Local characterization of the COVID-19 response: the case of a lockdown in Lusaka, Zambia

BACKGROUND

The onset of the COVID-19 pandemic has sparked heated debate among scholars on the relevance of lockdowns. There are those in favor of the lockdown and others who are critical of it. However, despite the increased interest in understanding the relevance of lockdowns, there still has not been much focus on its relevance in countries like Zambia. Thus, with the help of the Social Representation Theory (SRT), we set out to explore and document the local characterization of the lockdown by residents of Lusaka, Zambia.

METHODS

We recruited our participants through convenient and purposive sampling techniques. This was done through the use of the ZAMTEL public phone records. Initial contact was made to potential participants, and they were asked of their availability and willingness to participate in the interview. Upon agreeing to participate, they were included in the sample. A total of 68 people were selected to take part in this study. Their age ranged from 20 to 76 years old. 33 of them were male and 35 females. After this, we conducted interviews with the 68 participants. Due to COVID-19 restrictions, our interviews were conducted via telephone in conformity with the recommendations from the IRB in Lusaka and the advice of the ministry of health. We anonymized the demographic characteristics and responses from our participants. Later, thematic analysis was used to analyze the data.

RESULTS

The lockdown was on one hand lauded for slowing down the incidence rates, preventing fatalities, and protecting the healthcare system from collapse. On the other hand, it was criticized for exacerbating poverty levels, unemployment rates, increasing the rate of mental health problems, aiding gender-based violence, and intensifying political repression and corruption. The results speak to the complexity in the characterization of the lockdown as a response to COVID-19 in Lusaka, Zambia. This observation demonstrates the folly of viewing, applying and characterizing the COVID-19 lockdown as a 'one-size-fits-all' approach in Lusaka, Zambia.

CONCLUSION

Rather than establishing the lockdown as an incontestable good, as it is depicted by some scholars or as useless by its critics, our findings instead demonstrate the diversity and complexity in how it is locally viewed by Lusaka residents. The study provides grounds for caution on simplistic and binary characterization of lockdowns. It indicates the need for careful dialog between the designers of lockdowns and citizens in order to tailor such interventions to local realities in context-specific ways. It also shows that though the development of such interventions, all the various and complex elements it embodies must be taken into account in order to realize optimum outcomes.

Factors related with the incidence of acute respiratory infections in toddlers in Sleman, Yogyakarta, Indonesia: Evidence from the Sleman Health and Demographic Surveillance System

Various factors associated with Acute Respiratory Infections (ARI) in toddlers have been widely observed, but there are no studies using data from the Sleman Health and Demographic Surveillance System (HDSS). This study aimed to determine the factors associated with ARI in children under five in Sleman, Yogyakarta, Indonesia. This research was an observational analytic study with a cross-sectional design, using secondary data from the Sleman HDSS. Data of 463 children under five who met the inclusion and exclusion criteria were used in this study. Inclusion criteria were toddlers who have complete observed variable data. The variables observed were the characteristics of children under five, the attributes of the mother, the physical condition of the house, the use of mosquito coils, sanitation facilities, and sources of drinking water. The exclusion criteria were toddlers with pulmonary tuberculosis in the past year. Data analysis used chi-squared tests for bivariate analysis and multivariate logistic regression analysis. The results showed that working mothers had a greater risk of ARI under five children with OR 1.46 (95% CI = 1.01–2.11), and groundwater as a water source was a protective factor against the occurrence of ARI in toddlers with OR 0.46 (95% CI = 0.26–0.81). After a logistic regression analysis was performed, only the drinking water source variable had a statistically significant relationship with the incidence of ARI in children under five with OR = 0.47 (95% CI = 0.268–0.827). Research on the relationship between water quality and the incidence of ARI in children under five is needed to follow up on these findings.

Data-driven estimation of change points reveals correlation between face mask use and accelerated curtailing of the first wave of the COVID-19 epidemic in Italy

BACKGROUND

Italy was the first Western country to be seriously affected by COVID-19, and the first to implement drastic measures, which successfully curtailed the first wave of the epidemic.

METHODS

To understand which containment measures altered disease dynamics, we estimated change points in COVID-19 dynamics from official Italian data.

RESULTS

We found an excellent correlation between nationwide lockdown and the epidemic peak in late March 2020. Surprisingly, we found a change point in mid-April, which did not correspond to national measures, but may be explained by regional interventions. Change points in regional COVID-19 dynamics correlated well with local distribution of free face masks and regional orders requiring their mandatory use. Regions with no specific interventions showed no change point during April.

CONCLUSIONS

Our findings of the observed correlation between face mask use and disease dynamics lend further support to the importance of face masks in addition to lockdowns and other restrictions for the control of COVID-19.

Experimental Efficacy of the Face Shield and the Mask against Emitted and Potentially Received Particles

There is currently not sufficient evidence to support the effectiveness of face shields for source control. In order to evaluate the comparative barrier performance effect of face masks and face shields, we used an aerosol generator and a particle counter to evaluate the performance of the various devices in comparable situations. We tested different configurations in an experimental setup with manikin heads wearing masks (surgical type I), face shields (22.5 cm high with overhang under the chin of 7 cm and circumference of 35 cm) on an emitter or a receiver manikin head, or both. The manikins were face to face, 25 cm apart, with an intense particle emission (52.5 L/min) for 30 s. The particle counter calculated the total cumulative particles aspirated on a volume of 1.416 L In our experimental conditions, when the receiver alone wore a protection, the face shield was more effective (reduction factor = 54.8%), while reduction was lower with a mask (reduction factor = 21.8%) (p = 0.002). The wearing of a protective device by the emitter alone reduced the level of received particles by 96.8% for both the mask and face shield (p = NS). When both the emitter and receiver manikin heads wore a face shield, the protection allowed for better results in our experimental conditions: 98% reduction for the face shields versus 97.3% for the masks (p = 0.01). Face shields offered an even better barrier effect than the mask against small inhaled particles (<0.3 µm-0.3 to 0.5 µm-0.5 to 1 µm) in all configurations. Therefore, it would be interesting to include face shields as used in our experimental study as part of strategies to reduce transmission within the community setting.

Control of malaria-transmitting mosquitoes using gene drives

Gene drives are selfish genetic elements that can be re-designed to invade a population and they hold tremendous potential for the control of mosquitoes that transmit disease. Much progress has been made recently in demonstrating proof of principle for gene drives able to suppress populations of malarial mosquitoes, or to make them refractory to the Plasmodium parasites they transmit. This has been achieved using CRISPR-based gene drives. In this article, I will discuss the relative merits of this type of gene drive, as well as barriers to its technical development and to its deployment in the field as malaria control. This article is part of the theme issue 'Novel control strategies for mosquito-borne diseases'.

Novel control strategies for mosquito-borne diseases

Mosquito-borne diseases are an increasing global health challenge, threatening over 40% of the world's population. Despite major advances in malaria control since 2000, recent progress has stalled. Additionally, the risk of Aedes-borne arboviruses is rapidly growing, with the unprecedented spread of dengue and chikungunya viruses, outbreaks of yellow fever and the 2015 epidemic of Zika virus in Latin America. To counteract this growing problem, diverse and innovative mosquito control technologies are currently under development. Conceptually, these span an impressive spectrum of approaches, from invasive transgene cassettes with the potential to crash mosquito populations or reduce the vectorial capacity of a population, to low-cost alterations in housing design that restrict mosquito entry. This themed issue will present articles providing insight into the breadth of mosquito control research, while demonstrating the requirement for an interdisciplinary approach. The issue will highlight mosquito control technologies at varying stages of development and includes both opinion pieces and research articles with laboratory and field-based data on control strategy development. This article is part of the theme issue 'Novel control strategies for mosquito-borne diseases'.

Family medicine practitioners' stress during the COVID-19 pandemic: a cross-sectional survey

BACKGROUND

The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization's decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work.

METHODS

We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of "not stressed" (≤20), "borderline" (21 ≤ PSS-10 ≤ 26), and "stressed" (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made.

RESULTS

Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40-3.50], p < 0.001). Analysis of verbatims revealed that GPs felt isolated in a hospital-based model.

CONCLUSION

The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.

Estimating the risk of outbreaks of COVID-19 associated with shore leave by merchant ship crews: simulation studies for New Zealand

AIM

We aimed to estimate the risk of COVID-19 outbreaks in a COVID-19-free destination country (New Zealand) associated with shore leave by merchant ship crews who were infected prior to their departure or on their ship.

METHODS

We used a stochastic version of the SEIR model CovidSIM v1.1 designed specifically for COVID-19. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics and plausible control measures.

RESULTS

When no control interventions were in place, we estimated that an outbreak of COVID-19 in New Zealand would occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1,000 population per week, crews of 20 with a voyage length of 10 days and 1 day of shore leave per crew member both in New Zealand and abroad, and 108 port visits by international merchant ships per week). For this example, the uncertainty around when outbreaks occur is wide (an outbreak occurs with 95% probability between 1 and 124 days). The combination of PCR testing on arrival, self-reporting of symptoms with contact tracing and mask use during shore leave increased this median time to 1.0 year (14 days to 5.4 years, or a 49% probability within a year). Scenario analyses found that onboard infection chains could persist for well over 4 weeks, even with crews of only 5 members.

CONCLUSION

This modelling work suggests that the introduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. But the risk can be substantially mitigated by control measures such as PCR testing and mask use.

Experiences with tick exposure, Lyme disease, and use of personal prevention methods for tick bites among members of the U.S. population, 2013-2015

Consistent and effective use of personal prevention methods for tickborne diseases, including Lyme disease (LD), is dependent on risk awareness. To improve our understanding of the general U.S. population's experiences with tick exposure and use of personal prevention methods, we used data from ConsumerStyles, a web-based, nationally representative questionnaire on health-related topics. Questions addressed tick bites and LD diagnosis in the last year, use of personal prevention methods to prevent tick bites, and willingness to receive a theoretical LD vaccine. Of 10,551 participants surveyed over three years, 12.3 % reported a tick bite for themselves or a household member in the last year, including 15.4 % of participants in high LD incidence (LDI) states, 16.3 % in states neighboring high LDI states, and 9.4 % in low LDI states. Participants in high LDI states and neighboring states were most likely to use personal prevention methods, though 46.6 % of participants in high LDI states and 53.9 % in neighboring states reported not using any method. Participants in low LDI states, adults ≥ 75 years of age, those with higher incomes, and those living in urban housing tended to be less likely to practice personal prevention methods. Likeliness to receive a theoretical LD vaccine was high in high LDI (64.5 %), neighboring (52.5 %), and low LDI (49.7 %) states. Targeted educational efforts are needed to ensure those in high LDI and neighboring states, particularly older adults, are aware of their risk of LD and recommended personal prevention methods.

An Ethical Analysis of Hospital Visitor Restrictions and Masking Requirements During the COVID-19 Pandemic

Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor restrictions are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified.

Heralding the Digitalization of Life in Post-Pandemic East Asian Societies

Following the outbreak of what would become the COVID-19 pandemic, social distancing measures were quickly introduced across East Asia-including drastic shelter-in-place orders in some cities-drawing on experience with the outbreak of severe acute respiratory syndrome (SARS) almost two decades ago. "Smart City" technologies and other digital tools were quickly deployed for infection control purposes, ranging from conventional thermal scanning cameras to digital tracing in the surveillance of at-risk individuals. Chatbots endowed with artificial intelligence have also been deployed to shift part of healthcare provision away from hospitals and to support a number of programmes for self-management of chronic disease in the community. With the closure of schools and adults working from home, digital technologies have also sustained many aspects of both professional and social life at a pace and scale not considered to be practicable before the outbreak. This paper considers how these new experiences with digital technologies in public health surveillance are spurring digitalization in East Asian societies beyond the conventional public health context. It also considers some of the concerns and challenges that are likely to arise with rapid digitalization, particularly in healthcare.

The Great Mask Debate: A Debate That Shouldn't Be a Debate at All

BACKGROUND

Despite a rapidly growing and evolving literature, there continues to be a vigorous public debate about whether the community use of face coverings can mitigate the spread of COVID-19 ten months into the pandemic.

OBJECTIVES

This article describes a semi-structured literature review of the use of face coverings to prevent the spread of coronaviruses and similar respiratory pathogens, with a focus on SARS-CoV-2 (COVID-19).

METHODS

: The author conducted a semi-structured literature review using search terms "COVID19" or "SARS-CoV-2" crossed with "mask/s" or "face covering/s." Articles were evaluated through October 30, 2020 for inclusion, as were key references cited within the primary references and other references identified through traditional and social media outlets.

RESULTS

There is strong evidence to support the community use of face coverings to mitigate the spread of COVID-19 from various laboratory, epidemiological, natural history, clinical, and economic studies, although there was only 1 high-quality published randomized controlled trial of this topic at the time of review.

CONCLUSIONS

The evidence in favor of community face coverings to slow the spread of COVID-19 is strong. Although most of the benefit of wearing a face covering is conferred to the community and to bystanders, a face covering also can protect the wearer to some extent, both by reducing the risk of COVID-19 infection, and perhaps by reducing the severity of illness for those who contract a COVID-19 infection.

COVID-19: What we talk about when we talk about masks

Even though most current recommendations include the general use of masks to prevent community transmission of SARS-Cov-2, the effectiveness of this measure is still debated. The studies on this policy include physical filtering tests with inanimate microparticles, randomized clinical trials, observational studies, ecological analyses, and even computational modeling of epidemics. Much of the so-called evidence is inferred from studies on different respiratory viruses and epidemiological settings. Heterogeneity is a major factor limiting the generalization of inferences. In this article, we reviewed the empirical and rational bases of mask use and how to understand these recommendations compared to other policies of social distancing, restrictions on non-essential services, and lockdown. We conclude that recent studies suggest a synergistic effect of the use of masks and social distancing rather than opposing effects of the two recommendations. Developing social communication approaches that clarify the need to combine different strategies is a challenge for public health authorities.

A model respiratory personal protective programme for the New Zealand healthcare industry

In the absence of advice from the workplace regulator, a model respiratory protection programme for healthcare workers is presented based in healthcare and wider industry experience. Hospital and other healthcare institutions can use this as a basis for their programmes in preparation for the next infective disease outbreak.

The need for fully bio-based facemasks to counter coronavirus outbreaks: A perspective

The onset of coronavirus pandemic has sparked a shortage of facemasks in almost all nations. Without this personal protective equipment, healthcare providers, essential workers, and the general public are exposed to the risk of infection. In light of the aforementioned, it is critical to balance the supply and demand for masks. COVID-19 will also ensure that masks are always considered as an essential commodity in future pandemic preparedness. Moreover, billions of facemasks are produced from petrochemicals derived raw materials, which are non-degradable upon disposal after their single use, thus causing environmental pollution and damage. The sustainable way forward is to utilise raw materials that are side-stream products of local industries to develop facemasks having equal or better efficiency than the conventional ones. In this regard, wheat gluten biopolymer, which is a by-product or co-product of cereal industries, can be electrospun into nanofibre membranes and subsequently carbonised at over 700 °C to form a network structure, which can simultaneously act as the filter media and reinforcement for gluten-based masks. In parallel, the same gluten material can be processed into cohesive thin films using plasticiser and hot press. Additionally, lanosol, a naturally-occurring substance, imparts fire (V-0 rating in vertical burn test), and microbe resistance in gluten plastics. Thus, thin films of flexible gluten with very low amounts of lanosol (<10 wt%) can be bonded together with the carbonised mat and shaped by thermoforming to create the facemasks. The carbon mat acting as the filter can be attached to the masks through adapters that can also be made from injection moulded gluten. The creation of these masks could simultaneously be effective in reducing the transmittance of infectious diseases and pave the way for environmentally benign sustainable products.

Business Closures, Stay-at-Home Restrictions, and COVID-19 Testing Outcomes in New York City

INTRODUCTION

In response to the coronavirus disease 2019 (COVID-19) pandemic, New York City closed all nonessential businesses and restricted the out-of-home activities of residents as of March 22, 2020. This order affected different neighborhoods differently, as stores and workplaces are not randomly distributed across the city, and different populations may have responded differently to the out-of-home restrictions. This study examines how the business closures and activity restrictions affected COVID-19 testing results. An evaluation of whether such actions slowed the spread of the pandemic is a crucial step in designing effective public health policies.

METHODS

Daily data on the fraction of COVID-19 tests yielding a positive result at the zip code level were analyzed in relation to the number of visits to local businesses (based on smartphone location) and the number of smartphones that stayed fixed at their home location. The regression model also included vectors of fixed effects for the day of the week, the calendar date, and the zip code of residence.

RESULTS

A large number of visits to local businesses increased the positivity rate of COVID-19 tests, while a large number of smartphones that stayed at home decreased it. A doubling in the relative number of visits increases the positivity rate by about 12.4 percentage points (95% CI, 5.3 to 19.6). A doubling in the relative number of stay-at-home devices lowered it by 2.0 percentage points (95% CI, -2.9 to -1.2). The business closures and out-of-home activity restrictions decreased the positivity rate, accounting for approximately 25% of the decline observed in April and May 2020.

CONCLUSION

Policy measures decreased the likelihood of positive results in COVID-19 tests. These specific policy tools may be successfully used when comparable health crises arise in the future.

Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments

The objective of this study was to investigate whether cotton mask worn by respiratory infection person could suppress respiratory droplet levels compared to medical mask. We recruited adult volunteers with confirmed influenza and suspected cases of coronavirus disease 2019 (COVID-19) to wear medical masks and self-designed triple-layer cotton masks in a regular bedroom and a car with air conditioning. Four 1-hour repeated measurements (two measurements for bedroom the others for car) of particles with a size range of 20-1000 nm measured by number concentrations (NC0.02-1), temperature and relatively humidity, and cough/sneeze counts per hour were conducted for each volunteer. The paired t-tests were used for within-group comparisons in a bedroom and in a car. The results showed that there was no significant difference in NC0.02-1 or cough/sneeze counts between volunteers with medical masks and cotton masks in a bedroom or a car. We concluded that the cotton mask could be a potential substitute for medical mask for respiratory infection person in microenvironment with air conditioning. Healthy people may daily use cotton mask in the community since cotton mask is washable and reusable.

Impact of the COVID-19 pandemic on cytology practice: An international survey in the Asia-Pacific region

BACKGROUND

The purpose of the current study was to examine the impact of coronavirus disease 2019 (COVID-19) on various aspects of cytology practice in the Asia-Pacific region.

METHODS

An online questionnaire was distributed to cytopathology laboratories in 24 Asia-Pacific countries to explore the impact of restrictive measures on access to health care, use of general and personal protective equipment (PPE), and changes in cytology workflow and workload from February to April 2020.

RESULTS

A total of 167 cytopathology laboratories from 24 countries responded to the survey; the majority reported that restrictive measures that limited the accessibility of health care services had been implemented in their cities and/or countries (80.8%) and their hospitals (83.8%). The respondents noted that COVID-19 had an impact on the cytologic workflow as well as the workload. Approximately one-half of the participants reported the implementation of new biosafety protocols (54.5%) as well as improvements in laboratory facilities (47.3%). Rearrangement or redeployment of the workforce was reported in 53.3% and 34.1% of laboratories, respectively. The majority of the respondents reported a significant reduction (>10%) in caseload associated with both gynecological (82.0%) and nongynecological specimens (78.4%). Most laboratories reported no significant change in the malignancy rates of both gynecological (67.7%) and nongynecological specimens (58.7%) compared with the same period in 2019.

CONCLUSIONS

The results of the survey demonstrated that the COVID-19 pandemic resulted in a significant reduction in the number of cytology specimens examined along with the need to implement new biosafety protocols. These findings underscore the need for the worldwide standardization of biosafety protocols and cytology practice.

Last-resort strategies during mask shortages: optimal design features of cloth masks and decontamination of disposable masks during the COVID-19 pandemic

Face masks and respirators are the most widely used intervention measures for respiratory protection. In the wake of COVID-19, in response to shortages and lack of availability of surgical masks and respirators, the use of cloth masks has become a research focus. Various fabrics have been promoted with little evidence-based foundation and without guidelines on design principles for optimal performance. In these circumstances, it is essential to understand the properties, key performance factors, filter mechanisms and evidence on cloth masks materials. The general community might also need to decontaminate and reuse disposable, single-use devices as a last resort. We present an overview of the filter materials, filter mechanisms and effectiveness, key performance factors, and hydrophobicity of the common disposable masks, as well as cloth masks. We also reviewed decontamination methods for disposable respiratory devices. As an alternative to surgical masks and respirators, we recommend a cloth mask made of at least three layers (300-350 threads per inch) and adding a nylon stocking layer over the mask for a better fit. Water-resistant fabrics (polyesters/nylon), blends of fabrics and water-absorbing fabrics (cotton) should be in the outside layer, middle layer/layers and inside layer, respectively. The information outlined here will help people to navigate their choices if facing shortages of appropriate respiratory protection during the COVID-19 pandemic.

Optimal control on a mathematical model to pattern the progression of coronavirus disease 2019 (COVID-19) in Indonesia

Background

Understanding the pattern of COVID-19 infection progression is critical for health policymakers. Reaching the exponential peak of cases, flattening the curve, and treating all of the active cases are the keys to success in reducing outbreak transmission. The objective of this study was to determine the most effective model for predicting the peak of COVID-19 in Indonesia, using a deterministic model.

Methods

The SEI2RS model considers five strategies for control, namely: large-scale social restriction ( u1 ), contact tracing ( u2 ), mass testing ( u3 ) , case detection and treatment ( u4 ), and the wearing of face masks ( u5 ). Three scenarios were developed, each differentiated by the controls. The model used April 10, 2020, and December 31, 2020, as the initial and final times.

Results

The simulation results indicated that the peak of COVID-19 cases for scenarios 1, 2, and 3 occur on the 59th day with 33,151 cases, on the 38th day with 37,908 cases, and on the 40th day with 39,305 cases. For all of the scenarios, the decline phase shows a slow downward slope and about 8000 cases of COVID-19 still active by the end of 2020.

Conclusion

The study concludes that scenario 2, which consists of large-scale social restriction (u1), contact tracing (u2), case detection and treatment (u4), and the wearing of face masks (u5), is the most rational scenario to control COVID-19 spreading in Indonesia.

Digital technology applications for contact tracing: the new promise for COVID-19 and beyond?

Among the most critical strategies in the fight against the Corona Virus Disease (COVID-19) is the rapid tracing and notification of potentially infected persons. Several nations have implemented mobile software applications ("apps") to alert persons exposed to the coronavirus. The expected advantages of this new technology over the traditional method of contact tracing include speed, specificity, and mass reach. Beyond its use for mitigating and containing COVID-19, digital technology can complement or even augment the traditional approach to global health program implementation. However, as with any new system, strong regulatory frameworks are necessary to ensure that individual information is not used for surveillance purposes, and user privacy will be maintained. Having safeguarded this, perhaps the global health community will witness the beginning of a new era of implementing mass health programs through the medium of digital technology.

Reduction of Contagion Risks by SARS-Cov-2 (COVID-19) in Air-Conditioned Work Environments

BACKGROUND

The coronavirus emergency obliged Italy's government to stop production and trade activities to limit the =risk of contagion. Italy will restart activities in a few days and some security measures will have to be taken to limit the risks of spreading the virus as much as possible.

OBJECTIVE

This work summarizes the rules that are to be adopted for the reduction of the risks of SARS-CoV-2 infection with particular regard to the air conditioning systems in working environments, the sources of risk, and possible risk reduction measures.

RESULTS

Ducted air systems are of great importance, widespread, and often overlooked in risk assessment. Scientific evidence has shown that air conditioning systems can be both an infection risk reducer and, if misused, a multiplier of infection possibility.

LIMITATIONS

A narrative review with paucity of literature.

The fabric of life: what if mosquito nets were durable and widely available but insecticide-free?

BACKGROUND

Bed nets are the commonest malaria prevention tool and arguably the most cost-effective. Their efficacy is because they prevent mosquito bites (a function of physical durability and integrity), and kill mosquitoes (a function of chemical content and mosquito susceptibility). This essay follows the story of bed nets, insecticides and malaria control, and asks whether the nets must always have insecticides.

METHODS

Key attributes of untreated or pyrethroid-treated nets are examined alongside observations of their entomological and epidemiological impacts. Arguments for and against adding insecticides to nets are analysed in contexts of pyrethroid resistance, personal-versus-communal protection, outdoor-biting, need for local production and global health policies.

FINDINGS

Widespread resistance in African malaria vectors has greatly weakened the historical mass mosquitocidal effects of insecticide-treated nets (ITNs), which previously contributed communal benefits to users and non-users. Yet ITNs still achieve substantial epidemiological impact, suggesting that physical integrity, consistent use and population-level coverage are increasingly more important than mosquitocidal properties. Pyrethroid-treatment remains desirable where vectors are sufficiently susceptible, but is no longer universally necessary and should be re-examined alongside other attributes, e.g. durability, coverage, acceptability and access. New ITNs with multiple actives or synergists could provide temporary relief in some settings, but their performance, higher costs, and drawn-out innovation timelines do not justify singular emphasis on insecticides. Similarly, sub-lethal insecticides may remain marginally-impactful by reducing survival of older mosquitoes and disrupting parasite development inside the mosquitoes, but such effects vanish under strong resistance.

CONCLUSIONS

The public health value of nets is increasingly driven by bite prevention, and decreasingly by lethality to mosquitoes. For context-appropriate solutions, it is necessary to acknowledge and evaluate the potential and cost-effectiveness of durable untreated nets across different settings. Though ~ 90% of malaria burden occurs in Africa, most World Health Organization-prequalified nets are manufactured outside Africa, since many local manufacturers lack capacity to produce the recommended insecticidal nets at competitive scale and pricing. By relaxing conditions for insecticides on nets, it is conceivable that non-insecticidal but durable, and possibly bio-degradable nets, could be readily manufactured locally. This essay aims not to discredit ITNs, but to illustrate how singular focus on insecticides can hinder innovation and sustainability.

On Pause for the Pandemic: Health Issues Sidelined Amid COVID-19 Response

Any physician can look out over the COVID-19 landscape and see important areas of health care tied to their specialty that are being downplayed or ignored as resources pour into fighting the pandemic and scared patients chose not to come to their doctors' offices.

Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses

Optimal management of infectious diseases is guided by up-to-date information at the individual and public health levels. For infections of global importance, including emerging pandemics such as COVID-19 or prevalent endemic diseases such as dengue, identifying patients at risk of severe disease and clinical deterioration can be challenging, considering that the majority present with a mild illness. In our article, we describe the use of wearable technology for continuous physiological monitoring in healthcare settings. Deployment of wearables in hospital settings for the management of infectious diseases, or in the community to support syndromic surveillance during outbreaks, could provide significant, cost-effective advantages and improve healthcare delivery. We highlight a range of promising technologies employed by wearable devices and discuss the technical and ethical issues relating to implementation in the clinic, focusing on low- and middle- income countries. Finally, we propose a set of essential criteria for the rollout of wearable technology for clinical use.

Decision tree machine learning applied to bovine tuberculosis risk factors to aid disease control decision making

Identifying and understanding the risk factors for endemic bovine tuberculosis (TB) in cattle herds is critical for the control of this disease. Exploratory machine learning techniques can uncover complex non-linear relationships and interactions within disease causation webs, and enhance our knowledge of TB risk factors and how they are interrelated. Classification tree analysis was used to reveal associations between predictors of TB in England and each of the three surveillance risk areas (High Risk, Edge, and Low Risk) in 2016, identifying the highest risk herds. The main classifying predictor for farms in England overall related to the TB prevalence in the 100 nearest cattle herds. In the High Risk and Edge areas it was the number of slaughterhouse destinations and in the Low Risk area it was the number of cattle tested in surveillance tests. How long ago the last confirmed incident was resolved was the most frequent classifier in trees; if within two years, leading to the highest risk group of herds in the High Risk and Low Risk areas. At least two different slaughterhouse destinations led to the highest risk group of herds in England, whereas in the Edge area it was a combination of no contiguous low-risk neighbours (i.e. in a 1 km radius) and a minimum proportion of 6-23 month-old cattle in November. A threshold value of prevalence in 100 nearest neighbours increased the risk in all areas, although the value was specific to each area. Having low-risk contiguous neighbours reduced the risk in the Edge and High Risk areas, whereas high-risk ones increased the risk in England overall and in the Edge area specifically. The best classification tree models informed multivariable binomial logistic regression models in each area, adding statistical inference outputs. These two approaches showed similar predictive performance although there were some disparities regarding what constituted high-risk predictors. Decision tree machine learning approaches can identify risk factors from webs of causation: information which may then be used to inform decision making for disease control purposes.

Mobile Phones As Surveillance Tools: Implementing and Evaluating a Large-Scale Intersectoral Surveillance System for Rabies in Tanzania

Katie Hampson and colleagues describe their experience of developing and deploying a large-scale rabies surveillance system based on mobile phones in southern Tanzania.

Comparison of Indoor Residual Spray Equipment for Malaria Control in Liberia

We describe and compare a new innovative backpack compressed-air sprayer (JQSX-12) to a Stihl® 450 backpack mist blower and a manually operated compression sprayer for its effectiveness as an alternative operational tool for indoor residual insecticide application to control malaria in Liberia. Advantages and physical characteristics of each sprayer and their spray atomization parameters are discussed.

[Effect of standardized construction of laboratories of schistosomiasis control institutions in Hubei Province in 2013]

OBJECTIVE

To investigate the effect and current situation of the standardized construction of laboratories of schis- tosomiasis control institutions in Hubei Province, so as to provide the evidence for establishing and improving the quality control system of diagnosis of schistosomiasis after the transmission of schistosomiasis was under control.

METHODS

According to the procedures of self-examination, field operation, and laboratory on-site, five laboratories were assessed, and all the results were analyzed comparatively.

RESULTS

The average number of staffs were (7.00±1.58) persons, and the staffs of the laboratories of the schistosomiasis control institutions with senior professional titles in the city level were more than that in the county level (t = 5.563, P < 0.05). The average space was (3.20±1.64) rooms, and the average area was (117.00±88.29) m2. The average score of field operation was (96.40±4.49) points. The average score of laboratory on-site assessment was (106.6±6.15) points. The highest and lowest of the laboratory on-site assessment scores were environment and facilities (19.60 ± 0.55) points and management system of laboratory quality control (15.70±2.39) points (F = 2.869, P < 0.05), respectively.

CONCLUSION

The cultivation of laboratory staff should be strengthened, and the diagnostic capacity should be maintained and improved. The laboratory quality control system should be paid more attention to, and the construction and management of schistosomiasis laboratories should be standardized.

[Schistosomiasis control effect of measures of replacing cattle with machine for cultivation and forbidding depasturage of livestock on marshlands in marshland and lake regions]

OBJECTIVE

To evaluate the schistosomiasis control effect of the measures of replacing cattle with machine for cultivation and forbidding depasturage of livestock on marshlands in marshland and lake regions.

METHODS

The retrospective review and field survey were implemented in the Jiangling and Gongan counties of Hubei Province where were implemented with the measure of replacing cattle with machine for cultivation, and Yuanjiang and Huarong counties of Hunan Province where were implemented with the measure of forbidding the depasturage of livestock on marshlands. The schistosome infection status of human, cattle, and Oncomelania hupensis snails, and schistosome-infested field excreta were surveyed from 2007 to 2013. The effects of the interventions were compared before and after their implementations.

RESULTS

The 6 villages of Hubei Province were implemented with the measure of replacing cattle with machine for cultivation, and 7 villages of Hunan Province were implemented with the measure of forbidding the depasturage of livestock on marshlands. From 2007 to 2013, the schistosome infection rates of residents declined from 3.95% to 0.70% (χ2 = 128.376, P < 0.05), with the descend range of 82.53%. The descend ranges of the measures of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands were 83.081% and 81.62% respectively, and there was no significant difference between the two measures (χ2 = 0.132, P > 0.05). The infection rate of cattle decreased from 3.66% in 2007 to 0.65% in 2013, and the descend range was 82.24% (χ2 = 13.692, P < 0.05). The field excreta was surveyed in the snail breeding place in 2013. The investigated area was 157.435 hm2, and 625 samples of field feces of cattle were collected with the density of field excreta of 3.97/hm2, and the positive rate was 1.12% (7/625). The schistosome infection rate of snails and the density of infected snails decreased successively from 2007, and no infected snails were detected from 2011 to 2013.

CONCLUSIONS

The schistosomiasis endemic situation are decreased significantly after the interventions of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands. Therefore, schistosomiasis control effect of these measures is notable in the marshland and lake regions.

[Effect of comprehensive schistosomiasis control strategy based on infection source control in Hanchuan City]

OBJECTIVE

To evaluate the effect of comprehensive schistosomiasis control measures based on infection source control in Hanchuan City (marshland and lake endemic regions).

METHODS

The data of comprehensive schistosomiasis control in Hanchuan City from 2004 to 2013 were collected, and the change trends of the Oncomelania hupensis snail status and the infection situation of human and livestock were analyzed to evaluate the control effect.

RESULTS

After the implementation of the comprehensive measures, the infection rates of residents and cattle decreased from 6.38% and 8.11% in 2004 to 0.16% and 0 in 2013 respectively. There were no acute schistosomiasis patients since 2007, no new infection cases since 2011, and no infected snails since 2012. Compared with 2004, the occurrence rate of frames with living snails and the average density of living snails decreased by 56.78% and 68.35%, respectively, but the snail area and susceptible area increased by 0.62% and 7.10%, respectively. In 2013, all the 367 endemic villages in 26 townships reached the criteria of transmission controlled.

CONCLUSIONS

The comprehensive schistosomiasis control measures based on infection source control can control the schistosomiasis transmission effectively in marshland and lake endemic regions. When consolidating the achievement, the snail area in inner embankment should be compressed to prevent the schistosome re-infection in human and livestock.

[Evaluation of comprehensive measures of schistosomiasis control in Caidian District, Wuhan City]

OBJECTIVE

To evaluate the implementation and effectiveness of comprehensive control measures of schistosomiasis in Caidian District, Wuhan City.

METHODS

The data of implementation of the schistosomiasis control measures in Caidian District was collected and analyzed statistically.

RESULTS

The number of Oncomelania hupensis snail environments and snail area decreased from 213 sites and 223.47 hm2 in 2003 to 59 sites and 51.20 hm2 in 2013, with the decreasing rate of 72.30% and 77.09%, respectively. The infection rate of schistosomiasis of human decreased from 1.58% in 2006 to 0.24% in 2013, with the decreasing rate of 84.81%. The positive rate of stool tests of cattle was 2.19% in 2006 while it was 0 in 2013.

CONCLUSION

The comprehensive control measures of schistosomiasis are effective.

[Improvement of epidemiologic control of infectious diseases by using geoinformational systems]

Problems of the perspective of geoinformational systems (GIS) use for improvement of epidemiologic control of infectious diseases including during mass events are examined. A scheme of creation of the decision making support system (DMSS) is proposed, the system is based on GIS, has general primary data and analytical-prognostic tool base including subsystems: real-time primary information intake, information analysis, epizootic and epidemic activity prognosis on the certain territories and the federal level. Specialized personnel training, creation of infrastructure for DMSS functioning in primary Federal Service of Surveillance for Protection of Consumers Rights and Human Welfare units are designated as priority tasks.

Multipurpose prevention technologies: products in development

Multipurpose prevention technologies (MPTs) are broadly defined as products capable of simultaneously addressing multiple sexual and reproductive health needs including unintended pregnancy, STIs including HIV-1, and other reproductive tract infections. MPTs have been discussed for a few decades but little product development has occurred. With the recent proof-of-concept that a topically applied antiretroviral (ARV) can effectively reduce sexual transmission of HIV-1 (tenofovir 1% gel) the impetus to develop MPTs is gaining momentum. Products currently in development are broadly categorized as either long-acting or on-demand. Long-acting MPTs include intravaginal rings (IVRs) and long-acting injectable products. Several IVR MPTs are under development including one designed to release tenofovir to prevent transmission of HIV-1 and levonorgestrel (LNG) to prevent unintended pregnancy over a 90-day period. Another MPT IVR under development is designed to release the ARV dapivirine and LNG for 2 months. Long-acting injectable pre-exposure prophylaxis (PrEP) formulations of rilpivirine (TMC278) and GSK1265744 have entered clinical evaluation and could form the basis of long-acting injectable products for HIV-1 prevention and prevention of unintended pregnancy. On-demand products include TFV 1% gel (HIV-1/HSV-2 prevention), a zinc/carrageenan zinc gel (HIV-1/HSV-2 prevention), and the SILCS diaphragm administered with TFV 1% gel. Significant technical, funding, and regulatory hurdles must be overcome to develop most MPTs; however, the significant reproductive health benefits to many women around the world should provide motivation to overcome these hurdles. This article is based on a presentation at the "Product Development Workshop 2013: HIV and Multipurpose Prevention Technologies", held in Arlington, Virginia on February 21-22, 2013. It forms part of a special supplement to Antiviral Research.

[Short-term effect of black film covering on Oncomelania hupensis snail control in marshland and lake regions]

OBJECTIVE

To evaluate the short-term effect of the black film covering combined with niclosamide on Oncomelania hupensis snail control in marshland and lake regions.

METHODS

A ditch with snails in Anxiang County was selected as the experimental sites. The ditch was divided into 3 groups: a film group, a niclosamide group, and a niclosamide and film group. The snails were surveyed before the test and 1, 3, 5, 7 days after the experiment.

RESULTS

After the film covering, the highest temperature of the surface of soil was 63.7 degrees C on the first day, and the temperature higher than 40 degrees C lasted 4.34 hours. On the second day, the highest temperature was 52.3 degrees C, and the temperature higher than 40 degrees C lasted 4.96 hours. On the fourth day and fifth day, the temperature was lower than 30 degrees C, while the temperature was lower than 34 degrees C on the sixth day. On the seventh day of the experiment, the snail death rates of the film group, the niclosamide group, and the niclosamide and film group on the soil surface were 16.36%, 58.40% and 53.57%, respectively. On the seventh day, the snail death rates of the film group, and the niclosamide and film group under the soil were 20.00% and 40.00%, respectively, while no snails were found under the soil in the niclosamide group 3 days after the experiment. In mesh bags, the snail death rates of the film group, the niclosamide group, and the niclosamide and film group were 84.00%, 95.33% and 95.33%, respectively.

CONCLUSION

The short-term effect of the black film covering on snail control is not obvious, and the black film covering does no promote the molluscicidal effect of niclosamide.

Insect repellents and associated personal protection for a reduction in human disease

Personal protection measures against biting arthropods include topical insect repellents, area repellents, insecticide-treated bednets and treated clothing. The literature on the effectiveness of personal protection products against arthropods is mainly limited to studies of prevention of bites, rather than prevention of disease. Tungiasis was successfully controlled by application of topical repellents and scrub typhus was reduced through the use of treated clothing. Successful reduction of leishmaniasis was achieved through the use of topical repellents, treated bednets and treated clothing in individual studies. Malaria has been reduced by the use of insecticide-treated bednets (ITN), certain campaigns involving topical repellents, and the combination of treated bednets and topical repellents. Although area repellents such as mosquito coils are used extensively, their ability to protect humans from vector-transmitted pathogens has not been proven. Taken together, the literature indicates that personal protection measures must be used correctly to be effective. A study that showed successful control of malaria by combining treated bednets and topical repellents suggests that combinations of personal protection measures are likely to be more effective than single methods. Implementation of successful programmes based on personal protection will require a level of cooperation commonly associated with other basic societal functions, such as education and food safety.

Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations

Facemasks are widely used as a protective measure by general public to prevent inhalation of airborne pathogens including seasonal, swine and other forms of influenza and severe acute respiratory syndrome (SARS), etc. However, scientific data on effectiveness of facemasks in reducing infections in the community are extremely limited and even inconsistent. In this work, two manikins labelled as 'source' and 'susceptible' were used to measure the protection provided by facemasks under various emission scenarios. The source was modified to generate polydisperse ultrafine particles, whereas the susceptible was modified to mimic a realistic breathing pattern. The facemask was challenged by both pseudo-steady and highly transient emissions generated by an expiratory process where parameters, such as separation distance between manikins, emission velocity and expiratory duration, were controlled and measured systematically. Performances of four different types of facemask fits, varying from ideal to normal wearing practice, were also investigated. Under the pseudo-steady concentration environment, facemask protection was found to be 45 per cent, while under expiratory emissions, protection varied from 33 to 100 per cent. It was also observed that the separation between the source and the manikin was the most influential parameter affecting facemask protection.

[Application of spatial statistical analysis methods and related analytic softwares in research of infectious diseases]

This paper summarizes the application of several spatial statistical analysis methods, and their related softwares in the research of infectious diseases, in order to improve the prevention and control of infectious diseases.

An analysis on the detection of biological contaminants aboard aircraft

The spread of infectious disease via commercial airliner travel is a significant and realistic threat. To shed some light on the feasibility of detecting airborne pathogens, a sensor integration study has been conducted and computational investigations of contaminant transport in an aircraft cabin have been performed. Our study took into consideration sensor sensitivity as well as the time-to-answer, size, weight and the power of best available commercial off-the-shelf (COTS) devices. We conducted computational fluid dynamics simulations to investigate three types of scenarios: (1) nominal breathing (up to 20 breaths per minute) and coughing (20 times per hour); (2) nominal breathing and sneezing (4 times per hour); and (3) nominal breathing only. Each scenario was implemented with one or seven infectious passengers expelling air and sneezes or coughs at the stated frequencies. Scenario 2 was implemented with two additional cases in which one infectious passenger expelled 20 and 50 sneezes per hour, respectively. All computations were based on 90 minutes of sampling using specifications from a COTS aerosol collector and biosensor. Only biosensors that could provide an answer in under 20 minutes without any manual preparation steps were included. The principal finding was that the steady-state bacteria concentrations in aircraft would be high enough to be detected in the case where seven infectious passengers are exhaling under scenarios 1 and 2 and where one infectious passenger is actively exhaling in scenario 2. Breathing alone failed to generate sufficient bacterial particles for detection, and none of the scenarios generated sufficient viral particles for detection to be feasible. These results suggest that more sensitive sensors than the COTS devices currently available and/or sampling of individual passengers would be needed for the detection of bacteria and viruses in aircraft.