Impact of the Burden of COVID-19 in Italy: Results of Disability-Adjusted Life Years (DALYs) and Productivity Loss

Molnupiravir Real-World Utilization in COVID-19 Patients in the Czech Republic

Background/Objectives: Molnupiravir (MOV), an oral antiviral COVID-19 treatment, was introduced in the Czech Republic in December 2021 for COVID-19 patients at a high risk of progression to severe disease requiring hospitalization. In this observational, retrospective study, we aimed to describe the characteristics and healthcare resource utilization in non-hospitalized, adult COVID-19 patients prescribed MOV in the Czech Republic between 1 January and 30 April 2022. Methods: A total of 621 patients were included and followed up with for 28 days. Results: The median age was 68.0 (20-99) years, 77.8% were overweight or obese, 14.1% smoked, and 85.7% were vaccinated. The overall cumulative incidence (95% CI) of all-cause hospitalization was 0.71 (0.37; 1.24) per 1000 person years or 1.9%, with similar rates across sexes, age groups, BMI category, multimorbidity category, polypharmacy category, and COVID-19 vaccination status. Among patients reported hospitalized, oxygen-based resources were not observed, and no deaths occurred. Conclusions: These data describe the characteristics and healthcare resource utilization in Czech MOV-treated patients whose clinical characteristics may put them at increased risk of severe disease.

Pulmonary function 3-6 months after acute COVID-19: A systematic review and multicentre cohort study

Aims

To describe pulmonary function 3-6 months following acute COVID-19, to evaluate potential predictors of decreased pulmonary function and to review literature for the effect of COVID-19 on pulmonary function.

Materials and methods

A systematic review and cohort study were conducted. Within the P4O2 COVID-19 cohort, 95 patients aged 40-65 years were recruited from outpatient post-COVID-19 clinics in five Dutch hospitals between May 2021-September 2022. At 3-6 months post COVID-19, medical records data and biological samples were collected and questionnaires were administered. In addition, pulmonary function tests (PFTs), including spirometry and transfer factor, were performed. To identify factors associated with PFTs, linear regression analyses were conducted, adjusted for covariates.

Results

In PFTs (n = 90), mean ± SD % of predicted was 89.7 ± 18.2 for forced vital capacity (FVC) and 79.8 ± 20.0 for transfer factor for carbon monoxide (DLCO). FVC was

Conclusion

A low DLCO 3-6 months following acute COVID-19 was observed more often than a low FVC, both in the P4O2 COVID-19 study and the literature review.

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Key Words

• Long COVID
• Post COVID-19
• Pulmonary function
• Transfer factor for carbon monoxide

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Affiliation(s)

Merel E.B. Cornelissen Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Asabi Leliveld Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Nadia Baalbaki Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Debbie Gach Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
Ivo van der Lee Department of Pulmonology, Spaarne Hospital, the Netherlands
Esther J. Nossent Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
Lizan D. Bloemsma Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Anke H. Maitland-van der Zee Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands

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Health Hazard Among Shrimp Cultivators in India: A Quantitative Burden of Disease Study

Background

The lack of focus on the health status of shrimp cultivators by previous studies while the production of shrimp has been rising over the years after the introduction of the blue revolution in India. The present study estimated the burden of diseases among shrimp cultivators in India.

Methods

Primary data were collected by using simple random sampling. The sample size was 357. The classification of diseases were made by using the international classification of diseases, tenth revision (ICD-10), version 2019. Disability-adjusted life years (DALY) were used to measure the health status of shrimp cultivators. DALY is the summation of the burden of disease from mortality and morbidity. Sensitive and uncertainty analysis was used by changing the value of the parameter and method, respectively.

Results

The burden of disease among shrimp cultivators in 2020 ranges from 101.03 DALY based on equal age weightage, without discount rate, and potential life expectancy (DALY0,0,PLE) to 84.02 DALY based on unequal age weightage, discount rate, and standardized life expectancy (DALY1,0.03,SLE). The burden of disease per 100,000 shrimp cultivators was 28,477.74 DALY and 23,600.84 DALY when calculated by using DALY0,0,PLE and DALY1,0.03,SLE method, respectively. The higher burden of diseases from non-communicable diseases was followed by injury and communicable diseases for both methods. The disease burden from mortality was more than two-thirds of the total burden of disease and the rest from morbidity. The burden of disease among shrimp cultivators was sensitive to parameter changes because it changes between 92.10 DALY and 63.03 DALY with the change in the parameter. Uncertainty in the burden of disease among them was due to method variation, which ranges from 120.03 DALY to 74.06 DALY.

Conclusion

The higher burden of non-communicable diseases, and the lower burden of communicable, and injuries per 100,000 shrimp cultivators compared to the national level in India.

The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society.

OBJECTIVES

This meta-analysis aims to quantitatively assess the global economic burden of COVID-19.

METHODS

A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference.

RESULTS

The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US $79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher.

CONCLUSIONS

Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention.

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.

A prospective natural history study of post acute sequalae of COVID-19 using digital wearables: Study protocol

Background

Post-acute sequelae of COVID-19 (PASC) is characterized by having 1 + persistent, recurrent, or emergent symptoms post the infection's acute phase. The duration and symptom manifestation of PASC remain understudied in nonhospitalized patients. Literature on PASC is primarily based on data from hospitalized patients where clinical indicators such as respiratory rate, heart rate, and oxygen saturation have been predictive of disease trajectories. Digital wearables allow for a continuous collection of such physiological parameters. This protocol outlines the design, aim, and procedures of a natural history study of PASC using digital wearables.

Methods

This is a single-arm, prospective, natural history study of a cohort of 550 patients, ages 18 to 65 years old, males or females who own a smartphone and/or a tablet that meets pre-determined Bluetooth version and operating system requirements, speak English, and provide documentation of a positive COVID-19 test issued by a healthcare professional or organization within 5 days before enrollment. The study aims to identify wearables collected physiological parameters that are associated with PASC in patients with a positive diagnosis. The primary endpoint is long COVID-19, defined as ≥ 1 symptom at 3 weeks beyond first symptom onset or positive diagnosis, whichever comes first. The secondary endpoint is chronic COVID-19, defined as ≥ 1 symptom at 12 weeks beyond first symptom onset or positive diagnosis. We hypothesize that physiological parameters collected via wearables are associated with self-reported PASC. Participants must be willing and able to consent to participate in the study and adhere to study procedures for six months.

Discussion

This is a fully decentralized study investigating PASC using wearable devices to collect physiological parameters and patient-reported outcomes. Given evidence on key demographics and risk profiles associated with PASC, the study will shed light on the duration and symptom manifestation of PASC in nonhospitalized patient subgroups and is an exemplar of use of wearables as population-level monitoring health tools for communicable diseases.

Trial registration

ClinicalTrials.gov NCT04927442.

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.

Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review

OBJECTIVES

The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role.

DESIGN

A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null.

DATA SOURCES

Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021.

ELIGIBILITY CRITERIA

Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible.

DATA EXTRACTION AND SYNTHESIS

Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist.

RESULTS

We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented.

CONCLUSIONS

COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.

Gender and age group-wise inequality in health burden and value of premature death from COVID-19 in India

Background

Earlier studies have focused on the age-group-wise health burden of COVID-19 while few studies have focused on the gender-wise analysis of the burden of COVID-19. The present study estimated the health burden and value of premature mortality from COVID-19 based on gender and age.

Methods

This study was based on secondary data collected from several sources of the government of India. To quantify the health burden, the disability-adjusted life years (DALY) method was used. An abridged life table was used to estimate the fall in life expectancy due to COVID-19. The value of premature mortality was estimated by using the human capital approach.

Results

Among COVID-19 cases, 65.08% were males and 34.92% were females. The overall health burden caused by COVID-19 was 19,24,107 DALY in 2020, 43,40,526 DALY in 2021, and 8,08,124 DALY in 2022. The health burden per 1000 males was more than double that per 1000 females. This was due to higher rates of infection and case fatality rate among males compared to females. The age group 60-64 years experienced the highest loss of healthy life years per 1000 people, while the age group 55-59 years had the highest overall loss. Due to additional deaths from COVID-19, life expectancy decreased by 0.24 years in 2020, 0.47 years in 2021, and 0.07 years in 2022. The total value of premature death in the first three years of the COVID-19 pandemic amounted to 15,849.99 crores INR.

Conclusion

In India, males and the older population were more susceptible to the impact of COVID-19.

The spatial linkage mechanism: medical level, public health security, and economic climate from 19 OECD EU countries

Introduction

The global spread of the COVID-19 has brought about global changes, especially in terms of economic growth. Therefore, it has become a global issue to explore the impact of public health security on the economy.

Methods

Employing a dynamic spatial Durbin model, this study analyzes the spatial linkage mechanism of medical level, public health security, and economic climate in 19 countries as well as investigates the relationship between economic climate and COVID-19 by the panel data of 19 OECD European Union countries from March 2020 to September 2022.

Results

Results show that an improvement in the medical level can reduce the negative impact of public health security on the economy. Specifically, there is a significant spatial spillover effect. The degree of economic prosperity hurts the reproduction rate of COVID-19.

Discussion

Policymakers should consider both the severity of the public health security issues and the economic level when developing prevention and control policies. Given this, corresponding suggestions provide theoretical support for formulating policies to reduce the economic impact of public health security issues.

The burden of disease due to COVID-19 in Florianópolis, Santa Catarina, Brazil, over a one-year period

COVID-19 has had a powerful impact on society with high rates of morbidity and mortality. The use of an epidemiological indicator that estimates the burden of a disease by aggregating early mortality and non-fatal cases in a single measure has the potential to assist in the planning of more appropriate actions at different levels of health care. The scope of this article is to estimate the burden of disease due to COVID-19 in Florianópolis/SC from April 2020 through March 2021. An ecological study was carried out with data from notification and deaths by COVID-19 in the period of 12 months. The burden indicator called Disability-Adjusted Life Years (DALY) was used, obtained by adding the Years of Life Lost (YLL) to the Years of healthy life lost due to disability (YLD). A total of 78,907 confirmed COVID-19 cases were included. Of these, 763 died during the period under study. Overall, 4,496.9 DALYs were estimated, namely a rate of 883.8 DALYs per 100,000 inhabitants. In males, there were 2,693.1 DALYs, a rate of 1,098.0 DALYs per 100,000 males. In women, there were 1,803.8 DALYs, a rate of 684.4 DALYs per100,000 women. The age group most affected in both sexes was 60 to 69 years. The burden of COVID-19 was high in the city studied. The highest rates were in females and in the 60-69 age group.

Identity and COVID-19 in Canada: Gender, ethnicity, and minority status

BACKGROUND

During the COVID-19 pandemic, growing evidence from the United States, the United Kingdom, and China has demonstrated the unequal social and economic burden of this health crisis. Yet, in Canada, studies assessing the socioeconomic and demographic determinants of COVID-19, and how these determinants vary by gender and ethnic minority status, remain scarce. As new strains of COVID-19 emerge, it is important to understand the disparities to be able to initiate policies and interventions that target and prioritise the most at-risk sub-populations.

AIM

The objective of this study is to assess the socioeconomic and demographic factors associated with COVID-19-related symptoms in Canada, and how these determinants vary by identity factors including gender and visible minority status.

METHODS

We implemented an online survey and collected a nationally representative sample of 2,829 individual responses. The original data collected via the SurveyMonkey platform were analysed using a cross-sectional study. The outcome variables were COVID-19-related symptoms among respondents and their household members. The exposure variables were socioeconomic and demographic factors including gender and ethnicity as well as age, province, minority status, level of education, total annual income in 2019, and number of household members. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed to test the associations. The results were presented as adjusted odds ratios (aORs) at p < 0.05 and a 95% confidence interval.

RESULTS

We found that the odds of having COVID-19-related symptoms were higher among respondents who belong to mixed race [aOR = 2.77; CI = 1.18-6.48] and among those who lived in provinces other than Ontario and Quebec [aOR = 1.88; CI = 1.08-3.28]. There were no significant differences in COVID-19 symptoms between males and females, however, we did find a significant association between the province, ethnicity, and reported COVID-19 symptoms for female respondents but not for males. The likelihood of having COVID-19-related symptoms was also lower among respondents whose total income was $100,000 or more in 2019 [aOR = 0.18; CI = 0.07-0.45], and among those aged 45-64 [aOR = 0.63; CI = 0.41-0.98] and 65-84 [aOR = 0.42; CI = 0.28-0.64]. These latter associations were stronger among non-visible minorities. Among visible minorities, being black or of the mixed race and living in Alberta were associated with higher odds of COVID-19-related symptoms.

CONCLUSION

We conclude that ethnicity, age, total income in 2019, and province were significantly associated with experiencing COVID-19 symptoms in Canada. The significance of these determinants varied by gender and minority status. Considering our findings, it will be prudent to have COVID-19 mitigation strategies including screening, testing, and other prevention policies targeted toward the vulnerable populations. These strategies should also be designed to be specific to each gender category and ethnic group, and to account for minority status.

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.

Physical and mental health impact of the COVID-19 pandemic at first year in a Spanish adult cohort

The COVID-19 pandemic and the political and health measures have profoundly affected the health of our populations. However, very few studies have been published assessing its impact using a prospective cohort. The aim of this study is to describe the impact on physical and mental health due to the COVID-19 pandemic in the general population in Spain, and according to COVID-19 clinical status, during the first year of the pandemic. A longitudinal cohort study with two online surveys were performed on a representative sample of the adult Spanish population before (N = 2005, October/November 2019) and during the pandemic (N = 1357, November/December 2020). We assessed disability using the World Health Organisation Disability Assessment Schedule (WHODAS), major depressive episode (MDE) and suicidal thoughts and behaviours (STB), using an adapted version of the Composite International Diagnostic Interview (CIDI 3.0); generalised anxiety disorder (GAD) using the GAD-7 scale; post-traumatic stress disorder (PTSD) symptoms using the PTSD checklist for DSM-5 (PCL-5). For physical health, there was a statistically significant loss of weight (mean/SD) (T0, 73.22/15.56 vs. T1, 71.21/11.94), less use of tobacco (T0, 11.4% vs. T1, 9.0%) and decreased disability (mean/SD) (T0, 21.52/9.22 vs. T1, 19.03/7.32). For mental health, there was a significant increase in MDE (T0, 6.5% vs. T1, 8.8%) and in the prevalence of GAD (T0, 13.7% vs. T1, 17.7%). The prevalence of STB (T0, 15.1% vs. T1, 7.1%) significantly decreased. Individuals who declared they had been diagnosed with COVID-19 (3.6%) showed a worsening in physical health and an increase in mental health problems and PTSD symptoms. Although suicide risk during the first year of the pandemic was significantly less, many suicide risk factors increased: such as the incidence and persistence of MDE and GAD, the presence of PTSD symptoms in those diagnosed with COVID-19, and a worsening in self-assessed health status. We expect an increase in STB in the population in the long-term. Future research should gather information about the long-term impact of the pandemic.

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.

Perda de Produtividade Atribuída a Neoplasias na América do Sul

Introdução: A carga da doença tem sido empregada em estimativas do impacto das neoplasias, mas a perda de produtividade em razão dessas enfermidades ainda não foi tão explorada. Objetivo: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade por conta da mortalidade prematura relacionada ao câncer em países da América do Sul em 2019. Método: Dados de mortalidade disponíveis no Global Burden of Disease (GBD) Study 2019 foram usados para estimar a carga de doença atribuível a neoplasias. A perda de produtividade em termos monetários foi calculada usando um proxy da abordagem do capital humano (ACH). Os cálculos foram realizados por sexo, nas faixas etárias de trabalho. Resultados: O total de óbitos foi de 192.240 e o de AVPP, 2.463.155. A perda total de produtividade permanente foi de US$ 4,4 bilhões e US$ 9,4 bilhões em purchasing power parity (PPP) – 0,13% do produto interno bruto (PIB) da região. O custo total por morte foi de US$ 23.617. Houve diferenças significativas entre os países, mas a variação dos cenários mostra robustez das estimativas. Conclusão: O câncer impõe um ônus econômico significativo à América do Sul tanto em termos de saúde quanto de produtividade. Sua caracterização pode subsidiar os governos na alocação de recursos destinados ao planejamento de políticas e execução de intervenções de saúde.

The Pattern of COVID-19 in Horn of Africa countries, from March-December 2020

BACKGROUND

Coronavirus-19 (COVID-19) is a novel, highly infectious, and potentially fatal communicable pandemic disease. It has taken longer to reach Africa than the other continents.

OBJECTIVE

To examine the pattern of COVID-19 in the Horn of Africa countries from March to December 2020.

METHODS

A prospective cross-sectional study in which the total number of daily reported cases and deaths were collected from the official website of the World Health Organization (WHO) and Worldometer. Data were standardized based on the total population provided by World Population Prospects 2020 per million. Data sources of WHO reports and governmental reports from March to December 2020 were analyzed in this study. Data extraction was done using the microsoft excel spreadsheet tool, variables relating to the countries were computed in terms of frequencies and percentages.

RESULTS

The findings revealed that as of 31st December 2020, 136,129 (7590 per million) cases were reported from the four countries in the Horn of Africa. The overall case fatality rate (CFR) in the Horn of Africa was 1.14%. The majority of the cases were reported from Djibouti (77.20%), followed by Ethiopia (14.07%), Eritrea (4.87%), and Somalia (3.86%). The highest case fatality rate (0.81%) was from Djibouti, and the lowest (0.01%) was from Eritrea.

CONCLUSIONS

The epidemiological pattern of COVID-19 among the Horn of African countries seems to have slow progress, given the prevalence of the new infections remains low, and the death toll seems stable throughout the study periods, except for Djibouti. Hence, the prevention control measures implemented in the countries should be further strengthened and supported. It is recommended that relevant stakeholders responsible for tackling the COVID-19 pandemic should put up measures to curb the spread of the virus in the region and set up a crisis management system to combat future pandemics.

Optimal spatial evaluation of a pro rata vaccine distribution rule for COVID-19

The COVID-19 Vaccines Global Access (COVAX) is a World Health Organization (WHO) initiative that aims for an equitable access of COVID-19 vaccines. Despite potential heterogeneous infection levels across a country, countries receiving allotments of vaccines may follow WHO's allocation guidelines and distribute vaccines based on a jurisdictions' relative population size. Utilizing economic-epidemiological modeling, we benchmark the performance of this pro rata allocation rule by comparing it to an optimal one that minimizes the economic damages and expenditures over time, including a penalty representing the social costs of deviating from the pro rata strategy. The pro rata rule performs better when the duration of naturally- and vaccine-acquired immunity is short, when there is population mixing, when the supply of vaccine is high, and when there is minimal heterogeneity in demographics. Despite behavioral and epidemiological uncertainty diminishing the performance of the optimal allocation, it generally outperforms the pro rata vaccine distribution rule.

Losses of Life Expectancy and Productivity Associated with COVID-19 Pandemic in Canada: Policy Implication for Future Communicable Disease Control

This research examines whether the Coronavirus disease 2019 (COVID-19) did harm to the population's health through comparing the changes in the life expectancy of Canadians with those of Australians over the period from March 2019 to February 2021 by using a difference-in-differences (DID) estimation method. We found that the pandemic did cause differences in life expectancies between Canada and Australia, probably because of different initial control policies for COVID-19. This study uses the indicator of disability-adjusted life years (DALYs) to measure the societal health burden, which was corroborated by estimating temporal productivity loss (TPL) and permanent productivity loss (PPL) based on the human capital approach (HCA) using data from Health Canada. The societal health burden in Canada amounted to 6.493 DALYs per 1000 male persons and 5.316 DALYs per 1000 female persons. The economy's permanent productivity loss was around USD 5.3 billion, while the temporary productivity loss was around USD 3 billion from February 2020 to April 2022. The sum of the above two losses amounted to 0.477% of the GDP in 2019. Swift and decisive decisions at the very early stage of a pandemic can nip contagions in the bud before numbers get out of hand and would be less damaging to people's health and the economy, as seen in Australia, in contrast to what happened in Canada. We thus recommend that such policies plus telecommunication systems in healthcare services be implemented early on to cope with the future outbreak of any emerging infectious diseases such as COVID-19.

Estimated global public health and economic impact of COVID-19 vaccines in the pre-omicron era using real-world empirical data

BACKGROUND

Limited data are available describing the global impact of COVID-19 vaccines. This study estimated the global public health and economic impact of COVID-19 vaccines before the emergence of the Omicron variant.

METHODS

A static model covering 215 countries/territories compared the direct effects of COVID-19 vaccination to no vaccination during 13 December 2020-30 September 2021. After adjusting for underreporting of cases and deaths, base case analyses estimated total cases and deaths averted, and direct outpatient and productivity costs saved through averted health outcomes. Sensitivity analyses applied alternative model assumptions.

RESULTS

COVID-19 vaccines prevented an estimated median (IQR) of 151.7 (133.7-226.1) million cases and 620.5 (411.1-698.1) thousand deaths globally through September 2021. In sensitivity analysis applying an alternative underreporting assumption, median deaths averted were 2.1 million. Estimated direct outpatient cost savings were $21.2 ($18.9-30.9) billion and indirect savings of avoided productivity loss were $135.1 ($121.1-206.4) billion, yielding a total cost savings of $155 billion globally through averted infections.

CONCLUSIONS

Using a conservative modeling approach that considered direct effects only, we estimated that COVID-19 vaccines have averted millions of infections and deaths, generating billions of cost savings worldwide, which underscore the continued importance of vaccination in public health response to COVID-19.

Cost of lost productivity from acute respiratory infections in South America

Objectives

To estimate the burden of permanent productivity losses caused by acute respiratory infections in South American countries in 2019.

Methods

Mortality data from the Global Burden of Disease Study 2019 were analyzed to estimate the burden of disease attributable to acute respiratory infections. An approach based on the human capital method was used to estimate the cost of permanent productivity losses associated with respiratory diseases. To calculate this cost, the sum of the years of productive life lost for each death was multiplied by the proportion in the workforce and the employment rate, and then by the annual minimum wage or purchasing power parity in United States dollars (US$) for each country in the economically active age groups. Separate calculations were done for men and women.

Results

The total number of deaths from acute respiratory infections in 2019 was 30 684 and the years of productive life lost were 465 211 years. The total cost of permanent productivity loss was about US$ 835 million based on annual minimum wage and US$ 2 billion in purchasing power parity, representing 0.024% of the region's gross domestic product. The cost per death was US$ 33 226. The cost of productivity losses differed substantially between countries and by sex.

Conclusion

Acute respiratory infections impose a significant economic burden on South America in terms of health and productivity. Characterization of the economic costs of these infections can support governments in the allocation of resources to develop policies and interventions to reduce the burden of acute respiratory infections.

Cost of Illness of COVID-19 and Its Consequences on Health and Economic System

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

Modelling optimal lockdowns with waning immunity

This paper studies continuing optimal lockdowns (can also be interpreted as quarantines or self-isolation) in the long run if a disease (Covid-19) is endemic and immunity can fail, that is, the disease has SIRS dynamics. We model how disease related mortality affects the optimal choices in a dynamic general equilibrium neoclassical growth framework. An extended welfare function that incorporates loss from mortality is used. In a disease endemic steady state, without this welfare loss even if there is continuing mortality, it is not optimal to impose even a partial lockdown. We characterize how the optimal restriction and equilibrium outcomes vary with the effectiveness of the lockdown, the productivity of working from home, the rate of mortality from the disease, and failure of immunity. We provide the sufficiency conditions for economic models with SIRS dynamics with disease related mortality-a class of models which are non-convex and have endogenous discounting so that no existing results are applicable.

An assessment on loss of workforce due to COVID-19 among healthcare personnel: A university hospital experience

BACKGROUND: Healthcare personnel are among the COVID-19 risk groups. For this reason, increased absence from work affects the loss of labor. OBJECTIVE: This study aimed to evaluate the workforce loss amongst health personnel working in our hospital due to COVID-19 in a one-year period. METHODS: Workforce loss of healthcare workers was assessed via absenteeism and life expectancy. Loss of workforce for COVID-19 PCR positive or PCR negative but CT findings compatible with COVID-19 and personnel with high-risk exposure for COVID-19 were determined with absenteeism. Healthcare personnel who passed away due to COVID-19 was determined with the consideration of the retirement age and expected life years. RESULTS: Total lost time from work was 14635 days (excluding deaths). Loss of workforce rates resulting from COVID-19 positivity for male employees was greater in comparison to the results for females (p = 0.018). High-risk exposure of healthcare personnel working in clinical sciences was higher than those in other departments (p < 0.001). Total loss in workforce for 3 people passed away was 14 years 5 months, and total life expectancy was 64 years. Healthcare personnel under the age of 40 had less absenteeism than those over 40 years (p < 0.001). CONCLUSIONS: It was observed that all occupational groups working at the hospital were impacted by COVID-19. The two most important factors that influenced absenteeism were the reason for being affected (positivity and high risk) and age. Absenteeism and daily case tracing of healthcare personnel working on the frontlines will aid in both the pandemic control and management of workload for those left behind.

How Did People with Functional Disability Experience the First COVID-19 Lockdown? A Thematic Analysis of YouTube Comments

People with functional disability endure barriers to health and other services and to full participation in social life. In the context of COVID-19, this discrimination has been intensified worldwide. We examine how the experience of COVID-19 lockdown was depicted in comments to a video about functional disability and COVID published on VICE's YouTube channel. We analysed the first 100 comments on the video, which was posted in spring 2020, during the first COVID-19 lockdown (roughly from March to June 2020, with some variations around the world). We identified four themes: lack of access to care and services, isolation and lifestyle changes, mental health consequences, and peer support. Legal regulations regarding COVID-19 and people with functional disability have not been sufficient in most countries. The COVID-19 pandemic has exposed inadequate care systems, even in Western countries with advanced social protection policies.

Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress

This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients.

Burden of COVID-19: DALY and productivity loss for Karnataka, India

Background

COVID-19 is a pandemic that is devastating the world right now quelling over 2.5 million people worldwide. Similarly, in India and its largest southern state Karnataka, the coronavirus is responsible for around 161,000 and 12,449 deaths, respectively. These numbers capture the havoc caused by this novel coronavirus, but fail to discern the complete picture.

Objectives

Broadly, this study aimed to study the mortality, morbidity, and the economic issues inflicted by the COVID-19 in the state of Karnataka. Specifically, the study used publically available epidemiological data to study both mortality and morbidity by means of disability-adjusted life years (DALYs). Furthermore, the study aimed at estimating the permanent losses to the state gross domestic product (SGDP) due to the pandemic.

Materials and Methods

Publicly available epidemiological data are used from selected sources and DALYs are computed. The permanent loss to the SGDP is estimated using the human capital approach.

Results

The total DALYs for Karnataka are computed to be 22,506 of which 22,041 correspond to mortality and remaining correspond to morbidity. Financially, Karnataka lost around 208 years of productive years of lives costing around ₹590 million rupees to the SGDP.

Conclusions

It is found that major burden of COVID-19 during study period is due to mortality. Morbidity accounts for around 2% of the total DALYs. Males are the most affected by the mortality and also the morbidity. With respect to loss in productivity, the losses due to premature mortality of COVID-19 amounted to ₹590 million.

Quality of Sleep and Work Productivity among White-Collar Workers during the COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic has disrupted routine sleep and work patterns in the general population. We conducted an anonymous online survey among white-collar workers from various finance, IT and technology companies in Lithuania to define factors associated with worse sleep quality and diminished productivity during a COVID-19 lockdown. Materials and Methods: Employees of selected companies in Lithuania completed an anonymous questionnaire online that included the Pittsburgh Sleep Quality Index (PSQI), The Sleep Locus of Control (SLOC), the Generalized Anxiety Disorder Scale-7 (GAD-7), and the World Health Organization’s Health and Work Performance Questionnaire (WHO-HPQ). Respondents also provided information about their sleep hygiene, physical activity and alcohol use. Results: Data of 114 respondents (56, 49.1% male) were used for analysis. Among them, 49 (43.0%) suffered from poor sleep and 29 (25.4%) had clinically relevant levels of anxiety. However, there were only negligible levels of absenteeism in the sample (a median of zero hours of work lost over the past month). In a stepwise linear regression model (F(5,108) = 11.457, p < 0.001, R2adj = 0.316), high levels of anxiety, daily hours spent using the screen, use of electronic devices in the bedroom, smoking in the evening, and COVID-19-related changes in appetite were associated with worse sleep quality. Absenteeism was associated with physical activity of moderate intensity and decreased self-reported productivity during the pandemic (F(2,111) = 7.570, p = 0.001, R2adj = 0.104). However, there was no strong relationship between sleep-related variables (i.e., sleep hygiene, sleep locus of control, quality of sleep) or levels of anxiety and measures of work productivity. Conclusions: Our findings suggest that while bad sleep hygiene, anxiety, and changes in appetite are associated with worse sleep quality among white-collar workers during the pandemic, work productivity may remain high irrespective of disrupted sleep.

COVID-19 Vaccination Campaign among the Health Workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS: A Cost–Benefit Analysis

Vaccinations generate health, economic and social benefits in both vaccinated and unvaccinated populations. The aim of this study was to conduct a cost–benefit analysis to estimate the costs and benefits associated with the COVID-19 vaccination campaign for health workers in Fondazione Policlinico Universitario Agostino Gemelli IRCCS (FPG). The analysis included 5152 healthcare workers who voluntarily received the Pfizer–BioNTech COVID-19 vaccine, divided into physicians, nurses and other health workers. Data about vaccine cost, administration and materials were derived from administrative databases of the FPG from 28 December 2020 to 31 March 2021. The costs associated with the COVID-19 vaccination campaign amounted to EUR 2,221,768, while the benefits equaled EUR 10,345,847. The benefit-to-cost ratio resulted in EUR 4.66, while the societal return on investment showed a ratio of EUR 3.66. The COVID-19 vaccination campaign for health workers in FPG has high social returns and it strengthens the need to inform and update decision-making about the economic and social benefits associated with a vaccination campaign. Health economic evaluations on vaccines should always be considered by decision-makers when considering the inclusion of a new vaccine into the national program.

Estimating the Direct Disability-Adjusted Life Years Associated With SARS-CoV-2 (COVID-19) in the Republic of Ireland: The First Full Year

Objectives: Burden of Disease frameworks facilitate estimation of the health impact of diseases to be translated into a single measure, such as the Disability-Adjusted-Life-Year (DALY).

Methods: DALYs were calculated as the sum of Years of Life Lost (YLL) and Years Lived with Disability (YLD) directly associated with COVID-19 in the Republic of Ireland (RoI) from 01 March 2020, to 28 February 2021. Life expectancy is based on the Global Burden of Disease (GBD) Study life tables for 2019.

Results: There were 220,273 confirmed cases with a total of 4,500 deaths as a direct result of COVID-19. DALYs were estimated to be 51,622.8 (95% Uncertainty Intervals [UI] 50,721.7, 52,435.8). Overall, YLL contributed to 98.5% of the DALYs. Of total symptomatic cases, 6.5% required hospitalisation and of those hospitalised 10.8% required intensive care unit treatment. COVID-19 was likely to be the second highest cause of death over our study’s duration.

Conclusion: Estimating the burden of a disease at national level is useful for comparing its impact with other diseases in the population and across populations. This work sets out to standardise a COVID-19 BoD methodology framework for the RoI and comparable nations in the EU.

Allergic reactions to COVID-19 vaccines: statement of the Belgian Society for Allergy and Clinical Immunology (BelSACI)

Vaccination against COVID-19 constitutes a huge hope and a major challenge. For the first time in modern history, a global vaccination campaign has started worldwide in a short period of time and with products that were recently developed. Consequently, legitimate concerns regarding the safety and tolerability of COVID-19 vaccines arise.In line with international allergy societies, the Belgian Society for Allergy and Clinical Immunology (BelSACI) provides this statement to guide health care providers (general practitioners, specialists including allergists) and stakeholders.In this statement, we first review current evidence on allergic reactions to vaccines and the potential risk factors that have been identified.Second, we provide a risk stratification method that may be used as a worksheet during the vaccination campaign.Finally, we discuss the management of suspected or confirmed allergic reactions following vaccination.

Economic Burden of COVID-19: A Systematic Review

Objective

To review and qualitatively synthesize the evidence related to the economic burden of COVID-19, including healthcare resource utilization and costs.

Methods

A systematic review of studies that assessed the economic burden [eg, direct costs, productivity, macroeconomic impact due to non-pharmaceutical interventions (NPIs) and equity] of COVID-19 was conducted by searches in EMBASE, MEDLINE, MEDLINE-IN-PROCESS, and The Cochrane Library, as well as manual searches of unpublished research for the period between January 2020 to February 2021. Single reviewer data extraction was confirmed independently by a second reviewer.

Results

The screening process resulted in a total of 27 studies: 25 individual publications, and 2 systematic literature reviews, of narrower scopes, that fulfilled the inclusion criteria. The patients diagnosed with more severe COVID-19 were associated with higher costs. The main drivers for higher costs were consistent across countries and included ICU admission, in-hospital resource use such as mechanical ventilation, which lead to increase costs of $2082.65 ± 345.04 to $2990.76 ± 545.98. The most frequently reported indirect costs were due to productivity losses. On average, older COVID-19 patients incurred higher costs when compared to younger age groups. An estimation of a 20% COVID-19 infection rate based on a Monte Carlo simulation in the United States led to a total direct medical cost of $163.4 billion over the course of the pandemic.

Conclusion

The COVID-19 pandemic has generated a considerable economic burden on patients and the general population. Preventative measures such as NPIs only have partial success in lowering the economic costs of the pandemic. Implementing additional preventative measures such as large-scale vaccination is vital in reducing direct and indirect medical costs, decreased productivity, and GDP losses.

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13169-x.

Resilience as a measure of preparedness for pandemic influenza outbreaks

The global crisis generated by COVID-19 has heightened awareness of pandemic outbreaks. From a public health preparedness standpoint, it is essential to assess the impact of a pandemic and also the resilience of the affected communities, which is the ability to withstand and recover quickly after a pandemic outbreak. The infection attack rate has been the common metric to assess community response to a pandemic outbreak, while it focuses on the number of infected it does not capture other dimensions such as the recovery time. The aim of this research is to develop community resilience measures and demonstrate their estimation using a simulated pandemic outbreak in a region in the USA. Three scenarios are analysed with different combinations of virus transmissibility rates and non-pharmaceutical interventions. I The inclusion of the resilience framework in the pandemics outbreak analysis will enable decision makers to capture the multi dimensional nature of community response.

Burden of COVID-19: a preliminary analysis in the population of Saudi Arabia

Background

Coronavirus infection (COVID-19) has resulted in an unprecedented number of human deaths and economic losses. Analyzing the role of disease in different groups of people is useful for determining the burden of disease. As a result, the purpose of this study was to investigate the influence of COVID-19 on the Saudi Arabian population's quality of life, with a particular emphasis on the likely fall in their life expectancy.

Methods

A cross-sectional and retrospective analysis of 2,988 patients' databases was performed to assess COVID-19-induced mortality and complications in the community. The data was gathered from official websites that track the disease's impact daily between July and October 2021. On the acquired data, disability-adjusted life years (DALYs) and relative risk analysis were performed. The data was statistically analyzed using SPSS IBM 25. The Pearson's correlation test was used to examine the relationship between age and disease impact. The significance of the findings was determined by using a P value of less than 0.05.

Results

The data from the study indicated that the positive test rate, infection rate, and mortality rate in the population were 1.84% [+0.11/-0.39 of 95% confidence interval (CI)], 1.54% (+0.38/-0.52 of CI), and 1.59% (+0.4/-0.7 of CI), respectively. Highest percentage of mortality was observed in Riyadh (17%), followed by Jeddah (8.7%) and Makkah (7.5%). The DALYs/100,000 inhabitants increased progressively as the age of the population increased, and the highest value was found for those over 70 years old (25.73 ± 2.09). Similarly, the risk outcome (55%) increased significantly (p = 0.037) from 40 years onwards, and the maximum was observed at above 70 years (184%, p = 0.006). The correlation analysis indicated a significant association (p = 0.032) between age and COVID-19 induced mortality from the 40-year-old population onwards.

Conclusion

The current study found that the COVID-19 load in Saudi Arabia was comparable to that in nations that were said to have performed well during the pandemic. DALYs increased from 40 years to 60 years, although people over 60 years had a lower life expectancy and were more susceptible to infection. After 60 years, the occurrence of numerous co-morbid illnesses may have added to the population's burden of COVID-19. Further research in this area may yield a more precise estimate of the COVID-19-induced burden on the entire population.

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.

Iranian nursing students experiences regarding the status of e-learning during COVID-19 pandemic

Introduction

With the emergence of the COVID-19 pandemic, universities immediately responded to protect students’ lives by implementing e-learning in order to stop the spread of the communicable disease within the academic population. This study aimed to describe iranian nursing students’ experiences of e-learning during the COVID-19 pandemic.

Materials and methods

The current study used a qualitative descriptive study. Ten nursing undergraduate students from a single Iranian university identified using purposive sampling methods. Face-to-face semi-structured interview conducted from May to July 2021 and analyzed through thematic analysis. Lincoln and Goba criteria were used to obtain data validity and reliability.

Results

Four themes emerged including"novelty of e-learning","advantages of e-learning", "disadvantages of e-learning"and"passage of time and the desire to return to face education". Participants evaluated e-learning as a novel method without proper infrastructure, it was initially confusing but became the new normal as their knowledge of the way to use it improved. Advantages included self-centered flexible learning and reduction in their concerns experienced with face-to-face learning. Disadvantages including changing the way they interact with teachers, decreasing interactions with classmates, problems with education files, superficial learning, hardware problems, family members’ perceptions of the student role, interference of home affairs with e-learning, cheating on exams and assignments and being far away from the clinical context.

Conclusion

The findings revealed that e-learning has been introduced as a new method for the current research participants and despite the perceived benefits, these students believed that e-learning could supplement face education but not replace it.

Estimating US Earnings Loss Associated with COVID-19 Based on Human Capital Calculation

Infection with COVID-19 could result in lockdown, quarantine of contacts, absenteeism from work, and temporary productivity loss. This research aims to calculate (1) how the pandemic affects on-the-job probability and earnings for the working population, and (2) how much productivity loss is associated with self or a family member sick with COVID-19. Based on data collected from the U.S Research and Development Survey (RANDS), this research projects the relationship between on-the-job possibility and age of the index group and calculates the employment possibilities of the index group relative to the healthy group, namely the employment ratio. The weekly loss of productivity, presented by earnings, associated with COVID-19 for groups aged 18-44 years and 45-64 years was calculated, since the 18- to 64-year-old population is an economy's active workforce. Analytical results indicate that the older the age group, the lower the on-the-job possibility, and the higher the weekly productivity loss due to self or a family member being sick from COVID-19. For the group aged 45-64 years, the employment ratio of the index group relative to the healthy group dropped from 0.863 to 0.39, corresponding to a weekly productivity loss of 136-590 US dollars. The overall impact would be about a 9% loss in GDP. Infected or quarantined people would be confined to working in relatively isolated offices or places to allow for social distancing. Proactive health promotion in the workplace plus reactive work through telecommunication systems would reduce such losses. Such preparedness needs to be implemented early for more vulnerable workers who are of middle or old age and/or those comorbid with diabetes.

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.

Mortality comparisons of COVID-19 with all-cause and non-communicable diseases in Cyprus, Iceland and Malta: lessons learned and forward planning

OBJECTIVES

The COVID-19 pandemic has spread throughout the world, including Cyprus, Iceland and Malta. Considering the small population sizes of these three island countries, it was anticipated that COVID-19 would be adequately contained and mortality would be low. This study aims to compare and contrast COVID-19 mortality with mortality from all causes and common non-communicable diseases (NCDs) over 8 months between these three islands.

METHODS

Data were obtained from the Ministry of Health websites and COVID dashboards from Cyprus, Iceland and Malta. The case-to-fatality ratio (CFR) and years of life lost (YLLs) were calculated. Comparisons were made between the reported cases, deaths, CFR, YLLs, swabbing rates, restrictions and mitigation measures.

RESULTS

Low COVID-19 case numbers and mortality rates were observed during the first wave and transition period in Cyprus, Iceland and Malta. The second wave saw a drastic increase in the number of confirmed cases and mortality rates, especially for Malta, with high CFR and YLLs. Similar restrictions and measures were evident across the three island countries. Results show that COVID-19 mortality was generally lower than mortality from NCDs.

CONCLUSIONS

The study highlights that small geographical and population size, along with similar restrictive measures, did not appear to have an advantage against the spread and mortality rate of COVID-19, especially during the second wave. Population density, an ageing population and social behaviours may play a role in the burden of COVID-19. It is recommended that a country-specific syndemic approach is used to deal with the local COVID-19 spread based on the population's characteristics, behaviours and the presence of other pre-existing epidemics.

Mid-term psychiatric consequences of the COVID-19 pandemic: a 4 months observational study on emergency room admissions for psychiatric evaluation after the (first) lockdown period in Italy

PURPOSE

The aim of our study is to evaluate the number and the features of admissions to the emergency room (ER) requiring psychiatric consultation, in the period between May 4th and August 31st 2020.

METHODS

We carried out a retrospective longitudinal observational study examining the 4 months following the initial lockdown imposed during the COVID-19 outbreak (May 4th and August 31st 2020). More specifically, the ER admissions leading to psychiatric referral were reviewed at all seven public hospitals of AUSL Romagna (Emilia Romagna region, Italy). Socio-demographic variables, history of medical comorbidities or psychiatric disorders, reason for ER admission, psychiatric diagnosis at discharge, and actions taken by the psychiatrist were collected.

RESULTS

An 11.3% (p = 0.007) increase in psychiatric assessments was observed when compared with the same period of the previous year (2019). A positive personal history of psychiatric disorders (OR:0.68, CI: 0.53-0.87) and assessments leading to no indication for follow-up (OR: 0.22, CI: 0.13-0.39) were significantly less frequent, while there was a significant increase of cases featuring organic comorbidities (OR: 1.24, CI: 1.00-1.52) and suicidal ideation/self-harm/suicide attempt (OR: 1,71, CI: 1.19-2.45) or psychomotor agitation (OR: 1.46, CI: 1.02-2.07) as reason for admission.

CONCLUSIONS

Our results showed an increase in ER psychiatric consultations compared to the previous year, underlying the increased psychological distress caused by the lockdown.

Burden of severe COVID-19 in center of Iran: results of disability-adjusted life years (DALYs)

The outbreak of COVID-19 disease is an international public health concern. Therefore, the analysis of information related to mortality and disability due to COVID-19 is considered important, so the present study was designed and conducted with the aim of assessing COVID-19 Disability-Adjusted Life Years (DALYs) in Yazd. In Yazd province, all suspected cases of COVID-19 that would be referred to central hospitals in order to get confirmed through PCR or CT scan test, were recruited to our study. The fatality data of COVID-19 was gathered from the forensic medicine organization. The Disability-Adjusted Life Years (DALYs) combines in one measure years of life lost (YLL), the loss of healthy life due to premature mortality and years of life lived with disability (YLD), the loss of healthy life because of disease and disability. The total burden of COVID-19 was 23,472 years. The number of years lost due to premature death was 23385 and the number of years of life with disability due to COVID-19 was estimated to be 87 years. The disease burden was 12992 years for men and 10480 years for women. The overall incidence of COVID-19 was 1411 per 100,000, of which 1419 in men and 1402 in women per 100,000. The outbreak of COVID-19 pandemic affected a large population and the residents of Yazd Province lost many years of their lives due to this disease.

Years of potential life lost and productivity costs due to COVID-19 in Turkey: one yearly evaluation

OBJECTIVES

The aim of the study is to calculate the years of life lost (YLL) and years of potential life lost (YPLL) due to COVID-19, according to age groups in Turkey in the first year of the pandemic and the cost of this burden.

STUDY DESIGN

This is an observational study with quantitative analyses.

METHODS

YLL due to premature deaths was calculated for men and women by interpolating the number of deaths and the expected life expectancy. YPLL was calculated according to the age 65 years. Productivity loss is an estimation of the cost of time lost at work-related activities-in a scenario analysis-using predetermined wage rates with the human capital theory.

RESULTS

Men lost 205,177 (67.57%) years of life, whereas women lost 125,330 (32.43%) years of life. The YLL average age in men was 63.66 ± 14.66 years, and the YLL average age in women was 66.07 ± 15.46 years. The average YLL age in men was younger than in women (P < 0.001). Men lost 65,180 (70.16%) YPLL, whereas women lost 27,723 (29.84%) YPLL. The average YPLL age in women was younger than in men (P < 0.001). During one year of the pandemic, premature death cost Turkey 227,396,694 USD, the cost for one premature death was 14,187 USD, and the cost of any year of life lost was 1261 USD.

CONCLUSION

YLL and YPLLs are very closely associated with COVID-19 deaths in the country. The economic dimensions of the pandemic with human losses are quite high.

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.

Systematic review of productivity loss among healthcare workers due to Covid-19

Objective

To assess existing evidence on the effects of COVID‐19 on healthcare workers (HCWs) using the health‐related productivity loss approach.

Methods

A systematic search of online databases including PubMed, Scopus, Ovid, Web of Science, and EMBASE was conducted up to 25 August 2020. Following two screening stages, studies related to the effects of COVID‐19 on healthcare workers were included in the study.

Results

82 studies were included in the analysis. The COVID‐19 related death rate among HCWs ranged from 0.00‐0.7%, while the positive test incidence varied between 0.00 and 24.4%. 39 evidences assessed psychological disorders. A wide range of psychological disorders observed among HCWs: 5.2 to 71.2% in anxiety, 1.00 to 88.3% in stress, 8.27 to 61.67% in insomnia, and 4.5 to 50.4% in depression.

Conclusions

The early evidence suggests that healthcare workers are one of the most vulnerable groups when it comes to positive COVID‐19 infection, mortality, and mental illness.

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.