Years of Life Lost Attributable to COVID-19 in High-incidence Countries

A four-week study on the toxicity of repeated intramuscular administration of plant-based BA-CoV2-0301 vaccine against SARS-CoV-2 in Sprague-Dawley rats

In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China, leading to the global Coronavirus Disease pandemic. The rapid spread of SARS-CoV-2 highlighted the urgent need for effective vaccines. However, the high cost, cold storage requirements, and scalability challenges associated with mRNA vaccines have necessitated alternative vaccine technologies. In the study, the safety of a plant-based vaccine was evaluated. The vaccine, an emulsion of the SARS-CoV-2 S1 antigen and a synthetic TLR4 agonist produced and purified from Nicotiana benthamiana, was administered to Sprague-Dawley rats three times over 4 wk. Mortality, clinical signs, body weight, food consumption, vision, urinalysis, gross findings, organ weight, hematology, serum biochemistry, histopathology, and immunogenicity were evaluated. The results showed that antibodies were efficiently produced and maintained for one month following vaccination with the plant-derived receptor-binding domain (RBD) antigen of COVID-19. Furthermore, the rats showed no toxicological symptoms, with reversible changes at the injection site and minor histological alterations in the spinal cord and bone marrow, typical of vaccine responses. The plant-derived SARS-CoV-2 vaccine appears safe following repeated administration over 4 wk and represents a promising alternative for potential use in human clinical trials and clinical applications.

The impact of COVID-19: consequences of a 3-Year struggle in Iran

BACKGROUND

The disability-adjusted life year (DALY) approach gives policymakers a clear understanding of the scale of the health issue. This study aimed to estimate DALYs attributed to coronavirus disease 2019 (COVID-19) for the population of Bushehr province and, by extension, the Iranian population during the first three years of the pandemic.

METHOD

This retrospective study was performed to estimate the DALY of COVID-19 in Iran and Bushehr province from 2021 to 2023. The concentration index and Gini coefficient were used to measure Covid-related deaths among the counties of Bushehr provinces according to the availability of hospital beds. A one-way sensitivity analysis was also performed to account for data uncertainties.

RESULT

The study revealed that during the study period, there were 2,554 deaths due to COVID-19 in Bushehr province. The calculated DALYs for Bushehr province and Iran were 36,004 and 2,073,036, respectively. Among these DALYs, 99.25% were YLLs, while the remaining 0.75% were YLDs. In Bushehr province, the concentration index and calculated Gini coefficient for 2022 were 0.25 and 0.49, respectively.

CONCLUSION

The results revealed that the burden of COVID-19 in Iran was significantly high in 2021 and 2022. Implementing specific policies and strategies at the national level is imperative. These policies should prioritize the allocation of vital resources, improve disease surveillance systems, and optimize service delivery. Concurrently, at the provincial level, concerted efforts must be made to enhance inter-sectoral collaboration, promote health literacy, and effectively monitor processes.

The burden of COVID-19 based on disability-adjusted life years: a systematic review of available evidence

Background

The present study tries to evaluate and summarize the available evidence to provide insights into the COVID-19 burden worldwide using disability-adjusted life years (DALYs) and compare the level of damage across countries during this pandemic.

Method

We conducted a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to investigate the global burden of COVID-19. Studies were identified through searches conducted on Ovid Medline, Cochrane, Science Direct, Scopus, and PubMed databases as well as, the Google Scholar search engine. All stages of the search, study selection, qualitative assessment, and data extraction were carried out by two authors separately. Any disagreement among reviewers was resolved by discussion.

Results

The total DALYs incurred by COVID-19 varied widely among nations, with rates per 100,000 population ranging from approximately 5 in Korea to 5,363 in the US. Deaths due to COVID-19 could substantially impact years of life lost (YLLs), emerging as a major contributing factor to DALYs. Furthermore, unlike in high-income countries, a significant proportion of YLLs in low- and middle-income countries is associated with individuals dying at younger ages. Years lived with disability (YLDs) were also identified as a minor contributing factor to DALY estimates associated with COVID-19.

Conclusion

Our findings from this investigation provide valuable insights into the impacts of COVID-19 on global health that may be an important basis for assessing its global burden, facilitating international comparisons, and allocating efforts to manage the epidemic. However, challenges persist in identifying and quantifying the economic costs and non-health effects of the event on an international scale.

Designing a model to estimate the burden of COVID-19 in Iran

The novel coronavirus disease 2019 (COVID-19) is the latest evidence of an epidemic disease resulting in an extraordinary number of infections and claimed several lives, along with extensive economic and social consequences. In response to the emergency situation, countries introduced different policies to address the situation, with different levels of efficacy. This paper outlines the protocol for developing a model to analyze the burden of COVID-19 in Iran and the effect of policies on the incidence and cumulative death of the disease. The importance of the model lies in the fact that no study, according to the authors' best knowledge, tried to quantify the impact of the disease on Iran society and the impact of various implemented interventions on disease control. Based on a systematic review of COVID-19 prediction models and expert interviews, we developed a system dynamics model that not only includes an epidemic part but also considers the impact of various policies implemented by the Ministry of Health. The epidemic model estimates the incidence and mortality of COVID-19 in Iran. The model also intends to evaluate the effect of implemented policies on these outcomes. The model reflects the continuum of COVID-19 infection and care in Iran (of which some of its elements are unique) and key activities and decisions in delivering care. The model is calibrated and validated using data published by the Ministry of Health of Iran. Finally, the study aims to provide evidence of the impact of interventions intended to curb COVID-19 in Iran. Insights provided by the model will be necessary for controlling either future waves of the disease or similar future pandemics.

Age and sex differences in cause-specific excess mortality and years of life lost associated with COVID-19 infection in the Swedish population

BACKGROUND

Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic.

METHODS

In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017-19 in the whole Swedish population.

RESULTS

COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65-110 years and women aged 75-110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020.

CONCLUSIONS

Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.

Years of life lost to COVID-19 in 49 countries: A gender- and life cycle-based analysis of the first two years of the pandemic

Specific mortality rates have been widely used to monitor the main impacts of the COVID-19 pandemic; however, a more meaningful measure is the Years of Life Lost (YLL) due to the disease, considering it takes into account the premature nature of each death. We estimated the YLL due to COVID-19 between January 2020 and December 2021 in 49 countries for which information was available, developing an analytical method that mathematically refines that proposed by the World Health Organization. We then calculated YLL rates overall, as well as by sex and life cycle. Additionally, we estimated the national cost-effective budgets required to manage COVID-19 from a health system perspective. During the two years of analysis, we estimated that 85.6 million years of life were lost due to COVID-19 in the 49 countries studied. However, due to a lack of data, we were unable to analyze the burden of COVID-19 in about 75% of the countries in the world. We found no difference in the magnitude of YLL rates by gender but did find differences according to life cycle, with older adults contributing the greatest burden of YLL. The COVID-19 pandemic has posed a significant burden of disease, which has varied between countries. However, due to the lack of quality and disaggregated data, it has been difficult to monitor and compare the pandemic internationally. Therefore, it is imperative to strengthen health information systems in order to prepare for future pandemics as well as to evaluate their impacts.

Updating Korean Disability Weights for Causes of Disease: Adopting an Add-on Study Method

OBJECTIVES

Disability weights require regular updates, as they are influenced by both diseases and societal perceptions. Consequently, it is necessary to develop an up-to-date list of the causes of diseases and establish a survey panel for estimating disability weights. Accordingly, this study was conducted to calculate, assess, modify, and validate disability weights suitable for Korea, accounting for its cultural and social characteristics.

METHODS

The 380 causes of disease used in the survey were derived from the 2019 Global Burden of Disease Collaborative Network and from 2019 and 2020 Korean studies on disability weights for causes of disease. Disability weights were reanalyzed by integrating the findings of an earlier survey on disability weights in Korea with those of the additional survey conducted in this study. The responses were transformed into paired comparisons and analyzed using probit regression analysis. Coefficients for the causes of disease were converted into predicted probabilities, and disability weights in 2 models (model 1 and 2) were rescaled using a normal distribution and the natural logarithm, respectively.

RESULTS

The mean values for the 380 causes of disease in models 1 and 2 were 0.488 and 0.369, respectively. Both models exhibited the same order of disability weights. The disability weights for the 300 causes of disease present in both the current and 2019 studies demonstrated a Pearson correlation coefficient of 0.994 (p=0.001 for both models). This study presents a detailed add-on approach for calculating disability weights.

CONCLUSIONS

This method can be employed in other countries to obtain timely disability weight estimations.

Economic evaluation of strategies against coronavirus: a systematic review

BACKGROUND

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

MATERIAL AND METHOD

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

RESULTS

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

CONCLUSION

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

Years of life lost (YLL) associated with COVID-19 deaths in Khorasan-RAZAVI province, Iran

BACKGROUND

The number of deaths among people with coronavirus disease 2019 (COVID-19) does not show the true impact of the disease on communities. Therefore, this study aimed to calculate years of life lost (YLL) due to premature death in patients with COVID-19.

METHODS

We performed a descriptive cross-sectional study based on data from one of the largest provinces of Iran, in the period 13 February 2020 to 17 May 2021. We used WHO proposed guidelines for the calculation of the burden of diseases to calculate the YLL among patients with COVID-19, taking into consideration gender in different age groups.

RESULTS

Findings showed that 13 628 deaths were due to COVID-19 with associated 249 309 YLL. The study reported higher mortality among men (1222 cases) in the age group over 85 years than in women (840) of the same age group. The minimum number of YLL for men was 1749 in the 5-9 years age group and that for women was 1551 years in the 14-10 years age group.

CONCLUSION

The high number of deaths due to COVID-19 has led to high YLL due to premature death. The provision of adequate health care and appropriate policies will bring about a decrease in YLL due to COVID-19.

Disability-adjusted life years (DALYs) based COVID-19 health impact assessment: a systematic review

BACKGROUND

The emergence of COVID-19 has resulted in health, socio-economic, and political crises. The overall health impact of this disease can be measured by disability-adjusted life years (DALYs) which is the sum of the life years lost due to disability (YLDs) and the years life lost due to premature death (YLLs). The overarching objective of this systematic review was to identify the health burdens of COVID-19 and summarise the literature that can aid health regulators to make evidence-based decisions on COVID-19 mitigation strategies.

METHODS

This systematic review was conducted using the PRISMA 2020 guidelines. DALYs-based primary studies were collected from databases, manual searches, and included studies' references. The primary studies published in English language, conducted since the emergence of COVID-19, and using DALYs or its subsets (years life lost due to disability and/or years life lost due to premature death) as health impact metrics, were the inclusion criteria. The combined disability and mortality health impact of COVID-19 was measured in DALYs. The risk of bias due to literature selection, identification, and reporting processes was assessed using the Joanna Bridges Institute critical appraisal tool for cross-sectional studies, and the certainty of evidence was assessed using the GRADE Pro tool.

RESULT

Of the 1459 identified studies, twelve of them were eligible for inclusion in the review. The years life lost due to COVID-19 related mortality was dominant over the years life lost due to COVID-19 related disability (disability times from the onset of COVID-19 to recovery, from diseases occurrence to mortality, and the long-term consequences of COVID-19) in all included studies. The long-term consequence disability time and the pre-death disability time were not assessed by most of the reviewed articles.

CONCLUSION

The impact of COVID-19 on both the length and quality of life has been substantial and has been causing considerable health crises worldwide. The health burden of COVID-19 was greater than other infectious diseases. Further studies focussing on issues examining increasing preparedness for future pandemics, public sensitization, and multi-sectorial integration are recommended.

Economic evaluation of COVID-19 vaccination: A systematic review

Background

Safe and effective vaccination is considered to be the most critical strategy to fight coronavirus disease 2019 (COVID-19), leading to individual and herd immunity protection. We aimed to systematically review the economic evaluation of COVID-19 vaccination globally.

Methods

We performed a systematic search to identify relevant studies in two major databases (MEDLINE/PubMed and EBSCO) published until September 8, 2022. After deduplication, two researchers independently screened the study titles and abstracts according to pre-determined inclusion and exclusion criteria. The remaining full-text studies were assessed for eligibility. We assessed their quality of reporting using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist and summarized and narratively presented the results.

Results

We identified 25 studies that assessed the economic evaluation of COVID-19 vaccination worldwide by considering several input parameters, including vaccine cost, vaccine efficacy, utility value, and the size of the targeted population. All studies suggested that COVID-19 vaccination was a cost-effective or cost-saving intervention for mitigating coronavirus transmission and its effect in many countries within certain conditions. Most studies reported vaccine efficacy values ranging from 65% to 75%.

Conclusions

Given the favorable cost-effectiveness profile of COVID-19 vaccines and disparities in affordability across countries, considering prioritization has become paramount. This review provides comprehensive insights into the economic evaluation of COVID-19 vaccination that will be useful to policymakers, particularly in highlighting preventive measures and preparedness plans for the next possible pandemic.

Disability-adjusted life years (DALYs) based COVID-19 health impact assessment: A systematic review protocol

Background

COVID-19 is a highly contagious infectious disease that emerged in 2019. This disease is causing devastating health, socio-economic, and economic crises. More specifically COVID-19 is affecting both the quality and length of human life. The overall health impact of this disease is measured by the disability-adjusted life years which is the sum of the life years lost due to disability (the effect on the health quality) and the years life lost due to premature death (effect on the length of life). The purpose of this review is to summarise DALYs-based health impact publications and produce compiled and informative literature that can aid the health regulators to make evidence-based decisions on mitigating COVID-19.

Methods

The review will be conducted using the PRISMA 2020 guidelines. The DALYs-based original observational and cross-sectional studies will be collected for assessing the health impact of COVID-19. Both the life quality and length impacts of COVID-19 will be reviewed. The life quality impact of COVID-19 will be measured using the life years lost due to disability (pre-recovery illness, pre-death illness, and post-acute consequences), and its impact on the length of life will be measured with years of life lost due to premature death (shortening of life expectancy). The combined health impact of COVID-19 on the quality and length of life will be measured in disability-adjusted life years.

Discussion

The impacts of COVID-19 on the two health outcomes (quality and length of life) will indicate the level of COVID-19 health burden. The increase or decrease of COVID-19 health impact might be due to the sample size differences of different studies and the omission of years lost due to post-acute consequences in some studies. After having a summarized systematic review health decision-makers will apply an impact-based response to COVID-19.

Trail registration

Systematic review registration: This protocol is pre-registered in PROSPERO with the registration number CRD42022324931.

Years of life lost associated with COVID-19 deaths in the USA during the first 2 years of the pandemic

Background

Prior estimates of the years of life lost (YLLs) in the USA associated with coronavirus disease 2019 (COVID-19) were 1.2 million through 11 July 2020 and 3.9 million through 31 January 2021 (which roughly coincides with the first full year of the pandemic). The aim of this study is to update YLL estimates through the first 2 years of the pandemic.

Methods

We employed data regarding COVID-19 deaths through 5 February 2022 by jurisdiction, gender and age group. We used actuarial life expectancy tables by gender and age to estimate YLLs.

Results

We estimated roughly 9.7 million YLLs due to COVID-19 deaths. The number of YLLs per 10 000 capita was 297.5, with the highest rate in Mississippi (482.7) and the lowest in Vermont (61.4). There was substantial interstate variation in the timing of YLLs and differences in YLLs by gender. YLLs per death increased from 9.2 in the first year of the pandemic to 10.8 through the first 2 years.

Conclusions

Our findings improve our understanding of how the mortality effects of COVID-19 have evolved. This insight can be valuable to public health officials as the disease moves to an endemic phase.

Is Mandatory Vaccination in Population over 60 Adequate to Control the COVID-19 Pandemic in E.U.?

Vaccine hesitancy, which potentially leads to the refusal or delayed acceptance of COVID-19 vaccines, is considered a key driver of the increasing death toll from the pandemic in the EU. The European Commission and several member states’ governments are either planning or have already directly or indirectly announced mandatory vaccination for individuals aged over 60, the group which has repeatedly proved to be the most vulnerable. In this paper, an assessment of this strategy’s benefits is attempted by deriving a metric for the potential gains of vaccination mandates that can be used to compare EU member states. This is completed by examining the reduction in Standard Expected Years of Life Lost (SEYLL) per person for the EU population over 60 as a function of the member states’ vaccination percentage in these ages. The publicly available data and results of the second iteration of the SHARE COVID-19 survey on the acceptance of COVID-19 vaccines, conducted during the summer of 2021, are used as inputs.

Disability-adjusted life years (DALYs) due to the direct health impact of COVID-19 in India, 2020

COVID-19 has affected all countries. Its containment represents a unique challenge for India due to a large population (> 1.38 billion) across a wide range of population densities. Assessment of the COVID-19 disease burden is required to put the disease impact into context and support future pandemic policy development. Here, we present the national-level burden of COVID-19 in India in 2020 that accounts for differences across urban and rural regions and across age groups. Input data were collected from official records or published literature. The proportion of excess COVID-19 deaths was estimated using the Institute for Health Metrics and Evaluation, Washington data. Disability-adjusted life years (DALY) due to COVID-19 were estimated in the Indian population in 2020, comprised of years of life lost (YLL) and years lived with disability (YLD). YLL was estimated by multiplying the number of deaths due to COVID-19 by the residual standard life expectancy at the age of death due to the disease. YLD was calculated as a product of the number of incident cases of COVID-19, disease duration and disability weight. Scenario analyses were conducted to account for excess deaths not recorded in the official data and for reported COVID-19 deaths. The direct impact of COVID-19 in 2020 in India was responsible for 14,100,422 (95% uncertainty interval [UI] 14,030,129–14,213,231) DALYs, consisting of 99.2% (95% UI 98.47–99.64%) YLLs and 0.80% (95% UI 0.36–1.53) YLDs. DALYs were higher in urban (56%; 95% UI 56–57%) than rural areas (44%; 95% UI 43.4–43.6) and in men (64%) than women (36%). In absolute terms, the highest DALYs occurred in the 51–60-year-old age group (28%) but the highest DALYs per 100,000 persons were estimated for the 71–80 years old age group (5481; 95% UI 5464–5500 years). There were 4,815,908 (95% UI 4,760,908–4,924,307) DALYs after considering reported COVID-19 deaths only. The DALY estimations have direct and immediate implications not only for public policy in India, but also internationally given that India represents one sixth of the world’s population.

Premature mortality attributable to COVID-19: potential years of life lost in 17 countries around the world, January-August 2020

BACKGROUND

Understanding the impact of the burden of COVID-19 is key to successfully navigating the COVID-19 pandemic. As part of a larger investigation on COVID-19 mortality impact, this study aims to estimate the Potential Years of Life Lost (PYLL) in 17 countries and territories across the world (Australia, Brazil, Cape Verde, Colombia, Cyprus, France, Georgia, Israel, Kazakhstan, Peru, Norway, England & Wales, Scotland, Slovenia, Sweden, Ukraine, and the United States [USA]).

METHODS

Age- and sex-specific COVID-19 death numbers from primary national sources were collected by an international research consortium. The study period was established based on the availability of data from the inception of the pandemic to the end of August 2020. The PYLL for each country were computed using 80 years as the maximum life expectancy.

RESULTS

As of August 2020, 442,677 (range: 18-185,083) deaths attributed to COVID-19 were recorded in 17 countries which translated to 4,210,654 (range: 112-1,554,225) PYLL. The average PYLL per death was 8.7 years, with substantial variation ranging from 2.7 years in Australia to 19.3 PYLL in Ukraine. North and South American countries as well as England & Wales, Scotland and Sweden experienced the highest PYLL per 100,000 population; whereas Australia, Slovenia and Georgia experienced the lowest. Overall, males experienced higher PYLL rate and higher PYLL per death than females. In most countries, most of the PYLL were observed for people aged over 60 or 65 years, irrespective of sex. Yet, Brazil, Cape Verde, Colombia, Israel, Peru, Scotland, Ukraine, and the USA concentrated most PYLL in younger age groups.

CONCLUSIONS

Our results highlight the role of PYLL as a tool to understand the impact of COVID-19 on demographic groups within and across countries, guiding preventive measures to protect these groups under the ongoing pandemic. Continuous monitoring of PYLL is therefore needed to better understand the burden of COVID-19 in terms of premature mortality.

Decrease in life expectancy due to COVID-19 disease not offset by reduced environmental impacts associated with lockdowns in Italy

The consequence of the lockdowns implemented to address the COVID-19 pandemic on human health damage due to air pollution and other environmental issues must be better understood. This paper analyses the effect of reducing energy demand on the evolution of environmental impacts during the occurrence of 2020-lockdown periods in Italy, with a specific focus on life expectancy. An energy metabolism analysis is conducted based on the life cycle assessment (LCA) of all monthly energy consumptions, by sector, category and province area in Italy between January 2015 to December 2020. Results show a general decrease (by ∼5% on average) of the LCA midpoint impact categories (global warming, stratospheric ozone depletion, fine particulate matter formation, etc.) over the entire year 2020 when compared to past years. These avoided impacts, mainly due to reductions in fossil energy consumptions, are meaningful during the first lockdown phase between March and May 2020 (by ∼21% on average). Regarding the LCA endpoint damage on human health, ∼66 Disability Adjusted Life Years (DALYs) per 100,000 inhabitants are estimated to be saved. The analysis shows that the magnitude of the officially recorded casualties is substantially larger than the estimated gains in human lives due to the environmental impact reductions. Future research could therefore investigate the complex cause-effect relationships between the deaths occurred in 2020 imputed to COVID-19 disease and co-factors other than the SARS-CoV-2 virus.

Disability-Adjusted Life Years for the COVID-19 Pandemic in the Mexican Population

Mexico is one of the countries most affected by the COVID-19 disease. Although there is vast information on the disease, there still are unknown data on the societal and economic cost of the pandemic. To estimate this impact, the disability-adjusted life years (DALYs) can be a useful tool. Objective: To assess the DALYs due to COVID-19 in Mexico. Methods: We used the data released by the Mexican Ministry of Health to estimate the DALYs by the sum of the years of life lived with disability (YLDs) and the years of life lost (YLLs). Results: A total of 1,152,885 confirmed cases and 324,570 suspected cases of COVID-19 have been registered. Half of the cases were men, with a median age of 43.4 ± 16.9 years. About 8.3% died. A total of 39,202 YLDs were attributable to COVID-19. The total YLLs caused by COVID-19 were 2,126,222. A total of 2,165,424.5 DALYs for COVID-19 were estimated. The total DALYs were the highest in people between 50 and 59 years. The DALYs for each COVID-19 case were the highest in individuals between 60 and 79 years. Conclusion: The DALYs generated by the COVID-19 represent a more significant disease burden than that reported for other causes, such as the 2009 H1N1 influenza pandemic. Although it impacts all age groups in terms of disability, the most affected group are people over 50 years of age, whose risk of death is higher.

COVID-19 and the Authority of Science

In an attempt to respond effectively to the COVID-19 pandemic, policy makers and scientific experts who advise them have aspired to present a unified front. Leveraging the authority of science, they have at times portrayed politically favored COVID interventions, such as lockdowns, as strongly grounded in scientific evidence—even to the point of claiming that enacting such interventions is simply a matter of “following the science.” Strictly speaking, all such claims are false, since facts alone never yield moral-political conclusions. More importantly, attempts to present a unified front have led to a number of other actions and statements by scientists and policy makers that erode the authority of science. These include actions and statements that: (1) mislead the public about epidemiological matters such as mortality rates, cause of death determinations, and computerized modeling, or fail to correct mainstream media sources that interpret such concepts in misleading ways; (2) incorporate moral-political opinions into ostensible statements of fact; and (3) misrepresent or misuse scientific expertise. The fundamental thesis of the paper is not primarily that such actions and statements have proliferated during the COVID-19 epidemic (though I think they have), but rather that they are unscientific and that presenting them as science undermines the authority of science. In the moral-political realm, the great power of science and the source of its authority derives from its agnosticism about fundamental moral-political claims. Science, for instance, has no built-in presumption that we should respect life, promote freedom, or practice toleration; nor does it tell us which of these values to prioritize when values conflict. Because of this agnosticism, science is recognized across a broad diversity perspectives as morally and politically impartial, and authoritative within its proper sphere. When it is infused with partisan bias, it loses that authority.

Impact of COVID-19 on care-home mortality and life expectancy in Scotland

BACKGROUND

COVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified.

METHODS

Care-home residency was identified via a national primary care registration database linked to mortality data. Life expectancy was estimated using Makeham-Gompertz models to (i) describe yearly life expectancy from November 2015 to October 2020 (ii) compare life expectancy (during 2016-18) between care-home residents and the wider population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL).

RESULTS

Among care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Age-sex-specific life expectancy in 2016-18 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90, respectively). Applying care home-specific life expectancies to COVID-19 deaths yield mean YLLs for care-home residents of 2.6 and 2.2 for women and men, respectively. In total YLL care-home residents have lost 3,560 years in women and 2,046 years in men. Approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents.

CONCLUSION

COVID-19 infection has led to the loss of substantial years of life in care-home residents aged 70 years and over in Scotland. Prioritising the 5% of older adults who are care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of YLL.

Years of life lost by COVID-19 in Portugal and comparison with other European countries in 2020

BACKGROUND

The impact of the COVID-19 pandemic has been measured in different metrics, mostly by counting deaths and its impact on health services. Few studies have attempted to calculate years of life lost (YLL) to COVID-19 and compare it with YLL due to other causes in different countries.

METHODS

We calculated YLL to COVID-19 from week10 to week52 in 2020 for eight European countries by methods defined by the WHO. We calculated excess YLL by subtracting the average YLL from 2017 to 2019 to the YLL in 2020. Our analysis compared YLL to COVID-19 and the excess YLL of non-COVID-19 causes across countries in Europe.

RESULTS

Portugal registered 394,573 cases and 6619 deaths due to COVID-19, accounting for 25,395 YLL in just 10 months. COVID-19 was responsible for 6.7% of all deaths but accounted for only 4.2% of all YLL. We estimate that Portugal experienced an excess of 35,510 YLL (+ 6.2%), of which 72% would have been due to COVID-19 and 28% due to non-COVID-19 causes. Spain, Portugal, and the Netherlands experienced excess YLL to non-COVID-19 causes. We also estimated that Portugal experienced an excess of 10,115 YLL due to cancer (3805), cardiovascular diseases (786) and diseases of the respiratory system (525).

CONCLUSION

COVID-19 has had a major impact on mortality rates in Portugal, as well as in other European countries. The relative impact of COVID-19 on the number of deaths has been greater than on the number of YLL, because COVID-19 deaths occur mostly in advanced ages.

Disease burden from COVID-19 symptoms among inpatients at the temporary military hospitals in Wuhan: a retrospective multicentre cross-sectional study

OBJECTIVES

We aimed to establish a set of disability weights (DWs) for COVID-19 symptoms, evaluate the disease burden of inpatients and analyse the characteristics and influencing factors of the disease.

DESIGN

This was a multicentre retrospective cross-sectional descriptive study.

SETTING

The medical records generated in three temporary military hospitals in Wuhan.

PARTICIPANTS

Medical records of 2702 inpatients generated from 5 February to 5 April 2020 were randomly selected for this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

DWs of COVID-19 symptoms were determined by the person trade-off approach. The inpatients' medical records were analysed and used to calculate the disability-adjusted life years (DALYs). The mean DALY was evaluated across sex and age groups. The relationship between DALY and age, sex, body mass index, length of hospital stay, symptom duration before admission and native place was determined by multiple linear regression.

RESULTS

For the DALY of each inpatient, severe expiratory dyspnoea, mild cough and sore throat had the highest (0.399) and lowest (0.004) weights, respectively. The average synthetic DALY and daily DALY were 2.29±1.33 and 0.18±0.15 days, respectively. Fever and fatigue contributed the most DALY at 31.36%, whereas nausea and vomiting and anxiety and depression contributed the least at 7.05%. There were significant differences between sex and age groups in both synthetic and daily DALY. Age, body mass index, length of hospital stay and symptom duration before admission were strongly related to both synthetic and daily DALY.

CONCLUSIONS

Although the disease burden was higher among women than men, their daily disease burdens were similar. The disease burden in the younger population was higher than that in the older population. Treatment at the hospitals relieved the disease burden efficiently, while a delay in hospitalisation worsened it.

Risk Factors of Outcomes of COVID-19 Patients in Korea: Focus on Early Symptoms

BACKGROUND

Coronavirus disease 2019 (COVID-19) has spread around the globe, and it is important to determine the risk factors of death in the general population. Our study aimed to determine the risk factors of death and severe illness requiring supplemental oxygen therapy based on the demographic and clinical characteristics of COVID-19 patients in Korea.

METHODS

In this study, we used data provided by the Korea Disease Control and Prevention Agency (KDCA) and analyzed a total of 5,068 patients with COVID-19, excluding 19 pregnant women and 544 individuals with missing data. We performed logistic regression analysis to determine the impact of early symptoms on survival and severe disease. Logistic regression models included sex, age, number of comorbidities, symptoms on admission, blood pressure, heart rate, and body temperature as explanatory variables, and death and oxygen therapy as outcome variables.

RESULTS

Logistic regression analyses revealed that the male sex, older age (≥ 60 years), higher number of comorbidities, presence of symptoms on admission, heart rate ≥ 120 bpm, and body temperature ≥ 37.5°C presented with higher risk of in-hospital death and oxygen therapy requirement. Conversely, rhinorrhea and headache were associated with a low risk of death and oxygen therapy requirement. The findings showed that cough, sputum, and fever were the most common symptoms on admission, while 25.3% of patients with COVID-19 were asymptomatic.

CONCLUSION

COVID-19 patients with high-risk early symptoms on admission, such as dyspnea and altered mental status, and those without low-risk symptoms of rhinorrhea and headache should be included in priority treatment groups.

Male-Female Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: A State-by-State Analysis

Males are at higher risk relative to females of severe outcomes following COVID-19 infection. Focusing on COVID-19-attributable mortality in the United States (U.S.), we quantify and contrast years of potential life lost (YPLL) attributable to COVID-19 by sex based on data from the U.S. National Center for Health Statistics as of 31 March 2021, specifically by contrasting male and female percentages of total YPLL with their respective percent population shares and calculating age-adjusted male-to-female YPLL rate ratios both nationally and for each of the 50 states and the District of Columbia. Using YPLL before age 75 to anchor comparisons between males and females and a novel Monte Carlo simulation procedure to perform estimation and uncertainty quantification, our results reveal a near-universal pattern across states of higher COVID-19-attributable YPLL among males compared to females. Furthermore, the disproportionately high COVID-19 mortality burden among males is generally more pronounced when measuring mortality in terms of YPLL compared to age-irrespective death counts, reflecting dual phenomena of males dying from COVID-19 at higher rates and at systematically younger ages relative to females. The U.S. COVID-19 epidemic also offers lessons underscoring the importance of a public health environment that recognizes sex-specific needs as well as different patterns in risk factors, health behaviors, and responses to interventions between men and women. Public health strategies incorporating focused efforts to increase COVID-19 vaccinations among men are particularly urged.

Years of life lost associated with COVID-19 deaths in the USA during the first year of the pandemic

Background

Years of Life Lost (YLLs) measure the shortfall in life expectancy due to a medical condition and have been used in multiple contexts. Previously it was estimated that there were 1.2 million YLLs associated with coronavirus disease 2019 (COVID-19) deaths in the USA through 11 July 2020. The aim of this study is to update YLL estimates for the first full year of the pandemic.

Methods

We employed data regarding COVID-19 deaths in the USA through 31 January 2021 by jurisdiction, gender and age group. We used actuarial life expectancy tables by gender and age to estimate YLLs.

Results

We estimated roughly 3.9 million YLLs due to COVID-19 deaths, which correspond to roughly 9.2 YLLs per death. We observed a large range across states in YLLs per 10 000 capita, with New York City at 298 and Vermont at 12. Nationally, the YLLs per 10 000 capita were greater for males than females (136.3 versus 102.3), but there was significant variation in the differences across states.

Conclusions

Our estimates provide further insight into the mortality effects of COVID-19. The observed differences across states and genders demonstrate the need for disaggregated analyses of the pandemic’s effects.

Estimation of Excess Mortality and Years of Life Lost to COVID-19 in Norway and Sweden between March and November 2020

We estimate the weekly excess all-cause mortality in Norway and Sweden, the years of life lost (YLL) attributed to COVID-19 in Sweden, and the significance of mortality displacement. We computed the expected mortality by taking into account the declining trend and the seasonality in mortality in the two countries over the past 20 years. From the excess mortality in Sweden in 2019/20, we estimated the YLL attributed to COVID-19 using the life expectancy in different age groups. We adjusted this estimate for possible displacement using an auto-regressive model for the year-to-year variations in excess mortality. We found that excess all-cause mortality over the epidemic year, July 2019 to July 2020, was 517 (95%CI = (12, 1074)) in Norway and 4329 [3331, 5325] in Sweden. There were 255 COVID-19 related deaths reported in Norway, and 5741 in Sweden, that year. During the epidemic period of 11 March–11 November, there were 6247 reported COVID-19 deaths and 5517 (4701, 6330) excess deaths in Sweden. We estimated that the number of YLL attributed to COVID-19 in Sweden was 45,850 [13,915, 80,276] without adjusting for mortality displacement and 43,073 (12,160, 85,451) after adjusting for the displacement accounted for by the auto-regressive model. In conclusion, we find good agreement between officially recorded COVID-19 related deaths and all-cause excess deaths in both countries during the first epidemic wave and no significant mortality displacement that can explain those deaths.

The COVID-19 Disease Burden in Germany in 2020—Years of Life Lost to Death and Disease Over the Course of the Pandemic

BACKGROUND

The SARS-CoV-2 pandemic presented major challenges to the health sector in 2020. The burden of disease arising from COVID-19 can be expressed as the number of years of life lost to disease or death. For example, death at age 40 involves a loss of far more years of life than death at age 80.

METHODS

The disability-adjusted life years (DALY) lost to COVID-19 were calculated as the sum of the years of life lost through death (YLL) and the number of years lived with disability (YLD), on the basis of laboratory-confirmed notifiable cases of SARS-CoV-2 infection in Germany in 2020 (documented as of 18 January 2021). The methodology was based on that used in the Global Burden of Disease Study. Pre-existing diseases do not enter into the determination of YLL; rather, the residual life expectancy that is applied in this calculation corresponds to a mean age-specific level of morbidity.

RESULTS

305 641 years of life were lost to COVID-19 in Germany in 2020. The percentage of DALY lost by persons under 70 was 34.8% in men and 21.0% in women. 99.3% of the COVID-19 disease burden was accounted for by death (YLL). The daily average years of life lost due to death was lower for COVID-19 than for the major non-communicable diseases. Persons who died of COVID-19 lost a mean of 9.6 years of life; those who were under 70 when they died lost a mean of 25.2 years of life. Men lost more years of life than women (11.0 vs. 8.1 years).

CONCLUSION

The effects of COVID-19 on public health can be expressed through the burden of disease indicators. This method yields additional information that should be put to use early in the course of future outbreaks.

Economic evaluation of programs against COVID-19: A systematic review

BACKGROUND

The COVID-19 pandemic has become a public health emergency and raised global concerns in about 213 countries without vaccines and with limited medical capacity to treat the disease. The COVID-19 has prompted an urgent search for effective interventions, and there is little information about the money value of treatments. The present study aimed to summarize economic evaluation evidence of preventing strategies, programs, and treatments of COVID-19.

MATERIAL AND METHODS

We searched Medline/PubMed, Cochrane Library, Web of Science Core Collection, Embase, Scopus, Google Scholar, and specialized databases of economic evaluation from December 2019 to July 2020 to identify relevant literature to economic evaluation of programs against COVID-19. Two researchers screened titles and abstracts, extracted data from full-text articles, and did their quality assessment by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Then, quality synthesis of results was done.

RESULTS

Twenty-six studies of economic evaluations met our inclusion criteria. The CHEERS scores for most studies (n = 9) were 85 or higher (excellent quality). Eight studies scored 70 to 85 (good quality), eight studies scored 55 to 70 (average quality), and one study < %55 (poor quality). The decision-analytic modeling was applied to twenty-three studies (88%) to evaluate their services. Most studies utilized the SIR model for outcomes. In studies with long-time horizons, social distancing was more cost-effective than quarantine, non-intervention, and herd immunity. Personal protective equipment was more cost-effective in the short-term than non-intervention. Screening tests were cost-effective in all studies.

CONCLUSION

The results suggested screening tests and social distancing to be cost-effective alternatives in preventing and controlling COVID-19 on a long-time horizon. However, evidence is still insufficient and too heterogeneous to allow any definite conclusions regarding costs of interventions. Further research as are required in the future.