1
|
Pandey A, Fitzpatrick MC, Singer BH, Galvani AP. Mortality and morbidity ramifications of proposed retractions in healthcare coverage for the United States. Proc Natl Acad Sci U S A 2024; 121:e2321494121. [PMID: 38648491 DOI: 10.1073/pnas.2321494121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
In the absence of universal healthcare in the United States, federal programs of Medicaid and Medicare are vital to providing healthcare coverage for low-income households and elderly individuals, respectively. However, both programs are under threat, with either enacted or proposed retractions. Specifically, raising Medicare age eligibility and the addition of work requirements for Medicaid qualification have been proposed, while termination of continuous enrollment for Medicaid was recently effectuated. Here, we assess the potential impact on mortality and morbidity resulting from these policy changes. Our findings indicate that the policy change to Medicare would lead to over 17,000 additional deaths among individuals aged 65 to 67 and those to Medicaid would lead to more than 8,000 deaths among those under the age of 65. To illustrate the implications for morbidity, we further consider a case study among those people with diabetes who would be likely to lose their health insurance under the policy changes. We project that these insurance retractions would lead to the loss of coverage for over 700,000 individuals with diabetes, including more than 200,000 who rely on insulin.
Collapse
Affiliation(s)
- Abhishek Pandey
- Epidemiology of Microbial Diseases, Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Meagan C Fitzpatrick
- Epidemiology of Microbial Diseases, Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Burton H Singer
- Department of Mathematics, Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Epidemiology of Microbial Diseases, Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| |
Collapse
|
2
|
Wells CR, Pandey A, Moghadas SM, Fitzpatrick MC, Singer BH, Galvani AP. Evaluation of Strategies for Transitioning to Annual SARS-CoV-2 Vaccination Campaigns in the United States. Ann Intern Med 2024. [PMID: 38527289 DOI: 10.7326/m23-2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The U.S. Food and Drug Administration has proposed administering annual SARS-CoV-2 vaccines. OBJECTIVE To evaluate the effectiveness of an annual SARS-CoV-2 vaccination campaign, quantify the health and economic benefits of a second dose provided to children younger than 2 years and adults aged 50 years or older, and optimize the timing of a second dose. DESIGN An age-structured dynamic transmission model. SETTING United States. PARTICIPANTS A synthetic population reflecting demographics and contact patterns in the United States. INTERVENTION Vaccination against SARS-CoV-2 with age-specific uptake similar to that of influenza vaccination. MEASUREMENTS Incidence, hospitalizations, deaths, and direct health care cost. RESULTS The optimal timing between the first and second dose delivered to children younger than 2 years and adults aged 50 years or older in an annual vaccination campaign was estimated to be 5 months. In direct comparison with a single-dose campaign, a second booster dose results in 123 869 fewer hospitalizations (95% uncertainty interval [UI], 121 994 to 125 742 fewer hospitalizations) and 5524 fewer deaths (95% UI, 5434 to 5613 fewer deaths), averting $3.63 billion (95% UI, $3.57 billion to $3.69 billion) in costs over a single year. LIMITATIONS Population immunity is subject to degrees of immune evasion for emerging SARS-CoV-2 variants. The model was implemented in the absence of nonpharmaceutical interventions and preexisting vaccine-acquired immunity. CONCLUSION The direct health care costs of SARS-CoV-2, particularly among adults aged 50 years or older, would be substantially reduced by administering a second dose 5 months after the initial dose. PRIMARY FUNDING SOURCE Natural Sciences and Engineering Research Council of Canada, Notsew Orm Sands Foundation, National Institutes of Health, Centers for Disease Control and Prevention, and National Science Foundation.
Collapse
Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut (C.R.W., A.P., A.P.G.)
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut (C.R.W., A.P., A.P.G.)
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada (S.M.M.)
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland (M.C.F.)
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida (B.H.S.)
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut (C.R.W., A.P., A.P.G.)
| |
Collapse
|
3
|
Mehrab Z, Stundal L, Venkatramanan S, Swarup S, Lewis B, Mortveit HS, Barrett CL, Pandey A, Wells CR, Galvani AP, Singer BH, Leblang D, Colwell RR, Marathe MV. An agent-based framework to study forced migration: A case study of Ukraine. PNAS Nexus 2024; 3:pgae080. [PMID: 38505694 PMCID: PMC10949908 DOI: 10.1093/pnasnexus/pgae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/06/2024] [Indexed: 03/21/2024]
Abstract
The ongoing Russian aggression against Ukraine has forced over eight million people to migrate out of Ukraine. Understanding the dynamics of forced migration is essential for policy-making and for delivering humanitarian assistance. Existing work is hindered by a reliance on observational data which is only available well after the fact. In this work, we study the efficacy of a data-driven agent-based framework motivated by social and behavioral theory in predicting outflow of migrants as a result of conflict events during the initial phase of the Ukraine war. We discuss policy use cases for the proposed framework by demonstrating how it can leverage refugee demographic details to answer pressing policy questions. We also show how to incorporate conflict forecast scenarios to predict future conflict-induced migration flows. Detailed future migration estimates across various conflict scenarios can both help to reduce policymaker uncertainty and improve allocation and staging of limited humanitarian resources in crisis settings.
Collapse
Affiliation(s)
- Zakaria Mehrab
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA 22904, USA
| | - Logan Stundal
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Political Science, University of Virginia, Charlottesville, VA 22904, USA
| | | | - Samarth Swarup
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
| | - Bryan Lewis
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
| | - Henning S Mortveit
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, USA
| | - Christopher L Barrett
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA 22904, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520, USA
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
| | - David Leblang
- Department of Political Science, University of Virginia, Charlottesville, VA 22904, USA
| | - Rita R Colwell
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA
| | - Madhav V Marathe
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA 22904, USA
| |
Collapse
|
4
|
Moghadas SM, Shoukat A, Bawden CE, Langley JM, Singer BH, Fitzpatrick MC, Galvani AP. Cost-effectiveness of Prefusion F Protein-based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States. Clin Infect Dis 2023:ciad658. [PMID: 38035791 DOI: 10.1093/cid/ciad658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. METHODS We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the United States. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-year (QALY) gained as a measure of effectiveness and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. RESULTS Using a willingness-to-pay of $95 000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD up to $127 with Arexvy and $118 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the United States, the budget impact of these programs at the maximum PPD ranged from $6.48 to $6.78 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $235 for Arexvy and $245 for Abrysvo, with 2-year budget impacts of $11.78 and $12.25 billion, respectively. CONCLUSIONS Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
Collapse
Affiliation(s)
- Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Affan Shoukat
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Carolyn E Bawden
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
5
|
Horwitz RI, Singer BH. Clinimetrics and Allostatic Load. Psychother Psychosom 2023; 92:283-286. [PMID: 37883947 DOI: 10.1159/000534257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Ralph I Horwitz
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Burton H Singer
- Adjunct Professor, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
6
|
Moghadas SM, Shoukat A, Bawden CE, Langley JM, Singer BH, Fitzpatrick MC, Galvani AP. Cost-Effectiveness of Prefusion F Protein-Based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States. medRxiv 2023:2023.08.14.23294076. [PMID: 37645896 PMCID: PMC10462221 DOI: 10.1101/2023.08.14.23294076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against Respiratory Syncytial Virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. Methods We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the US. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-years (QALY) gained as a measure of effectiveness, and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. Results Using a willingness-to-pay of $95,000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD under $120 with Arexvy and $111 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the US, the budget impact of these programs at the maximum PPD ranged from $5.74 to $6.10 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $250 for Arexvy and $233 for Abrysvo, with two-year budget impacts of $11.59 and $10.89 billion, respectively. Conclusions Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
Collapse
|
7
|
Pandey A, Wells CR, Stadnytskyi V, Moghadas SM, Marathe MV, Sah P, Crystal W, Meyers LA, Singer BH, Nesterova O, Galvani AP. Disease burden among Ukrainians forcibly displaced by the 2022 Russian invasion. Proc Natl Acad Sci U S A 2023; 120:e2215424120. [PMID: 36780515 PMCID: PMC9974407 DOI: 10.1073/pnas.2215424120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023] Open
Abstract
The Russian invasion of Ukraine on February 24, 2022, has displaced more than a quarter of the population. Assessing disease burdens among displaced people is instrumental in informing global public health and humanitarian aid efforts. We estimated the disease burden in Ukrainians displaced both within Ukraine and to other countries by combining a spatiotemporal model of forcible displacement with age- and gender-specific estimates of cardiovascular disease (CVD), diabetes, cancer, HIV, and tuberculosis (TB) in each of Ukraine's 629 raions (i.e., districts). Among displaced Ukrainians as of May 13, we estimated that more than 2.63 million have CVDs, at least 615,000 have diabetes, and over 98,500 have cancer. In addition, more than 86,000 forcibly displaced individuals are living with HIV, and approximately 13,500 have TB. We estimated that the disease prevalence among refugees was lower than the national disease prevalence before the invasion. Accounting for internal displacement and healthcare facilities impacted by the conflict, we estimated that the number of people per hospital has increased by more than two-fold in some areas. As regional healthcare systems come under increasing strain, these estimates can inform the allocation of critical resources under shifting disease burdens.
Collapse
Affiliation(s)
- Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT06520
| | - Chad R. Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT06520
| | | | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON, Canada, M3J 1P3
| | - Madhav V. Marathe
- Network Systems Science and Advanced Computing Division, Biocomplexity Institute, University of Virginia, Charlottesville, VA22904
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22904
| | - Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT06520
| | - William Crystal
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT06520
| | | | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL32610
| | - Olena Nesterova
- Ukrainian Institute for Public Health Research, Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine04071
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT06520
| |
Collapse
|
8
|
Horwitz RI, Hayes-Conroy A, Singer BH, Cullen MR, Badal K, Sim I. Falling down the biological rabbit hole: Epstein-Barr virus, biography, and multiple sclerosis. J Clin Invest 2022; 132:e164141. [PMID: 36047497 PMCID: PMC9435645 DOI: 10.1172/jci164141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Allison Hayes-Conroy
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | | | | | - Ida Sim
- Division of General Internal Medicine and Computational Precision Health, UCSF, San Francisco, California, USA
| |
Collapse
|
9
|
Horwitz RI, Conroy AH, Cullen MR, Colella K, Mawn M, Singer BH, Sim I. Long COVID and Medicine's Two Cultures. Am J Med 2022; 135:945-949. [PMID: 35417745 DOI: 10.1016/j.amjmed.2022.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
Abstract
Medicine has separated the two cultures of biological science and social science in research, even though they are intimately connected in the lives of our patients. To understand the cause, progression, and treatment of long COVID , biology and biography, the patient's lived experience, must be studied together.
Collapse
Affiliation(s)
- Ralph I Horwitz
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Penn.
| | | | - Mark R Cullen
- Stanford Center for Population Health Sciences (retired), Stanford University, Stanford, Calif
| | - Katharine Colella
- Lewis Katz School of Medicine, Temple University, Philadelphia, Penn
| | - McKayla Mawn
- Lewis Katz School of Medicine, Temple University, Philadelphia, Penn
| | | | - Ida Sim
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
| |
Collapse
|
10
|
Wells CR, Pandey A, Gokcebel S, Krieger G, Donoghue AM, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and serial testing for variants of SARS-CoV-2 with benefits of vaccination and boosting on consequent control of COVID-19. PNAS Nexus 2022; 1:pgac100. [PMID: 35909795 PMCID: PMC9335027 DOI: 10.1093/pnasnexus/pgac100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
Quarantine and serial testing strategies for a disease depend principally on its incubation period and infectiousness profile. In the context of COVID-19, these primary public health tools must be modulated with successive SARS CoV-2 variants of concern that dominate transmission. Our analysis shows that (1) vaccination status of an individual makes little difference to the determination of the appropriate quarantine duration of an infected case, whereas vaccination coverage of the population can have a substantial effect on this duration, (2) successive variants can challenge disease control efforts by their earlier and increased transmission in the disease time course relative to prior variants, and (3) sufficient vaccine boosting of a population substantially aids the suppression of local transmission through frequent serial testing. For instance, with Omicron, increasing immunity through vaccination and boosters-for instance with 100% of the population is fully immunized and at least 24% having received a third dose-can reduce quarantine durations by up to 2 d, as well as substantially aid in the repression of outbreaks through serial testing. Our analysis highlights the paramount importance of maintaining high population immunity, preferably by booster uptake, and the role of quarantine and testing to control the spread of SARS CoV-2.
Collapse
Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT 06520, USA
| | - Senay Gokcebel
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA,Department of Biochemistry, Grinnell College, Grinnell, IA 50112, USA
| | - Gary Krieger
- NewFields E&E, Boulder, CO 80301, USA,Skaggs School of Pharmacy and Pharmaceutical Science, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - A Michael Donoghue
- Group HSE, BHP Group Ltd, 171 Collins Street, Melbourne, VIC 3000, Australia
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL 32610, USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT 06520, USA
| | | |
Collapse
|
11
|
Galvani AP, Parpia AS, Pandey A, Sah P, Colón K, Friedman G, Campbell T, Kahn JG, Singer BH, Fitzpatrick MC. Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic. Proc Natl Acad Sci U S A 2022; 119:e2200536119. [PMID: 35696578 PMCID: PMC9231482 DOI: 10.1073/pnas.2200536119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.
Collapse
Affiliation(s)
- Alison P. Galvani
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- 1To whom correspondence may be addressed. or
| | - Alyssa S. Parpia
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Abhishek Pandey
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Pratha Sah
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Kenneth Colón
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- bMaxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY 13244
| | - Gerald Friedman
- cDepartment of Economics, College of Social and Behavioral Sciences, University of Massachusetts Amherst, Amherst, MA 01002
| | - Travis Campbell
- cDepartment of Economics, College of Social and Behavioral Sciences, University of Massachusetts Amherst, Amherst, MA 01002
| | - James G. Kahn
- dInstitute for Health Policy Studies, School of Medicine, University of California, San Francisco, CA 94118
| | - Burton H. Singer
- eEmerging Pathogens Institute, University of Florida, Gainesville, FL 32610
- 1To whom correspondence may be addressed. or
| | - Meagan C. Fitzpatrick
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- fCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| |
Collapse
|
12
|
Abstract
Environmental disasters, pandemics, and other major traumatic events such as the Covid-19 pandemic or war contribute to psychosocial stress which manifests in a wide range of mental and physical consequences. The increasing frequency and severity of such events suggest that the adverse effects of toxic stress are likely to become more widespread and pervasive in the future. The allostatic load (AL) model has important elements that lend themselves well for identifying adverse health effects of disasters. Here we examine several articulations of AL from the standpoint of using AL to gauge short- and long-term health effects of disasters and to provide predictive capacity that would enable mitigation or prevention of some disaster-related health consequences. We developed a transdisciplinary framework combining indices of psychosocial AL and physiological AL to produce a robust estimate of overall AL in people affected by disasters and other traumatic events. In conclusion, we urge researchers to consider the potential of using AL as a component in a proposed disaster-oriented human health observing system.
Collapse
Affiliation(s)
- Paul A Sandifer
- Center for Coastal Environmental and Human Health, School of Sciences and Mathematics, College of Charleston, 66 George Street, Charleston, SC 29424, USA.
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
| | - Teresa E Seeman
- David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA
| | - Maureen Y Lichtveld
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| |
Collapse
|
13
|
Horwitz RI, Singer BH, Hayes-Conroy A, Cullen MR, Mawn M, Colella K, Sim I. Biosocial Pathogenesis. Psychother Psychosom 2022; 91:73-77. [PMID: 35104822 DOI: 10.1159/000521567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Ralph I Horwitz
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Burton H Singer
- Department of Mathematics, University of Florida, Gainesville, Florida, USA
| | | | - Mark R Cullen
- Stanford Center for Population Health Sciences, Palo Alto, California, USA
| | - McKayla Mawn
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Katharine Colella
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Ida Sim
- Division of General Internal Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
14
|
Wells CR, Pandey A, Fitzpatrick MC, Crystal WS, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study. Lancet Reg Health Eur 2022; 14:100304. [PMID: 35036981 PMCID: PMC8743228 DOI: 10.1016/j.lanepe.2021.100304] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Numerous countries have imposed strict travel restrictions during the COVID-19 pandemic, contributing to a large socioeconomic burden. The long quarantines that have been applied to contacts of cases may be excessive for travel policy. METHODS We developed an approach to evaluate imminent countrywide COVID-19 infections after 0-14-day quarantine and testing. We identified the minimum travel quarantine duration such that the infection rate within the destination country did not increase compared to a travel ban, defining this minimum quarantine as "sufficient." FINDINGS We present a generalised analytical framework and a specific case study of the epidemic situation on November 21, 2021, for application to 26 European countries. For most origin-destination country pairs, a three-day or shorter quarantine with RT-PCR or antigen testing on exit suffices. Adaptation to the European Union traffic-light risk stratification provided a simplified policy tool. Our analytical approach provides guidance for travel policy during all phases of pandemic diseases. INTERPRETATION For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. FUNDING EasyJet (JPT and APG), the Elihu endowment (JPT), the Burnett and Stender families' endowment (APG), the Notsew Orm Sands Foundation (JPT and APG), the National Institutes of Health (MCF), Canadian Institutes of Health Research (SMM) and Natural Sciences and Engineering Research Council of Canada EIDM-MfPH (SMM).
Collapse
Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - William S. Crystal
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL, 32610, USA
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, 06525, USA
| | - Jeffrey P. Townsend
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, 06525, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, 06510, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, 06511, USA
- Program in Microbiology, Yale University, New Haven, Connecticut, 06511, USA
| |
Collapse
|
15
|
Russo M, Singer BH, Dunson DB. Multivariate mixed membership modeling: Inferring domain-specific risk profiles. Ann Appl Stat 2022; 16:391-413. [DOI: 10.1214/21-aoas1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Burton H. Singer
- Emerging Pathogens Institute and Department of Mathematics, University of Florida
| | | |
Collapse
|
16
|
Wells CR, Pandey A, Moghadas SM, Singer BH, Krieger G, Heron RJL, Turner DE, Abshire JP, Phillips KM, Michael Donoghue A, Galvani AP, Townsend JP. Comparative analyses of eighteen rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation. Commun Med (Lond) 2022; 2:84. [PMID: 35822105 PMCID: PMC9271059 DOI: 10.1038/s43856-022-00147-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Rapid antigen (RA) tests are being increasingly employed to detect SARS-CoV-2 infections in quarantine and surveillance. Prior research has focused on RT-PCR testing, a single RA test, or generic diagnostic characteristics of RA tests in assessing testing strategies. Methods We have conducted a comparative analysis of the post-quarantine transmission, the effective reproduction number during serial testing, and the false-positive rates for 18 RA tests with emergency use authorization from The United States Food and Drug Administration and an RT-PCR test. To quantify the extent of transmission, we developed an analytical mathematical framework informed by COVID-19 infectiousness, test specificity, and temporal diagnostic sensitivity data. Results We demonstrate that the relative effectiveness of RA tests and RT-PCR testing in reducing post-quarantine transmission depends on the quarantine duration and the turnaround time of testing results. For quarantines of two days or shorter, conducting a RA test on exit from quarantine reduces onward transmission more than a single RT-PCR test (with a 24-h delay) conducted upon exit. Applied to a complementary approach of performing serial testing at a specified frequency paired with isolation of positives, we have shown that RA tests outperform RT-PCR with a 24-h delay. The results from our modeling framework are consistent with quarantine and serial testing data collected from a remote industry setting. Conclusions These RA test-specific results are an important component of the tool set for policy decision-making, and demonstrate that judicious selection of an appropriate RA test can supply a viable alternative to RT-PCR in efforts to control the spread of disease.
Collapse
Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL USA
| | - Gary Krieger
- NewFields E&E, Boulder, CO USA.,Skaggs School of Pharmacy and Pharmaceutical Science, , University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | | | | | | | | | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT USA
| | - Jeffrey P Townsend
- Department of Biostatistics, Yale School of Public Health, New Haven, CT USA.,Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT USA.,Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT USA.,Program in Microbiology, Yale University, New Haven, CT USA
| |
Collapse
|
17
|
Wells CR, Pandey A, Fitzpatrick MC, Crystal WS, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study. medRxiv 2021:2021.04.25.21256082. [PMID: 34729563 PMCID: PMC8562544 DOI: 10.1101/2021.04.25.21256082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Numerous countries imposed strict travel restrictions, contributing to the large socioeconomic burden during the COVID-19 pandemic. The long quarantines that apply to contacts of cases may be excessive for travel policy. METHODS We developed an approach to evaluate imminent countrywide COVID-19 infections after 0-14-day quarantine and testing. We identified the minimum travel quarantine duration such that the infection rate within the destination country did not increase compared to a travel ban, defining this minimum quarantine as "sufficient." FINDINGS We present a generalised analytical framework and a specific case study of the epidemic situation on November 21, 2021, for application to 26 European countries. For most origin-destination country pairs, a three-day or shorter quarantine with RT-PCR or antigen testing on exit suffices. Adaptation to the European Union traffic-light risk stratification provided a simplified policy tool. Our analytical approach provides guidance for travel policy during all phases of pandemic diseases. INTERPRETATION For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. FUNDING EasyJet (JPT and APG), the Elihu endowment (JPT), the Burnett and Stender families' endowment (APG), the Notsew Orm Sands Foundation (JPT and APG), the National Institutes of Health (MCF), Canadian Institutes of Health Research (SMM) and Natural Sciences and Engineering Research Council of Canada EIDM-MfPH (SMM).
Collapse
Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - William S. Crystal
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL 32610, USA
| | | | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut 06525, USA
| | - Jeffrey P. Townsend
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut 06525, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut 06510, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut 06511, USA
- Program in Microbiology, Yale University, New Haven, Connecticut 06511, USA
| |
Collapse
|
18
|
Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, Meyers LA, Neuzil KM, Langley JM, Fitzpatrick MC, Galvani AP. The Impact of Vaccination on Coronavirus Disease 2019 (COVID-19) Outbreaks in the United States. Clin Infect Dis 2021; 73:2257-2264. [PMID: 33515252 PMCID: PMC7929033 DOI: 10.1093/cid/ciab079] [Citation(s) in RCA: 251] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Global vaccine development efforts have been accelerated in response to the devastating coronavirus disease 2019 (COVID-19) pandemic. We evaluated the impact of a 2-dose COVID-19 vaccination campaign on reducing incidence, hospitalizations, and deaths in the United States. METHODS We developed an agent-based model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and parameterized it with US demographics and age-specific COVID-19 outcomes. Healthcare workers and high-risk individuals were prioritized for vaccination, whereas children under 18 years of age were not vaccinated. We considered a vaccine efficacy of 95% against disease following 2 doses administered 21 days apart achieving 40% vaccine coverage of the overall population within 284 days. We varied vaccine efficacy against infection and specified 10% preexisting population immunity for the base-case scenario. The model was calibrated to an effective reproduction number of 1.2, accounting for current nonpharmaceutical interventions in the United States. RESULTS Vaccination reduced the overall attack rate to 4.6% (95% credible interval [CrI]: 4.3%-5.0%) from 9.0% (95% CrI: 8.4%-9.4%) without vaccination, over 300 days. The highest relative reduction (54%-62%) was observed among individuals aged 65 and older. Vaccination markedly reduced adverse outcomes, with non-intensive care unit (ICU) hospitalizations, ICU hospitalizations, and deaths decreasing by 63.5% (95% CrI: 60.3%-66.7%), 65.6% (95% CrI: 62.2%-68.6%), and 69.3% (95% CrI: 65.5%-73.1%), respectively, across the same period. CONCLUSIONS Our results indicate that vaccination can have a substantial impact on mitigating COVID-19 outbreaks, even with limited protection against infection. However, continued compliance with nonpharmaceutical interventions is essential to achieve this impact.
Collapse
Affiliation(s)
- Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Thomas N Vilches
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas SP, Brazil
| | - Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Affan Shoukat
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Lauren Ancel Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, Texas, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
19
|
Horwitz RI, Lobitz G, Mawn M, Conroy AH, Cullen MR, Sim I, Singer BH. Rethinking Table 1. J Clin Epidemiol 2021; 142:242-245. [PMID: 34800675 DOI: 10.1016/j.jclinepi.2021.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022]
Abstract
Clinical and translational medicine studies of disease risk or treatment response typically include a table 1 comparing groups on age, sex, and race and/or ethnicity. Although customarily treated as biological variables, each denote biography, elements of a person's lived experience. Capturing these biographical features is essential to achieving the ambition of personalized medicine.
Collapse
Affiliation(s)
- Ralph I Horwitz
- Department of Medicine, Temple University Lewis Katz School of Medicine, Philadelphia, PA.
| | - Gabriella Lobitz
- Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - McKayla Mawn
- Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | | | - Mark R Cullen
- Stanford Center for Population Health Sciences, Palo Alto, CA
| | - Ida Sim
- Division of General Internal Medicine at University of California San Francisco, San Francisco, CA
| | | |
Collapse
|
20
|
Horwitz RI, Singer BH, Seeman TE. Biology and Lived Experience in Health and Disease: A Tribute to Bruce McEwen (1938-2020), a Scientist without Silos. Psychother Psychosom 2021; 90:5-10. [PMID: 33171463 DOI: 10.1159/000512598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Ralph I Horwitz
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA,
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Teresa E Seeman
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
21
|
Sah P, Moghadas SM, Vilches TN, Shoukat A, Singer BH, Hotez PJ, Schneider EC, Galvani AP. Implications of suboptimal COVID-19 vaccination coverage in Florida and Texas. Lancet Infect Dis 2021; 21:1493-1494. [PMID: 34627498 PMCID: PMC8497018 DOI: 10.1016/s1473-3099(21)00620-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON, Canada
| | - Thomas N Vilches
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA; Agent-Based Modelling Laboratory, York University, Toronto, ON, Canada
| | - Affan Shoukat
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA.
| |
Collapse
|
22
|
Abstract
The COVID-19 pandemic and increasing frequency and severity of environmental disasters reveal an urgent need for a robust health observing/surveillance system. With the possible exception of Brazil, we know of no such comprehensive health observing capacity. The US should create a national system of linked regionally-based health monitoring systems similar to those for weather, ocean conditions, and climate. Like those for weather, the health observing system should operate continuously, collecting mental, physical, and community health data before, during, and after events. The system should include existing cross-sectional health data surveys, along with significant new investment in regional longitudinal cohort studies. The recently described framework for a Gulf of Mexico Community Health Observing System is suggested as a potential model for development of a nation-wide system.
Collapse
Affiliation(s)
- Paul A Sandifer
- Center for Coastal Environmental and Human Health, School of Sciences and Mathematics, College of Charleston, Charleston, SC, United States
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Rita R Colwell
- Johns Hopkins University Bloomberg School of Public Health, University of Maryland Institute for Advanced Computer Studies, University of Maryland College Park, Baltimore, MD, United States
| |
Collapse
|
23
|
Horwitz RI, Lobitz G, Mawn M, Conroy AH, Cullen MR, Sim I, Singer BH. Biosocial medicine: Biology, biography, and the tailored care of the patient. SSM Popul Health 2021; 15:100863. [PMID: 34430699 PMCID: PMC8374477 DOI: 10.1016/j.ssmph.2021.100863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Biosocial Medicine, with its emphasis on the full integration of the person's biology and biography, proposes a strategy for clinical research and the practice of medicine that is transformative for the care of individual patients. In this paper, we argue that Biology is one component of what makes a person unique, but it does not do so alone. Biography, the lived experience of the person, integrates with biology to create a unique signature for each individual and is the foundational concept on which Biosocial Medicine is based. Biosocial Medicine starts with the premise that the individual patient is the focus of clinical care, and that average results for "ideal" patients in population level research cannot substitute for the "real" patient for whom clinical decisions are needed. The paper begins with a description of the case-based method of clinical reasoning, considers the strengths and limitations of Randomized Controlled Trials and Evidence Based Medicine, reviews the increasing focus on precision medicine and then explores the neglected role of biography as part of a new approach to the tailored care of patients. After a review of the analytical challenges in Biosocial Medicine, the paper concludes by linking the physician's commitment to understanding the patient's biography as a critical element in developing trust with the patient.
Collapse
Affiliation(s)
- Ralph I. Horwitz
- Department of Medicine at Temple, University Lewis Katz School of Medicine, USA
| | | | - McKayla Mawn
- Temple University Lewis Katz School of Medicine, USA
| | | | - Mark R. Cullen
- Stanford Center for Population Health Sciences (retired), USA
| | - Ida Sim
- Division of General Internal Medicine at University of California San Francisco, USA
| | | |
Collapse
|
24
|
Solo-Gabriele HM, Fiddaman T, Mauritzen C, Ainsworth C, Abramson DM, Berenshtein I, Chassignet EP, Chen SS, Conmy RN, Court CD, Dewar WK, Farrington JW, Feldman MG, Ferguson AC, Fetherston-Resch E, French-McCay D, Hale C, He R, Kourafalou VH, Lee K, Liu Y, Masi M, Maung-Douglass ES, Morey SL, Murawski SA, Paris CB, Perlin N, Pulster EL, Quigg A, Reed DJ, Ruzicka JJ, Sandifer PA, Shepherd JG, Singer BH, Stukel MR, Sutton TT, Weisberg RH, Wiesenburg D, Wilson CA, Wilson M, Wowk KM, Yanoff C, Yoskowitz D. Towards integrated modeling of the long-term impacts of oil spills. Mar Policy 2021; 131:1-18. [PMID: 37850151 PMCID: PMC10581399 DOI: 10.1016/j.marpol.2021.104554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Although great progress has been made to advance the scientific understanding of oil spills, tools for integrated assessment modeling of the long-term impacts on ecosystems, socioeconomics and human health are lacking. The objective of this study was to develop a conceptual framework that could be used to answer stakeholder questions about oil spill impacts and to identify knowledge gaps and future integration priorities. The framework was initially separated into four knowledge domains (ocean environment, biological ecosystems, socioeconomics, and human health) whose interactions were explored by gathering stakeholder questions through public engagement, assimilating expert input about existing models, and consolidating information through a system dynamics approach. This synthesis resulted in a causal loop diagram from which the interconnectivity of the system could be visualized. Results of this analysis indicate that the system naturally separates into two tiers, ocean environment and biological ecosystems versus socioeconomics and human health. As a result, ocean environment and ecosystem models could be used to provide input to explore human health and socioeconomic variables in hypothetical scenarios. At decadal-plus time scales, the analysis emphasized that human domains influence the natural domains through changes in oil-spill related laws and regulations. Although data gaps were identified in all four model domains, the socioeconomics and human health domains are the least established. Considerable future work is needed to address research gaps and to create fully coupled quantitative integrative assessment models that can be used in strategic decision-making that will optimize recoveries from future large oil spills.
Collapse
Affiliation(s)
- Helena M. Solo-Gabriele
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL 33146, USA
| | | | - Cecilie Mauritzen
- Department of Climate, Norwegian Meteorological Institute, Oslo, Norway
| | - Cameron Ainsworth
- College of Marine Science, University of South Florida, St. Petersburg, FL 33701, USA
| | - David M. Abramson
- School of Global Public Health, New York University, New York, NY 10003, USA
| | - Igal Berenshtein
- Department of Ocean Sciences, Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL 33149, USA
- Cooperative Institute for Marine and Atmospheric Studies, Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL 33149, USA
| | - Eric P. Chassignet
- Center for Ocean-Atmospheric Prediction Studies, Florida State University, Tallahassee, FL 32306, USA
| | - Shuyi S. Chen
- Department of Atmospheric Sciences, University of Washington, Seattle, WA, USA
| | - Robyn N. Conmy
- Office of Research and Development, US Environmental Protection Agency, Cincinnati, OH 45268, USA
| | - Christa D. Court
- Food and Resource Economics Department, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA
| | - William K. Dewar
- Laboratoire de Glaciologie et Geophysique de l’Environnement, French National Center for Scientific Research (CNRS), Grenoble, France 38000, and Department of Earth, Ocean, and Atmospheric Science, Florida State University, Tallahassee, FL 32306, USA
| | | | - Michael G. Feldman
- Consortium for Ocean Leadership, Gulf of Mexico Research Initiative, Washington, DC 20005, USA
| | - Alesia C. Ferguson
- Built Environment Department, College of Science and Technology, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA
| | | | | | - Christine Hale
- Harte Research Institute for Gulf of Mexico Studies, Texas A&M University Corpus Christi, Corpus Christi, TX 78412, USA
| | - Ruoying He
- Dept. of Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Vassiliki H. Kourafalou
- Department of Ocean Sciences, Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL 33149, USA
| | - Kenneth Lee
- Fisheries and Oceans Canada, Ecosystem Science, Ottawa, Ontario, K1A 0E6, Canada
| | - Yonggang Liu
- College of Marine Science, University of South Florida, St. Petersburg, FL 33701, USA
| | - Michelle Masi
- Southeast Fisheries Science Center, National Marine Fisheries Service, NOAA, Galveston, TX 77551, USA
| | | | - Steven L. Morey
- School of the Environment, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA
| | - Steven A. Murawski
- College of Marine Science, University of South Florida, St. Petersburg, FL 33701, USA
| | - Claire B. Paris
- Department of Ocean Sciences, Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL 33149, USA
| | - Natalie Perlin
- Department of Atmospheric Sciences, Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL 33149, USA
| | - Erin L. Pulster
- College of Marine Science, University of South Florida, St. Petersburg, FL 33701, USA
| | - Antonietta Quigg
- Department of Marine Biology, Texas A&M University at Galveston, Galveston, TX 77553, USA
| | - Denise J. Reed
- Pontchartrain Institute for Environmental Sciences, University of New Orleans, 2000 Lakeshore Drive, New Orleans, LA 70148, USA
| | - James J. Ruzicka
- Cooperative Institute for Marine Resources Studies, Oregon State University, Newport, OR 97365, USA
| | - Paul A. Sandifer
- Center for Coastal Environmental and Human Health, College of Charleston, Charleston, SC 29424, USA
| | - John G. Shepherd
- School of Ocean & Earth Science, National Oceanography Centre, University of Southampton, Southampton SO14 3ZH, UK
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
| | - Michael R. Stukel
- Department of Earth, Ocean, and Atmospheric Science, Florida State University, Tallahassee, FL 32306, USA
| | - Tracey T. Sutton
- Guy Harvey Oceanographic Center, Halmos College of Arts and Sciences, Nova Southeastern University, Dania Beach, FL 33004, USA
| | - Robert H. Weisberg
- College of Marine Science, University of South Florida, St. Petersburg, FL 33701, USA
| | - Denis Wiesenburg
- School of Ocean Science and Engineering, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | | | - Monica Wilson
- Florida Sea Grant, University of Florida, St. Petersburg, FL 33701, USA
| | - Kateryna M. Wowk
- Harte Research Institute for Gulf of Mexico Studies, Texas A&M University Corpus Christi, Corpus Christi, TX 78412, USA
| | - Callan Yanoff
- Consortium for Ocean Leadership, Gulf of Mexico Research Initiative, Washington, DC 20005, USA
| | - David Yoskowitz
- Harte Research Institute for Gulf of Mexico Studies, Texas A&M University Corpus Christi, Corpus Christi, TX 78412, USA
| |
Collapse
|
25
|
Sah P, Fitzpatrick MC, Zimmer CF, Abdollahi E, Juden-Kelly L, Moghadas SM, Singer BH, Galvani AP. Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. Proc Natl Acad Sci U S A 2021; 118:e2109229118. [PMID: 34376550 PMCID: PMC8403749 DOI: 10.1073/pnas.2109229118] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.
Collapse
Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Charlotte F Zimmer
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Elaheh Abdollahi
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| |
Collapse
|
26
|
Sah P, Vilches TN, Shoukat A, Fitzpatrick MC, Pandey A, Singer BH, Moghadas SM, Galvani AP. Quantifying the potential dominance of immune-evading SARS-CoV-2 variants in the United States. medRxiv 2021:2021.05.10.21256996. [PMID: 34013295 PMCID: PMC8132270 DOI: 10.1101/2021.05.10.21256996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent evidence suggests that some new SARS-CoV-2 variants with spike mutations, such as P.1 (Gamma) and B.1.617.2 (Delta), exhibit partial immune evasion to antibodies generated by natural infection or vaccination. By considering the Gamma and Delta variants in a multi-variant transmission dynamic model, we evaluated the dominance of these variants in the United States (US) despite mounting vaccination coverage and other circulating variants. Our results suggest that while the dominance of the Gamma variant is improbable, the Delta variant would become the most prevalent variant in the US, driving a surge in infections and hospitalizations. Our study highlights the urgency for accelerated vaccination and continued adherence to non-pharmaceutical measures until viral circulation is driven low.
Collapse
Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Thomas N. Vilches
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Affan Shoukat
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL 32610, USA
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
27
|
Sah P, Vilches TN, Moghadas SM, Fitzpatrick MC, Singer BH, Hotez PJ, Galvani AP. Accelerated vaccine rollout is imperative to mitigate highly transmissible COVID-19 variants. EClinicalMedicine 2021; 35:100865. [PMID: 33937735 PMCID: PMC8072134 DOI: 10.1016/j.eclinm.2021.100865] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND More contagious variants of SARS-CoV-2 have emerged around the world, sparking concerns about impending surge in cases and severe outcomes. Despite the development of effective vaccines, rollout has been slow. We evaluated the impact of accelerated vaccine distribution on curbing the disease burden of novel SARS-CoV-2 variants. METHODS We used an agent-based model of SARS-CoV-2 transmission and vaccination to simulate the spread of novel variants with S-Gene Target Failure (SGTF) in addition to the original strain. We incorporated age-specific risk and contact patterns and implemented a two-dose vaccination campaign in accord with CDC-recommended prioritization. As a base case, we projected hospitalizations and deaths at a daily vaccination rate of 1 million doses in the United States (US) and compared with accelerated campaigns in which daily doses were expanded to 1.5, 2, 2.5, or 3 million. FINDINGS We found that at a vaccination rate of 1 million doses per day, an emergent SGTF variant that is 20-70% more transmissible than the original variant would become dominant within 2 to 9 weeks, accounting for as much as 99% of cases at the outbreak peak. Our results show that accelerating vaccine delivery would substantially reduce severe health outcomes. For a SGTF with 30% higher transmissibility, increasing vaccine doses from 1 to 3 million per day would avert 152,048 (95% CrI: 134,772-168,696) hospitalizations and 48,448 (95% CrI: 42,042-54,285) deaths over 300 days. Accelerated vaccination would also prevent additional COVID-19 waves that would otherwise be fuelled by waning adherence to non-pharmaceutical interventions (NPIs). INTERPRETATION We found that the current pace of vaccine rollout is insufficient to prevent the exacerbation of the pandemic that will be attributable to the novel, more contagious SARS-CoV-2 variants. Accelerating the vaccination rate should be a public health priority for averting the expected surge in COVID-19 hospitalizations and deaths that would be associated with widespread dissemination of the SGTF variants. Our results underscore the need to bolster the production and distribution of COVID-19 vaccines, to rapidly expand vaccination priority groups and distribution sites.
Collapse
Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, USA
| | - Thomas N. Vilches
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3 Canada
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3 Canada
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W Baltimore St, Baltimore, MD 21201, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
| | - Peter J. Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
28
|
Castro MC, Kim S, Barberia L, Ribeiro AF, Gurzenda S, Ribeiro KB, Abbott E, Blossom J, Rache B, Singer BH. Spatiotemporal pattern of COVID-19 spread in Brazil. Science 2021; 372:821-826. [PMID: 33853971 DOI: 10.1126/science.abh1558] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/09/2021] [Indexed: 01/06/2023]
Abstract
Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We used daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures, show that although no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.
Collapse
Affiliation(s)
- Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Sun Kim
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lorena Barberia
- Department of Political Science, University of São Paulo (USP), Sao Paulo, SP, Brazil
| | - Ana Freitas Ribeiro
- Universidade Nove de Julho, São Paulo, SP, Brazil.,Universidade Municipal de São Caetano do Sul, São Cetano do Sul, SP, Brazil
| | - Susie Gurzenda
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Karina Braga Ribeiro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Collective Health, São Paulo, SP, Brazil
| | - Erin Abbott
- Center for Geographical Analysis, Harvard University, Cambridge, MA, USA
| | - Jeffrey Blossom
- Center for Geographical Analysis, Harvard University, Cambridge, MA, USA
| | - Beatriz Rache
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| |
Collapse
|
29
|
Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, Meyers LA, Neuzil KM, Langley JM, Fitzpatrick MC, Galvani AP. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv 2021:2020.11.27.20240051. [PMID: 33269359 PMCID: PMC7709178 DOI: 10.1101/2020.11.27.20240051] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Global vaccine development efforts have been accelerated in response to the devastating COVID-19 pandemic. We evaluated the impact of a 2-dose COVID-19 vaccination campaign on reducing incidence, hospitalizations, and deaths in the United States (US). METHODS We developed an agent-based model of SARS-CoV-2 transmission and parameterized it with US demographics and age-specific COVID-19 outcomes. Healthcare workers and high-risk individuals were prioritized for vaccination, while children under 18 years of age were not vaccinated. We considered a vaccine efficacy of 95% against disease following 2 doses administered 21 days apart achieving 40% vaccine coverage of the overall population within 284 days. We varied vaccine efficacy against infection, and specified 10% pre-existing population immunity for the base-case scenario. The model was calibrated to an effective reproduction number of 1.2, accounting for current non-pharmaceutical interventions in the US. RESULTS Vaccination reduced the overall attack rate to 4.6% (95% CrI: 4.3% - 5.0%) from 9.0% (95% CrI: 8.4% - 9.4%) without vaccination, over 300 days. The highest relative reduction (54-62%) was observed among individuals aged 65 and older. Vaccination markedly reduced adverse outcomes, with non-ICU hospitalizations, ICU hospitalizations, and deaths decreasing by 63.5% (95% CrI: 60.3% - 66.7%), 65.6% (95% CrI: 62.2% - 68.6%), and 69.3% (95% CrI: 65.5% - 73.1%), respectively, across the same period. CONCLUSIONS Our results indicate that vaccination can have a substantial impact on mitigating COVID-19 outbreaks, even with limited protection against infection. However, continued compliance with non-pharmaceutical interventions is essential to achieve this impact.
Collapse
Affiliation(s)
- Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, M3J 1P3 Canada
| | - Thomas N. Vilches
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas SP, Brazil
| | - Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8 Canada
| | - Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Affan Shoukat
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
| | - Lauren Ancel Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712 USA
| | - Kathleen M. Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W Baltimore St, Baltimore, MD 21201 USA
| | - Joanne M. Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax, Nova Scotia, B3K 6R8 Canada
| | - Meagan C. Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W Baltimore St, Baltimore, MD 21201 USA
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
30
|
Shoukat A, Wells CR, Langley JM, Singer BH, Galvani AP, Moghadas SM. Projection de la demande de lits de soins intensifs durant l’épidémie de COVID-19 au Canada. CMAJ 2020; 192:E1315-E1322. [PMID: 33106307 DOI: 10.1503/cmaj.200457-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Affan Shoukat
- Center for Infectious Disease Modeling and Analysis (A. Shoukat, C. Wells, A. Galvani), École de santé publique de Yale, New Haven (Connecticut); Centre canadien de vaccinologie (J. Langley), Université Dalhousie, Centre de soins de santé IWK et Régie de la santé de la Nouvelle-Écosse (J. Langley), Halifax (Nouvelle-Écosse); Emerging Pathogens Institute (B. Singer), Université de Floride, Gainesville (Floride); Agent-Based Modelling Laboratory (S. Moghadas), Université York, Toronto (Ontario)
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis (A. Shoukat, C. Wells, A. Galvani), École de santé publique de Yale, New Haven (Connecticut); Centre canadien de vaccinologie (J. Langley), Université Dalhousie, Centre de soins de santé IWK et Régie de la santé de la Nouvelle-Écosse (J. Langley), Halifax (Nouvelle-Écosse); Emerging Pathogens Institute (B. Singer), Université de Floride, Gainesville (Floride); Agent-Based Modelling Laboratory (S. Moghadas), Université York, Toronto (Ontario)
| | - Joanne M Langley
- Center for Infectious Disease Modeling and Analysis (A. Shoukat, C. Wells, A. Galvani), École de santé publique de Yale, New Haven (Connecticut); Centre canadien de vaccinologie (J. Langley), Université Dalhousie, Centre de soins de santé IWK et Régie de la santé de la Nouvelle-Écosse (J. Langley), Halifax (Nouvelle-Écosse); Emerging Pathogens Institute (B. Singer), Université de Floride, Gainesville (Floride); Agent-Based Modelling Laboratory (S. Moghadas), Université York, Toronto (Ontario)
| | - Burton H Singer
- Center for Infectious Disease Modeling and Analysis (A. Shoukat, C. Wells, A. Galvani), École de santé publique de Yale, New Haven (Connecticut); Centre canadien de vaccinologie (J. Langley), Université Dalhousie, Centre de soins de santé IWK et Régie de la santé de la Nouvelle-Écosse (J. Langley), Halifax (Nouvelle-Écosse); Emerging Pathogens Institute (B. Singer), Université de Floride, Gainesville (Floride); Agent-Based Modelling Laboratory (S. Moghadas), Université York, Toronto (Ontario)
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (A. Shoukat, C. Wells, A. Galvani), École de santé publique de Yale, New Haven (Connecticut); Centre canadien de vaccinologie (J. Langley), Université Dalhousie, Centre de soins de santé IWK et Régie de la santé de la Nouvelle-Écosse (J. Langley), Halifax (Nouvelle-Écosse); Emerging Pathogens Institute (B. Singer), Université de Floride, Gainesville (Floride); Agent-Based Modelling Laboratory (S. Moghadas), Université York, Toronto (Ontario)
| | - Seyed M Moghadas
- Center for Infectious Disease Modeling and Analysis (A. Shoukat, C. Wells, A. Galvani), École de santé publique de Yale, New Haven (Connecticut); Centre canadien de vaccinologie (J. Langley), Université Dalhousie, Centre de soins de santé IWK et Régie de la santé de la Nouvelle-Écosse (J. Langley), Halifax (Nouvelle-Écosse); Emerging Pathogens Institute (B. Singer), Université de Floride, Gainesville (Floride); Agent-Based Modelling Laboratory (S. Moghadas), Université York, Toronto (Ontario)
| |
Collapse
|
31
|
Galvani A, Hastings A, Levin SA, Singer BH. Robert May, 1936-2020: A man for all disciplines. Proc Natl Acad Sci U S A 2020; 117:23199-23201. [PMID: 32913048 PMCID: PMC7519286 DOI: 10.1073/pnas.2016616117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alison Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Medicine, New Haven, CT 06510
| | - Alan Hastings
- Department of Environmental Science and Policy, University of California, Davis, CA 95616
| | - Simon A Levin
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544;
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611
- Department of Mathematics, University of Florida, Gainesville, FL 32611
- Weill Cornell Medicine, Graduate School of Medical Sciences, Cornell University, New York, NY 10065
| |
Collapse
|
32
|
Lobitz G, Armstrong K, Concato J, Singer BH, Horwitz RI. The Biological and Biographical Basis of Precision Medicine. Psychother Psychosom 2020; 88:333-340. [PMID: 31578017 DOI: 10.1159/000502486] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/04/2019] [Indexed: 11/19/2022]
Abstract
Construction of a patient narrative (case history) is a core strategy in the care of patients. Recent advances in biomarker identification and digital sensors to monitor physiological and behavioral features have made constructing a case history more complex. Notably, however, although a biological profile is increasingly a part of the patient's profile, an analogous patient-based biographical (life experience) profile is typically overlooked. Evolving concepts such as allostasis and allostatic load refer to processes promoting stability of physiological systems in the presence of diverse life experiences. Integrating details of both biology and biography is a goal of "precision medicine." In this review, we describe how complex interactions between biology and biography affect disease risk and treatment response and highlight a strategy to develop narratives that establish the integration of biology and biography as the scientific basis for precision medicine.
Collapse
Affiliation(s)
- Gabriella Lobitz
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Katrina Armstrong
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Concato
- Research Center, VA Connecticut HealthCare System, Cooperative Studies Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Ralph I Horwitz
- Temple Transformative Medicine Institute, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA,
| |
Collapse
|
33
|
Abstract
Regions with insufficient vaccination have hindered worldwide poliomyelitis eradication, as they are vulnerable to sporadic outbreaks through reintroduction of the disease. Despite Israel's having been declared polio-free in 1988, a routine sewage surveillance program detected polio in 2013. To curtail transmission, the Israel Ministry of Health launched a vaccine campaign to vaccinate children-who had only received the inactivated polio vaccine-with the oral polio vaccine (OPV). Determining the degree of prosocial motivation in vaccination behavior is challenging because vaccination typically provides direct benefits to the individual as well as indirect benefits to the community by curtailing transmission. However, the Israel OPV campaign provides a unique and excellent opportunity to quantify and model prosocial vaccination as its primary objective was to avert transmission. Using primary survey data and a game-theoretical model, we examine and quantify prosocial behavior during the OPV campaign. We found that the observed vaccination behavior in the Israeli OPV campaign is attributable to prosocial behavior and heterogeneous perceived risk of paralysis based on the individual's comprehension of the prosocial nature of the campaign. We also found that the benefit of increasing comprehension of the prosocial nature of the campaign would be limited if even 24% of the population acts primarily from self-interest, as greater vaccination coverage provides no personal utility to them. Our results suggest that to improve coverage, communication efforts should also focus on alleviating perceived fears surrounding the vaccine.
Collapse
Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Amit Huppert
- The Biostatistics & Biomathematics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel
- School of Public Health, The Sackler Faculty of Medicine, Tel-Aviv University, 69978 Tel Aviv, Israel
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Baruch Velan
- The Biostatistics & Biomathematics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610;
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| |
Collapse
|
34
|
Wells CR, Fitzpatrick MC, Sah P, Shoukat A, Pandey A, El-Sayed AM, Singer BH, Moghadas SM, Galvani AP. Projecting the demand for ventilators at the peak of the COVID-19 outbreak in the USA. Lancet Infect Dis 2020; 20:1123-1125. [PMID: 32325039 PMCID: PMC7172723 DOI: 10.1016/s1473-3099(20)30315-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 6510, USA
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 6510, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 6510, USA
| | - Affan Shoukat
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 6510, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 6510, USA
| | - Abdulrahman M El-Sayed
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Public Health, Wayne State University, Detroit, MI, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON, Canada
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 6510, USA.
| |
Collapse
|
35
|
Moghadas SM, Shoukat A, Fitzpatrick MC, Wells CR, Sah P, Pandey A, Sachs JD, Wang Z, Meyers LA, Singer BH, Galvani AP. Projecting hospital utilization during the COVID-19 outbreaks in the United States. Proc Natl Acad Sci U S A 2020; 117:9122-9126. [PMID: 32245814 PMCID: PMC7183199 DOI: 10.1073/pnas.2004064117] [Citation(s) in RCA: 304] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the wake of community coronavirus disease 2019 (COVID-19) transmission in the United States, there is a growing public health concern regarding the adequacy of resources to treat infected cases. Hospital beds, intensive care units (ICUs), and ventilators are vital for the treatment of patients with severe illness. To project the timing of the outbreak peak and the number of ICU beds required at peak, we simulated a COVID-19 outbreak parameterized with the US population demographics. In scenario analyses, we varied the delay from symptom onset to self-isolation, the proportion of symptomatic individuals practicing self-isolation, and the basic reproduction number R0 Without self-isolation, when R0 = 2.5, treatment of critically ill individuals at the outbreak peak would require 3.8 times more ICU beds than exist in the United States. Self-isolation by 20% of cases 24 h after symptom onset would delay and flatten the outbreak trajectory, reducing the number of ICU beds needed at the peak by 48.4% (interquartile range 46.4-50.3%), although still exceeding existing capacity. When R0 = 2, twice as many ICU beds would be required at the peak of outbreak in the absence of self-isolation. In this scenario, the proportional impact of self-isolation within 24 h on reducing the peak number of ICU beds is substantially higher at 73.5% (interquartile range 71.4-75.3%). Our estimates underscore the inadequacy of critical care capacity to handle the burgeoning outbreak. Policies that encourage self-isolation, such as paid sick leave, may delay the epidemic peak, giving a window of time that could facilitate emergency mobilization to expand hospital capacity.
Collapse
Affiliation(s)
- Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Affan Shoukat
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Jeffrey D Sachs
- Center for Sustainable Development at Columbia University, Columbia University, New York, NY 10032
| | - Zheng Wang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510
| | - Lauren A Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| |
Collapse
|
36
|
Shoukat A, Wells CR, Langley JM, Singer BH, Galvani AP, Moghadas SM. Projecting demand for critical care beds during COVID-19 outbreaks in Canada. CMAJ 2020; 192:E489-E496. [PMID: 32269020 DOI: 10.1503/cmaj.200457] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Increasing numbers of coronavirus disease 2019 (COVID-19) cases in Canada may create substantial demand for hospital admission and critical care. We evaluated the extent to which self-isolation of mildly ill people delays the peak of outbreaks and reduces the need for this care in each Canadian province. METHODS We developed a computational model and simulated scenarios for COVID-19 outbreaks within each province. Using estimates of COVID-19 characteristics, we projected the hospital and intensive care unit (ICU) bed requirements without self-isolation, assuming an average number of 2.5 secondary cases, and compared scenarios in which different proportions of mildly ill people practised self-isolation 24 hours after symptom onset. RESULTS Without self-isolation, the peak of outbreaks would occur in the first half of June, and an average of 569 ICU bed days per 10 000 population would be needed. When 20% of cases practised self-isolation, the peak was delayed by 2-4 weeks, and ICU bed requirement was reduced by 23.5% compared with no self-isolation. Increasing self-isolation to 40% reduced ICU use by 53.6% and delayed the peak of infection by an additional 2-4 weeks. Assuming current ICU bed occupancy rates above 80% and self-isolation of 40%, demand would still exceed available (unoccupied) ICU bed capacity. INTERPRETATION At the peak of COVID-19 outbreaks, the need for ICU beds will exceed the total number of ICU beds even with self-isolation at 40%. Our results show the coming challenge for the health care system in Canada and the potential role of self-isolation in reducing demand for hospital-based and ICU care.
Collapse
Affiliation(s)
- Affan Shoukat
- Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont
| | - Joanne M Langley
- Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont.
| | - Burton H Singer
- Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont
| | - Seyed M Moghadas
- Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont
| |
Collapse
|
37
|
Wells CR, Sah P, Moghadas SM, Pandey A, Shoukat A, Wang Y, Wang Z, Meyers LA, Singer BH, Galvani AP. Impact of international travel and border control measures on the global spread of the novel 2019 coronavirus outbreak. Proc Natl Acad Sci U S A 2020; 117:7504-7509. [PMID: 32170017 PMCID: PMC7132249 DOI: 10.1073/pnas.2002616117] [Citation(s) in RCA: 349] [Impact Index Per Article: 87.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The novel coronavirus outbreak (COVID-19) in mainland China has rapidly spread across the globe. Within 2 mo since the outbreak was first reported on December 31, 2019, a total of 566 Severe Acute Respiratory Syndrome (SARS CoV-2) cases have been confirmed in 26 other countries. Travel restrictions and border control measures have been enforced in China and other countries to limit the spread of the outbreak. We estimate the impact of these control measures and investigate the role of the airport travel network on the global spread of the COVID-19 outbreak. Our results show that the daily risk of exporting at least a single SARS CoV-2 case from mainland China via international travel exceeded 95% on January 13, 2020. We found that 779 cases (95% CI: 632 to 967) would have been exported by February 15, 2020 without any border or travel restrictions and that the travel lockdowns enforced by the Chinese government averted 70.5% (95% CI: 68.8 to 72.0%) of these cases. In addition, during the first three and a half weeks of implementation, the travel restrictions decreased the daily rate of exportation by 81.3% (95% CI: 80.5 to 82.1%), on average. At this early stage of the epidemic, reduction in the rate of exportation could delay the importation of cases into cities unaffected by the COVID-19 outbreak, buying time to coordinate an appropriate public health response.
Collapse
Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Affan Shoukat
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Yaning Wang
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, 100101 Beijing, China
| | - Zheng Wang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510
| | - Lauren A Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712
- Santa Fe Institute, Santa Fe, NM 87501
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| |
Collapse
|
38
|
Galvani AP, Parpia AS, Foster EM, Singer BH, Fitzpatrick MC. Improving the prognosis of health care in the USA. Lancet 2020; 395:524-533. [PMID: 32061298 PMCID: PMC8572548 DOI: 10.1016/s0140-6736(19)33019-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 01/22/2023]
Abstract
Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.
Collapse
Affiliation(s)
- Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA.
| | - Alyssa S Parpia
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Eric M Foster
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
39
|
Andrade MO, Pang Z, Achor DS, Wang H, Yao T, Singer BH, Wang N. The flagella of 'Candidatus Liberibacter asiaticus' and its movement in planta. Mol Plant Pathol 2020; 21:109-123. [PMID: 31721403 PMCID: PMC6913195 DOI: 10.1111/mpp.12884] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Citrus huanglongbing (HLB) is the most devastating citrus disease worldwide. 'Candidatus Liberibacter asiaticus' (Las) is the most prevalent HLB causal agent that is yet to be cultured. Here, we analysed the flagellar genes of Las and Rhizobiaceae and observed two characteristics unique to the flagellar proteins of Las: (i) a shorter primary structure of the rod capping protein FlgJ than other Rhizobiaceae bacteria and (ii) Las contains only one flagellin-encoding gene flaA (CLIBASIA_02090), whereas other Rhizobiaceae species carry at least three flagellin-encoding genes. Only flgJAtu but not flgJLas restored the swimming motility of Agrobacterium tumefaciens flgJ mutant. Pull-down assays demonstrated that FlgJLas interacts with FlgB but not with FliE. Ectopic expression of flaALas in A. tumefaciens mutants restored the swimming motility of ∆flaA mutant and ∆flaAD mutant, but not that of the null mutant ∆flaABCD. No flagellum was observed for Las in citrus and dodder. The expression of flagellar genes was higher in psyllids than in planta. In addition, western blotting using flagellin-specific antibody indicates that Las expresses flagellin protein in psyllids, but not in planta. The flagellar features of Las in planta suggest that Las movement in the phloem is not mediated by flagella. We also characterized the movement of Las after psyllid transmission into young flush. Our data support a model that Las remains inside young flush after psyllid transmission and before the flush matures. The delayed movement of Las out of young flush after psyllid transmission provides opportunities for targeted treatment of young flush for HLB control.
Collapse
Affiliation(s)
- Maxuel O. Andrade
- Citrus Research and Education CenterDepartment of Microbiology and Cell ScienceUniversity of Florida/Institute of Food and Agricultural SciencesLake AlfredFLUSA
| | - Zhiqian Pang
- Citrus Research and Education CenterDepartment of Microbiology and Cell ScienceUniversity of Florida/Institute of Food and Agricultural SciencesLake AlfredFLUSA
| | - Diann S. Achor
- Citrus Research and Education CenterDepartment of Microbiology and Cell ScienceUniversity of Florida/Institute of Food and Agricultural SciencesLake AlfredFLUSA
| | - Han Wang
- Citrus Research and Education CenterDepartment of Microbiology and Cell ScienceUniversity of Florida/Institute of Food and Agricultural SciencesLake AlfredFLUSA
| | - Tingshan Yao
- Citrus Research and Education CenterDepartment of Microbiology and Cell ScienceUniversity of Florida/Institute of Food and Agricultural SciencesLake AlfredFLUSA
- National Engineering Research Center for Citrus, Citrus Research Institute, Southwest UniversityChongqing400712People’s Republic of China
| | - Burton H. Singer
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFLUSA
| | - Nian Wang
- Citrus Research and Education CenterDepartment of Microbiology and Cell ScienceUniversity of Florida/Institute of Food and Agricultural SciencesLake AlfredFLUSA
| |
Collapse
|
40
|
Sah P, Alfaro-Murillo JA, Fitzpatrick MC, Neuzil KM, Meyers LA, Singer BH, Galvani AP. Future epidemiological and economic impacts of universal influenza vaccines. Proc Natl Acad Sci U S A 2019; 116:20786-20792. [PMID: 31548402 PMCID: PMC6789917 DOI: 10.1073/pnas.1909613116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The efficacy of influenza vaccines, currently at 44%, is limited by the rapid antigenic evolution of the virus and a manufacturing process that can lead to vaccine mismatch. The National Institute of Allergy and Infectious Diseases (NIAID) recently identified the development of a universal influenza vaccine with an efficacy of at least 75% as a high scientific priority. The US Congress approved $130 million funding for the 2019 fiscal year to support the development of a universal vaccine, and another $1 billion over 5 y has been proposed in the Flu Vaccine Act. Using a model of influenza transmission, we evaluated the population-level impacts of universal influenza vaccines distributed according to empirical age-specific coverage at multiple scales in the United States. We estimate that replacing just 10% of typical seasonal vaccines with 75% efficacious universal vaccines would avert ∼5.3 million cases, 81,000 hospitalizations, and 6,300 influenza-related deaths per year. This would prevent over $1.1 billion in direct health care costs compared to a typical season, based on average data from the 2010-11 to 2018-19 seasons. A complete replacement of seasonal vaccines with universal vaccines is projected to prevent 17 million cases, 251,000 hospitalizations, 19,500 deaths, and $3.5 billion in direct health care costs. States with high per-hospitalization medical expenses along with a large proportion of elderly residents are expected to receive the maximum economic benefit. Replacing even a fraction of seasonal vaccines with universal vaccines justifies the substantial cost of vaccine development.
Collapse
Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Jorge A Alfaro-Murillo
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Lauren A Meyers
- Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| |
Collapse
|
41
|
Wells CR, Pandey A, Parpia AS, Fitzpatrick MC, Meyers LA, Singer BH, Galvani AP. Ebola vaccination in the Democratic Republic of the Congo. Proc Natl Acad Sci U S A 2019; 116:10178-10183. [PMID: 31036657 PMCID: PMC6525480 DOI: 10.1073/pnas.1817329116] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Following the April 2018 reemergence of Ebola in a rural region of the Democratic Republic of the Congo (DRC), the virus spread to an urban center by early May. Within 2 wk of the first case confirmation, a vaccination campaign was initiated in which 3,017 doses were administered to contacts of cases and frontline healthcare workers. To evaluate the spatial dynamics of Ebola transmission and quantify the impact of vaccination, we developed a geographically explicit model that incorporates high-resolution data on poverty and population density. We found that while Ebola risk was concentrated around sites initially reporting infections, longer-range dissemination also posed a risk to areas with high population density and poverty. We estimate that the vaccination program contracted the geographical area at risk for Ebola by up to 70.4% and reduced the level of risk within that region by up to 70.1%. The early implementation of vaccination was critical. A delay of even 1 wk would have reduced these effects to 33.3 and 44.8%, respectively. These results underscore the importance of the rapid deployment of Ebola vaccines during emerging outbreaks to containing transmission and preventing global spread. The spatiotemporal framework developed here provides a tool for identifying high-risk regions, in which surveillance can be intensified and preemptive control can be implemented during future outbreaks.
Collapse
Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Alyssa S Parpia
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Lauren A Meyers
- Department of Integrative Biology, University of Texas, Austin TX, 78712
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| |
Collapse
|
42
|
Shimwela MM, Halbert SE, Keremane ML, Mears P, Singer BH, Lee WS, Jones JB, Ploetz RC, van Bruggen AHC. In-Grove Spatiotemporal Spread of Citrus Huanglongbing and Its Psyllid Vector in Relation to Weather. Phytopathology 2019; 109:418-427. [PMID: 30256188 DOI: 10.1094/phyto-03-18-0089-r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Reports of spatial patterns of 'Candidatus Liberibacter asiaticus'-infected asymptomatic citrus trees and 'Ca. L. asiaticus'-positive Asian citrus psyllids (ACP) are rare, as are published relationships between huanglongbing (HLB), ACP, and weather. Here, spatial patterns of 'Ca. L. asiaticus'-positive asymptomatic and symptomatic trees were determined every half year in a small grove over 2.5 years, and of HLB-symptomatic trees and ('Ca. L. asiaticus'-positive) ACP populations every month in two commercial groves for 1 year. Spread of symptomatic trees followed that of asymptomatic 'Ca. L. asiaticus'-positive trees with <6 months' delay. 'Ca. L. asiaticus'-positive asymptomatic and symptomatic fronts moved at 2.5 to 3.6 m month-1. No spatial relationship was detected between ACP populations and HLB-infected trees. HLB incidence and 'Ca. L. asiaticus'-positive ACP dynamics were tentatively positively correlated with monthly rainfall data and, to a lesser extent, with average minimum temperature.
Collapse
Affiliation(s)
- M M Shimwela
- 1 Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611
- 2 Emerging Pathogens Institute, University of Florida, Gainesville 32610
| | - S E Halbert
- 3 Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 32608
| | - M L Keremane
- 4 United States Department of Agriculture-Agricultural Research Service, National Clonal Germplasm Repository for Citrus and Dates, Riverside, CA 92507
| | - P Mears
- 5 Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Immokalee, FL 34142-3829
| | - B H Singer
- 2 Emerging Pathogens Institute, University of Florida, Gainesville 32610
| | - W S Lee
- 6 Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and
| | - J B Jones
- 1 Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611
| | - R C Ploetz
- 7 Plant Pathology Department, TREC, University of Florida, Homestead 33031
| | - A H C van Bruggen
- 1 Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611
- 2 Emerging Pathogens Institute, University of Florida, Gainesville 32610
| |
Collapse
|
43
|
Shimwela MM, Schubert TS, Albritton M, Halbert SE, Jones DJ, Sun X, Roberts PD, Singer BH, Lee WS, Jones JB, Ploetz RC, van Bruggen AHC. Regional Spatial-Temporal Spread of Citrus Huanglongbing Is Affected by Rain in Florida. Phytopathology 2018; 108:1420-1428. [PMID: 29873608 DOI: 10.1094/phyto-03-18-0088-r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Citrus huanglongbing (HLB), associated with 'Candidatus Liberibacter asiaticus' (Las), disseminated by Asian citrus psyllid (ACP), has devastated citrus in Florida since 2005. Data on HLB occurrence were stored in databases (2005 to 2012). Cumulative HLB-positive citrus blocks were subjected to kernel density analysis and kriging. Relative disease incidence per county was calculated by dividing HLB numbers by relative tree numbers and maximum incidence. Spatiotemporal HLB distributions were correlated with weather. Relative HLB incidence correlated positively with rainfall. The focus expansion rate was 1626 m month-1, similar to that in Brazil. Relative HLB incidence in counties with primarily large groves increased at a lower rate (0.24 year-1) than in counties with smaller groves in hotspot areas (0.67 year-1), confirming reports that large-scale HLB management may slow epidemic progress.
Collapse
Affiliation(s)
- M M Shimwela
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - T S Schubert
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - M Albritton
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - S E Halbert
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - D J Jones
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - X Sun
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - P D Roberts
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - B H Singer
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - W S Lee
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - J B Jones
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - R C Ploetz
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| | - A H C van Bruggen
- First, tenth, and twelfth authors: Department of Plant Pathology, IFAS, University of Florida, Gainesville 32611; first, eighth, and twelfth authors: Emerging Pathogens Institute, University of Florida, Gainesville 32610; second, third, fourth, fifth, and sixth authors: Florida Department of Agriculture and Consumer Services, Division of Plant Industry, Gainesville 33825; seventh author: Department of Plant Pathology, IFAS, SWFREC, University of Florida, Immokalee 34142; ninth author: Department of Agricultural and Biological Engineering, Gainesville, FL 32611; and eleventh author: University of Florida, Plant Pathology Department, TREC-Homestead, FL 33031
| |
Collapse
|
44
|
Abstract
BACKGROUND For the past 70- years patient care has been dominated by Evidence Based Medicine (EBM) with its emphasis on Randomized Controlled Trials (RCTs) and clinical guidelines to standardize medical decision-making. METHODS Critical assessment of the literature and analyses of the arguments that favor patient care based primarily on individual variability in disease risk or treatment response versus emphasis on group standardization. RESULTS Medicine Based Evidence (MBE) is used to guide decision making for an individual patient at hand by profiling the clinical features (biology) and life experience (biography) of the patient and then finding approximate matches to the patient in a clinical library of patients assembled from diverse sources (RCTs, cohorts, registries, electronic health records and more). CONCLUSION Medicine is transitioning from population based model of clinical care that relies on average results from RCTs to an individual-based model of "personalized" medicine. For individualized care of the patient at hand, MBE is the preferred scientific strategy to generate evidence for patient care.
Collapse
Affiliation(s)
- Ralph I Horwitz
- Temple Transformative Medicine Institute, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Mary E Charlson
- Weill Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | |
Collapse
|
45
|
Horwitz RI, Hayes-Conroy A, Singer BH. A Reply to Stiefel et al. "Losing the 'Person' in Personalized Medicine". Psychother Psychosom 2017; 86:301. [PMID: 28903114 DOI: 10.1159/000475469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Ralph I Horwitz
- Transformative Medicine Institute, Temple University, Philadelphia, PA, USA
| | | | | |
Collapse
|
46
|
Fitzpatrick MC, Singer BH, Hotez PJ, Galvani AP. Saving lives efficiently across sectors: the need for a Congressional cost-effectiveness committee. Lancet 2017; 390:2410-2412. [PMID: 28669643 PMCID: PMC5960984 DOI: 10.1016/s0140-6736(17)31440-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Meagan C Fitzpatrick
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA; Center for Health and Biosciences, James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.
| |
Collapse
|
47
|
Horwitz RI, Hayes-Conroy A, Singer BH. Biology, Social Environment, and Personalized Medicine. Psychother Psychosom 2017; 86:5-10. [PMID: 27884014 DOI: 10.1159/000452134] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Ralph I Horwitz
- Temple Transformative Medicine Institute, Philadelphia, PA, USA
| | | | | |
Collapse
|
48
|
Galvani AP, Fitzpatrick MC, Vermund SH, Singer BH. Fund global health: Save lives and money. Science 2017; 356:1018-1019. [PMID: 28596330 DOI: 10.1126/science.aan4683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA. .,Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06511, USA.,A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Meagan C Fitzpatrick
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Sten H Vermund
- Office of the Dean, Yale School of Public Health, New Haven, CT 06510, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610-0009, USA
| |
Collapse
|
49
|
|
50
|
Castro MC, Krieger GR, Balge MZ, Tanner M, Utzinger J, Whittaker M, Singer BH. Examples of coupled human and environmental systems from the extractive industry and hydropower sector interfaces. Proc Natl Acad Sci U S A 2016; 113:14528-14535. [PMID: 27791077 PMCID: PMC5187694 DOI: 10.1073/pnas.1605678113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Large-scale corporate projects, particularly those in extractive industries or hydropower development, have a history from early in the twentieth century of creating negative environmental, social, and health impacts on communities proximal to their operations. In many instances, especially for hydropower projects, the forced resettlement of entire communities was a feature in which local cultures and core human rights were severely impacted. These projects triggered an activist opposition that progressively expanded and became influential at both the host community level and with multilateral financial institutions. In parallel to, and spurred by, this activism, a shift occurred in 1969 with the passage of the National Environmental Policy Act in the United States, which required Environmental Impact Assessment (EIA) for certain types of industrial and infrastructure projects. Over the last four decades, there has been a global movement to develop a formal legal/regulatory EIA process for large industrial and infrastructure projects. In addition, social, health, and human rights impact assessments, with associated mitigation plans, were sequentially initiated and have increasingly influenced project design and relations among companies, host governments, and locally impacted communities. Often, beneficial community-level social, economic, and health programs have voluntarily been put in place by companies. These flagship programs can serve as benchmarks for community-corporate-government partnerships in the future. Here, we present examples of such positive phenomena and also focus attention on a myriad of challenges that still lie ahead.
Collapse
Affiliation(s)
- Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115;
| | | | | | - Marcel Tanner
- Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland
- University of Basel, CH-4003 Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland
- University of Basel, CH-4003 Basel, Switzerland
| | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| |
Collapse
|