Slums and pandemics

Perception of Risk for Developing Severe Illness or Complications from COVID-19 in Brazil: Focus on Factors Linked to Socially Vulnerable Populations, 2020-2023

In this study, the aim was to comparatively examine the perception of risk for developing severe illness or complications due to COVID-19 among the general population and socially vulnerable populations in Brazil, focusing on uncovering the associated factors that disproportionately impacted people experiencing homelessness and slum dwellers. This study is part of the project "Social Thermometer-COVID-19 in Brazil", which employed a hybrid approach, combining a national online survey with field research in state capitals and the Federal District. Data collection took place from August 2020 to October 2023, and the data were analyzed using descriptive statistics and logistic regression. A total of 5094 participants were included in this study, with 2363 from the general population and 2731 from the socially vulnerable population. Among the general population, the majority of participants were women, white individuals, those with higher incomes, formal employment, and higher education levels. Concerning the vulnerable population, most were men, Black individuals, those with lower incomes, unemployment, and lower education levels. It was observed that 87% of the general population perceived a risk of severe COVID-19, compared to 74% of the vulnerable population. Slum dwellers who received emergency aid (ORa = 1.39; 95% CI: 1.02-1.91), adhered to mask-wearing practices (ORa = 1.93; 95% CI: 1.39-2.66), used COVID-19-related medications (ORa = 2.13; 95% CI: 1.31-3. 64), and those with pre-existing conditions, such as high blood pressure (ORa = 1.86; 95% CI: 1.20-2.98), demonstrated a heightened perception of risk for severe COVID-19 complications. Among the homeless population, individuals who wore masks (ORa = 1.67; 95% CI: 1.26-2.20 and had been vaccinated (ORa = 1.44; 95% CI: 1.04-1.98) were also more likely to perceive a high risk. In conclusion, in this study, significant disparities are revealed in the perception of COVID-19 risk between the general and socially vulnerable populations in Brazil. Factors such as receiving emergency aid, adherence to mask-wearing, use of COVID-19-related medications, and pre-existing health conditions were associated with increased risk perception. Despite facing greater socioeconomic challenges, vulnerable groups, particularly those experiencing homelessness and slum dwellers, showed a lower perception of the risk for severe COVID-19 complications.

Global burden of subarachnoid hemorrhage among adolescents and young adults aged 15-39 years: A trend analysis study from 1990 to 2021

OBJECTIVE

This study aims to analyze the global burden of subarachnoid hemorrhage (SAH) among adolescents and young adults (AYAs) aged 15-39 years from 1990 to 2021, highlighting spatial and temporal trends and providing insights for future public health strategies.

METHODS

Data were collected from the Global Burden of Disease Study 2021 (GBD 2021), which includes comprehensive evaluations of health conditions and associated risk factors across 204 countries and territories. The focus was on SAH incidence, prevalence, mortality, and disability-adjusted life years (DALYs) among AYAs. The data were segmented by age groups (15-19, 20-24, 25-29, 30-34, 35-39 years) and socio-demographic index (SDI) quintiles. Statistical analyses, including Joinpoint regression and decomposition analysis, were employed to assess temporal trends and the impact of population growth, aging, and epidemiological changes.

RESULTS

From 1990 to 2021, the global number of SAH incident cases among AYAs increased by 12.6%, from 109,120 cases in 1990 to 122,822 cases in 2021. Prevalent cases rose by 17.1%, from 1,212,170 cases in 1990 to 1,419,127 cases in 2021. Conversely, the number of deaths decreased by approximately 26.6%, from 30,348 cases in 1990 to 22,266 cases in 2021. Similarly, DALYs decreased by 23.7%, from 1,996,041 cases in 1990 to 1,523,328 cases in 2021. Notably, over these thirty years, the age-standardized rates (ASR) of incidence, prevalence, mortality, and DALYs for the AYA population showed an overall decreasing trend, despite fluctuations in specific periods. The age-standardized mortality rate (ASMR) and age-standardized DALYs (ASR for DALYs) decreased continuously with an average annual percentage change (AAPC) of -2.2% (95% CI: -2.36, -2.04) and -2.02% (95% CI: -2.17, -1.88), respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) had an AAPC of -0.8% (95% CI: -0.85, -0.75) and -0.65% (95% CI: -0.66, -0.64), respectively. Particularly, the ASIR showed a continuous decline from 1990 to 2015, followed by a slight increase from 2014 to 2019 (APC: 0.14%, 95% CI: 0.03, 0.25), and accelerated growth from 2019 to 2021 (APC: 1.23%, 95% CI: 0.88, 1.57). The ASPR declined from 1990 to 2019, followed by an increase from 2019 to 2021 (APC: 0.15%, 95% CI: 0.05, 0.25). Regional analysis revealed substantial burdens in the Middle-SDI and Low-Middle-SDI regions, with the Middle-SDI region having the highest incidence, prevalence, mortality, and DALYs. Decomposition analysis indicated that population growth was the primary driver of increased SAH cases, while epidemiological changes contributed significantly to the decline in deaths and DALYs.

CONCLUSION

The findings underscore the need for targeted public health interventions, particularly in low and low-middle-SDI regions, to reduce the burden of SAH among AYAs. Improved healthcare resources, enhanced health education, and preventive strategies are crucial. This study provides valuable data to inform future public health policies and resource allocation, emphasizing the importance of addressing the unique challenges faced by AYAs.

Firm behavior during an epidemic

We derive a model in which firms operate in an epidemic environment and internalize infections among their employees in the workplace. The model is calibrated to fit the moments of the Covid-19 epidemic. We show that firms have incentives to fight against infections and can do so very effectively by increasing teleworking and rotating employees between on-site work, teleworking, and leave. The fight against infections in firms flattens the aggregate infections curve. Subsidies to teleworking reduce infections and save lives. Subsidies to sick leave reduce the cost of sick workers and raise workplace infections. Firms delay and weaken the fight against infections during economic downturns. We also consider the problem of a government that values output and lives. We show that the government prefers to severely restrict the epidemic by tolerating short-term output losses when it has a high valuation of life.

Maré cohort-profile: a prospective cohort study based in a socially vulnerable community during the COVID-19 pandemic in Rio de Janeiro, Brazil

Background: Socially vulnerable populations were vastly affected by the COVID-19 pandemic. The pandemic significantly impacted Brazil, pressuring its healthcare system for several months, with high mortality rates, even among the youngest population. Cohort studies combining disease surveillance are essential for understanding virus circulation in the community, surrogates of protection, vaccine effectiveness, and demand for health resources. Methods: Here, we present the protocol for a community-based prospective cohort study in the largest complex of favelas (slums) in Rio de Janeiro, Brazil (Complexo da Maré). The study participants are residents initially recruited during a massive vaccination campaign in the community. Five waves of data collection at approximately six-month intervals were planned. The first two waves have been completed at the time of writing this study protocol, and the third is underway. The protocol comprises interviews, blood sampling, and records linkage with secondary data to enrich the profiles of cohort participants and community information. We will describe COVID-19 seroprevalence, socio-demographic characteristics, and the burden of COVID-19, followed by estimating the association of socioeconomic factors and the burden of disease with seroprevalence. Discussion: The primary aims of the study are to assess COVID-19 clinical, epidemiological and genomic profiles and outcomes in residents from Maré, including vaccine effectiveness, surrogates of immune protection, virus transmission in households, and the overall burden of the pandemic.

COVID-19 and the city: Did urbanized countries suffer more fatalities?

In this paper we derive a theoretical model of the spread of a viral infection which we use as basis for an estimation strategy to test four interrelated hypotheses on the relationship between country-level COVID-19 mortality rates and the extent of urban development. Using data covering 81 countries we find evidence that countries with a higher population density, a higher share of the urban population living in the largest city, and countries with a higher urbanization rate had on average the same or fewer COVID-19 fatalities compared to less urbanized countries in 2020. Even though COVID-19 spreads faster in cities, fatalities may be lower, conditional on economic development, trust in government, and a well-functioning health care system. Generally, urbanization and city development are associated with economic development: with the resources urbanized countries have, it is easier for them to manage and maintain stricter lockdowns, and to roll out effective pharmaceutical interventions.

Urban density and COVID-19: understanding the US experience

This paper revisits the debate around the link between population density and the severity of COVID-19 spread in the USA. We do so by conducting an empirical analysis based on graphical evidence, regression analysis and instrumental variable strategies borrowed from the agglomeration literature. Studying the period between the start of the epidemic and the beginning of the vaccination campaign at the end of 2020, we find that the cross-sectional relationship between density and COVID-19 deaths changed as the year evolved. Initially, denser counties experienced more COVID-19 deaths. Yet, by December, the relationship between COVID deaths and urban density was completely flat. This is consistent with evidence indicating density affected the timing of the outbreak-with denser locations more likely to have an early outbreak-yet had no influence on time-adjusted COVID-19 cases and deaths. Using data from Google, Facebook, the US Census and other sources, we investigate potential mechanisms behind these findings.

THE DISTRIBUTIONAL EFFECTS OF COVID-19 AND OPTIMAL MITIGATION POLICIES

This paper develops a quantitative heterogeneous agent-life cycle-epidemiological model that is used to study the aggregate and distributional consequences of COVID-19 and mitigation policies. First, a stay-at-home subsidy is preferred to a lockdown because it reduces deaths by more and output by less. Second, Pareto-improving policies can reduce deaths by nearly 45 percent without any reduction in output relative to no public mitigation. Finally, it is possible to simultaneously improve public health and economic outcomes, suggesting that debates regarding a tradeoff between economic and health objectives may be misguided. This article is protected by copyright. All rights reserved.

Comment on "COVID-19 in segmented societies" by Constantino Hevia, Manuel Macera, and Pablo Andrés Neumeyer

This comment briefly summarizes Hevia et al. (2022), who utilize a unique dataset to shed light on the inequality of the epidemiological burden for low- and high-income individuals in Bogotá. Some suggestions and ideas for future research are provided.