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1.
Healthcare ; 10(8):1428, 2022.
Article in English | MDPI | ID: covidwho-1969174

ABSTRACT

Low-income countries, such as Haiti, are facing challenges in fighting the COVID-19 pandemic due to resource shortages and fragile healthcare systems. This study assessed the functional capacity and preparedness of the Haitian healthcare system regarding the COVID-19 pandemic. It employed a narrative review approach to analyze secondary data and used the Donabedian model and the global health security index as the theoretical frameworks to evaluate preparedness. The findings reveal that Haiti faces challenges in tackling the COVID-19 pandemic due to a lack of biosafety and biosecurity regulations, inadequate laboratory systems for COVID-19 testing, and shortages of human resources and personal protective equipment. Moreover, poverty remains widespread, and people lack access to clean water and sanitation services, resulting in a high risk of COVID-19 infection. Furthermore, a lack of communication, rumors, the circulation of fake news regarding COVID-19, and stigmatization cause distrust and reduce the number of people seeking healthcare services. Haiti faces challenges with respect to tackling the pandemic. The Haitian government can strengthen and improve the capacity of the healthcare system to fight against the COVID-19 pandemic and infectious diseases emerging in the future.

2.
Hum Vaccin Immunother ; 18(5): 2050121, 2022 Nov 30.
Article in English | MEDLINE | ID: covidwho-1764460

ABSTRACT

COVID-19 vaccination is an effective intervention preventing individuals from contracting SARS-CoV-2 or transmitting the virus to others. However, in many countries, vaccine hesitancy has impeded the progress of mass vaccination to reach herd immunity. This study aimed to understand the similarities and differences in the determinants of COVID-19 vaccine hesitancy in Taiwan, the United States, the Netherlands, and Haiti. A qualitative study was conducted by face-to-face interviews with participants in Taiwan and remote online interviews with participants in the United States, the Netherlands, and Haiti. In total, 47 interviews were conducted. A reflective thematic analysis was employed to analyze the collected data. Distrust of COVID-19 vaccines was reported by the participants in all countries. A perception of a lack of necessity or urgency to be vaccinated was reported by the Taiwanese and Haitian participants. Lack of knowledge regarding COVID-19 vaccines was reported by the Taiwanese, U.S. and Haitian participants, contributing to hesitation or refusal to vaccination. Regarding misinformation and rumors, misinformation was found among a few Taiwanese and Dutch participants. Additionally, rumors concerning COVID-19 vaccines were mentioned by the Dutch and Haitian participants. Furthermore, a lack of verified information was reported by the participants in all four countries. Overall, the current study suggests that vaccine hesitancy exists among participants in Taiwan, the United States, the Netherlands, and Haiti. Building trust in the COVID-19 vaccine, cultivating vaccine literacy, clarifying misinformation and rumors concerning COVID-19 vaccines, and providing verified information are critical for increasing public acceptance of the COVID-19 vaccine.


Subject(s)
COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Haiti/epidemiology , Humans , Netherlands , Patient Acceptance of Health Care , SARS-CoV-2 , Taiwan , Trust , United States , Vaccination , Vaccination Hesitancy
3.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-324619

ABSTRACT

Using data on imported and domestic COVID-19 cases from Taiwan and New Zealand between January and June 2020, we develop a Bayesian random-effects Poisson model to detect cluster infections from imported cases. We find remarkable consistency in the predictive power of the model. An increase in one imported case increased the risk of domestic cases by 9.54% in Taiwan and 10.97% in New Zealand. The Taiwan epidemic curve revealed that imported cases did not lead to a large-scale community-acquired outbreak. In New Zealand, a community-acquired outbreak during 29th March-4th April could have been averted if control actions had been taken one-week earlier prior to the predicted cluster infection between 22nd and 28th March. Our model can be used as an early warning of outbreaks during the initial stage of pandemic or the resurgence of outbreaks after lifting containment measures, such as lockdown orders and border control, during a pandemic.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-295641

ABSTRACT

Background: There is continuing uncertainty about the effectiveness of testing, tracing, isolation, and quarantine (TTIQ) policies during the pandemic.<br><br>Methods: We developed proxy indicators of the implementation of TTIQ policies at subnational and national (Republic of Korea), and international level (111 countries) from the beginning of 2020 to September 2021. These were: proportion of quarantined population (“Q-proportion”) among newly diagnosed COVID-19 cases/week, ratio of quarantined people to cases, and ratio of negative tests to new cases, with higher values suggesting more complete TTIQ. We used linear regression to analyze the association between TTIQ indicators and 1-week lagged cases and cumulative deaths, separating periods before and after vaccines becoming available.<br><br>Findings: We found consistently inverse associations between TTIQ indicators and COVID-19 outcomes, with gradual attenuation as vaccination coverage rose. Q-proportion overall (β= -0·091;p -value < 0·001) and log-transformed quarantined population per case (β ranges from -0·626;p < 0.001 to -0·288;p = 0·023) in each of 9 provinces were negatively associated with log-transformed 1-week lagged incidence in Korea overall. The strength of association decreased with greater vaccination coverage. The ratio of negative test results/new case was also inversely associated with incidence (β= -1·19;p -value < 0·001) in Korea. Globally, increasing negative test ratio was significantly associated with lower cumulative cases and deaths per capita, more so earlier in the pandemic. Jurisdictions with lower vaccination coverage showed the strongest association.<br><br>Interpretation: A real-world evaluation demonstrates an association between performance of testing, contact tracing, isolation, and quarantine and better disease outcomes.<br><br>Funding Information: Ministry of Foreign Affairs, Republic of Korea. <br><br>Declaration of Interests: None to declare.

5.
Sci Rep ; 11(1): 13717, 2021 07 02.
Article in English | MEDLINE | ID: covidwho-1294481

ABSTRACT

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country's 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective 'pool' in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , COVID-19/epidemiology , Humans , Incidence , Pandemics/prevention & control , Transportation , Travel , Travel-Related Illness , Workplace
6.
Stoch Environ Res Risk Assess ; 35(7): 1319-1333, 2021.
Article in English | MEDLINE | ID: covidwho-1052979

ABSTRACT

The outbreak of COVID-19 on the Diamond Princess Cruise Ship provides an unprecedented opportunity to estimate its original transmissibility with basic reproductive number (R0) and the effectiveness of containment measures. We developed an ordinary differential equation-based Susceptible-Exposed-Infected-Recovery (SEIR) model with Bayesian underpinning to estimate the main parameter of R0 determined by transmission coefficients, incubation period, and the recovery rate. Bayesian Markov Chain Monte Carlo (MCMC) estimation method was used to tackle the parameters of uncertainty resulting from the outbreak of COVID-19 given a small cohort of the cruise ship. The extended stratified SEIR model was also proposed to elucidate the heterogeneity of transmission route by the level of deck with passengers and crews. With the application of the overall model, R0 was estimated as high as 5.70 (95% credible interval: 4.23-7.79). The entire epidemic period without containment measurements was approximately 47 days and reached the peak one month later after the index case. The partial containment measure reduced 63% (95% credible interval: 60-66%) infected passengers. With the deck-specific SEIR model, the heterogeneity of R0 estimates by each deck was noted. The estimated R0 figures were 5.18 for passengers (5-14 deck), mainly from the within-deck transmission, and 2.46 for crews (2-4 deck), mainly from the between-deck transmission. Modelling the dynamic of COVID-19 on the cruise ship not only provides an insight into timely evacuation and early isolation and quarantine but also elucidates the relative contributions of different transmission modes on the cruise ship though the deck-stratified SEIR model. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at (10.1007/s00477-020-01968-w).

7.
J Med Internet Res ; 22(9): e22469, 2020 09 17.
Article in English | MEDLINE | ID: covidwho-781824

ABSTRACT

BACKGROUND: Implementing and lifting social distancing (LSD) is an urgent global issue during the COVID-19 pandemic, particularly when the travel ban is lifted to revive international businesses and economies. However, when and whether LSD can be considered is subject to the spread of SARS-CoV-2, the recovery rate, and the case-fatality rate. It is imperative to provide real-time assessment of three factors to guide LSD. OBJECTIVE: A simple LSD index was developed for health decision makers to do real-time assessment of COVID-19 at the global, country, region, and community level. METHODS: Data on the retrospective cohort of 186 countries with three factors were retrieved from a publicly available repository from January to early July. A simple index for guiding LSD was measured by the cumulative number of COVID-19 cases and recoveries, and the case-fatality rate was envisaged. If the LSD index was less than 1, LSD can be considered. The dynamic changes of the COVID-19 pandemic were evaluated to assess whether and when health decision makers allowed for LSD and when to reimplement social distancing after resurgences of the epidemic. RESULTS: After large-scale outbreaks in a few countries before mid-March (prepandemic phase), the global weekly LSD index peaked at 4.27 in March and lasted until mid-June (pandemic phase), during which most countries were affected and needed to take various social distancing measures. Since, the value of LSD has gradually declined to 0.99 on July 5 (postpandemic phase), at which 64.7% (120/186) of countries and regions had an LSD<1 with the decile between 0 and 1 to refine risk stratification by countries. The LSD index decreased to 1 in about 115 days. In addition, we present the results of dynamic changes of the LSD index for the world and for each country and region with different time windows from January to July 5. The results of the LSD index on the resurgence of the COVID-19 epidemic in certain regions and validation by other emerging infectious diseases are presented. CONCLUSIONS: This simple LSD index provides a quantitative assessment of whether and when to ease or implement social distancing to provide advice for health decision makers and travelers.


Subject(s)
Algorithms , Coronavirus Infections/prevention & control , Health Policy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Policy Making , Social Isolation , Betacoronavirus , COVID-19 , Coronavirus Infections/mortality , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/mortality , Pneumonia, Viral/transmission , Retrospective Studies , SARS-CoV-2 , Travel
8.
J Med Internet Res ; 22(6): e20586, 2020 06 23.
Article in English | MEDLINE | ID: covidwho-742636

ABSTRACT

BACKGROUND: Frontline health care workers, including physicians, are at high risk of contracting coronavirus disease (COVID-19) owing to their exposure to patients suspected of having COVID-19. OBJECTIVE: The aim of this study was to evaluate the benefits and feasibility of a double triage and telemedicine protocol in improving infection control in the emergency department (ED). METHODS: In this retrospective study, we recruited patients aged ≥20 years referred to the ED of the National Taiwan University Hospital between March 1 and April 30, 2020. A double triage and telemedicine protocol was developed to triage suggested COVID-19 cases and minimize health workers' exposure to this disease. We categorized patients attending video interviews into a telemedicine group and patients experiencing face-to-face interviews into a conventional group. A questionnaire was used to assess how patients perceived the quality of the interviews and their communication with physicians as well as perceptions of stress, discrimination, and privacy. Each question was evaluated using a 5-point Likert scale. Physicians' total exposure time and total evaluation time were treated as primary outcomes, and the mean scores of the questions were treated as secondary outcomes. RESULTS: The final sample included 198 patients, including 93 cases (47.0%) in the telemedicine group and 105 cases (53.0%) in the conventional group. The total exposure time in the telemedicine group was significantly shorter than that in the conventional group (4.7 minutes vs 8.9 minutes, P<.001), whereas the total evaluation time in the telemedicine group was significantly longer than that in the conventional group (12.2 minutes vs 8.9 minutes, P<.001). After controlling for potential confounders, the total exposure time in the telemedicine group was 4.6 minutes shorter than that in the conventional group (95% CI -5.7 to -3.5, P<.001), whereas the total evaluation time in the telemedicine group was 2.8 minutes longer than that in the conventional group (95% CI -1.6 to -4.0, P<.001). The mean scores of the patient questionnaire were high in both groups (4.5/5 to 4.7/5 points). CONCLUSIONS: The implementation of the double triage and telemedicine protocol in the ED during the COVID-19 pandemic has high potential to improve infection control.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Emergency Service, Hospital , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Telemedicine/methods , Triage/methods , Adult , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Feasibility Studies , Female , Health Personnel , Humans , Infection Control/standards , Male , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Retrospective Studies , SARS-CoV-2 , Taiwan/epidemiology
9.
J Med Internet Res ; 22(5): e19540, 2020 05 05.
Article in English | MEDLINE | ID: covidwho-174968

ABSTRACT

BACKGROUND: Low infection and case-fatality rates have been thus far observed in Taiwan. One of the reasons for this major success is better use of big data analytics in efficient contact tracing and management and surveillance of those who require quarantine and isolation. OBJECTIVE: We present here a unique application of big data analytics among Taiwanese people who had contact with more than 3000 passengers that disembarked at Keelung harbor in Taiwan for a 1-day tour on January 31, 2020, 5 days before the outbreak of coronavirus disease (COVID-19) on the Diamond Princess cruise ship on February 5, 2020, after an index case was identified on January 20, 2020. METHODS: The smart contact tracing-based mobile sensor data, cross-validated by other big sensor surveillance data, were analyzed by the mobile geopositioning method and rapid analysis to identify 627,386 potential contact-persons. Information on self-monitoring and self-quarantine was provided via SMS, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were offered for symptomatic contacts. National Health Insurance claims big data were linked, to follow-up on the outcome related to COVID-19 among those who were hospitalized due to pneumonia and advised to undergo screening for SARS-CoV-2. RESULTS: As of February 29, a total of 67 contacts who were tested by reverse transcription-polymerase chain reaction were all negative and no confirmed COVID-19 cases were found. Less cases of respiratory syndrome and pneumonia were found after the follow-up of the contact population compared with the general population until March 10, 2020. CONCLUSIONS: Big data analytics with smart contact tracing, automated alert messaging for self-restriction, and follow-up of the outcome related to COVID-19 using health insurance data could curtail the resources required for conventional epidemiological contact tracing.


Subject(s)
Big Data , Contact Tracing/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Disease Outbreaks/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Public Health Surveillance/methods , Quarantine/methods , Ships , Betacoronavirus/isolation & purification , COVID-19 , Communicable Disease Control , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disease Outbreaks/statistics & numerical data , Geographic Information Systems , Humans , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Retrospective Studies , SARS-CoV-2 , Taiwan/epidemiology
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