Effect of social distancing on COVID-19 incidence and mortality in the US

Nurses Lived Experiences, Burdens and Coping Strategies During COVID-19 Pandemic

This is a qualitative phenomenological study that was designed to navigate through nurses' lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses' lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses' eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.

Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic

Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.

Considerations of COVID-19 in Ophthalmology

Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. As a result, clinical ophthalmologists, optometrists, and eyecare professionals have had to familiarize themselves with the ocular manifestations of COVID-19, as well as its treatments and vaccines. The implementation of measures to prevent the transmission of the virus, such as restrictions, lockdowns, telemedicine, and artificial intelligence (AI), have led to substantial and potentially irreversible changes in routine clinical practice, education, and research. This has resulted in the emergence of a new mode of managing patients in a routine clinical setting. This brief review aims to provide an overview of various aspects of COVID-19 in ophthalmology, including the ocular manifestations related to the disease, the modes of transmission of SARS-CoV-2 infection, precautions taken in ophthalmic practice to prevent the spread of the virus, drugs, and vaccines used in the treatment of COVID-19, the impact of the pandemic on patients, clinicians, and the eye care system as a whole, and the future of ophthalmology conditioned by this global pandemic experience.

Assessing COVID-19 pandemic policies and behaviours and their economic and educational trade-offs across US states from Jan 1, 2020, to July 31, 2022: an observational analysis

BACKGROUND

The USA struggled in responding to the COVID-19 pandemic, but not all states struggled equally. Identifying the factors associated with cross-state variation in infection and mortality rates could help to improve responses to this and future pandemics. We sought to answer five key policy-relevant questions regarding the following: 1) what roles social, economic, and racial inequities had in interstate variation in COVID-19 outcomes; 2) whether states with greater health-care and public health capacity had better outcomes; 3) how politics influenced the results; 4) whether states that imposed more policy mandates and sustained them longer had better outcomes; and 5) whether there were trade-offs between a state having fewer cumulative SARS-CoV-2 infections and total COVID-19 deaths and its economic and educational outcomes.

METHODS

Data disaggregated by US state were extracted from public databases, including COVID-19 infection and mortality estimates from the Institute for Health Metrics and Evaluation's (IHME) COVID-19 database; Bureau of Economic Analysis data on state gross domestic product (GDP); Federal Reserve economic data on employment rates; National Center for Education Statistics data on student standardised test scores; and US Census Bureau data on race and ethnicity by state. We standardised infection rates for population density and death rates for age and the prevalence of major comorbidities to facilitate comparison of states' successes in mitigating the effects of COVID-19. We regressed these health outcomes on prepandemic state characteristics (such as educational attainment and health spending per capita), policies adopted by states during the pandemic (such as mask mandates and business closures), and population-level behavioural responses (such as vaccine coverage and mobility). We explored potential mechanisms connecting state-level factors to individual-level behaviours using linear regression. We quantified reductions in state GDP, employment, and student test scores during the pandemic to identify policy and behavioural responses associated with these outcomes and to assess trade-offs between these outcomes and COVID-19 outcomes. Significance was defined as p<0·05.

FINDINGS

Standardised cumulative COVID-19 death rates for the period from Jan 1, 2020, to July 31, 2022 varied across the USA (national rate 372 deaths per 100 000 population [95% uncertainty interval [UI] 364-379]), with the lowest standardised rates in Hawaii (147 deaths per 100 000 [127-196]) and New Hampshire (215 per 100 000 [183-271]) and the highest in Arizona (581 per 100 000 [509-672]) and Washington, DC (526 per 100 000 [425-631]). A lower poverty rate, higher mean number of years of education, and a greater proportion of people expressing interpersonal trust were statistically associated with lower infection and death rates, and states where larger percentages of the population identify as Black (non-Hispanic) or Hispanic were associated with higher cumulative death rates. Access to quality health care (measured by the IHME's Healthcare Access and Quality Index) was associated with fewer total COVID-19 deaths and SARS-CoV-2 infections, but higher public health spending and more public health personnel per capita were not, at the state level. The political affiliation of the state governor was not associated with lower SARS-CoV-2 infection or COVID-19 death rates, but worse COVID-19 outcomes were associated with the proportion of a state's voters who voted for the 2020 Republican presidential candidate. State governments' uses of protective mandates were associated with lower infection rates, as were mask use, lower mobility, and higher vaccination rate, while vaccination rates were associated with lower death rates. State GDP and student reading test scores were not associated with state COVD-19 policy responses, infection rates, or death rates. Employment, however, had a statistically significant relationship with restaurant closures and greater infections and deaths: on average, 1574 (95% UI 884-7107) additional infections per 10 000 population were associated in states with a one percentage point increase in employment rate. Several policy mandates and protective behaviours were associated with lower fourth-grade mathematics test scores, but our study results did not find a link to state-level estimates of school closures.

INTERPRETATION

COVID-19 magnified the polarisation and persistent social, economic, and racial inequities that already existed across US society, but the next pandemic threat need not do the same. US states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society were able to match the best-performing nations in minimising COVID-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises.

FUNDING

Bill & Melinda Gates Foundation, J Stanton, T Gillespie, J and E Nordstrom, and Bloomberg Philanthropies.

[Evidence map on post-acute COVID-19 sequelae and rehabilitation: Update as of July 2022Mapa de evidencia sobre las secuelas y la rehabilitación tras la COVID-19 aguda: versión actualizada en julio del 2022]

Objective

To update the evidence map on the effects of interventions for post-acute COVID-19 rehabilitation.

Method

The search scope was defined according to the population (patients with symptomatic COVID-19 and post-acute COVID sequelae), the context (interventions for rehabilitation), and the type of study (systematic reviews, rapid reviews, scoping reviews or overviews of reviews). Following a search in PubMed and the Virtual Health Library, two independent authors selected the articles for review. The map was updated on July 27, 2022, using the same procedures employed in the initial review.

Results

The initial evidence map included 22 studies (four systematic reviews, four rapid reviews, four reviews of case reports, one scoping review, and nine systematic review protocols). In the present update, an additional 10 studies were included. The analysis revealed four groups of interventions (multimodal, therapeutic, complementary, and pharmacological) and seven groups of outcomes (pathological conditions, diseases/respiratory disorders, pain, physiological and metabolic markers, mental health/quality of life, sensory function, and mortality), totaling 166 associations between interventions and outcomes. The highest number of associations was observed for complementary therapies (n = 94). Among the outcomes, the highest number of associations was observed for physiological and metabolic markers, pathological conditions, and mental health/quality of life (44, 41, and 35 associations respectively).

Conclusions

The map update involved the analysis of 69 associations, most notably exercise (isolated, multicomponent, or multimodal intervention), with 23 positive and four potentially positive effects) and pharmacologic and complementary therapies for sensorial functions (15 associations). The high number of systematic review protocols indicates that the literature is still incipient.

Efficacy of COVID-19 Public Health Measures in Philadelphia, New York City, Baltimore, and Chicago

Introduction

From the early days of the pandemic, US cities have implemented a variety of public health measures to reduce the spread of COVID-19. This study investigates which policies were most effective in reducing cases of COVID-19 in four major cities: Philadelphia, New York City, Baltimore, and Chicago.

Methods

Through a cross-comparative analysis, we developed a timeline that tracked the implementation of a range of public health measures along with changes in COVID-19 cases, hospitalizations, and deaths. Data were collected from publicly available government sites and from press releases.

Results

The results from the stay-at-home orders illustrate the delayed impact it has in reducing COVID-19 cases and hospitalizations. The mask mandate led to the immediate and sustained reduction in cases across all four cities. During the spike of COVID-19 in the Fall of 2020, restrictions on indoor dining contributed significantly to reducing COVID-19 cases.

Discussion

Of all the measures that were examined, the implementation of mask mandates was most closely associated with a decline in COVID-19 cases, hospitalizations, and deaths across all four cities. Restrictions on indoor dining were also associated with a reduction in COVID-19 cases. Future studies should further investigate the adherence to different policies to better understand their impacts.

Lessons Learned from In-Person Conferences in the Times of COVID-19

Scientific societies and conference secretariats have recently resumed in-person meetings after a long pause owing to the COVID-19 pandemic. Some safety measures continue to be implemented at these in-person events to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With increased numbers of waves of infection, caused by the emergence of SARS-CoV-2 variants, additional information is needed to ensure maximal safety at in-person events. The MEX-DART case study was conducted at the in-person Hep-DART 2021 conference, which was held in Los Cabos, Mexico, in December 2021. Many COVID-19 safety measures were implemented, and incidence of SARS-CoV-2 infection during the conference was tested onsite. In this study, we highlight the specific conditions and safety measures set in place at the conference. In addition to vaccination requirements, social distancing, and mask wearing, daily rapid testing was implemented for the duration of the conference. At the end of the 4-day meeting, none of the 166 delegates (and family members attending the conference) had tested antigen positive for SARS-CoV-2. Two delegates tested positive in the week after the conference; the timing of their positive test result suggests that they contracted the virus during their travels home or during postconference vacationing. We believe that this model can serve as a helpful template for organizing future in-person meetings in the era of COVID-19 and any other respiratory virus pandemics of the future. While the outcomes of this case study are encouraging, seasonal surges in respiratory virus infections such as SARS-CoV-2, RSV, and influenza virus incidence suggest that continued caution is warranted.

COVID-19 Deaths and the Impact of Health Disparities, Hospital Characteristics, Community, Social Distancing, and Health System Competition

The United States has one of the highest cumulative mortalities of coronavirus disease 2019 (COVID-19) and has reached 1 million deaths as of May 19th, 2022. Understanding which community and hospital factors contributed to disparities in COVID-19 mortality is important to inform public health strategies. This study aimed to explore the potential relationship between hospital service area (1) community (ie, health professional shortage areas, market competition, and uninsured percentage) and (2) hospital (ie, teaching, system, and ownership status) characteristics (2013-2018) on publicly available COVD-19 (February to October 2020) mortality data. The study included 2514 health service areas and used multilevel mixed-effects linear model to account for the multilevel data structure. The outcome measure was the number of COVID-19 deaths. This study found that public health, as opposed to acute care provision, was associated with community health and, ultimately, COVID-19 mortality. The study found that population characteristics including more uninsured greater proportion of those over 65 years, more diverse populations, and larger populations were all associated with a higher rate of death. In addition, communities with fewer hospitals were associated with a lower rate of death. When considering region in the United States, the west region showed a higher rate of death than all other regions. The association between some community characteristics and higher COVID-19 deaths demonstrated that access to health care, either for COVID-19 infection or worse health from higher disease burden, is strongly associated with COVID-19 deaths. Thus, to be better prepared for potential future pandemics, a greater emphasis on public health infrastructure is needed.

The importance of sustained compliance with physical distancing during COVID-19 vaccination rollout

Background

Increasing vaccination coverage against SARS-CoV-2 enabled relaxation of lockdowns in many countries in Europe. As the vaccination rollouts progressed, the public health authorities were seeking recommendations on the continuation of physical distancing measures during ongoing vaccination rollouts. Compliance with these measures was declining while more transmissible virus variants have emerged.

Methods

We used a SARS-CoV-2 transmission model to investigate the feedback between compliance, infection incidence, and vaccination coverage. We quantified our findings in terms of cumulative number of new hospitalisations three and six months after the start of vaccination.

Results

Our results suggest that the combination of fast waning compliance in non-vaccinated individuals, low compliance in vaccinated individuals, low vaccine efficacy against infection and more transmissible virus variants may result in a higher cumulative number of new hospitalisations than in a situation without vaccination. These adverse effects can be alleviated by deploying behavioural interventions that should preferably target both vaccinated and non-vaccinated individuals. The choice of the most appropriate intervention depends on vaccination rate and vaccine efficacy against infection.

Conclusions

Supplementary behavioural interventions aiming to boost compliance to physical distancing measures can improve the outcome of vaccination programmes, until vaccination coverage is sufficiently high. For optimal results, these interventions should be selected based on the vaccine efficacy against infection and expected vaccination rate. While we considered the dynamics of SARS-CoV-2, the qualitative effects of the interplay between infectious disease spread and behavior on the outcomes of a vaccination programme can be used as guidance in a future similar pandemic.

Diabetes self-management during the COVID-19 pandemic and its associations with COVID-19 anxiety syndrome, depression and health anxiety

INTRODUCTION

The effects of the COVID-19 pandemic on mental health have been profound. Mental health and diabetes self-care are inter-related. We examined whether COVID-19 anxiety, depressive symptoms and health anxiety were associated with domains of diabetes self-management and investigated whether greater COVID-19 anxiety syndrome would independently contribute to suboptimal diabetes self-care.

RESEARCH DESIGN AND METHODS

Surveys were sent to people attending diabetes clinics of three London hospitals. Participants completed the Diabetes Self-Management Questionnaire (DSMQ), the COVID-19 Anxiety Syndrome Scale (C-19 ASS), which measures perseveration and avoidant maladaptive coping behaviour, assessed with measures of co-existent depressive symptoms and anxiety, controlling for age, gender and social deprivation. Clinical data, including pre- and post-lockdown HbA_1c measures, were obtained from hospital records for 369 respondents, a response rate of 12.8%.

RESULTS

Depressive symptom scores were high. Both pre-existing health anxiety and depressive symptoms were independently linked to improvable measures of diabetes care, as was lower socio-economic rank. However, avoidant COVID-19 anxiety responses were independently associated with higher diabetes self-care scores. HbA_1c levels improved modestly over the year of UK lockdown in this cohort.

CONCLUSION

During the height of lockdown, avoidant coping behaviours characteristic of the COVID-19 anxiety syndrome may in fact work to improve diabetes self-care, at least in the short term. We recommend screening for depressive symptoms and being aware of the significant minority of people with COVID-19 anxiety syndrome who may now find it difficult to re-engage with face-to-face clinic opportunities.

Efficacy and safety profile of COVID-19 mRNA vaccine in patients with hematological malignancies: Systematic review and meta-analysis

Patient populations, including those with hematological malignancies, have different responses to COVID-19 vaccines. This study aimed to quantitatively analyze the efficacy and safety of COVID-19 mRNA vaccines in patients with hematological malignancies. Studies reporting on the efficacy and safety of COVID-19 mRNA vaccines in cohorts with hematological malignancies compared to healthy controls were systematically searched in four databases. Meta-analysis and subgroup analyses were performed to generate quantitative synthesis. Fifteen studies with 2,055 cohorts with hematological malignancies and 1,105 healthy subjects as control were included. After two doses of COVID-19 vaccination, only 60% of cohorts with hematological malignancies were seroconverted compared to healthy controls (RR 0.60; 95%CI 0.50–0.71). A single dose of the vaccine resulted in a significantly lower seroconversion rate (RR 0.30; 95%CI 0.16–0.54). Non-Hodgkin lymphoma cohorts had the lowest rate of seroconversion (RR 0.5; 95%CI 0.35–0.71) and those who received active treatments had lower immunological responses (RR 0.59; 95%CI 0.46–0.75). Antibody titers were lower in cohorts with hematological malignancies without any differences in adverse effects in both groups. In conclusion, cohorts with hematological malignancies showed a lower seroconversion rate and antibody titers after receiving COVID-19 mRNA vaccines. The type of malignancy and the status of treatment had a significant impact on the response to vaccination. The vaccines were shown to be safe for both patients with hematological malignancies and healthy controls. Booster doses and stricter health protocols might be beneficial for patient populations.

Estimating the Impact of COVID-19 Pandemic on Customers’ Dining-Out Activities in South Korea

This study classified the types of dining-out activities into three categories: visiting restaurants, using delivery services, and using take-out services to understand how customers’ various dining-out activities were carried out during the COVID-19 pandemic. The study used the Theory of Planed Behavior (TPB) model to analyze the structural relationship between the main factors and three dining-out activities. An online survey method was used to distribute and collect survey link addresses through respondents’ SNS and e-mail and a data analysis was performed on the final 429(85.8%) effective samples. A paired t-test and structural equation modeling (SEM) were used to investigate customers’ dining-out activities. This study is of significant contribution in that it compared and analyzed customers’ various dining-out activities using the TPB model, laid the theoretical foundation for related research, and suggested ways to help related industry workers establish marketing strategies under the pandemic.

Predicting COVID-19 county-level case number trend by combining demographic characteristics and social distancing policies

Objective

Predicting daily trends in the Coronavirus Disease 2019 (COVID-19) case number is important to support individual decisions in taking preventative measures. This study aims to use COVID-19 case number history, demographic characteristics, and social distancing policies both independently/interdependently to predict the daily trend in the rise or fall of county-level cases.

Materials and Methods

We extracted 2093 features (5 from the US COVID-19 case number history, 1824 from the demographic characteristics independently/interdependently, and 264 from the social distancing policies independently/interdependently) for 3142 US counties. Using the top selected 200 features, we built 4 machine learning models: Logistic Regression, Naïve Bayes, Multi-Layer Perceptron, and Random Forest, along with 4 Ensemble methods: Average, Product, Minimum, and Maximum, and compared their performances.

Results

The Ensemble Average method had the highest area-under the receiver operator characteristic curve (AUC) of 0.692. The top ranked features were all interdependent features.

Conclusion

The findings of this study suggest the predictive power of diverse features, especially when combined, in predicting county-level trends of COVID-19 cases and can be helpful to individuals in making their daily decisions. Our results may guide future studies to consider more features interdependently from conventionally distinct data sources in county-level predictive models. Our code is available at: https://doi.org/10.5281/zenodo.6332944.

Privacy-Preserving Techniques in Social Distancing Applications: A Comprehensive Survey

During the world’s challenge to confront the rapidly spreading coronavirus disease (COVID-19) pandemic and the consequent heavy losses and disruption to society, returning to normal life has become a demand. Social distancing, also known as physical distancing, plays a pivotal role in this scenario. Social distancing is a practice to maintain a safe space between a person and others who are not from the same household, preventing the spread of contagious viral diseases. To support this case, several public authorities and governments around the world have proposed social distancing applications (also known as contact-tracing apps). However, the adoption of these applications is arguable because of concerns regarding privacy and user data protection. In this study, we present a comprehensive survey of privacy-preserving techniques for social distancing applications. We provide an extensive background on social distancing applications, including measuring the physical distance between people. We also discuss various privacy-preserving techniques that are used by social distancing applications; specifically, we thoroughly analyze and compare these applications, considering multiple features. Finally, we provide insights and recommendations for designing social distancing applications while reducing the burden of privacy problems.

Prioritizing high-contact occupations raises effectiveness of vaccination campaigns

A twenty-year-old idea from network science is that vaccination campaigns would be more effective if high-contact individuals were preferentially targeted. Implementation is impeded by the ethical and practical problem of differentiating vaccine access based on a personal characteristic that is hard-to-measure and private. Here, we propose the use of occupational category as a proxy for connectedness in a contact network. Using survey data on occupation-specific contact frequencies, we calibrate a model of disease propagation in populations undergoing varying vaccination campaigns. We find that vaccination campaigns that prioritize high-contact occupational groups achieve similar infection levels with half the number of vaccines, while also reducing and delaying peaks. The paper thus identifies a concrete, operational strategy for dramatically improving vaccination efficiency in ongoing pandemics.

Mental Well-Being during COVID-19: A Cross-Sectional Study of Fly-In Fly-Out Workers in the Mining Industry in Australia

Coronavirus disease 2019 (COVID-19) has devastated the world, and its mental health impact has been recognized in the general population. However, little is known about the mental health impact of COVID-19 on fly-in fly-out (FIFO) workers, who are flown to temporarily stay and work in remote areas, during this pandemic. This study examined the mental well-being of FIFO workers in the mining industry during COVID-19 restrictions in Western Australia. An online survey was conducted between May to November 2020 among (N = 842) FIFO workers who underwent COVID-19 screening at a large mining company in Western Australia. The mental well-being score among workers was higher than population norms. One-way ANOVA with Bonferroni post-hoc tests showed significant differences in mental well-being by age, being placed under travel quarantine, undertaking self-isolation, impact of social distance guidelines, and experience of COVID-19 related symptoms. Multiple linear regression analysis showed workers who were younger, placed under travel quarantine and experienced two or more COVID-19 related symptoms were more likely to have worse mental well-being. Acknowledging the negative emotions and distress experiences among the vulnerable groups could help in providing suitable support to help lessen these negative experiences in FIFO workers.

Increased Incidence of COVID-19 Infections Amongst Interpersonal Violence Patients

OBJECTIVE

To investigate whether any specific acute care surgery patient populations are associated with a higher incidence of COVID-19 infection.

BACKGROUND

Acute care providers may be exposed to an increased risk of contracting the COVID-19 infection since many patients present to the emergency department without complete screening measures. However, it is not known which patients present with the highest incidence.

METHODS

All acute care surgery (ACS) patients who presented to our level I trauma center between March 19, 2020, and September 20, 2020 and were tested for COVID-19 were included in the study. The patients were divided into two cohorts: COVID positive (+) and COVID negative (-). Patient demographics, type of consultation (emergency general surgery consults [EGS], interpersonal violence trauma consults [IPV], and non-interpersonal violence trauma consults [NIPV]), clinical data and outcomes were analyzed. Univariate and multivariate analyses were used to compare differences between the groups.

RESULTS

In total, 2177 patients met inclusion criteria. Of these, 116 were COVID+ (5.3%) and 2061 were COVID- (94.7%). COVID+ patients were more frequently Latinos (64.7% versus 61.7%, P = 0.043) and African Americans (18.1% versus 11.2%, P < 0.001) and less frequently Caucasian (6.0% versus 14.1%, P < 0.001). Asian/Filipino/Pacific Islander (7.8% versus 7.2%, P = 0.059) and Native American/Other/Unknown (3.4% versus 5.8%, P = 0.078) groups showed no statistical difference in COVID incidence. Mortality, hospital and ICU lengths of stay were similar between the groups and across patient populations stratified by the type of consultation. Logistic regression demonstrated higher odds of COVID+ infection amongst IPV patients (OR 2.33, 95% CI 1.62-7.56, P < 0.001) compared to other ACS consultation types.

CONCLUSION

Our findings demonstrate that victims of interpersonal violence were more likely positive for COVID-19, while in hospital outcomes were similar between COVID-19 positive and negative patients.

The "Great Lockdown": Inactive workers and mortality by Covid-19

In response to the Covid-19 outbreak, the Italian Government imposed an economic lockdown on March 22, 2020, and ordered the closing of all non-essential economic activities. This paper estimates the causal effects of this measure on mortality by Covid-19 and on mobility patterns. The identification of the causal effects exploits the variation in the active population across municipalities induced by the economic lockdown. The difference-in-differences empirical design compares outcomes in municipalities above and below the median variation in the share of active population before and after the lockdown within a province, also controlling for municipality-specific dynamics, daily shocks at the provincial level, and municipal unobserved characteristics. Our results show that the intensity of the economic lockdown is associated with a statistically significant reduction in mortality by Covid-19 and, in particular, for age groups between 40 and 64 and older (with larger and more significant effects for individuals above 50). Back of the envelope calculations indicate that 4793 deaths were avoided, in the 26 days between April 5 and April 30, in the 3518 municipalities which experienced a more intense lockdown. Several robustness checks corroborate our empirical findings.

A systematic review and meta-analysis of effect of vitamin D levels on the incidence of COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a disease primarily affecting the respiratory tract, however due to the nature of the pathogenesis it is able to affect the whole body. So far, no causative treatment has been found and the main strategy when dealing with COVID-19 relies on widespread vaccination programs and symptomatic treatment. Vitamin D due to its ability to modulate the immunological system has been proposed as a factor playing role in the organism response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, we decided to perform this meta-analysis which aimed to establish a connection between vitamin D status and COVID-19 infection.

METHODS

Study was designed as a systematic review and meta-analysis. PubMed, EMBASE, Web of Science, Cochrane Collaboration Databases and Scopus electronic databases were searched for relevant studies from database inception to May 10th, 2021. Mean differences (MDs) with their 95% confidence intervals (CI) were calculated.

RESULTS

Thirteen studies providing data for 14,485 participants met the inclusion criteria. Mean vitamin D levels in SARS-CoV-2 negative patients was 17.7 ± 6.9 ng/mL compared to SARS-CoV-2 positive patients 14.1 ± 8.2 ng/mL (MD = 3.93; 95% CI 2.84-5.02; I2 = 99%; p < 0.001).

CONCLUSIONS

Low serum vitamin D levels are statistically significantly associated with the risk of COVID-19 infection. Supplementation of vitamin D especially in the deficiency risk groups is indicated.

COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department

The first wave of COVID-19 spread worldwide from March to May 2020. Italy was one of the countries in the world where the lockdown period was most prolonged and restrictive. To date, the impact of prolonged lockdown on pediatric traumas has not fully investigated. This paper aimed to analyze, and compare to 2019, the incidence and the fracture pattern in patients admitted to our pediatric hospital during the total lockdown period. A single-center retrospective study was performed. The data were gathered from the Pediatric Emergency Department (PED) of the Bambino Gesù Children Hospital of Rome (Palidoro). This PED is the pediatric referral center for Rome and the hub for pediatric traumas of the region. Any admission diagnosis for fracture, trauma, sprains and dislocation during the lockdown period (10 March-4 May) were included. The demographic data, diagnosis, type of treatment, fracture segment, bone involvement and time interval between trauma and presentation to the PED were recorded. In 2020, a reduction of total traumas and fractures, compared to 2019 (p < 0.001), occurred (81%). Superior limb and inferior limb fractures decreased in 2020 compared to 2019 (p < 0.05). The identification of pediatric traumas and fractures trend could be useful to reorganize the PED. Epidemiological data from the previous lockdown could be helpful to prepare the healthcare system for new pandemic waves. Moreover, sharing national statistics and correlating those to other countries' protocols, could be helpful to solve problems in case of worldwide emergency situations.

Towards human distance estimation using a thermal sensor array

Human distance estimation is essential in many vital applications, specifically, in human localisation-based systems, such as independent living for older adults applications, and making places safe through preventing the transmission of contagious diseases through social distancing alert systems. Previous approaches to estimate the distance between a reference sensing device and human subject relied on visual or high-resolution thermal cameras. However, regular visual cameras have serious concerns about people's privacy in indoor environments, and high-resolution thermal cameras are costly. This paper proposes a novel approach to estimate the distance for indoor human-centred applications using a low-resolution thermal sensor array. The proposed system presents a discrete and adaptive sensor placement continuous distance estimators using classification techniques and artificial neural network, respectively. It also proposes a real-time distance-based field of view classification through a novel image-based feature. Besides, the paper proposes a transfer application to the proposed continuous distance estimator to measure human height. The proposed approach is evaluated in different indoor environments, sensor placements with different participants. This paper shows a median overall error of ± 0.2  m in continuous-based estimation and 96.8 % achieved-accuracy in discrete distance estimation.

Determinants of Social Distancing Among South Africans From 12 Days Into the COVID-19 Lockdown: A Cross Sectional Study

Introduction: Social or physical distancing has been an effective measure for reducing the spread of COVID-19 infections. Investigating the determinants of adherence to social distancing can inform public health strategies to improve the behaviour. However, there is a lack of data in various populations. This study investigates the degree to which South Africans complied with social distancing during the country's COVID-19 lockdown and identifies the determinants associated with being in close contact with large numbers of people. Materials and Methods: Data was collected from a South African national online survey on a data free platform, supplemented with telephone interviews. The survey was conducted from 8 to 29 April 2020. The primary outcome was the number of people that participants came into close contact with (within a 2-metre distance) the last time they were outside their home during the COVID-19 lockdown. Multivariate multinomial regression investigated the socio-demographic, psychosocial and household environmental determinants associated with being in contact with 1-10, 11-50 and more than 50 people. Results: Of the 17,563 adult participants, 20.3% reported having not left home, 50.6% were in close physical distance with 1-10 people, 21.1% with 11-50 people, and 8.0% with >50 people. Larger household size and incorrect knowledge about the importance of social distancing were associated with being in contact with >50 people. Male gender, younger age and being in the White and Coloured population groups were significantly associated with being in contact with 1-10 people but not with larger numbers of people. Employment, at least secondary school education, lack of self-efficacy in being able to protect oneself from infection, and moderate or high risk perception of becoming infected, were all associated with increased odds of close contact with 1-10, 11-50, and >50 people relative to remaining at home. Conclusion: The findings identify subgroups of individuals that are less likely to comply with social distancing regulations. Public health communication, interventions and policy can be tailored to address these determinants of social distancing.

COVID-19 non-pharmaceutical intervention portfolio effectiveness and risk communication predominance

Non-pharmaceutical interventions (NPIs) including resource allocation, risk communication, social distancing and travel restriction, are mainstream actions to control the spreading of Coronavirus disease 2019 (COVID-19) worldwide. Different countries implemented their own combinations of NPIs to prevent local epidemics and healthcare system overloaded. Portfolios, as temporal sets of NPIs have various systemic impacts on preventing cases in populations. Here, we developed a probabilistic modeling framework to evaluate the effectiveness of NPI portfolios at the macroscale. We employed a deconvolution method to back-calculate incidence of infections and estimate the effective reproduction number by using the package EpiEstim. We then evaluated the effectiveness of NPIs using ratios of the reproduction numbers and considered them individually and as a portfolio systemically. Based on estimates from Japan, we estimated time delays of symptomatic-to-confirmation and infection-to-confirmation as 7.4 and 11.4 days, respectively. These were used to correct surveillance data of other countries. Considering 50 countries, risk communication and returning to normal life were the most and least effective yielding the aggregated effectiveness of 0.11 and - 0.05 that correspond to a 22.4% and 12.2% reduction and increase in case growth. The latter is quantified by the change in reproduction number before and after intervention implementation. Countries with the optimal NPI portfolio are along an empirical Pareto frontier where mean and variance of effectiveness are maximized and minimized independently of incidence levels. Results indicate that implemented interventions, regardless of NPI portfolios, had distinct incidence reductions and a clear timing effect on infection dynamics measured by sequences of reproduction numbers. Overall, the successful suppression of the epidemic cannot work without the non-linear effect of NPI portfolios whose effectiveness optimality may relate to country-specific socio-environmental factors.

Determinants of COVID-19 Case Fatality Rate in the United States: Spatial Analysis Over One Year of the Pandemic

Background: The United States continues to account for the highest proportion of the global Coronavirus Disease-2019 (COVID-19) cases and deaths. Currently, it is important to contextualize COVID-19 fatality to guide mitigation efforts. Objectives: The objective of this study was to assess the ecological factors (policy, health behaviors, socio-economic, physical environment, and clinical care) associated with COVID-19 case fatality rate (CFR) in the United States. Methods: Data from the New York Times' COVID-19 repository and the Centers for Disease Control and Prevention Data (01/21/2020 - 02/27/2021) were used. County-level CFR was modeled using the Spatial Durbin model (SDM). The SDM estimates were decomposed into direct and indirect impacts. Results: The study found percent positive for COVID-19 (0.057% point), stringency index (0.014% point), percent diabetic (0.011% point), long-term care beds (log) (0.010% point), premature age-adjusted mortality (log) (0.702 % point), income inequality ratio (0.078% point), social association rate (log) (0.014% point), percent 65 years old and over (0.055% point), and percent African Americans (0.016% point) in a given county were positively associated with its COVID-19 CFR. The study also found food insecurity, long-term beds (log), mental health-care provider (log), workforce in construction, social association rate (log), and percent diabetic of a given county as well as neighboring county were associated with given county's COVID-19 CFR, indicating significant externalities. Conclusion: The spatial models identified percent positive for COVID-19, stringency index, elderly, college education, race/ethnicity, residential segregation, premature mortality, income inequality, workforce composition, and rurality as important ecological determinants of the geographic disparities in COVID-19 CFR.

Progression of Changes in Vascular Surgery Practices during the Novel Corona Virus SARS-CoV-2 Pandemic

Introduction

The novel coronavirus SARS-CoV-2 (COVID-19) has spread rapidly since it was identified. We sought to understand its effects on vascular surgery practices stratified by VASCON surgical readiness level and determine how these effects have changed during the course of the pandemic.

Methods

All members of the Vascular and Endovascular Surgery Society were sent electronic surveys questioning the effects of COVID-19 on their practices in the early pandemic in April (EP) and four months later in the pandemic in August (LP) 2020.

Results

Response rates were 206/731 (28%) in the EP group and 108/731 (15%) in the LP group (P < 0.0001). Most EP respondents reported VASCON levels less than 3 (168/206,82%), indicating increased hospital limitations while 6/108 (6%) in the LP group reported this level (P < 0.0001). The EP group was more likely to report a lower VASCON level (increased resource limitations), and decreased clinic, hospital and emergency room consults. Despite an increase of average cases/week to pre-COVID-19 levels, 46/108 (43%) of LP report continued decreased compensation, with 57% reporting more than 10% decrease. Respondents in the decreased compensation group were more likely to have reported a VASCON level 3 or lower earlier in the pandemic (P = 0.018). 91/108(84%) of LP group have treated COVID-19 patients for thromboembolic events, most commonly acute limb ischemia (76/108) and acute DVT (76/108). While the majority of respondents are no longer delaying the vascular surgery cases, 76/108 (70%) feel that vascular patient care has suffered due to earlier delays, and 36/108 (33%) report a backlog of cases caused by the pandemic.

Conclusions

COVID-19 had a profound effect on vascular surgery practices earlier in the pandemic, resulting in continued detrimental effects on the provision of vascular care as well as compensation received by vascular surgeons.

Transmission of SARS-CoV-2 before and after symptom onset: impact of nonpharmaceutical interventions in China

Nonpharmaceutical interventions, such as contact tracing and quarantine, have been the primary means of controlling the spread of SARS-CoV-2; however, it remains uncertain which interventions are most effective at reducing transmission at the population level. Using serial interval data from before and after the rollout of nonpharmaceutical interventions in China, we estimate that the relative frequency of presymptomatic transmission increased from 34% before the rollout to 71% afterward. The shift toward earlier transmission indicates a disproportionate reduction in transmission post-symptom onset. We estimate that, following the rollout of nonpharmaceutical interventions, transmission post-symptom onset was reduced by 82% whereas presymptomatic transmission decreased by only 16%. The observation that only one-third of transmission was presymptomatic at baseline, combined with the finding that NPIs reduced presymptomatic transmission by less than 20%, suggests that the overall impact of NPIs was driven in large part by reductions in transmission following symptom onset. This implies that interventions which limit opportunities for transmission in the later stages of infection, such as contact tracing and isolation, are particularly important for control of SARS-CoV-2. Interventions which specifically reduce opportunities for presymptomatic transmission, such as quarantine of asymptomatic contacts, are likely to have smaller, but non-negligible, effects on overall transmission.

What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic?

Purpose of Review

This article aims to summarize some recent trends in occupational allergic contact dermatitis (ACD), including dermatitis related to pandemic-level personal protective equipment in healthcare workers, hazards patients may experience when working from home, and occupational perspectives on the recent American Contact Dermatitis Society (ACDS) allergens of the year and ACDS Core Allergen Series updates.

Recent Findings

Recent ACDS Allergens of the Year may be particularly relevant to healthcare workers, including isobornyl acrylate, which is present in glucose sensors and propylene glycol present in hand cleansers and disinfectants. Lavender, limonene, and linalool, all of which are new additions to the ACDS Core Allergen Series, have been reported as causes for occupational ACD in massage therapists and aromatherapists. Isothiazolinone allergy continues to rise in both consumer and occupational settings. Finally, the COVID-19 pandemic has resulted in a wave of occupational ACD in healthcare workers to personal protective equipment, and revealed new potential allergens for individuals working from home.

Summary

Occupational allergic contact dermatitis continues to exert a significant occupational disease burden. Remaining aware of the current trends in allergens may allow for earlier recognition, diagnosis, and treatment, subsequently helping our patients to work in healthier and safer environments.

Should I stay, or should I go? Consumers' perceived risk and intention to visit restaurants during the COVID-19 pandemic in Brazil

This study aimed to verify how consumers’ intention to visit restaurants during the pandemic is affected by consumers’ risk perception and different types of trust. The sample was composed of 546 consumers from 89 different cities in Brazil. An adapted 43 items questionnaire with 5-point scales was administered, and analyzed using structural equation modeling. The results indicate that consumers' trust in a restaurant and brand, fair price, solidarity with the restaurant sector, disease denial, and health surveillance trust predict intention to visit a restaurant during the COVID-19 pandemic. Age has significant moderated effects, reducing disease denial effects. The trust in restaurants and brands was the factor with the largest effect size. In a multigroup analysis, it was found that solidarity with the sector does not affect the intention to visit restaurants for consumers without formal work. It is discussed the implications of an increased consumers' risk perception, directly affecting their intentions. Special attention to consumers’ trust and fair price perception is fundamental, given consumers’ solidary inclination toward helping the restaurant sector. These aspects must be recognized by restaurant owners and managers to be improved and be used to attract consumers.

[Curricular teaching during the COVID-19-pandemic : Evaluation of an online-based teaching concept]

BACKGROUND

The COVID-19 pandemic has created multiple challenges for health care, social and economic systems worldwide, but also for school and university teaching. Most learning has been shifted to online classes. So far, it is unclear whether these changes are well received within the student body.

OBJECTIVES

The aim of this study was the evaluation of a newly developed online-based teaching concept for medical students studying radiology during the COVID-19 pandemic.

MATERIALS AND METHODS

The concept consisted of 12 online seminars of the 11-week course "Imaging Procedures", which were combined with 31 prerecorded video presentations. Five weeks after the start of the summer term, we conducted an anonymous online survey, which consisted of 12 questions and a box for additional comments. Furthermore, we analysed the number of requests of the presentations, the duration and the average viewing time.

RESULTS

In all, 110 of 213 students (51.6%) completed the survey; 72.7% stated that the new teaching concept drew their interest for radiology, 78.2% agreed that it incited self-study as well as would facilitate time- and place-independent learning (95.5%). The majority indicated that the time investment for the video presentations was appropriate, but shorter video sections would simplify the learning process (70.9%) and the ideal timeframe would be 10-20 min. The majority (80.9%) agreed that the concept should be maintained in upcoming semesters.

CONCLUSIONS

This newly developed online-based teaching concept enjoys high acceptance rates among students. It offers advantages such as time- and location-independent learning, possibilities for self-study and should be maintained in upcoming semesters after the end of social distancing due to the COVID-19 pandemic.

Risk Communication Effectiveness During COVID-19 Pandemic Among General Population in Saudi Arabia

Purpose

The novel coronavirus (COVID-19), declared a pandemic by WHO in March 2020, is an unprecedented occurrence in our recent history. Effective risk communication by health authorities, through relaying reliable and authoritative information, is imperative in combating the spread of the outbreak. We aimed to measure the effectiveness of risk communication campaign and overall awareness during COVID-19 pandemic among the general population in Saudi Arabia.

Patients and Methods

A cross-sectional survey of 5472 individuals in Saudi Arabia was conducted to assess several factors regarding the risk communication messages during the COVID-19 pandemic, including the knowledge and response of the general population toward COVID-19 and MoH efforts. The questionnaire was divided into five main sections: general knowledge of COVID-19, channels and social media platforms used perceived risk and stress or panic toward COVID-19, satisfaction and community perception, most trusted source of information, and type of information received.

Results

A total of 5472 individuals participated in the study residing in Saudi Arabia. Overall knowledge of COVID-19 was determined to be above average (0.58 + 0.159). Of the general population, 57.1% perceived that the risk of getting sick with COVID-19 is low, while nearly half of the respondents (45.7%) have a high level of stress and panic toward COVID-19. The majority of responders to the questionnaire reinforced that MoH was their most trusted source of information for the COVID-19 pandemic (91.7%).

Conclusion

This study showed that the risk communication campaign by healthcare authorities during the COVID-19 pandemic has improved the awareness among the general population in Saudi Arabia, where the overwhelming majority placed high trust in the MoH as its main reference for COVID-19 information.

Social distancing decreases an individual's likelihood of contracting COVID-19

Past research has established the value of social distancing as a means of deterring the spread of COVID-19 largely by examining aggregate level data. Locales in which efforts were undertaken to encourage distancing experienced reductions in their rate of transmission. However, these aggregate results tell us little about the effectiveness of social distancing at the level of the individual, which is the question addressed by the current research. Four months after participating in a study assessing their social distancing behavior, 2,120 participants indicated whether they had contracted COVID-19. Importantly, the assessment of social distancing involved not only a self-report measure of how strictly participants had followed social distancing recommendations but also a series of virtual behavior measures of social distancing. These simulations presented participants with graphical depictions mirroring specific real-world scenarios, asking them to position themselves in relation to others in the scene. Individuals' social distancing behavior, particularly as assessed by the virtual behavior measure, predicted whether they contracted COVID-19 during the intervening 4 mo. This was true when considering only participants who reported having tested positively for the virus and when considering additional participants who, although untested, believed that they had contracted the virus. The findings offer a unique form of additional evidence as to why individuals should practice social distancing. What the individual does matters, not only for the health of the collective, but also for the specific individual.

Trends in US Pediatric Hospital Admissions in 2020 Compared With the Decade Before the COVID-19 Pandemic

IMPORTANCE

In early 2020, the United States declared a public health emergency in response to coronavirus disease 2019 (COVID-19) and implemented a variety of social distancing measures. The association between the COVID-19 pandemic and the number of pediatric admissions is unclear.

OBJECTIVE

To determine the changes in patterns of pediatric admissions in 2020 compared with the prior decade.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included 49 US hospitals contributing to the Pediatric Health Information Systems database. Inpatient admissions were transformed into time-series data, and ensemble forecasting models were generated to analyze admissions across a range of diagnoses in 2020 compared with previous years. The setting was inpatient admissions. All patients discharged between January 1, 2010, and June 30, 2020, from an inpatient hospital encounter were included.

MAIN OUTCOMES AND MEASURES

Number of hospital admissions by primary diagnosis for each encounter.

RESULTS

Of 5 424 688 inpatient encounters among 3 372 839 patients (median [interquartile range] age, 5.1 [0.7-13.3] years; 2 823 748 [52.1%] boys; 3 171 224 [58.5%] White individuals) at 49 hospitals, 213 571 (3.9%) were between January 1, 2020, and June 30, 2020. There was a decrease in the number of admissions beginning in March 2020 compared with the period from 2010 to 2019. At the nadir, admissions in April 2020 were reduced 45.4% compared with prior years (23 798 in April 2020 compared with a median [interquartile range] of 43 550 [42 110-43 946] in April 2010-2019). Inflation-adjusted hospital charges decreased 27.7% in the second quarter of 2020 compared with prior years ($4 327 580 511 in 2020 compared with a median [interquartile range] of $5 983 142 102 [$5 762 690 022-$6 324 978 456] in 2010-2019). Seasonal patterns were evident between 2010 and 2019 for a variety of common pediatric conditions, including asthma, atrial septal defects, bronchiolitis, diabetic ketoacidosis, Kawasaki syndrome, mental health admissions, and trauma. Ensemble models were able to discern seasonal patterns in admission diagnoses and accurately predicted admission rates from July 2019 until December 2019 but not from January 2020 to June 2020. All diagnoses except for birth decreased below the model 95% CIs between January 2020 and June 2020.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, pediatric admissions to US hospitals decreased in 2020 across an array of pediatric conditions. Although some conditions may have decreased in incidence, others may represent unmet needs in pediatric care during the COVID-19 pandemic.

Interstate Variability in COVID-19 Infection and Death Rates: Do Climate, Health Conditions, and Distancing Policies Matter?

A comprehensive model to explain variation across U. S. states in COVID-19 outcomes through August 7, 2020 indicated that improvements in social distancing, intermediate spring relative humidity and temperature, and lower concentrations of elderly residents were associated with lower rates of coronavirus/COVID-19 infection and mortality as well as changes over time. These influences were observed after accounting for testing prevalence per 100,000 state residents. Findings indicate the benefits of continued preventive efforts by states and the value of tailoring resources at multiple levels of risk.

Timing of social distancing policies and COVID-19 mortality: county-level evidence from the U.S

Using county-level data on COVID-19 mortality and infections, along with county-level information on the adoption of non-pharmaceutical interventions (NPIs), we examine how the speed of NPI adoption affected COVID-19 mortality in the United States. Our estimates suggest that adopting safer-at-home orders or non-essential business closures 1 day before infections double can curtail the COVID-19 death rate by 1.9%. This finding proves robust to alternative measures of NPI adoption speed, model specifications that control for testing, other NPIs, and mobility and across various samples (national, the Northeast, excluding New York, and excluding the Northeast). We also find that the adoption speed of NPIs is associated with lower infections and is unrelated to non-COVID deaths, suggesting these measures slowed contagion. Finally, NPI adoption speed appears to have been less effective in Republican counties, suggesting that political ideology might have compromised their efficacy.

Prevention of SARS-CoV-2 Infection Among Police Officers in Poland-Implications for Public Health Policies

BACKGROUND

This study aimed to characterize sources of knowledge on the means of prevention of SARS-CoV-2 infections as well as to assess the methods of preventing SARS-CoV-2 infection among police employees in Poland and their potential impact on the risk of SARS-CoV-2 infection.

METHODS

The study consisted of two phases: questionnaire and laboratory tests for SARS-CoV-2 infection. The questionnaire included 30 questions related to risk factors, knowledge about SARS-CoV-2, and methods of infection prevention.

RESULTS

Data were obtained from 5082 police employees. The most common source of knowledge for a daily update on SARS-CoV-2 infection prevention was the Internet (42.6%), television (40.3%), and radio (39.7%). The most commonly used methods of SARS-CoV-2 infection included washing one's hands for at least 20 seconds (95.8%), wearing facemasks (82.9%), and physical distancing (74.9%). Results of IgG tests were lower in police units where the overall compliance with the preventive measures was higher (p < 0.01). Women were more likely to exercise SARS-CoV-2 infection prevention behaviors compared to men. Compliance with the recommended protective measures increased with age.

CONCLUSIONS

Lower anti-SARS-CoV-2 IgG seropositivity rates were observed in police units with better overall compliance with the preventive measures, suggesting the key importance of group rather than individual behaviors.

Association of social distancing and masking with risk of COVID-19

Given the continued burden of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) disease (COVID-19) across the U.S., there is a high unmet need for data to inform decision-making regarding social distancing and universal masking. We examined the association of community-level social distancing measures and individual masking with risk of predicted COVID-19 in a large prospective U.S. cohort study of 198,077 participants. Individuals living in communities with the greatest social distancing had a 31% lower risk of predicted COVID-19 compared with those living in communities with poor social distancing. Self-reported masking was associated with a 63% reduced risk of predicted COVID-19 even among individuals living in a community with poor social distancing. These findings provide support for the efficacy of mask-wearing even in settings of poor social distancing in reducing COVID-19 transmission. In the current environment of relaxed social distancing mandates and practices, universal masking may be particularly important in mitigating risk of infection.

The Social Distance Scale (v1): A Screening Instrument to Assess Patient Adherence to Prevention Strategies during Pandemics

BACKGROUND

This paper describes the development of a brief self-report screening measure of adherence to social distancing and self-protective behaviors in pandemic situations. Items measured behaviors currently established as primary strategies to prevent and reduce the spread of the COVID-19 infection.

METHODS

An item pool of 29 questions was generated with the aim of estimating the frequency of specific behaviors and were written to avoid confounding the description of behavioral actions with evaluative judgements. Responses were collected from 401 young adults using an anonymous online survey.

RESULTS

An Exploratory Factor Analysis was conducted with the purpose of item reduction and subscale development. A 14-item Social Distance Scale emerged, consisting of four subscales: Isolation from Community (IC), Work from Home (WH), Family Contact (FC), and Protective Behaviors (PB). The initial psychometric evaluation of the scales indicated adequate internal consistency and test-retest reliability. (4) Conclusions: The Social Distance Scale (v1) is a promising new instrument which may be applied at the population or individual level. It may be used in conjunction with COVID-19 testing to measure interactions between social distancing factors and transmission. In addition, a reliable screening measure has utility for health service providers to assess patient risk and to provide educational/counseling.

COVID-19 Prevalence, Risk Perceptions, and Preventive Behavior in Asymptomatic Latino Population: A Cross-Sectional Study

Aims To determine the prevalence, level of coronavirus disease 2019 (COVID-19) risk perception attitude and preventive behavior implemented by the Latino population in the United States of America (USA). Methods This cross-sectional study was conducted between July 25 and August 25, 2020, and included asymptomatic Latino participants (n=410) with no current/previous COVID-19 within a religious community in Maryland. Participants answered a questionnaire consisting of three components: patient demographics/socioeconomic status, COVID-19 risk perception, and precautionary behavior. Additionally, a focused history taking and physical examination were performed, and nasal swabs for COVID-19 testing were obtained. Results Around 80% of our study population was 35 years and older, considerably healthy, with only about a third reporting history of chronic disease (~80%); most were females (~66%). Of our participants, 90% lived under poverty; only ~6% had made it to college. When asked about the likelihood of acquiring COVID-19, 97.3% stated they have a low risk of getting infected. However, as we asked about the risk of individuals living in their neighborhood, state, and country, the rates changed to moderate to high (78.4%, 86.3%, and 86.6%, respectively). When asked about preventive behavior, 71.2% stated they never wear masks and 85.4% mentioned they never keep social distance. Additionally, 76 (18.5%) tested positive for COVID-19, whereas 64 (84.2%) developed symptoms at follow-up, 57 (75%) were hospitalized, and 4 (5.2%) died. Conclusions Our study identified inadequate COVID-19 threat perception and lack of engagement in preventive behavior among a group of Latinos living in the USA. We believe that Latino communities across the USA are at markedly high risk of acquiring, spreading, and dying of COVID-19.

Rapid real-time tracking of non-pharmaceutical interventions and their association with SARS-CoV-2 positivity: The COVID-19 Pandemic Pulse Study

BACKGROUND

Current mitigation strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on population-wide adoption of non-pharmaceutical interventions (NPIs). Collecting demographically and geographically resolved data on NPIs and their association with SARS-CoV-2 infection history can provide critical information related to reopening geographies.

METHODS

We sampled 1,030 individuals in Maryland from June 17 - June 28, 2020 to capture socio-demographically and geographically resolved information about NPI adoption, access to SARS-CoV-2 testing, and examine associations with self-reported SARS-CoV-2 positivity.

RESULTS

Median age of the sample was 43 years and 45% were men; Whites and Blacks/African Americans represented 60% and 23%, respectively. Overall, 96% of the sample reported traveling outside their home for non-employment related services: most commonly cited reasons were essential services (92%) and visiting friends/family (66%). Use of public transport was reported by 18% of respondents. 68% reported always social distancing indoors and 53% always wearing masks indoors; indoor social distancing was significantly less common among younger vs. older individuals, and race/ethnicity and income were significantly associated with mask use (p<0.05 for all). 55 participants (5.3%) self-reported ever testing positive for SARS-CoV-2 with strong dose-response relationships between movement frequency and SARS-CoV-2 positivity that were significantly attenuated by social distancing. In multivariable analysis, history of SARS-CoV-2 infection was negatively associated with the practice of social distancing (adjusted Odd Ratio [aOR]: 0.10; 95% Confidence Interval: 0.03 - 0.33); the only travel associated with higher likelihood of SARS-CoV-2 infection was use of public transport (aOR for ≥7 times vs. never: 4.29) and visiting a place of worship (aOR for ≥3 times vs. never: 16.0) after adjusting for social distancing.

CONCLUSIONS

Using a rapid cost-efficient approach, we highlight the role of movement and social distancing on SARS-CoV-2 transmission risk. Continued monitoring of NPI uptake, access to testing, and the subsequent impact on SARS-CoV-2 transmission will be critical for pandemic control and decisions about reopening geographies.

Social distancing, population density, and spread of COVID-19 in England: a longitudinal study

BACKGROUND

The UK government introduced social distancing measures between 16-22 March 2020, aiming to slow down transmission of COVID-19.

AIM

To explore the spreading of COVID-19 in relation to population density after the introduction of social distancing measures.

DESIGN & SETTING

Longitudinal design with 5-weekly COVID-19 incidence rates per 100 000 people for 149 English Upper Tier Local Authorities (UTLAs), between 16 March and 19 April 2020.

METHOD

Multivariable multilevel model to analyse weekly incidence rates per 100 000 people; time was level-1 unit and UTLA level-2 unit. Population density was divided into quartiles. The model included an interaction between week and population density. Potential confounders were percentage aged ≥65, percentage non-white British, and percentage in two highest classes of the National Statistics Socioeconomic Classification. Co-variates were male life expectancy at birth, and COVID-19 prevalence rate per 100 000 people on March 15. Confounders and co-variates were standardised around the mean.

RESULTS

Incidence rates per 100 000 people peaked in the week of March 30-April 5, showing higher adjusted incidence rate per 100 000 people (46.2; 95% confidence interval [CI] = 40.6 to 51.8) in most densely populated ULTAs (quartile 4) than in less densely populated ULTAs (quartile 1: 33.3, 95% CI = 27.4 to 37.2; quartile 2: 35.9, 95% CI = 31.6 to 40.1). Thereafter, incidence rate dropped in the most densely populated ULTAs resulting in rate of 22.4 (95% CI = 16.9 to 28.0) in the week of April 13-19; this was lower than in quartiles 1, 2, and 3, respectively 31.4 (95% CI = 26.5 to 36.3), 34.2 (95% CI = 29.9 to 38.5), and 43.2 (95% CI = 39.0 to 47.4).

CONCLUSION

After the introduction of social distancing measures, the incidence rates per 100 000 people dropped stronger in most densely populated ULTAs.