COVID-19 policy-related financial disruptions with child mental health outcomes. School disruptions did not affect indices of children's mental health. These findings suggest public policy should consider the economic impact on families due to pandemic containment measures, in part to protect child mental health until vaccines and antiviral drugs become available.

A Spatial Examination of COVID-19 Policies among Missouri School Districts

BACKGROUND

As the COVID-19 pandemic spread, school district administrators in the United States were faced with difficult decisions regarding the implementation of virtual or in-person learning to reduce risk of infection throughout student and staff populations. While a coordinated effort with surrounding districts would be most beneficial when encountering a highly infectious respiratory-based infectious disease, the determinants of type of education delivery is unclear.

METHODS

Data from the Missouri Department of Elementary and Secondary Education assessing education delivery method at each school district across the state of Missouri (n = 514) from August 2020 were used. This cross-sectional study, using results from a school district-level survey, local COVID-19 rates, and community-level sociodemographic characteristics, conducted a spatially adjusted analysis of variance (ANOVA) to determine associations between education delivery type and geographic-level sociogeographic characteristics.

RESULTS

Among Missouri school districts, 172 (33.4%) reported starting the 2020-2021 academic year with an in-person policy, 52 (10.1%) with a distant/virtual policy, 242 (47.1%) in-person with a distance option, and 48 (9.3%) with a blended policy. This study found districts with lower household income levels were less likely to offer students any virtual learning options. Additionally, community COVID-19 infection rates were not associated with the selection of virtual or in-person education delivery.

CONCLUSIONS

These findings suggest the presence of a specific school policy was spatially random in regard to neighboring community policies, even when accounting for community characteristics. The efficacy of policy is likely to benefit upon application of a spatial framework when addressing a crisis fundamentally tied to location. Future planning that highlights and focuses on regional coordination for community resilience in the face of a pandemic should incorporate data sources that inform decisions made for families, students, and communities.

An Empirical Study on Emergency of Distant Tertiary Education in the Southern Region of Bangladesh during COVID-19: Policy Implication

Many fields have been affected by COVID-19, including education. The pandemic has prompted a change in education due to the requirement for social distancing. Campuses are now closed in many educational institutions across the globe, and teaching and learning are now conducted online. Internationalization has significantly slowed down. A mixed-method study was designed for this research, with the goal of ascertaining the impact of COVID-19 on Bangladeshi students enrolled in higher education during and after the pandemic. A questionnaire with 19 questions on a Google form was used to collect quantitative data using a 4-point Likert scale and was conducted on 100 students from different universities in the southern part of Bangladesh, such as Barisal University, Patuakhali Science and Technology University, and Bangabandhu Sheikh Mujibur Rahman Science and Technology University. For collecting qualitative data, six quasi-interviews were conducted. A statistical package for Social Science (SPSS) was used to analyze both quantitative and qualitative data. The quantitative results demonstrated that during the COVID-19 pandemic, pupils continuously received teaching and learning. The current study's findings revealed a significant positive correlation between the COVID-19 pandemic and teaching, learning, and student achievement and a significant negative correlation between the COVID-19 pandemic and student goals. The study also revealed that the COVID-19 pandemic had a detrimental effect on students enrolled in higher education programs at the universities. The qualitative judgment showed that students faced many problems when joining classes, such as poor Internet connection and insufficient network and technological facilities, etc. Some students live in rural areas and have slow Internet speeds, which sometimes prevented them from joining class. The findings of the study can help policy makers in higher education to review and adopt a new policy in higher education in Bangladesh. It can also help education instructors in universities to develop a proper study plan for their students.

Worldwide Estimation of Parental Acceptance of COVID-19 Vaccine for Their Children: A Systematic Review and Meta-Analysis

Currently, the best method to well control the spread of COVID-19 without severe mental health problems is to reach herd immunity. Therefore, the vaccination rate of the COVID-19 vaccine is critical. Among the populations, children are the vulnerable ones to get vaccinated; therefore, it is important to assess parents’ and guardians’ willingness to have their children vaccinated. The present systematic review and meta-analysis synthesized evidence to estimate the parents’ acceptance rate of COVID-19 vaccination toward their children. Additionally, factors explaining the acceptance rate were investigated. Four academic databases (PubMed, Scopus, Web of Science, and ProQuest) together with Google Scholar were searched, and the references of the included publications were searched as well. Using the PECO-S framework (population, exposure, comparison, outcome, and study design), observational studies of cross-sectional, cohort, or case-control studies were included. The outcome was parents’ or guardians’ willingness to let their children be vaccinated. The studies included in the present review were restricted to English and peer-reviewed papers published between December 2019 and July 2022. A total of 98 papers across 69 different countries with 413,590 participants were included. The mean age of the parents was 39.10 (range: 18–70) years and that of their children was 8.45 (range: 0–18) years. The pooled estimated prevalence of parental acceptance to vaccinate their children with the COVID-19 vaccine was 57% (98 studies, 95% CI: 52–62%, I2: 99.92%, τ2: 0.06). Moreover, data collection time was a significant factor explaining parental willingness in the multivariable meta-regression, with a 13% decrease in parental willingness by each month increase in time, explaining 11.44% of variance. Qualitative synthesis results showed that parents’ COVID-19 vaccine knowledge, trust in theCOVID-19 vaccine, and facilitators in vaccination (e.g., low cost, good vaccine accessibility, and government incentive) were significant factors for higher willingness, while mental health problems (e.g., having worries and psychological distress) were significant factors for lower willingness. Given that the acceptance rate was relatively low (57%) and does not achieve the requirement of herd immunity (i.e., 70%), governments and healthcare authorities should try to elevate parents’ knowledge and trust in the COVID-19 vaccine, facilitate in vaccination, and reduce their mental difficulties to improve the overall vaccination rate among children.

Escalating spread of SARS-CoV-2 infection after school reopening among students in hotspot districts of Oromia Region in Ethiopia: Longitudinal study

BACKGROUND

COVID-19 pandemic caused by extended variants of SARS-CoV-2 has infected more than 350 million people, resulting in over 5.5 million deaths globally. However, the actual burden of the pandemic in Africa, particularly among children, remains largely unknown. We aimed to assess the seroepidemiological changes of SARS-CoV-2 infection after school reopening among school children in Oromia, Ethiopia.

METHODS

A prospective cohort study involving students aged 10 years and older were used. A serological survey was performed twice, at school reopening in December 2020 and four months later in April 2021. Participants were selected from 60 schools located in 15 COVID-19 hotspot districts in Oromia Region. Serology tests were performed by Elecsys anti-SARS-CoV-2 nucleocapsid assay. Data were collected using CSentry CSProData Entry 7.2.1 and exported to STATA version 14.2 for data cleaning and analysis.

RESULTS

A total of 1884 students were recruited at baseline, and 1271 completed the follow-up. SARS-CoV-2 seroprevalence almost doubled in four months from 25.7% at baseline to 46.3% in the second round, with a corresponding seroincidence of 1910 per 100,000 person-week. Seroincidence was found to be higher among secondary school students (grade 9-12) compared to primary school students (grade 4-8) (RR = 1.6, 95% CI 1.21-2.22) and among those with large family size (> = 5) than those with a family size of <3 (RR = 2.1, 95% CI 1.09-4.17). The increase in SARS-CoV-2 seroprevalence among the students corresponded with Ethiopia's second wave of the COVID-19 outbreak.

CONCLUSION

SARS-CoV-2 seroprevalence among students in hotspot districts of the Oromia Region was high even at baseline and almost doubled within four months of school recommencement. The high seroincidence coincided with the second wave of the COVID-19 outbreak in Ethiopia, indicating a possible contribution to school opening for the new outbreak wave.

Trends in respiratory diseases before and after the COVID-19 pandemic in China from 2010 to 2021

BACKGROUND

The ongoing benefits of coronavirus disease 2019 (COVID-19) nonpharmaceutical interventions (NPIs) for respiratory infectious diseases in China are still unclear. We aimed to explore the changes in seven respiratory infectious diseases before, during, and after COVID-19 in China from 2010 to 2021.

METHODS

The monthly case numbers of seven respiratory infectious diseases were extracted to construct autoregressive integrated moving average (ARIMA) models. Eight indicators of NPIs were chosen from the COVID-19 Government Response Tracker system. The monthly case numbers of the respiratory diseases and the eight indicators were used to establish the Multivariable generalized linear model (GLM) to calculate the incidence rate ratios (IRRs).

RESULTS

Compared with the year 2019, the percentage changes in 2020 and 2021 were all below 100% ranging from 3.81 to 84.71%. Pertussis and Scarlet fever started to increase in 2021 compared with 2020, with a percentage change of 183.46 and 171.49%. The ARIMA model showed a good fit, and the predicted data fitted well with the actual data from 2010 to 2019, but the predicted data was bigger than the actual number in 2020 and 2021. All eight indicators could negatively affect the incidence of respiratory diseases. The seven respiratory diseases were significantly reduced during the COVID-19 pandemic in 2020 and 2021 compared with 2019, with significant estimated IRRs ranging from 0.06 to 0.85. In the GLM using data for the year 2020 and 2021, the IRRs were not significant after adjusting for the eight indicators in multivariate analysis.

CONCLUSION

Our study demonstrated the incidence of the seven respiratory diseases decreased rapidly during the COVID-19 pandemic in 2020 and 2021. At the end of 2021, we did see a rising trend for the seven respiratory diseases compared to the year 2020 when the NPIs relaxed in China, but the rising trend was not significant after adjusting for the NPIs indicators. Our study showed that NPIs have an effect on respiratory diseases, but Relaxation of NPIs might lead to the resurgence of respiratory diseases.

Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices

BACKGROUND

Early in the coronavirus disease 2019 (COVID-19) pandemic, governments implemented exceptional public health measures (PHMs) in the face of uncertainty. This study aimed to compare mitigation policies implemented by Israel and their timing in the first wave of the pandemic to those of other countries, and to assess whether country characteristics such as democracy, trust, education, economic strength and healthcare reserve were associated with decision-making.

METHODS

PHMs and pre-pandemic characteristics, using internationally accepted indices, of 50 countries were collected from 1/1/2020-30/06/2020; and associations between them were assessed. Time to implementation of these measures was compared among the Organisation for Economic Co-operation (OECD) nations. Log-rank test was used for univariate analysis. Cox regression was performed to assess the independent contribution of pre-pandemic characteristics to time-to-implementation of measures. Correlations between timing of specific measures and COVID-19 mortality at 60 days were assessed.

RESULTS

Israel ranked in the upper third of the OECD in swiftness to implementation of eight of the ten measures compared. In univariate survival analysis, countries with an education level below the OECD median were more likely to implement a lockdown (p-value = 0.043) and to close restaurants and entertainment venues (p-value = 0.007) when compared to countries above the OECD median. In Cox regression models, controlling for geographic location, democracy level above the OECD median was associated with a longer time-to-implementation of a lockdown (HR=0.35, 95% CI=0.14-0.88, p-value=0.025). Similarly, a high level of GDP per capita was inversely associated with closing schools; and a high level of education inversely associated with closure of restaurants and entertainment venues. Earlier initiation of all PHMs was associated with lower mortality at 60 days, controlling for geographic location.

CONCLUSIONS

Israel's initial response to the pandemic was relatively quick, and may have been facilitated by its geographic isolation. Countries with lower pre-pandemic socio-economic indices were quicker to initiate forced social distancing. Early initiation of PHMs was associated with reduced mortality in the short run. Timing of initiation of measures relative to the country-specific spread of disease is a significant factor contributing to short-term early local pandemic control, perhaps more than the exact measures implemented. It is important to note that this study is limited to the initial pandemic response. Furthermore, it does not take into account the broader long-term effects of certain PHMs, which should be a focus of further research.

Case-Control Study on the Routes of Transmission of SARS-CoV-2 after the Third Pandemic Wave in Tuscany, Central Italy

The emergence of hyper-transmissible SARS-CoV-2 variants that rapidly became prevalent throughout the world in 2022 made it clear that extensive vaccination campaigns cannot represent the sole measure to stop COVID-19. However, the effectiveness of control and mitigation strategies, such as the closure of non-essential businesses and services, is debated. To assess the individual behaviours mostly associated with SARS-CoV-2 infection, a questionnaire-based case-control study was carried out in Tuscany, Central Italy, from May to October 2021. At the testing sites, individuals were invited to answer an online questionnaire after being notified regarding the test result. The questionnaire collected information about test result, general characteristics of the respondents, and behaviours and places attended in the week prior to the test/symptoms onset. We analysed 440 questionnaires. Behavioural differences between positive and negative subjects were assessed through logistic regression models, adjusting for a fixed set of confounders. A ridge regression model was also specified. Attending nightclubs, open-air bars or restaurants and crowded clubs, outdoor sporting events, crowded public transportation, and working in healthcare were associated with an increased infection risk. A negative association with infection, besides face mask use, was observed for attending open-air shows and sporting events in indoor spaces, visiting and hosting friends, attending courses in indoor spaces, performing sport activities (both indoor and outdoor), attending private parties, religious ceremonies, libraries, and indoor restaurants. These results might suggest that during the study period people maintained a particularly responsible and prudent approach when engaging in everyday activities to avoid spreading the virus.

Hand Hygiene, Face Mask Use, and Associated Factors during the COVID-19 Pandemic among the Students of Mongar Higher Secondary School, Bhutan: A Cross-Sectional Study

Non-pharmacological measures, such as hand hygiene and face mask use, continue to play an important role in the fight against the COVID-19 pandemic. However, there is a paucity of studies on the adherence to these measures among students in Bhutan. Therefore, we aimed to investigate hand hygiene and face mask-wearing behaviours, as well as their associated factors, among the students of Mongar Higher Secondary School, Bhutan. We conducted a cross-sectional study amongst the students of Mongar Higher Secondary School in Bhutan. The students self-answered the questionnaire on web-based Google Forms. Multivariable logistic regression for good hand washing and face mask use was conducted in order to identify statistically significant socio-demographic covariates. The correlation between hand hygiene and mask use was investigated using Pearson’s correlation coefficient. A total of 533 students completed the survey questionnaire, 52.9% (282) of whom were female students. Facebook (44.3%, 236) and TV (35.5%, 189) were the two most popular sources of information on COVID-19 prevention and control. Good (scores of ≥80% of total scores) hand hygiene and face mask use were reported in 33.6% (179) and 22.1% (118) of students. In multivariable logistic regression, male students presented 79% (adjusted odds ratio [AOR] = 1.79, 95% confidence interval [CI] = 1.23−2.613) odds of engaging in good hand hygiene, compared to female students. Compared to grade 9, those in grade 10 were 60% (AOR = 0.4, 95% CI 0.158−0.998) less likely to engage in good hand hygiene. Boarding students presented 68% (AOR = 1.68, 95% CI 1.001, 2.813) higher odds of wearing a face mask compared to day students. There was a significant positive correlation between good hand hygiene and face mask use (r = 0.3671, p-value < 0.001). Good hand hygiene and face mask use were reported in less than one-third of the study participants. It is recommended to continue educating students on good hand hygiene and face mask use through popular information sources.