Examining the role of COVID-19 testing availability on intention to isolate: A Randomized hypothetical scenario.

BACKGROUND: Little information exists on how COVID-19 testing influences intentions to engage in risky behavior. Understanding the behavioral effects of diagnostic testing may highlight the role of adequate testing on controlling viral transmission. In order to evaluate these effects, simulated scenarios were conducted evaluating participant intentions to self-isolate based on COVID-19 diagnostic testing availability and results. METHODS: Participants from the United States were recruited through an online survey platform (Amazon Mechanical Turk) and randomized to one of three hypothetical scenarios. Each scenario asked participants to imagine having symptoms consistent with COVID-19 along with a clinical diagnosis from their physician. However, scenarios differed in either testing availability (testing available v. unavailable) or testing result (positive v. negative test). The primary outcome was intention to engage in high-risk COVID-19 behaviors, measured using an 11-item mean score (range 1-7) that was pre-registered prior to data collection. Multi-variable linear regression was used to compare the mean composite scores between conditions. The randomized survey was conducted between July 23rd to July 29th, 2020. RESULTS: A total of 1400 participants were recruited through a national, online, opt-in survey. Out of 1194 respondents (41.6% male, 58.4% female) with a median age of 38.5 years, participants who had no testing available in their clinical scenario showed significantly greater intentions to engage in behavior facilitating COVID-19 transmission compared to those who received a positive confirmatory test result scenario (mean absolute difference (SE): 0.14 (0.06), P = 0.016), equating to an 11.1% increase in mean score risky behavior intentions. Intention to engage in behaviors that can spread COVID-19 were also positively associated with male gender, poor health status, and Republican party affiliation. CONCLUSION: Testing availability appears to play an independent role in influencing behaviors facilitating COVID-19 transmission. Such findings shed light on the possible negative externalities of testing unavailability. TRIAL REGISTRATION: Effect of Availability of COVID-19 Testing on Choice to Isolate and Socially Distance, NCT04459520, https://clinicaltrials.gov/ct2/show/NCT04459520.

Projecting Quarantine Utilization During a Pandemic.

Objectives. To develop an approach to project quarantine needs during an outbreak, particularly for communally housed individuals who interact with outside individuals. Methods. We developed a method that uses basic surveillance data to do short-term projections of future quarantine needs. The development of this method was rigorous, but it is conceptually simple and easy to implement and allows one to anticipate potential superspreading events. We demonstrate how this method can be used with data from the fall 2020 semester of a large urban university in Boston, Massachusetts, that provided quarantine housing for students living on campus in response to the COVID-19 pandemic. Our approach accounted for potentially infectious interactions between individuals living in university housing and those who did not. Results. Our approach was able to accurately project 10-day-ahead quarantine utilization for on-campus students in a large urban university. Our projections were most accurate when we anticipated weekend superspreading events around holidays. Conclusions. We provide an easy-to-use software tool to project quarantine utilization for institutions that can account for mixing with outside populations. This software tool has potential application for universities, corrections facilities, and the military. (Am J Public Health. 2022;112(2):277-283. https://doi.org/10.2105/AJPH.2021.306573).

The network limits of infectious disease control via occupation-based targeting.

Policymakers commonly employ non-pharmaceutical interventions to reduce the scale and severity of pandemics. Of non-pharmaceutical interventions, physical distancing policies-designed to reduce person-to-person pathogenic spread - have risen to recent prominence. In particular, stay-at-home policies of the sort widely implemented around the globe in response to the COVID-19 pandemic have proven to be markedly effective at slowing pandemic growth. However, such blunt policy instruments, while effective, produce numerous unintended consequences, including potentially dramatic reductions in economic productivity. In this study, we develop methods to investigate the potential to simultaneously contain pandemic spread while also minimizing economic disruptions. We do so by incorporating both occupational and contact network information contained within an urban environment, information that is commonly excluded from typical pandemic control policy design. The results of our methods suggest that large gains in both economic productivity and pandemic control might be had by the incorporation and consideration of simple-to-measure characteristics of the occupational contact network. We find evidence that more sophisticated, and more privacy invasive, measures of this network do not drastically increase performance.

Cuidado infantil, aislamiento y virtualización educativa durante la pandemia del COVID-19 en la Argentina

La pandemia de COVID-19 iniciada a finales de 2019 tuvo un impacto en la salud colectiva, aunque diferencial en función de la vulneración de derechos básicos de vastos sectores de la población y de las dificultades para el acceso a la atención en salud. Interpeló a los Estados y a las sociedades respecto de los obstáculos y las posibilidades de las políticas sanitarias integrales, las políticas del cuidado y la salud comunitaria. Asimismo, la complejidad socio-sistémica que evidenció la pandemia puso de manifiesto los límites del enfoque biomédico para afrontar la crisis sanitaria y la necesidad de considerar la perspectiva de la determinación social de la salud para la generación de respuestas adecuadas para garantizar los derechos de la población. Dentro de las poblaciones especialmente afectadas se encuentra la población infantil. En Argentina, INDEC determinó que, a fines del 2020, más de la mitad (57,7%) de las personas de 0 a 14 años eran pobres. Asimismo, durante la pandemia se profundizaron las brechas educativas, digitales y nutricionales y la exposición a situaciones de violencia. En este escenario, ante las recomendaciones de diversos organismos acerca del cuidado infantil en el período de cuarentena surgen interrogantes sobre las posibilidades y obstáculos para su desenvolvimiento. (AU)

A global analysis of the impact of COVID-19 stay-at-home restrictions on crime.

The stay-at-home restrictions to control the spread of COVID-19 led to unparalleled sudden change in daily life, but it is unclear how they affected urban crime globally. We collected data on daily counts of crime in 27 cities across 23 countries in the Americas, Europe, the Middle East and Asia. We conducted interrupted time series analyses to assess the impact of stay-at-home restrictions on different types of crime in each city. Our findings show that the stay-at-home policies were associated with a considerable drop in urban crime, but with substantial variation across cities and types of crime. Meta-regression results showed that more stringent restrictions over movement in public space were predictive of larger declines in crime.

Estimating the effects of non-pharmaceutical interventions on the number of new infections with COVID-19 during the first epidemic wave.

The novel coronavirus (SARS-CoV-2) has rapidly developed into a global epidemic. To control its spread, countries have implemented non-pharmaceutical interventions (NPIs), such as school closures, bans of small gatherings, or even stay-at-home orders. Here we study the effectiveness of seven NPIs in reducing the number of new infections, which was inferred from the reported cases of COVID-19 using a semi-mechanistic Bayesian hierarchical model. Based on data from the first epidemic wave of n = 20 countries (i.e., the United States, Canada, Australia, the EU-15 countries, Norway, and Switzerland), we estimate the relative reduction in the number of new infections attributed to each NPI. Among the NPIs considered, bans of large gatherings were most effective, followed by venue and school closures, whereas stay-at-home orders and work-from-home orders were least effective. With this retrospective cross-country analysis, we provide estimates regarding the effectiveness of different NPIs during the first epidemic wave.

How does globalization affect COVID-19 responses?

BACKGROUND: The ongoing COVID-19 pandemic has highlighted the vast differences in approaches to the control and containment of coronavirus across the world and has demonstrated the varied success of such approaches in minimizing the transmission of coronavirus. While previous studies have demonstrated high predictive power of incorporating air travel data and governmental policy responses in global disease transmission modelling, factors influencing the decision to implement travel and border restriction policies have attracted relatively less attention. This paper examines the role of globalization on the pace of adoption of international travel-related non-pharmaceutical interventions (NPIs) during the coronavirus pandemic. This study aims to offer advice on how to improve the global planning, preparation, and coordination of actions and policy responses during future infectious disease outbreaks with empirical evidence. METHODS AND DATA: We analyzed data on international travel restrictions in response to COVID-19 of 185 countries from January to October 2020. We applied time-to-event analysis to examine the relationship between globalization and the timing of travel restrictions implementation. RESULTS: The results of our survival analysis suggest that, in general, more globalized countries, accounting for the country-specific timing of the virus outbreak and other factors, are more likely to adopt international travel restrictions policies. However, countries with high government effectiveness and globalization were more cautious in implementing travel restrictions, particularly if through formal political and trade policy integration. This finding is supported by a placebo analysis of domestic NPIs, where such a relationship is absent. Additionally, we find that globalized countries with high state capacity are more likely to have higher numbers of confirmed cases by the time a first restriction policy measure was taken. CONCLUSIONS: The findings highlight the dynamic relationship between globalization and protectionism when governments respond to significant global events such as a public health crisis. We suggest that the observed caution of policy implementation by countries with high government efficiency and globalization is a by-product of commitment to existing trade agreements, a greater desire to 'learn from others' and also perhaps of 'confidence' in a government's ability to deal with a pandemic through its health system and state capacity. Our results suggest further research is warranted to explore whether global infectious disease forecasting could be improved by including the globalization index and in particular, the de jure economic and political, and de facto social dimensions of globalization, while accounting for the mediating role of government effectiveness. By acting as proxies for a countries' likelihood and speed of implementation for international travel restriction policies, such measures may predict the likely time delays in disease emergence and transmission across national borders.

Impact of COVID-19 pandemic lockdown on occupational therapy practice and use of telerehabilitation - A cross sectional study.

OBJECTIVE: COVID-19 has become a global public health emergency affecting 223 countries and territories, and it drastically changed the life of public and health care delivery systems. Although many guidelines have been proposed to avoid infection from COVID-19 and to promote the use of telerehabilitation, there is still no clear answer for the current scenario and strategies of therapists' practice during the COVID-19 pandemic lockdown. This study aimed to explore the impact of COVID-19 lockdown on Occupational Therapists' (OTs) practice, the use of telerehabilitation strategies by OTs, and their employment and mental health. Also, this study aimed to explore the OTs perspective on the role of telerehabilitation during this pandemic lockdown. MATERIALS AND METHODS: Online cross-sectional survey was conducted between April 2020 and May 2020. RESULTS: 114 OTs completed the survey. The results of this study showed that 52.8% of therapists had stress and anxiety due to COVID-19 lockdown. We found that 60.7% of OTs (n=65) used telerehabilitation, versus 36.1% (n=39) before the lockdown. Telerehabilitation approaches were mostly implemented during this lockdown for children with autistic problems (66.6%), stroke (12.9%), cerebral palsy (6.4%), learning disabilities (9.6%), Parkinson's diseases (1.6%), and other medical conditions (2.8%). 10% of therapists reported that they lost their job, and 76% reported that this lockdown affected their income negatively. Overall, 87.8% of therapists reported that mobile technology was very useful to overcome the stress due to COVID-19 related lockdown, social isolation, and social distancing. CONCLUSIONS: The COVID-19 pandemic lockdown experiences made us rethink the current approach of therapy services into alternative method (mixed mode) delivery of occupational therapy practice, which is including the combined method of video-based (telerehabilitation) consultation and face to face intervention.

Modeling the interplay between demography, social contact patterns, and SARS-CoV-2 transmission in the South West Shewa Zone of Oromia Region, Ethiopia.

BACKGROUND: COVID-19 spread may have a dramatic impact in countries with vulnerable economies and limited availability of, and access to, healthcare resources and infrastructures. However, in sub-Saharan Africa, a low prevalence and mortality have been observed so far. METHODS: We collected data on individuals' social contacts in the South West Shewa Zone (SWSZ) of Ethiopia across geographical contexts characterized by heterogeneous population density, work and travel opportunities, and access to primary care. We assessed how socio-demographic factors and observed mixing patterns can influence the COVID-19 disease burden, by simulating SARS-CoV-2 transmission in remote settlements, rural villages, and urban neighborhoods, under school closure mandate. RESULTS: From national surveillance data, we estimated a net reproduction number of 1.62 (95% CI 1.55-1.70). We found that, at the end of an epidemic mitigated by school closure alone, 10-15% of the population residing in the SWSZ would have been symptomatic and 0.3-0.4% of the population would require mechanical ventilation and/or possibly result in a fatal outcome. Higher infection attack rates are expected in more urbanized areas, but the highest incidence of critical disease is expected in remote subsistence farming settlements. School closure contributed to reduce the reproduction number by 49% and the attack rate of infections by 28-34%. CONCLUSIONS: Our results suggest that the relatively low burden of COVID-19 in Ethiopia observed so far may depend on social mixing patterns, underlying demography, and the enacted school closures. Our findings highlight that socio-demographic factors can also determine marked heterogeneities across different geographical contexts within the same region, and they contribute to understand why sub-Saharan Africa is experiencing a relatively lower attack rate of severe cases compared to high-income countries.

Impact of Coronavirus Disease 2019 Shutdown on Neurotrauma Volume in Pennsylvania.

OBJECTIVE: The 2020 coronavirus disease 2019 (COVID-19) pandemic resulted in state-specific quarantine protocols and introduced the concept of social distancing into modern parlance. We assess the impact of the COVID-19 pandemic on neurotrauma presentations in the first 3 months after shutdown throughout Pennsylvania. METHODS: The Pennsylvania Trauma Systems Foundation was queried for registry data from the Pennsylvania Trauma Outcomes Study between March 12 and June 5 in each year from 2017 to 2020. RESULTS: After the COVID-19 shutdown, there was a 27% reduction in neurotrauma volume, from 2680 cases in 2017 to 2018 cases in 2020, and a 28.8% reduction in traumatic brain injury volume. There was no significant difference in neurotrauma phenotype incurred relative to total cases. Injury mechanism was less likely to be motor vehicle collision and more likely caused by falls, gunshot wound, and recreational vehicle accidents (P < 0.05). Location of injury was less likely on roads and public locations and more likely at indoor private locations (P < 0.05). The proportion of patients with neurotrauma with blood alcohol concentration >0.08 g/dL was reduced in 2020 (11.4% vs. 9.0%; P < 0.05). Mortality was higher during 2020 compared with pre-COVID years (7.7% vs. 6.4%; P < 0.05). CONCLUSIONS: During statewide shutdown, neurotrauma volume and alcohol-related trauma decreased and low-impact traumas and gunshot wounds increased, with a shift toward injuries occurring in private, indoor locations. These changes increased mortality. However, there was not a change in the types of injuries sustained.

The mobility gap: estimating mobility thresholds required to control SARS-CoV-2 in Canada.

BACKGROUND: Nonpharmaceutical interventions remain the primary means of controlling severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) until vaccination coverage is sufficient to achieve herd immunity. We used anonymized smartphone mobility measures to quantify the mobility level needed to control SARS-CoV-2 (i.e., mobility threshold), and the difference relative to the observed mobility level (i.e., mobility gap). METHODS: We conducted a time-series study of the weekly incidence of SARS-CoV-2 in Canada from Mar. 15, 2020, to Mar. 6, 2021. The outcome was weekly growth rate, defined as the ratio of cases in a given week versus the previous week. We evaluated the effects of average time spent outside the home in the previous 3 weeks using a log-normal regression model, accounting for province, week and mean temperature. We calculated the SARS-CoV-2 mobility threshold and gap. RESULTS: Across the 51-week study period, a total of 888 751 people were infected with SARS-CoV-2. Each 10% increase in the mobility gap was associated with a 25% increase in the SARS-CoV-2 weekly case growth rate (ratio 1.25, 95% confidence interval 1.20-1.29). Compared to the prepandemic baseline mobility of 100%, the mobility threshold was highest in the summer (69%; interquartile range [IQR] 67%-70%), and dropped to 54% in winter 2021 (IQR 52%-55%); a mobility gap was present in Canada from July 2020 until the last week of December 2020. INTERPRETATION: Mobility strongly and consistently predicts weekly case growth, and low levels of mobility are needed to control SARS-CoV-2 through spring 2021. Mobility measures from anonymized smartphone data can be used to guide provincial and regional loosening and tightening of physical distancing measures.

Evaluating the impact of curfews and other measures on SARS-CoV-2 transmission in French Guiana.

While general lockdowns have proven effective to control SARS-CoV-2 epidemics, they come with enormous costs for society. It is therefore essential to identify control strategies with lower social and economic impact. Here, we report and evaluate the control strategy implemented during a large SARS-CoV-2 epidemic in June-July 2020 in French Guiana that relied on curfews, targeted lockdowns, and other measures. We find that the combination of these interventions coincided with a reduction in the basic reproduction number of SARS-CoV-2 from 1.7 to 1.1, which was sufficient to avoid hospital saturation. We estimate that thanks to the young demographics, the risk of hospitalisation following infection was 0.3 times that of metropolitan France and that about 20% of the population was infected by July. Our model projections are consistent with a recent seroprevalence study. The study showcases how mathematical modelling can be used to support healthcare planning in a context of high uncertainty.

Assessing the feasibility and effectiveness of household-pooled universal testing to control COVID-19 epidemics.

Outbreaks of SARS-CoV-2 are threatening the health care systems of several countries around the world. The initial control of SARS-CoV-2 epidemics relied on non-pharmaceutical interventions, such as social distancing, teleworking, mouth masks and contact tracing. However, as pre-symptomatic transmission remains an important driver of the epidemic, contact tracing efforts struggle to fully control SARS-CoV-2 epidemics. Therefore, in this work, we investigate to what extent the use of universal testing, i.e., an approach in which we screen the entire population, can be utilized to mitigate this epidemic. To this end, we rely on PCR test pooling of individuals that belong to the same households, to allow for a universal testing procedure that is feasible with the limited testing capacity. We evaluate two isolation strategies: on the one hand pool isolation, where we isolate all individuals that belong to a positive PCR test pool, and on the other hand individual isolation, where we determine which of the individuals that belong to the positive PCR pool are positive, through an additional testing step. We evaluate this universal testing approach in the STRIDE individual-based epidemiological model in the context of the Belgian COVID-19 epidemic. As the organisation of universal testing will be challenging, we discuss the different aspects related to sample extraction and PCR testing, to demonstrate the feasibility of universal testing when a decentralized testing approach is used. We show through simulation, that weekly universal testing is able to control the epidemic, even when many of the contact reductions are relieved. Finally, our model shows that the use of universal testing in combination with stringent contact reductions could be considered as a strategy to eradicate the virus.

Abstinence Among Alcohol Use Disorder Patients During the COVID-19 Pandemic: Insights From Spain.

BACKGROUND: Patients with alcohol use disorder (AUD) are likely to suffer disproportionate harms related to the COVID-19 pandemic and related policy measures. While many surveys have been conducted, most are focused on drinking changes in the general population and validation with biological markers is lacking. METHOD: We performed a retrospective cohort study among patients with AUD attending a urine drug screening program. With mixed-effects logistic regression models, we assessed the probability of screening positive for ethyl glucuronide according to patients' main clinical characteristics and time of analysis (either prior to or after a lockdown was implemented in Spain). RESULTS: A total of 362 patients provided 2,040 urine samples (1,295 prior to lockdown, 745 during lockdown). The mean age of participants was 52.0 years (SD 12.6), and 69.2% were men. Of the 43% of patients tested for other drugs 22% screened positive. After adjusting for all covariates, the odds of screening positive for ethyl glucuronide during lockdown almost doubled (OR = 1.99, 95% CI 1.20 to 3.33, p = 0.008). Other significant covariates included testing positive for other drugs (OR = 10.79, 95% CI 4.60 to 26.97) and length of treatment (OR = 0.59, 95% CI 0.47 to 0.74). CONCLUSIONS: Our data support an association between the lockdown due to COVID-19 and increased alcohol use in patients with AUD. Thus, addiction healthcare systems could face significant challenges ahead. In light of these findings, it is essential to evaluate prospectively how patients with AUD are affected by the pandemic and how health systems respond to their needs.

Impact of the COVID-19 pandemic on clinical research in hospitals: observational study in the first epicenter of the epidemic during the general lockdown in France.

OBJECTIVE: The COVID-19 epidemic has had a strong impact on the entire healthcare sector in France with priority being given to research for new therapeutic options for COVID-19. Nevertheless, continuity of care for patients suffering from other diseases represents a crucial challenge, and clinical research is no exception in this respect. This study aims to assess the impact of the strict Covid-19 lockdown on non-Covid-19 clinical research in the French University Hospital of Strasbourg. MATERIALS AND METHODS: Clinical research activity (non-Covid-19) from the point of view of pharmacy department was estimated and compared to the pre-lockdown period. The impact of lockdown was assessed through five indicators: site initiation visits, the initiation of experimental therapies in non-Covid-19 patients, the delivery of non-Covid-19 investigational medical products, the number of drug shipments to patients' homes, and the number of monitoring or closure visits. RESULTS: During the study period, the number of site initiation visits decreased by 90%, total inclusions by 72%, and delivery of investigational medical products by 30%. During the lockdown period, 15 treatments were sent to patients' homes. Monitoring activity decreased by 98%. CONCLUSIONS: Although the COVID-19 outbreak has created an incredible momentum in the field of clinical research, research not focused on SaRS-CoV-2 has suffered greatly from this situation. The impact on patients is difficult to estimate but should be further investigated.

The impact of non-pharmaceutical interventions on SARS-CoV-2 transmission across 130 countries and territories.

BACKGROUND: Non-pharmaceutical interventions (NPIs) are used to reduce transmission of SARS coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). However, empirical evidence of the effectiveness of specific NPIs has been inconsistent. We assessed the effectiveness of NPIs around internal containment and closure, international travel restrictions, economic measures, and health system actions on SARS-CoV-2 transmission in 130 countries and territories. METHODS: We used panel (longitudinal) regression to estimate the effectiveness of 13 categories of NPIs in reducing SARS-CoV-2 transmission using data from January to June 2020. First, we examined the temporal association between NPIs using hierarchical cluster analyses. We then regressed the time-varying reproduction number (Rt) of COVID-19 against different NPIs. We examined different model specifications to account for the temporal lag between NPIs and changes in Rt, levels of NPI intensity, time-varying changes in NPI effect, and variable selection criteria. Results were interpreted taking into account both the range of model specifications and temporal clustering of NPIs. RESULTS: There was strong evidence for an association between two NPIs (school closure, internal movement restrictions) and reduced Rt. Another three NPIs (workplace closure, income support, and debt/contract relief) had strong evidence of effectiveness when ignoring their level of intensity, while two NPIs (public events cancellation, restriction on gatherings) had strong evidence of their effectiveness only when evaluating their implementation at maximum capacity (e.g. restrictions on 1000+ people gathering were not effective, restrictions on < 10 people gathering were). Evidence about the effectiveness of the remaining NPIs (stay-at-home requirements, public information campaigns, public transport closure, international travel controls, testing, contact tracing) was inconsistent and inconclusive. We found temporal clustering between many of the NPIs. Effect sizes varied depending on whether or not we included data after peak NPI intensity. CONCLUSION: Understanding the impact that specific NPIs have had on SARS-CoV-2 transmission is complicated by temporal clustering, time-dependent variation in effects, and differences in NPI intensity. However, the effectiveness of school closure and internal movement restrictions appears robust across different model specifications, with some evidence that other NPIs may also be effective under particular conditions. This provides empirical evidence for the potential effectiveness of many, although not all, actions policy-makers are taking to respond to the COVID-19 pandemic.