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

COVID-19 Disease and Economic Burden to Healthcare Systems in Adults in Six Latin American Countries Before Nationwide Vaccination Program: Ministry of Health Database Assessment and Literature Review

The COVID-19 pandemic imposed a substantial burden on healthcare systems worldwide, yet reliable data on COVID-19 morbidity, mortality, and healthcare costs in Latin America remain limited. This study explored the disease and economic burden of COVID-19 in Argentina, Brazil, Chile, Colombia, Mexico, and Peru during the pre-vaccination period. Using national databases and a systematic review of the literature, we analyzed data on adults aged 18 and older, reporting cases, death rates, years of life lost, excess mortality, and direct medical costs. Before vaccination programs began, the average COVID-19 incidence rate was 6741 per 100,000 adults. Of these, 91% were mild cases, 7% moderate/severe, and 2% critical. Among 2,201,816 hospitalizations, 27.8% required intensive care, and 17.5% required mechanical ventilation. Excess mortality ranged from 76 to 557 per 100,000, and years of life lost spanned 241,089 to 3,312,346. Direct medical costs ranged from USD 258 million to USD 10,437 million, representing 2-5% of national health expenditures. The findings highlight significant variability across countries and provide crucial insights to help policymakers to make informed decisions and allocate resources effectively to improve national strategies around surveillance, preventive and treatment strategies to control the spread of COVID-19 disease in the future.

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.

Disability-adjusted life years associated with COVID-19 in Brazil, 2020

BACKGROUND

We quantified the national- and state-level burden of COVID-19 in Brazil and its states during 2020 and contrasted it to the burden from other causes of disease and injury.

METHODS

We used national surveillance data on COVID-19 cases, hospitalisations and deaths between February/2020 to December/2020. We calculated disability-adjusted life years (DALYs) based on the COVID-19 consensus model and methods developed by the European Burden of Disease Network, which includes mild to moderate, severe, and critical COVID-19 cases, long covid and deaths due to COVID-19. We used Brazil DALYs estimates from the Global Burden of Disease Collaborative Network to compare the COVID-19 burden to that from other causes of disease and injury.

RESULTS

COVID-19's led to 5,445,785 DALYs, or 2,603 DALYs/100,000, with > 99% of the burden caused by mortality. Males accounted for the largest fraction of DALYs (3,214,905 or 59%) and DALYs per 100,000 population (140,594 or 63%). Most populated states experienced the highest DALYs. However, the DALYs per 100,000 population were higher in the states of Rio de Janeiro (4,504 DALYs/100,000), Amapá (4,106 DALYs/100,000) and Roraima (3,981 DALYs/100,000). Assuming no major changes in disease burden from other causes of disease and injury from 2019 to 2020 in Brazil, COVID-19's burden would rank as the leading cause of disability in 2020.

CONCLUSIONS

Compared with studies with similar methodology, our findings showed that Brazil experienced the highest COVID-19 burden (per 100,000 population) in the world. COVID-19 severely impacted Brazil's populational health in 2020, highlighting the lack of effective mitigation efforts.

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.

Impact on Fatality Rates and Years of Life Lost During the COVID-19 Pandemic: The Experience of the Mexican Public Health Incident Management Command

BACKGROUND

The SARS-CoV-2 pandemic challenged health systems worldwide. In Mexico, the Public Health Incident Management Command (COISS) strategy was implemented to improve health care for patients with COVID-19 who required hospitalization.

AIM

To evaluate the impact of the COISS strategy on case fatality rates (CFR) and years of life lost (YLL) in hospitalized patients with COVID-19.

MATERIALS AND METHODS

The COISS strategy included eight actions implemented in states with high epidemic risk (COISS states). A secondary analysis of the public database from the Mexican Ministry of Health was performed considering patients with confirmed diagnoses of SARS-CoV-2 infection. The COISS strategy effectiveness was evaluated by its impact on in-hospital CFR and YLL at the beginning (T0) and end (T1) of the third wave, and at the end of the fourth wave (T2) and compared to states without intervention (non-COISS states).

RESULTS

At T0, COISS states showed a higher CFR for hospitalized patients than non-COISS states, which decreased after the strategy implementation. After correction for baseline conditions, lower relative CFR at T1 and T2, compared to T0, and a protective effect in different age groups, especially in those ≥65 years, were found in hospitalized patients in COISS states. The COISS strategy was associated with lower CFR in hospitalized patients with COVID-19 at both T1 and T2. At T0, YLLs were higher in COISS states, but there were no significant differences at T1 and T2.

CONCLUSIONS

COISS interventions effectively reduced CFR in hospitalized patients with COVID-19, providing protection to vulnerable patients and reducing the YLL gap.

Years of Potential Life Lost due to COVID-19 according to race/color and gender in Brazil between 2020 and 2021

Mortality caused by the COVID-19 pandemic has impacted indicators of Years of Potential Life Lost (YPLL) worldwide. This study aimed to estimate the YPLL due to mortality caused by COVID-19, according to sex, age group, and race/color in Brazil, from March 2020 to December 2021. Deaths caused by COVID-19 were characterized, in which the rates and ratios of standardized YPLL rates, the average number of years of potential life lost (ANYPLL), and the average age at death (AAD) were estimated and compared. Overall, 13,776,969.50 potential years of life were lost, which resulted in an average loss of 22.5 potential years not lived. A greater loss of potential years of life was identified in men (58.12%) and in the age groups from 0 to 59 years in the black (58.92%) and indigenous (63.35%) populations, while in the age groups of 60 years and over, a greater loss of YPLL was observed in the white (45.89%) and yellow (53.22%) populations. Women recorded the highest ADD, with the exception of indigenous women. White men (1.63), brown men (1.59), and black men (1.61) had the highest rates when compared to white women. Although COVID-19 has a greater impact on the elderly, it was the black and indigenous populations under the age of 60 who had the greatest loss of potential years of life.

Estimating the disability adjusted life years associated with COVID-19 in Iran for the first 2 years of the pandemic

Background

The World Health Organization (WHO) declared a pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on 11 March 2020. Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality, allowing for comprehensive comparisons of the population. The purpose of this study was to estimate DALYs due to COVID-19 in Iran for the first 2 years of the pandemic.

Methods

DALYs were estimated as the sum of Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) associated with COVID-19 in Iran from 19 February 2020 to 20 March 2022. The life expectancy for COVID-19 YLL estimations was based on the Global Burden of Disease (GBD) 2019 study.

Results

There were 15,639,243 outpatients and 1,170,602 hospitalized confirmed cases, of which 120,965 deaths were as a direct result of COVID-19. DALYs were estimated to be 2,376,552. Overall, YLL contributed to 99.34% of the DALYs, while the remaining 0.66% was attributed to YLD.

Conclusion

COVID-19 had a significant impact on population health in Iran during the first 2 years of the pandemic; this study provides a comprehensive depiction of COVID-19's burden and is helpful for comparing its impact with other diseases in the population and across populations.

Analysis of the Economic Burden of COVID-19 on the Workers of a Teaching Hospital in the Centre of Italy: Changes in Productivity Loss and Healthcare Costs Pre and Post Vaccination Campaign

Introduction: Following the concerning levels of spread and severity of the infection, on 11 March 2020, the World Health Organisation declared the COVID-19 outbreak a pandemic. In response to the pandemic, governments adopted several mitigation strategies. The pandemic posed a great threat to the Italian healthcare workforce (HW), with Italy being one of the hardest-hit countries. The aim of this study is to estimate the economic burden of COVID-19 on the workforce of a teaching hospital in Central Italy. Two periods are compared: 1 March 2020-9 February 2021 vs. 10 February 2021-31 March 2022. Methods: This study is conducted from a societal perspective. The database (n = 3298) of COVID-19-confirmed cases among the HW was obtained from the occupational health office of the hospital. The first entry on the database refers to 1 March 2020. Cost data were used to assess the economic burden of COVID-19 on the hospital workforce. They include two main groups: hourly salaries and medical expenses. The cost of productivity loss, hospital admission, at-home treatments, and contact tracing and screening tests were computed for the first and second periods of the analysis. Results: The total economic burden during the first period is estimated to be around EUR 3.8 million and in the second period EUR 4 million. However, the average cost per person is smaller in the second period (EUR 1561.78) compared to the first one (EUR 5906). In both periods, the cost of productivity loss is the largest component of the economic burden (55% and 57%). The cost of hospital admission decreased by more than 60% in the second period. Conclusion: Outcomes of the analysis suggest that the economic burden of COVID-19 on the HW is higher in the first period of analysis compared to the second period. The main reason could be identified in the shift from more severe and critical confirmed cases to more asymptomatic, mild, and moderate cases. The causes of this shift are not easily detectable. Vaccination, variants of the virus, and an individual's determinants of health could all be causes of the decrease in the economic burden of COVID-19 on the HW. COVID-19 can generate a high economic burden on healthcare workers and, more generally, on HWs. However, a comprehensive estimate of the economic burden of the pandemic needs to integrate the mental health repercussions and the long-term COVID-19 that will become evident in the coming years.

Burden of COVID-19 in Córdoba, A Department of Colombia: Results of Disability-Adjusted Life-Years: Carga de COVID-19 en Córdoba, un Departamento de Colombia: Resultados de los Años de Vida Ajustados por Discapacidad

OBJECTIVES

This study aimed to estimate the burden of acute COVID-19 in Córdoba, one of the most affected departments (states) in Colombia, through the estimation of disability-adjusted life-years (DALYs).

METHODS

DALYs were estimated based on the number of cases of severe acute respiratory syndrome coronavirus 2 infection cases reported by official Colombian sources. A transition probability matrix among severity states was calculated using data obtained from a retrospective cohort that included 1736 COVID-19 confirmed subjects living in Córdoba.

RESULTS

Córdoba had 120.23 deaths per 100 000 habitants during the study period (March 2020 to April 2021). Estimated total DALYs were 49 243 (2692 DALYs per 100 000 inhabitants), mostly attributed to fatal cases (99.7%). On average, 25 years of life were lost because of death by this infection. A relevant proportion of years of life lost because of COVID-19 (46.6%) was attributable to people < 60 years old and was greater in men. People ≥ 60 years old showed greater risk of progression to critical state than people between the age of 35 and 60 years (hazard ratio 2.5; 95% confidence interval 2.5-12.5) and younger than 35 years (9.1; 95% confidence interval 4.0-20.6).

CONCLUSION

In Córdoba, premature mortality because of COVID-19 was substantially represented by people < 60 years old and was greater in males. Our data may be representative of Latin American populations with great infection spread during the first year of the pandemic and contribute to novel methodological aspects and parameter estimations that may be useful to measure COVID-19 burden in other countries of the region.

Burden of COVID‐19 disease in Kurdistan province in west of Iran using disability‐adjusted life years

Background and Aims

During the coronavirus disease 2019 (COVID‐19) pandemic, about seven million people were infected with the disease, of which more than 133,000 died. Health policymakers need to know the extent and magnitude of the disease burden to decide on how much to allocate resources for disease control. The results of this investigation could be helpful in this field.

Methods

We used the secondary data released by the Kurdistan University of Medical Sciences between February 2020 to October 2021 to estimate the age‐sex standardized disability‐adjusted life years (DALY) by the sum of the years of life lived with disability (YLD) and the years of life lost (YLL). We also applied the local and specific values of the disease utility in the calculations.

Results

The total DALY was estimated at 23316.5 and 1385.5 per 100,000 populations The YLD and YLL constituted 1% and 99% of the total DALY, respectively. The DALY per 100,000 populations was highest in the men and people aged more than 65 years, but the prevalence was the highest in people under the age of 40.

Conclusions

Compared to the findings of the “burden of disease study 2019,” the burden of COVID‐19 in Iran is ranked first and eighth among communicable and noncommunicable diseases, respectively. Although the disease affects all groups, the elderly suffer the most from it. Given the very high YLL of COVID‐19, the best strategy to reduce the burden of COVID‐19 in subsequent waves should be to focus on preventing infection in the elderly population and reducing mortality.

Disease burden due to COVID-19 in Taiwan: disability-adjusted life years (DALYs) with implication of Monte Carlo simulations

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) has affected a large number of countries. Informing the public and decision makers of the COVID-19's economic burdens is essential for understanding the real pandemic impact.

METHODS

COVID-19 premature mortality and disability impact in Taiwan was analyzed using the Taiwan National Infectious Disease Statistics System (TNIDSS) by estimating the sex/age-specific years of life lost through death (YLLs), the number of years lived with disability (YLDs), and the disability-adjusted life years (DALYs) from January 2020 to November 2021.

RESULTS

Taiwan recorded 1004.13 DALYs (95% CI: 1002.75-1005.61) per 100,000 population for COVID-19, with YLLs accounting for 99.5% (95% CI: 99.3%99.6%) of all DALYs, with males suffering more from the disease than females. For population aged ≥ 70 years, the disease burdens of YLDs and YLLs were 0.1% and 99.9%, respectively. Furthermore, we found that duration of disease in critical state contributed 63.9% of the variance in DALY estimations.

CONCLUSIONS

The nationwide estimation of DALYs in Taiwan provides insights into the demographic distributions and key epidemiological parameter for DALYs. The essentiality of enforcing protective precautions when needed is also implicated. The higher YLLs percentage in DALYs also revealed the fact of high confirmed death rates in Taiwan. To reduce infection risks and disease, it is crucial to maintain moderate social distancing, border control, hygiene measures, and increase vaccine coverage levels.

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.

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.

The impact of the COVID-19 pandemic on people living with HIV in Zimbabwe

The COVID-19 pandemic was reported from March 2020 in Zimbabwe. COVID-19 containment measures which included repeated lockdowns have disrupted community interactions, reduced working hours, restricted travel and restricted HIV services for people living with HIV (PLHIV), among others. The study adopted a cross-sectional design. Both qualitative and quantitative data were collected in all the 10 provinces and analysed. A sample size of 480 was calculated for the cross-sectional survey. Secondary data on HIV early warning indicators from 2018 to 2021 were extracted from 20 randomly selected health facilities and used for modelling. Mathematical modelling was conducted to assess the impact of COVID-19 on PLHIV. AIDS-related deaths increased from 20 100 in 2019 to 22 200 in 2020. In addition, there were significant years of life lost (yLLs) from premature mortality and years of life lost due to disability (yLDs) from COVID-19. Prevalence of COVID-19 among PLHIV was 4%. COVID-19 vaccination coverage was 64%, which is higher than the national average of 42%. Stress and breach of confidentiality as ARV medicines were given out in open spaces and fear of contracting COVID-19 were the perceived psychological issues. COVID-19 disrupted HIV service provision, increased AIDS-related deaths and caused psychological challenges.

Burden of Disease of COVID-19: Strengthening the Collaboration for National Studies

Objectives

Quantifying the combined impact of morbidity and mortality is a key enabler to assessing the impact of COVID-19 across countries and within countries relative to other diseases, regions, or demographics. Differences in methods, data sources, and definitions of mortality due to COVID-19 may hamper comparisons. We describe efforts to support countries in estimating the national-level burden of COVID-19 using disability-adjusted life years.

Methods

The European Burden of Disease Network developed a consensus methodology, as well as a range of capacity-building activities to support burden of COVID-19 studies. These activities have supported 11 national studies so far, with study periods between January 2020 and December 2021.

Results

National studies dealt with various data gaps and different assumptions were made to face knowledge gaps. Still, they delivered broadly comparable results that allow for interpretation of consistencies, as well as differences in the quantified direct health impact of the pandemic.

Discussion

Harmonized efforts and methodologies have allowed for comparable estimates and communication of results. Future studies should evaluate the impact of interventions, and unravel the indirect health impact of the COVID-19 crisis.

Modelling the potential acute and post-acute burden of COVID-19 under the Australian border re-opening plan

BACKGROUND

Concerns have grown that post-acute sequelae of COVID-19 may affect significant numbers of survivors. However, the analyses used to guide policy-making for Australia's national and state re-opening plans have not incorporated non-acute illness in their modelling. We, therefore, develop a model by which to estimate the potential acute and post-acute COVID-19 burden using disability-adjusted life years (DALYs) associated with the re-opening of Australian borders and the easing of other public health measures, with particular attention to longer-term, post-acute consequences and the potential impact of permanent functional impairment following COVID-19.

METHODS

A model was developed based on the European Burden of Disease Network protocol guideline and consensus model to estimate the burden of COVID-19 using DALYs. Data inputs were based on publicly available sources. COVID-19 infection and different scenarios were drawn from the Doherty Institute's modelling report to estimate the likely DALY losses under the Australian national re-opening plan. Long COVID prevalence, post-intensive care syndrome (PICS) and potential permanent functional impairment incidences were drawn from the literature. DALYs were calculated for the following health states: the symptomatic phase, Long COVID, PICS and potential permanent functional impairment (e.g., diabetes, Parkinson's disease, dementia, anxiety disorders, ischemic stroke). Uncertainty and sensitivity analysis were performed to examine the robustness of the results.

RESULTS

Mortality was responsible for 72-74% of the total base case COVID-19 burden. Long COVID and post-intensive care syndrome accounted for at least 19 and 3% of the total base case DALYs respectively. When included in the analysis, potential permanent impairment could contribute to 51-55% of total DALYs lost.

CONCLUSIONS

The impact of Long COVID and potential long-term post-COVID disabilities could contribute substantially to the COVID-19 burden in Australia's post-vaccination setting. As vaccination coverage increases, the share of COVID-19 burden driven by longer-term morbidity rises relative to mortality. As Australia re-opens, better estimates of the COVID-19 burden can assist with decision-making on pandemic control measures and planning for the healthcare needs of COVID-19 survivors. Our estimates highlight the importance of valuing the morbidity of post-COVID-19 sequelae, above and beyond simple mortality and case statistics.

A One Health strategy for emerging infectious diseases based on the COVID-19 outbreak

Coronavirus disease 2019 (COVID-19) is as an emerging infectious disease (EID) that has caused the worst public health catastrophe of the 21st century thus far. In terms of impact, the COVID-19 pandemic is second only to the Spanish Flu pandemic of 1918 in modern world history. As of 7 September 2021, there have been 220 million confirmed cases of COVID-19 and more than 4.5 million deaths. EIDs pose serious public health and socio-economic risks, and 70% of EIDs originate from wildlife. Preventing development of EIDs such as COVID-19 is a pressing concern. Here, taking the COVID-19 pandemic as an example, we illustrate the disastrous effects of EIDs and assess their emergence and evolution from a One Health perspective. We propose a One Health strategy, centered on ‘moving the gates forward’, for EID prevention and control at the human–animal–environment interface. This strategy may be instructive and provide early warnings of EIDs in the future.

Evaluation of the Effectiveness and Safety of the BNT162b2 COVID-19 Vaccine in the Vaccination Campaign among the Health Workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Health workers, especially those in patient-facing roles, had a significantly increased risk of COVID-19 infection, having serious outcomes, and risking spreading the virus to patients and staff. Vaccination campaign planning suggests allocating initial supplies of BNT162b2 vaccine to health workers given the importance of early protection to safeguard the continuity of care to patients. The aim of the study is to assess the effectiveness and safety of BNT162b2 vaccine among the health workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS (FPG). The retrospective cohort study was conducted among health staff working at the FPG. Vaccination data were collected from hospital records. The primary end points were vaccine effectiveness and safety. A total of 6649 health workers were included, of whom 5162 received injections. There were 14 cases of COVID-19 with onset at least 14 days after the second dose among vaccinated health workers and 45 cases among unvaccinated ones. BNT162b2 was 91.5% effective against COVID-19 (95% credible interval, 84.7% to 95.3%). The safety profile of BNT162b2 vaccine consisted of short-term, non-serious events. The promotion and boost of the COVID-19 vaccination campaign represents a key public health measure useful to curb the spread of the pandemic especially in vulnerable contexts, such as hospitals, where health workers carry out a paramount role for the entire community, and requires further protection with a possible booster dose in view of autumn-winter 2021.

Progression of the Pathway for Public Health Care during the COVID-19 Outbreak at District Health Office

Public health activities under district health offices (DHOs) play a major role in Malaysia's fight against COVID-19. This article aims to describe and illustrate the public health activity pathway in combating the COVID-19 pandemic, and a team of public health workers who are familiar with DHO work settings was created in April 2020 for that purpose. Review of documents and the Ministry of Health's updates was carried out, followed by a series of discussions with stakeholders. Based on the steps in the outbreak investigation tasks, the flow of activities from January to May 2020 was listed in line with the phases of the country's National Movement Control Order 2020. Results show that the activities can be classified into three different sections-namely, the main action areas, category of cases, and level of care. The main process flow of activities comprised the case management and support activities. Case management flow was split into tasks for patients under investigation and persons under surveillance, while the support services existed throughout the phases. The pathways illustrate that the progression of the pandemic translated directly to changes in the pattern of activities, with additional subgroups of activities in accordance with all imposed guidelines.