Four months into the COVID-19 pandemic, Sweden's prized herd immunity is nowhere in sight

The "Bystander at the Switch" Revisited? Ethical Implications of the Government Strategies Against COVID-19

Suppose COVID-19 is the runaway tram in the famous moral thought experiment, known as the "Bystander at the Switch." Consider the two differentiated responses of governments around the world to this new threat, namely the option of quarantine/lockdown and herd immunity. Can we contrast the hypothetical with the real scenario? What do the institutional decisions and strategies for dealing with the virus, in the beginning of 2020, signify in a normative moral framework? This paper investigates these possibilities in order to highlight the similarities and, more importantly, the differences that exist between utilitarianism and Kantian ethics. Analysis shows that the hypothetical scenario can never be fully compared to the complex multifactorial nature of the real world. But if a comparison is attempted, the most obvious difference between the two governmental strategies is the concept of duty within the Kantian perspective. Ultimately, it is a matter of comparing freedom and life. Attributing a moral "priority ticket" to one or the other can be analysed through interpersonal aggregation.

An adaptive testing strategy for efficient utilization of healthcare resources during an epidemic

Lockdowns are found to be effective against rapidly spreading epidemics like COVID-19. Two downsides to strategies rooted in social distancing and lockdowns are that they adversely affect the economy and prolong the duration of the epidemic. The extended duration observed in these strategies is often due to the under-utilization of medical facilities. Even though an under-utilized health care system is preferred over an overwhelmed one, an alternate strategy could be to maintain medical facilities close to their capacity, with a factor of safety. We explore the practicality of this alternate mitigation strategy and show that it can be achieved by varying the testing rate. We present an algorithm to calculate the number of tests per day to maintain medical facilities close to their capacity. We illustrate the efficacy of our strategy by showing that it reduced the epidemic duration by 40% in comparison to lockdown-based strategies.

Affect, dis/ability and the pandemic

The pandemic has heightened anxieties, impacted mental health and threatened to create an overwhelming sense of existential dread. We recognise the material ways in which disabled people have been differentially impacted by Covid-19 and make a case for understanding the affective dimensions of the pandemic. We develop a theoretical approach - cutting across medical sociology and critical disability studies - that understands affect as a social, cultural, relational and psychopolitical phenomenon. We introduce a public engagement project that took place in March and April of 2020 that garnered blogspots from around the world to capture the pandemic's impact on the lives of disabled people. Our data analysis reveals three key affective themes: fragility, anxiety and affirmation. To understand the emotional impacts of Covid-19 upon the lives of disabled people we embed critical analyses of affect in the dual processes of disablism and ableism: the dis/ability complex. We conclude by considering how we might conceive of a post-pandemic recovery that places the health and well-being of disabled people at the centre of proceedings.

Genetic determination of regional connectivity in modelling the spread of COVID-19 outbreak for more efficient mitigation strategies

For the COVID-19 pandemic, viral transmission has been documented in many historical and geographical contexts. Nevertheless, few studies have explicitly modeled the spatiotemporal flow based on genetic sequences, to develop mitigation strategies. Additionally, thousands of SARS-CoV-2 genomes have been sequenced with associated records, potentially providing a rich source for such spatiotemporal analysis, an unprecedented amount during a single outbreak. Here, in a case study of seven states, we model the first wave of the outbreak by determining regional connectivity from phylogenetic sequence information (i.e. "genetic connectivity"), in addition to traditional epidemiologic and demographic parameters. Our study shows nearly all of the initial outbreak can be traced to a few lineages, rather than disconnected outbreaks, indicative of a mostly continuous initial viral flow. While the geographic distance from hotspots is initially important in the modeling, genetic connectivity becomes increasingly significant later in the first wave. Moreover, our model predicts that isolated local strategies (e.g. relying on herd immunity) can negatively impact neighboring regions, suggesting more efficient mitigation is possible with unified, cross-border interventions. Finally, our results suggest that a few targeted interventions based on connectivity can have an effect similar to that of an overall lockdown. They also suggest that while successful lockdowns are very effective in mitigating an outbreak, less disciplined lockdowns quickly decrease in effectiveness. Our study provides a framework for combining phylodynamic and computational methods to identify targeted interventions.

Experiences of People with Cardiovascular Disease during COVID-19 in Sweden: A Qualitative Study

Although people with cardiovascular conditions were subjected to more rigorous restrictions during the COVID-19 pandemic, there is limited knowledge of how the restrictions affected their lives and well-being. Thus, the aim of this study was to describe how people with cardiovascular conditions experienced their life situation and physical and mental health during the second wave of the pandemic in Sweden. Fifteen participants (median age 69 years; nine women) were individually interviewed, and data were analyzed with systematic text condensation. The findings revealed that some of the participants were fearful of contracting COVID-19 as their medical condition made them vulnerable. Additionally, the restrictions changed their daily routines and their ability to take part in social activities, as well as their access to specialized outpatient care (medical check-ups and physiotherapy). Although emotional and psychological distress were present, several participants found strategies that reduced their worries, such as exercising and meeting friends outdoors. However, some had adopted a more sedentary lifestyle and unhealthy diets. These findings indicate that healthcare professionals should provide individualized support to persons with cardiovascular diseases in order to find well-functioning emotion- and problem-focused strategies aimed at improving physical and mental health during crises such as pandemics.

Handling Public's Well-being during the COVID-19 Crisis: An Empirical Study with Municipalities' Representatives in Sweden

BACKGROUND

COVID-19 had a significant impact on the public's health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public's well-being, however comes in second in relation to the public's safety from the COVID-19 virus. In Sweden, a country with a decentralized public health and welfare system relied on less stringent approaches for handling the crisis. The limited restrictions of Sweden allowed the recreational activities to take place despite the pandemic, which could be attributed to considerations for the public's well-being.

OBJECTIVE

The objective of this study is to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis.

METHODS

We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles, from 18 distinct municipalities (of 18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics was used as a method to summarize the close-ended responses.

RESULTS

In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results show a significant impact on the municipalities as a result of COVID-19, where 78.3% of participants state significant changes due to the pandemic. 88.9% indicate efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for public's health and safety is indicated by 78.3%. Information and Communications Technologies (ICTs) were considered significant for dealing with COVID-19 as per 87% of participants. Our qualitative results further show details of public's health and safety considerations, efforts to support recreational activities particularly for youth, and ICTs role and requirements. Challenges relating to the usability of ICTs were also highlighted.

CONCLUSIONS

Despite the critique of Sweden's lenient strategy of handling the COVID-19 crisis, our results show significant considerations for both the public's safety and well-being by the municipalities (additionally on a regional and local levels) in this study. Trusting the public with safety guidelines in addition to efforts for publics' safety, supporting public's well-being with approaches for maintaining recreational activities, and giving special care to youth, was the Swedish approach to handling the crisis. Despite having technological solutions in place, challenges using digital solutions and requirements for future development are noted.

CLINICALTRIAL

None.

Prevalence of ongoing or previous SARS-CoV-2 infection among dental personnel - the Swedish experience

CONCLUSIONS

The seroprevalence of SARS-CoV-2 infection was approximately similar to that in healthcare personnel, and approximately equal compared to that in the general population.

MATERIALS AND METHODS

We carried out an observational cohort study from March to June 2020, including 341 employees randomly selected from Public Dental Service in the County of Stockholm. The primary outcome variable was the prevalence of SARS-CoV-2 RNA and/or antibodies against SARS-CoV-2. Throat samples were analysed for SARS-CoV-2 RNA. Venous blood was collected to detect antibodies against SARS-CoV-2 using the Luminex analysis tool (immunoassay) and ELISA. Logistic regression analysis was used to compare the independent groups and calculate the unadjusted odds ratio.

OBJECTIVE

To investigate whether personnel in a public dental clinic had a higher frequency of ongoing or previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than hospital healthcare workers or the general public in Stockholm during weeks 23-25 in 2020.

RESULTS

The mean age of the participants was 50.1 years, and 11.7% were male. The prevalence of SARS-CoV-2 RNA and/or antibodies against SARS-CoV-2 was 12.0% (95% confidence interval 8.8-16.0). Among them, 82.5% reported symptoms and 85.4% were on sick-leave between March and June 2020.

The SEIR model incorporating asymptomatic cases, behavioral measures, and lockdowns: Lesson learned from the COVID-19 flow in Sweden

The Sweden approach is unique in handling the COVID-19 flow, compared to other European countries. While other countries have practiced the full lockdowns, Sweden has practiced the lighter lockdowns or the partial lockdowns as public spaces such as cafes and restaurants are allowed to serve their customers subject to government recommendations. This study aims to develop an SEIR model for Sweden capturing important issues such as the roles of behavioral measures, partial lockdowns, and undocumented cases. The suggested SEIR model is probably the first SEIR model capturing the roles of behavioral measures, partial lockdowns, hospital preparedness, and asymptomatic cases for Sweden. The SEIR model can successfully reproduce similar main observed outputs, namely documented infected cases and documented death cases. This study finds that the effects of partial lockdowns effectively start 52 days after the first confirmed case. Again, behavioral measures and partial lockdowns reduce possible infected cases about 22% and 70% respectively. This study also suggests that the Sweden government should step up to the full lockdowns by conducting public closures so COVID-19 flow can be curtailed significantly. Likewise, owing to airborne transmission, protecting vulnerable people such as senior citizens should be prioritised.

Perception and Acceptance of COVID-19 Vaccine Among Nurses in Jordan

Introduction

Vaccination against coronavirus disease (COVID-19) is a key factor in protecting vulnerable populations, reducing healthcare burdens, and mitigating the economic and social impacts of the pandemic.

Objective

This study aims to investigate Jordanian nurses' perceptions, acceptance, and factors affecting their decisions toward the COVID-19 vaccines.

Methods

In this study, we conducted a cross-sectional design. Data have been investigated between July 1, 2021 and August 30, 2021. Nurses at three private hospitals in Jordan were surveyed online. The online survey, created using Google Forms, was distributed to nurses via email and social media sites (e.g., WhatsApp and Facebook). Participants were eligible if they were a RN nurse and/or nursing assistance, and had access to the internet via computer and/or smartphone.

Results

Out of 189 responses, 50.6% agreed to receive the COVID-19 vaccine, while 25.5% disagreed, and 23.9% were undecide to receive the vaccine. A large proportion (84.66%) of the respondents had a negative perception toward the vaccine, while only a small minority (15.34%) had a positive perception of it. The older nurses, those with more experience, and those with a higher level of education were more likely to accept the vaccine, with acceptance rates of 56.1%, 54.8%, and 63.9%, respectively.

Conclusion

Of the nurses surveyed, 84.66% had a negative perception of the COVID-19 vaccine, and only 50.6% reported that they would be willing to get vaccinated. It is crucial to address the concerns and reduce apprehension among nurses about the vaccine. Efforts to increase awareness about the importance of vaccination in controlling the disease through workshops and online meetings are needed.

A cross-country comparison of Covid-19 containment measures and their effects on the epidemic curves

BACKGROUND

European countries are still searching to eliminate or contain the Covid-19 pandemic. A variety of approaches have achieved different levels of success in limiting the spread of the disease early and preventing avoidable deaths. Governmental policy responses may explain these differences and this study aims to describe evidence about the effectiveness of containment measures throughout the course of the pandemic in five European countries (France, Germany, Italy, Spain and the UK).

METHODS

The research approach adopted consisted of three steps: 1) Build a Containment Index (C.I.) that considers nine parameters to make an assessment on the strength of measures; 2) Develop dynamic epidemiological models for forecasting purposes; 3) Predict case numbers by assuming containment measures remain constant for a period of 30 days.

RESULTS

Our analysis revealed that in the five European countries we compared, the use of different approaches definitively affected the effectiveness of containment measures for the Covid-19 pandemic.

CONCLUSION

The evidence found in our research can be useful to inform policy makers' decisions when deciding to introduce or relax containment measures and their timing, both during the current pandemic or in addressing possible future health crises.

Experts vs. policymakers in the COVID-19 policy response

We build an evolutionary game-theoretic model of the interaction between policymakers and experts in shaping the policy response to the COVID-19 pandemic. Players' decisions concern two alternative strategies of pandemic management: a "hard" approach, enforcing potentially unpopular measures such as strict confinement orders, and a "soft" approach, based upon voluntary and short-lived social distancing. Policymakers' decisions may also rely upon expert advice. Unlike experts, policymakers are sensitive to a public consensus incentive that makes lifting restrictions as soon as possible especially desirable. This incentive may conflict with the overall goal of mitigating the effects of the pandemic, leading to a typical policy dilemma. We show that the selection of strategies may be path-dependent, as their initial distribution is a crucial driver of players' choices. Contingent on cultural factors and the epidemiological conditions, steady states in which both types of players unanimously endorse the strict strategy can coexist with others where experts and policymakers agree on the soft strategy, depending on the initial conditions. The model can also lead to attractive asymmetric equilibria where experts and policymakers endorse different strategies, or to cyclical dynamics where the shares of adoption of strategies oscillate indefinitely around a mixed strategy equilibrium. This multiplicity of equilibria can explain the coexistence of contrasting pandemic countermeasures observed across countries in the first wave of the outbreak. Our results suggest that cross-country differences in the COVID-19 policy response need not be the effect of poor decision making. Instead, they can endogenously result from the interplay between policymakers and experts incentives under the local social, cultural and epidemiological conditions.

Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems

Beginning in December 2019, the world faced a critical new public health stressor with the emergence of SARS-CoV-2. Its spread was extraordinarily rapid, and in a matter of weeks countries across the world were affected, notably in their ability to manage health care needs. While many sectors of public structures were impacted by the pandemic, it particularly highlighted shortcomings in medical care infrastructures around the world that underscored the need to reorganize medical systems, as they were vastly unprepared and ill-equipped to manage a pandemic and simultaneously provide general and specialized medical care. This paper presents modalities in approaches to the pandemic by various countries, and the triaged reorganization of medical sections not considered first-line in the pandemic that was in many cases transformed into wards for treating COVID-19 cases. As new viruses and structural variants emerge, it is important to find solutions to streamline medical care in hospitals, which includes the expansion of digital network medicine (i.e., telemedicine and mobile health apps) for patients to continue to receive appropriate care without risking exposure to contagions. Mobile health app development continues to evolve with specialized diagnostics capabilities via external attachments that can provide rapid information sharing between patients and care providers while eliminating the need for office visits. Telemedicine, still in the early stages of adoption, especially in the developing world, can ensure access to medical information and contact with care providers, with the potential to release emergency rooms from excessive cases, and offer multidisciplinary access for patients and care providers that can also be a means to avoid contact during a pandemic. As this pandemic illustrated, an overhaul to streamline health care is essential, and a move towards greater use of mobile health and telemedicine will greatly benefit public health to control the spread of new variants and future outbreaks.

Side Effects of COVID-19 Inactivated Virus vs. Adenoviral Vector Vaccines: Experience of Algerian Healthcare Workers

Healthcare workers were prioritized in vaccination campaigns globally because they are exposed to the highest risk of contamination by SARS-CoV-2. This study evaluated the self-reported post-vaccination side effects of inactivated (BBIBP-CorV and CoronaVac) and adenoviral vector-based (AZD1222, Gam-COVID-Vac and Ad26.COV2.S) vaccines among Algerian healthcare workers using a validated questionnaire. The final analysis included 721 healthcare workers, with a predominance of females (59.1%) and younger individuals 20–30 years old (39.4%). Less than half (49.1%) of the respondents reported at least one local side effect, while 53.8% reported at least one systemic side effect. These side effects were more prevalent among viral vector vaccinees than inactivated virus vaccinees. The most common local side effects were injection site pain (39%) and arm pain (25.4%), while fatigue (34.4%), fever (28.4%), headache (24.8%) and myalgia (22.7%) were the most prevalent systemic side effects. The side effects appeared earlier among inactivated virus vaccines recipients and generally lasted for 2 to 3 days for the two vaccinated groups. The risk factors associated with a higher prevalence of side effects included female gender, allergic individuals, individuals with regular medication, those who contracted the COVID-19 disease and those who received two doses for both inactivated and viral-based vaccines groups. Despite the higher prevalence of post-vaccination side effects among adenoviral vector vaccines recipients, both vaccines groups were equally effective in preventing symptomatic infections, and no life-threatening side effects were reported in either vaccine group.

An exploration of the political, social, economic and cultural factors affecting how different global regions initially reacted to the COVID-19 pandemic

Responses to the early (February-July 2020) COVID-19 pandemic varied widely, globally. Reasons for this are multiple but likely relate to the healthcare and financial resources then available, and the degree of trust in, and economic support provided by, national governments. Cultural factors also affected how different populations reacted to the various pandemic restrictions, like masking, social distancing and self-isolation or self-quarantine. The degree of compliance with these measures depended on how much individuals valued their needs and liberties over those of their society. Thus, several themes may be relevant when comparing pandemic responses across different regions. East and Southeast Asian populations tended to be more collectivist and self-sacrificing, responding quickly to early signs of the pandemic and readily complied with most restrictions to control its spread. Australasian, Eastern European, Scandinavian, some Middle Eastern, African and South American countries also responded promptly by imposing restrictions of varying severity, due to concerns for their wider society, including for some, the fragility of their healthcare systems. Western European and North American countries, with well-resourced healthcare systems, initially reacted more slowly, partly in an effort to maintain their economies but also to delay imposing pandemic restrictions that limited the personal freedoms of their citizens.

Covid-19 Serosurveillance Positivity in General Population: Comparison at Different Times

Introduction: Serological surveys estimating the cumulative incidence of the disease are powerful and effective tools for monitoring the epidemic and in determining the immunity status. Objectives: To compare the percentage sero-positivity for IgG antibodies against SARS-CoV2 at two different time period in the same population to understand the pandemic and predict about the immunity status of the population. Methods: As a part of Covid19 pandemic management, two separate population based sero-survey within a gap of 1½ months were carried in Ahmedabad city to scientifically document the progress of the Covid19 pandemic. Various demographic factors and other parameters from both the survey were compared with seropositivity for valid and precise estimation of disease situation as well as immunity status of the population. Results: The study documents an increase in seropositivity by 5.32% (from 17.92% to 23.24%). The seropositivity shows increasing trend with increase in the age group and the seropositivity is significantly higher among females. Overall higher seropositivity against the reported cases in the first sero-survey and the narrow increase in the seropositivity during the subsequent sero-survey inspite of high number of cases may indicate temporary status of the antibodies. This may also be due to the difference in the level of stigma, health care service delivery, service utilization and related field level situation affecting the asymptomatic/unreported case positivity. Conclusion: The result of seropositivity comparison indicates the scopes for further research to confirm and generate greater evidences regarding the factors affecting seropositivity.

Topic Evolution of Chinese COVID-19 Policies Based on Co-Occurrence Clustering Network Analysis

This study aims to explore the changes of Chinese coronavirus disease-2019 (COVID-19) policy topics in the eclipse, outbreak, and convalescent stage of COVID-19 based on 4982 textual policies. By using the co-occurrence clustering network method, we find that the strict prevention and control of the epidemic is the only topic of policies in the eclipse stage. In the outbreak stage, strict epidemic prevention and control is still the most important policy topic. The policies of resuming work of “essential” enterprises and stabilizing market prices are important support and guarantee for fighting against COVID-19. In the convalescent stage, as the prevention and control of COVID-19 has become regular, promoting and ensuring the resumption of work in all sectors of society is the most important topic of the policies. Moreover, the success of Wuhan City’s fight against COVID-19 reflects China’s governance characteristics of “concentrating power to do a major event”. Finally, the possible improvements for Chinese COVID-19 policies are discussed, which can provide practical suggestions for government departments on how to effectively respond to public health emergencies.

Natural resistance against infections: focus on COVID-19

Not all individuals exposed to a pathogen develop illness: some are naturally resistant whereas others develop an asymptomatic infection. Epidemiological studies suggest that there is similar variability in susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We propose that natural resistance is part of the disease history in some individuals exposed to this new coronavirus. Epidemiological arguments for natural resistance to SARS-CoV-2 are the lower seropositivity of children compared to adults, studies on closed environments of ships with outbreaks, and prevalence studies in some developing countries. Potential mechanisms of natural resistance include host genetic variants, viral interference, cross-protective natural antibodies, T cell immunity, and highly effective innate immune responses. Better understanding of natural resistance can help to advance preventive and therapeutic measures against infections for improved preparedness against potential future pandemics.

Analyzing natural herd immunity media discourse in the United Kingdom and the United States

Natural herd immunity, where community-acquired infections in low-risk populations are used to protect high risk populations from infection-has seen high profile support in some quarters, including through the Great Barrington Declaration. However, this approach has been widely criticized as ineffective and misinformed. In this study, we examine media discourse around natural herd immunity in the United States (US) and United Kingdom (UK) to better understand how this approach was promoted. Country-specific news media publications between March 11, 2020 and January 31, 2021 were searched for references to herd immunity. News articles focused on herd immunity and including a stakeholder quote about herd immunity were collected, resulting in 400 UK and 144 US articles. Stakeholder comments were then coded by name, organization, organization type, and concept agreement or disagreement. Government figures and a small but vocal coalition of academics played a central role in promoting natural herd immunity in the news media whereas critics were largely drawn from academia and public health. These groups clashed on whether: natural herd immunity is an appropriate and effective pandemic response; the consequences of a lockdown are worse than those of promoting herd immunity; high-risk populations could be adequately protected; and if healthcare resources would be adequate under a herd immunity strategy. False balance in news media coverage of natural herd immunity as a pandemic response legitimized this approach and potentially undermined more widely accepted mitigation approaches. The ability to protect high risk populations while building herd immunity was a central but poorly supported pillar of this approach. The presentation of herd immunity in news media underscores the need for greater appreciation of potential harm of media representations that contain false balance.

Immunology

The novel coronavirus, Severe Acute Respiratory Syndrome (SARS)-CoV-2 originating in the City of Wuhan, China in December 2019 and spread rapidly throughout China (an epidemic). Within 2 months, it had spread throughout the entire world becoming the pandemic labeled COVID-19. As this chapter is being written (early 2021), this devastating disease remains uncontrolled, causing countless and tragic death worldwide. The life cycle of the virus including its spike protein and affinity to ACE-2 receptors is well understood, but notwithstanding vaccines (Pfizer and Moderna mRNA), antiviral drugs, and monoclonal antibodies just being FDA approved (emergency use authorization—EAU), this highly contagious agent continues to spread. Only classic public health preventive measures like isolation, social distancing, masks, and copious handwashing are effective, yet difficult to enforce with people and politics in open societies. As with any pandemic, unless herd immunity is achieved through an effective immunization program, identifying infected individuals is critical. Antigen tests (polymerase chain reaction) detect active viral infection while antibody tests identify previously infected people who might be considered henceforth immune (though inconclusive with SARS-CoV2). Perhaps the most valuable information on the disease is coming from the enormous body of AI assisted research of which this chapter addresses.

Defining Antibody Seroprevalence and Duration of Humoral Responses to SARS-CoV-2 Infection and/or Vaccination in a Greek Community

BACKGROUND

In this work, we aimed to evaluate antibody-response longevity to SARS-CoV-2 infection and/or vaccination in one of the Greek communities that was worst hit by the pandemic, Deskati, five months after a previous serosurveillance and nine months after the pandemic wave initiation (October 2020).

METHODS

The SARS-CoV-2 IgG II Quant method (Architect, Abbott, IL, USA) was used for antibody testing.

RESULTS

A total of 69 subjects, who previously tested positive or negative for COVID-19 antibodies, participated in the study. We found that 48% of participants turned positive due to vaccination. 27% of participants were both previously infected and vaccinated. However, all previously infected participants retained antibodies to the virus, irrespective of their vaccination status. The antibody titers were significantly higher in previously infected participants that had been vaccinated than those who were unvaccinated and in those that had been previously hospitalized for COVID-19 than those with mild disease.

CONCLUSIONS

Antibody responses to SARS-CoV-2 infection were maintained nine months after the pandemic. Vaccination alone had generated an immune response in almost half of the population. Higher antibody titers were found in the case of vaccination in previously infected subjects and especially in those with severe disease leading to hospitalization.

Public health, surveillance policies and actions to prevent community spread of COVID-19 in Denmark, Serbia and Sweden

Aim: This study investigates the non-medical public health and surveillance policies and actions for tackling the community spread of COVID-19 pandemic in Denmark, Serbia and Sweden during the first five months of the pandemic in 2020. Method: The study is inspired by a process-tracing design for case study with a focus on the non-medical measures and surveillance strategies implemented by the three countries. The comprehensive collection and study of national documents formed the basis of the document analysis. Results: The Danish strategy was to prolong the transmission period, preventing high numbers of infected cases from impacting their healthcare capacity. The government's strategy was characterized by strict governance elements, health guidelines and behavioural recommendations. In Serbia, the main strategy was to prevent the spread and control of the infectious disease by shifting all human and material resources towards the function of controlling the spread. Serbia applied the strictest measures in the fight against coronavirus in relation to other countries in the region and in Europe. The Swedish strategy focused more on recommendations than requirements to motivate the public to modify their behaviours voluntarily. Sweden's loose pandemic strategy implementation focused on voluntary and stepwise action rather than legislation and compulsory measures. Conclusions: The public health policies and actions implemented to prevent community spread of COVID-19 in Denmark, Serbia and Sweden varied during the first five months of the pandemic. The differences in their response were due to delays in implementation, inconsistencies in perspectives towards the outbreak and the capacity of each country in terms of their pandemic preparedness and response.

Tracking GDP in real-time using electricity market data: Insights from the first wave of COVID-19 across Europe

This paper develops a methodology for tracking in real-time the impact of shocks (such as natural disasters, financial crises or pandemics) on gross domestic product (GDP) by analyzing high-frequency electricity market data. As an illustration, we estimate the GDP loss caused by COVID-19 in twelve European countries during the first wave of the pandemic. Our results are almost indistinguishable from the official statistics during the first two quarters of 2020 (the correlation coefficient is 0.98) and are validated by several robustness tests. We provide estimates that are more chronologically disaggregated and up-to-date than standard macroeconomic indicators and, therefore, can provide timely information for policy evaluation in time of crisis. Our results show that pursuing "herd immunity" did not shelter from the harmful economic impacts of the first wave of the pandemic. They also suggest that coordinating policies internationally is fundamental for minimizing spillover effects from non-pharmaceutical interventions across countries.

Concise Update on Genomics of COVID-19: Approach to Its latest Mutations, Escalated Contagiousness, and Vaccine Resistance

The novel coronavirus disease 2019 (COVID-19) that started to invade the world from the Chinese fish market, causes an acute respiratory distress syndrome. COVID-19 is a dreadful infectious disease that surfaced only less than 8 months ago and caused the deadly COVID-19 pandemic. In this new species with a positive, single-strand RNA genome and a huge size, from the proteomics point view, there are no changes in sequences of amino acids in NSP7, 13, matrix, or envelope or other proteins including 8b and p6 and excluding NSP2 and NSP3. P6 is a multifunctional golgi-endoplasmic reticulum membrane-associated protein. This complex has a key duty to increase the replication rate of the virus and also causes intrinsic immune system responses by suppressing the signal transducer and activator of transcription factor 1 (STAT 1) translocated to the nucleus. Palmitoylated proteins elevate hydrophobicity which helps in membrane connection. Inside the N-linked glycosylation, moieties oligosaccharide is adhering to Asn-X-Ser/Thr canonical sequence. This helps for exact enfolding and carrying viral proteins by industriously using host's chaperon proteins including calreticulin and calnexin. 2B proteins encourage the internalization of major histocompatibility complex, class-I (MHC-I) protein and meanwhile inhibit their transfer to the surface of the cell as a recognition side. The deubiquitination of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has precise modification apparatus in the posttranslational stage. In this article, we outlined the recent and up-to-date data on genomic and molecular structures, epidemiology, vaccine development, and, last but not least, the clinical features, diagnostics, and treatment of the novel coronavirus.

COVID-19 seropositivity among non-medical frontline office staff from two cities in Rajasthan, India

Aims:

The indigenously developed Indian Council of Medical Research (ICMR)-NIV COVID Kavach IgG enzyme linked immunosorbent assay (ELISA) has been recommended for seroprevalence among vulnerable populations in India, which provided essential services throughout the lockdown. The staff working in the High Court was one such group. We compared anti-SARS-CoV-2 IgG seropositivity among the staff of Jodhpur and Jaipur High Courts, Rajasthan, India.

Methods:

Asymptomatic judiciary staff of Jodhpur and Jaipur benches of High Courts were enrolled after informed written consent. A questionnaire was filled and 3–5 ml venous blood was collected from participants. The ICMR-NIV COVID Kavach IgG ELISA and EUROIMMUN IgG ELISA were used for detection of Anti-SARS-CoV-2 IgG antibodies.

Results:

A total of 63 samples (41 from Jodhpur and 22 from Jaipur) were collected between 28^th July to 4^th August 2020. The overall anti-SARS-CoV-2 IgG seroprevalence was found to be 6.35%. Seropositivity was higher among the staff from Jaipur (13.64%) as compared to Jodhpur (2.44%). The Kavach ELISA results were in complete agreement with EUROIMMUN ELISA. The infection control measures were deemed effective.

Conclusion:

Seroprevalence among the staff of Jodhpur High Court was found to be lower than Jaipur, reflecting higher susceptibility to COVID-19 in the former. Many offices worldwide are closed till mid 2020 but need to come up with pre-emptive policies eventually. This study may help to anticipate the possible challenges when other government/private offices start functioning. The infection control practices of one workplace may help formulate guidelines for other offices.

Self-Perceived Life Satisfaction during the First Wave of the COVID-19 Pandemic in Sweden: A Cross-Sectional Study

Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.

Population-based seropositivity for IgG antibodies against SARS-CoV-2 in Ahmedabad city

CONTEXT

Ahmedabad city with approximately 7 million population was one of the earliest cities to witness the high case load of COVID-19 pandemic in India. A population-based sero-survey was ideally suited in Ahmedabad to guide the public health response for managing COVID-19 pandemic.

OBJECTIVES

To study the percentage sero-positivity for SARS-CoV-2 to understand the pandemic status and deriving conclusions for guiding the public health measures for managing the COVID-19 pandemic.

SETTINGS AND DESIGN

Population-based cross-sectional sero-surveillance.

METHODS AND MATERIAL

Large scale sero-surveillance with population-based stratified sampling covering more than 10,000 samples from general population of Ahmedabad was carried out during second half of August 2020. The seropositivity was correlated and compared with various demographic factors and other parameters for valid and precise predictions on the immunity status of the population.

RESULTS

With 2,396 samples positive for IgG antibodies from a total of 10,310 samples, the seropositivity against COVID-19 in the general population of Ahmedabad is around 23.24%. The seropositivity has increasing trend with increasing age and is significantly higher among females (25.37%) than males (21.81%). The zone wise positivity ranged from 11.74% to 33.14%. This closely correlates with the cases recorded so far, higher for those zones with high current or past cases.

CONCLUSIONS

Seropositivity of 23.24% in general population indicate the overall current level of protection. Since effective vaccine is not yet available, it is required to continue emphasis on the public health preventive measures for controlling and managing the COVID-19 pandemic.

Societal Impacts of Pandemics: Comparing COVID-19 With History to Focus Our Response

COVID-19 has disrupted everyday life worldwide and is the first disease event since the 1918 H1N1 Spanish influenza (flu) pandemic to demand an urgent global healthcare response. There has been much debate on whether the damage of COVID-19 is due predominantly to the pathogen itself or our response to it. We compare SARS-CoV-2 against three other major pandemics (1347 Black Death, 1520's new world smallpox outbreaks, and 1918 Spanish Flu pandemic) over the course of 700 years to unearth similarities and differences in pathogen, social and medical context, human response and behavior, and long-term social and economic impact that should be used to shape COVID-19 decision-making. We conclude that <100 years ago, pandemic disease events were still largely uncontrolled and unexplained. The extensive damage wreaked by historical pandemics on health, economy, and society was a function of pathogen characteristics and lack of public health resources. Though there remain many similarities in patterns of disease spread and response from 1300 onwards, the major risks posed by COVID-19 arise not from the pathogen, but from indirect effects of control measures on health and core societal activities. Our understanding of the epidemiology and effective treatment of this virus has rapidly improved and attention is shifting toward the identification of long-term control strategies that balance consideration of health in at risk populations, societal behavior, and economic impact. Policymakers should use lessons from previous pandemics to develop appropriate risk assessments and control plans for now-endemic COVID-19, and for future pandemics.

Data-driven optimized control of the COVID-19 epidemics

Optimizing the impact on the economy of control strategies aiming at containing the spread of COVID-19 is a critical challenge. We use daily new case counts of COVID-19 patients reported by local health administrations from different Metropolitan Statistical Areas (MSAs) within the US to parametrize a model that well describes the propagation of the disease in each area. We then introduce a time-varying control input that represents the level of social distancing imposed on the population of a given area and solve an optimal control problem with the goal of minimizing the impact of social distancing on the economy in the presence of relevant constraints, such as a desired level of suppression for the epidemics at a terminal time. We find that with the exception of the initial time and of the final time, the optimal control input is well approximated by a constant, specific to each area, which contrasts with the implemented system of reopening 'in phases'. For all the areas considered, this optimal level corresponds to stricter social distancing than the level estimated from data. Proper selection of the time period for application of the control action optimally is important: depending on the particular MSA this period should be either short or long or intermediate. We also consider the case that the transmissibility increases in time (due e.g. to increasingly colder weather), for which we find that the optimal control solution yields progressively stricter measures of social distancing. We finally compute the optimal control solution for a model modified to incorporate the effects of vaccinations on the population and we see that depending on a number of factors, social distancing measures could be optimally reduced during the period over which vaccines are administered to the population.

Exploring the Trade-Off Between Economic and Health Outcomes During a Pandemic: A Discrete Choice Experiment of Lockdown Policies in Australia

Background

All countries experienced social and economic disruption and threats to health security from the COVID-19 pandemic in 2020, but the responses in terms of control measures varied considerably. While control measures, such as quarantine, lockdown and social distancing, reduce infections and infection-related deaths, they have severe negative economic and social consequences.

Objectives

The objective of this study was to explore the acceptability of different infectious disease control measures, and examine how respondents trade off between economic and health outcomes.

Methods

A discrete choice experiment was developed, with attributes covering: control restrictions, duration of restrictions, tracking, number of infections and of deaths, unemployment, government expenditure and additional personal tax. A representative sample of Australians (n = 1046) completed the survey, which included eight choice tasks. Data were analysed using mixed logit regression to identify heterogeneity and latent class models to examine heterogeneity.

Results

In general, respondents had strong preferences for policies that avoided high infection-related deaths, although lower unemployment and government expenditure were also considered important. Respondents preferred a shorter duration for restrictions, but their preferences did not vary significantly for the differing levels of control measures. In terms of tracking, respondents preferred mobile phone tracking or bracelets when compared to no tracking. Significant differences in preferences was identified, with two distinct classes: Class 1 (57%) preferred the economy to remain open with some control measures, whereas Class 2 (43%), had stronger preferences for policies that reduced avoidable deaths.

Conclusions

This study found that the Australian population is willing to relinquish some freedom, in the short term, and trade off the negative social and economic impacts of the pandemic, to avoid the negative health consequences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40271-021-00503-5.

COVID-19 pandemic management and the rheumatology patient

We discuss the evidence behind mask use, including evidence for homemade masks, social distancing, and the local coronavirus disease-2019 (COVID-19) epidemics in countries that initially employed more limited public health interventions. Given the absence of data for specific interventions in the rheumatic disease population, we reviewed the evidence available for the general population. The risk of poor outcomes with COVID-19 in patients with rheumatic diseases is a potential concern given the immunosuppression associated with these conditions and disease-modifying anti-rheumatic drug therapy, as well as advancing age and many of the comorbidities present in such patients. Infection prevention is key, for both individual patients and their community. Given the data collected from the general population, we recommend ongoing proper mask use, social distancing, and hand hygiene for patients with rheumatic diseases and encourage providers to counsel these patients in prevention strategies and attempt to dispel abundant misinformation.

How did Sweden Fail the Pandemic?

Sweden has since the start of the pandemic a COVID-19 mortality rate that is 4 to 10 times higher than in the other Nordic countries. Also, measured as age-standardized all-cause excess mortality in the first half of 2020 compared to previous years Sweden failed in comparison with the other Nordic countries, but only among the elderly. Sweden has large socioeconomic and ethnic inequalities in COVID-19 mortality. Geographical, ethnic, and socioeconomic inequalities in mortality can be due to differential exposure to the virus, differential immunity, and differential survival. Most of the country differences are due to differential exposure, but the socioeconomic disparities are mainly driven by differential survival due to an unequal burden of comorbidity. Sweden suffered from an unfortunate timing of tourists returning from virus hotspots in the Alps and Sweden's government response came later and was much more limited than elsewhere. The government had an explicit priority to protect the elderly in nursing and care homes but failed to do so. The staff in elderly care are less qualified and have harder working conditions in Sweden, and they lacked adequate care for the clients. Sweden has in recent years diverged from the Scandinavian welfare model by strong commercialization of primary care and elderly care.

Immunitarianism: defence and sacrifice in the politics of Covid-19

As witnessed over the last year, immunity emerged as one of most highly debated topics in the current Covid-19 pandemic. Countries around the globe have been debating whether herd immunity or lockdown is the best response, as the race continues for the development and rollout of effective vaccines against coronavirus and as the economic costs of implementing strict containment measures are weighed against public health costs. What became evident all the more is that immunity is precisely what bridges between biological life and political life in the current climate, be it in terms of the contentious notion of herd immunity, the geopolitical struggle for vaccines, or the possible emergence of "Covid-elite", i.e. holders of so-called "immunity passports". Immunity, as such, is certainly not only a matter of science and biology alone, but is inherently political in the way that pandemics themselves are often highly politicised. Drawing on the work of Roberto Esposito and other literature from the field of biopolitics and immunology, this paper provides a critical examination of the concept of immunity in light of the recent events, highlighting the intersections between the politics of defence and the politics of sacrifice which animate governments' immunitary responses to the Covid-19 pandemic. The paper ends with a discussion on the forms of solidarity and local initiatives that have been mobilised during the current pandemic and their potential for an affirmative form of biopolitics. Overall, the main aim of this paper is to provide a critical cultural and philosophical analysis of Covid-19 debates and responses and a nuanced account on the biopolitical effects of the current pandemic, highlighting the paradoxical nature of immunity which straddles at once negative practices of defence and sacrifice as well as affirmative forms of community and solidarity beyond state apparatuses.

Technology, Privacy, and User Opinions of COVID-19 Mobile Apps for Contact Tracing: Systematic Search and Content Analysis

BACKGROUND

Many countries across the globe have released their own COVID-19 contact tracing apps. This has resulted in the proliferation of several apps that used a variety of technologies. With the absence of a standardized approach used by the authorities, policy makers, and developers, many of these apps were unique. Therefore, they varied by function and the underlying technology used for contact tracing and infection reporting.

OBJECTIVE

The goal of this study was to analyze most of the COVID-19 contact tracing apps in use today. Beyond investigating the privacy features, design, and implications of these apps, this research examined the underlying technologies used in contact tracing apps. It also attempted to provide some insights into their level of penetration and to gauge their public reception. This research also investigated the data collection, reporting, retention, and destruction procedures used by each of the apps under review.

METHODS

This research study evaluated 13 apps corresponding to 10 countries based on the underlying technology used. The inclusion criteria ensured that most COVID-19-declared epicenters (ie, countries) were included in the sample, such as Italy. The evaluated apps also included countries that did relatively well in controlling the outbreak of COVID-19, such as Singapore. Informational and unofficial contact tracing apps were excluded from this study. A total of 30,000 reviews corresponding to the 13 apps were scraped from app store webpages and analyzed.

RESULTS

This study identified seven distinct technologies used by COVID-19 tracing apps and 13 distinct apps. The United States was reported to have released the most contact tracing apps, followed by Italy. Bluetooth was the most frequently used underlying technology, employed by seven apps, whereas three apps used GPS. The Norwegian, Singaporean, Georgian, and New Zealand apps were among those that collected the most personal information from users, whereas some apps, such as the Swiss app and the Italian (Immuni) app, did not collect any user information. The observed minimum amount of time implemented for most of the apps with regard to data destruction was 14 days, while the Georgian app retained records for 3 years. No significant battery drainage issue was reported for most of the apps. Interestingly, only about 2% of the reviewers expressed concerns about their privacy across all apps. The number and frequency of technical issues reported on the Apple App Store were significantly more than those reported on Google Play; the highest was with the New Zealand app, with 27% of the reviewers reporting technical difficulties (ie, 10% out of 27% scraped reviews reported that the app did not work). The Norwegian, Swiss, and US (PathCheck) apps had the least reported technical issues, sitting at just below 10%. In terms of usability, many apps, such as those from Singapore, Australia, and Switzerland, did not provide the users with an option to sign out from their apps.

CONCLUSIONS

This article highlighted the fact that COVID-19 contact tracing apps are still facing many obstacles toward their widespread and public acceptance. The main challenges are related to the technical, usability, and privacy issues or to the requirements reported by some users.

COVID-19 lockdown reveals tourists as seabird guardians

The widespread lockdowns put in place to limit the spread of the new coronavirus disease (COVID-19) offers a rare opportunity in understanding how human presence influence ecosystems. Using data from long-term seabird monitoring, we reveal a previously concealed guarding effect by tourist groups on an iconic seabird colony in the Baltic Sea. The absence of tourists in 2020 lead to a sevenfold increase in presence of white-tailed eagles Haliaeetus albicilla, a sevenfold increase in their disturbance of breeding common murres Uria aalge and causing 26% lower murre productivity than the long-term average. Eagles did not prey on murres, but their frequent disturbances delayed egg laying and facilitated egg predation from herring gulls Larus argentatus and hooded crows Corvus cornix. Based on our findings, we suggest that human presence could be used as a strategic measure in guarding seabird colonies, and that a social-ecological systems perspective is vital for long-term success in protected area management.

Leveraging epidemiological principles to evaluate Sweden's COVID-19 response

In the response to COVID-19, countries have implemented response strategies along a continuum of population- and venue-level specificity ranging from suppression to mitigation strategies. Suppression strategies generally include population-wide shelter-in-place mandates or lockdowns, closure of nonessential physical venues, travel bans, testing and contact tracing, and quarantines. Sweden followed a mitigation strategy focused on risk-tailored approaches to mitigate specific acquisition risks among the elderly, minimizing the disruption to education and the delivery of other health care services, and recommendations for social distancing to minimize the disease burden. To date, Sweden has reported higher case counts and attributable mortality than other Scandinavian countries and lower than other Northern European countries. However, there are several limitations with comparison given heterogeneity in testing strategies, suspected and confirmed case definitions, and assessment of attributable mortality. The decisions in Sweden also reflect social priorities such as equity being a foundational principle of Swedish social systems. Consistently, in-person education for those aged less than 16 years continued throughout. Notably, the mitigation strategy did not eliminate the inequitable impacts of COVID-19 cases and mortality in Sweden with higher-exposure and generally lower-income occupations being associated with higher risks intersecting with these communities often residing in more dense multigenerational households. From January 1 to November 15, there has been a 1.8% increase in all-cause mortality in 2020 compared with the average of 2015-2019, representing an excess of 14.3 deaths per 100,000 population. However, the final assessment of excess deaths in Sweden in 2020 including stratification by age and integration of secular trends can only be calculated in the coming years. In response to increasing cases in the fall of 2020, Sweden has continued to leverage business-oriented regulations and public-oriented guidelines for social distancing rather than police-enforced mandates. Ultimately, pandemics present no winners. Countries have implemented a range of different COVID-19 prevention and mitigation strategies responsive to their own priorities and legal systems including equity and the balancing of competing health priorities. Given these varied approaches, countries that pursued elimination, suppression, or mitigation strategies can collaboratively learn from both successes and challenges of the different strategies to inform COVID-19 and future pandemic responses.

Acceptance of a COVID-19 Vaccine and Its Related Determinants among the General Adult Population in Kuwait

OBJECTIVE

The objective of this study was to determine the acceptance of a coronavirus disease 2019 (COVID-19) vaccine among the general adult population in Kuwait and assess its determinants.

SUBJECTS AND METHODS

A web-based cross-sectional study was conducted by enrolling adults living in Kuwait (n = 2,368; aged ≥21 years). Acceptance of a COVID-19 vaccine was inferred if participants indicated that they "definitely or probably will accept vaccination against COVID-19 once a vaccine is available." Associations were explored by applying a modified Poisson regression to estimate and infer adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI).

RESULTS

In total, 53.1% (1,257/2,368) of the participants were willing to accept a COVID-19 vaccine once available. Male subjects were more willing to accept a COVID-19 vaccine than females (58.3 vs. 50.9%, p < 0.001). Subjects who viewed vaccines in general to have health-related risks were less willing to accept vaccination (aPR = 0.39, 95% CI: 0.35-0.44). Moreover, participants who previously received an influenza vaccine were more likely to accept a COVID-19 vaccine (aPR = 1.44, 95% CI: 1.31-1.58). Willingness to get vaccinated against COVID-19 increased as the self-perceived chances of contracting the infection increased (p < 0.001).

CONCLUSION

Overall, 53.1% of the study participants demonstrated willingness to get vaccinated against COVID-19. We found several factors influencing the level of acceptance. Since vaccination appears to be an essential preventive measure that can halt the COVID-19 pandemic, factors relating to low vaccine acceptance need to be urgently addressed by public health strategies.

A review of deciphering the successes and learning from the failures in preventive and health policies to stop the COVID-19 pandemic

Since the onset of the COVID-19 pandemic, some countries have had successful experiences as well as failures. Countries have taken significant and different approaches to reducing the spread of COVID-19. This chapter states the soft method and herd immunity policy of some European countries (e.g., Sweden) in the early days of the epidemic, which failed. Most countries (e.g., Italy) that enacted a mandatory lockdown during the epidemic soon realized that this trend should not continue for longer periods because of side effects, namely social and economic troubles. Some other countries (e.g., Germany) imposed a social distancing of two meters in public places, which have been effective in reducing infection. Nowadays, reports indicate that some Asian countries have had more success than most European and American countries in taking containment measures. Hong Kong and Singapore are among the most successful countries in the world since the beginning of the pandemic, while the United States and Brazil are among the countries that have handled the development of the pandemic worst. Wearing a face mask in combination with social distancing is effective around 50% of the time. However, a complete combination of the following contention policies must be carried out by all countries, always considering the political, social, and above all, economic characteristics of each of them: (1) use face masks in public places, (2) keep suitable physical distancing, (3) extremely thorough hand hygiene, and (4) isolate all infected people. This should also include improving the ventilation in enclosed environments, designing safe routes in public and particular business locations, together with cleaning and disinfection activities.

Impact of control interventions on COVID-19 population dynamics in Malaysia: a mathematical study

Coronavirus disease 2019 (COVID-19) pandemic has posed a serious threat to both the human health and economy of the affected nations. Despite several control efforts invested in breaking the transmission chain of the disease, there is a rise in the number of reported infected and death cases around the world. Hence, there is the need for a mathematical model that can reliably describe the real nature of the transmission behaviour and control of the disease. This study presents an appropriately developed deterministic compartmental model to investigate the effect of different pharmaceutical (treatment therapies) and non-pharmaceutical (particularly, human personal protection and contact tracing and testing on the exposed individuals) control measures on COVID-19 population dynamics in Malaysia. The data from daily reported cases of COVID-19 between 3 March and 31 December 2020 are used to parameterize the model. The basic reproduction number of the model is estimated. Numerical simulations are carried out to demonstrate the effect of various control combination strategies involving the use of personal protection, contact tracing and testing, and treatment control measures on the disease spread. Numerical simulations reveal that the implementation of each strategy analysed can significantly reduce COVID-19 incidence and prevalence in the population. However, the results of effectiveness analysis suggest that a strategy that combines both the pharmaceutical and non-pharmaceutical control measures averts the highest number of infections in the population.

Humoral Responses and Serological Assays in SARS-CoV-2 Infections

In December 2019, the novel betacoronavirus Severe Acute Respiratory Disease Coronavirus 2 (SARS-CoV-2) was first detected in Wuhan, China. SARS-CoV-2 has since become a pandemic virus resulting in hundreds of thousands of deaths and deep socioeconomic implications worldwide. In recent months, efforts have been directed towards detecting, tracking, and better understanding human humoral responses to SARS-CoV-2 infection. It has become critical to develop robust and reliable serological assays to characterize the abundance, neutralization efficiency, and duration of antibodies in virus-exposed individuals. Here we review the latest knowledge on humoral immune responses to SARS-CoV-2 infection, along with the benefits and limitations of currently available commercial and laboratory-based serological assays. We also highlight important serological considerations, such as antibody expression levels, stability and neutralization dynamics, as well as cross-reactivity and possible immunological back-boosting by seasonal coronaviruses. The ability to accurately detect, measure and characterize the various antibodies specific to SARS-CoV-2 is necessary for vaccine development, manage risk and exposure for healthcare and at-risk workers, and for monitoring reinfections with genetic variants and new strains of the virus. Having a thorough understanding of the benefits and cautions of standardized serological testing at a community level remains critically important in the design and implementation of future vaccination campaigns, epidemiological models of immunity, and public health measures that rely heavily on up-to-date knowledge of transmission dynamics.

Infection control challenges in setting up community isolation and treatment facilities for patients with coronavirus disease 2019 (COVID-19): Implementation of directly observed environmental disinfection

Background:

Extensive environmental contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We report our experience with the practice of directly observed environmental disinfection (DOED) in a community isolation facility (CIF) and a community treatment facility (CTF) in Hong Kong.

Methods:

The CIF, with 250 single-room bungalows in a holiday camp, opened on July 24, 2020, to receive step-down patients from hospitals. The CTF, with 500 beds in open cubicles inside a convention hall, was activated on August 1, 2020, to admit newly diagnosed COVID-19 patients from the community. Healthcare workers (HCWs) and cleaning staff received infection control training to reinforce donning and doffing of personal protective equipment and to understand the practice of DOED, in which the cleaning staff observed patient and staff activities and then performed environmental disinfection immediately thereafter. Supervisors also observed cleaning staff to ensure the quality of work. In the CTF, air and environmental samples were collected on days 7, 14, 21, and 28 for SARS-CoV-2 detection by RT-PCR. Patient compliance with mask wearing was also recorded.

Results:

Of 291 HCWs and 54 cleaning staff who managed 243 patients in the CIF and 674 patients in the CTF from July 24 to August 29, 2020, no one acquired COVID-19. All 24 air samples and 520 environmental samples collected in the patient area of the CTF were negative for SARS-CoV-2. Patient compliance with mask wearing was 100%.

Conclusion:

With appropriate infection control measures, zero environmental contamination and nosocomial transmission of SARS-CoV-2 to HCWs and cleaning staff was achieved.

Addressing Healthcare Gaps in Sweden during the COVID-19 Outbreak: On Community Outreach and Empowering Ethnic Minority Groups in a Digitalized Context

Since its early stages, the COVID-19 pandemic has interacted with existing divides by ethnicity and socioeconomic statuses, exacerbating further inequalities in high-income countries. The Swedish public health strategy, built on mutual trust between the government and the society and giving the responsibility to the individual, has been criticized for not applying a dedicated and more diverse strategy for most disadvantaged migrants in dealing with the pandemic. In order to mitigate the unequal burden on the marginalized members of society, increasing efforts have been addressed to digital health technologies. Despite the strong potential of providing collective public health benefits, especially in a highly digitalized context as Sweden, need for a stronger cooperation between the public health authorities and migrant community leaders, representatives of migrant associations, religious leaders and other influencers of disadvantaged groups has emerged. Suggestions are presented on more culturally congruent, patient-centered health care services aimed to empower people to participate in a more effective public health response to the COVID-19 crisis.

The bumpy road to achieve herd immunity in COVID-19

Herd immunity is a form of indirect protection that is offered to the community when a large proportion of individuals contained in the community are immune to a certain infection. This immunity can be due to vaccination or to the recovery post-disease. Effective herd immunity in SARS-CoV-2 infection has several hurdles upon achievement. Herd immunity cannot be obtained concomitantly in many geographical areas because the areas have different population density and the societal measures to contain the spreading are different. A proportion of 50-66% of the population needs to be immunized naturally or artificially in this SARS-Cov2 pandemic and this percentage is not easily achievable. The duration of herd immunity is another issue while information on the long-term immune response against SARS-CoV2 is yet scarce. Epitope stability, another issue to be solved when achieving herd immunity, is important. Mutation in the viral structure will call upon other sets of neutralizing antibodies and hence for other herd immunity type installment. The societal tactics to achieve the much-needed herd immunity should be developed keeping in mind the welfare of the population. Without being exhaustive, throughout our paper we will elaborate on each of the hurdles encountered in developing herd immunity to SARS-Cov2 infection.