A multinational Delphi consensus to end the COVID-19 public health threat.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic^1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches¹, while maintaining proven prevention measures using a vaccines-plus approach² that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities³ in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021.

Importance: The COVID-19 pandemic caused a large decrease in US life expectancy in 2020, but whether a similar decrease occurred in 2021 and whether the relationship between income and life expectancy intensified during the pandemic are unclear. Objective: To measure changes in life expectancy in 2020 and 2021 and the relationship between income and life expectancy by race and ethnicity. Design, Setting, and Participants: Retrospective ecological analysis of deaths in California in 2015 to 2021 to calculate state- and census tract-level life expectancy. Tracts were grouped by median household income (MHI), obtained from the American Community Survey, and the slope of the life expectancy-income gradient was compared by year and by racial and ethnic composition. Exposures: California in 2015 to 2019 (before the COVID-19 pandemic) and 2020 to 2021 (during the COVID-19 pandemic). Main Outcomes and Measures: Life expectancy at birth. Results: California experienced 1 988 606 deaths during 2015 to 2021, including 654 887 in 2020 to 2021. State life expectancy declined from 81.40 years in 2019 to 79.20 years in 2020 and 78.37 years in 2021. MHI data were available for 7962 of 8057 census tracts (98.8%; n = 1 899 065 deaths). Mean MHI ranged from $21 279 to $232 261 between the lowest and highest percentiles. The slope of the relationship between life expectancy and MHI increased significantly, from 0.075 (95% CI, 0.07-0.08) years per percentile in 2019 to 0.103 (95% CI, 0.098-0.108; P < .001) years per percentile in 2020 and 0.107 (95% CI, 0.102-0.112; P < .001) years per percentile in 2021. The gap in life expectancy between the richest and poorest percentiles increased from 11.52 years in 2019 to 14.67 years in 2020 and 15.51 years in 2021. Among Hispanic and non-Hispanic Asian, Black, and White populations, life expectancy declined 5.74 years among the Hispanic population, 3.04 years among the non-Hispanic Asian population, 3.84 years among the non-Hispanic Black population, and 1.90 years among the non-Hispanic White population between 2019 and 2021. The income-life expectancy gradient in these groups increased significantly between 2019 and 2020 (0.038 [95% CI, 0.030-0.045; P < .001] years per percentile among Hispanic individuals; 0.024 [95% CI: 0.005-0.044; P = .02] years per percentile among Asian individuals; 0.015 [95% CI, 0.010-0.020; P < .001] years per percentile among Black individuals; and 0.011 [95% CI, 0.007-0.015; P < .001] years per percentile among White individuals) and between 2019 and 2021 (0.033 [95% CI, 0.026-0.040; P < .001] years per percentile among Hispanic individuals; 0.024 [95% CI, 0.010-0.038; P = .002] years among Asian individuals; 0.024 [95% CI, 0.011-0.037; P = .003] years per percentile among Black individuals; and 0.013 [95% CI, 0.008-0.018; P < .001] years per percentile among White individuals). The increase in the gradient was significantly greater among Hispanic vs White populations in 2020 and 2021 (P < .001 in both years) and among Black vs White populations in 2021 (P = .04). Conclusions and Relevance: This retrospective analysis of census tract-level income and mortality data in California from 2015 to 2021 demonstrated a decrease in life expectancy in both 2020 and 2021 and an increase in the life expectancy gap by income level relative to the prepandemic period that disproportionately affected some racial and ethnic minority populations. Inferences at the individual level are limited by the ecological nature of the study, and the generalizability of the findings outside of California are unknown.

A theory of fiscal policy response to an epidemic.

Governments worldwide have issued massive amounts of debt to inject fiscal stimulus during the COVID-19 pandemic. This paper analyzes fiscal responses to an epidemic, in which interactions at work increase the risk of disease and mortality. Fiscal policies, which are designed to borrow against the future and provide transfers to individuals suffering economic hardship, can facilitate consumption smoothing while reduce hours worked and hence mitigate infections. We examine the optimal fiscal policy and characterize the condition under which fiscal policy improves social welfare. We then extend the model analyzing the static and dynamic pecuniary externalities under scale economies-the decrease in labor supply during the epidemic lowers the contemporaneous average wage rate while enhances the post-epidemic workforce health and productivity. We suggest that fiscal policy may not work effectively unless the government coordinates working time, and the optimal size of public debt is affected by production technology and disease severity and transmissibility.

Understanding the uneven spread of COVID-19 in the context of the global interconnected economy.

The worldwide spread of the COVID-19 pandemic is a complex and multivariate process differentiated across countries, and geographical distance is acceptable as a critical determinant of the uneven spreading. Although social connectivity is a defining condition for virus transmission, the network paradigm in the study of the COVID-19 spatio-temporal spread has not been used accordingly. Toward contributing to this demand, this paper uses network analysis to develop a multidimensional methodological framework for understanding the uneven (cross-country) spread of COVID-19 in the context of the globally interconnected economy. The globally interconnected system of tourism mobility is modeled as a complex network and studied within the context of a three-dimensional (3D) conceptual model composed of network connectivity, economic openness, and spatial impedance variables. The analysis reveals two main stages in the temporal spread of COVID-19, defined by the cutting-point of the 44th day from Wuhan. The first describes the outbreak in Asia and North America, the second stage in Europe, South America, and Africa, while the outbreak in Oceania intermediates. The analysis also illustrates that the average node degree exponentially decays as a function of COVID-19 emergence time. This finding implies that the highly connected nodes, in the Global Tourism Network (GTN), are disproportionally earlier infected by the pandemic than the other nodes. Moreover, countries with the same network centrality as China are early infected on average by COVID-19. The paper also finds that network interconnectedness, economic openness, and transport integration are critical determinants in the early global spread of the pandemic, and it reveals that the spatio-temporal patterns of the worldwide spreading of COVID-19 are more a matter of network interconnectivity than of spatial proximity.

The impact of COVID-19 on cryptocurrency markets: A network analysis based on mutual information.

The purpose of our study is to figure out the transitions of the cryptocurrency market due to the outbreak of COVID-19 through network analysis, and we studied the complexity of the market from different perspectives. To construct a cryptocurrency network, we first apply a mutual information method to the daily log return values of 102 digital currencies from January 1, 2019, to December 31, 2020, and also apply a correlation coefficient method for comparison. Based on these two methods, we construct networks by applying the minimum spanning tree and the planar maximally filtered graph. Furthermore, we study the statistical and topological properties of these networks. Numerical results demonstrate that the degree distribution follows the power-law and the graphs after the COVID-19 outbreak have noticeable differences in network measurements compared to before. Moreover, the results of graphs constructed by each method are different in topological and statistical properties and the network's behavior. In particular, during the post-COVID-19 period, it can be seen that Ethereum and Qtum are the most influential cryptocurrencies in both methods. Our results provide insight and expectations for investors in terms of sharing information about cryptocurrencies amid the uncertainty posed by the COVID-19 pandemic.

Impact of COVID-19-Related Stress and Lockdown on Mental Health Among People Living With HIV in Argentina.

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS: A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION: The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.

Short-term impact of the Covid-19 pandemic on the global and Turkish economy

Background/aim: The Covid-19 pandemic is one of those rare events that affects everyone on earth and changes our lives. The pandemic, which has killed over four million people worldwide, is putting unprecedented pressure on governments to maintain essential health and social services, as well as keep their economies running, even as the virus threatens people's daily life on every level. Thus, the purpose of this study is to discuss the short-term economic impact of the pandemic by assessing its costs using official economic data for both the world and Turkey. Furthermore, this research highlights possible economic, social, and political pathways for a postpandemic new world. Materials and methods: This study is a review article that overviews and tracks the economic development of the Covid-19 pandemic from the start, synthesizes and compares current data of reliable institutions, and provides an overall assessment. Results: The pandemic has certainly caused short-term and long-term damage to economies and living standards for many people. Although there are estimates on what this damage is, the exact degree of the damage is still unknown. However, it seems that the recovery will be gradual, long-lasting, and unpredictable due to the unprecedented uncertainty characteristic of the pandemic. Conclusion: Early economic growth projections show that there will be no ordinary recovery for the world economy since short-term countries' recovery paths are different. It is likely to remain uneven and depend on the effectiveness of the vaccination process, fiscal policy support, public health management, and hard-hit sectors' growth size in economies. Due to the uncertainty and lack of confidence, governments should ensure an equal and sustainable economic recovery from the Covid-19 pandemic by conducting flexible monetary and fiscal policies. However, without structural reforms, economies can not boost either in the short-term and long-term.

The COVID-19 pandemic beyond Health Sciences: reflections on its social determination. / A pandemia de COVID-19 para além das Ciências da Saúde: reflexões sobre sua determinação social.

This paper aims to perform a theoretical reflection on the historical-social foundations of the COVID-19 pandemic. The "capital worldization", "capital-imperialism", "space-time compression", and "structural crisis of capital" categories are conjured from the historical materialistic-theoretical matrix, outlining a course that transcends the limits of Health Sciences to understand global health, of which the COVID-19 pandemic is an expression. We then return to the field of health, when the category of "social determination of health" allows elucidating the bases of the pandemic studied. We show that, other elements typical of the current phase of contemporary capitalism have become universal besides the SARS-CoV-2 characteristics or the dynamics of the rapid movement of people and objects around the world, unifying the health social determination process.

Este artigo possui o objetivo de realizar uma reflexão teórica sobre os fundamentos histórico-sociais da pandemia de COVID-19. A partir da matriz teórica materialista histórica, evoca-se as categorias da "mundialização do capital", "capital-imperialismo", "compressão espaço-tempo" e "crise estrutural do capital" traçando um percurso que ultrapassa os limites das Ciências da Saúde a fim de entender a saúde global, da qual a pandemia de COVID-19 é expressão. Posteriormente, faz-se o retorno ao campo da saúde, quando a categoria da "determinação social da saúde" permite elucidar as bases da pandemia estudada. Demonstra-se que, para além das características próprias do SARS-CoV-2 ou da dinâmica de rápido trânsito de pessoas e objetos pelo mundo, há outros elementos típicos da atual fase do capitalismo contemporâneo que se tornaram universais, unificando o processo de determinação social da saúde.

Factors associated with people's behavior in social isolation during the COVID-19 pandemic. / Fatores associados ao comportamento da população durante o isolamento social na pandemia de COVID-19.

This paper presents the results of an opinion poll conducted in Brazil on the perception of social isolation during the COVID-19 pandemic. The questionnaire was prepared on Google Forms, disseminated through social networks, with questions about the socioeconomic profile and factors associated with isolation. A non-probabilistic sample was obtained with 16,440 respondents. Data were analyzed using the Stata 13 software. Social interaction was the most affected aspect among people with higher education and income (45.8%), and financial problems caused a more significant impact (35%) among people with low income and education. Those who practice some physical activity showed lower levels of stress 13%, as well as greater normality in sleep 50.3%. People who reported living in worse habitability conditions reported willingness to remain isolated for less time, 73.9%. Among non-isolated people (10.7% of the total sample), 75.8% believe that social isolation will reduce the number of victims of COVID-19. We conclude, based on this sample, that the perception about social isolation as a pandemic mitigation action varies by income, education, age, and gender. However, most believe that it is the most appropriate control measure and are willing to wait as long as necessary to contribute to the fight against COVID-19.

O artigo apresenta resultados da pesquisa de opinião realizada no Brasil sobre a percepção do isolamento social durante a pandemia de COVID-19. O questionário foi elaborado no Google Forms, disseminado por redes sociais, com questões sobre o perfil socioeconômico e fatores associados ao isolamento. Obteve-se uma amostra com 16.440 respondentes. Os dados foram analisados no software Stata 13. O convívio social foi o aspecto mais afetado entre pessoas com maior escolaridade e renda 45,8%, para pessoas de baixas renda e escolaridade, problemas financeiros provocam maior impacto 35%. Os que praticam atividade física revelaram menores níveis de estresse 13%, bem como uma maior normalidade no sono 50,3%. Pessoas que referiram residir em piores condições de habitabilidade, informaram disposição a permanecer menos tempo isoladas 73,9%. Dentre as pessoas que não estão isoladas (10,7% do total), 75,8% acredita que o isolamento social reduzirá o número de vítimas da COVID-19. Concluímos, que a percepção das pessoas quanto ao isolamento social como medida de mitigação da pandemia, varia conforme a renda, escolaridade, idade e sexo, porém a maior parte acredita que se trata da medida de controle mais indicada e estão dispostas a esperar o tempo que for necessário para contribuir com o enfrentamento à COVID-19.