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

Unravelling the determinants of life expectancy during and after the COVID-19 pandemic: a qualitative comparative analysis

Background

Disparities in life expectancy persist across countries, despite overall improvements in recent years. The COVID-19 pandemic further exacerbated these disparities. While substantial research has investigated life expectancy determinants, the factors driving variations across countries remain insufficiently explored.

Methods

This study innovatively employed Qualitative Comparative Analysis with data from 2020-2022, integrating multiple global data sources. We examined the complex causal patterns among conditions, including educational attainment, economic prosperity, environmental quality, social stability, urban development, and public health capacity within a case-oriented framework. Variables were calibrated into fuzzy sets to analyse necessary and sufficient conditions, with intermediate results tested across cases per solution, including robustness tests to validate the findings.

Results

Environmental quality, represented by access to electricity, consistently emerged as a necessary and sufficient condition across seven key case scenarios for achieving high life expectancy. Each case highlights unique pathways that align with different combinations of socioeconomic and policy conditions, illustrating that diverse approaches can lead to positive outcomes. In addition to environmental quality, factors such as mean years of schooling, gross national income per capita, urban population density, and measles immunisation were found to be influential in various combinations within these cases, underscoring the complexity of life expectancy determinants.

Conclusions

Our findings indicate that while core determinants like environmental quality are crucial, countries can enhance life expectancy through unique, context-dependent pathways that integrate environmental, educational, economic, and public health factors. Specifically, countries may focus on different policy areas based on their socio-economic conditions and development priorities to optimise life expectancy outcomes.

Comparative spatial-temporal analysis of SARS-CoV-2 lineages B.1.1.33 and BQ.1.1 Omicron variant across pandemic phases

The evolution of COVID-19 pandemic has been characterized by the rapid emergence of new SARS-CoV-2 variants, each of which poses unique challenges to public health. This study analyzes the dispersion profiles during the Pre-Omicron and Post-Omicron phases in different epidemiological contexts. The Brazilian state of Espirito Santo, despite its low population density, plays a critical role as a commercial hub due to its intense port activity, which may have contributed to COVID-19 cases and mortality rates being higher than the national average. The state recorded 34,000 confirmed cases and 377 deaths per 100,000 inhabitants. Genomic surveillance revealed that the Pre-Omicron phase was dominated by the B.1.1.33 lineage, characterized by localized intraregional circulation. In contrast, the Post-Omicron phase, dominated by the BQ.1.1 lineage, exhibited greater diversity in circulating lineages, increased international interactions, and rapid viral dissemination, highlighting distinct transmission dynamics between such periods. This study highlights the need for adaptive public health strategies that account for both viral behavior and regional socioeconomic factors, while highlighting the strategic importance of Espirito Santo in monitoring SARS-CoV-2 evolution.

Treatment of oropharyngeal cancer during the COVID-19 lockdown - outcomes for patients treated during the pandemic

Background

The onset of the coronavirus disease 2019 (COVID-19) outbreak caused major interruptions to the entire healthcare network affecting referral, diagnosis and treatment pathways with the potential to affect cancer treatment outcomes. In Ireland a national lockdown was initiated in March 2020 involving a stay-at-home order with a limitation on travel, social interactions and closure of schools, universities and childcare facilities. We designed a retrospective study comparing treatment outcomes for patients with oropharyngeal cancer treated before and during the COVID pandemic.

Materials and methods

All patients receiving radical radiotherapy for oropharyngeal cancer pre-COVID (July 17 - July 18) and during COVID (Mar 20 - Mar 21) were included. Patient and disease characteristics, diagnostic timelines, treatment delays and disease outcomes were extracted from the patient record. Disease free survival and overall survival were calculated for both groups.

Results

159 oropharynx patients were included, 76 in the pre-COVID group (Group 1) and 83 in the pandemic group (Group 2). When comparing Group 1 and 2, respectively: There were no differences in human papilloma virus (HPV) status (74% vs. 71% p = 0.795) or Tumour-Node-Metastasis (TNM) overall stage [American Joint Committee on Cancer (AJCC) ed. 8]: (Stage 1: 25% vs. 45.8%, Stage 2: 28.9% vs. 18.1%, Stage 3: 21% vs. 15.7%, Stage 4: 25% vs. 20.5%, p = 0.268). Use of moderate hypofractionated regime increased during the pandemic (2.6% to 10.8%) and one patient omitted chemotherapy due to COVID-related reasons. There was no change in overall treatment times between groups with COVID-related sepsis accounting for one significant delay and one death during treatment. Overall survival at 2 years via Kaplan-Meier analysis; Group 1 cumulative proportion surviving at 2 years was 77% [95% confidence interval (CI): 67-86%] vs. 85% in Group 2 (95% CI: 77-93%, p = 0.35). The disease free survival at 2 years was 69% in Group 1 (95% CI: 59-80%) vs. 76% in Group 2 (95% CI: 67-85%, p = 0.567).

Conclusion

In spite of challenges related to the COVID-19 pandemic, we have demonstrated that oropharyngeal cancer patients treatment standards and outcomes were maintained. We did not demonstrate any significant difference in overall survival and disease free survival at 2 years when compared to a similar group prior to the pandemic.

Serological survey in a university community after the fourth wave of COVID-19 in Senegal

A cross-sectional survey was conducted at Polytechnic High School (PHS) to assess the spread of COVID-19 infection among students and staff. A random cluster sampling was conducted between May 19 and August 18, 2022, after the fourth wave of COVID-19 in Senegal. IgM and IgG SARS-CoV-2 antibodies were screened using WANTAI SARS-CoV-2 ELISA assays. Seroprevalence and descriptive statistics were calculated, and associations between seropositivity and different factors were determined using logistic regression. A total of 637 participants were recruited and the median age was 21 years [18-63]. 62.0% of the participants were female, and 36.89% were male, with a male-to-female ratio = 0.59. The overall IgG and IgM seroprevalence were 92% and 6.91% respectively. Among those who tested positive for IgM, 6.75% were also positive for IgG, and 0.15% were negative for IgG. Interestingly, 6.90% of participants tested negative for both IgM and IgG. We found a higher IgM seroprevalence in men than women (9.4% vs. 5.6%) and a lower IgM seroprevalence in (18-25) age group compared to (55-65) years. We revealed a significant difference according to IgG seroprevalence among participants who declared fatigue symptoms [92.06% (95% CI: 89.96-94.16)] compared to those who did not [80.39% (95% CI: 77.31-83.47)], p = 0.0027. IgM seropositivity was found to be associated with Body Mass Index (BMI) categories (O.R. 0.238, p = 0.043), ethnic group (O.R. 0.723, p = 0.046), and marital status (O.R. 2.399, p = 0.021). Additionally, IgG seropositivity was linked to vaccination status (O.R. 4.741, p < 0.001). Our study found that most students and staff at PHS were exposed to SARS-CoV-2, confirming the virus's circulation at the time of the survey. We also identified differences in individual susceptibility that need further clarification. Our results highlight the importance of seroepidemiological surveys to assess the true impact of the COVID-19 pandemic in a community and to monitor variations in antibody response.

Impact of remote social interaction during the COVID-19 pandemic on the cognitive and psychological status of older adults with and without cognitive impairment: A randomized controlled study

BACKGROUND

Social isolation and loneliness have both been associated with psychological health and cognitive decline in older adults. This study investigated the impact of social interaction through remote communication technologies during the COVID-19 pandemic on the cognitive and psychological status of older adults with and without cognitive impairment.

METHODS

Participants were recruited from Boston (USA) and Chieti (Italy). The study used a randomized single-blinded controlled crossover design with an intervention (remote social conversations with research staff over 20-minute video or telephone calls three times per week) and a passive control condition, each one of 4-weeks duration. The primary outcome was a composite cognitive score change from baseline to week 4. Secondary outcomes included scales for mood, anxiety, and loneliness.

RESULTS

Out of 196 participants recruited from April 2020 to April 2021, 17% dropped out. Based on the blind MoCA, 52% had cognitive impairment, and 25% were at risk of social isolation according to the Lubben social network scale. We observed that larger social networks were linked to better cognitive status and lower depression and anxiety levels, while loneliness was directly associated to depression severity. Older adults with cognitive impairment exhibited higher levels of depression and anxiety and were at greater risk for social isolation. In terms of the intervention, 91% preferred telephone over video calls. The intervention did not lead to improvements in cognitive or psychological scores.

CONCLUSIONS

More work is needed to assess the utility of this intervention for the support of a heterogenous cross-cultural sample of older adults at-risk for social isolation, including individuals with cognitive impairment. Future research should explore longer intervention periods, categorize participants by call type, and target those meeting social isolation criteria.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04480112.

Impact of pharmaceutical and non-pharmaceutical interventions on COVID-19 in Tunisia

BACKGROUND

In COVID-19 management, a variety of pharmaceutical interventions (PI) and non- pharmaceutical interventions (NPI) were adopted to limit the spread of the disease and its associated deaths. We aimed to evaluate the impact of PI and NPI on risks of COVID-19 transmission and deaths.

METHOD

We collected aggregate data from March 2nd, 2020, to December 1, 2022 from the Tunisian Ministry of Health's website and OurWorldInData.org site. NPI Periods (NPIP: March 2020 to March 2021) and PI Periods (PIP) were distributed to NPIP1, 2, 3 and 4 and to PIP1, 2, 3 and 4, respectively. We calculated the Relative Risks (RR) and 95% Confidence Intervals (CI) by comparing the subsequent period with previous one.

RESULTS

The risk of SARS-CoV-2 transmission increased progressively from the zero cases period (NPIP2) to the mitigate strategy period (NPIP3) (RR = 14.0; 95% CI: 12.4-15.8) and to the stop-and-go epidemic control period (NPIP4) (RR = 23.1 (95% CI: 22.4-23.9). It was stabilized in the targeted vaccination period (PIP1) (RR = 1.08, 95% CI: 1.07-1.08) and reduced during the mass vaccination period (PIP2) (RR: 0.50, 95% CI: 0.50-0.51). SARS-CoV-2 transmission, increased during PIP3 concomitant with the Omicron wave (RR = 2.65, 95% CI: 2.64-2.67). It remained at a low level in PIP4 (RR = 0.18; 95% CI: 0.18-0.18). Compared to NPIP2, NPIP3 and NPIP4 were associated with a higher risk of COVID-19 mortality (RR = 3.337; 95% CI: 1.797-6.195) and (RR = 72.63 (95% CI: 54.01-97.68), respectively. Since the start of the immunization program, the risk of COVID-19 death has consistently decreased. In comparison to each previous period, the risk transitioned in PIP1 to RR = 0.91; 95% CI: 0.88-0.93, then to RR = 0.85; 95% CI: 0.83-0.88 in PIP2, to RR = 0.47; 95% CI: 0.45-0.50 in PIP3, and to RR = 0.19; 95% CI: 0.18-0.24 during PIP4.

CONCLUSION

In terms of lowering the risk of transmission and mortality, the NP strategy at the beginning of the epidemic outperformed the IP strategy during the outbreak.

Information Seeking and Avoidance in the COVID-19 Pandemic as a Function of Political Ideology and National Context: A Survey Comparing the US and Germany

The COVID-19 pandemic sparked a globally heightened need for scientific information. At the same time, the abundance of information led to tendencies of media fatigue and information avoidance. Both information seeking and avoidance are embedded in a specific national context, in which conditions of and measures against the pandemic may differ dramatically. In addition, the pandemic quickly became entangled with political ideology. Using the Risk Information Seeking and Processing Model (RISP) as a theoretical background, we investigate the role of national context and political ideology for information seeking and avoidance in a comparative survey in the U.S. and Germany during the early phase of the pandemic. Results show that the factors predicting information behavior are effective in both countries with only few differences: In both countries, perceived hazard characteristics, information norms and perceived information gathering capacity were related to higher information seeking and lower information avoidance. Ideology too is an important influence: Right-leaning ideology was associated with lower levels of information norms in both countries; but only in the US was right-leaning ideology connected to less perceived hazard characteristics and less negative affective responses. Results are discussed regarding their implications for the RISP model.

Considering the Role of Behavioural Fatigue in the COVID-19 Lockdown Debates in Great Britain: A Retrospective Analysis of a National Survey Assessing the Relationships between Capability, Opportunity, Motivation, and Behaviour

During the COVID-19 pandemic, the term "behavioural fatigue" became the centre of policy debates in Great Britain. These debates involved deciding when to go into lockdown and whether behavioural interventions could be effective. Behavioural interventions can only succeed where people's Capabilities, Opportunities, and Motivations to perform target behaviours are supported. Our retrospective data analyses examine the relationships between people's Capabilities, Opportunities, Motivations, and Behaviours, i.e., adherence to lockdown guidelines. Our cross-sectional analyses include 17,962 unique participants in Great Britain who completed a survey over the initial 30 days of the first lockdown (April 2020). We examine trends in responses to each scale and then the relationships between the scales using Granger's causality test with tests for stationarity and cointegration. A mixture of increasing and decreasing trends was identified for Capabilities and Opportunities. Decreasing trends were identified for Motivation and Behaviour. Granger's causality tests found that Capability forecasts Opportunity and Behaviour and that Motivation forecasts Opportunity. The discussion reiterates that to realise and maintain Behaviour changes, policies surrounding people's Capabilities, Opportunities, and Motivations must continue to support target behaviours.

The impact of the early COVID-19 pandemic on maternal mental health during pregnancy and postpartum

PURPOSE

The aim of this study was to investigate the effects of the COVID-19 pandemic on maternal mental health during pregnancy and the postpartum period.

METHODS

The impact of the COVID-19 pandemic situation during and post pregnancy was addressed on three main factors; maternal mental health, mother-child bonding, and maternal self-confidence. To do this, two different patient cohorts were compared; data from one cohort was collected pre-pandemic, and data was collected from the other cohort at the beginning of the pandemic. Questionnaires were used to collect data regarding depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS]), anxiety (State Trait Anxiety Inventory [STAI]), maternal self-confidence (Lips Maternal Self-Confidence Scale [LMSCS]) and mother-child bonding (Postpartum Bonding Questionnaire [PBQ]).

RESULTS

There were no significant differences in depressive symptoms (EPDS with an average median of 4.00-5.00) or anxiety (STAI with an average median of 29.00-33.00) between the cohorts. However, the quality of postpartum maternal bonding was higher at 3-6 months in the pandemic cohort, which was also influenced by education and the mode and number of births. The maternal self-confidence was lower in the pandemic sample, also depending on the mode of birth delivery.

CONCLUSIONS

In this study, a differential effect of the COVID-19 pandemic on mother-child bonding and maternal self-confidence was observed. The results thereby identified possible protective factors of the pandemic, which could potentially be implemented to improve maternal mental health and bonding to the child under normal circumstances.

Predictive relationship between COVID-19 anxiety and psychological distress in adolescents during the COVID-19 pandemic

COVID-19 was a novel stressor that gave rise to pandemic related anxiety and increased the risk of mental health issues, particularly in youth. It is important to understand how such events contribute to psychological distress in young people to adequately intervene in the aftermath and to plan for future similar events. Using cross-sectional data from the CoSPACE Ireland study dataset this paper reports on the predictive relationship between COVID-19 anxiety and psychological distress for Irish adolescents (N = 314, M = 14.05, SD = 2.7, 11-18 years), while controlling for other influencing factors across multiple levels of a bioecological systems approach. Covariates were age, gender, ethnicity, social economic status, Peer Support, School Support and Parent-Child Closeness. Findings indicate that COVID-19 anxiety was a significant predictor of adolescents' psychological distress. Specifically, Consequence Anxiety (worries about the indirect consequences of COVID-19) was found to be a predictor of adolescents' psychological distress rather than Disease Anxiety (worries about the COVID-19 virus itself). Individual factors (e.g., age, ethnicity, special educational needs) and microsystem factors (e.g., parent child closeness, peer support) were also found to impact on adolescents' levels of psychological distress. A significant moderation analysis revealed that greater parent-child closeness reduced the strength of the positive association between Consequence Anxiety and psychological distress. These findings suggest that strategies to alleviate adolescents' psychological distress during pandemics should focus on reducing pandemic-related anxiety, specifically Consequence Anxiety. A multisystemic approach is also recommended to reduce the negative mental health impacts of the pandemic on adolescents.

Impact of COVID-19 on total excess mortality and geographic disparities in Europe, 2020-2023: a spatio-temporal analysis

Background

COVID-19 dramatically reshaped mortality across Europe. This study aimed to assess its impact on total mortality in European countries taking into consideration the relationship with selected country-level socioeconomic indicators, non-pharmaceutical interventions, and vaccine uptake.

Methods

We obtained weekly mortality data from 2010 to 2023 from the Short-term Mortality Fluctuations data series, the annual population data from the United Nations archives, selected sociodemographic and economic indicators from the World Bank's database, the stringency index and the percentage of the population fully vaccinated from Our World in Data. A quasi-Poisson regression model trained on pre-pandemic years was used to estimate expected number of deaths in 2020-2023 in 29 European countries. Excess mortality was estimated using three different metrics: excess deaths (number), relative excess mortality (% different from expected deaths) and age-standardized excess death rate per 10,000 population. The relationship between socioeconomic indicators and excess mortality was evaluated using linear regression models, which included both linear and quadratic terms for the predictors to account for possible non-linear relationships.

Findings

We estimated 1,642,586 excess deaths (95% confidence interval, CI: 1,607,161-1,678,010) across all countries over the four years (+8.0% compared to the expected number of deaths). Excess mortality was mainly concentrated in 2020-2022 (0.52 million excess deaths in 2020, 0.57 million in 2021 and 0.44 million in 2022), with no substantial excess (0.11 million) estimated for 2023. Over the period 2020-23, the highest number of excess deaths was estimated for Italy (227,736 deaths, +8.7%), Poland (223,735 deaths, +13.7%), and Germany (218,111 deaths, +5.6%), while the highest excesses in relative terms were in Bulgaria (72,328 deaths, +17.2%), Lithuania (23,813 deaths, +16.1%), and Slovakia (31,984 deaths, +14.9%). The age-standardised death rates ranged from 1.8 per 10,000 population in Sweden to 24.7 in Bulgaria. The percentage of the population living below the poverty line and the Gini index were significantly associated with an increased excess death rate, with p-values for the linear and quadratic terms being 0.003 and 0.003 for the Gini index, and 0.024 and 0.017 for the population living below the poverty line. Conversely, gross domestic product per capita (p-values for the linear and quadratic terms: <0.001, 0.003), health expenditure (0.001, 0.273) and the percentage of people fully vaccinated by the end of 2021 (<0.001, 0.989) or 2022 (0.001, 0.890) were inversely associated with excess death rate. No significant association was observed with population density and stringency index.

Interpretation

The observed geographic disparities in total mortality excess across Europe can be related to differences in socioeconomic contexts, as well as to suboptimal vaccine uptakes in some countries.

Funding

This research was supported by European Union (EU) funding within the NextGeneration EU-MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases (Project no. PE00000007, INF-ACT). The funding source had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Strategies and bottlenecks to tackle infodemic in public health: a scoping review

Background

The World Health Organization defines "infodemic" as the phenomenon of an uncontrolled spread of information in digital and physical environments during a disease outbreak, causing confusion and risk-taking behaviors that can harm health. The aim of this scoping review is to examine international evidence and identify strategies and bottlenecks to tackle health-related fake news.

Methods

We performed a scoping review of the literature from 1 January 2018 to 26 January 2023 on PubMed, Web of Science, and Scopus electronic databases. We also performed a search of grey literature on institutional websites. The research question has been defined according to the PCC (population, concept, and context) mnemonic for constructing research questions in scoping reviews.

Results

The overall research in the scientific databases yielded a total of 5,516 records. After removing duplicates, and screening the titles, abstracts, and full texts, we included 21 articles from scientific literature. Moreover, 5 documents were retrieved from institutional websites. Based on their content, we decided to group recommendations and bottlenecks into five different and well-defined areas of intervention, which we called strategies: "foster proper communication through the collaboration between science and social media companies and users," "institutional and regulatory interventions," "check and debunking," "increase health literacy," and "surveillance and monitoring through new digital tools."

Conclusion

The multidisciplinary creation of standardized toolkits that collect recommendations from the literature and institutions can provide a valid solution to limit the infodemic, increasing the health education of both citizens and health professionals, providing the knowledge to recognize fake news, as well as supporting the creation and validation of AI tools aimed at prebunking and debunking.

Qualitative comparative analysis of policies implemented by 26 European countries during the 2020 great lockdown

Introduction

During the first wave of the COVID-19 pandemic in Europe, from March 1 to April 15, 2020, significant variations emerged among countries regarding the implementation of lockdown policies. During this period, viewed strictly from an epidemiological perspective, lockdown measures are considered the most effective means of containing a pandemic. However, the adoption of such measures varied, raising questions about whether the reluctance or failure of countries to implement lockdown policies reflected a disregard for epidemiological knowledge or stemmed from an inability to enforce these measures.

Methods

This article employs Qualitative Comparative Analysis (QCA) with 26 European countries as case studies to investigate under what combination of conditions a country would implement lockdown policies.

Results

The QCA results identify three distinct combinations of conditions that lead countries to implement lockdown measures. First, countries with relatively concentrated political power are more likely to implement lockdown policies. Among the 10 countries governed by a majority party or majority coalition within a two-party or moderate multi-party system, seven implemented lockdown policies. Second, in cases of relatively dispersed political power, countries facing state fragility risks are more likely to implement lockdown policies. Among the eight countries that meet both conditions, five implemented lockdown policies. Finally, factors such as political heritage, severity of the pandemic, demographic composition, healthcare access, quality standards, and the ruling party's ideology play a lesser role in the decision to enact lockdown measures.

Discussion

This article offers a novel perspective on the dynamics of party politics and state capacity in the context of decision-making during the COVID-19 pandemic. It contributes to a deeper understanding of the intricate relationship between political systems and public health crisis management, highlighting how various political and governance factors influence the adoption of public health interventions during crises.

COVID-19 pandemic impact on adolescent mental health: a reassessment accounting for development

Current prospective reports suggest a pandemic-related increase in adolescent mental health problems. We examine whether age-related change over 11-14 years accounts for this increase. Mothers and adolescents in a UK-based birth cohort (Wirral Child Health and Development Study; WCHADS; N = 737) reported on adolescent depression and behavioural problems pre-pandemic (December 2019-March 2020), mid-pandemic (June 2020-March 2021) and late pandemic (July 2021-March 2022). Analysis used repeated measures models for over-dispersed Poisson counts with an adolescent-specific intercept with age as a time-varying covariate. Maturational curves for girls, but not for boys, showed a significant increase in self-reported depression symptoms over ages 11-14 years. Behavioural problems decreased for both. After adjusting for age-related change, girls' depression increased by only 13% at mid-pandemic and returned to near pre-pandemic level at late pandemic (mid versus late - 12%), whereas boys' depression increased by 31% and remained elevated (mid versus late 1%). Age-adjusted behavioural problems increased for both (girls 40%, boys 41%) and worsened from mid- to late pandemic (girls 33%, boys 18%). Initial reports of a pandemic-related increase in depression in young adolescent girls could be explained by a natural maturational rise. In contrast, maturational decreases in boys' depression and both boys' and girls' behavioural problems may mask an effect of the pandemic.

A data-driven analysis on the mediation effect of compartment models between control measures and COVID-19 epidemics

By collecting various control policies taken by 127 countries/territories during the first wave of COVID-19 pandemic until July 2nd, 2020, we evaluate their impacts on the epidemic dynamics quantitatively through a combination of the multiple linear regression, neural-network-based nonlinear regression and sensitivity analysis. Remarkable differences in the public health policies are observed across these countries, which affect the spreading rate and infected population size to a great extent. Several key dynamical features, like the normalized cumulative numbers of confirmed/cured/death cases on the 100th day and the half time, show statistically significant linear correlations with the control measures, which thereby confirms their dramatic impacts. Most importantly, we perform the mediation analysis on the SEIR-QD model, a representative of general compartment models, by using the structure equation modeling for multiple mediators operating in parallel. This, to the best of our knowledge, is the first of its kind in the field of epidemiology. The infection rate and the protection rate of the SEIR-QD model are confirmed to exhibit a statistically significant mediation effect between the control measures and dynamical features of epidemics. The mediation effect along the pathway from control measures in Category 2 to four dynamical features through the infection rate, highlights the crucial role of nucleic acid testing and suspected cases tracing in containing the spread of the epidemic. Our data-driven analysis offers a deeper insight into the inherent correlations between the effectiveness of public health policies and the dynamic features of COVID-19 epidemics.

Use of bio-information and communication technology shortens time to peak at a lower height of the epidemic curve: An alternative to flattening for countries with early COVID-19 outbreaks

INTRODUCTION

The traditional approach to epidemic control has been to slow down the rate of infection while building up healthcare capacity, resulting in a flattened epidemic curve. Advancements in bio-information-communication technology (BICT) have enabled the preemptive isolation of infected cases through efficient testing and contact tracing. This study aimed to conceptualize the BICT-enabled epidemic control (BICTEC) and to document its relationships with epidemic curve shaping and epidemic mitigation performance.

METHODS

Daily COVID-19 incidences were collected from outbreak to Aug. 12, 2020, for nine countries reporting the first outbreak on or before Feb. 1, 2020. Key epidemic curve determinants-peak height (PH), time to peak (TTP), and area under the curve (AUC)-were estimated for each country, and their relationships were analyzed to test if epidemic curves peak quickly at a shorter height. CFR (Case Fatality Rate) and CI (Cumulative Incidence) were compared across the countries to identify relationships between epidemic curve shapes and epidemic mitigation performance.

RESULTS

China and South Korea had the quickest TTPs (40.70 and 45.37 days since outbreak, respectively) and the shortest PHs (2.95 and 4.65 cases per day, respectively). Sweden, known for its laissez-faire approach, had the longest TTP (120.36) and the highest PH (279.74). Quicker TTPs were correlated with shorter PHs (ρ = 0·896, p = 0·0026) and lower AUCs (0.790, p = 0.0028), indicating that epidemic curves do not follow a flattened trajectory. During the study period, countries with quicker TTPs tended to have lower CIs (ρ = .855, P = .006) and CFRs (ρ = 0.684, P = .061). For example, South Korea, with the second-quickest TTP, reported the second lowest CI and the lowest CFR.

CONCLUSIONS

Countries that experienced early COVID-19 outbreaks demonstrated the epidemic curves that quickly peak at a shorter height, indicating a departure from the traditional flattened trajectory. South Korea's BICTEC was found to be at least as effective as most lockdowns in reducing CI and CFR.

Is a tiered restrictions system an effective intervention for COVID-19 control? Results from Portugal, November-December 2020

BACKGROUND

In November 2020, similar to other European countries, Portugal implemented a tiered restrictions system to control the COVID-19 pandemic. We aimed to compare the COVID-19 growth rate across tiers to assess the effect of a tiered restrictions system in Portugal, using models with different times between tiers assessment. Our hypothesis was that being in a higher tier brings a faster deceleration in the growth rate than being in a lower tier.

METHODS

The national database of notified COVID-19 cases and publicly available data were used to analyse the effect of the tiered restrictions system on the COVID-19 incidence growth rate. The tiers were based on the European Centre for Disease Control risk classification: moderate, high, very and extremely high. We used a generalised mixed-effects regression model to estimate the growth rate ratio (GRR) for each tier, comparing the growth rates of higher tiers using moderate tier as reference. Three models were fitted using different times between tiers assessment, separated by 14 days.

RESULTS

We included 156 034 cases. Very high tier was the most frequent combination in all the three moments assessed (21.2%), and almost 50% of the municipalities never changed tier during the study period. Immediately after the tiers implementation, a reduction was identified in the municipalities in high tier (GRR high tier: 0.90 [95%CI: 0.79; 1.02]) and very high tier (GRR very high tier: 0.68 [95%CI: 0.61; 0.77]), however with some imprecision in the 95% confidence interval for the high tier. A reduction in very high tier growth rate was identified two weeks (GRR: 0.79 [95%CI: 0.71; 0.88]) and four weeks (GRR: 0.77 [95%CI: 0.74; 0.82]) after the implementation, compared to moderate tier. In high tier, a reduction was also identified in both times, although smaller.

CONCLUSIONS

We observed a reduction in the growth rate in very high tier after the tiered restriction system was implemented, but we also observed a lag between tiered restriction system implementation and the onset of consequent effects. This could suggest the importance of early implementation of stricter measures for pandemic control. Thus, studies analysing a broader period of time are needed.

Factors related to increased alcohol misuse by students compared to non-students during the first Covid-19 lockdown in France: the Confins study

BACKGROUND

The closure of bars and lockdowns related to the Covid-19 pandemic changed alcohol use levels in France during the spring of 2020. We wondered whether this sudden cessation of social interactions impacted students more than non-students and what factors specific to students would explain the increase in alcohol misuse. The aims of this study were to compare self-reported changes in alcohol misuse (alcohol intake and binge-drinking frequency) during the first Covid-19 lockdown from March 17 to May 10, 2020, between French students and non-students and describe factors associated with this alcohol misuse in each subgroup.

METHODS

Data collected in the Confins study from April 8 to May 10, 2020, were used in cross-sectional analyses stratified by student status. Multiple logistic regression was performed to estimate the association between self-reported increase in alcohol intake or binge-drinking frequency (at least six drinks of alcohol on one occasion) and demographic, socioeconomic, and clinical factors, as well as conditions associated with the Covid-19 pandemic. The population-attributable fraction was then used to estimate the contribution of identified risk factors to increased alcohol misuse in students and non-students.

RESULTS

Among both students and non-students, a self-reported decrease or no change in alcohol intake or binge-drinking was more common than an increase. However, the risk factors explaining an increase in alcohol intake differed among students (≥ 25 years old, not working or studying in the health field, and having suicidal ideation during the last 7 days) and non-students (having a medical diagnosis of mental disorders). The risk factors explaining an increase in binge-drinking frequency were similar in the two subgroups (being a tobacco smoker before lockdown and not practicing any physical activity during the last 7 days), except suicidal thoughts, which was a risk factor for alcohol misuse specific to students.

CONCLUSIONS

These results highlight the vulnerability of certain French students to alcohol misuse and the necessity of combining both mental health and substance use-related screening in the student population.

Impact of the COVID-19 Pandemic on COPD Patient Mortality: A Nationwide Study in France

Objectives: We investigated the mortality patterns of chronic obstructive pulmonary disease (COPD) patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019. Methods: COPD patient and sex, age and residence matched control cohorts were created from the French National Health Data System. Survival was analyzed using Cox regressions and standardized rates. Results: All-cause mortality increased in 2020 compared to 2019 in the COPD population (+4%), but to a lesser extent than in the control population (+10%). Non-COVID-19 mortality decreased to a greater extent in COPD patients (-5%) than in the controls (-2%). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs. 279 per 100,000 person-years). Conclusion: The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing.

Assessment of Knowledge and Attitudes Over Time in Postacute COVID-19 Environments: Protocol for an Epidemiological Study

BACKGROUND

Globally, COVID-19 is in transition from the acute pandemic phase into a postacute phase, and special attention should be paid at this time to COVID-19 control strategies. Understanding public knowledge and attitudes plays a pivotal role in controlling COVID-19's spread and provides information about the public's adherence to preventive and control measures.

OBJECTIVE

This study protocol describes the planning and management of a survey to investigate the persistent or changing trends in knowledge and attitudes regarding COVID-19, vaccination, and nonpharmaceutical preventive measures among COVID-19 cases' household contacts aged 18 years and older, after the acute phase of the pandemic in Catalonia and Navarre in Spain. The secondary objectives include investigating the rate of secondary transmission in households, taking into account the demographic characteristics, clinical manifestations, and preventive measures toward COVID-19.

METHODS

A telephone questionnaire was designed to assess the changing trends in knowledge, preventive measures, and attitudes toward COVID-19 in 3 rounds (after identification as a household contact, 3 months later, and 6 months later). The questionnaire was developed following an extensive literature review and through discussions with a panel of experts who designed and assessed the validity of the questionnaire in terms of relevance, consistency, completeness, and clarity. The questionnaire consists of the following 7 sections: social and demographic characteristics (ie, gender, age, educational level, and workplace), comorbidities and risk factors (according to the recommendations from the COVID-19 vaccination strategy), epidemiological data (ie, exposure time, relationship with index cases, and frequency of use of nonpharmaceutical preventive measures), COVID-19 vaccination status (ie, the number and date of doses received), knowledge and attitudes toward COVID-19 (assessed using a 5-point Likert scale-totally agree, agree, neither agree nor disagree, disagree, and totally disagree), and sources of information (including traditional mass media, social media, and official sources).

RESULTS

A pilot study was performed in May 2022 to evaluate the questionnaire with 22 household contacts. Preliminary findings indicated that the questionnaire was feasible and acceptable in the general population. The average response time was 15 minutes, with greater variations in responses by older participants. After the pilot study, recruitment of participants began and is expected to be completed at the end of the year 2023, after which the final results will be available in 2024.

CONCLUSIONS

Despite the low transmission levels of SARS-CoV-2 and the relaxation of containment measures, the implementation of the survey during the postacute phase will provide valuable insight to assist public health decision-making and control the transmission of SARS-CoV-2 and other respiratory viruses, thereby attenuating the negative effects of COVID-19 at individual and population level.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52114.

COVID-19 vaccination and governance in the case of low, middle and high-income countries

BACKGROUND

Global crises, regardless of the place where they started to spread or of the factors that triggered them, require a comprehensive approach, primarily based on good communication, cooperation and mutual support. No individual and no institution should remain indifferent to crises but, on the contrary, be fully aware that any involvement in curbing them matters. Although humanity can be affected by various types of crises, in this paper we refer to the one related to COVID-19 pandemic. There are certain reasons that come to justify our choice: first of all, being a shock with a strong impact on people, its analysis should be performed from several angles; this may bring to light an image with its disparate propagation and measures to counteract it both in developed countries, and especially in those with a shortage of resources. Secondly, in the context of the emergence of vaccines against COVID-19, it is helpful to have an overview of COVID-19 through the lens of the relationship between the vaccination process and the elements that characterize governance, with a differentiated dashboard by country categories worldwide: low, middle and high-income countries. Our study is far from capturing the complexity arising from such social problem, but rather aims to outline the defining role of governance when it comes to providing firm reactions to the COVID-19 crisis.

METHODS

Given that our sample consists of a large number of countries, namely 170, first, examined all together, and then, split into three groups (high, middle and low-income), it is challenging to address governance in association with COVID-19 vaccination, in order to see how much they interact and how each of the six aggregate governance indicators of the World Bank (Worldwide Governance Indicators) is reflected in this process. Even if they do not oscillate strongly over relatively short periods of time, reporting on health issues requires a sequential inventory, considering closer time intervals, so as to be able to act promptly. Thus, to better distinguish how the COVID-19 vaccination process evolved in low, middle and high-income countries, but also how it was imprinted by governance, we present the situation quarterly (March, June, September and December), in 2021, the year when the immunization campaigns were the most intense at the global level. Regarding the applied methods, we mention both OLS regressions with robust estimators and a panel model, used to investigate the determinants of COVID-19 vaccination, some of them describing the good governance, as well as other dimensions.

RESULTS

The findings point out that the influence of governance on COVID-19 vaccination differs depending on whether a country belongs to high, middle or low-income typology: the strongest determinism of governance on vaccination is encountered in high-income countries, and the weakest in low-income ones; in some cases, governance does not matter significantly. However, exploring the three groups of states included in the research, it is observed that the most relevant factors in this relationship are government effectiveness, regulatory quality and control of corruption.

CONCLUSIONS

Besides the order of importance of governance indicators on COVID-19 vaccination, our study indicates that, overall, governance positively shapes the vaccination rate at the level of the chosen sample. In normative terms, these findings can be translated particularly by the fact that they can serve as information to raise awareness on the relevance of the existence of an institutional framework that allows the formulation of strategies according to the patterns of each country, especially since the actionable tools depend on the available resources. As a general conclusion, public policies should be designed in such a way as to strengthen trust in vaccination regulations and in governments, to reduce the multifaceted negative effects of this health crisis and to hope for its total end.

Perceived impacts of COVID-19 responses on routine health service delivery in Liberia and UK: cross-country lessons for resilient health systems for equitable service delivery during pandemics

BACKGROUND

COVID-19 has caused significant public health problems globally, with catastrophic impacts on health systems. This study explored the adaptations to health services in Liberia and Merseyside UK at the beginning of the COVID-19 pandemic (January-May 2020) and their perceived impact on routine service delivery. During this period, transmission routes and treatment pathways were as yet unknown, public fear and health care worker fear was high and death rates among vulnerable hospitalised patients were high. We aimed to identify cross-context lessons for building more resilient health systems during a pandemic response.

METHODS

The study employed a cross-sectional qualitative design with a collective case study approach involving simultaneous comparison of COVID-19 response experiences in Liberia and Merseyside. Between June and September 2020, we conducted semi-structured interviews with 66 health system actors purposively selected across different levels of the health system. Participants included national and county decision-makers in Liberia, frontline health workers and regional and hospital decision-makers in Merseyside UK. Data were analysed thematically in NVivo 12 software.

RESULTS

There were mixed impacts on routine services in both settings. Major adverse impacts included diminished availability and utilisation of critical health services for socially vulnerable populations, linked with reallocation of health service resources for COVID-19 care, and use of virtual medical consultation in Merseyside. Routine service delivery during the pandemic was hampered by a lack of clear communication, centralised planning, and limited local autonomy. Across both settings, cross-sectoral collaboration, community-based service delivery, virtual consultations, community engagement, culturally sensitive messaging, and local autonomy in response planning facilitated delivery of essential services.

CONCLUSION

Our findings can inform response planning to assure optimal delivery of essential routine health services during the early phases of public health emergencies. Pandemic responses should prioritise early preparedness, with investment in the health systems building blocks including staff training and PPE stocks, address both pre-existing and pandemic-related structural barriers to care, inclusive and participatory decision-making, strong community engagement, and effective and sensitive communication. Multisectoral collaboration and inclusive leadership are essential.

Economic evaluation of strategies against coronavirus: a systematic review

BACKGROUND

The COVID-19 outbreak was defined as a pandemic on 11 March 2020 by the World Health Organization. After that, COVID-19 has enormously influenced health systems around the world, and it has claimed more than 4.2 million deaths until July 2021. The pandemic has led to global health, social and economic costs. This situation has prompted a crucial search for beneficial interventions and treatments, but little is known about their monetary value. This study is aimed at systematically reviewing the articles conducted on the economic evaluation of preventive, control and treatment strategies against COVID-19.

MATERIAL AND METHOD

We searched PubMed, Web of Science, Scopus, and Google Scholar from December 2019 to October 2021 to find applicable literature to the economic evaluation of strategies against COVID-19. Two researchers screened potentially eligible titles and abstracts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to quality assessment of studies.

RESULTS

Thirty-six studies were included in this review, and the average CHEERS score was 72. Cost-effectiveness analysis was the most common type of economic evaluation, used in 21 studies. And the quality-adjusted life year (QALY) was the main outcome applied to measure the effectiveness of interventions, which was used in 19 studies. In addition, articles were reported a wide range of incremental cost-effectiveness ratio (ICER), and the lowest cost per QALY ($321.14) was related to the use of vaccines.

CONCLUSION

Based on the results of this systematic review, it seems that all strategies are likely to be more cost-effective against COVID-19 than no intervention and vaccination was the most cost-effective strategy. This research provides insight for decision makers in choosing optimal interventions against the next waves of the current pandemic and possible future pandemics.

Seasonal trends in COVID-19 cases, hospitalizations, and mortality in the United States and Europe

Determining whether SARS-CoV-2 exhibits seasonality like other respiratory viruses is critical for public health planning. We evaluated whether COVID-19 rates follow a seasonal pattern using time series models. We used time series decomposition to extract the annual seasonal component of COVID-19 case, hospitalization, and mortality rates from March 2020 through December 2022 for the United States and Europe. Models were adjusted for a country-specific stringency index to account for confounding by various interventions. Despite year-round disease activity, we identified seasonal spikes in COVID-19 from approximately November through April for all outcomes and in all countries. Our results support employing annual preventative measures against SARS-CoV-2, such as administering seasonal booster vaccines in a similar timeframe as those in place for influenza. Whether certain high-risk individuals may need more than one COVID-19 vaccine booster dose each year will depend on factors like vaccine durability against severe illness and levels of year-round disease activity.

Applications, benefits and challenges of telehealth in India during COVID-19 pandemic and beyond: a systematic review

BACKGROUND

India, the seventh-largest country in the world and the second-most populated faces enormous challenges when it comes to healthcare. The country's healthcare system was close to collapse due to the detrimental effects of the COVID-19 pandemic. Telehealth, which enables treating patients remotely, played a critical role during these challenging times. This systematic review investigates in detail the role of telehealth during COVID-19 and its application beyond the pandemic.

METHODS

Database searches on PubMed, Scopus, Science Direct and Web of Science were carried out for studies published on telehealth, and articles were included if they focused on any audio or video telehealth consultation during the pandemic in India. Findings were synthesised into three main themes: applications, benefits and challenges of telehealth services. Methodological quality was assessed using JBI critical appraisal tools.

RESULTS

The initial search on databases yielded 1143 articles. Of those, 19 met the eligibility criteria. Findings highlight the effective utilisation of telehealth across multiple medical specialities. Although insufficient technological infrastructure and other barriers due to the virtual consultation challenge the successful implementation of telehealth in India, it has the potential to bridge the rural-urban healthcare divide with cost-effective and easily accessible services.

CONCLUSION

High patient/provider satisfaction underscores the need to integrate telehealth into routine healthcare practices in the country. However, the review urges the government and healthcare practitioners to address the telehealth challenges with prime importance to ensure quality healthcare throughout the nation even after the pandemic.