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1.
Bridgetown; PAHO; 2022-01-07.
en Inglés | PAHO-IRIS | ID: phr2-55591

RESUMEN

SITUATION IN NUMBERS: Region of the Americas 108,806,129 cases; 2,422,138 deaths in 56 countries, areas, or territories; 1,482,883,046 total vaccine doses administered. | Global 296,496,809 cases; 5,462,631 deaths in 236 countries, areas, or territories; 9,118,223,397 total vaccine doses administered.


Asunto(s)
COVID-19 , Coronavirus , Infecciones por Coronavirus , Betacoronavirus , Análisis de la Situación , Inmunización , Vacunas , Urgencias Médicas , Américas , Región del Caribe
2.
Preprint en Inglés | bioRxiv | ID: ppbiorxiv-475918

RESUMEN

Though it has been 2 years since the start of the Coronavirus Disease 19 (COVID-19) pandemic, COVID-19 continues to be a worldwide health crisis. Despite the development of preventive vaccines, very little progress has been made to identify curative therapies to treat COVID-19 and other inflammatory diseases which remain a major unmet need in medicine. Our study sought to identify drivers of disease severity and death to develop tailored immunotherapy strategies to halt disease progression. Here we assembled the Mount Sinai COVID-19 Biobank which was comprised of ~600 hospitalized patients followed longitudinally during the peak of the pandemic. Moderate disease and survival were associated with a stronger antigen (Ag) presentation and effector T cell signature, while severe disease and death were associated with an altered Ag presentation signature, increased numbers of circulating inflammatory, immature myeloid cells, and extrafollicular activated B cells associated with autoantibody formation. Strikingly, we found that in severe COVID-19 patients, lung tissue resident alveolar macrophages (AM) were not only severely depleted, but also had an altered Ag presentation signature, and were replaced by inflammatory monocytes and monocyte-derived macrophages (MoM{phi}). Notably, the size of the AM pool correlated with recovery or death, while AM loss and functionality were restored in patients that recovered. These data therefore suggest that local and systemic myeloid cell dysregulation is a driver of COVID-19 severity and that modulation of AM numbers and functionality in the lung may be a viable therapeutic strategy for the treatment of critical lung inflammatory illnesses.

3.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22268675

RESUMEN

BackgroundOne of the proposed interventions for mitigating COVID-19 epidemics, particularly in low-income and crisis-affected settings, is to physically isolate individuals known to be at high risk of severe disease and death due to age or co-morbidities. This intervention, known as shielding, could be implemented in various ways. If shielded people are grouped together in residences and isolation is imperfect, any introduction of infections within the shielding group could cause substantial mortality and thus negate the interventions benefits. We explored the effectiveness of shielding under various modalities of implementation and considered mitigation measures to reduce its possible harms. MethodsWe used an individual-based mathematical model to simulate the evolution of a COVID-19 epidemic in a population of which a fraction above a given age cut-off are relocated to shielding residences, in which they have variable levels of contacts with their original household, the outside world and fellow shielding residents. We set our simulation with the context of an internally displaced persons camp in Somaliland, for which we had recently collected data on household demographics and social mixing patterns. We compared an unmitigated epidemic with a shielding intervention accompanied by various measures to reduce the risk of virus introduction and spread within the shielding residences. We did sensitivity analyses to explore parameters such as residence size, reduction in contacts, basic reproduction number, and prior immunity in the population. ResultsShielded residences are likely to be breached with infection during the outbreak. Nonetheless, shielding can be effective in preventing COVID-19 infections in the shielded population. The effectiveness of shielding is mostly affected by the size of the shielded residence, and by the degree by which contacts between shielded and unshielded individuals are reduced. Reductions in contacts between shielded individuals could further increase the effectiveness of shielding, but is only effective in larger shielded residences. Large shielded residences increase the risk of infection, unless very large reductions in contacts can be achieved. In epidemics with a lower reproduction number, the effectiveness of shielding could be negative effectiveness. DiscussionShielding could be an effective method to protect the most at-risk individuals. It should be considered where other measures cannot easily be implemented, but with attention to the epidemiological situation. Shielding should only be implemented through small to medium-sized shielding residences, with appropriate mitigation measures such as reduced contact intensity between shielded individuals and self-isolation of cases to prevent subsequent spread.

4.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-21267140

RESUMEN

ObjectiveThe LIVE-AIR trial demonstrated that the anti-GM-CSF monoclonal antibody, lenzilumab improved the likelihood of survival without invasive mechanical ventilation (SWOV) in COVID-19 patients; with greatest effect in those with baseline CRP below the median baseline value of 79 mg/L. Similar to GM-CSF, C-reactive protein (CRP) levels are correlated with COVID-19 severity. This current analysis assessed the utility of baseline CRP levels to guide treatment with lenzilumab. DesignLIVE-AIR was a phase 3, double-blind, placebo-controlled trial. Participants were randomized 1:1 and stratified according to age and disease severity, to receive lenzilumab or placebo on Day 0, were followed through Day 28. SettingSecondary and tertiary care hospitals in the US and Brazil. Participants520 hospitalized COVID-19 participants with SpO2[≤] 94% on room air or required supplemental oxygen but not invasive mechanical ventilation were included. InterventionsLenzilumab (1800mg; divided as 3 doses, q8h) or placebo infusion alongside standard treatments including corticosteroids and remdesivir. Main outcome measuresA multi-variate logistic regression analysis assessed key baseline risk factors for progression to IMV or death. The primary endpoint, SWOV, and key secondary endpoints were analyzed according to baseline CRP levels in all participants with CRP values. ResultsThe multi-variate analysis demonstrated that elevated baseline plasma CRP was the most predictive feature for progression to IMV or death. SWOV was achieved in 152 (90%; 95%CI: 85to 94) lenzilumab and 183 (79%; 72 to 84) placebo participants with baseline CRP<150 mg/L and its likelihood was greater with lenzilumab than placebo (HR: 2.54; 95%CI, 1.46 to 4.41; p=0.0009) but not in participants with CRP[≥]150 mg/L at baseline. CRP as a covariate in the overall analysis demonstrated a statistically significant interaction with lenzilumab treatment (p=0.044). Grade [≥] 3 adverse events in participants with baseline CRP<150 mg/L were reported in 18% and 28% in lenzilumab or placebo, respectively. No treatment-emergent serious adverse events were attributable to lenzilumab. ConclusionThese finding suggest that COVID-19 participants with low baseline CRP levels achieve the greatest clinical benefit from lenzilumab and that baseline CRP levels may be a useful biomarker to guide therapeutic intervention. Trial RegistrationClinicalTrials.gov NCT04351152 WHAT IS ALREADY KNOWN ON THIS TOPICGM-CSF is one of the early upstream mediators and orchestrators of the hyperinflammatory immune response following SARS-CoV-2 infection. Baseline levels of GM-CSF and CRP have each been shown to correlate with COVID-19 disease progression. Increases in CRP are driven by elevations of IL-6 during the hyperinflammatory response following SARS-CoV-2 infection. In the phase 3, randomized, double-blind, placebo-controlled LIVE-AIR study, GM-CSF neutralization with lenzilumab significantly improved the likelihood of survival without invasive mechanical ventilation (SWOV, primary endpoint, also referred to as ventilator-free survival) vs. placebo (HR:1.54; 95% CI, 1.02 to 2.32; p=0.0403), which included standard supportive care including corticosteroids and remdesivir. No treatment-emergent serious adverse events attributable to lenzilumab have been reported to date. WHAT THIS STUDY ADDSA comprehensive analysis of LIVE -AIR CRP data provides evidence for the utility of baseline CRP to predict progression to IMV and death. Baseline CRP was identified to be the strongest predictor of SWOV in this study. Patients with baseline CRP<150 mg/L represented 78% of the study population and demonstrated the greatest clinical benefit with lenzilumab, including SWOV through day 28 (HR: 2.54; 95%CI; 1.46-4.41; nominal p=0.0009). A biomarker-driven approach using baseline CRP levels to guide therapeutic intervention may improve outcomes in those hospitalized with COVID-19. Participants with baseline CRP levels above 150 mg/L were described as experiencing COVID-19-associated hyperinflammation and were at risk of imminent escalation of respiratory support or death. Elevated baseline plasma CRP was the most predictive feature for progression to IMV or death (OR, 0.15; 95%CI, 0.07-0.29; nominal p<0.001). These findings suggest that baseline CRP may be a useful biomarker in determining which participants may be most successfully treated with lenzilumab.

5.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-21268236

RESUMEN

ImportanceThe coronavirus disease 2019 (Covid-19) pandemic continues to place a devastating strain on healthcare services worldwide and there remains an ongoing requirement for new treatments. A key mechanism recognised in progressive severe disease is virus-induced endothelial dysregulation. Endothelin-1 (ET-1), being the most highly expressed peptide in endothelial cells and potent vasoconstrictor of human blood vessels, represents a potential therapeutic target through the use of Endothelin receptor antagonists. ObjectiveTo investigate the association of plasma ET-1 with Covid-19 disease severity DesignRetrospective longitudinal cohort study of Covid-19 patients divided into Group A (asymptomatic or symptoms not requiring hospitalisation), Group B (symptoms requiring hospitalisation) and Group C (symptoms requiring supplemental oxygen therapy or assisted ventilation) recruited between March and July 2020 (the first wave of the Covid-19 pandemic in the UK). Data were compared with a contemporaneous cross-section of non-infected volunteers (Controls). SettingSingle Tertiary National Health Service Hospital. ParticipantsTissue banked plasma samples were obtained from 194 patients. ExposuresQuantitation of ET-1 in plasma by specific enzyme linked immunosorbent assay. Main outcome and measuresPairwise comparison of ET-1 levels (median [IQR]) between patient categories, and subgroups defined by clinical outcomes. ResultsBaseline ET-1 plasma levels (pg/ml) were elevated in patients requiring hospitalisation compared with controls and patients with asymptomatic or mild infection (Group B: 1.59 [1.13-1.98], and Group C: 1.65 [1.02-2.32] versus controls: 0.68 [0.47-0.87], p=<0.001 and Group A: 0.72 [0.57-1.10], p=<0.001). ET-1 levels were also elevated in patients that died (2.09 [1.66-3.15]), developed acute kidney (1.70 [1.07-2.36]) or myocardial injury (1.50 [0.92-2.28]) compared with patients with an uncomplicated infection (1.00 [0.61-1.57], p=<0.01). Amongst surviving hospitalised patients, ET-1 concentrations decreased when measured at 28 days (Group B: 0.86 [0.60-1.61] and Group C: 1.17 [0.66-1.62] versus baseline, p=<0.05) and 90 days (Group B: 0.69 [0.59-1.38] and Group C: 1.01 [0.64-1.21] versus baseline, p=<0.05). Conclusions and relevanceHospitalised Covid-19 patients demonstrate elevated ET-1 levels during the acute phase of infection and this is associated with increasing clinical severity of the disease. The results support the hypothesis that endothelin receptor antagonists may be beneficial for certain Covid-19 patients. Key PointsO_ST_ABSQuestionC_ST_ABSWhat is the association of the endothelial peptide and potent vasoconstrictor: endothelin-1 with disease severity in Covid-19 infection? FindingsHospitalised Covid-19 patients (especially those requiring supplemental oxygen and assisted ventilation, dying patients, and those who developed acute myocardial or kidney injury) have higher circulating endothelin-1 levels during the acute phase of their infection, compared with patients with asymptomatic or only mildly symptomatic Covid-19 infection. MeaningEndothelial dysregulation is a well-recognised mechanism for progressive severe Covid-19 infection and these results suggest targeting endothelin-1 activity through the use of Endothelin receptor antagonists may be of benefit.

6.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-21268529

RESUMEN

BackgroundSolid organ transplant recipients (SOTR), who typically receive post-transplant immunosuppression, show increased COVID-19-related mortality. It is unclear whether an additional dose of COVID-19 vaccines in SOTR can overcome the reduced immune responsiveness against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants. MethodsWe performed a prospective cohort study of 53 SOTR receiving SARS-CoV-2 vaccination into a prospective cohort study performing detailed immunoprofiling of humoral immune responses against SARS-CoV-2 and its variants. ResultsPrior to the additional vaccine dose, 60.3% of SOTR showed no measurable neutralization and only 18.9% demonstrated neutralizing activity of >90% following two vaccine doses. More intensive immunosuppression, antimetabolites in particular, negatively impacted antiviral immunity. While absolute IgG levels were lower in SOTR than controls, antibody titers against microbial recall antigens were in fact higher. In contrast, SOTR showed reduced vaccine-induced IgG/IgA antibody titers against SARS-CoV-2 and its delta variants. Vaccinated SOTR showed a markedly fewer linear B cell epitopes, indicating reduced B cell diversity. Importantly, a third vaccine dose led to an increase in anti-SARS-CoV-2 antibody titers and neutralizing activity across alpha, beta and delta variants. However, we observed a significant decrease in anti-spike antibody titers with the omicron variant. ConclusionsOnly a small subgroup of SOTR generated functionally relevant antibodies after completing the initial vaccine series based on dysfunctional priming of immune responses against novel antigens. An additional dose of the vaccine results in dramatically improved antibody responses against all SARS-CoV-2 variants except omicron.

7.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-21268526

RESUMEN

BackgroundAfter COVID-19 vaccines received approval, vaccination campaigns were launched worldwide. Initially, these were characterized by a shortage of vaccine supply, and specific risk groups were prioritized. Once supply was guaranteed and vaccination coverage saturated, the focus shifted from risk groups to anti-vaxxers, the underaged population, and regions of low coverage. At the same time, hopes to reach herd immunity by vaccination campaigns were put into perspective by the emergence and spread of more contagious and aggressive viral variants. Particularly, concerns were raised that not all vaccines protect against the new-emerging variants. Methods and findingsA model designed to predict the effect of vaccination campaigns on the spread of viral variants is introduced. The model is a comprehensive extension of the model underlying the pandemic preparedness tool CovidSim 2.0 (http://covidsim.eu/). The model is age and spatially stratified, incorporates a finite (but arbitrary) number of different viral variants, and incorporates different vaccine products. The vaccines are allowed to differ in their vaccination schedule, vaccination rates, the onset of vaccination campaigns, and their effectiveness. These factors are also age and/or location dependent. Moreover, the effectiveness and the immunizing effect of vaccines are assumed to depend on the interaction of a given vaccine and viral variant. Importantly, vaccines are not assumed to immunize perfectly. Individuals can be immunized completely, only partially, or fail to be immunized against one or many viral variants. Not all individuals in the population are vaccinable. The model is formulated as a high-dimensional system of differential equations, which is implemented efficiently in the programming language Julia. As an example, the model was parameterized to reflect the epidemic situation in Germany until November 2021 and predicted the future dynamics of the epidemic under different interventions. In particular, without tightening contact reductions, a strong epidemic wave is predicted. At the current state, mandatory vaccination would be too late to have a strong effect on reducing the number of infections. However, it would reduce mortality. An emergency brake, i.e., an incidence-based stepwise lockdown would be efficient to reduce the number of infections and mortality. Furthermore, to specifically account for mobility between regions, the model was applied to two German provinces of particular interest: Saxony, which currently has the lowest vaccine rollout in Germany and high incidence, and Schleswig-Holstein, which has high vaccine rollout and low incidence. ConclusionsA highly sophisticated and flexible but easy-to-parameterize model for the ongoing COVID-19 pandemic is introduced. The model is capable of providing useful predictions for the COVID-19 pandemic, and hence provides a relevant tool for epidemic decision-making. The model can be adjusted to any country, to derive the demand for hospital and ICU capacities as well as economic collateral damages.

8.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-21268575

RESUMEN

BackgroundVaccines are highly effective in preventing severe disease and death from COVID-19, and new medications that can reduce severity of disease have been approved. However, many countries are facing limited supply of vaccine doses and medications. A model estimating the probabilities for hospitalization and mortality according to individual risk factors and vaccine doses received could help prioritize vaccination and yet scarce medications to maximize lives saved and reduce the burden on hospitalization facilities. MethodsElectronic health records from 101,039 individuals infected with SARS-CoV-2, since the beginning of the pandemic and until November 30, 2021 were extracted from a national healthcare organization in Israel. Logistic regression models were built to estimate the risk for subsequent hospitalization and death based on the number of BNT162b2 mRNA vaccine doses received and few major risk factors (age, sex, body mass index, hemoglobin A1C, kidney function, and presence of hypertension, pulmonary disease and malignancy). ResultsThe models built predict the outcome of newly infected individuals with remarkable accuracy: area under the curve was 0.889 for predicting hospitalization, and 0.967 for predicting mortality. Even when a breakthrough infection occurs, having received three vaccination doses significantly reduces the risk of hospitalization by 66% (OR=0.339) and of death by 78% (OR=0.223). ConclusionsThe models enable rapid identification of individuals at high risk for hospitalization and death when infected. These patients can be prioritized to receive booster vaccination and the yet scarce medications. A calculator based on these models is made publicly available on http://covidest.web.app

9.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22269148

RESUMEN

Objectives: We aimed to compare COVID-19 outcomes in the Omicron-driven fourth wave with prior waves in the Western Cape, the contribution of undiagnosed prior infection to differences in outcomes in a context of high seroprevalence due to prior infection, and whether protection against severe disease conferred by prior infection and/or vaccination was maintained. Methods: In this cohort study, we included public sector patients aged [≥]20 years with a laboratory confirmed COVID-19 diagnosis between 14 November-11 December 2021 (wave four) and equivalent prior wave periods. We compared the risk between waves of the following outcomes using Cox regression: death, severe hospitalization or death and any hospitalization or death (all [≤]14 days after diagnosis) adjusted for age, sex, comorbidities, geography, vaccination and prior infection. Results: We included 5,144 patients from wave four and 11,609 from prior waves. Risk of all outcomes was lower in wave four compared to the Delta-driven wave three (adjusted Hazard Ratio (aHR) [95% confidence interval (CI)] for death 0.27 [0.19; 0.38]. Risk reduction was lower when adjusting for vaccination and prior diagnosed infection (aHR:0.41, 95% CI: 0.29; 0.59) and reduced further when accounting for unascertained prior infections (aHR: 0.72). Vaccine protection was maintained in wave four (aHR for outcome of death: 0.24; 95% CI: 0.10; 0.58). Conclusions: In the Omicron-driven wave, severe COVID-19 outcomes were reduced mostly due to protection conferred by prior infection and/or vaccination, but intrinsically reduced virulence may account for an approximately 25% reduced risk of severe hospitalization or death compared to Delta.

10.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22269045

RESUMEN

BackgroundThe Omicron (B.1.1.529) variant of SARS-CoV-2 has rapidly achieved global dissemination, accounting for most infections in the United States by December 2021. Risk of severe outcomes associated with Omicron infections, as compared to earlier SARS-CoV-2 variants, remains unclear. MethodsWe analyzed clinical and epidemiologic data from cases testing positive for SARS-CoV-2 infection within the Kaiser Permanente Southern California healthcare system from November 30, 2021 to January 1, 2022, using S gene target failure (SGTF) as assessed by the ThermoFisher TaqPath ComboKit assay as a proxy for Omicron infection. We fit Cox proportional hazards models to compare time to any hospital admission and hospital admissions associated with new-onset respiratory symptoms, intensive care unit (ICU) admission, mechanical ventilation, and mortality among cases with Omicron and Delta (non-SGTF) variant infections. We fit parametric competing risk models to compare lengths of hospital stay among admitted cases with Omicron and Delta variant infections. ResultsOur analyses included 52,297 cases with SGTF (Omicron) and 16,982 cases with non-SGTF (Delta [B.1.617.2]) infections, respectively. Hospital admissions occurred among 235 (0.5%) and 222 (1.3%) of cases with Omicron and Delta variant infections, respectively. Among cases first tested in outpatient settings, the adjusted hazard ratios for any subsequent hospital admission and symptomatic hospital admission associated with Omicron variant infection were 0.48 (0.36-0.64) and 0.47 (0.35-0.62), respectively. Rates of ICU admission and mortality after an outpatient positive test were 0.26 (0.10-0.73) and 0.09 (0.01-0.75) fold as high among cases with Omicron variant infection as compared to cases with Delta variant infection. Zero cases with Omicron variant infection received mechanical ventilation, as compared to 11 cases with Delta variant infections throughout the period of follow-up (two-sided p<0.001). Median duration of hospital stay was 3.4 (2.8-4.1) days shorter for hospitalized cases with Omicron variant infections as compared to hospitalized patients with Delta variant infections, reflecting a 69.6% (64.0-74.5%) reduction in hospital length of stay. ConclusionsDuring a period with mixed Delta and Omicron variant circulation, SARS-CoV-2 infections with presumed Omicron variant infection were associated with substantially reduced risk of severe clinical endpoints and shorter durations of hospital stay. Trial registrationNot applicable

11.
Washington, D.C.; PAHO; 2022-01-11.
en Inglés, Español | PAHO-IRIS | ID: phr-55594

RESUMEN

[WEEKLY SUMMARY]. North America: Overall, influenza activity remained low but increasing. In Canada, influenza A and B virus co-circulated with influenza A(H3N2) and A(H1N1)pdm09 among samples where subtyping was performed; SARS-CoV-2 activity slightly increased. In Mexico, influenza A(H3N2) prevailed, with B co-circulating and SARS-CoV-2 activity increased. In the United States, influenza A(H3N2) predominated, with SARS-CoV-2 activity increasing, hospitalizations and deaths remained elevated. Respiratory syncytial virus activity remained high in Canada. Caribbean: Influenza remained at low activity levels. Haiti reported a few detections in recent weeks with the predominance of influenza B/Victoria and A(H1N1)pdm09. In Suriname, SARS-CoV-2 and SARI activity decreased to low levels. Central America: Influenza activity continued low and SARS-CoV-2 activity decreased to low levels overall. In Guatemala, influenza activity decreased with the predominance of influenza A(H3N2) in the previous week, while influenza A(H3N2) circulation increased in Honduras with low SARI and ILI activity. Andean: Overall, influenza activity remained low; however, Bolivia, Ecuador, and Peru reported increased influenza activity associated with A(H3N2) detections. SARS-CoV-2 activity stands elevated in Bolivia and Ecuador; and in Bolivia, SARI activity continued at extraordinary levels. Brazil and Southern Cone: Influenza activity increased to pre-pandemic levels, and SARS-CoV-2 activity continues at low levels, except in Argentina. Influenza A(H3N2) detections continue to rise in Brazil, Chile, Paraguay, and Uruguay. Most activity and increasing A(H3N2) detections are recorded in Brazil and Uruguay. Global: In the temperate zones of the northern hemisphere, influenza activity, although still low, appeared to increase in some countries with detections of mainly influenza A(H3N2) and B Victoria lineage (mainly in China). In Europe, influenza activity continued to increase. Influenza A(H3N2) predominated. In East Asia, influenza activity continued rising in China, while influenza illness indicators and activity remained low in the rest of the subregion. Influenza B/Victoria viruses predominated. In tropical Africa, overall influenza activity continued decreasing, with both influenza A and B detected. In Southern Asia, influenza virus detections of predominately influenza A(H3N2) increased overall, although reducing in a few countries. In South-East Asia, sporadic influenza detections were reported in the Philippines. However, in the temperate zones of the southern hemisphere, influenza activity remained low overall. SARS-CoV-2 percent positivity from sentinel surveillance increased to approximately 30%. Activity remained under 10% positivity in the Eastern Mediterranean, South-East Asian and Western Pacific Regions of WHO. In the other WHO Regions, an increasing trend in positivity was observed in recent weeks. Overall positivity from non-sentinel sites also increased and was at 25%.


[RESUMEN SEMANAL] América del Norte: en general, la actividad de la influenza se mantuvo baja pero en aumento. En Canadá, el virus de la influenza A y B circularon concurrentemente con los virus influenza A(H3N2) y A(H1N1)pdm09 en las muestras a las que se les determinó el subtipo; la actividad del SARS-CoV-2 aumentó ligeramente. En México, predominó el virus influenza A(H3N2), con la circulación concurrente de B, y la actividad del SARS-CoV-2 aumentó. En los Estados Unidos, predominó la influenza A(H3N2), con un aumento de la actividad del SARS-CoV-2, las hospitalizaciones y muertes se mantuvieron elevadas. La actividad del virus respiratorio sincitial se mantuvo alta en Canadá. Caribe: la influenza se mantuvo en niveles bajos de actividad. Haití reportó algunas detecciones en las últimas semanas con predominio de influenza B/Victoria y A(H1N1)pdm09. En Surinam, la actividad del SARS-CoV-2 e IRAG disminuyó a niveles bajos. América Central: la actividad de la influenza continuó baja y la actividad del SARS-CoV-2 disminuyó a niveles bajos en general. En Guatemala, la actividad de la influenza disminuyó con el predominio de la influenza A(H3N2) en semanas previa, mientras que la circulación de la influenza A(H3N2) aumentó en Honduras con baja actividad de IRAG y ETI. Andina: en general, la actividad de la influenza se mantuvo baja; sin embargo, Bolivia, Ecuador y Perú informaron un aumento de la actividad de la influenza asociada con las detecciones de A(H3N2). La actividad de SARS-CoV-2 se mantiene elevada en Bolivia y Ecuador; y en Bolivia, la actividad de la IRAG continuó en niveles extraordinarios. Brasil y Cono Sur: la actividad de la influenza aumentó a niveles prepandémicos y la actividad del SARS-CoV-2 continúa en niveles bajos, excepto en Argentina. Las detecciones de influenza A(H3N2) continúan aumentando en Brasil, Chile, Paraguay y Uruguay. La mayor parte de la actividad y las detecciones crecientes de A(H3N2) se registran en Brasil y en Uruguay. Global: en las zonas templadas del hemisferio norte, la actividad de la influenza, aunque todavía baja, pareció aumentar en algunos países con detecciones de influenza principalmente A(H3N2) y B linaje Victoria (principalmente en China). En Europa, la actividad gripal siguió aumentando. Predominó influenza A(H3N2). En el este de Asia, la actividad de la influenza siguió aumentando en China, mientras que los indicadores y la actividad de la enfermedad por influenza se mantuvieron bajos en el resto de la subregión. Predominaron los virus influenza B linaje Victoria. En África tropical, la actividad general de la influenza continuó disminuyendo y se detectaron tanto la influenza A como la B. En el sur de Asia, en general, las detecciones de los virus de la influenza predominantemente A(H3N2) aumentaron, aunque disminuyeron en algunos países. En el sudeste asiático, en Filipinas se informaron detecciones esporádicas de influenza. Sin embargo, en las zonas templadas del hemisferio sur, la actividad de influenza se mantuvo baja en general. El porcentaje de positividad de SARS-CoV-2 de la vigilancia centinela aumentó a aproximadamente el 30%. La actividad se mantuvo por debajo del 10 % de positividad en las Regiones del Mediterráneo Oriental, Asia Sudoriental y el Pacífico Occidental. En las otras Regiones, se observó una tendencia creciente en la positividad en las últimas semanas. La positividad general de los sitios no centinela también aumentó y fue del 25%.


Asunto(s)
Gripe Humana , COVID-19 , SARS-CoV-2 , Betacoronavirus , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe , Gripe Humana , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe
12.
Artículo en Portugués | PAHO-IRIS | ID: phr-55572

RESUMEN

[RESUMO]. Objetivo. Identificar os fatores correlacionados à incidência e mortalidade por COVID-19 e verificar situações de sindemia em escala global. Métodos. Realizou-se um estudo ecológico de casos e óbitos confirmados de COVID-19 a partir de informações coletadas do European Center for Disease Prevention and Control em 2019 e 2020. Para a caracterização dos países, utilizaram-se indicadores do Banco Mundial e Worldometer Coronavirus. Foram realizadas análises descritivas e de correlação entre as variáveis independentes para posteriormente realizar o modelo de regressão linear múltipla, com o objetivo de identificar os fatores correlacionados à incidência e mortalidade por COVID-19. Resultados. Obtiveram-se dados de 185 países. A média da incidência dos casos foi de 16 482/mil habitantes, enquanto a média para mortalidade por COVID-19 foi de 291/mil habitantes, sendo América do Norte e Leste Asiático e Pacífico as regiões que apresentaram maiores e menores índices, respectivamente. Identificouse correlação positiva da taxa de incidência com proporção da população com idade de 15 a 64 anos, população urbana, desigualdade conforme Índice de Gini e com seis das sete regiões analisadas (exceto Leste Asiático e Pacífico). A taxa de mortalidade apresentou correlação negativa com a população de 0 a 14 anos e positiva com população urbana, desigualdade conforme índice de Gini e todas as regiões analisadas, exceto Leste Asiático e Pacífico. Conclusões. A morbimortalidade da COVID-19 esteve correlacionada à carga de condições crônicas, ao envelhecimento da população e à baixa capacidade dos serviços de saúde para testagem e oferta de leitos hospitalares, quadro agravado em países ou regiões com elevada desigualdade social, caracterizando uma situação de sindemia.


[ABSTRACT]. Objective. To identify factors correlated with the incidence and mortality from COVID-19 and investigate syndemic situations at the global level. Method. An ecologic study of confirmed COVID-19 cases and deaths was performed using information collected from the European Center for Disease Prevention and Control in 2019 and 2020. World Bank indicators and information obtained from Worldometer Coronavirus were used to characterize the countries. Descriptive analyses and correlations between independent variables were performed, followed by multiple linear regression analysis to identify factors correlated with COVID-19 incidence and mortality. Results. Data were obtained for 185 countries. Mean case incidence was 16 482/1,000 population, whereas mean COVID-19 mortality was 291/1,000 population, with the highest and lowest rates recorded in North America and East Asia and Pacific respectively. A positive correlation was identified between incidence rate and percent population aged 15 to 64 years, urban population, inequality measured by the Gini coefficient, and six out of the seven regions analyzed (except East Asia and Pacific). Mortality rate was negatively correlated with population aged 0 to 14 years and positively correlated with urban population, inequality measured by the Gini coefficient, and all regions analyzed except East Asia and Pacific. Conclusions. COVID-19 morbidity and mortality were correlated with the burden of chronic diseases, aging population, and low capacity of healthcare services for testing and providing hospital beds, a scenario complicated by social inequality in countries and regions, indicating a syndemic effect.


[RESUMEN]. Objetivo. Identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa y verificar las situaciones de sindemia a escala mundial. Métodos. Se realizó un estudio ecológico de casos de COVID-19 y de defunciones confirmadas por esa causa a partir de la información obtenida del Centro Europeo para la Prevención y el Control de las Enfermedades en el 2019 y el 2020. Para caracterizar a los países, se utilizaron indicadores del Banco Mundial y del sitio web de referencia Worldometer Coronavirus. Se hicieron análisis descriptivos y de correlación entre las variables independientes para crear posteriormente un modelo de regresión lineal múltiple con el fin de identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa. Resultados. Se obtuvieron datos de 185 países. La tasa media de incidencia de casos de COVID-19 fue de 16 482 por mil habitantes y la tasa media de mortalidad por esa causa fue de 291 por mil habitantes. Las regiones de América del Norte y de Asia oriental y el Pacífico presentaron los mayores y menores índices, respectivamente. Se observó una correlación positiva de la tasa de incidencia con la proporción del grupo de 15 a 64 años de edad, la población urbana, la desigualdad medida por el coeficiente de Gini y seis de las siete regiones analizadas (excepto Asia oriental y el Pacífico). La tasa de mortalidad presentó una correlación negativa con el grupo de 0 a 14 años de edad y positiva con la población urbana, la desigualdad medida por el coeficiente de Gini y todas las regiones analizadas, excepto Asia oriental y el Pacífico. Conclusiones. La morbimortalidad por COVID-19 guardó una correlación con la carga de problemas crónicos de salud, el envejecimiento de la población y la poca capacidad de realizar pruebas en los servicios de salud y de ofrecer camas de hospital, cuadro agravado en los países o regiones con una elevada tasa de desigualdad social y característico de una situación de sindemia.


Asunto(s)
COVID-19 , Atención a la Salud , Salud Pública , Sindémico , Epidemiología , Atención a la Salud , Salud Pública , Sindémico , Pandemias , Epidemiología , Atención a la Salud , Salud Pública , Sindémico , Pandemias , Epidemiología
13.
Artículo en Español | PAHO-IRIS | ID: phr-55571

RESUMEN

[RESUMEN]. Objetivo. Estimar el impacto presupuestal de la vacunación contra COVID-19 en seis países de América Latina: Argentina, Brasil, Chile, Colombia, México y Perú, durante el periodo 2021-2022. Métodos. Se evaluaron las vacunas de Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Instituto de Gamaleya (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273) y Pfizer (BNT162b2), según disponibilidad para cada país. Se adoptó la perspectiva del sistema de salud, de manera que solo se incluyeron costos médicos directos. El horizonte temporal se adoptó teniendo en cuenta los tiempos de implementación de cada plan de vacunación, excluyendo menores de 16 años y gestantes. Se incluyeron los siguientes costos: costo de la vacunación y aplicación, costos de la hospitalización general aislamiento, cuidado intermedio e intensivo. Se compararon dos escenarios de vacunación: 1) Población que desea vacunarse (según las encuestas nacionales) y 2) Población que debería vacunarse (total susceptible de vacunación). Los costos agregados para cada escenario de vacunación se compararon con el escenario de no vacunación. Adicionalmente, se realizaron análisis de sensibilidad determinísticos y probabilísticos. Resultados. Los diferentes esquemas de vacunación contra COVID-19 disponibles en América Latina generan ahorros potenciales que oscilan entre USD 100 y USD 1 500 millones de dólares por país para el período 2021-2022, asumiendo que se logra implementar en su totalidad el plan de vacunación previsto en cada país. Conclusiones. La vacunación contra COVID-19 es una estrategia que además de reducir la morbilidad y mortalidad para Latinoamérica, genera ahorros potenciales para los sistemas de salud en la región.


[ABSTRACT]. Objective. To estimate the budgetary impact of COVID-19 vaccination in six Latin American countries: Argentina, Brazil, Chile, Colombia, Mexico, and Peru, during the 2021-2022 biennium. Methods. Vaccines from Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Gamaleya Institute (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273), and Pfizer (BNT162b2) were evaluated, according to their availability in each country. The health system perspective was adopted, so that only direct health care costs were included. The time horizon adopted took into account the implementation times of each vaccination plan, excluding children under 16 years of age and pregnant persons. The following costs were included: cost of vaccination/vaccine administration and costs of hospitalization (general isolation, stepdown care, and intensive care). Two vaccination scenarios were compared: 1) population wanting to be vaccinated (according to national surveys); and 2) population that should be vaccinated (total population susceptible to vaccination). The aggregate costs for each vaccination scenario were compared with the no-vaccination scenario. Deterministic and probabilistic sensitivity analyses were also performed. Results. The different COVID-19 vaccination regimens available in Latin America generate potential savings ranging from USD 100 million to USD 1.5 billion per country for the 2021-2022 biennium, assuming that the vaccination plan proposed for each country is fully implemented. Conclusions. COVID-19 vaccination is a strategy that not only reduces morbidity and mortality in Latin America, but also generates potential savings for health systems in the region.


[RESUMO]. Objetivo. Estimar o impacto orçamentário da vacinação contra a COVID-19 em seis países da América Latina: Argentina, Brasil, Chile, Colômbia, México e Peru, no período 2021-2022. Métodos. Foram avaliadas as vacinas da Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Instituto Gamaleya (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273) e Pfizer (BNT162b2), conforme a disponibilidade para cada país. Adotou-se a perspectiva do sistema de saúde, de forma que só foram incluídos custos médicos diretos. O horizonte temporal foi adotado levando em consideração os tempos de implementação de cada plano de vacinação, excluindo crianças menores de 16 anos e gestantes. Foram incluídos os seguintes custos: custos de vacinação e aplicação, custos gerais de hospitalização, isolamento, e cuidados intermediários e intensivos. Compararam-se dois cenários de vacinação: 1) população disposta a se vacinar (com base em pesquisas nacionais) e 2) população que deveria ser vacinada (total elegível de vacinação). Os custos agregados para cada cenário de vacinação foram comparados com o cenário de não vacinação. Além disso, foram realizadas análises de sensibilidade determinísticas e probabilísticas. Resultados. Os diferentes esquemas de vacinação contra a COVID-19 disponíveis na América Latina geram economias potenciais entre 100 milhões e 1,5 bilhão de dólares por país para o período 2021-2022, considerando a implementação completa do plano de vacinação previsto em cada país. Conclusões. A vacinação contra a COVID-19 é uma estratégia que, além de reduzir a morbidade e a mortalidade na América Latina, gera economias potenciais para os sistemas de saúde da região.


Asunto(s)
Vacunación , Coronavirus , COVID-19 , SARS-CoV-2 , Costos de la Atención en Salud , Vacunas contra la COVID-19 , América Latina , Vacunación , Vacunas contra la COVID-19 , Costos de la Atención en Salud , América Latina , Vacunación , Vacunas contra la COVID-19 , Costos de la Atención en Salud
14.
Washington, D.C.; PAHO; 2022-01-10. (PAHO/FPL/IM/21-0012).
en Inglés | PAHO-IRIS | ID: phr-55560

RESUMEN

The countries of the Americas, with support from the Pan American Health Organization (PAHO), have made remarkable progress in providing children with an umbrella of protection against basic vaccine-preventable diseases. Sustained high national immunization coverage levels, the eradication of polio, the interruption of endemic measles virus transmission, and the more recent efforts towards rubella and congenital rubella syndrome elimination are hemispheric benchmarks of this progress. Countries are now vaccinating age groups outside those usually targeted in the traditional childhood immunization program, thus showing the critical need for national immunization programs to transition from child to family immunization. In the current context of the COVID-19 pandemic, the countries of the Region have taken important actions to implement innovative strategies and to maintain the high commitment of health workers to national immunization programs. Although these strategies have improved access to supply services, the COVID-19 pandemic and containment policies in the countries of the Region have affected the demand for vaccination services. In support to countries, one of PAHO's roles is to disseminate information that can highlight progress and challenges faced in the Region. This brochure highlights some of the achievements and challenges in immunization and summarizes 2020 key regional data in the Region of the Americas.


Asunto(s)
Inmunización , Programas de Inmunización , Vacunación , Enfermedades Prevenibles por Vacunación , COVID-19 , Vacunas contra la COVID-19 , Muerte Materna , Poliomielitis , Sarampión , Rubéola (Sarampión Alemán) , Salud del Niño , Estadísticas de Salud
15.
Washington, D.C.; OPS; 2022-01-06. (OPS/EGC/COVID-19/21-0006).
No convencional en Español | PAHO-IRIS | ID: phr-55557

RESUMEN

La COVID-19 ha generado efectos catastróficos en los sistemas de salud y en la salud de las personas en la Región de las Américas, en especial en el caso de las mujeres y las niñas, cuyas condiciones han empeorado en todos los ámbitos. Las mayores preocupaciones al respecto se centran en las consecuencias directas (morbilidad y mortalidad) de la acción del virus sobre poblaciones definidas, en los resultados de las medidas orientadas a mitigar la propagación del virus y en el efecto indirecto sobre las condiciones socioeconómicas. En este complejo escenario, el enfoque de género, con sus consecuencias en el contexto actual, no ha recibido la debida atención durante la pandemia. El género es uno de los determinantes estructurales asociados a la salud, pero no aparece en los análisis de los efectos directos e indirectos de la pandemia. Además, es fundamental para reconocer y analizar los efectos diferenciales de la pandemia sobre hombres y mujeres y su interacción con los diferentes determinantes de la salud. El presente informe es una iniciativa de la Organización Panamericana de la Salud y apunta a generar un conjunto de conocimientos que permitan, por un lado, reconocer, entender e instalar la temática de género y salud en el contexto de la pandemia, y, por otro, comprender el comportamiento de la enfermedad y sus posibles efectos. El informe se cierra con una serie de conclusiones y recomendaciones sobre datos y evidencia, y sobre respuestas en planes y políticas.


Asunto(s)
COVID-19 , Coronavirus , Infecciones por Coronavirus , Género y Salud , Mujeres , Determinantes Sociales de la Salud , Mortalidad , Morbilidad , Factores Socioeconómicos , Pandemias , Sistemas de Salud , Política de Salud
16.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22269157

RESUMEN

Well parameterised epidemiological models including accurate representation of contacts, are fundamental to controlling epidemics. However, age-stratified contacts are typically estimated from pre-pandemic/peace-time surveys, even though interventions and public response likely alter contacts. Here we fit age-stratified models, including re-estimation of relative contact rates between age-classes, to public data describing the 2020-21 COVID-19 outbreak in England. This data includes age-stratified population size, cases, deaths, hospital admissions, and results from the Coronavirus Infection Survey (almost 9000 observations in all). Fitting stochastic compartmental models to such detailed data is extremely challenging, especially considering the large number of model parameters being estimated (over 150). An efficient new inference algorithm ABC-MBP combining existing Approximate Bayesian Computation (ABC) methodology with model-based proposals (MBP) is applied. Modified contact rates are inferred alongside time-varying reproduction numbers that quantify changes in overall transmission due to pandemic response, and age-stratified proportions of asymptomatic cases, hospitalisation rates and deaths. These inferences are robust to a range of assumptions including the values of parameters that cannot be estimated from available data. ABC-MBP is shown to enable reliable joint analysis of complex epidemiological data yielding consistent parametrisation of dynamic transmission models that can inform data-driven public health policy and interventions.

17.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22269178

RESUMEN

Background We investigated the effect of HIV on COVID-19 outcomes with attention to selection bias due to differential testing and to comorbidity burden. Methods Retrospective cohort analysis using four hierarchical outcomes: positive SARS-CoV-2 test, COVID-19 hospitalization, intensive care unit (ICU) admission, and hospital mortality. The effect of HIV status was assessed using traditional covariate-adjusted, inverse probability weighted (IPW) analysis based on covariate distributions for testing bias (testing IPWs), HIV infection status (HIV IPWs), and combined models. Among PWH, we evaluated whether CD4 count and HIV plasma viral load (pVL) discriminated between those who did or did not develop study outcomes using receiver operating characteristic analysis. Results Between March and November 2020, 63,319 people were receiving primary care services at UCSD, of whom 4,017 were people living with HIV (PWH). PWH had 2.1 times the odds of a positive SARS-CoV-2 test compared to those without HIV after weighting for potential testing bias, comorbidity burden, and HIV-IPW (95% CI 1.6-2.8). Relative to persons without HIV, PWH did not have an increased rate of COVID-19 hospitalization after controlling for comorbidities and testing bias [adjusted incidence rate ratio (aIRR): 0.5, 95% CI: 0.1-1.4]. PWH had neither a different rate of ICU admission (aIRR:1.08, 95% CI; 0.31-3.80) nor in-hospital death (aIRR:0.92, 95% CI; 0.08-10.94) in any examined model. Neither CD4 count nor pVL predicted any of the hierarchical outcomes among PWH. Conclusions PWH have a higher risk of COVID-19 diagnosis but similar outcomes compared to those without HIV.

18.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22269104

RESUMEN

In order to characterize how sex disparities in COVID-19 mortality evolved over time in New York State (NY), we analyzed sex-disaggregated data from the US Gender/Sex COVID-19 Data Tracker from March 14, 2020 to August 28, 2021. We defined six different time periods and calculated mortality rates by sex and mortality rate ratios, both cumulatively and for each time period separately. As of August 28, 2021, 19 227 (44.2%) women and 24 295 (55.8%) men died from COVID-19 in NY. 72.7% of the cumulative difference in the number of COVID-19 deaths between women and men was accrued between March 14 and May 4, 2020. During this period, the COVID-19 mortality rate ratio for men compared to women was 1.56 (95% CI: 1.52-1.61). In the five subsequent time periods, the corresponding ratio ranged between 1.08 (0.98-1.18) and 1.24 (1.15-1.34). While the cumulative mortality rate ratio of men compared to women was 1.34 (1.31-1.37), the ratio equals 1.19 (1.16-1.22) if deaths during the initial COVID-19 surge are excluded from the analysis. This article shows that in NY the magnitude of sex disparities in COVID-19 mortality was not stable across time. While the initial surge in COVID-19 mortality was characterized by stark sex disparities, these were greatly attenuated after the introduction of public health controls.

19.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-22268891

RESUMEN

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSIntroductionC_ST_ABSOver the past two decades, vaccination programmes for vaccine-preventable diseases (VPDs) have expanded across low- and middle-income countries (LMICs). However, the rise of COVID-19 resulted in global disruption to routine immunisation (RI) activities. Such disruptions could have a detrimental effect on public health, leading to more deaths from VPDs, particularly without mitigation efforts. Hence, as RIs resume, it is important to estimate the effectiveness of different approaches for recovery. MethodsWe apply an impact extrapolation method developed by the Vaccine Impact Modelling Consortium to estimate the impact of COVID-19-related disruptions with different recovery scenarios for ten VPDs across 112 LMICs. We focus on deaths averted due to RIs occurring in the years 2020-2030 and investigate two recovery scenarios relative to a no-COVID-19 scenario. In the recovery scenarios, we assume a 10% COVID-19-related drop in RI coverage in the year 2020. We then linearly interpolate coverage to the year 2030 to investigate two routes to recovery, whereby the immunization agenda (IA2030) targets are reached by 2030 or fall short by 10%. ResultsWe estimate that falling short of the IA2030 targets by 10% leads to 11.26% fewer fully vaccinated persons (FVPs) and 11.34% more deaths over the years 2020-2030 relative to the no-COVID-19 scenario, whereas, reaching the IA2030 targets reduces these proportions to 5% fewer FVPs and 5.22% more deaths. The impact of the disruption varies across the VPDs with diseases where coverage expands drastically in future years facing a smaller detrimental effect. ConclusionOverall, our results show that drops in RI coverage could result in more deaths due to VPDs. As the impact of COVID-19-related disruptions is dependent on the vaccination coverage that is achieved over the coming years, the continued efforts of building up coverage and addressing gaps in immunity are vital in the road to recovery. SUMMARYO_ST_ABSWhat is already known?C_ST_ABSO_LIThe impact of vaccination programmes without COVID-19-related disruption has been assessed by the Vaccine Impact Modelling Consortium. C_LIO_LIThe COVID-19 pandemic has disrupted vaccination programmes resulting in a decline in coverage in the year 2020, the ramifications of this is unclear. C_LI What are the new findings?O_LIWe estimate the impact of disruptions to routine immunisation coverage and different routes to recovery. We compare to a scenario without COVID-19-related disruptions (assuming no drops in immunisation coverage). C_LIO_LIWe estimate that reaching the Immunization Agenda (IA2030) targets leads to 5% fewer FVPs and 5.22% more deaths over the years 2020 to 2030 relative to the scenario with no COVID-19-related disruptions, whereas falling short of the IA2030 targets by 10% leads to 11.26% fewer fully vaccinated persons (FVPs) and 11.34% more deaths. C_LIO_LIThe impact of the disruption varies across the vaccine-preventable diseases with those forecasted to have vast expansions in coverage post-2020 able to recover more. C_LI What do the new findings imply?O_LIA drop in vaccination coverage results in fewer vaccinated individuals and thus more deaths due to vaccine-preventable diseases. To mitigate this, building up coverage of routine immunisations and addressing immunity gaps with activities such as catch-up campaigns are vital in the road to recovery. C_LI

20.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-21268513

RESUMEN

IntroductionA discussion of waves of the COVID-19 epidemic in different countries is a part of the national conversation for many, but there is no hard and fast means of delineating these waves in the available data and their connection to waves in the sense of mathematical epidemiology is only tenuous. MethodsWe present an algorithm which processes a general time series to identify substantial, significant and sustained periods of increase in the value of the time series, which could reasonably be described as observed waves. This provides an objective means of describing observed waves in time series. ResultsThe output of the algorithm as applied to epidemiological time series related to COVID-19 corresponds to visual intuition and expert opinion. Inspecting the results of individual countries shows how consecutive observed waves can differ greatly with respect to the case fatality ratio. Furthermore, in large countries, a more detailed analysis shows that consecutive observed waves have different geographical ranges. We also show how waves can be modulated by government interventions and find that early implementation of non-pharmaceutical interventions correlates with a reduced number of observed waves and reduced mortality burden in those waves. ConclusionIt is possible to identify observed waves of disease by algorithmic methods and the results can be fruitfully used to analyse the progression of the epidemic.

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