Who is going to pay the price of Covid-19? Reflections about an unequal Brazil

The unequal impact of the pandemic at subnational levels and educational attainment-related inequalities in COVID-19 mortality, Brazil, 2020-2021

OBJECTIVES

We estimated COVID-19 mortality indicators in 2020-2021 to show the epidemic's impact at subnational levels and to analyze educational attainment-related inequalities in COVID-19 mortality in Brazil.

STUDY DESIGN

This was an ecological study with secondary mortality information.

METHODS

Crude and age-standardized COVID-19 mortality rates were calculated by gender, major regions, and states. The COVID-19 proportional mortality (percentage) was estimated by gender and age in each region. Measures of education-related inequalities in COVID-19 mortality were calculated per state, in each of which the COVID-19 maternal mortality rate (MMR) was estimated by the number of COVID-19 maternal deaths per 100,000 live births (LBs).

RESULTS

The analysis of mortality rates at subnational levels showed critical regional differences. The North region proved to be the most affected by the pandemic, followed by the Center-West, with age-standardized COVID-19 mortality rates above 2 per 1000 inhabitants. The peak of COVID-19 mortality occurred in mid-March/April 2021 in all regions. Great inequality by educational level was found, with the illiterate population being the most negatively impacted in all states. The proportional mortality showed that males and females aged 50-69 years were the most affected. The MMR reached critical values (>100/100,000 LB) in several states of the North, Northeast, Southeast, and Center-West regions.

CONCLUSIONS

This study highlights stark regional and educational disparities in COVID-19 mortality in Brazil. Exacerbated by the pandemic, these inequalities reveal potential areas for intervention to reduce disparities. The results also revealed high MMRs in certain states, underscoring pre-existing healthcare access challenges that worsened during the pandemic.

COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management

BACKGROUND

The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities in facing the emergency. In this article, we analyze data on COVID-19-related deaths in 2020-21 to show the epidemic consequences in Brazil.

METHODS

The Mortality Information System and the Live Birth Information System were the primary information sources. We used population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age, sex, and educational level. Considering the total number of COVID-19 deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily number of deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate (IMR); maternal mortality ratio (MMR); number and rate of orphans due to mother's COVID-19 death; the average number of years lost.

RESULTS

The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. The rate among illiterate people was 38.8/10,000, three times higher than a college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the age group of 40-59 years. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 live births (LB), representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 lost their mothers during the epidemic, with an orphans' rate of 7.5/10,000 children aged 0-17 years. The IMR was 11.7 per 1000 LB, with 0.2 caused by COVID-19. The peak of COVID-19 deaths occurred in March 2021, reaching almost 4000 COVID-19 deaths per day, higher than the average number of deaths per day from all causes in 2019.

CONCLUSIONS

The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.

Covid-19 Outbreak in Brazil: Health, Social, Political, and Economic Implications

COVID-19 outbreak quickly spread to all corners of the globe. In Brazil, the outbreak was particularly frightening because it worsened existing health, political, economic, and social problems. The results already observed show the contagion ripple-spreading process across the country, causing the death of thousands of people each day and counting, added to a very serious wave of unemployment, scientific denial, and social precariousness. Based on this, this study reviews recent research that looked at the role of the government, the Brazilian health system, and the main economic and social impacts fostered by the pandemic. We perform a scoping review according to the PRISMA-ScR to structure the qualitative synthesis of the 67 associated documents. The results reinforce the negative effects of the country's mismanagement and its consequent impacts on the Brazilian economy and society. The battleground against COVID-19 has fueled political tensions, shaken the health system, and unleashed social despair tinged with thousands of deaths. Finally, in the present scoping review, we discuss concerns about the impacts of the COVID-19 outbreak in Brazil and what the world hopes the country has learned from the current crisis.

The Role of Country-Level Availability and Generosity of Healthcare Services, and Old-Age Ageism for Missed Healthcare during the COVID-19 Pandemic Control Measures in Europe

Objectives: The effects of the COVID-19 outbreak on non-COVID-19-related healthcare need further investigation. Methods: Using the Survey of Health, Ageing and Retirement in Europe's COVID-19 module (2020) (N = 57,025), country-level data from the European Social Survey (2008) and OECD (2020), and logistic regressions, this study examines predictors of older Europeans' forgone, postponed, and denied healthcare during the pandemic. Results: Country-level availability of physicians, healthcare systems' generosity, and beliefs that older persons burden healthcare systems all increased forgone healthcare. Healthcare system generosity increased postponed and denied healthcare. Greater medical resources decreased denied healthcare. Furthermore, missed healthcare varied by individual-level gender (higher rates among women), age, education, and health. Discussion: This study reveals predictors of missed healthcare during the pandemic. To decrease unintended health consequences of a pandemic, both individual-level determinants, such as gender and health, and contextual-level determinants, such as healthcare systems' characteristics, should be considered in research and practice.

Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review

OBJECTIVE

Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil.

METHODS

This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations.

RESULTS

Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation.

CONCLUSIONS

Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.

Health-related and socio-economic burden of the COVID-19 pandemic in Vienna

Previous pandemics have rarely affected everyone equally and, so far, the COVID-19 pandemic is no exception. Emerging evidence has shown that incidence rate, hospitalisation rate, and mortality due to COVID-19 are higher among people in lower socio-economic position (SEP). In addition, first investigations indicate that not everyone is equally affected by this pandemic's collateral public health damage. Using a stratified random sample of 1,004 participants living in Vienna, a Central European city with approximately 1.9 million inhabitants, this study analysed the distribution of 10 adverse health-related and socio-economic outcomes attributable to the COVID-19 pandemic across socio-economic strata. To this end, we estimated differences in the incidence rate of these outcomes by SEP and each of its indicators using zero-inflated Poisson and logistic regression models, adjusted for age and gender. Data were collected during first lockdown measures between 27 April and 17 May 2020. Differences in the incidence rate between the two lowest and two highest SEP groups were clearly visible. Participants in the lowest SEP category had a 32.96% higher incidence rate (IRR = 1.333 [95% CI: 1.079-1.639]), and participants in the second lowest SEP category had a 44.69% higher incidence rate (IRR = 1.447 [95% CI: 1.190-1.760]) compared with participants in the highest SEP category. In sum, 6 out of 10 adverse COVID-19-related outcomes were, to a greater or lesser extent, disproportionately experienced by Viennese residents in lower SEP. Inequalities were most visible between income groups and for the outcomes job loss, worsening of the financial situation, and worse mental health. These results strengthen and extend the current evidence on the unequally distributed burden of the COVID-19 pandemic. In light of effect heterogeneity across SEP indicators, we encourage future investigators to pay increased attention to their operationalisation of SEP. Such awareness will help to correctly identify those in most urgent need of supportive polices.

Relationship Between Income Level and Hospitalization Rate in COVID-19 Cases; an Example of Social Factors Affecting Health

INTRODUCTION

Considering the population's socioeconomic status and clinical features is essential in planning and performing interventions related to disease control. The main purpose of this study was to investigate the relationship between income level and hospitalization rate of COVID-19 patients‌.

METHODS

A cross-sectional study was performed on 198,944 hospitalized COVID-19 patients in Tehran province between March 2020 and March 2021. Data of hospitalized COVID-19 patients was obtained from the Hospital Intelligent Management System (HIM). The income data of patients were obtained from the Iranian Database on Targeted Subsidies belonging to the Ministry of Cooperatives, Labor, and Social Welfare. Data analyses were performed using SPSS software.

RESULTS

About 2.5% of the inpatients were from the first decile, while 20.6% were from the tenth. The share of the lower three deciles of total hospitalization was about 11%, while the share of the upper three deciles was 50%. There was a big difference between the upper- and lower-income deciles regarding death rates. In the first decile, 30% of inpatients died, while the proportion was 10% in the tenth decile. There was a significant and positive relationship between income decline and hospitalization (r = 0.75; p = 0.02). Also, there was a significant and negative relationship between income decline and death rate (r = -0.90; p = 0.01).

CONCLUSION

Low-income groups use fewer inpatient services, are more prone to severe illness and death from COVID-19‌, and treatment in this group has a lower chance of success. Using a systemic approach to address socioeconomic factors in healthcare planning is crucial.

[Longitudinal care: factors associated with adherence to postpartum follow-up according to data from PMAQ-AB]

The aim was to identify factors of longitudinal care associated with women´s adherence to postpartum consultation in Brazil. This was a cross-sectional study of data from 19,177 postpartum women who participated in the external assessment of the third cycle of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), 2017. The dependent variable was postpartum consultation, and the independent variables, grouped hierarchically, were sociodemographic and economic at the distal level and issues analogous to longitudinal care at the proximal level. Multiple logistic regression analysis was performed with hierarchical entry of variables, where sociodemographic and economic variables were used to adjust the model. The results showed that 53% of women had undergone postpartum follow-up. The odds of adherence to postpartum follow-up were higher in women who received a home visit by a community health agents in the first week after childbirth (OR = 4.81), those with seven or more prenatal consultations (OR = 2.74), those who had sought care at the health unit in question (OR = 1.21), and those who had been seen by the same physician (OR = 1.14). In conclusion, the proportion of postpartum consultations was low (53%), and adherence to postpartum follow-up was higher when women received visits by community health agents, were accompanied by the same physician, had regular prenatal care, and had a specific healthcare unit as their regular source of care. Consistent longitudinal care was identified as an attribute of primary care that should be strengthened to improve postpartum care.

Framework for enhancing the estimation of model parameters for data with a high level of uncertainty

Reliable data are essential to obtain adequate simulations for forecasting the dynamics of epidemics. In this context, several political, economic, and social factors may cause inconsistencies in the reported data, which reflect the capacity for realistic simulations and predictions. In the case of COVID-19, for example, such uncertainties are mainly motivated by large-scale underreporting of cases due to reduced testing capacity in some locations. In order to mitigate the effects of noise in the data used to estimate parameters of models, we propose strategies capable of improving the ability to predict the spread of the diseases. Using a compartmental model in a COVID-19 study case, we show that the regularization of data by means of Gaussian process regression can reduce the variability of successive forecasts, improving predictive ability. We also present the advantages of adopting parameters of compartmental models that vary over time, in detriment to the usual approach with constant values.

Knowledge and perception of different plastic bags and packages: A case study in Brazil

The growing demand for plastics, for packaging and consumption, is a current environmental issue. Although there are many scientific developments concerning material science, knowledge about the public's perception is low, which can delay society's efforts to face this challenge. This study aimed to understand if Brazilians who practice different sustainable actions perceive differently biodegradable, recycled, and common plastics and have different purchase intentions for each specific type of packaging. A total of 1080 Brazilian adults were first classified by their day-to-day attitudes regarding sustainability efforts. Then, their purchase intention and perception about different plastics were assessed. Regardless of sustainability practices, people associate common plastic bags with negative attributes and biodegradable plastic bags with positive attributes. This shows that there is a well-established concept about these types of bags, even if there are some misconceptions (e.g. recyclable) or controversies (e.g. non-polluting). On the other hand, results showed that consumers who adopted more sustainable practices were 3.5 times more willing to pay for biodegradable packages, even though no differences were observed in the accepted price for biodegradable bags between consumer's groups. Finally, the purchase intention comparisons for products packaged in recycled and biodegradable plastics showed the consumers were more interested in those biodegradable plastics and the purchase intention was lower for perishable food (e.g. products that can have higher safety risks). The results are important for understanding environmental policy management in Brazil, highlighting the importance to improve the population's knowledge about different types of plastic, leading to more conscious choices.

Information and behavioral responses during a pandemic: Evidence from delays in Covid-19 death reports

Providing information is important for managing epidemics, but issues with data accuracy may hinder its effectiveness. Focusing on Covid-19 in Mexico, we ask whether delays in death reports affect individuals' beliefs and behavior. Exploiting administrative data and an online survey, we provide evidence that behavior, and consequently the evolution of the pandemic, are considerably different when death counts are presented by date reported rather than by date occurred, due to non-negligible reporting delays. We then use an equilibrium model incorporating an endogenous behavioral response to illustrate how reporting delays lead to slower individual responses, and consequently, worse epidemic outcomes.

Information and behavioral responses during a pandemic: Evidence from delays in Covid-19 death reports

Providing information is important for managing epidemics, but issues with data accuracy may hinder its effectiveness. Focusing on Covid-19 in Mexico, we ask whether delays in death reports affect individuals' beliefs and behavior. Exploiting administrative data and an online survey, we provide evidence that behavior, and consequently the evolution of the pandemic, are considerably different when death counts are presented by date reported rather than by date occurred, due to non-negligible reporting delays. We then use an equilibrium model incorporating an endogenous behavioral response to illustrate how reporting delays lead to slower individual responses, and consequently, worse epidemic outcomes.

Data-Driven Analytics Leveraging Artificial Intelligence in the Era of COVID-19: An Insightful Review of Recent Developments

This paper presents the role of artificial intelligence (AI) and other latest technologies that were employed to fight the recent pandemic (i.e., novel coronavirus disease-2019 (COVID-19)). These technologies assisted the early detection/diagnosis, trends analysis, intervention planning, healthcare burden forecasting, comorbidity analysis, and mitigation and control, to name a few. The key-enablers of these technologies was data that was obtained from heterogeneous sources (i.e., social networks (SN), internet of (medical) things (IoT/IoMT), cellular networks, transport usage, epidemiological investigations, and other digital/sensing platforms). To this end, we provide an insightful overview of the role of data-driven analytics leveraging AI in the era of COVID-19. Specifically, we discuss major services that AI can provide in the context of COVID-19 pandemic based on six grounds, (i) AI role in seven different epidemic containment strategies (a.k.a non-pharmaceutical interventions (NPIs)), (ii) AI role in data life cycle phases employed to control pandemic via digital solutions, (iii) AI role in performing analytics on heterogeneous types of data stemming from the COVID-19 pandemic, (iv) AI role in the healthcare sector in the context of COVID-19 pandemic, (v) general-purpose applications of AI in COVID-19 era, and (vi) AI role in drug design and repurposing (e.g., iteratively aligning protein spikes and applying three/four-fold symmetry to yield a low-resolution candidate template) against COVID-19. Further, we discuss the challenges involved in applying AI to the available data and privacy issues that can arise from personal data transitioning into cyberspace. We also provide a concise overview of other latest technologies that were increasingly applied to limit the spread of the ongoing pandemic. Finally, we discuss the avenues of future research in the respective area. This insightful review aims to highlight existing AI-based technological developments and future research dynamics in this area.

Ações governamentais para enfrentamento da crise de desinformação durante a pandemia da Covid-19

RESUMO A profusão de notícias falsas disseminadas no contexto da pandemia da Covid-19 colocou novos desafios a governos, gestores e profissionais de saúde, mídia e entidades de defesa da saúde e da vida. As ações governamentais de diferentes países frente a esse problema são o objeto deste estudo de revisão integrativa, que analisou 16 artigos, após busca em três bases de dados bibliográficos, no período de novembro de 2020 a janeiro de 2021, utilizando critérios de inclusão e exclusão. Agrupados por continentes (Ásia, Europa e América Latina), os resultados apontaram: existência de dispositivos reguladores; criminalização da desinformação; regulamentação da comunicação digital; uso de tecnologias para aproximar governo e cidadãos; monitoramento e verificação de notícias falsas; uso de plataformas refutadoras; redes digitais para identificação e remoção de notícias e contas; crise de desinformação como fomento para a divergência política; entre outros. Diferenças e desigualdades marcam as ações governamentais frente à desinformação no contexto da pandemia da Covid-19, refletindo coesão social, liderança, confiança institucional ou força coercitiva. Sugerem-se estudos aprofundados, que permitam compreender como as sociedades, com diferentes tipos de governo, economias e regimes políticos, definem as ações desenvolvidas para o controle da desinformação e seu potencial de eficiência.

Government actions to address the disinformation crisis during the COVID-19 pandemic

ABSTRACT The profusion of fake news disseminated in the context of the COVID-19 pandemic posed new challenges to governments, health care managers and professionals, media and entities committed to protect health and life. Government actions from different countries faced with this problem are the object of this integrative review study which analyzed 16 articles, after searching three bibliographic databases, from November 2020 to January 2021 using inclusion and exclusion criteria. Grouped by continents (Asia, Europe and Latin America), the results pointed to: the existence of regulatory devices; criminalization of disinformation; digital communication regulation; use of technologies to bring closer government and citizens; monitoring and verification of fake news; creation of rebuttal news platforms; digital network approaches for identification and removal of news and accounts; disinformation crisis as a foment for political divergence; among other issues. Differences and inequalities marked government actions against disinformation in the context of the COVID-19 pandemic reflecting social cohesion, leadership, institutional trust or coercive force. In-depth studies are suggested to understand how societies with different types of government, economies, and political regimes define the actions taken to control disinformation and their potential effectiveness.

Factors associated with depression, anxiety and stress among dentists during the COVID-19 pandemic

The objective of this work was to evaluate the relationship between factors associated with the COVID-19 pandemic and depression, anxiety, and stress (DAS) in dentists. Factors associated with the COVID-19 pandemic were evaluated using a questionnaire and scores of the Depression, Anxiety, and Stress Scales-21 were measured. The differences between the DAS scores based on the factors associated with the COVID-19 pandemic were tested through the successive application of multivariate analysis of variance (MANOVA, α = 0.05). After a sample size calculation, 998 participants with a mean age of 39.39 (± 11.69) years were included. The effect size indicated that changes in sleep quality (η2 = 0.161), eating habits (η2 = 0.057), and physical health (η2 = 0.051) were the ones that most negatively affected DAS scores. The highest DAS scores were observed in professionals who lived with someone at high-risk for COVID-19 (p < 0.001) and in those who did not engage in leisure activities during the pandemic (p < 0.001). Dentists who worked on the frontline against COVID-19 had higher scores of anxiety and stress (p = 0.029). The highest scores for anxiety, depression, and/or stress were seen in dentists living with someone at high-risk for COVID-19, who acts on the frontline, who does not practice in leisure activities during the pandemic, who completely changed eating habits, quality of sleep and physical health during the pandemic. In general, DAS levels of dentists were associated with factors related to the COVID-19 pandemic.

Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study

BACKGROUND

After 8 months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia.

METHODS

We conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from 2 March 2020 to 26 October 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the HR by age groups, sex, ethnicity, type of health insurance, area of residence and socioeconomic strata.

RESULTS

There were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between 2 March and 26 October. The risk of dying for COVID-19 among confirmed cases was higher in males (HR 1.68 95% CI 1.64 to 1.72), in people older than 60 years (HR 296.58 95% CI 199.22 to 441.51), in indigenous people (HR 1.20 95% CI 1.08 to 1.33), in people with subsidised health insurance regime (HR 1.89 95% CI 1.83 to 1.96) and in people living in the very low socioeconomic strata (HR 1.44 95% CI 1.24 to 1.68).

CONCLUSION

Our study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regimen and socioeconomic status.

Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis

INTRODUCTION

A well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system is critical to progress towards UHC. We aimed to measure and compare the performance of Kenya's public healthcare system at the county level and explore remediable drivers of poor healthcare system performance.

METHODS

Using administrative data from fiscal year 2014/2015 through fiscal year 2017/2018, we measured the technical efficiency of 47 county-level public healthcare systems in Kenya using stochastic frontier analysis. We then regressed the technical efficiency measure against a set of explanatory variables to examine drivers of efficiency. Additionally, in selected counties, we analysed surveys and focus group discussions to qualitatively understand factors affecting performance.

RESULTS

The median technical efficiency of county public healthcare systems was 84% in fiscal year 2017/2018 (with an IQR of 79% to 90%). Across the four fiscal years of data, 27 out of the 47 Kenyan counties had a declining technical efficiency score. Our regression analysis indicated that impediments to the flow of funding-measured by the budget absorption rate which is the ratio between funds spent and funds released-were significantly related to poor healthcare system performance. Our analysis of interviews and surveys yielded a similar conclusion as nearly 50% of respondents indicated issues stemming from poor budget absorption were significant drivers of poor healthcare system performance.

CONCLUSION

Public healthcare systems at the county-level in Kenya general performed well; however, addressing delays in the flow of funding is a concrete step to improve healthcare system performance. As Kenya-and other countries-provides additional funding to meet their UHC goals, establishing a strong and robust public financial management system is critical to ensure that the benefits of UHC are realised.

Music Listening in Times of COVID-19 Outbreak: A Brazilian Study

The COVID-19 outbreak required diverse strategies, such as social distancing and self-isolation, to avoid a healthcare system crisis. However, these measures have been associated with the onset or increase of anxiety and depression symptoms in the population. Music listening was previously shown to regulate emotion, consequently reducing depression symptoms. Since previous studies with Brazilian samples have already shown a high prevalence of depressive symptoms during the first confinement period, the aim of this study was threefold: (i) to compare groups with severe depression symptoms and no depression in what concerns to demographic and socio-economic factors as well as symptoms of anxiety and resilience levels, (ii) to explore changes in music listening daily routine during the confinement measures by both groups (no depression and severe depression), and (iii) to investigate which were the main factors influencing both two groups to music listening during the COVID-19 pandemic. This cross-sectional study included 494 Brazilian respondents aged 18 years and above. Our online survey comprised demographics, socio-economic, and COVID-19 related questionnaires, with questions regarding music listening used during social distancing measures on which the participants rated how much each of the 41 potential reasons for listening to music changed in importance compared to the situation before the pandemic and also the evaluation of anxiety, depression, and resilience levels. The respondents with severe depression were younger and showed higher levels of anxiety symptoms and lower resilience level. Furthermore, they were increasingly likely to listen to music to feel emotionally better with the situation, to feel comfort, to forget problems, to be energetic, to decrease sad feelings, to relax, to cheer up, to forget concerns, to express feelings, to reduce anxiety, to remember better times, to relieve boredom, to mentally stimulate themselves, and to ward off stressful thoughts compared to the participants with no depression. The exploratory factor analysis (FA) identified four types of music listening functions during social distancing measures: negative mood management, cognitive functioning, positive mood management, and physical involvement, in which the participants with severe depression revealed significant differences compared to non-depressed participants for the negative mood management factor, which shows the importance of music listening to regulate their negative emotions. As a conclusion, we can argue that most of our respondents used music listening to cope with and regulate their moods during confinement, especially those who presented with severe depression symptoms.

Exploring the Frequency of Anxiety and Depression Symptoms in a Brazilian Sample during the COVID-19 Outbreak

The COVID-19 pandemic is a public health emergency of international concern, and the main measures to contain the spread of the coronavirus causing COVID-19 were social distancing, quarantine, and self-isolation. Although these policies are effective in containing the spread of the virus, they might represent a challenge to psychological well-being, increasing levels of depressive and anxiety-related symptoms. Aims: We explored the frequency of anxiety and depression symptoms during COVID-19 restrictions and associations with sociodemographic factors in a Brazilian sample. Method: Data of a total of 936 Brazilian adults (68.2% women) aged 18 to 77 years old (M = 38.95, SD = 13.91) were collected through an online survey. Results: In general, we observed a frequency of 17.36% for severe anxiety and 66.13% for severe depression symptoms, in which younger participants (18–39 years old) and women showed higher scores in anxiety and depression scales compared to older age groups. Logistic regressions showed that women were more likely to present severe symptoms of anxiety (20.4%) compared to men (10.9%), as well as respondents in the educational sector (24.3%) compared to those in the health sector (10%). Conclusions: We highlight the importance of mental health professionals in developing strategies to help younger adults to mitigate the effects of social restriction.

Effect estimates of COVID-19 non-pharmaceutical interventions are non-robust and highly model-dependent

Objective

To compare the inference regarding the effectiveness of the various non-pharmaceutical interventions (NPIs) for COVID-19 obtained from different SIR models.

Study design and setting

We explored two models developed by Imperial College that considered only NPIs without accounting for mobility (model 1) or only mobility (model 2), and a model accounting for the combination of mobility and NPIs (model 3). Imperial College applied models 1 and 2 to 11 European countries and to the USA, respectively. We applied these models to 14 European countries (original 11 plus another 3), over two different time horizons.

Results

While model 1 found that lockdown was the most effective measure in the original 11 countries, model 2 showed that lockdown had little or no benefit as it was typically introduced at a point when the time-varying reproduction number was already very low. Model 3 found that the simple banning of public events was beneficial, while lockdown had no consistent impact. Based on Bayesian metrics, model 2 was better supported by the data than either model 1 or model 3 for both time horizons.

Conclusion

Inferences on effects of NPIs are non-robust and highly sensitive to model specification. In the SIR modeling framework, the impacts of lockdown are uncertain and highly model-dependent.

Social vulnerability and COVID-19 incidence in a Brazilian metropolis

Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (β=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (β=1.40), and maximum per capita household income of the poorest fifth (β=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.

Policy disparities in fighting COVID-19 among Japan, Italy, Singapore and China

Objective

In order to provide experiences for international epidemic control, this study systematically summarized the Coronavirus disease 2019 (COVID-19) prevention and control policies in Japan, Italy, China and Singapore, and also analyzed the possible inequalities that exist in these response approaches to improve global infectious disease control.

Methods

We summarized the epidemic prevention and control policies in Japan, Italy, China, and Singapore, and analyzed the policy effects of these four countries by using the data published by Johns Hopkins Coronavirus Resource Center.

Results

As of May 27, 2020, the growing trend of new cases in Japan, Italy, China and Singapore has stabilized. However, the cumulative number of confirmed cases (231139) and case-fatality rate (14.3%) in Italy far exceeded those in the other three countries, and the effect of epidemic control was inferior. Singapore began to experience a domestic resurgence after April 5, with a cumulative number of confirmed cases reaching 32,876, but the case-fatality rate remained extremely low (0.1%). The growth of cumulative confirmed cases in China (84547) was almost stagnant, and the case-fatality rate was low (5.5%). The growth of cumulative confirmed cases in Japan (16661) increased slowly, and the case-fatality rate (4.8%) was slightly lower than that in China.

Conclusion

This study divided the epidemic prevention and control policies of the four countries into two categories: the blocking measures adopted by China and Singapore, and the mitigation measures adopted by Japan and Italy. According to the Epidemic control results of these four countries, we can conclude that the blocking measures were generally effective. As the core strategy of blocking measures, admitting mild patients into hospital and cases tracing helped curb the spread of the outbreak in Singapore and China. Countries should choose appropriate response strategies on the premise of considering their own situation, increase investment in health resources to ensure global health equity, and eventually control the spread of infectious diseases in the world effectively.

Pediatric neurosurgery during the COVID-19 pandemic: update and recommendations from the Brazilian Society of Pediatric Neurosurgery

OBJECTIVES

Coronavirus disease (COVID-19) is a potentially severe respiratory illness that has threatened humanity globally. The pediatric neurosurgery practice differs from that of adults in that it treats children in various stages of physical and psychological development and contemplates diseases that do not exist in other areas. The aim of this study was to identify the level of knowledge and readiness of the healthcare providers, as well as to evaluate new preventive practices that have been introduced, psychological concerns, and the impact of the COVID-19 pandemic on pediatric neurosurgical units in Brazil.

METHODS

Pediatric neurosurgeons were given an online questionnaire developed by the Brazilian Society of Pediatric Neurosurgery to evaluate the impact of the COVID-19 pandemic on their clinical practice.

RESULTS

Of a cohort of 110 active members of the Brazilian Society of Pediatric Neurosurgery, 76 completed the survey (69%). Ninety-six percent were aware of the correct use of and indication for the types of personal protective equipment in clinical and surgical practices, but only 73.7% of them had unrestricted access to this equipment. Ninety-eight percent of participants agreed or strongly agreed that the pandemic had affected their pediatric neurosurgical practice. The COVID-19 pandemic interfered with outpatient care in 88% of the centers, it affected neurosurgical activity in 90.7%, and it led to the cancellation of elective neurosurgical procedures in 57.3%. Concerning the impact of COVID-19 on surgical activity, 9.2% of the centers had less than 25% of the clinical practice affected, 46.1% had 26%-50% of their activity reduced, 35.5% had a 51%-75% reduction, and 9.2% had more than 75% of their surgical work cancelled or postponed. Sixty-three percent affirmed that patients had been tested for COVID-19 before surgery. Regarding the impact of the COVID-19 pandemic on the mental health of those interviewed, 3.9% reported fear and anxiety with panic episodes, 7.9% had worsening of previous anxiety symptoms, 60.5% reported occasional fear, 10.5% had sadness and some depressive symptoms, and 2.6% reported depressive symptoms.

CONCLUSIONS

The COVID-19 pandemic has posed unprecedented challenges to healthcare services worldwide, including neurosurgical units. Medical workers, pediatric neurosurgeons included, should be aware of safety measures and follow the recommendations of local healthcare organizations, preventing and controlling the disease. Attention should be given to the psychological burden of exposure to SARS-CoV-2 in healthcare workers, which carries a high risk of anxiety and depression.

Genomic Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2, Colombia

Coronavirus disease (COVID-19) in Colombia was first diagnosed in a traveler arriving from Italy on February 26, 2020. However, limited data are available on the origins and number of introductions of COVID-19 into the country. We sequenced the causative agent of COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from 43 clinical samples we collected, along with another 79 genome sequences available from Colombia. We investigated the emergence and importation routes for SARS-CoV-2 into Colombia by using epidemiologic, historical air travel, and phylogenetic observations. Our study provides evidence of multiple introductions, mostly from Europe, and documents >12 lineages. Phylogenetic findings validate the lineage diversity, support multiple importation events, and demonstrate the evolutionary relationship of epidemiologically linked transmission chains. Our results reconstruct the early evolutionary history of SARS-CoV-2 in Colombia and highlight the advantages of genome sequencing to complement COVID-19 outbreak investigations.

Genomic Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2, Colombia

Coronavirus disease (COVID-19) in Colombia was first diagnosed in a traveler arriving from Italy on February 26, 2020. However, limited data are available on the origins and number of introductions of COVID-19 into the country. We sequenced the causative agent of COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from 43 clinical samples we collected, along with another 79 genome sequences available from Colombia. We investigated the emergence and importation routes for SARS-CoV-2 into Colombia by using epidemiologic, historical air travel, and phylogenetic observations. Our study provides evidence of multiple introductions, mostly from Europe, and documents >12 lineages. Phylogenetic findings validate the lineage diversity, support multiple importation events, and demonstrate the evolutionary relationship of epidemiologically linked transmission chains. Our results reconstruct the early evolutionary history of SARS-CoV-2 in Colombia and highlight the advantages of genome sequencing to complement COVID-19 outbreak investigations.

Global perspective of COVID-19 epidemiology for a full-cycle pandemic

As of October 2020, there are >1 million documented deaths with COVID-19. Excess deaths can be caused by both COVID-19 and the measures taken. COVID-19 shows extremely strong risk stratification across age, socioeconomic factors, and clinical factors. Calculation of years-of-life-lost from COVID-19 is methodologically challenging and can yield misleading over-estimates. Many early deaths may have been due to suboptimal management, malfunctional health systems, hydroxychloroquine, sending COVID-19 patients to nursing homes, and nosocomial infections; such deaths are partially avoidable moving forward. About 10% of the global population may be infected by October 2020. Global infection fatality rate is 0.15-0.20% (0.03-0.04% in those <70 years), with large variability across locations with different age-structure, institutionalization rates, socioeconomic inequalities, population-level clinical risk profile, public health measures, and health care. There is debate on whether at least 60% of the global population must be infected for herd immunity, or, conversely, mixing heterogeneity and pre-existing cross-immunity may allow substantially lower thresholds. Simulations are presented with a total of 1.58-8.76 million COVID-19 deaths over 5-years (1/2020-12/2024) globally (0.5-2.9% of total global deaths). The most favorable figures in that range would be feasible if high risk groups can be preferentially protected with lower infection rates than the remaining population. Death toll may also be further affected by potential availability of effective vaccines and treatments, optimal management and measures taken, COVID-19 interplay with influenza and other health problems, reinfection potential, and any chronic COVID-19 consequences. Targeted, precise management of the pandemic and avoiding past mistakes would help minimize mortality.

Pandemic response management framework based on efficiency of COVID-19 control and treatment

Aims: The existing response management system for pandemic disease fell short of controlling COVID-19. This study evaluates the response management relative efficiency of 58 countries in two stages, using two models. Materials & methods: Data envelopment analysis was applied for efficiency analysis. Results: 89.6% of countries were inefficient in pandemic control and 79% were inefficient in treatment measures. Sensitivity analysis underlines resources as a critical factor. Further examination points to absence of a robust and uniform mitigation measure against the pandemic in most countries. Conclusions: Preventing spread is not only the first line of defense; it is the only line of defense. The lack of a global public health database support system and uniform response compounded inefficiency. A robust pandemic response management framework is developed based on practices of key performers. Action plans are proposed, with a recommendation for a global public health pandemic database monitoring and support system as the nucleus.