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Ahmed F, Shafer L, Malla P, Hopkins R, Moreland S, Zviedrite N, Uzicanin A. Systematic review of empiric studies on lockdowns, workplace closures, and other non-pharmaceutical interventions in non-healthcare workplaces during the initial year of the COVID-19 pandemic: benefits and selected unintended consequences. BMC Public Health 2024; 24:884. [PMID: 38519891 PMCID: PMC10960383 DOI: 10.1186/s12889-024-18377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/17/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND We conducted a systematic review aimed to evaluate the effects of non-pharmaceutical interventions within non-healthcare workplaces and community-level workplace closures and lockdowns on COVID-19 morbidity and mortality, selected mental disorders, and employment outcomes in workers or the general population. METHODS The inclusion criteria included randomized controlled trials and non-randomized studies of interventions. The exclusion criteria included modeling studies. Electronic searches were conducted using MEDLINE, Embase, and other databases from January 1, 2020, through May 11, 2021. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Meta-analysis and sign tests were performed. RESULTS A total of 60 observational studies met the inclusion criteria. There were 40 studies on COVID-19 outcomes, 15 on anxiety and depression symptoms, and five on unemployment and labor force participation. There was a paucity of studies on physical distancing, physical barriers, and symptom and temperature screening within workplaces. The sign test indicated that lockdown reduced COVID-19 incidence or case growth rate (23 studies, p < 0.001), reproduction number (11 studies, p < 0.001), and COVID-19 mortality or death growth rate (seven studies, p < 0.05) in the general population. Lockdown did not have any effect on anxiety symptoms (pooled standardized mean difference = -0.02, 95% CI: -0.06, 0.02). Lockdown had a small effect on increasing depression symptoms (pooled standardized mean difference = 0.16, 95% CI: 0.10, 0.21), but publication bias could account for the observed effect. Lockdown increased unemployment (pooled mean difference = 4.48 percentage points, 95% CI: 1.79, 7.17) and decreased labor force participation (pooled mean difference = -2.46 percentage points, 95% CI: -3.16, -1.77). The risk of bias for most of the studies on COVID-19 or employment outcomes was moderate or serious. The risk of bias for the studies on anxiety or depression symptoms was serious or critical. CONCLUSIONS Empiric studies indicated that lockdown reduced the impact of COVID-19, but that it had notable unwanted effects. There is a pronounced paucity of studies on the effect of interventions within still-open workplaces. It is important for countries that implement lockdown in future pandemics to consider strategies to mitigate these unintended consequences. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration # CRD42020182660.
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Affiliation(s)
- Faruque Ahmed
- Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V18-2, Atlanta, GA, 30329-4027, USA.
| | - Livvy Shafer
- Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V18-2, Atlanta, GA, 30329-4027, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Pallavi Malla
- Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V18-2, Atlanta, GA, 30329-4027, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Roderick Hopkins
- Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V18-2, Atlanta, GA, 30329-4027, USA
- Cherokee Nation Operational Solutions, Tulsa, OK, USA
| | - Sarah Moreland
- Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V18-2, Atlanta, GA, 30329-4027, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Nicole Zviedrite
- Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V18-2, Atlanta, GA, 30329-4027, USA
| | - Amra Uzicanin
- Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V18-2, Atlanta, GA, 30329-4027, USA
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Fitzpatrick T, Camillo CA, Hillis S, Habbick M, Roerig M, Muhajarine N, Allin S. The Impact Of Provincial Proof- Of-Vaccination Policies On Age-Specific First-Dose Uptake Of COVID-19 Vaccines In Canada. Health Aff (Millwood) 2023; 42:1595-1605. [PMID: 37931201 DOI: 10.1377/hlthaff.2022.01237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Requirements of proof of COVID-19 vaccination were mandated for nonessential businesses and venues by Canada's ten provinces throughout the fall of 2021. Leveraging variations in the timing of these measures across the provinces, we applied event study regression to estimate the impact the announcement of these measures had nationally on age-specific first-dose uptake in the subsequent seven-week period. Proof-of-vaccination mandate announcements were associated with a rapid, significant increase in first-dose uptake, particularly in people younger than age fifty. However, these behavioral changes were short-lived, with uptake returning to preannouncement levels-or lower-in all age groups within six weeks, despite mandates remaining in place for at least four months; this decline occurred earlier and was more apparent among adolescents ages 12-17. We estimated that nationally, 290,168 additional people received their first dose in the seven weeks after provinces announced proof-of-vaccination policies, for a 17.5 percent increase over the number of vaccinations estimated in the absence of these policies. This study provides novel age-specific evidence showing that proof-of-vaccination mandates led to an immediate, significant increase in national first-dose uptake and were particularly effective for increasing vaccination uptake in younger to middle-aged adults. Proof-of-vaccination mandates may be effective short-term policy measures for increasing population vaccination uptake, but their impact may differ across age groups.
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Affiliation(s)
| | - Cheryl A Camillo
- Cheryl A. Camillo, University of Regina, Regina, Saskatchewan, Canada
| | - Shelby Hillis
- Shelby Hillis, Coronavirus Variants Rapid Response Network, Ottawa, Ontario, Canada
| | - Marin Habbick
- Marin Habbick, Coronavirus Variants Rapid Response Network
| | | | - Nazeem Muhajarine
- Nazeem Muhajarine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Agrawal V, Cantor J, Sood N, Whaley C. The impact of COVID-19 shelter-in-place policy responses on excess mortality. HEALTH ECONOMICS 2023; 32:2499-2515. [PMID: 37464737 DOI: 10.1002/hec.4737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/24/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023]
Abstract
As a way of slowing COVID-19 transmission, many countries and U.S. states implemented shelter-in-place (SIP) policies. However, the effects of SIP policies on public health are a priori ambiguous. Using an event study approach and data from 43 countries and all U.S. states, we measure changes in excess deaths following the implementation of COVID-19 shelter-in-place (SIP) policies. We do not find that countries or U.S. states that implemented SIP policies earlier had lower excess deaths. We do not observe differences in excess deaths before and after the implementation of SIP policies, even when accounting for pre-SIP COVID-19 death rates.
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Affiliation(s)
- Virat Agrawal
- University of Southern California, Los Angeles, California, USA
| | | | - Neeraj Sood
- University of Southern California, Los Angeles, California, USA
- National Bureau for Economic Research, Cambridge, Massachusetts, USA
| | - Christopher Whaley
- RAND Corporation, Santa Monica, California, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Murphy C, Lim WW, Mills C, Wong JY, Chen D, Xie Y, Li M, Gould S, Xin H, Cheung JK, Bhatt S, Cowling BJ, Donnelly CA. Effectiveness of social distancing measures and lockdowns for reducing transmission of COVID-19 in non-healthcare, community-based settings. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2023; 381:20230132. [PMID: 37611629 PMCID: PMC10446910 DOI: 10.1098/rsta.2023.0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023]
Abstract
Social distancing measures (SDMs) are community-level interventions that aim to reduce person-to-person contacts in the community. SDMs were a major part of the responses first to contain, then to mitigate, the spread of SARS-CoV-2 in the community. Common SDMs included limiting the size of gatherings, closing schools and/or workplaces, implementing work-from-home arrangements, or more stringent restrictions such as lockdowns. This systematic review summarized the evidence for the effectiveness of nine SDMs. Almost all of the studies included were observational in nature, which meant that there were intrinsic risks of bias that could have been avoided were conditions randomly assigned to study participants. There were no instances where only one form of SDM had been in place in a particular setting during the study period, making it challenging to estimate the separate effect of each intervention. The more stringent SDMs such as stay-at-home orders, restrictions on mass gatherings and closures were estimated to be most effective at reducing SARS-CoV-2 transmission. Most studies included in this review suggested that combinations of SDMs successfully slowed or even stopped SARS-CoV-2 transmission in the community. However, individual effects and optimal combinations of interventions, as well as the optimal timing for particular measures, require further investigation. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
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Affiliation(s)
- Caitriona Murphy
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Wey Wen Lim
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Cathal Mills
- Department of Statistics, University of Oxford, Oxford, UK
| | - Jessica Y. Wong
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Dongxuan Chen
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, New Territories, Hong Kong, People's Republic of China
| | - Yanmy Xie
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Mingwei Li
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, New Territories, Hong Kong, People's Republic of China
| | - Susan Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Hualei Xin
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Justin K. Cheung
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Samir Bhatt
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Benjamin J. Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, New Territories, Hong Kong, People's Republic of China
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, Oxford, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Keser M, Sariyer G, Kahraman S. Event Study Design for Modeling Early Relaxation in Turkish Public with COVID-19 Vaccine. Disaster Med Public Health Prep 2023; 17:e478. [PMID: 37665200 DOI: 10.1017/dmp.2023.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Vaccination is crucial to fighting the coronavirus disease (COVID-19) pandemic. A large body of literature investigates the effect of the initiation of the COVID-19 vaccination in case numbers in Turkey, including the resistance and willingness to taking the vaccine. The effect of early relaxation in the Turkish public with the initiation of vaccination on new daily cases is unknown. METHODS This study performs an event study analysis to explore the pre-relaxation effect of vaccination on the Turkish public by using daily data of new cases, stringency index, and residential mobility. Two events are comparatively defined as the vaccination of the health personnel (Event 1) and the citizens age 65 and over (Event 2). The initial dates of these events are January 13 and February 12, 2021, respectively. The length of the estimation window is determined as 14 days for the 2 events. To represent only the early stages of the vaccination, the study period ends on April 12, 2021. Thus, whereas the event window of Event 1 includes 90 observations, Event 2 covers 60 observations. RESULTS While average values of residential mobility, stringency index, and daily numbers of cases are 15.36, 71.03, and 11 978.93 in the estimation window for Event 1, these averages are 8.89, 70.88, and 17 303.20 in the event window. For Event 2, the same average values are 9.14, 69.38, and 7 664.93 in the estimation window and 8.25, 71.12, and 22 319.10 in the event window. When 14-day abnormal growth rates of the daily number of cases for Event 1 and Event 2 are compared, it is observed that Event 1 has negative growth rates initially and reaches a 7.59% growth at most. On the other hand, Event 2 starts with a 1.11% growth rate, and having a steady increase, it reaches a 23.70% growth in the last 14 days of the study period. CONCLUSION The preliminary result shows that, despite taking more strict governmental measures, while residential mobility decreases, the daily number of COVID-19 cases increases in the early stages of vaccination compared to short pre-periods of it. This indicates that the initiation of vaccination leads to early behavioral relaxation in public. Moreover, the effect of Event 2 on the case numbers is more significant and immediate, compared to that of Event 1, which may be linked to the characteristic of the Turkish culture being more sensitive to the older adult population.
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Affiliation(s)
- Merve Keser
- Department of Economics, Yasar University, İzmir, Turkey
| | - Gorkem Sariyer
- Department of Business Administration, Yasar University, İzmir, Turkey
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Bulterys PL, Leung NY, Saleem A, Budvytiene I, Pinsky BA, Banaei N. Postpandemic Effects of COVID-19 Shelter-in-Place Orders on the Gastrointestinal Pathogen Landscape. J Clin Microbiol 2023; 61:e0038523. [PMID: 37466426 PMCID: PMC10446857 DOI: 10.1128/jcm.00385-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Philip L. Bulterys
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Nicole Y. Leung
- Stanford University School of Medicine, Stanford, California, USA
| | - Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Indre Budvytiene
- Clinical Virology Laboratory, Stanford University Medical Center, Stanford, California, USA
| | - Benjamin A. Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- Clinical Virology Laboratory, Stanford University Medical Center, Stanford, California, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
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Arambepola R, Schaber KL, Schluth C, Huang AT, Labrique AB, Mehta SH, Solomon SS, Cummings DAT, Wesolowski A. Fine scale human mobility changes within 26 US cities in 2020 in response to the COVID-19 pandemic were associated with distance and income. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002151. [PMID: 37478056 PMCID: PMC10361529 DOI: 10.1371/journal.pgph.0002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/18/2023] [Indexed: 07/23/2023]
Abstract
Human mobility patterns changed greatly due to the COVID-19 pandemic. Despite many analyses investigating general mobility trends, there has been less work characterising changes in mobility on a fine spatial scale and developing frameworks to model these changes. We analyse zip code-level within-city mobility data from 26 US cities between February 2 -August 31, 2020. We use Bayesian models to characterise the initial decrease in mobility and mobility patterns between June-August at this fine spatial scale. There were similar temporal trends across cities but large variations in the magnitude of mobility reductions. Long-distance routes and higher-income subscribers, but not age, were associated with greater mobility reductions. At the city level, mobility rates around early April, when mobility was lowest, and over summer showed little association with non-pharmaceutical interventions or case rates. Changes in mobility patterns lasted until the end of the study period, despite overall numbers of trips recovering to near baseline levels in many cities.
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Affiliation(s)
- Rohan Arambepola
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kathryn L. Schaber
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Catherine Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Angkana T. Huang
- Department of Genetics, Cambridge University, Cambridge, United Kingdom
| | - Alain B. Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Sunil S. Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Derek A. T. Cummings
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Paat YF, Hope TL, Zamora H, Hernandez E. Predictors of General Deviance in the Context of COVID-19. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231172644. [PMID: 37394821 PMCID: PMC10315875 DOI: 10.1177/0306624x231172644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
This study examined predictors of individual general deviance (i.e., substance use, risk-taking, property crime, and interpersonal conflict/violence) within the context of COVID-19, focusing on the role of prior deviance, opportunities for crime, and levels of COVID-19- related stress. Our study showed that while some predictors relating to opportunity and strain were predictive of general deviance during the pandemic, few maintained statistical significance once controls for deviant behavior before the pandemic were included in the analyses, indicating the importance of within-individual behavioral stability over time. Further, respondents who participated in deviance prior to the pandemic were more likely to engage in other forms of criminal and high-risk activities during the pandemic. The close connections between criminal and high-risk behavior may imply that even if overall crime rates decreased during the pandemic, within-person behavioral patterns remained stable.
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Peters JA, Farhadloo M. The Effects of Non-Pharmaceutical Interventions on COVID-19 Cases, Hospitalizations, and Mortality: A Systematic Literature Review and Meta-Analysis. AJPM FOCUS 2023; 2:100125. [PMID: 37362389 PMCID: PMC10265928 DOI: 10.1016/j.focus.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction To assess the effects of various non-pharmaceutical interventions (NPI) on cases, hospitalizations, and mortality during the first wave of the COVID-19 pandemic. Methods To empirically investigate the impacts of different NPIs on COVID-19-related health outcomes, a systematic literature review was conducted. We studied the effects of 10 NPIs on cases, hospitalizations, and mortality across three periodic lags (2, 3, and 4 weeks-or-more following implementation). Articles measuring the impact of NPIs were sourced from three databases by May 10, 2022, and risk of bias was assessed using the Newcastle-Ottawa scale. Results Across the 44 papers, we found that mask wearing corresponded to decreased per capita cases across all lags (up to -2.71 per 100,000). All NPIs studied except business and bar/restaurant closures corresponded to reduced case growth rates in the two weeks following implementation, while policy stringency and travelling restrictions were most effective after four. While we did not find evidence of reduced deaths in our per capita estimates, policy stringency, masks, SIPOs, limited gatherings, school and business closures were associated with decreased mortality growth rates. Moreover, the two NPIs studied in hospitalizations (SIPOs and mask wearing) showed negative estimates. Conclusions When assessing the impact of NPIs, considering the duration of effectiveness following implementation has paramount significance. While some NPIs may reduce the COVID-19 impact, others can disrupt the mitigative progression of containing the virus. Policymakers should be aware of both the scale of their effectiveness and duration of impact when adopting these measures for future COVID-19 waves.
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Affiliation(s)
- James A. Peters
- Department of Supply Chain & Business Technology Management, John Molson School of Business, Concordia University, Montreal, Quebec, Canada
| | - Mohsen Farhadloo
- Department of Supply Chain & Business Technology Management, John Molson School of Business, Concordia University, Montreal, Quebec, Canada
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Zaremba K. Opening of hotels and ski facilities: Impact on mobility, spending, and Covid-19 outcomes. HEALTH ECONOMICS 2023; 32:1148-1180. [PMID: 36791023 DOI: 10.1002/hec.4660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
This paper investigates how reopening hotels and ski facilities in Poland impacted tourism spending, mobility, and COVID-19 outcomes. We used administrative data from a government program that subsidizes travel to show that the policy increased the consumption of tourism services in ski resorts. By leveraging geolocation data from Facebook, we showed that ski resorts experienced a significant influx of tourists, increasing the number of local users by up to 50%. Furthermore, we confirmed an increase in the probability of meetings between pairs of users from distanced locations and users from tourist and non-tourist areas. As the policy impacted travel and gatherings, we then analyzed its effect on the diffusion of COVID-19. We found that counties with ski facilities experienced more infections after the reopening. Moreover, counties strongly connected to the ski resorts during the reopening had more subsequent cases than weakly connected counties.
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White RC, Luo R, Rothenberg R. Nonpharmaceutical Interventions in Georgia: Public Health Implications. South Med J 2023; 116:383-389. [PMID: 37137470 PMCID: PMC10143397 DOI: 10.14423/smj.0000000000001552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES As coronavirus disease 2019 (COVID-19) spread, many states implemented nonpharmaceutical interventions in the absence of effective therapies with varying degrees of success. Our aim was to evaluate restrictions comparing two regions of Georgia and their impact on outcomes as measured by confirmed illness and deaths. METHODS Using The New York Times COVID-19 incidence data and mandate information from various web sites, we examined trends in cases and deaths using joinpoint analysis at the region and county level before and after the implementation of a mandate. RESULTS We found that rates of cases and deaths showed the greatest decrease in acceleration after the simultaneous implementation of a statewide shelter-in-place for vulnerable populations combined with social distancing for businesses and limiting gatherings to <10 people. County-level shelters-in-place, business closures, limits on gatherings to <10, and mask mandates showed significant case rate decreases after a county implemented them. School closures had no consistent effect on either outcome. CONCLUSIONS Our findings indicate that protecting vulnerable populations, implementing social distancing, and mandating masks may be effective countermeasures to containment while mitigating the economic and psychosocial effects of strict shelters-in-place and business closures. In addition, states should consider allowing local municipalities the flexibility to enact nonpharmaceutical interventions that are more or less restrictive than the state-level mandates under some conditions in which the data indicate it is necessary to protect communities from disease or undue economic burden.
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Affiliation(s)
- Renee C White
- From the Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta
| | - Ruiyan Luo
- From the Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta
| | - Richard Rothenberg
- From the Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta
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Amemiya Y, Nishiura H. Combined effect of early diagnosis and treatment on the case fatality risk of COVID-19 in Japan, 2020. Sci Rep 2023; 13:6679. [PMID: 37095151 PMCID: PMC10124700 DOI: 10.1038/s41598-023-33929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Abstract
Japanese government initially enforced restrictions on outpatient attendances among febrile individuals suspected of having COVID-19, asking everyone to remain at home for at least 4 days from the onset of fever. This restriction was cancelled on 8 May 2020, and a new antiviral, remdesivir, was approved from 7 May 2020. To investigate how this policy change influenced the prognosis of people with COVID-19, we estimated the case fatality risk as a function of the date of illness onset from April to June 2020. We used an interrupted time-series analysis model with an intervention date of 8 May 2020, and estimated time-dependent case fatality risk by age group. The case fatality risk showed a decreasing trend in all groups, and models were favored accounting for an abrupt causal effect, i.e., immediate decline in fatality risk. The trend was estimated at - 1.1% (95% CI [confidence interval]: - 3.9, 3.0) among people aged 60-69 years, - 7.2% (95% CI - 11.2, - 2.4) among those aged 70-79 years, - 7.4% (95% CI - 14.2, 0.2) among those aged 80-89 years, and - 10.3% (95% CI - 21.1, 2.7) among those aged 90 and over. Early diagnosis and treatment greatly contributed to reducing the case fatality risk.
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Affiliation(s)
- Yuri Amemiya
- School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hiroshi Nishiura
- School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Sun Y, Bisesti EM. Political Economy of the COVID-19 Pandemic: How State Policies Shape County-Level Disparities in COVID-19 Deaths. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2023; 9:23780231221149902. [PMID: 36777497 PMCID: PMC9902801 DOI: 10.1177/23780231221149902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors examine how two state-level coronavirus disease 2019 (COVID-19) policy indices (one capturing economic support and one capturing stringency measures such as stay-at-home orders) were associated with county-level COVID-19 mortality from April through December 2020 and whether the policies were more beneficial for certain counties. Using multilevel negative binominal regression models, the authors found that high scores on both policy indices were associated with lower county-level COVID-19 mortality. However, the policies appeared to be most beneficial for counties with fewer physicians and larger shares of older adults, low-educated residents, and Trump voters. They appeared to be less effective in counties with larger shares of non-Hispanic Black and Hispanic residents. These findings underscore the importance of examining how state and local factors jointly shape COVID-19 mortality and indicate that the unequal benefits of pandemic policies may have contributed to county-level disparities in COVID-19 mortality.
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Affiliation(s)
- Yue Sun
- Syracuse University, Syracuse, NY, USA,Yue Sun, Syracuse University, Maxwell School of Citizenship and Public Affairs, Sociology Department, 314 Lyman Hall, Syracuse, NY 13244, USA.
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Margerison CE, Bruckner TA, MacCallum-Bridges C, Catalano R, Casey JA, Gemmill A. Exposure to the early COVID-19 pandemic and early, moderate and overall preterm births in the United States: A conception cohort approach. Paediatr Perinat Epidemiol 2023; 37:104-112. [PMID: 35830303 PMCID: PMC9350314 DOI: 10.1111/ppe.12894] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The United States (US) data suggest fewer-than-expected preterm births in 2020, but no study has examined the impact of exposure to the early COVID-19 pandemic at different points in gestation on preterm birth. OBJECTIVE Our objective was to determine-among cohorts exposed to the early COVID-19 pandemic-whether observed counts of overall, early and moderately preterm birth fell outside the expected range. METHODS We used de-identified, cross-sectional, national birth certificate data from 2014 to 2020. We used month and year of birth and gestational age to estimate month of conception for birth. We calculated the count of overall (<37 weeks gestation), early (<33 weeks gestation) and moderately (33 to <37 weeks gestation) preterm birth by month of conception. We employed time series methods to estimate expected counts of preterm birth for exposed conception cohorts and identified cohorts for whom the observed counts of preterm birth fell outside the 95% detection interval of the expected value. RESULTS Among the 23,731,146 births in our study, the mean prevalence of preterm birth among monthly conception cohorts was 9.7 per 100 live births. Gestations conceived in July, August or December of 2019-that is exposed to the early COVID-19 pandemic in the first or third trimester-yielded approximately 3245 fewer moderately preterm and 3627 fewer overall preterm births than the expected values for moderate and overall preterm. Gestations conceived in August and October of 2019-that is exposed to the early COVID-19 pandemic in the late second to third trimester-produced approximately 498 fewer early preterm births than the expected count for early preterm. CONCLUSIONS Exposure to the early COVID-19 pandemic may have promoted longer gestation among close-to-term pregnancies, reduced risk of later preterm delivery among gestations exposed in the first trimester or induced selective loss of gestations.
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Affiliation(s)
| | - Tim A. Bruckner
- Department of Health, Society, and Behavior, and the Center for Population, Inequality, and Policy, University of California, Irvine
| | | | - Ralph Catalano
- School of Public Health, University of California, Berkeley
| | - Joan A. Casey
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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15
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Jones AN, Power MC. Pre-pandemic factors associated with delayed health care among US older adults during the COVID-19 pandemic. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231202860. [PMID: 37872971 PMCID: PMC10590541 DOI: 10.1177/27550834231202860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/06/2023] [Indexed: 10/25/2023]
Abstract
Background During the first year of the COVID-19 pandemic, more than one-third of US older adults (aged 65 years and older) reported delaying medical care. Delayed health care may exacerbate short- and long-term health changes in older adults. Older adults more likely to delay health care may benefit from targeted follow-up to return these individuals to the health care system. Objective The aim of this study was to describe pre-pandemic sociodemographic, psychological, cognitive, and medical factors associated with delayed health care among US older adults during the COVID-19 pandemic. Design We conducted a secondary analysis of 2905 participants from the National Health and Aging Trends Study (NHATS), a nationally representative, prospective cohort of US older adult Medicare beneficiaries. Methods Pre-pandemic factors were reported at the Round 9 interview (2019). Delayed health care, including medical (e.g. usual doctor) and supplementary (e.g. dental) care, was reported on the COVID-19 questionnaire (2020). We calculated adjusted odds ratios using weighted logistic regression, accounting for the NHATS sampling design. Results Overall, 40% of participants reported delayed care. After adjustment, female participants and those reporting fair (vs good) health were consistently more likely to delay health care while persons with lower income or excellent health were less likely to delay care. Other associations varied by care type. Conclusion Women and those with higher income or fair health before the COVID-19 pandemic were more likely to delay care during the pandemic. Our results may inform targeted outreach to older adults who delayed care during the COVID-19 pandemic, or other disruptions to the health care system, to return these individuals to care and promote better management of their health needs.
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Affiliation(s)
- Alyssa N Jones
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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16
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Arambepola R, Schaber KL, Schluth C, Huang AT, Labrique AB, Mehta SH, Solomon SS, Cummings DAT, Wesolowski A. Fine scale human mobility changes in 26 US cities in 2020 in response to the COVID-19 pandemic were associated with distance and income. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.11.04.22281943. [PMID: 36380765 PMCID: PMC9665343 DOI: 10.1101/2022.11.04.22281943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Human mobility patterns changed greatly due to the COVID-19 pandemic. Despite many analyses investigating general mobility trends, there has been less work characterising changes in mobility on a fine spatial scale and developing frameworks to model these changes. We analyse zip code-level mobility data from 26 US cities between February 2 â€" August 31, 2020. We use Bayesian models to characterise the initial decrease in mobility and mobility patterns between June - August at this fine spatial scale. There were similar temporal trends across cities but large variations in the magnitude of mobility reductions. Long-distance routes and higher-income subscribers, but not age, were associated with greater mobility reductions. At the city level, mobility rates around early April, when mobility was lowest, and over summer showed little association with non-pharmaceutical interventions or case rates. Changes in mobility patterns lasted until the end of the study period, despite overall numbers of trips recovering to near baseline levels in many cities.
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Deo P, Sliwa J. The Impact of the Early COVID-19 Pandemic on Inpatient Clinical Experience for Physical Medicine and Rehabilitation Resident Physicians. Am J Phys Med Rehabil 2022; 101:1038-1041. [PMID: 35687755 DOI: 10.1097/phm.0000000000002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The objective of this retrospective, observational study was to quantitatively study the impact of the early COVID-19 pandemic on the inpatient clinical experience of Physical Medicine and Rehabilitation resident physicians in an inpatient rehabilitation facility setting. Inpatient clinical experience as evidenced by admissions, rehabilitation diagnosis, medical emergencies, acute care transfers, and resident work hours from January to June 2019 (prepandemic) were compared January to June 2020 (immediately before and during pandemic). There was a statistically significant decrease in the mean daily admissions in April 2020 and a significant increase in medically complex admissions in June 2020, reflective of medical patterns due to the pandemic. There was a decrease in mean work hours during the pandemic, but no statistically significant difference in admission rate of other rehabilitation diagnoses, medical emergencies, or transfers to acute care. This study demonstrates no substantial pandemic-related impact on inpatient clinical experience for physical medicine and rehabilitation residents in the studied program.
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Affiliation(s)
- Prabhav Deo
- From the Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Shirley Ryan Ability Lab, Chicago, Illinois
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18
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Maeng D, Li Y, Lawrence M, Keane S, Cross W, Conner KR, Lee HB. Impact of mandatory COVID-19 shelter-in-place order on controlled substance use among rural versus urban communities in the United States. J Rural Health 2022; 39:21-29. [PMID: 35710976 PMCID: PMC9349882 DOI: 10.1111/jrh.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Mandatory COVID-19 shelter-in-place (SIP) orders have been imposed to fight the pandemic. They may also have led to unintended consequences of increased use of controlled substances especially among rural communities due to increased social isolation. Using the data from the American Association of Poison Control Centers, this study tests the hypothesis that the poison control centers received higher rates of calls related to exposures to controlled substances from rural counties than they did from urban counties during the SIP period. METHODS Call counts received by the poison control centers between October 19, 2019 and July 6, 2020 due to exposure to controlled substance (methamphetamine, opioids, cocaine, benzodiazepines, and other narcotics) were aggregated to per-county-per-month-per-10,000 population exposure rates. A falsification test was conducted to reduce the possibility of spurious correlations. FINDINGS During the study period, 2,649 counties in the United States had mandatory SIP orders. The rate of calls reporting exposure to any of the aforementioned controlled substances among the rural counties was higher (14%; P = .047) relative to the urban counties. This overall increase was due to increases in the rates of calls reporting exposure to opioids (26%; P = .017) and methamphetamine (39%; P = .077). Moreover, the rate of calls reporting exposures at home was also higher among the rural counties (14%; P = .069). CONCLUSION The mandatory SIP orders may have had an unintended consequence of exacerbating the use of controlled substances at home in rural communities relative to urban communities.
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Affiliation(s)
- Daniel Maeng
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Yue Li
- Division of Health Policy and Outcomes ResearchDepartment of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Michele Lawrence
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinead Keane
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wendi Cross
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Kenneth R. Conner
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hochang B. Lee
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Dalton MK, Miller AL, Bergmark RW, Semco R, Zogg CK, Goralnick E, Jarman MP. The Utility of a Novel Definition of Health Care Regions in the United States in the Era of COVID-19: A Validation of the Pittsburgh Atlas Using Pneumonia Admissions. Ann Emerg Med 2022; 79:518-526. [PMID: 34952728 PMCID: PMC8612818 DOI: 10.1016/j.annemergmed.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE The COVID-19 pandemic in the United States has underscored the need to understand health care in a regional context. However, there are multiple definitions of health care regions available for conducting geospatial analyses. In this study, we compare the novel Pittsburgh Atlas, which defined regions for emergency care, with the existing definitions of regions, counties, and the Dartmouth Atlas, with respect to nonemergent acute medical conditions using pneumonia admissions. METHODS We identified patients hospitalized with a primary diagnosis of pneumonia or a primary admitting diagnosis of sepsis with a secondary diagnosis of pneumonia in the Agency for Healthcare Research and Quality's State Inpatient Databases. We calculated the percentage of region concordant care, the localization index, and market share for 3 definitions of health care regions (the Pittsburgh Atlas, Dartmouth Atlas, and counties). We used logistic regression identified predictors of region concordant care. RESULTS We identified 1,582,287 patients who met the inclusion criteria. We found that the Pittsburgh Atlas and Dartmouth Atlas definitions of regions performed similarly with respect to both localization index (92.0 [interquartile range 87.9 to 95.7] versus 90.3 [interquartile range 81.4 to 94.5]) and market share (8.5 [interquartile range 5.1 to 13.6] versus 9.4 [interquartile range 6.7 to 14.1]). Both atlases outperformed the localization index (67.5 [interquartile range 49.9 to 83.9]) and market share (20.0% [interquartile range 11.4 to 31.4]) of the counties. Within a given referral region, the demographic factors, including age, sex, race/ethnicity, insurance status, and the level of severity, affected concordance rates between residential and hospital regions. CONCLUSION Because the Pittsburgh Atlas also has the benefit of respecting state and county boundaries, the use of this definition may have improved policy applicability without sacrificing accuracy in defining health care regions for acute medical conditions.
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Affiliation(s)
- Michael K. Dalton
- Center for Surgery and Public Health, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA,Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Ashley L. Miller
- Division of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Regan W. Bergmark
- Center for Surgery and Public Health, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Semco
- Center for Surgery and Public Health, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA
| | - Cheryl K. Zogg
- Center for Surgery and Public Health, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA,Yale School of Medicine, New Haven, CT
| | - Eric Goralnick
- Center for Surgery and Public Health, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA,Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Molly P. Jarman
- Center for Surgery and Public Health, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA,Corresponding Author
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20
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Dong C, Yu Z, Liu W, Zhang Y, Zhang Z, Zhang L, Cui Z, Fan X, Zhu Y, Peng H, Gao B, Ma X. Impact of COVID-19 social distancing on medical research from the perspective of postgraduate students: a cross-sectional online survey. PeerJ 2022; 10:e13384. [PMID: 35582619 PMCID: PMC9107783 DOI: 10.7717/peerj.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/14/2022] [Indexed: 01/13/2023] Open
Abstract
Objective To investigate the impact of COVID-19 social distancing on medical research from the perspective of postgraduate students. Methods A cross-sectional study using an online survey was conducted from October 31 to November 1, 2021. A questionnaire was used to assess the impact of COVID-19 social distancing on medical research among postgraduate students. The questionnaire included basic information, medical research information, and information about social distancing measures. Participants also completed the self-made Research Work Affected Scale of Postgraduates (RWAS-P; qualitative evaluation: very mildly 0-10; mildly 11-20; moderately 21-30; severely 31-40; very severely 41-50). Logistic regression was used to identify factors related to the impact of COVID-19 social distancing. Results A total of 468 participants were analyzed; 95.2% of the participants adhered to social distancing measures. The median total RWAS-P score was 22. The median RWAS-P scores for earlier research data, current research projects, future research plans, paper publication, and graduation schedule were 2, 6, 6, 6, and 4, respectively (score range 0-10). The higher grade of students, experimental research, and existence of inappetence or sleeplessness were related to negative attitude towards COVID-19 social distancing (odd ratio = 6.35, 9.80, 2.31, 2.15, 1.95, respectively). Conclusions Participants reported that social distancing had a moderate overall impact on their medical research. Social distancing had the greatest impact on current research projects, future research plans, and paper publications among postgraduate students. Higher grade level, experimental research type, inappetence, and sleeplessness were related to the impact of social distancing on their medical research.
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Affiliation(s)
- Chen Dong
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhou Yu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Wei Liu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yu Zhang
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhe Zhang
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Lei Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhiwei Cui
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xiao Fan
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yuhan Zhu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Han Peng
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Botao Gao
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xianjie Ma
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
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21
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Jiang DH, Roy DJ, Pollock BD, Shah ND, McCoy RG. Association of stay-at-home orders and COVID-19 incidence and mortality in rural and urban United States: a population-based study. BMJ Open 2022; 12:e055791. [PMID: 35393311 PMCID: PMC8990263 DOI: 10.1136/bmjopen-2021-055791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We examined the association between stay-at-home order implementation and the incidence of COVID-19 infections and deaths in rural versus urban counties of the United States. DESIGN We used an interrupted time-series analysis using a mixed effects zero-inflated Poisson model with random intercept by county and standardised by population to examine the associations between stay-at-home orders and county-level counts of daily new COVID-19 cases and deaths in rural versus urban counties between 22 January 2020 and 10 June 2020. We secondarily examined the association between stay-at-home orders and mobility in rural versus urban counties using Google Community Mobility Reports. INTERVENTIONS Issuance of stay-at-home orders. PRIMARY AND SECONDARY OUTCOME MEASURES Co-primary outcomes were COVID-19 daily incidence of cases (14-day lagged) and mortality (26-day lagged). Secondary outcome was mobility. RESULTS Stay-at-home orders were implemented later (median 30 March 2020 vs 28 March 2020) and were shorter in duration (median 35 vs 54 days) in rural compared with urban counties. Indoor mobility was, on average, 2.6%-6.9% higher in rural than urban counties both during and after stay-at-home orders. Compared with the baseline (pre-stay-at-home) period, the number of new COVID-19 cases increased under stay-at-home by incidence risk ratio (IRR) 1.60 (95% CI, 1.57 to 1.64) in rural and 1.36 (95% CI, 1.30 to 1.42) in urban counties, while the number of new COVID-19 deaths increased by IRR 14.21 (95% CI, 11.02 to 18.34) in rural and IRR 2.93 in urban counties (95% CI, 1.82 to 4.73). For each day under stay-at-home orders, the number of new cases changed by a factor of 0.982 (95% CI, 0.981 to 0.982) in rural and 0.952 (95% CI, 0.951 to 0.953) in urban counties compared with prior to stay-at-home, while number of new deaths changed by a factor of 0.977 (95% CI, 0.976 to 0.977) in rural counties and 0.935 (95% CI, 0.933 to 0.936) in urban counties. Each day after stay-at-home orders expired, the number of new cases changed by a factor of 0.995 (95% CI, 0.994 to 0.995) in rural and 0.997 (95% CI, 0.995 to 0.999) in urban counties compared with prior to stay-at-home, while number of new deaths changed by a factor of 0.969 (95% CI, 0.968 to 0.970) in rural counties and 0.928 (95% CI, 0.926 to 0.929) in urban counties. CONCLUSION Stay-at-home orders decreased mobility, slowed the spread of COVID-19 and mitigated COVID-19 mortality, but did so less effectively in rural than in urban counties. This necessitates a critical re-evaluation of how stay-at-home orders are designed, communicated and implemented in rural areas.
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Affiliation(s)
- David H Jiang
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Darius J Roy
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin D Pollock
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, Minnesota, USA
| | - Nilay D Shah
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rozalina G McCoy
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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22
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Schroeder ME, Manderski MT, Amro C, Swaminathan S, Parekh A, Yoshitake S, Yang J, Romeo P, Reyes D, Choron R, Rodricks M. Large Gathering Attendance is Associated with Increased Odds of Contracting COVID-19: A Survey Based Study. JOURNAL OF PREVENTION (2022) 2022; 43:157-166. [PMID: 35445374 PMCID: PMC8735732 DOI: 10.1007/s10935-021-00665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
We used a telephone survey to determine risk factors associated with a positive polymerase chain reaction test of a nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) at a community hospital in Central New Jersey during the early stages of the pandemic. We compared survey responses of 176 patients in March 2020. Respondents were asked about their living situation, work environment, use of public transportation and attendance at one or more large gatherings (more than 10 people) in the 3 weeks prior to undergoing COVID testing. We found that those who attended a large gathering in the 3 weeks prior to their COVID test had a 2.50 odds ratio (95% CI 1.19, 5.22) of testing positive after controlling for age, sex, race/ethnicity, occupation, living situation and recent visit to a nursing home. The total number of gatherings attended or the number of people in attendance was not associated with a positive test. An association was also seen for specific job types such as factory workers, construction workers, and facilities managers. Attendance at a gathering of more than ten people was associated with testing positive for COVID-19.
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Affiliation(s)
- Mary E Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 West Watertown Plank Road, 53226, Milwaukee, WI, United States.
| | - Michelle Tb Manderski
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, NJ, United States
| | - Chris Amro
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Sneha Swaminathan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Akshat Parekh
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Sho Yoshitake
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Jason Yang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Paul Romeo
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Daniel Reyes
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Rachel Choron
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Michael Rodricks
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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23
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Huntley KS, Wahood W, Mintz J, Raine S, Hardigan P, Haffizulla F. Associations of Stay-at-Home Order Enforcement With COVID-19 Population Outcomes: An Interstate Statistical Analysis. Am J Epidemiol 2022; 191:561-569. [PMID: 34729584 PMCID: PMC8780467 DOI: 10.1093/aje/kwab267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/29/2021] [Accepted: 10/29/2021] [Indexed: 12/16/2022] Open
Abstract
In the United States, state governors initially enacted coronavirus diseases 2019 (COVID-19)-mitigation policies with limited epidemiologic data. One prevailing legislative approach, from March to May 2020, was the implementation of "stay-at-home" (SAH) executive orders. Although social distancing was encouraged, SAH orders varied between states, and the associations between potential legal prosecution and COVID-19 outcomes are currently unknown. Here, we provide empirical evidence on how executive enforcement of movement restrictions may influence population health during an infectious disease outbreak. A generalized linear model with negative binomial regression family compared COVID-19 outcomes in states with law-enforceable stay-at-home (eSAH) orders versus those with unenforceable or no SAH orders (uSAH), controlling for demographic factors, socioeconomic influences, health comorbidities, and social distancing. COVID-19 incidence was less by 1.22 cases per day per capita in eSAH states compared with uSAH states (coefficient = -1.22, 95% confidence interval (CI): -1.83, -0.61; P < 0.001), and each subsequent day without an eSAH order was associated with a 0.03 incidence increase (coefficient = 0.03, 95% CI: 0.03, 0.04; P < 0.001). Daily mortality was 1.96 less for eSAH states per capita (coefficient = -1.96, 95% CI: -3.25, -0.68; P = 0.004). Our findings suggest allowing the enforcement of public health violations, compared with community education alone, is predictive of improved COVID-19 outcomes.
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Affiliation(s)
- Kyle S Huntley
- Correspondence to Kyle S. Huntley, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, 3200 S. University Drive Fort Lauderdale, FL, 33328 (e-mail: )
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24
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Riehm KE, Badillo Goicoechea E, Wang FM, Kim E, Aldridge LR, Lupton-Smith CP, Presskreischer R, Chang TH, LaRocca S, Kreuter F, Stuart EA. Association of Non-Pharmaceutical Interventions to Reduce the Spread of SARS-CoV-2 With Anxiety and Depressive Symptoms: A Multi-National Study of 43 Countries. Int J Public Health 2022; 67:1604430. [PMID: 35308051 PMCID: PMC8927027 DOI: 10.3389/ijph.2022.1604430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/31/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives: To examine the association of non-pharmaceutical interventions (NPIs) with anxiety and depressive symptoms among adults and determine if these associations varied by gender and age. Methods: We combined survey data from 16,177,184 adults from 43 countries who participated in the daily COVID-19 Trends and Impact Survey via Facebook with time-varying NPI data from the Oxford COVID-19 Government Response Tracker between 24 April 2020 and 20 December 2020. Using logistic regression models, we examined the association of [1] overall NPI stringency and [2] seven individual NPIs (school closures, workplace closures, cancellation of public events, restrictions on the size of gatherings, stay-at-home requirements, restrictions on internal movement, and international travel controls) with anxiety and depressive symptoms. Results: More stringent implementation of NPIs was associated with a higher odds of anxiety and depressive symptoms, albeit with very small effect sizes. Individual NPIs had heterogeneous associations with anxiety and depressive symptoms by gender and age. Conclusion: Governments worldwide should be prepared to address the possible mental health consequences of stringent NPI implementation with both universal and targeted interventions for vulnerable groups.
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Affiliation(s)
- Kira E. Riehm
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States,*Correspondence: Kira E. Riehm,
| | | | - Frances M. Wang
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Luke R. Aldridge
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Ting-Hsuan Chang
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Frauke Kreuter
- Joint Program in Survey Methodology, University of Maryland, College Park, MD, United States,School of Social Sciences, University of Mannheim, Mannheim, Germany,Statistical Methods Group, Institute for Employment Research, Nuremberg, Germany
| | - Elizabeth A. Stuart
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
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25
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Li Y, Cheng Z, Cai X, Holloway M, Maeng D, Simning A. Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5694. [PMID: 35170782 PMCID: PMC8884256 DOI: 10.1002/gps.5694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance. RESULTS The rate of care delay or avoidance since March of 2020 was 29.1% among all respondents (n = 1997), and 10.1% higher for lonely (n = 1,150%, 57.6%) versus non-lonely respondents (33.5% vs. 23.4%; odds ratio = 1.59, p = 0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems. Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn't afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor's visit as the two most common care delayed or avoided. CONCLUSIONS Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.
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Affiliation(s)
- Yue Li
- Department of Public Health SciencesDivision of Health Policy and Outcomes ResearchUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Zijing Cheng
- Department of Public Health SciencesDivision of Health Policy and Outcomes ResearchUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Xueya Cai
- Department of Biostatistics and Computational BiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Melissa Holloway
- University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Daniel Maeng
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Adam Simning
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
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26
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Zhang X, Warner ME, Grant M. Water Shutoff Moratoria Lowered COVID-19 Infection and Death Across U.S. States. Am J Prev Med 2022; 62:149-156. [PMID: 34663550 PMCID: PMC8433038 DOI: 10.1016/j.amepre.2021.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022]
Abstract
INTRODUCTION A total of 34 U.S. state governments imposed moratoria on water shutoffs between March and May 2020 to ensure equitable access to water during the COVID-19 pandemic. However, by the end of 2020, most of these moratoria had expired, and millions of people were exposed to the risk of water disconnections. This study examines the linkage between water equity and public health and provides policy recommendations for improving water access and health equity. METHODS Event study was used to analyze the impact of a water shutoff moratorium on COVID-19 daily infection growth rate and daily death growth rate from April 17, 2020 to December 31, 2020. The data were collected at the state level. The model controlled for mask mandates, at-risk groups (percentage Hispanic population, percentage essential workers), and percentage health insurance coverage. RESULTS During the study period, having a water shutoff moratorium in place significantly lowered the COVID-19 infection daily growth rate by 0.235% and significantly lowered the death growth rate by 0.135%. In addition, a comprehensive moratorium covering all water systems (public and private) significantly lowered the infection growth rate by 0.169% and significantly lowered the death growth rate by 0.228%. CONCLUSIONS This study raises attention to the importance of water equity and the need for government actions to create more uniform protections from water shutoffs across all states. A comprehensive approach to water equity can protect the health and safety of all communities.
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Affiliation(s)
- Xue Zhang
- Department of City and Regional Planning, Cornell AAP Architecture Art Planning, Cornell University, Ithaca, New York; Department of Global Development, Cornell CALS College of Agriculture and Life Sciences, Cornell University, Ithaca, New York.
| | - Mildred E Warner
- Department of City and Regional Planning, Cornell AAP Architecture Art Planning, Cornell University, Ithaca, New York; Department of Global Development, Cornell CALS College of Agriculture and Life Sciences, Cornell University, Ithaca, New York
| | - Mary Grant
- Food & Water Watch and Food & Water Action, Baltimore, Maryland
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Abstract
The COVID-19 poses a disproportionate threat to nursing home residents. Although recent studies suggested the effectiveness of state social distancing measures in the United States on curbing COVID-19 morbidity and mortality among the general population, there is a lack of evidence as to how these state orders may have affected nursing home patients or what potential negative health consequences they may have had. In this longitudinal study, we evaluated changes in state strength of social distancing restrictions from June to August of 2020, and their associations with the weekly numbers of new COVID-19 cases, new COVID-19 deaths, and new non-COVID-19 deaths in nursing homes of the US. We found that stronger state social distancing measures were associated with improved COVID-19 outcomes (case and death rates), reduced across-facility disparities in COVID-19 outcomes, and somewhat increased non-COVID-19 death rate, although the estimates for non-COVID-19 deaths were sensitive to alternative model specifications.
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Haber NA, Clarke-Deelder E, Feller A, Smith ER, Salomon JA, MacCormack-Gelles B, Stone EM, Bolster-Foucault C, Daw JR, Hatfield LA, Fry CE, Boyer CB, Ben-Michael E, Joyce CM, Linas BS, Schmid I, Au EH, Wieten SE, Jarrett B, Axfors C, Nguyen VT, Griffin BA, Bilinski A, Stuart EA. Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength. BMJ Open 2022; 12:e053820. [PMID: 35017250 PMCID: PMC8753111 DOI: 10.1136/bmjopen-2021-053820] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. METHODS We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on 26 November 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation. RESULTS After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-sectional), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes. DISCUSSION The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigour to be actionable by policy-makers. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
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Affiliation(s)
- Noah A Haber
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Emma Clarke-Deelder
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Avi Feller
- Department of Statistics, Goldman School of Public Policy, University of California Berkeley, Berkeley, California, USA
| | - Emily R Smith
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Benjamin MacCormack-Gelles
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Clara Bolster-Foucault
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Jamie R Daw
- Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Laura Anne Hatfield
- Department of Biostatistics, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie E Fry
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA
| | - Christopher B Boyer
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Eli Ben-Michael
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Caroline M Joyce
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Beth S Linas
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Applied Public Health and Research, RTI International, Washington, DC, USA
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric H Au
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah E Wieten
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Brooke Jarrett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cathrine Axfors
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Van Thu Nguyen
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | | | - Alyssa Bilinski
- Interfaculty Initiative in Health Policy, Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Johnson CA, Tran DN, Mwangi A, Sosa-Rubí SG, Chivardi C, Romero-Martínez M, Pastakia S, Robinson E, Jennings Mayo-Wilson L, Galárraga O. Incorporating respondent-driven sampling into web-based discrete choice experiments: preferences for COVID-19 mitigation measures. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022; 22:297-316. [PMID: 35035272 PMCID: PMC8747856 DOI: 10.1007/s10742-021-00266-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/22/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
To slow the spread of COVID-19, most countries implemented stay-at-home orders, social distancing, and other nonpharmaceutical mitigation strategies. To understand individual preferences for mitigation strategies, we piloted a web-based Respondent Driven Sampling (RDS) approach to recruit participants from four universities in three countries to complete a computer-based Discrete Choice Experiment (DCE). Use of these methods, in combination, can serve to increase the external validity of a study by enabling recruitment of populations underrepresented in sampling frames, thus allowing preference results to be more generalizable to targeted subpopulations. A total of 99 students or staff members were invited to complete the survey, of which 72% started the survey (n = 71). Sixty-three participants (89% of starters) completed all tasks in the DCE. A rank-ordered mixed logit model was used to estimate preferences for COVID-19 nonpharmaceutical mitigation strategies. The model estimates indicated that participants preferred mitigation strategies that resulted in lower COVID-19 risk (i.e. sheltering-in-place more days a week), financial compensation from the government, fewer health (mental and physical) problems, and fewer financial problems. The high response rate and survey engagement provide proof of concept that RDS and DCE can be implemented as web-based applications, with the potential for scale up to produce nationally-representative preference estimates.
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Affiliation(s)
- Courtney A Johnson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI 02912 USA
| | - Dan N Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA USA
| | - Ann Mwangi
- Department of Behavioural Science, School of Medicine, Moi University, Eldoret, Kenya
| | | | - Carlos Chivardi
- National Institute of Public Health (INSP), Cuernavaca, Morelos Mexico
| | | | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, Indianapolis, IN USA
| | | | | | - Omar Galárraga
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI 02912 USA
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Harris TF, Yelowitz A, Courtemanche C. Did COVID-19 change life insurance offerings? THE JOURNAL OF RISK AND INSURANCE 2021; 88:831-861. [PMID: 34226761 PMCID: PMC8242708 DOI: 10.1111/jori.12344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/11/2021] [Accepted: 05/01/2021] [Indexed: 06/13/2023]
Abstract
The profitability of life insurance offerings is contingent on accurate projections and pricing of mortality risk. The COVID-19 pandemic created significant uncertainty, with dire mortality predictions from early forecasts resulting in widespread government intervention and greater individual precaution that reduced the projected death toll. We analyze how life insurance companies changed pricing and offerings in response to COVID-19 using monthly data on term life insurance policies from Compulife. We estimate event-study models that exploit well-established variation in the COVID-19 mortality rate based on age and underlying health status. Despite the increase in mortality risk and significant uncertainty, the results generally indicate that life insurance companies did not increase premiums or decrease policy offerings due to COVID-19. Nonetheless, we find some evidence that premiums differentially increased for individuals with very high risk and that some policies were removed for the oldest of the old.
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Affiliation(s)
| | - Aaron Yelowitz
- Department of Economics, Gatton College of Business and EconomicsUniversity of KentuckyLexingtonKentuckyUSA
| | - Charles Courtemanche
- Department of Economics, Gatton College of Business and EconomicsUniversity of KentuckyLexingtonKentuckyUSA
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31
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Haber NA, Clarke-Deelder E, Salomon JA, Feller A, Stuart EA. Impact Evaluation of Coronavirus Disease 2019 Policy: A Guide to Common Design Issues. Am J Epidemiol 2021; 190:2474-2486. [PMID: 34180960 PMCID: PMC8344590 DOI: 10.1093/aje/kwab185] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Policy responses to COVID-19, particularly those related to non-pharmaceutical interventions, are unprecedented in scale and scope. However, policy impact evaluations require a complex combination of circumstance, study design, data, statistics, and analysis. Beyond the issues that are faced for any policy, evaluation of COVID-19 policies is complicated by additional challenges related to infectious disease dynamics and a multiplicity of interventions. The methods needed for policy-level impact evaluation are not often used or taught in epidemiology, and differ in important ways that may not be obvious. Methodological complications of policy evaluations can make it difficult for decision-makers and researchers to synthesize and evaluate strength of evidence in COVID-19 health policy papers. We (1) introduce the basic suite of policy impact evaluation designs for observational data, including cross-sectional analyses, pre/post, interrupted time-series, and difference-in-differences analysis, (2) demonstrate key ways in which the requirements and assumptions underlying these designs are often violated in the context of COVID-19, and (3) provide decision-makers and reviewers a conceptual and graphical guide to identifying these key violations. The overall goal of this paper is to help epidemiologists, policy-makers, journal editors, journalists, researchers, and other research consumers understand and weigh the strengths and limitations of evidence.
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Affiliation(s)
- Noah A Haber
- Meta-Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, CA, USA
- Correspondence to Dr. Noah A Haber, Meta Research Innovation Center at Stanford University, Stanford University, 1265 Welch Rd, Palo Alto, CA 94305 (e-mail: , phone +1 (650) 497-0811, fax: +1 (650) 725-6247)
| | - Emma Clarke-Deelder
- Department of Global Health & Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joshua A Salomon
- Department of Medicine, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford, CA, USA
| | - Avi Feller
- Goldman School of Public Policy, University of California, Berkeley, CA, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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32
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Hayatghaibi SE, Trout AT, Dillman JR, Callahan M, Iyer R, Nguyen H, Riedesel E, Ayyala RS. Trends in Pediatric Appendicitis and Imaging Strategies During Covid-19 in the United States. Acad Radiol 2021; 28:1500-1506. [PMID: 34493456 PMCID: PMC8390378 DOI: 10.1016/j.acra.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To determine if, during the first wave of the COVID-19 pandemic, 1) the proportion of complicated appendicitis changed, and 2) if imaging strategies for appendicitis in children changed. MATERIALS AND METHODS Retrospective cross-sectional study using administrative data from the Pediatric Health Information System, inclusive of pediatric patients diagnosed with appendicitis from March to May in 2017, 2018, 2019 and 2020. We compared trends during COVID-19 pandemic (March-May 2020) with corresponding pre-COVID-19 periods in 2017-201.9 Study outcomes were the proportion of complicated appendicitis and trends in imaging for appendicitis explained by patient-level variables. RESULTS The proportion of complicated appendicitis cases increased by 4.4 percentage points, from 46.5% pre-COVID-19 (2017-2019) to 50.9% during COVID-19 (2020), p < 0.001. Mean count of uncomplicated acute appendicitis cases decreased from pre-COVID-19 to the 2020 COVID-19 period (2017: n = 2555; 2018: n = 2679; 2019: n = 2722; 2020: n = 2231). Mean count of complicated appendicitis was unchanged between study periods (2017: n = 2189; 2018: n = 2302, 2019: n = 2442; 2020: n = 2311). Imaging approaches were largely unchanged between study periods; ultrasound was the most utilized modality in both study periods (68.3%, 70.2%; p = 0.033). CONCLUSION During the first wave of the COVID-19 pandemic, the proportion of complicated appendicitis cases increased without an absolute increase in the number of complicated appendicitis cases, but instead a decrease in the number of uncomplicated acute appendicitis diagnoses.
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Affiliation(s)
- Shireen E Hayatghaibi
- Department of Radiology, Texas Children's Hospital, Houston Texas; University of Texas, School of Public Health, Houston, Texas
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Callahan
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramesh Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - HaiThuy Nguyen
- Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Erica Riedesel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Division of Pediatric Radiology, Children's Healthcare of Atlanta Division of Pediatric Radiology, Atlanta, Georgia
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
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Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave. PLoS One 2021; 16:e0258308. [PMID: 34648525 PMCID: PMC8516194 DOI: 10.1371/journal.pone.0258308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/23/2021] [Indexed: 01/04/2023] Open
Abstract
The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.
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Nguyen M. Mask Mandates and COVID-19 Related Symptoms in the US. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:757-766. [PMID: 34429625 PMCID: PMC8379388 DOI: 10.2147/ceor.s326728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study investigates the extent to which the Public Mask Mandate, a policy that requires the use of face masks in public, can protect people from developing COVID-19 symptoms during the initial stage of the pandemic from mid-April to early June 2020 in the United States (US). METHODS We employ the difference-in-differences model that exploits the differential timing of the mask mandate implementation across states. RESULTS Our findings show that the Public Mask Mandate significantly lowers the incidence of developing all COVID-19 symptoms by 0.29 percentage points. The estimate implies an average reduction of 290%, compared to the proportion of the mandate-unaffected individuals who display all symptoms (0.1%). CONCLUSION The study provides suggestive evidence for the health benefits of wearing masks in public in the initial stage of the COVID-19 pandemic. The study also highlights the relevance of public mask wearing for the ongoing pandemic where the vaccination rate is precarious and access to vaccines is still limited in many countries.
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Affiliation(s)
- My Nguyen
- Faculty of Economics and Public Management, Ho Chi Minh City Open University, Ho Chi Minh City, Vietnam
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35
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Milligan WR, Fuller ZL, Agarwal I, Eisen MB, Przeworski M, Sella G. Impact of essential workers in the context of social distancing for epidemic control. PLoS One 2021; 16:e0255680. [PMID: 34347855 PMCID: PMC8336873 DOI: 10.1371/journal.pone.0255680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
New emerging infectious diseases are identified every year, a subset of which become global pandemics like COVID-19. In the case of COVID-19, many governments have responded to the ongoing pandemic by imposing social policies that restrict contacts outside of the home, resulting in a large fraction of the workforce either working from home or not working. To ensure essential services, however, a substantial number of workers are not subject to these limitations, and maintain many of their pre-intervention contacts. To explore how contacts among such "essential" workers, and between essential workers and the rest of the population, impact disease risk and the effectiveness of pandemic control, we evaluated several mathematical models of essential worker contacts within a standard epidemiology framework. The models were designed to correspond to key characteristics of cashiers, factory employees, and healthcare workers. We find in all three models that essential workers are at substantially elevated risk of infection compared to the rest of the population, as has been documented, and that increasing the numbers of essential workers necessitates the imposition of more stringent controls on contacts among the rest of the population to manage the pandemic. Importantly, however, different archetypes of essential workers differ in both their individual probability of infection and impact on the broader pandemic dynamics, highlighting the need to understand and target intervention for the specific risks faced by different groups of essential workers. These findings, especially in light of the massive human costs of the current COVID-19 pandemic, indicate that contingency plans for future epidemics should account for the impacts of essential workers on disease spread.
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Affiliation(s)
- William R. Milligan
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
| | - Zachary L. Fuller
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
| | - Ipsita Agarwal
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
| | - Michael B. Eisen
- Howard Hughes Medical Institute, University of California, Berkeley, California, United States of America
- Department of Molecular and Cell Biology, University of California, Berkeley, California, United States of America
| | - Molly Przeworski
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
- Department of Systems Biology, Columbia University, New York City, New York, United States of America
- Program for Mathematical Genomics, Columbia University, New York City, New York, United States of America
| | - Guy Sella
- Department of Biological Sciences, Columbia University, New York City, New York, United States of America
- Program for Mathematical Genomics, Columbia University, New York City, New York, United States of America
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36
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Digitale JC, Stojanovski K, McCulloch CE, Handley MA. Study Designs to Assess Real-World Interventions to Prevent COVID-19. Front Public Health 2021; 9:657976. [PMID: 34386470 PMCID: PMC8353119 DOI: 10.3389/fpubh.2021.657976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: In the face of the novel virus SARS-CoV-2, scientists and the public are eager for evidence about what measures are effective at slowing its spread and preventing morbidity and mortality. Other than mathematical modeling, studies thus far evaluating public health and behavioral interventions at scale have largely been observational and ecologic, focusing on aggregate summaries. Conclusions from these studies are susceptible to bias from threats to validity such as unmeasured confounding, concurrent policy changes, and trends over time. We offer recommendations on how to strengthen frequently applied study designs which have been used to understand the impact of interventions to reduce the spread of COVID-19, and suggest implementation-focused, pragmatic designs that, moving forward, could be used to build a robust evidence base for public health practice. Methods: We conducted a literature search of studies that evaluated the effectiveness of non-pharmaceutical interventions and policies to reduce spread, morbidity, and mortality of COVID-19. Our targeted review of the literature aimed to explore strengths and weaknesses of implemented studies, provide recommendations for improvement, and explore alternative real-world study design methods to enhance evidence-based decision-making. Results:Study designs such as pre/post, interrupted time series, and difference-in-differences have been used to evaluate policy effects at the state or country level of a range of interventions, such as shelter-in-place, face mask mandates, and school closures. Key challenges with these designs include the difficulty of disentangling the effects of contemporaneous changes in policy and correctly modeling infectious disease dynamics. Pragmatic study designs such as the SMART (Sequential, Multiple-Assignment Randomized Trial), stepped wedge, and preference designs could be used to evaluate community re-openings such as schools, and other policy changes. Conclusions: As the epidemic progresses, we need to move from post-hoc analyses of available data (appropriate for the beginning of the pandemic) to proactive evaluation to ensure the most rigorous approaches possible to evaluate the impact of COVID-19 prevention interventions. Pragmatic study designs, while requiring initial planning and community buy-in, could offer more robust evidence on what is effective and for whom to combat the global pandemic we face and future policy decisions.
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Affiliation(s)
- Jean C. Digitale
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Kristefer Stojanovski
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Margaret A. Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
- PRISE Center (Partnerships for Research in Implementation Science for Equity), University of California, San Francisco, San Francisco, CA, United States
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37
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Adjodah D, Dinakar K, Chinazzi M, Fraiberger SP, Pentland A, Bates S, Staller K, Vespignani A, Bhatt DL. Association between COVID-19 outcomes and mask mandates, adherence, and attitudes. PLoS One 2021; 16:e0252315. [PMID: 34161332 PMCID: PMC8221503 DOI: 10.1371/journal.pone.0252315] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023] Open
Abstract
We extend previous studies on the impact of masks on COVID-19 outcomes by investigating an unprecedented breadth and depth of health outcomes, geographical resolutions, types of mask mandates, early versus later waves and controlling for other government interventions, mobility testing rate and weather. We show that mask mandates are associated with a statistically significant decrease in new cases (-3.55 per 100K), deaths (-0.13 per 100K), and the proportion of hospital admissions (-2.38 percentage points) up to 40 days after the introduction of mask mandates both at the state and county level. These effects are large, corresponding to 14% of the highest recorded number of cases, 13% of deaths, and 7% of admission proportion. We also find that mask mandates are linked to a 23.4 percentage point increase in mask adherence in four diverse states. Given the recent lifting of mandates, we estimate that the ending of mask mandates in these states is associated with a decrease of -3.19 percentage points in mask adherence and 12 per 100K (13% of the highest recorded number) of daily new cases with no significant effect on hospitalizations and deaths. Lastly, using a large novel survey dataset of 847 thousand responses in 69 countries, we introduce the novel results that community mask adherence and community attitudes towards masks are associated with a reduction in COVID-19 cases and deaths. Our results have policy implications for reinforcing the need to maintain and encourage mask-wearing by the public, especially in light of some states starting to remove their mask mandates.
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Affiliation(s)
- Dhaval Adjodah
- Connection Science, MIT, Cambridge, MA, United States of America
- Center of Complex Interventions, Wellesley, MA, United States of America
| | | | - Matteo Chinazzi
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, United States of America
| | - Samuel P. Fraiberger
- Connection Science, MIT, Cambridge, MA, United States of America
- Development Data Group, World Bank, Washington, DC, United States of America
- Department of Computer Science, New York University, New York, NY, United States of America
| | - Alex Pentland
- Media Lab, MIT, Cambridge, MA, United States of America
| | - Samantha Bates
- Center of Complex Interventions, Wellesley, MA, United States of America
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Harvard University Boston, MA, United States of America
| | - Alessandro Vespignani
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, United States of America
| | - Deepak L. Bhatt
- Heart & Vascular Center, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Harvard University Boston, MA, United States of America
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38
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Li Q, Yang Y, Wang W, Lee S, Xiao X, Gao X, Oztekin B, Fan C, Mostafavi A. Unraveling the dynamic importance of county-level features in trajectory of COVID-19. Sci Rep 2021; 11:13058. [PMID: 34158571 PMCID: PMC8219723 DOI: 10.1038/s41598-021-92634-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/14/2021] [Indexed: 11/15/2022] Open
Abstract
The objective of this study was to investigate the importance of multiple county-level features in the trajectory of COVID-19. We examined feature importance across 2787 counties in the United States using data-driven machine learning models. Existing mathematical models of disease spread usually focused on the case prediction with different infection rates without incorporating multiple heterogeneous features that could impact the spatial and temporal trajectory of COVID-19. Recognizing this, we trained a data-driven model using 23 features representing six key influencing factors affecting the pandemic spread: social demographics of counties, population activities, mobility within the counties, movement across counties, disease attributes, and social network structure. Also, we categorized counties into multiple groups according to their population densities, and we divided the trajectory of COVID-19 into three stages: the outbreak stage, the social distancing stage, and the reopening stage. The study aimed to answer two research questions: (1) The extent to which the importance of heterogeneous features evolved at different stages; (2) The extent to which the importance of heterogeneous features varied across counties with different characteristics. We fitted a set of random forest models to determine weekly feature importance. The results showed that: (1) Social demographic features, such as gross domestic product, population density, and minority status maintained high-importance features throughout stages of COVID-19 across 2787 studied counties; (2) Within-county mobility features had the highest importance in counties with higher population densities; (3) The feature reflecting the social network structure (Facebook, social connectedness index), had higher importance for counties with higher population densities. The results showed that the data-driven machine learning models could provide important insights to inform policymakers regarding feature importance for counties with various population densities and at different stages of a pandemic life cycle.
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Affiliation(s)
- Qingchun Li
- Zachry Department of Civil and Environmental Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA.
| | - Yang Yang
- Department of Computer Science and Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
| | - Wanqiu Wang
- Department of Computer Science and Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
| | - Sanghyeon Lee
- Department of Computer Science and Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
| | - Xin Xiao
- Department of Computer Science and Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
| | - Xinyu Gao
- Department of Computer Science and Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
| | - Bora Oztekin
- Department of Computer Science and Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
| | - Chao Fan
- Department of Computer Science and Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
| | - Ali Mostafavi
- Zachry Department of Civil and Environmental Engineering, Texas A&M University, 199 Spence St., College Station, TX, 77843, USA
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39
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Bulterys PL, Leung NY, Saleem A, Budvytiene I, Banaei N. Impact of COVID-19 Shelter-in-Place Order on Transmission of Gastrointestinal Pathogens in Northern California. J Clin Microbiol 2021; 59:e0044921. [PMID: 33846223 PMCID: PMC8218763 DOI: 10.1128/jcm.00449-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Philip L. Bulterys
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Nicole Y. Leung
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Indre Budvytiene
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA
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40
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The impact of non-pharmaceutical interventions on COVID-19 epidemic growth in the 37 OECD member states. Eur J Epidemiol 2021; 36:629-640. [PMID: 34114189 PMCID: PMC8192111 DOI: 10.1007/s10654-021-00766-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/25/2021] [Indexed: 01/17/2023]
Abstract
We estimated the impact of a comprehensive set of non-pharmeceutical interventions on the COVID-19 epidemic growth rate across the 37 member states of the Organisation for Economic Co-operation and Development during the early phase of the COVID-19 pandemic and between October and December 2020. For this task, we conducted a data-driven, longitudinal analysis using a multilevel modelling approach with both maximum likelihood and Bayesian estimation. We found that during the early phase of the epidemic: implementing restrictions on gatherings of more than 100 people, between 11 and 100 people, and 10 people or less was associated with a respective average reduction of 2.58%, 2.78% and 2.81% in the daily growth rate in weekly confirmed cases; requiring closing for some sectors or for all but essential workplaces with an average reduction of 1.51% and 1.78%; requiring closing of some school levels or all school levels with an average reduction of 1.12% or 1.65%; recommending mask wearing with an average reduction of 0.45%, requiring mask wearing country-wide in specific public spaces or in specific geographical areas within the country with an average reduction of 0.44%, requiring mask-wearing country-wide in all public places or all public places where social distancing is not possible with an average reduction of 0.96%; and number of tests per thousand population with an average reduction of 0.02% per unit increase. Between October and December 2020 work closing requirements and testing policy were significant predictors of the epidemic growth rate. These findings provide evidence to support policy decision-making regarding which NPIs to implement to control the spread of the COVID-19 pandemic.
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41
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Souliotis K, Giannouchos TV, Peppou LE, Samara MT, Nimatoudis J, Papageorgiou C, Economou M. "Public Health Behaviors during the COVID-19 Pandemic in Greece and Associated Factors: A Nationwide Cross-sectional Survey". INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211022913. [PMID: 34053304 PMCID: PMC8170349 DOI: 10.1177/00469580211022913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this cross-sectional survey was to estimate the association
between multiple socioeconomic, and health-related characteristics, COVID-19
related attitudes and adoption of public health preventive behaviors. A national
cross-sectional survey among 1205 adults was conducted in April 2020 in Greece.
Multivariable ordered logistic regression models were used to estimate the
association between COVID-19 related attitudes and knowledge and adoption of
preventive behaviors, controlling for socioeconomic and health-related
characteristics. A total of 923 individuals fully completed the survey.
Individuals who believed that the virus is out of control, is transmitted
through the air, and is not similar to the common flu were more likely to adopt
public health preventive behaviors more frequently, particularly wearing masks
in public spaces, washing their hands, and spending fewer hours out of their
homes. Uncertainty about the virus symptomatology was associated with less
frequent mask-wearing and handwashing. Increased social support, frequent media
use for COVID-19 updates, trust to authorities, older age, worse health status,
female gender and being a healthcare professional were also associated with
uptake of some preventive health behaviors. Attitudinal and socioeconomic
determinants critically affect public engagement in preventive behaviors. Health
policy initiatives should focus on community outreach approaches to raise
awareness and to strengthen social support mechanisms by integrating multiple
stakeholders.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Education Sciences, University of Peloponnese, Corinth, Greece.,Health Policy Institute, Athens, Greece
| | - Theodoros V Giannouchos
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Lily E Peppou
- First Department of Psychiatry, Medical School, Aiginition Hospital, National & Kapodistrian University of Athens, Athens, Greece.,Unit of Social Psychiatry & Psychosocial Care, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis" (UMHRI), Athens, Greece
| | - Myrto T Samara
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Nimatoudis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalambos Papageorgiou
- First Department of Psychiatry, Medical School, Aiginition Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Marina Economou
- First Department of Psychiatry, Medical School, Aiginition Hospital, National & Kapodistrian University of Athens, Athens, Greece.,Unit of Social Psychiatry & Psychosocial Care, University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis" (UMHRI), Athens, Greece
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42
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An L, Hawley S, Van Horn ML, Bacon E, Yang P, Resnicow K. Development of a coronavirus social distance attitudes scale. PATIENT EDUCATION AND COUNSELING 2021; 104:1451-1459. [PMID: 33353839 PMCID: PMC7685036 DOI: 10.1016/j.pec.2020.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Our goal was to develop a scale to assess social distance attitudes related to COVID-19. METHODS We performed an online national survey of US adults (n = 1,074) to assess social distance attitudes, COVID-19 related beliefs and behaviors, and demographics. We assessed scale structure using confirmatory factor analysis and evaluated internal consistency and validity. We assessed association of scale factors with respondent characteristics. RESULTS Confirmatory factor analysis supported a hypothesized two-factor solution. Internal consistency was high for both positive (Alpha = 0.92) and negative (Alpha = 0.91) attitude factors. Analyses supported construct and predictive validity with expected associations between scale factors and perceived norms and behavior (e.g. trips out of the home). We found an interaction suggesting that holding highly negative attitudes reduced the effect of holding positive beliefs. Both attitude factors were related to age, gender, race/ethnicity, and political affiliation. Perceived COVID-19 risk (to others but not for self) and perceived severity were consistently associated with higher positive and lower negative attitudes. CONCLUSION This COVID-19 Social Distance Attitude Scale contains positive and negative factors with high internal consistency and construct and predictive validity. PRACTICE IMPLICATION A greater understanding and ongoing assessment of COVID-19 social distance attitudes could inform policymakers, researchers, and clinicians who seek to promote protective social distance behaviors.
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Affiliation(s)
- Lawrence An
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA; University of Michigan, Division of General Medicine, School of Medicine, Ann Arbor, MI, USA.
| | - Sarah Hawley
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA; University of Michigan, Division of General Medicine, School of Medicine, Ann Arbor, MI, USA; Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Elizabeth Bacon
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Penny Yang
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Ken Resnicow
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, Ann Arbor, MI, USA; University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
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43
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Gupta S, Georgiou A, Sen S, Simon K, Karaca-Mandic P. US Trends in COVID-19-Associated Hospitalization and Mortality Rates Before and After Reopening Economies. JAMA HEALTH FORUM 2021; 2:e211262. [PMID: 35977172 PMCID: PMC8796994 DOI: 10.1001/jamahealthforum.2021.1262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
Importance After abrupt closures of businesses and public gatherings in the US in late spring 2020 due to the COVID-19 pandemic, by mid-May 2020, most states reopened their economies. Owing in part to a lack of earlier data, there was little evidence on whether state reopening policies influenced important pandemic outcomes-COVID-19-related hospitalizations and mortality-to guide future decision-making in the remainder of this and future pandemics. Objective To investigate changes in COVID-19-related hospitalizations and mortality trends after reopening of US state economies. Design Setting and Participants Using an interrupted time series approach, this cross-sectional study examined trends in per-capita COVID-19-related hospitalizations and deaths before and after state reopenings between April 16 and July 31, 2020. Daily state-level data from the University of Minnesota COVID-19 Hospitalization Tracking Project on COVID-19-related hospitalizations and deaths across 47 states were used in the analysis. Exposures Dates that states reopened their economies. Main Outcomes and Measures State-day observations of COVID-19-related hospitalizations and COVID-19-related new deaths per 100 000 people. Results The study included 3686 state-day observations of hospitalizations and 3945 state-day observations of deaths. On the day of reopening, the mean number of hospitalizations per 100 000 people was 17.69 (95% CI, 12.54-22.84) and the mean number of daily new deaths per 100 000 people was 0.395 (95% CI, 0.255-0.536). Both outcomes displayed flat trends before reopening, but they started trending upward thereafter. Relative to the hospitalizations trend in the period before state reopenings, the postperiod trend was higher by 1.607 per 100 000 people (95% CI, 0.203-3.011; P = .03). This estimate implied that nationwide reopenings were associated with 5319 additional people hospitalized for COVID-19 each day. The trend in new deaths after reopening was also positive (0.0376 per 100 000 people; 95% CI, 0.0038-0.0715; P = .03), but the change in mortality trend was not significant (0.0443; 95% CI, -0.0048 to 0.0933; P = .08). Conclusions and Relevance In this cross-sectional study conducted over a 3.5-month period across 47 US states, data on the association of hospitalizations and mortality with state reopening policies may provide input to state projections of the pandemic as policy makers continue to balance public health protections with sustaining economic activity.
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Affiliation(s)
- Sumedha Gupta
- Department of Economics, Indiana University Purdue University, Indianapolis
| | | | - Soumya Sen
- Information & Decision Sciences, Carlson School of Management, Minneapolis, Minnesota
| | - Kosali Simon
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
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44
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Biese KM, McGuine TA, Haraldsdottir K, Goodavish L, Watson AM. COVID-19 Risk in Youth Club Sports: A nationwide sample representing over 200,000 Athletes. J Athl Train 2021; 56:465819. [PMID: 34038934 PMCID: PMC8675317 DOI: 10.4085/1062-6050-0187.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The COVID-19 pandemic has affected almost every aspect of life including youth sports. Little data exists on COVID-19 incidences and risk mitigation strategies in youth club sports. OBJECTIVE To determine the reported incidence of COVID-19 cases among youth club sport athletes and the information sources used to develop COVID-19 risk mitigation procedures. DESIGN Cross-sectional study. SETTING Online surveys. PATIENTS Soccer and volleyball youth club directors. INTERVENTION A survey was completed by directors of youth volleyball and soccer clubs across the country in October 2020. Surveys included self-reported date of re-initiation, number of players, player COVID-19 cases, sources of infection, COVID-19 mitigation strategies, and information sources for the development of COVID-19 mitigation strategies. MAIN OUTCOME MEASURES Total number of cases reported, number of players, and days since club re-initiation were used to calculate an incidence rate of cases per 100,000 player-days. To compare reported incidence rates between soccer and volleyball, a negative binomial model was developed to predict player cases with sport and state incidence as covariates and log(player-days) as an offset. Estimates were exponentiated to yield a reported incidence rate ratio (IRR) with Wald confidence intervals. RESULTS A total of 205,136 athletes (soccer=165,580; volleyball=39,556) were represented by 437 clubs (soccer=159; volleyball=278). Club organizers reported 673 COVID-19 cases (soccer=322; volleyball=351), for a reported incidence rate of 2.8 cases per 100,000 player-days (soccer=1.7, volleyball=7.9). Volleyball had a significantly higher reported COVID-19 incidence rate compared to soccer (reported IRR = 3.06 [2.0-4.6], p<0.001). Out of 11 possible mitigation strategies, the median number of strategies used by all clubs was 7 with an interquartile range of 2. CONCLUSIONS The incidence of self-reported cases of COVID-19 was lower in soccer clubs than volleyball clubs. Most clubs report using many COVID-19 mitigation strategies to reduce the risk of COVID-19.
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Affiliation(s)
- Kevin M. Biese
- Department of Kinesiology, University of Wisconsin–Madison
| | - Timothy A. McGuine
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
| | - Kristin Haraldsdottir
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
| | - Leslie Goodavish
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
| | - Andrew M. Watson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison
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45
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Haber NA, Clarke-Deelder E, Feller A, Smith ER, Salomon J, MacCormack-Gelles B, Stone EM, Bolster-Foucault C, Daw JR, Hatfield LA, Fry CE, Boyer CB, Ben-Michael E, Joyce CM, Linas BS, Schmid I, Au EH, Wieten SE, Jarrett BA, Axfors C, Nguyen VT, Griffin BA, Bilinski A, Stuart EA. Problems with Evidence Assessment in COVID-19 Health Policy Impact Evaluation (PEACHPIE): A systematic review of study design and evidence strength. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501457 PMCID: PMC7836129 DOI: 10.1101/2021.01.21.21250243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. This study systematically reviewed the strength of evidence in the published COVID-19 policy impact evaluation literature. Methods: We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on November 26, 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation, assessing what impact evaluation method was used, graphical display of outcomes data, functional form for the outcomes, timing between policy and impact, concurrent changes to the outcomes, and an overall rating. Results: After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. The majority (n=23/36) of studies in our sample examined the impact of stay-at-home requirements. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-section), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 1/27 studies passed all of the above checks, and 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes. Discussion: The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigor to be actionable by policymakers. This was largely driven by the circumstances under which policies were passed making it difficult to attribute changes in COVID-19 outcomes to particular policies. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
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Affiliation(s)
- Noah A Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Emma Clarke-Deelder
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Avi Feller
- Goldman School of Public Policy, UC Berkeley, Berkeley, CA, USA
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C, USA
| | - Joshua Salomon
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Clara Bolster-Foucault
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Jamie R Daw
- Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Carrie E Fry
- Department of Health Policy, Vanderbilt University, Nashville, TN, USA
| | - Christopher B Boyer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eli Ben-Michael
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Caroline M Joyce
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Beth S Linas
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Clinical Quality and Informatics, MITRE Corp, McLean, VA, USA
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric H Au
- School of Public Health, University of Sydney, Sydney, Australia
| | - Sarah E Wieten
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Brooke A Jarrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Van Thu Nguyen
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | | | - Alyssa Bilinski
- Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Amiri A. Role of social distancing in tackling COVID-19 during the first wave of pandemic in Nordic region: Evidence from daily deaths, infections and needed hospital resources. Int J Nurs Sci 2021; 8:145-151. [PMID: 33758674 PMCID: PMC7975574 DOI: 10.1016/j.ijnss.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To measure the effect of social distancing on reducing daily deaths, infections and hospital resources needed for coronavirus disease 2019 (COVID-19) patients during the first wave of the pandemic in Nordic countries. METHODS The observations of social distancing, daily deaths, infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds, beds needed in ICUs and infection wards, nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation (IHME) by the University of Washington. The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME. The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run. RESULTS Results of dynamic long-run models confirm that a 1% rise in social distancing by reducing human contacts may decline daily deaths, daily infections, all hospital beds needed, beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%, 15.26%, 1.10%, 1.17% and 1.89%, respectively. Moreover, results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing, the lengths of restoring back to equilibrium are 67, 62, 40, 22 and 49 days for daily deaths, daily infections, all hospital beds needed, nurses/beds needed in ICUs and nurses/beds needed in infection wards, respectively. CONCLUSION Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries. The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.
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Affiliation(s)
- Arshia Amiri
- Department of Nursing Science, University of Turku, Turku, Finland
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
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Hatef E, Kitchen C, Chang HY, Kharrazi H, Tang W, Weiner JP. Early relaxation of community mitigation policies and risk of COVID-19 resurgence in the United States. Prev Med 2021; 145:106435. [PMID: 33486000 PMCID: PMC7825905 DOI: 10.1016/j.ypmed.2021.106435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/15/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
This study aimed to assess the impact of coronavirus disease (COVID-19) prevalence in the United States in the week leading to the relaxation of the stay-at-home orders (SAH) on future prevalence across states that implemented different SAH policies. We used data on the number of confirmed COVID-19 cases as of August 21, 2020 on county level. We classified states into four groups based on the 7-day change in prevalence and the state's approach to SAH policy. The groups included: (1) High Change (19 states; 7-day prevalence change ≥50th percentile), (2) Low Change (19 states; 7-day prevalence change <50th percentile), (3) No SAH (11 states: did not adopt SAH order), and (4) No SAH End (2 states: did not relax SAH order). We performed regression modeling assessing the association between change in prevalence at the time of SAH order relaxation and COVID-19 prevalence days after the relaxation of SAH order for four selected groups. After adjusting for other factors, compared to the High Change group, counties in the Low Change group had 33.8 (per 100,000 population) fewer cases (standard error (SE): 19.8, p < 0.001) 7 days after the relaxation of SAH order and the difference was larger by time passing. On August 21, 2020, the No SAH End group had 383.1 fewer cases (per 100,000 population) than the High Change group (SE: 143.6, p < 0.01). A measured, evidence-based approach is required to safely relax the community mitigation strategies and practice phased-reopening of the country.
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Affiliation(s)
- Elham Hatef
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Christopher Kitchen
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Hsien-Yen Chang
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Hadi Kharrazi
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Wenze Tang
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States of America
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Lynch CJ, Gore R. Short-Range Forecasting of COVID-19 During Early Onset at County, Health District, and State Geographic Levels Using Seven Methods: Comparative Forecasting Study. J Med Internet Res 2021; 23:e24925. [PMID: 33621186 PMCID: PMC7990039 DOI: 10.2196/24925] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Forecasting methods rely on trends and averages of prior observations to forecast COVID-19 case counts. COVID-19 forecasts have received much media attention, and numerous platforms have been created to inform the public. However, forecasting effectiveness varies by geographic scope and is affected by changing assumptions in behaviors and preventative measures in response to the pandemic. Due to time requirements for developing a COVID-19 vaccine, evidence is needed to inform short-term forecasting method selection at county, health district, and state levels. OBJECTIVE COVID-19 forecasts keep the public informed and contribute to public policy. As such, proper understanding of forecasting purposes and outcomes is needed to advance knowledge of health statistics for policy makers and the public. Using publicly available real-time data provided online, we aimed to evaluate the performance of seven forecasting methods utilized to forecast cumulative COVID-19 case counts. Forecasts were evaluated based on how well they forecast 1, 3, and 7 days forward when utilizing 1-, 3-, 7-, or all prior-day cumulative case counts during early virus onset. This study provides an objective evaluation of the forecasting methods to identify forecasting model assumptions that contribute to lower error in forecasting COVID-19 cumulative case growth. This information benefits professionals, decision makers, and the public relying on the data provided by short-term case count estimates at varied geographic levels. METHODS We created 1-, 3-, and 7-day forecasts at the county, health district, and state levels using (1) a naïve approach, (2) Holt-Winters (HW) exponential smoothing, (3) a growth rate approach, (4) a moving average (MA) approach, (5) an autoregressive (AR) approach, (6) an autoregressive moving average (ARMA) approach, and (7) an autoregressive integrated moving average (ARIMA) approach. Forecasts relied on Virginia's 3464 historical county-level cumulative case counts from March 7 to April 22, 2020, as reported by The New York Times. Statistically significant results were identified using 95% CIs of median absolute error (MdAE) and median absolute percentage error (MdAPE) metrics of the resulting 216,698 forecasts. RESULTS The next-day MA forecast with 3-day look-back length obtained the lowest MdAE (median 0.67, 95% CI 0.49-0.84, P<.001) and statistically significantly differed from 39 out of 59 alternatives (66%) to 53 out of 59 alternatives (90%) at each geographic level at a significance level of .01. For short-range forecasting, methods assuming stationary means of prior days' counts outperformed methods with assumptions of weak stationarity or nonstationarity means. MdAPE results revealed statistically significant differences across geographic levels. CONCLUSIONS For short-range COVID-19 cumulative case count forecasting at the county, health district, and state levels during early onset, the following were found: (1) the MA method was effective for forecasting 1-, 3-, and 7-day cumulative case counts; (2) exponential growth was not the best representation of case growth during early virus onset when the public was aware of the virus; and (3) geographic resolution was a factor in the selection of forecasting methods.
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Affiliation(s)
- Christopher J Lynch
- Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, Suffolk, VA, United States
| | - Ross Gore
- Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, Suffolk, VA, United States
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Abouk R, Heydari B. The Immediate Effect of COVID-19 Policies on Social-Distancing Behavior in the United States. Public Health Rep 2021; 136:245-252. [PMID: 33400622 PMCID: PMC8093844 DOI: 10.1177/0033354920976575] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Although anecdotal evidence indicates the effectiveness of coronavirus disease 2019 (COVID-19) social-distancing policies, their effectiveness in relation to what is driven by public awareness and voluntary actions needs to be determined. We evaluated the effectiveness of the 6 most common social-distancing policies in the United States (statewide stay-at-home orders, limited stay-at-home orders, nonessential business closures, bans on large gatherings, school closure mandates, and limits on restaurants and bars) during the early stage of the pandemic. METHODS We applied difference-in-differences and event-study methodologies to evaluate the effect of the 6 social-distancing policies on Google-released aggregated, anonymized daily location data on movement trends over time by state for all 50 states and the District of Columbia in 6 location categories: retail and recreation, grocery stores and pharmacies, parks, transit stations, workplaces, and residences. We compared the outcome of interest in states that adopted COVID-19-related policies with states that did not adopt such policies, before and after these policies took effect during February 15-April 25, 2020. RESULTS Statewide stay-at-home orders had the strongest effect on reducing out-of-home mobility and increased the time people spent at home by an estimated 2.5 percentage points (15.2%) from before to after policies took effect. Limits on restaurants and bars ranked second and resulted in an increase in presence at home by an estimated 1.4 percentage points (8.5%). The other 4 policies did not significantly reduce mobility. CONCLUSION Statewide stay-at-home orders and limits on bars and restaurants were most closely linked to reduced mobility in the early stages of the COVID-19 pandemic, whereas the potential benefits of other such policies may have already been reaped from voluntary social distancing. Further research is needed to understand how the effect of social-distancing policies changes as voluntary social distancing wanes during later stages of a pandemic.
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Affiliation(s)
- Rahi Abouk
- Department of Economics, Finance and Global Business, William
Paterson University, Wayne, NJ, USA
| | - Babak Heydari
- College of Engineering and Network Science Institute,
Northeastern University, Boston, MA, USA
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50
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Abouk R, Heydari B. The Immediate Effect of COVID-19 Policies on Social-Distancing Behavior in the United States. Public Health Rep 2021; 136:245-252. [PMID: 33400622 DOI: 10.1101/2020.04.07.20057356] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE Although anecdotal evidence indicates the effectiveness of coronavirus disease 2019 (COVID-19) social-distancing policies, their effectiveness in relation to what is driven by public awareness and voluntary actions needs to be determined. We evaluated the effectiveness of the 6 most common social-distancing policies in the United States (statewide stay-at-home orders, limited stay-at-home orders, nonessential business closures, bans on large gatherings, school closure mandates, and limits on restaurants and bars) during the early stage of the pandemic. METHODS We applied difference-in-differences and event-study methodologies to evaluate the effect of the 6 social-distancing policies on Google-released aggregated, anonymized daily location data on movement trends over time by state for all 50 states and the District of Columbia in 6 location categories: retail and recreation, grocery stores and pharmacies, parks, transit stations, workplaces, and residences. We compared the outcome of interest in states that adopted COVID-19-related policies with states that did not adopt such policies, before and after these policies took effect during February 15-April 25, 2020. RESULTS Statewide stay-at-home orders had the strongest effect on reducing out-of-home mobility and increased the time people spent at home by an estimated 2.5 percentage points (15.2%) from before to after policies took effect. Limits on restaurants and bars ranked second and resulted in an increase in presence at home by an estimated 1.4 percentage points (8.5%). The other 4 policies did not significantly reduce mobility. CONCLUSION Statewide stay-at-home orders and limits on bars and restaurants were most closely linked to reduced mobility in the early stages of the COVID-19 pandemic, whereas the potential benefits of other such policies may have already been reaped from voluntary social distancing. Further research is needed to understand how the effect of social-distancing policies changes as voluntary social distancing wanes during later stages of a pandemic.
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Affiliation(s)
- Rahi Abouk
- 15665 Department of Economics, Finance and Global Business, William Paterson University, Wayne, NJ, USA
| | - Babak Heydari
- 1848 College of Engineering and Network Science Institute, Northeastern University, Boston, MA, USA
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