Active testing of groups at increased risk of acquiring SARS-CoV-2 in Canada: costs and human resource needs.

BACKGROUND: Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is largely passive, which impedes epidemic control. We defined active testing strategies for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) for groups at increased risk of acquiring SARS-CoV-2 in all Canadian provinces. METHODS: We identified 5 groups who should be prioritized for active RT-PCR testing: contacts of people who are positive for SARS-CoV-2, and 4 at-risk populations - hospital employees, community health care workers and people in long-term care facilities, essential business employees, and schoolchildren and staff. We estimated costs, human resources and laboratory capacity required to test people in each group or to perform surveillance testing in random samples. RESULTS: During July 8-17, 2020, across all provinces in Canada, an average of 41 751 RT-PCR tests were performed daily; we estimated this required 5122 personnel and cost $2.4 million per day ($67.8 million per month). Systematic contact tracing and testing would increase personnel needs 1.2-fold and monthly costs to $78.9 million. Conducted over a month, testing all hospital employees would require 1823 additional personnel, costing $29.0 million; testing all community health care workers and persons in long-term care facilities would require 11 074 additional personnel and cost $124.8 million; and testing all essential employees would cost $321.7 million, requiring 25 965 added personnel. Testing the larger population within schools over 6 weeks would require 46 368 added personnel and cost $816.0 million. Interventions addressing inefficiencies, including saliva-based sampling and pooling samples, could reduce costs by 40% and personnel by 20%. Surveillance testing in population samples other than contacts would cost 5% of the cost of a universal approach to testing at-risk populations. INTERPRETATION: Active testing of groups at increased risk of acquiring SARS-CoV-2 appears feasible and would support the safe reopening of the economy and schools more broadly. This strategy also appears affordable compared with the $169.2 billion committed by the federal government as a response to the pandemic as of June 2020.

The Impact of Childcare on Poor Urban Women's Economic Empowerment in Africa.

Despite evidence from other regions, researchers and policy-makers remain skeptical that women's disproportionate childcare responsibilities act as a significant barrier to women's economic empowerment in Africa. This randomized control trial study in an informal settlement in Nairobi, Kenya, demonstrates that limited access to affordable early childcare inhibits poor urban women's participation in paid work. Women who were offered vouchers for subsidized early childcare were, on average, 8.5 percentage points more likely to be employed than those who were not given vouchers. Most of these employment gains were realized by married mothers. Single mothers, in contrast, benefited by significantly reducing the time spent working without any loss to their earnings by shifting to jobs with more regular hours. The effects on other measures of women's economic empowerment were mixed. With the exception of children's health care, access to subsidized daycare did not increase women's participation in other important household decisions. In addition, contrary to concerns that reducing the costs of childcare may elevate women's desire for more children, we find no effect on women's fertility intentions. These findings demonstrate that the impact of subsidized childcare differs by marital status and across outcomes. Nonetheless, in poor urban Africa, as elsewhere, failure to address women's childcare needs undermines efforts to promote women's economic empowerment.

Health, aging and childhood socio-economic conditions in Mexico.

We investigate the long-term effect of childhood socio-economic conditions on the health of the elderly in Mexico. We utilize a panel of individuals aged 50 and above from the Mexican Health and Aging Survey and find that the conditions under which the individual lived at the age of 10 affect health in old age, even accounting for education and income. This paper contributes to the literature of the long-term effects of childhood socio-economic status by being the first, to our knowledge, to consider exclusively the case of the elderly in a developing country.