Key Challenges in Modelling an Epidemic - What have we Learned from the COVID-19 Epidemic so Far

Lessons learnt while designing and conducting a longitudinal study from the first Italian COVID-19 pandemic wave up to 3 years

BACKGROUND

Several scientific contributions have summarized the "lessons learnt" during the coronavirus disease 2019 (COVID-19) pandemic, but only a few authors have discussed what we have learnt on how to design and conduct research during a pandemic. The main intent of this study was to summarize the lessons learnt by an Italian multidisciplinary research group that developed and conducted a longitudinal study on COVID-19 patients infected during the first wave in March 2020 and followed-up for 3 years.

METHODS

A qualitative research approach embedded into the primary CORonavirus MOnitoRing study (CORMOR) study was developed, according to the the consolidated criteria for reporting qualitative research. Multiple data collection strategies were performed: each member was invited to report the main lessons learnt according to his/her perspective and experience from the study design throughout its conduction. The narratives collected were summarized and discussed in face-to-face rounds. The narratives were then thematically analysed according to their main topic in a list that was resent to all members to check the content and their organization. The list of the final "lessons learnt" has been agreed by all members, as described in a detailed fashion.

RESULTS

Several lessons were learnt while designing and conducting a longitudinal study during the COVID-19 pandemic and summarised into ten main themes: some are methodological, while others concern how to conduct research in pandemics/epidemics/infectious disease emergencies.

CONCLUSIONS

The multidisciplinary approach, which also included patients' perspective, helped us to protect the consistency and quality of the research provided in pandemic times. The lesson learnt suggest that our research approach may benefit from changes in education, clinical practice and policies.

Did Human Microbes Affect Tourist Arrivals before the COVID-19 Shock? Pre-Effect Forecasting Model for Slovenia

In 2020, with a substantial decline in tourist arrivals slightly before the time of COVID-19, the innovative econometric approach predicted possible responses between the spread of human microbes (bacteria/viruses) and tourist arrivals. The article developed a conceptually tested econometric model for predicting an exogenous shock on tourist arrivals driven by the spread of disease using a time series approach. The reworked study is based on an autoregressive integrated moving average (ARIMA) model to avoid spurious results. The periods of robust empirical study were obtained from the data vectors i) from January 2008 to December 2018 and ii) from January 2008 to December 2020. The data were obtained from the National Institute of Public Health (NIPH) and the Statistical Office of the Republic of Slovenia. The ARIMA model predicted the number of declines in tourist arrivals for the approaching periods due to the spread of viruses. Before the outbreak of COVID-19, pre-pandemic results confirmed a one-fifth drop in tourist arrivals in the medium term. In the short term, the decline could be more than three-quarters. A further shock can be caused by forecasted bacterial infections; less likely to reduce tourist demand in the long term. The results can improve the evidence for public health demand in risk reduction for tourists as possible patients. The data from the NIPH are crucial for monitoring public health and tourism management as a base for predictions of unknown events.

The impact of COVID-19 on the orthopaedic patient in Slovenia: Hip and knee replacement surgery, 90-Day mortality, outpatient visits and waiting times

Introduction

The purpose of the study was to analyse the impact of the COVID-19 pandemic on the healthcare of the orthopaedic patient, i.e. numbers of hip and knee replacement surgeries, 90-day mortality, waiting times and outpatient clinic visits.

Methods

The Hip (HR) and Knee Replacement (KR) records from The National Arthroplasty Registry of Slovenia in the pandemic year 2020 were compared to the year 2019. To compare reasons for revision and 90-day mortality the Chi-square test was used. The median values of the number of operations and waiting times were compared with the 95% confidence intervals. The number of outpatient clinic visits was tested with the Wilcoxon Signed Ranked test.

Results

All operations fell by 19%, from 7825 to 6335. The number of Primary Total HR declined from 3530 to 2792 (21%) and the number of Primary KR from 3191 to 2423 (24%). The number of hip revisions declined by 10% and knee revisions by 25%. We did not find differences in 90-day mortality (p=0.408). Outpatient clinic visits fell from 228682 to 196582 (14%) per year. Waiting times increased by 15% for HR and by 12% for KR.

Conclusion

There was an inevitable drop in the number of surgeries and outpatient clinic visits in the spring and autumn lockdown. With the reorganisation of the orthopaedic service in Slovenia, the number of KR and HR stayed at a relatively high level despite the pandemic. An epidemiological model and mechanisms for the reduction of waiting times could overcome the impact of the epidemic.

Association Between Preventive Behaviour and Anxiety at the Start of the COVID-19 Pandemic in Slovenia

Introduction

The first large outbreak of SARS-CoV-2 in Europe occurred in Northern Italy in February 2020. The relatively fast spread of the infection to Slovenia was expected, and preventive measures for its suppression were widely discussed.

Methods

An online questionnaire was designed to evaluate adherence to preventive measures and the extent to which the taking of preventive measures was associated with people's anxiety level, psychological burden, their perceived vulnerability to disease, germ aversion and a number of demographic characteristics in the early stage of Covid-19 spread. The survey was active for 24 hours (13-14 March 2020). There were 12,307 responses and 7,764 questionnaires were completed in full.

Results

Higher preventive behaviour was found in individuals who experienced greater psychological distress, were more anxious, and expressed greater perceived infectability and germ aversion. Greater compliance with preventive behaviour was found among women, those sharing a household with people aged over 65, the elderly and those who knew somebody who had been infected. These groups also showed higher anxiety levels, which appeared to be significantly increased in general as a result of the specific situation. Quarantine was evaluated as the most efficient preventive measure, and was respected relatively strictly even before it became an officially announced protective measure.

Conclusion

This research reveals a strong association between preventive behaviour and anxiety. Anxiety, together with social distancing, may affect physical and psychological health in the population in the long term. Other aspects of public health might therefore be influenced by the measures currently being enforced to prevent the spread of SARS-CoV-2.