Health inequalities and infectious disease epidemics: a challenge for global health security

Mpox-AISM: AI-mediated super monitoring for mpox and like-mpox

Swift and accurate diagnosis for earlier-stage monkeypox (mpox) patients is crucial to avoiding its spread. However, the similarities between common skin disorders and mpox and the need for professional diagnosis unavoidably impaired the diagnosis of earlier-stage mpox patients and contributed to mpox outbreak. To address the challenge, we proposed "Super Monitoring", a real-time visualization technique employing artificial intelligence (AI) and Internet technology to diagnose earlier-stage mpox cheaply, conveniently, and quickly. Concretely, AI-mediated "Super Monitoring" (mpox-AISM) integrates deep learning models, data augmentation, self-supervised learning, and cloud services. According to publicly accessible datasets, mpox-AISM's Precision, Recall, Specificity, and F1-score in diagnosing mpox reach 99.3%, 94.1%, 99.9%, and 96.6%, respectively, and it achieves 94.51% accuracy in diagnosing mpox, six like-mpox skin disorders, and normal skin. With the Internet and communication terminal, mpox-AISM has the potential to perform real-time and accurate diagnosis for earlier-stage mpox in real-world scenarios, thereby preventing mpox outbreak.

Spatiotemporal Trends in Group A Streptococcal Pharyngitis in the United States

BACKGROUND

Group A Streptococcus (GAS) causes an estimated 5.2 million outpatient visits for pharyngitis annually in the United States, with incidence peaking in winter, but the annual spatiotemporal pattern of GAS pharyngitis across the United States is poorly characterized.

METHODS

We used outpatient claims data from individuals with private medical insurance between 2010 and 2018 to quantify GAS pharyngitis visit rates across U.S. census regions, subregions, and states. We evaluated seasonal and age-based patterns of geographic spread and the association between school start dates and the summertime upward inflection in GAS visits.

RESULTS

The South had the most visits per person (yearly average, 39.11 visits per 1000 people; 95% confidence interval, 36.21-42.01) and the West had the fewest (yearly average, 17.63 visits per 1000 people; 95% confidence interval, 16.76-18.49). Visits increased earliest in the South and in school-age children. Differences in visits between the South and other regions were most pronounced in the late summer through early winter. Visits peaked earliest in central southern states, in December to January, and latest on the coasts, in March. The onset of the rise in GAS pharyngitis visits correlated with, but preceded, average school start times.

CONCLUSIONS

The burden and timing of GAS pharyngitis varied across the continental United States, with the South experiencing the highest overall rates and earliest onset and peak in outpatient visits. Understanding the drivers of these regional differences in GAS pharyngitis will help in identifying and targeting prevention measures.

Representation of marginalised populations in digital surveillance for notifiable conditions in Australia: a systematic review

AIM

This study aims to establish whether digital surveillance methods for notifiable diseases in Australia collect and report data in relation to marginalised populations.

METHODS

The literature was systematically reviewed to identify primary research studies published between January 2005 and July 2023. Studies were included if they described an Australian digital surveillance system for notifiable conditions. The results were synthesised with a focus on evaluating the collection and reporting of data in relation to marginalised populations.

RESULTS

A total of 13 articles reporting on seven surveillance systems were identified. Influenza and adverse events following immunisation were the two most common notifiable conditions monitored. A total of six surveillance systems encompassing 16 articles reported information on sub-populations. Of these, three surveillance systems (nine articles) included data on marginalised populations.

CONCLUSION

The data collected or reported in relation to sub-groups that characterise diversity in terms of health care needs, access, and marginalised populations are minimal. It is recommended that a set of equity and reporting principles is established for the future creation and use of any digital surveillance system.

Self-Reported Social Determinants of Health and Area-Level Social Vulnerability

Importance

Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources.

Objective

To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract-level social vulnerability measured using the Social Vulnerability Index (SVI).

Design, Setting, and Participants

This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system.

Main Outcomes and Measures

Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI.

Results

In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile.

Conclusions and Relevance

In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.

Optimal environmental testing frequency for outbreak surveillance

Public health surveillance for pathogens presents an optimization problem: we require enough sampling to identify intervention-triggering shifts in pathogen epidemiology, such as new introductions or sudden increases in prevalence, but not so much that costs due to surveillance itself outweigh those from pathogen-associated illness. To determine this optimal sampling frequency, we developed a general mathematical model for the introduction of a new pathogen that, once introduced, increases in prevalence exponentially. Given the relative cost of infection vs. sampling, we derived equations for the expected combined cost per unit time of disease burden and surveillance for a specified sampling frequency, and thus the sampling frequency for which the expected total cost per unit time is lowest.

Rising role of 3D-printing in delivery of therapeutics for infectious disease

Modern drug delivery to tackle infectious disease has drawn close to personalizing medicine for specific patient populations. Challenges include antibiotic-resistant infections, healthcare associated infections, and customizing treatments for local patient populations. Recently, 3D-printing has become a facilitator for the development of personalized pharmaceutic drug delivery systems. With a variety of manufacturing techniques, 3D-printing offers advantages in drug delivery development for controlled, fine-tuned release and platforms for different routes of administration. This review summarizes 3D-printing techniques in pharmaceutics and drug delivery focusing on treating infectious diseases, and discusses the influence of 3D-printing design considerations on drug delivery platforms targeting these diseases. Additionally, applications of 3D-printing in infectious diseases are summarized, with the goal to provide insight into how future delivery innovations may benefit from 3D-printing to address the global challenges in infectious disease.

Social determinants of health during and after coronavirus: a qualitative study

BACKGROUND

Health has multiple dimensions influenced not only by individual factors but also by broader social, economic, cultural, and political structures. The widespread COVID-19 pandemic has multidimensional effects on people's lives, which can have effects on individuals' lifestyles after the COVID-19. This study aimed to speculate the social determinants of health during and after the COVID-19, which can lead to more effective planning for promoting community health.

METHODS

The present study interviewed 21 experts in social and medical fields during four months. The sampling method was snowball. The interviews were semi-structured and administered in-person or electronic. All interviews were transcribed and analyzed according to the Brown and Clarke's six-stage framework to extract themes.

RESULTS

the participants were 13 males, eight experts in social field, all had PhD, 17 were academic members, and 10 were members of the Social Determinants of Health Research Center. The qualitative content analysis induced seven different social themes that affect the health which included: justice (3 Subcategories), integration (4 Subcategories), acceptance (4 Subcategories), participation (2 Subcategories), adaptation (3 Subcategories), flourishing (4 Subcategories), and cohesion (3 Subcategories).

CONCLUSIONS

According to the present study, a grand plan to cover all positive and negative social effects of COVID-19 should have at least seven different dimensions. However, the present models of effective social determinants in health do not have such comprehensiveness. Future studies may provide a proper model to be used in clinical and research fields.

Effectiveness and impact of covid-19 response and vaccination challenges in Namibia: A systematic review

Namibia, as with many countries around the world is experiencing devastating impact of Covid-19 disease on the economy, psycho-social interactions, and well-being of the populace. These countries implemented several measures to limit the spread of the virus responsible for the severe acute respiratory syndrome (SARS-CoV-2). Namibia also put measures in place to curtail the spread and fatalities due to the virus. However, the nature and implementation strategies of Public Health regulations seriously have impact on preventing the spread and curtailing fatalities arising from the virus. This article presents a report on the effectiveness and impact of Public Health measures instituted by the Health Authority towards curtailing the scourge of covid-19 on the general populace. Elements of the PRISMA protocol was utilised in the review which enabled the synthesis of data on focused area. Multifaceted databases on covid-19 such as Scopus, Science Direct, Google Scholar, World Health Organisation and the Ministry of Health and Social Services of Namibia (MoHSS) among others was used. A steady increase in covid-19 infection at an average rate of eleven (11) per day was noted in the country up till June 2021. Highest rate was linked to densely populated regions of Erongo and Khomas. Control measures for infection prevention and vaccination drive was ineffective majorly as a result of misinformation. A paradigm shift of enhanced interaction with local populace for effective information dissemination is required towards limiting the scourge of the virus and hence, saving of lives.

Spatiotemporal Trends in Group A Streptococcal Pharyngitis in the United States

Background

Group A Streptococcus (GAS) causes an estimated 5.2 million outpatient visits for pharyngitis annually in the United States (U.S.) with incidence peaking in winter, but the annual spatiotemporal pattern of GAS pharyngitis across the U.S. is poorly characterized.

Methods

We used outpatient claims data from individuals with private medical insurance between 2010-2018 to quantify GAS pharyngitis visit rates across U.S. census regions, subregions, and states. We evaluated seasonal and age-based patterns of geographic spread and the association between school start dates and the summertime upward inflection in GAS visits.

Results

The South had the most visits per person (yearly average 39.11 visits per 1000 people, 95% CI: 36.21-42.01), and the West had the fewest (yearly average 17.63 visits per 1000 people, 95% CI: 16.76-18.49). Visits increased earliest in the South and in school-age children. Differences in visits between the South and other regions were most pronounced in the late summer through early winter. Visits peaked earliest in central southern states, in December to January, and latest on the coasts, in March. The onset of the rise in GAS pharyngitis visits correlated with, but preceded, average school start times.

Conclusions

The burden and timing of GAS pharyngitis varied across the continental U.S., with the South experiencing the highest overall rates and earliest onset and peak in outpatient visits. Understanding the drivers of these regional differences in GAS pharyngitis will help in identifying and targeting prevention measures.

Centering Health Equity Through the Social Determinants of Health, Interprofessional Education, and Sustainable Partnerships With Historically Black Colleges and Universities: Envisioning Upstream and Downstream Impacts

The social determinants of health (SDOH) framework identifies barriers to health care, education, financial stability, and other conditions that exist across socially determined parameters, often to the detriment of Communities of Color. Postsecondary healthcare students must be aware of these disparities. In order to address upstream and downstream healthcare equity, the SDOH framework must be leveraged as a cross-disciplinary curricular innovation to support interprofessional education. Historically Black Colleges and Universities have unrealized potential to develop extraordinary healthcare leaders; partnerships integrating SDOH can be a powerful force to advance health equity in the United States.

Enhanced EPIRISK tool for rapid epidemic risk analysis

OBJECTIVES

This study aims to create an enhanced EPIRISK tool in order to correctly predict COVID-19 severity in various countries. The original EPIRISK tool was developed in 2018 to predict the epidemic risk and prioritise response. The tool was validated against nine historical outbreaks prior to 2020. However, it rated many high-income countries that had poor performance during the COVID-19 pandemic as having lower epidemic risk.

STUDY DESIGN

This study was designed to modify EPIRISK by reparameterizing risk factors and validate the enhanced tool against different outbreaks, including COVID-19.

METHODS

We identified three factors that could be indicators of poor performance witnessed in some high-income countries: leadership, culture and universal health coverage. By adding these parameters to EPIRISK, we created a series of models for the calibration and validation. These were tested against non-COVID outbreaks in nine countries and COVID-19 outbreaks in seven countries to identify the best-fit model. The COVID-19 severity was determined by the global incidence and mortality, which were equally divided into four levels.

RESULTS

The enhanced EPIRISK tool has 17 parameters, including seven disease-related and 10 country-related factors, with an algorithm developed for risk level classification. It correctly predicted the risk levels of COVID-19 for all seven countries and all nine historical outbreaks.

CONCLUSIONS

The enhanced EPIRSIK is a multifactorial tool that can be widely used in global infectious disease outbreaks for rapid epidemic risk analysis, assisting first responders, government and public health professionals with early epidemic preparedness and prioritising response to infectious disease outbreaks.

[Occupational differences of COVID-19 morbidity and mortality in Germany. An analysis of health insurance data from 3.17 million insured persons]

INTRODUCTION

During the COVID-19 pandemic, occupation was assumed to play a central role in the occurrence of infection and disease. For Germany, however, there are only a few studies that analyse occupational differences in risk of COVID-19, COVID-19-associated hospitalisation, and mortality.

METHODS

The study uses longitudinal health insurance data from the research database of the Institute for Applied Health Research (InGef) with information on 3.17 million insured persons aged 18-67 years (1,488,452 women; 1,684,705 men). Outcomes (morbidity, hospitalisation, and mortality) were determined on the basis of submitted COVID-19 diagnoses between 1 January 2020 and 31 December 2021. Occupations were classified according to four groupings of the official German classification of occupations. In addition to cumulative incidences, relative risks (RR) were calculated - separately for men and women.

RESULTS

There is an increased risk of disease in personal service occupations, especially in health care, compared to other occupations (RR for women 1.46; for men 1.30). The same applies to social and cultural service occupations (but only for women) and for manufacturing occupations (only for men). In addition, the risks for hospitalisation and mortality are increased for cleaning occupations and transport and logistics occupations (especially for men). For all three outcomes, the risks are higher in non-managerial occupations and differ by skill level (highest for unskilled jobs and lowest for expert positions).

CONCLUSION

The study provides important findings on work- and gender-related differences in COVID-19 morbidity and mortality in Germany, which indicate starting points for structural infection protection measures.

The impact of stress-coping strategies on perceived stress during the COVID-19 pandemic among university students an interventional study

BACKGROUND

Coronavirus (COVID-19) pandemic is a public health emergency. During the outbreak, a broad range of psychological disorders affected people at the individual, community, and international levels. This study aimed to assess the role of stress-coping strategies in relieving perceived stress among university students during the COVID-19 pandemic.

METHODS

This interventional study was nested on a cross-sectional design and involved students at Faiyum University in 2022.

RESULTS

Out of a sample of 2640 students, 2176 (82.4%) experienced moderate perceived stress, while 56 (2.1%) had more severe levels. Being female, nonmedical students, and rural inhabitants having a low socioeconomic status were associated with scores for severe and moderate levels of perceived stress. Among the interventional group, Modified Perceived Stress Scale scores significantly decreased after the implementation of the stress-coping program, with a p value < 0.001. Improvements in perceived stress levels were observed among male, medical, and high-socioeconomic-status students.

CONCLUSION

Perceived stress levels were associated with being female, engaging in nonmedical study, and having low socioeconomic status and decreased after a stress-coping program was implemented. These findings assert the need to develop regular campaigns to provide psychological support and stress-coping strategies that may help students overcome different stressors.

Rethinking the Ethics of the Covid-19 Pandemic Lockdowns

Public health responses to the Covid-19 pandemic included various measures to mitigate the spread of the virus. Among these, the most restrictive was a broad category referred to as "lockdowns." We argue that the reasoning offered in favor of extended lockdowns-those lasting several months or longer-did not adequately account for a host of countervailing considerations, including the impact on mental illness, education, employment, and marginalized communities as well as health, educational, and economic inequities. Furthermore, justifications offered for extended lockdowns set aside a basic tenet of public health ethics: restrictions on liberty and autonomy should be the least intrusive means of achieving the desired end. Since it is now clear that extended lockdowns cause severe harm to many vulnerable populations, the burden of proof is on those who would advocate for them, and there must be a much higher bar to implement an extended lockdown, with high-quality evidence that the benefit would substantially exceed its harm.

Characteristics and clinical outcomes of COVID-19 in children: a hospital-based surveillance study in Latin America's hardest-hit city

BACKGROUND

In 2020, Brazil became the epicentre of the coronavirus disease (COVID-19) pandemic in Latin America, resulting in an unparalleled health catastrophe. Nevertheless, comprehensive clinical reports in Brazilian children are not available.

METHODS

This retrospective, hospital-based, active surveillance study was performed to identify paediatric patients with COVID-19 who presented at a private academic medical centre in a large urban area between March 2020 and March 2021. Clinical and demographic information was analysed for those requiring hospitalization, those with severe illness and those with clinical syndromes.

RESULTS

In total, 964 symptomatic cases were evaluated; of these, 17.7% required hospitalization, and 27.5% of hospitalized cases were classified as severe/critical. Acute bronchiolitis and pneumonia were the most common causes of hospitalization among the severe cases. Twenty-seven hospitalized children fulfilled the diagnostic criteria for multi-system inflammatory syndrome (median age 29 months; 85.2% cases were non-severe). A significant co-existing condition was present in 29% of hospitalized children. The risk of hospitalization was higher in children with at least one comorbidity, children aged <2 years and obese children. Increased risk of severe disease was described among those with leukopenia, leukocytosis or any significant comorbidity. No deaths occurred among the study population.

CONCLUSION

Although most children with COVID-19 experienced mild disease, and no deaths occurred among the study population, a significant proportion of cases required hospitalization and developed severe illness. Obesity, young age, underlying comorbidity, leukopenia and leukocytosis were risk factors for hospitalization or severe disease.

Health inequalities in infectious diseases: a systematic overview of reviews

OBJECTIVES

The aim of this systematic overview of reviews was to synthesise available evidence on inequalities in infectious disease based on three dimensions of inequalities; inclusion health groups, protected characteristics and socioeconomic inequalities.

METHODS

We searched MEDLINE, Embase, Web of Science and OpenGrey databases in November 2021. We included reviews published from the year 2000 which examined inequalities in the incidence, prevalence or consequences of infectious diseases based on the dimensions of interest. Our search focused on tuberculosis, HIV, sexually transmitted infections, hepatitis C, vaccination and antimicrobial resistance. However, we also included eligible reviews of any other infectious diseases. We appraised the quality of reviews using the Assessment of Multiple Systematic Reviews V.2 (AMSTAR2) checklist. We conducted a narrative data synthesis.

RESULTS

We included 108 reviews in our synthesis covering all the dimensions of inequalities for most of the infectious disease topics of interest, however the quality and volume of review evidence and consistency of their findings varied. The existing literature reviews provide strong evidence that people in inclusion health groups and lower socioeconomic status are consistently at higher risk of infectious diseases, antimicrobial resistance and incomplete/delayed vaccination. In the protected characteristics dimension, ethnicity, and sexual orientation are important factors contributing to inequalities across the various infectious disease topics included in this overview of reviews.

CONCLUSION

We identified many reviews that provide evidence of various types of health inequalities in different infectious diseases, vaccination, and antimicrobial resistance. We also highlight areas where reviews may be lacking. The commonalities in the associations and their directions suggest it might be worth targeting interventions for some high risk-groups that may have benefits across multiple infectious disease outcomes rather than operating purely in infectious disease siloes.

Exploratory Study of Determinants of the Spread of COVID-19 before Shelter-in-Place Orders

This study explores the impact of relevant characteristics of counties and their relationship with increases in COVID-19 cases before shelter-in-place (SIP) orders in the U.S. The recent emergence of COVID-19 occurs when there is little understanding of the related factors affecting the growth and spread of the disease. These relationships are examined through an analysis of 672 counties before SIP orders were issued. Areas that experienced the most significant transmission of disease are identified, and their characteristics are analyzed. A meaningful relationship was found between the increase of COVID-19 cases and several factors. Average commute time and the proportion of commuters using transit had a positive relationship. Along with other socio-economic factors, such as median house value and proportion of the Black population, several transportation-related factors had a significant association with the transmission of the disease. The decrease rate of total vehicle miles traveled (VMT) before and after SIP orders also had a solid and positive relationship with the expansion of the disease. The findings suggest that planners and transportation service providers must integrate evolving public health considerations into transportation services which affect the increase in the transmission of infectious diseases.

Racial and sociodemographic predictors of COVID-19 compared with influenza, appendicitis, and all-cause hospitalization: retrospective cohort analysis

OBJECTIVE

To determine whether inequities in COVID-19 infection and hospitalization differ from those for common medical conditions: influenza, appendicitis, and all-cause hospitalization.

DESIGN

Retrospective study based on electronic health records of three healthcare systems in San Francisco (university, public, and community) examining (1) racial/ethnic distribution in cases and hospitalization among patients with diagnosed COVID-19 (March-August 2020) and patients with diagnosed influenza, diagnosed appendicitis, or all-cause hospitalization (August 2017-March 2020), and (2) sociodemographic predictors of hospitalization among those with diagnosed COVID-19 and influenza.

RESULTS

Patients 18 years or older with diagnosed COVID-19 (N = 3934), diagnosed influenza (N = 5932), diagnosed appendicitis (N = 1235), or all-cause hospitalization (N = 62,707) were included in the study. The age-adjusted racial/ethnic distribution of patients with diagnosed COVID-19 differed from that of patients with diagnosed influenza or appendicitis for all healthcare systems, as did hospitalization from these conditions compared to any cause. For example, in the public healthcare system, 68% of patients with diagnosed COVID-19 were Latine, compared with 43% of patients with diagnosed influenza, and 48% of patients with diagnosed appendicitis (p < 0.05). In multivariable logistic regressions, COVID-19 hospitalizations were associated with male sex, Asian and Pacific Islander race/ethnicity, Spanish language, and public insurance in the university healthcare system, and Latine race/ethnicity and obesity in the community healthcare system. Influenza hospitalizations were associated with Asian and Pacific Islander and other race/ethnicity in the university healthcare system, obesity in the community healthcare system, and Chinese language and public insurance in both the university and community healthcare systems.

CONCLUSIONS

Racial/ethnic and sociodemographic inequities in diagnosed COVID-19 and hospitalization differed from those for diagnosed influenza and other medical conditions, with consistently higher odds among Latine and Spanish-speaking patients. This work highlights the need for disease-specific public health efforts in at-risk communities in addition to structural upstream interventions.

The biomedical securitization of global health

BACKGROUND

The COVID-19 outbreak has shifted the course in the global health debate further towards health security and biomedical issues. Even though global health had already played a growing role in the international policy agenda, the pandemic strongly reinforced the interest of the media, the general public and the community in cross-border infectious diseases. This led to a strengthening of the already dominant biomedical understanding of global health and the securitization of health in foreign policy.

METHODS

This paper critically provides a narrative, iterative review of the health security literature available to date, with a special focus on the development of the currently prevailing concept of health security and the dual trend towards the securitization and biomedicalization of global health.

FINDINGS

In a world increasingly determined by power asymmetries, unequal distribution of opportunities and resources, and inadequate governance structures, securitizing health has become a key feature of global governance. Health security is predominantly based on a concept that neglects the global burden of disease determined by non-communicable conditions rather than by infectious diseases. Moreover, it exhibits a trend towards biomedical solutions and neglects root causes of global health crises.

CONCLUSIONS

As important as health security is, the underlying concept driven by biomedical and technocratic reductionism falls short. It widely neglects the social, economic, political, commercial and environmental determination of health. Beyond improved health care and prevention, health-in-all policies are ultimately required for ensuring health security and reducing one of its main challenges, health inequalities within and between countries. Global health security must first and foremost seek to guarantee the universal right to health and therefore emphasise the social, economic, commercial and political determination of health.

The Cascade of Care for Hepatitis C Treatment in Rwanda: A Retrospective Cohort Study of the 2017–2019 Mass Screening and Treatment Campaign

Access to hepatitis C (HCV) testing and treatment is still limited globally. To address this, the Government of Rwanda launched a voluntary mass screening and treatment campaign in 2017. We studied the progression of patients through the cascade of HCV care during this campaign. We conducted a retrospective cohort study and included all patients screened at 46 hospitals between April 2017 and October 2019. We used hierarchical logistic regression to assess factors associated with HCV positivity, gaps in care, and treatment failure. A total of 860,801 people attended the mass screening during the study period. Some 5.7% tested positive for anti-HCV, and 2.9% were confirmed positive. Of those who were confirmed positive, 52% initiated treatment, and 72% of those initiated treatment, completed treatment and returned for assessment 12 weeks afterward. The cure rate was 88%. HCV positivity was associated with age, socio-economic status, sex, marital status, and HIV coinfection. Treatment failure was associated with cirrhosis, baseline viral load, and a family history of HCV. Our results suggest that future HCV screening and testing interventions in Rwanda and other similar settings should target high-risk groups. High dropout rates suggest that more effort should be put into patient follow-up to increase adherence to care.

How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach

The COVID-19 pandemic has exposed faults in the way we assess preparedness and response capacities for public health emergencies. Existing frameworks are limited in scope, and do not sufficiently consider complex social, economic, political, regulatory, and ecological factors. One Health, through its focus on the links among humans, animals, and ecosystems, is a valuable approach through which existing assessment frameworks can be analysed and new ways forward proposed. Although in the past few years advances have been made in assessment tools such as the International Health Regulations Joint External Evaluation, a rapid and radical increase in ambition is required. To sufficiently account for the range of complex systems in which health emergencies occur, assessments should consider how problems are defined across stakeholders and the wider sociopolitical environments in which structures and institutions operate. Current frameworks do little to consider anthropogenic factors in disease emergence or address the full array of health security hazards across the social-ecological system. A complex and interdependent set of challenges threaten human, animal, and ecosystem health, and we cannot afford to overlook important contextual factors, or the determinants of these shared threats. Health security assessment frameworks should therefore ensure that the process undertaken to prioritise and build capacity adheres to core One Health principles and that interventions and outcomes are assessed in terms of added value, trade-offs, and cobenefits across human, animal, and environmental health systems.

Leveraging Responsible, Explainable, and Local Artificial Intelligence Solutions for Clinical Public Health in the Global South

In the present paper, we will explore how artificial intelligence (AI) and big data analytics (BDA) can help address clinical public and global health needs in the Global South, leveraging and capitalizing on our experience with the "Africa-Canada Artificial Intelligence and Data Innovation Consortium" (ACADIC) Project in the Global South, and focusing on the ethical and regulatory challenges we had to face. "Clinical public health" can be defined as an interdisciplinary field, at the intersection of clinical medicine and public health, whilst "clinical global health" is the practice of clinical public health with a special focus on health issue management in resource-limited settings and contexts, including the Global South. As such, clinical public and global health represent vital approaches, instrumental in (i) applying a community/population perspective to clinical practice as well as a clinical lens to community/population health, (ii) identifying health needs both at the individual and community/population levels, (iii) systematically addressing the determinants of health, including the social and structural ones, (iv) reaching the goals of population's health and well-being, especially of socially vulnerable, underserved communities, (v) better coordinating and integrating the delivery of healthcare provisions, (vi) strengthening health promotion, health protection, and health equity, and (vii) closing gender inequality and other (ethnic and socio-economic) disparities and gaps. Clinical public and global health are called to respond to the more pressing healthcare needs and challenges of our contemporary society, for which AI and BDA can help unlock new options and perspectives. In the aftermath of the still ongoing COVID-19 pandemic, the future trend of AI and BDA in the healthcare field will be devoted to building a more healthy, resilient society, able to face several challenges arising from globally networked hyper-risks, including ageing, multimorbidity, chronic disease accumulation, and climate change.

The Use of Digital Technologies in the Inpatient Setting to Promote Communication During the Early Stage of an Infectious Disease Outbreak: A Scoping Review

Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies.

Lessons Learned during a Rapidly Evolving COVID-19 Pandemic: Aboriginal and Torres Strait Islander-Led Mental Health and Wellbeing Responses Are Key

As the world journeys towards the endemic phase that follows a pandemic, public health authorities are reviewing the efficacy of COVID-19 pandemic responses. The responses by Aboriginal and Torres Strait Islander communities in Australia have been heralded across the globe as an exemplary demonstration of how self-determination can achieve optimal health outcomes for Indigenous peoples. Despite this success, the impacts of pandemic stressors and public health responses on immediate and long-term mental health and wellbeing require examination. In December 2021, Aboriginal and Torres Strait Islander mental health and wellbeing leaders and allies (N = 50) attended a virtual roundtable to determine the key issues facing Aboriginal and Torres Strait Islander peoples and communities, and the actions required to address these issues. Roundtable attendees critically reviewed how the rapidly evolving pandemic context has impacted Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing (SEWB). This paper presents an overview of this national collaborative consultation process, and a summary of the key issues and actions identified. These results build on evidence from other roundtables held in Australia during 2020, and the emerging consensus across the globe that Indigenous self-determination remains essential to Indigenous SEWB, especially during and following a pandemic.

Inequalities in the Health Impact of the First Wave of the COVID-19 Pandemic in Piedmont Region, Italy

(1) Introduction: Several studies observe a social gradient in the incidence and health consequences of SARS-CoV-2 infection, but they rely mainly on spatial associations because individual-level data are lacking. (2) Objectives: To assess the impact of social inequalities in the health outcomes of COVID-19 during the first epidemic wave in Piedmont Region, Italy, evaluating the role of the unequal social distribution of comorbidities and the capacity of the healthcare system to promote equity. (3) Methods: Subjects aged over 35, resident in Piedmont on 22 February 2020, were followed up until 30 May 2020 for access to swabs, infection, hospitalization, admission to intensive care unit, in-hospital death, COVID-19, and all-cause death. Inequalities were assessed through an Index of Socioeconomic Disadvantage composed of information on education, overcrowding, housing conditions, and neighborhood deprivation. Relative incidence measures and Relative Index of Inequality were estimated through Poisson regression models, stratifying by gender and age groups (35-64 years; ≥65 years), adjusting for comorbidity. (4) Results: Social inequalities were found in the various outcomes, in the female population, and among elderly males. Inequalities in ICU were lower, but analyses only on in-patients discount the hypothesis of preferential access by the most advantaged. Comorbidities contribute to no more than 30% of inequalities. (5) Conclusions: Despite the presence of significant inequities, the pandemic does not appear to have further exacerbated health inequalities, partly due to the fairness of the healthcare system. It is necessary to reduce inequalities in the occurrence of comorbidities that confer susceptibility to COVID-19 and promote prevention policies that limit inequalities in the mechanisms of contagion and improve out-of-hospital timely treatment.

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic

BACKGROUND

The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic.

METHODS

This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335.

RESULTS

There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths.

CONCLUSIONS

Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.

Reducing COVID-19 Health Inequities by Identifying Social Needs and Clinical Deterioration of Discharged Emergency Department Patients

INTRODUCTION

The decision to discharge a patient from the hospital with confirmed or suspected coronavirus 2019 (COVID-19) is fraught with challenges. Patients who are discharged home must be both medically stable and able to safely isolate to prevent disease spread. Socioeconomically disadvantaged patient populations in particular may lack resources to safely quarantine and are at high risk for COVID-19 morbidity.

METHODS

We developed a telehealth follow-up program for emergency department (ED) patients who received testing for COVID-19 from April 24-June 29, 2020 and were discharged home. Patients who were discharged with a pending COVID-19 test received follow-up calls on Days 1, 4, and 8. The objective of our program was to screen and provide referrals for health-related social needs (HRSN), conduct clinical screening for worsening symptoms, and deliver risk-reduction strategies for vulnerable individuals. We conducted retrospective chart reviews on all patients in this cohort to collect demographic information, testing results, and outcomes of clinical symptom and HRSN screening. Our primary outcome measurement was the need for clinical reassessment and referral for an unmet HRSN.

RESULTS

From April 24-June 29, 2020, we made calls to 1,468 patients tested for COVID-19 and discharged home. On Day 4, we reached 67.0% of the 1,468 patients called. Of these, 15.9% were referred to a physician's assistant (PA) out of concern for clinical worsening and 12.4% were referred to an emergency department (ED) patient navigator for HRSNs. On Day 8, we reached 81.8% of the 122 patients called. Of these, 19.7% were referred to a PA for clinical reassessment and 14.0% were referred to an ED patient navigator for HRSNs. Our intervention reached 1,069 patients, of whom 12.6% required referral for HRSNs and 1.3% (n = 14) were referred to the ED or Respiratory Illness Clinic due to concern for worsening clinical symptoms.

CONCLUSION

In this patient population, the demand for interventions to address social needs was as high as the need for clinical reassessment. Similar ED-based programs should be considered to help support patients' interdependent social and health needs beyond those related to COVID-19.

Adolescent retention in HIV care within differentiated service-delivery models in sub-Saharan Africa

Adolescents and young people living with HIV are at risk of disengaging from HIV care at all stages of the care cascade. Differentiated models of care offer simplified HIV-service delivery options in the hope of improving treatment outcomes, including retention on antiretroviral therapy. However, it remains unclear how successful and widespread these models are for adolescents in sub-Saharan Africa, where the burden of HIV is the greatest. Very few differentiated models of care specifically targeted to adolescents can be found and this priority group are currently ineligible from several models that exist. Where differentiated care has been made available to adolescents, data on the implementation and effectiveness of these interventions remain scarce. Despite this scarcity of evidence on the effectiveness of differentiated care among adolescent populations, several interventions, particularly community-based groups with peer navigators or supporters, might have potential to increase the reach, effectiveness, and adoption of differentiated care in adolescent HIV-care programmes.

Causal connections between socioeconomic disparities and COVID-19 in the USA

With the increasing use of machine learning models in computational socioeconomics, the development of methods for explaining these models and understanding the causal connections is gradually gaining importance. In this work, we advocate the use of an explanatory framework from cooperative game theory augmented with do calculus, namely causal Shapley values. Using causal Shapley values, we analyze socioeconomic disparities that have a causal link to the spread of COVID-19 in the USA. We study several phases of the disease spread to show how the causal connections change over time. We perform a causal analysis using random effects models and discuss the correspondence between the two methods to verify our results. We show the distinct advantages a non-linear machine learning models have over linear models when performing a multivariate analysis, especially since the machine learning models can map out non-linear correlations in the data. In addition, the causal Shapley values allow for including the causal structure in the variable importance computed for the machine learning model.

Rate of Nutrition-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults

The prevalence of nutrition-related chronic diseases, such as obesity, cardiovascular disease, and type 2 diabetes, among adults in the U.S. is of increasing importance. These conditions adversely affect the overall public health, health care systems, and economy. Marginalized minority groups have been disproportionally affected by these conditions. Lack of or inadequate health insurance limits access to health care, which contributes to poor health outcomes among individuals with these conditions. South Florida is home to diverse racial/ethnic minority groups, many of whom are uninsured and do not have access to expert-delivered nutrition education services. It is imperative to thoroughly study the health needs of these underserved patient populations and examine the rate of nutrition-related conditions among them in order to develop medically and culturally tailored nutrition education programs for them. Therefore, the aim of this study was to assess the prevalence of nutrition-related diseases among multi-racial/ethnic uninsured individuals living in South Florida. A four-week electronic health record of adult patients (N=272) from a free clinic in South Florida was analyzed. Spearman`s correlation and binary regression models were used to assess the relationship between the variables. The sample included females (65%) and males (35%). The mean age was 49.08±14.56 years. Overall, 87% had at least one nutrition-related condition, with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). BMI was a significant predictor of the prevalence of hypertension among Whites (p=0.008) and Blacks (p=0.002) but not Asians (p=0.536). Overall, a high rate of nutrition-related chronic diseases was found among uninsured adults in this study. This supports the need for increased medically, culturally, and economically tailored nutrition education programs in free clinic settings.

Investigating COVID-19 transmission and mortality differences between indigenous and non-indigenous populations in Mexico

OBJECTIVES

Indigenous populations have been disproportionately affected during pandemics. We investigated COVID-19 mortality estimates among indigenous and non-indigenous populations at national and sub-national levels in Mexico.

METHODS

We obtained data from the Ministry of Health, Mexico, on 2,173,036 laboratory-confirmed RT-PCR positive COVID-19 cases and 238,803 deaths. We estimated mortality per 1000 person-weeks, mortality rate ratio (RR) among indigenous vs. non-indigenous groups, and hazard ratio (HR) for COVID-19 deaths across four waves of the pandemic, from February 2020 to March 2022. We also assessed differences in the reproduction number (R_t).

RESULTS

The mortality rate among indigenous populations of Mexico was 68% higher than that of non-indigenous groups. Out of 32 federal entities, 23 exhibited higher mortality rates among indigenous groups (P < 0.05 in 13 entities). The fourth wave showed the highest RR (2.40). The crude HR was 1.67 (95% CI: 1.62, 1.72), which decreased to 1.08 (95% CI: 1.04, 1.11) after controlling for other covariates. During the intense fourth wave, the R_t among the two groups was comparable.

CONCLUSION

Indigenous status is a significant risk factor for COVID-19 mortality in Mexico. Our findings may reflect disparities in non-pharmaceutical (e.g., handwashing and using facemasks), and COVID-19 vaccination interventions among indigenous and non-indigenous populations in Mexico.

Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic—A Scoping Review

Objectives: International evidence of socioeconomic inequalities in COVID-19 outcomes is extensive and growing, but less is known about the temporal dynamics of these inequalities over the course of the pandemic.

Methods: We systematically searched the Embase and Scopus databases. Additionally, several relevant journals and the reference lists of all included articles were hand-searched. This study follows the PRISMA guidelines for scoping reviews.

Results: Forty-six studies were included. Of all analyses, 91.4% showed stable or increasing socioeconomic inequalities in COVID-19 outcomes over the course of the pandemic, with socioeconomically disadvantaged populations being most affected. Furthermore, the study results showed temporal dynamics in socioeconomic inequalities in COVID-19, frequently initiated through higher COVID-19 incidence and mortality rates in better-off populations and subsequent crossover dynamics to higher rates in socioeconomically disadvantaged populations (41.9% of all analyses).

Conclusion: The identified temporal dynamics of socioeconomic inequalities in COVID-19 outcomes have relevant public health implications. Socioeconomic inequalities should be monitored over time to enable the adaption of prevention and interventions according to the social particularities of specific pandemic phases.

Socioeconomic-Related Inequalities in COVID-19 Vulnerability in South Africa

Individuals' vulnerability to the risk of COVID-19 infection varies due to their health, socioeconomic, and living circumstances, which also affect the effectiveness of implementing non-pharmacological interventions (NPIs). In this study, we analysed socioeconomic-related inequalities in COVID-19 vulnerability using data from the nationally representative South African General Household Survey 2019. We developed a COVID-19 vulnerability index, which includes health and social risk factors for COVID-19 exposure and susceptibility. The concentration curve and concentration index were used to measure socioeconomic-related inequalities in COVID-19 vulnerability. Recentred influence function regression was then utilised to decompose factors that explain the socioeconomic-related inequalities in COVID-19 vulnerability. The concentration index estimates were all negative and highly significant (p < 0.01), indicating that vulnerability to COVID-19 was more concentrated among the poor. According to the decomposition analysis, higher income and education significantly (p < 0.01) positively impacted lowering socioeconomic-related COVID-19 vulnerability. Living in an urban region, being Black, and old all had significant (p < 0.01) positive impacts on increasing socioeconomic-related COVID-19 vulnerability. Our findings contribute to a better understanding of socially defined COVID-19-vulnerable populations in South Africa and the implications for future pandemic preparedness plans.

Dual mediating effects of changes in daily life and anxiety on the relationship between occupation and depression in Korea during the COVID-19 pandemic

Background

A substantial proportion of the world’s population experienced social, economic, and mental health challenges, including considerable changes in everyday life, due to the COVID-19 pandemic. However, these challenges varied in intensity depending upon occupation type and working environment. In this context, this study helps shed light on the effects of occupation type on depression through the mediation of changes in daily life and anxiety as perceived by individual workers through their experiences of the COVID-19 pandemic.

Methods

In total, 68,207 adults (aged 19–65 years) working in the “office” or “service” sectors were analyzed based on the raw data extracted from the 2020 National Community Health Survey conducted by the Korea Disease Control and Prevention Agency. Data analysis was performed using PROCESS Macro (Model 6) for SPSS 25 to examine how depression is affected by occupation type through a dual mediation of the changes in daily life and anxiety caused by COVID-19 as perceived by individual workers during the pandemic.

Results

First, service workers perceived COVID-19-related changes in daily life more acutely than the office workers. Second, service workers felt more COVID-19-related anxiety than office workers, whereby the higher the level of COVID-19-related changes in daily life perceived by the workers, the higher the level of their COVID-19-related anxiety. Finally, service workers’ perceived COVID-19-related changes in daily life more acutely than office workers, which had a positive effect on the level of COVID-19-related anxiety, ultimately increasing depression.

Conclusions

It was found that the impact of a special disaster situation, such as the COVID-19 pandemic, on the perceived changes in daily life and anxiety varies depending on occupation type, which suggests that different occupations have different effects on mental health outcomes. This highlights the need to develop various customized services and policies to promote mental health according to the type of occupation, considering the working environment and work characteristics of those vulnerable to COVID-19 infection.

African Americans and the COVID-19 pandemic: A qualitative inquiry of preparedness, challenges, and strategies on how we can move forward

RATIONALE

The COVID-19 pandemic has disproportionately impacted Black Americans. Inequities in systems and social determinants of health along with racial health disparities impact degree of pandemic preparedness.

OBJECTIVE

In early pandemic stages, we aimed to explore: 1) state of pandemic preparedness; 2) effects of socio-ecological factors on preparedness; and 3) multi-level strategies to increase preparedness among uniquely, vulnerable Black American subgroups.

METHODS

We conducted 62 in-depth interviews with Black American community members representing parents, individuals with underlying medical conditions, essential workers, and young adults. Based on the McLeroy's Model Ecological for Health Promotion, an inductive-deductive content analysis approach was used to analyze the interview data around the factors influencing preparedness on individual, interpersonal processes and primary groups, community/institutional, and public policy.

RESULTS

Majority (56.5%) of the participants stated they were somewhat or very prepared. We identified four themes: 1) Lived Experiences during the COVID-19 Pandemic; 2) Challenges experienced during the COVID-19 Pandemic; 3) I would do this differently they say; 4) Changes Needed to Survive the Pandemic relate to Public Policy, Community/institutional factors, and Interpersonal processes and primary group(s). All participants described their adjustments to live in the new norm. Participants identified perceived challenges and solutions on multi-levels, driven by subgroup.

CONCLUSIONS

Pandemic response plans should use targeted strategies across multi-levels to enhance the preparedness of Black Americans, especially those in vulnerable groups. This could reduce the disproportionate COVID-19 disease burden exhibited by Black Americans and better prepare for future pandemics.

Selective border permeability: Governing complex environmental issues through and beyond COVID-19

COVID-19 has changed the permeability of borders in transboundary environmental governance regimes. While borders have always been selectively permeable, the pandemic has reconfigured the nature of cross-border flows of people, natural resources, finances and technologies. This has altered the availability of spaces for enacting sustainability initiatives within and between countries. In Southeast Asia, national governments and businesses seeking to expedite economic recovery from the pandemic-induced recession have selectively re-opened borders by accelerating production and revitalizing agro-export growth. Widening regional inequities have also contributed to increased cross-border flows of illicit commodities, such as trafficked wildlife. At the same time, border restrictions under the exigencies of controlling the pandemic have led to a rolling back and scaling down of transboundary environmental agreements, regulations and programs, with important implications for environmental democracy, socio-ecological justice and sustainability. Drawing on evidence from Southeast Asia, the article assesses the policy challenges and opportunities posed by the shifting permeability of borders for organising and operationalising environmental activities at different scales of transboundary governance.

Regional disparities in SARS-CoV-2 infections by labour market indicators: a spatial panel analysis using nationwide German data on notified infections

Background

Regional labour markets and their properties are named as potential reasons for regional variations in levels of SARS-CoV-2 infections rates, but empirical evidence is missing.

Methods

Using nationwide data on notified laboratory-confirmed SARS-CoV-2 infections, we calculated weekly age-standardised incidence rates (ASIRs) for working-age populations at the regional level of Germany’s 400 districts. Data covered nearly 2 years (March 2020 till December 2021), including four main waves of the pandemic. For each of the pandemic waves, we investigated regional differences in weekly ASIRs according to three regional labour market indicators: (1) employment rate, (2) employment by sector, and (3) capacity to work from home. We use spatial panel regression analysis, which incorporates geospatial information and accounts for regional clustering of infections.

Results

For all four pandemic waves under study, we found that regions with higher proportions of people in employment had higher ASIRs and a steeper increase of infections during the waves. Further, the composition of the workforce mattered: rates were higher in regions with larger secondary sectors or if opportunities of working from home were comparatively low. Associations remained consistent after adjusting for potential confounders, including a proxy measure of regional vaccination progress.

Conclusions

If further validated by studies using individual-level data, our study calls for increased intervention efforts to improve protective measures at the workplace, particularly among workers of the secondary sector with no opportunities to work from home. It also points to the necessity of strengthening work and employment as essential components of pandemic preparedness plans.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07643-5.

Sustainable social development promotes COVID-19 pandemic control

The rapid spread of COVID-19 had a negative impact on public health and economic recovery worldwide. There is a large and growing literature on pandemic prevention and control. However, these existing studies seldom focus on the role of sustainable social development in this process. By setting specifications of fixed-effect models based on the score data of sustainable development goals (SDG) and infection case data from 257 Chinese cities, we evaluate the positive effect of sustainable social development on pandemic control. Our results show that sustainable social development leads to a remarkable improvement in pandemic prevention and control, especially for SDG4 (Quality Education) and SDG5 (Gender Equality). Significant positive effects of sustainable social development still exist in the post-pandemic era. This study highlights the importance of promoting social SDGs by linking them with pandemic prevention and control and suggests region-specific policies based on the heterogeneous analysis results.

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This study highlights the importance of social SDGs by linking them to pandemic control

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Social SDGs improve pandemic prevention and control in two pandemic development stages

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Cities with better education/gender equality performed better in pandemic control

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The impact of social SDGs on pandemic control is heterogeneous in different regions

Role of social determinants in anxiety and depression symptoms during COVID-19: A longitudinal study of adults in North Carolina and Massachusetts

Trajectory studies of the COVID-19 pandemic have described patterns of symptoms over time. Yet, few have examined whether social determinants of health predict the progression of depression and anxiety symptoms during COVID-19 or identified which social determinants worsen symptom trajectories. Using a racially, ethnically, and linguistically diverse sample of adults participating in a randomized clinical trial with pre-existing moderate to severe depression and/or anxiety symptoms, we compare symptom patterns before and during COVID-19; characterize symptom trajectories over a 20-week follow-up period; and evaluate whether social determinants are associated with within- and between- person differences in symptom trajectories. Data were collected before and during COVID-19 in Massachusetts and North Carolina. On average, depression and anxiety symptoms did not seem to worsen during the pandemic compared to pre-pandemic. During COVID-19, anxiety scores at follow-up were higher for participants with baseline food insecurity (vs no food insecurity). Depression scores at follow-up were higher for participants with food insecurity and for those with utilities insecurity (vs no insecurity). Participants with child or family care responsibilities at baseline had depression symptoms decreasing at a slower rate than those without these responsibilities. We discuss the important implications of these findings.

Geospatial clustering and correlates of deaths during the Ebola outbreak in Liberia: a Bayesian geoadditive semiparametric analysis of nationally representative cross-sectional survey data

OBJECTIVE

To investigate the extent of geospatial clustering of reported deaths during the Ebola outbreak in Liberia and the covariates associated with the observed clustering.

DESIGN

Cross-sectional study.

PARTICIPANTS

Male and female respondents from the 2019-2020 Liberia Demographic and Health Survey. The analysis covered 11 928 (women=7854 and men=4074) respondents for whom complete data were available.

OUTCOME MEASURES

The outcome variable was the death of a household member or relative during the Ebola outbreak in Liberia, coded 1 if the respondent reported death and 0 otherwise.

METHODS

We applied the Bayesian geoadditive semiparametric regression to examine the extent of geospatial clustering of deaths at the district-level and community-level development and socioeconomic factors associated with the observed clustering.

RESULTS

Almost a quarter (24.8%) of all respondents reported the death of a household member or relative during the Ebola outbreak. The results show that deaths were clustered within districts in six (Grand Cape Mount, Bomi, Monsterrado, Margibi, Gbarpolu and Lofa) of the 15 counties in Liberia. Districts with high death clustering were all near or shared borders with Sierra Leone and Guinea. The community-level development indicators (global human footprint, gross cell production and population density) had a non-linear associative effect with the observed spatial clustering. Also, respondents' characteristics (respondent's age (non-linear effect), educational attainment and urban-rural place of residence) were associated with the observed clustering. The results show that death clustering during outbreaks was constrained to poor settings and impacts areas of moderate and high socioeconomic development.

CONCLUSION

Reported deaths during the Ebola outbreak in Liberia were not randomly distributed at the district level but clustered. The findings highlight the need to identify at-risk populations during epidemics and respond with the needed interventions to save lives.

State and citizen responsiveness in fighting a pandemic crisis: A systems thinking perspective

Management scholars have recognized organizational responsiveness among the essential capabilities of social organizations. It becomes essential for a social change to occur during a crisis, where the uncertainty or environmental dynamism is high. However, a social change cannot be successful unless constituent subsystems of a social organization exhibit responsiveness. Using systems theory, we conceptualize 'nation' as a social system and examine its responsiveness towards environmental uncertainly, taking an example of the COVID-19 pandemic. How can state and citizen community responsiveness help fight a pandemic crisis? We test these direct and moderating effects on data representing 14 countries. We perform a hierarchical regression analysis on the restructured, balanced country-wise panel data. Our findings highlight the importance of state and community interaction effects in controlling pandemic growth. Accordingly, we claim that only a collaborative approach by citizen communities with the respective governments will enable handling an uncertain situation.

Addressing the socioeconomic divide in computational modeling for infectious diseases

The COVID-19 pandemic has highlighted how structural social inequities fundamentally shape disease dynamics. Here, the authors provide a set of practical and methodological recommendations to address socioeconomic vulnerabilities in epidemic models.

Correlates of the country differences in the infection and mortality rates during the first wave of the COVID-19 pandemic: evidence from Bayesian model averaging

The COVID-19 pandemic resulted in great discrepancies in both infection and mortality rates between countries. Besides the biological and epidemiological factors, a multitude of social and economic criteria also influenced the extent to which these discrepancies appeared. Consequently, there is an active debate regarding the critical socio-economic and health factors that correlate with the infection and mortality rates outcome of the pandemic. Here, we leverage Bayesian model averaging techniques and country level data to investigate whether 28 variables, which describe a diverse set of health and socio-economic characteristics, correlate with the final number of infections and deaths during the first wave of the coronavirus pandemic. We show that only a few variables are able to robustly correlate with these outcomes. To understand the relationship between the potential correlates in explaining the infection and death rates, we create a Jointness Space. Using this space, we conclude that the extent to which each variable is able to provide a credible explanation for the COVID-19 infections/mortality outcome varies between countries because of their heterogeneous features.

Rhamnolipid Nano-Micelles versus Alcohol-Based Hand Sanitizer: A Comparative Study for Antibacterial Activity against Hospital-Acquired Infections and Toxicity Concerns

Hospital-acquired infections (HAIs) are considered to be a major global healthcare challenge, in large part because of the development of microbial resistance to currently approved antimicrobial drugs. HAIs are frequently preventable through infection prevention and control measures, with hand hygiene as a key activity. Improving hand hygiene was reported to reduce the transmission of healthcare-associated pathogens and HAIs. Alcohol-based hand sanitizers are commonly used due to their rapid action and broad spectrum of microbicidal activity, offering protection against bacteria and viruses. However, their frequent administration has been reported to be associated with many side effects, such as skin sensitivity, skin drying, and cracks, which promote further skin infections. Thus, there is an essential need to find alternative approaches to hand sanitation. Rhamnolipids are glycolipids produced by Pseudomonas aeruginosa, and were shown to have broad antimicrobial activity as biosurfactants. We have previously demonstrated the antimicrobial activity of rhamnolipid nano-micelles against selected drug-resistant Gram-negative (Salmonella Montevideo and Salmonella Typhimurium) and Gram-positive bacteria (Staphylococcus aureus, Streptococcus pneumoniae). To the best of our knowledge, the antimicrobial activity of rhamnolipid nano-micelles in comparison to alcohol-based hand sanitizers against microorganisms commonly causing HAIs in Egypt—such as Acinetobacter baumannii and Staphylococcus aureus—has not yet been studied. In the present work, a comparative study of the antibacterial activity of rhamnolipid nano-micelles versus alcohol-based hand sanitizers was performed, and their safety profiles were also assessed. It was demonstrated that rhamnolipid nano-micelles had a comparable antibacterial activity to alcohol-based hand sanitizer, with a better safety profile, i.e., rhamnolipid nano-micelles are unlikely to cause any harmful effects on the skin. Thus, rhamnolipid nano-micelles could be recommended to replace alcohol-based hand sanitizers; however, they must still be tested by healthcare workers in healthcare settings to ascertain their antimicrobial activity and safety.

Malaria and Helminthic Co-Infection during Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Malaria and helminthic co-infection during pregnancy causes fetomaternal haemorrhage and foetal growth retardation. This study determined the pooled burden of pregnancy malaria and helminthic co-infection in sub-Saharan Africa. CINAHL, EMBASE, Google Scholar, Scopus, PubMed, and Web of Science databases were used to retrieve data from the literature, without restricting language and publication year. The Joanna Briggs Institute’s critical appraisal tool for prevalence studies was used for quality assessment. STATA Version 14.0 was used to conduct the meta-analysis. The I² statistics and Egger’s test were used to test heterogeneity and publication bias. The random-effects model was used to estimate the pooled prevalence at a 95% confidence interval (CI). The review protocol has been registered in PROSPERO, with the number CRD42019144812. In total, 24 studies (n = 14,087 participants) were identified in this study. The pooled analysis revealed that 20% of pregnant women were co-infected by malaria and helminths in sub-Saharan Africa. The pooled prevalence of malaria and helminths were 33% and 35%, respectively. The most prevalent helminths were Hookworm (48%), Ascaris lumbricoides (37%), and Trichuris trichiura (15%). Significantly higher malaria and helminthic co-infection during pregnancy were observed. Health systems in sub-Saharan Africa must implement home-grown innovative solutions to underpin context-specific policies for the early initiation of effective intermittent preventive therapy.

Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning

Since the WHO's "Influenza Pandemic Preparedness Plan" in 1999, pandemic preparedness plans at the international and national level have been constantly adapted with the common goal to respond early to outbreaks, identify risks, and outline promising interventions for pandemic containment. Two years into the COVID-19 pandemic, public health experts have started to reflect on the extent to which previous preparations have been helpful as well as on the gaps in pandemic preparedness planning. In the present commentary, we advocate for the inclusion of social and ethical factors in future pandemic planning-factors that have been insufficiently considered so far, although social determinants of infection risk and infectious disease severity contribute to aggravated social inequalities in health.

COVID-19 Disease Burden Related to Social Vulnerability and Comorbidities: Challenges to Tuberculosis Control

Purpose: The first coronavirus disease (COVID-19) spike and subsequent pandemic in South Korea were rapid and disruptive. Government response measures for disadvantaged groups against infectious disease should be prioritized based on evidence and affordability. We investigated whether COVID-19 infection, intensive care unit (ICU) care, and mortality from COVID-19 are related to social and medical vulnerability, including tuberculosis (TB). Patients and Methods: Using the National Health Insurance Service COVID-19 database in South Korea, we analyzed 129,128 patients, including controls, from 1 January to 30 May 2020, during the early stage of the COVID-19 epidemic. The relationship between health insurance premiums (representing socioeconomic status), the Charlson comorbidity index (CCI) score for the severity of the underlying disease, and additional TB diagnosis was analyzed using the chi-square test and logistic regression. Results: For the demographics, 3244 out of 51,783 men (6.3%) and 4836 out of 77,345 women (6.3%) were infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 infection, ICU care, and mortality were related to older age (p < 0.001) and lower health insurance premium levels (p < 0.05). Regarding the CCI score, the CCI score, COVID-19 infection, and mortality increased (p < 0.0001). In terms of premium level, the highest group showed a lower risk of infection (OR 0.52, 0.48-0.57, p = 0.004), ICU care (OR 0.59, 0.46-0.75, p < 0.001), and mortality (OR 0.51, 0.32-0.78, p = 0.016) than the medical aid group. TB was related to ICU care for COVID-19 (OR 4.27, 1.27-14.38, p = 0.018). Conclusion: In the early epidemic, SARS-CoV-2 infection, ICU admission, and mortality from COVID-19 increased in socioeconomically and physically vulnerable groups. However, the relationship between tuberculosis, COVID-19 and mortality was not definite because of the possible under-reporting of TB cases and the relatively small number of TB patients.