The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach

Indirect Impact of Pandemic on the Diagnosis of New Primary Melanoma: A Retrospective, Multicenter Study

Background/Objectives: The indirect impact of the pandemic on the diagnosis and treatment of new primary melanoma has been carefully evaluated in recent years. The aim of the present study was to investigate if the indirect impact of the pandemic in Italy could be detectable also in the second year of the pandemic, as suggested by the characteristics of melanoma at diagnosis. Methods: Retrospective analysis of 1640 diagnoses of cutaneous melanoma in pre-pandemic period and 1292 diagnoses in the pandemic period from 10 centers (from 1 March 2019 to 28 February 2022). Results: Our findings confirmed an indirect impact of the pandemic on characteristics of incident melanoma, also in the second year of the pandemic in Italy (Breslow thickness p < 0.0001, tumor stage p = 0.002, ulceration p = 0.04, SNLB p = 0.03), without statistically significant differences between centers. A statistically significant reduction in the time interval from diagnosis to surgical treatment was observed, but only in centers that had to modify their case mix to address the needs of treating COVID-19 patients (p = 0.0002). Conclusions: Our study confirmed the indirect impact of the pandemic on melanoma characteristics at the diagnosis in the second year of the pandemic in Italy. We also found no differences in melanoma characteristics between hospitals with different organization. Diagnostic delays may be related to a delayed access of the patient to the entire diagnostic pathway, and therefore, especially in the case of a pandemic, policies to support early diagnosis are crucial.

The Impact of the COVID-19 Pandemic on the Clinical and Epidemiological Profile of Severe Acute Respiratory Infection in Bahia, Brazil: A Comparative Analysis of Pre- and Post-Pandemic Trends

In recent years, the incidence of Severe Acute Respiratory Infection (SARI) has increased due to the emergence of SARS-CoV-2. However, the impact of the COVID-19 pandemic extends beyond mortality rates. Recent analyses suggest that the introduction and spread of SARS-CoV-2 have significantly affected the epidemiology of other key respiratory viruses, such as influenza virus (FLUV), respiratory syncytial virus (RSV), and rhinovirus (RV). These changes raise new questions about the dynamics and incidence of post-COVID-19 respiratory infections, as well as potential alterations in symptom profiles and clinical outcomes. In this study, we analyzed data from the Epidemiological Surveillance Information System of Respiratory Viral Agents (SIVEP-Gripe), established by the Brazilian Ministry of Health, to examine the profile of SARI before and during the COVID-19 pandemic in Brazil. Our data reveal a distinct epidemiological pattern, with a significant decrease in FLUV notifications during the pandemic, accompanied by peaks in RSV and RV cases in late 2020. Additionally, there was a shift in the age distribution of RSV and other viral infections, with individuals infected during the pandemic being older than those infected before the pandemic. Interestingly, the introduction and spread of SARS-CoV-2 in Bahia State resulted in a reduction in the frequency of symptoms associated with non-SARS-CoV-2 SARI, without altering clinical outcomes. Our findings suggest that the circulation of SARS-CoV-2 has contributed to a clinical and epidemiological shift, particularly for FLUV, RSV, and other viruses, marked by a reduction in symptoms such as fever, dyspnea, respiratory distress, and the need for ventilatory support. The underlying mechanisms driving these changes remain unclear. These insights are crucial for public health authorities and policymakers to refine surveillance strategies and enhance control measures for respiratory viruses, particularly those causing SARI.

Schools and the transmission of Sars-Cov-2: Evidence from Italy

This paper studies the effect on the spread of Sars-Cov-2 in Italy of schools' re-openings and closures. Exploiting different re-opening dates across regions after the summer break of 2020, I show that early-opening regions experienced more cases in the 40 days following school re-openings compared with late-opening ones. However, there is great uncertainty around the estimates, and this suggests a wide dispersion in the effects of school re-openings on Sars-Cov-2 transmission. I also study the effect of school closures in Campania, one of the biggest regions in Southern Italy. Using a synthetic control approach, I show that school closures are associated with lower numbers of cases relative to the counterfactual group, particularly in younger age groups. In contrast, I find no significant effects on older age groups, which are more likely to require hospitalization. Finally, by exploiting survey data, I provide descriptive evidence on the increased incidence rate among teachers and students relative to the general population, following school re-openings.

Investigating mortality trends in Italy during the COVID-19 pandemic: life expectancy changes within provinces and vaccination campaign impact up to December 2022

OBJECTIVES

We used publicly available population data from 1 January 2019 up to 31 December 2022, to investigate mortality trends in Italy during the COVID-19 pandemic, evaluating changes in life expectancy (LE) at birth within provinces and the impact of COVID-19 vaccinations.

STUDY DESIGN

Aggregate data analysis.

METHODS

Annual period life tables were used to estimate sex-specific LEs within provinces from 2019 to 2022. We used Arriaga decomposition to analyze the contribution of age groups (<60 years and ≥60 years) to annual LE changes. We implemented a Quasi-Poisson regression model to estimate the number of averted deaths by the achieved COVID-19 vaccination rates from January 2021 up to December 2022, simulating a counterfactual scenario where vaccine doses were not administered.

RESULTS

The results revealed geographical heterogeneity in annual LE changes across Italian provinces during the pandemic. By the end of 2022, LE was below the prepandemic levels in 88% of provinces for females and in 76% for males. In addition, we estimated that the achieved vaccination rates averted 460,831 deaths (95% confidence interval: 250,976-707,920), corresponding to a 25% reduction in expected all-cause mortality.

CONCLUSIONS

Overall, the study highlighted the significant role of COVID-19 vaccinations in averting a considerable number of deaths and improving LE. However, by the end of 2022, LE had not fully recovered to prepandemic levels in many provinces. This could be attributed to concurrent factors, including enduring COVID-19 pandemic effects, intense summer heat waves and early onset of seasonal flu. Further research and continuous monitoring are essential to fully comprehend long-term mortality trends and optimize public health strategies.

The common interests of health protection and the economy: evidence from scenario calculations of COVID-19 containment policies

We develop a novel approach integrating epidemiological and economic models that allows data-based simulations during a pandemic. We examine the economically optimal opening strategy that can be reconciled with the containment of a pandemic. The empirical evidence is based on data from Germany during the SARS-CoV-2 pandemic. Our empirical findings reject the view that there is necessarily a conflict between health protection and economic interests and suggest a non-linear U-shape relationship: it is in the interest of public health and the economy to balance non-pharmaceutical interventions in a manner that further reduces the incidence of infections. Our simulations suggest that a prudent strategy that leads to a reproduction number of around 0.75 is economically optimal. Too restrictive policies cause massive economic costs. Conversely, policies that are too loose lead to higher death tolls and higher economic costs in the long run. We suggest this finding as a guide for policy-makers in balancing interests of public health and the economy during a pandemic.