Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study.

BACKGROUND: COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. METHODS: Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. FINDINGS: In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. INTERPRETATION: Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.

The metabolic cost of carrying a single- versus double-strap golf bag.

The purpose of this study was to compare energy expenditure and perceived comfort using two modes of carrying a golf bag. Fifteen men completed 2 trials of walking on a treadmill while carrying a golf bag. During 1 of 2 trials, an extra strap was added to convert a single-strap bag to a double-strap bag. The order was randomized. Oxygen consumption (L x min(-1)), heart rate, perceived exertion, and perceived comfort were measured during the 5-minute walk. Oxygen consumption was significantly lower carrying the double-strap golf bag (L x min(-1), p = 0.0004; ml x kg(-1) x min(-1), p < 0.0003), as were heart rate (p = 0.0013) and rate of perceived exertion (p < 0.005) During the double strap trial, the perceived comfort was higher (p < 0.005). Improvements in metabolic demands and comfort while carrying a double-strap golf bag should increase walking tolerance in golf.