Proximity to international airports and early transmission of COVID-19 in the United States-An epidemiological assessment of the geographic distribution of 490,000 cases.

BACKGROUND: Identifying hotspots in a pandemic is essential for early containment. In the context of the rapid global dissemination of the Covid-19 pandemic, describing viral infection rates in relation to international air travel early during the pandemic can help inform future public health policy. The objective of this study is to determine whether proximity to an international airport predicted higher infection rates during the early phase of the Covid-19 pandemic in the United States (US). METHODS: In this cross-sectional study, the authors examined the incidence of Covid-19 in areas near US international airports in the first weeks after detection of Covid-19 in all 50 states, using publicly available county-level incidence of Covid-19 data. They performed a multiple regression to determine the relative effects of population density and air traffic in the Counties Containing Airports (CCA) and the number of Covid-19 cases, and determined the odds of Covid-19 in CCA compared to the rest of the state. RESULTS: Multiple regression analysis revealed that air traffic was significantly correlated with Covid-19 cases during the initial phase of pandemic while population density was not significantly correlated. Three weeks into the pandemic, the pooled odds of Covid-19 cases in CCA was 2.66 (95% CI [2.64, 2.68], p < 0.0001). CONCLUSIONS: The counties in the US containing international airports represented initial hotspots for Covid-19 transmission. Early public health containment efforts focused on these areas may help mitigate disease transmission during future similar novel respiratory virus epidemics.

Global Contributors to Antibiotic Resistance.

INTRODUCTION: Antibiotic-resistant infections have become increasingly prevalent nowadays. As a result, it is essential to examine the key socioeconomic and political factors which contribute to the rise in the prevalence of antibiotic resistance in developing and developed nations. This study aims to identify the various contributors to the development of antibiotic resistance in each type of nation. METHODS: PUBMED was used to identify primary research, systematic reviews, and narrative reviews published before Jan 2017. Search terms included antibiotic resistance, antimicrobial resistance, superbugs, multidrug-resistant organisms, developing countries, developed countries. Publications from different countries were included to ensure generalizability. Publications were excluded if they didn't mention factors causing resistance, focused on the molecular basis of resistance, or if they were case reports. Publicly available reports from national and international health agencies were used. RESULTS: In developing countries, key contributors identified included: (1) Lack of surveillance of resistance development, (2) poor quality of available antibiotics, (3) clinical misuse, and (4) ease of availability of antibiotics. In developed countries, poor hospital-level regulation and excessive antibiotic use in food-producing animals play a major role in leading to antibiotic resistance. Finally, research on novel antibiotics is slow ing down due to the lack of economic incentives for antibiotic research. CONCLUSION: Overall, multiple factors, which are distinct for developing and developed countries, contribute to the increase in the prevalence of antibiotic resistance globally. The results highlight the need to improve the regulatory framework for antibiotic use and research globally.