Dynamic zero-COVID strategy in controlling COVID-19 in Shanghai, China: A cost-effectiveness analysis

The burden of COVID-19 based on disability-adjusted life years: a systematic review of available evidence

Background

The present study tries to evaluate and summarize the available evidence to provide insights into the COVID-19 burden worldwide using disability-adjusted life years (DALYs) and compare the level of damage across countries during this pandemic.

Method

We conducted a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to investigate the global burden of COVID-19. Studies were identified through searches conducted on Ovid Medline, Cochrane, Science Direct, Scopus, and PubMed databases as well as, the Google Scholar search engine. All stages of the search, study selection, qualitative assessment, and data extraction were carried out by two authors separately. Any disagreement among reviewers was resolved by discussion.

Results

The total DALYs incurred by COVID-19 varied widely among nations, with rates per 100,000 population ranging from approximately 5 in Korea to 5,363 in the US. Deaths due to COVID-19 could substantially impact years of life lost (YLLs), emerging as a major contributing factor to DALYs. Furthermore, unlike in high-income countries, a significant proportion of YLLs in low- and middle-income countries is associated with individuals dying at younger ages. Years lived with disability (YLDs) were also identified as a minor contributing factor to DALY estimates associated with COVID-19.

Conclusion

Our findings from this investigation provide valuable insights into the impacts of COVID-19 on global health that may be an important basis for assessing its global burden, facilitating international comparisons, and allocating efforts to manage the epidemic. However, challenges persist in identifying and quantifying the economic costs and non-health effects of the event on an international scale.

Cost-effectiveness of preventive COVID-19 interventions: a systematic review and network meta-analysis of comparative economic evaluation studies based on real-world data

Background

There is a knowledge gap regarding the effectiveness and utility of various preventive interventions during the COVID-19 pandemic. In this study, we aimed to evaluate the cost-effectiveness of various COVID-19 preventive interventions, including non-medical interventions (NMIs) and vaccination programs, using real-world data across different demographic and socioeconomic contexts worldwide.

Methods

We searched Medline, Cochrane Library, Embase, and Web of Science Core Collection from December 2019 to March 2024. We identified 75 studies which compared 34 COVID-19 preventive interventions. We conducted a network meta-analysis to assess the incremental net benefits (INB) of these interventions from both societal and health care system perspectives. We adjusted purchasing power parity (PPP) and standardised willingness to pay (WTP) to enhance the comparability of cost-effectiveness across different economic levels. We performed sensitivity and subgroup analyses to examine the robustness of the results.

Results

Movement restrictions and expanding testing emerged as the most cost-effective strategies from a societal perspective, with WTP-standardised INB values of USD 21 050 and USD 11 144. In contrast, combinations of NMIs with vaccination were less cost-effective, particularly in high-income regions. From a health care system perspective, vaccination plus distancing and test, trace, and isolate strategy were highly cost-effective, while masking requirements were less economically viable. The effectiveness of interventions varied significantly across different economic contexts, underlining the necessity for region-specific strategies.

Conclusions

In this study, we highlight significant variations in the cost-effectiveness of COVID-19 preventive interventions. Tailoring strategies to specific regional economic and infrastructural conditions is crucial. Continuous evaluation and adaptation of these strategies are essential for effective management of ongoing and future public health threats.

Registration

PROSPERO: CRD42023385169.

Influence of COVID-19 public health restrictions on community-acquired pneumonia pathogens in children in Henan, China: a multicenter retrospective study

OBJECTIVE

To investigate the distribution of pathogens and epidemiological changes in children hospitalized with community-acquired pneumonia (CAP) during and after the COVID-19 pandemic public health restrictive measures. aiming to provide a foundation for clinical diagnosis, treatment, and policy formulation.

METHODS

This multicenter retrospective study spanned January 2019 to December 2023. The study included 78,256 children hospitalized for CAP in four hospitals in Henan, China, among which 27,580 cases (35.2%) were tested for pathogens using multiplex real-time fluorescent polymerase chain reaction (PCR). The pathogens detected include Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), respiratory syncytial virus (RSV), influenza A virus (Flu A), influenza B virus (Flu B), and Mycoplasma pneumoniae (MP).

RESULTS

Pathogens were identified in 18,690 of the 27,580 children, resulting in a 67.8% positive detection rate. Of these cases, 15,105 (54.8%) were single pathogen infections and 3,585 (13%) were mixed pathogen infections. The pathogen positivity rate was lowest in the first year of the COVID-19 pandemic (2020), at 54.7%, and peaked at 79.1% in 2023, after public health restrictions were lifted. During the COVID-19 pandemic (2020-2022), seasonal variation in pathogen prevalence was disrupted. Post-restriction, there was a significant increase in RSV and MP cases. SP remained the leading bacterial cause of CAP, especially in young children. RSV was the predominant viral pathogen, particularly affecting infants. MP showed a rising trend with age, yet it also affected younger individuals.

CONCLUSION

The COVID-19 pandemic altered the epidemiological characteristics of pathogens in children with CAP. This impact is likely to persist, necessitating enhanced surveillance of CAP pathogens to mitigate the healthcare burden in children.

CLINICAL TRIAL NUMBER

Not applicable.

The role of economic evaluation in modelling public health and social measures for pandemic policy: a systematic review

BACKGROUND

Dynamic transmission models are often used to provide epidemiological guidance for pandemic policy decisions. However, how economic evaluation is typically incorporated into this technique to generate cost-effectiveness estimates of pandemic policy responses has not previously been reviewed.

METHODS

We systematically searched the Embase, PubMed and Scopus databases for dynamic epidemiological modelling studies that incorporated economic evaluation of public health and social measures (PHSMs), with no date restrictions, on 7 July 2024.

RESULTS

Of the 2,719 screened studies, 51 met the inclusion criteria. Most studies (n = 42, 82%) modelled SARS-CoV-2. A range of PHSMs were examined, including school closures, testing/screening, social distancing and mask use. Half of the studies utilised an extension of a Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model. The most common type of economic evaluation was cost-effectiveness analysis (n = 24, 47%), followed by cost-utility analysis (n = 17, 33%) and cost-benefit analysis (n = 17, 33%).

CONCLUSIONS

Economic evaluation is infrequently incorporated into dynamic epidemiological modelling studies of PHSMs. The scope of this research should be expanded, given the substantial cost implications of pandemic PHSM policy responses.

The effect of social support on home isolation anxiety and depression among college students in the post-pandemic era: the mediating effect of perceived loss of control and the moderating role of family socioeconomic status

Background

There is an escalating concern about the rising levels of anxiety and depression among college students, especially during the post-pandemic era. A thorough examination of the various dimensions of social support and their impact on these negative emotions in college students is imperative.

Aim

This study aimed to determine if a perceived loss of control mediates the relationship between social support and levels of anxiety and depression among college students during the post-pandemic era. Additionally, it examined whether family socioeconomic status moderates this mediated relationship.

Methods

We administered an online cross-sectional survey in China, securing responses from 502 participants. The sample comprised home-isolated college students impacted by COVID-19. Established scales were employed to assess social support, anxiety, depression, perceived loss of control, and family socioeconomic status. Analytical techniques included descriptive statistics, correlation analysis, and a bootstrap method to investigate mediating and moderating effects.

Results

Social support was found to negatively affect anxiety and depression in college students, with perceived loss of control partially mediating this relationship. In addition, family socio-economic status was shown to moderate this moderating process. Furthermore, family socioeconomic status influenced this mediation, with higher socioeconomic families exhibiting a stronger moderating effect on perceived loss of control across different dimensions of social support.

Conclusion

This study may help to develop strategies to mitigate the impact of anxiety and depression in the lives and studies of university students during unexpected public health crises, and to promote better mental health among college students.

Risk profiles for smoke behavior in COVID-19: a classification and regression tree analysis approach

BACKGROUND

COVID-19 pandemic emerged worldwide at the end of 2019, causing a severe global public health threat, and smoking is closely related to COVID-19. Previous studies have reported changes in smoking behavior and influencing factors during the COVID-19 period, but none of them explored the main influencing factor and high-risk populations for smoking behavior during this period.

METHODS

We conducted a nationwide survey and obtained 21,916 valid data. Logistic regression was used to examine the relationships between each potential influencing factor (sociodemographic characteristics, perceived social support, depression, anxiety, and self-efficacy) and smoking outcomes. Then, variables related to smoking behavior were included based on the results of the multiple logistic regression, and the classification and regression tree (CART) method was used to determine the high-risk population for increased smoking behavior during COVID-19 and the most profound influencing factors on smoking increase. Finally, we used accuracy to evaluated the performance of the tree.

RESULTS

The strongest predictor of smoking behavior during the COVID-19 period is acceptance degree of passive smoking. The subgroup with a high acceptation degree of passive smoking, have no smokers smoked around, and a length of smoking of ≥ 30 years is identified as the highest smoking risk (34%). The accuracy of classification and regression tree is 87%.

CONCLUSION

The main influencing factor is acceptance degree of passive smoking. More knowledge about the harm of secondhand smoke should be promoted. For high-risk population who smoke, the "mask protection" effect during the COVID-19 pandemic should be fully utilized to encourage smoking cessation.

Diversity of classic and novel human astrovirus in outpatient children with acute gastroenteritis in Shanghai, China

Introduction

Human astrovirus (HAstV) is an important pathogen of acute gastroenteritis (AGE) in children. This study was aimed at investigating the diversity and epidemiology of classic and novel HAstV in outpatient children aged 0-16 years old with AGE in Shanghai.

Methods

From May 2020 to December 2022, a total of 1,482 stool samples were collected from children diagnosed as AGE from the Children's Hospital of Fudan University. HAstV was identified using pan-astrovirus consensus primers by Reverse transcription PCR.

Results

During the study period, 3.3% (49/1,482) of specimens were identified as HAstV, with a detection rate of 2.5% (37/1,482) for classic HAstV and 0.8% (12/1,482) for novel HAstV. Among the 12 novel HAstV strains, 11 (91.7%) belonged to the HAstV-MLB and 1 (8.3%) was HAstV-VA. Genotyping revealed six circulating genotypes. Strain HAstV-1 was predominant in the study population with a detection rate of 1.8% (26/1,482) followed by HAstV-MLB1 (0.7%, 10/1,482) and HAstV-4 (0.6%, 9/1,482). Of note, all the HAstV-4 strains detected in this study were close to one astrovirus strain isolated from Bactrian camels with 99.0-100.0% amino acid sequences identity. In this study, HAstV was detected in all age groups with the highest detection rate of HAstV-positive specimens observed in children older than 73 months (5.7%, 12/209).

Discussion

This study provided useful information and contributed to the molecular epidemiology of both classic and novel HAstV, which were simultaneously characterized and reported for the first time in Shanghai.

Risk perceptions of COVID-19, vocational identity, and employment aspirations of Chinese aviation students: a structural equation modeling approach

BACKGROUND

The COVID-19 pandemic has wreaked havoc on the aviation and education sectors in China. This study examined the relationships between risk perceptions of the pandemic, vocational identity, and employment aspirations of Chinese aviation students.

METHODS

The study used a convenience sampling approach to collect data (n = 276 respondents) from August 2 to 8, 2022. An online survey was sent via WeChat and QQ to Chinese students majoring in aviation service management who were under lockdown at six Chinese schools.

RESULTS

In spite of the strong support for the stringent COVID policies and full awareness of infection risk and protective measures, respondents were worried about the current unstable situation and felt fear for its severity and long-lasting symptoms. The casual path from career commitment to employment aspiration was supported, but high risk perceptions of the pandemic failed to have any psychological effect on the two constructs of vocational identity and employment aspirations.

CONCLUSIONS

The findings not only demonstrate the power of career commitment on employment aspirations but also reveal that a relatively high self-assessment of career proficiency may not necessarily lead to a clear career aspiration, possibly due to poor risk communication and insufficient career planning guidance. Thus, Chinese aviation students should improve their career proficiency and commitment, broaden their career options and adaptability, and have a clear career plan, in order to be well prepared for the fierce job market that will face the next wave of the ongoing pandemic.