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1.
N Z Med J ; 134(1529): 10-25, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33582704

RESUMEN

AIMS: We developed a model, updated daily, to estimate undetected COVID-19 infections exiting quarantine following selectively opening New Zealand's borders to travellers from low-risk countries. METHODS: The prevalence of infectious COVID-19 cases by country was multiplied by expected monthly passenger volumes to predict the rate of arrivals. The rate of undetected infections entering the border following screening and quarantine was estimated. Level 1, Level 2 and Level 3 countries were defined as those with an active COVID-19 prevalence of up to 1/105, 10/105 and 100/105, respectively. RESULTS: With 65,272 travellers per month, the number of undetected COVID-19 infections exiting quarantine is 1 every 45, 15 and 31 months for Level 1, Level 2 and Level 3 countries, respectively. The overall rate of undetected active COVID-19 infections exiting quarantine is expected to increase from the current 0.40 to 0.50 per month, or an increase of one extra infection every 10 months. CONCLUSIONS: Loosening border restrictions results in a small increase in the rate of undetected COVID-19 infections exiting quarantine, which increases from the current baseline by one infection every 10 months. This information may be useful in guiding decision-making on selectively opening of borders in the COVID-19 era.


Asunto(s)
Control de Enfermedades Transmisibles , Enfermedades Transmisibles Importadas , Transmisión de Enfermedad Infecciosa , Reglamento Sanitario Internacional , Cuarentena , /epidemiología , /transmisión , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Enfermedades Transmisibles Importadas/epidemiología , Enfermedades Transmisibles Importadas/prevención & control , Enfermedades Transmisibles Importadas/transmisión , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Predicción , Salud Global , Humanos , Reglamento Sanitario Internacional/organización & administración , Reglamento Sanitario Internacional/tendencias , Nueva Zelanda/epidemiología , Prevalencia , Política Pública , Cuarentena/organización & administración , Cuarentena/estadística & datos numéricos , Viaje/legislación & jurisprudencia , Viaje/estadística & datos numéricos
2.
Bull Math Biol ; 83(4): 25, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33594478

RESUMEN

We present a classic SEIR model taking into account the daily movements of individuals in different places. The model also takes into account partial confinement of individuals. This model is coupled with a model of protection against the epidemic by the use of masks. We are studying the effects of combined confinement and protection measures on the dynamics of the epidemic. We consider a constant proportion of asymptomatic people. We assume that symptomatic infected people may change their urban travel behavior due to the disease which causes them to travel less to places where they used to move and to stay at home more often. We present a sensitivity study with respect to the parameters. We show that the combination of the use of masks with almost complete release of confinement makes it possible to avoid the occurrence of a secondary peak of the epidemic. The model predicts that a total release of confinement can be successful for an epidemic of [Formula: see text] if on average a proportion of [Formula: see text] of the population wears masks of [Formula: see text] efficacy. However, if [Formula: see text] of the population remains confined, the same goal can be achieved with a proportion of [Formula: see text] of the population wearing masks with efficacy of the order of [Formula: see text].


Asunto(s)
/epidemiología , Epidemias/prevención & control , Epidemias/estadística & datos numéricos , Modelos Biológicos , Infecciones Asintomáticas/epidemiología , Susceptibilidad a Enfermedades , Humanos , Máscaras/estadística & datos numéricos , Conceptos Matemáticos , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Viaje/estadística & datos numéricos , Población Urbana
3.
Proc Natl Acad Sci U S A ; 118(8)2021 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-33536312

RESUMEN

Several lines of existing evidence support the possibility of airborne transmission of coronavirus disease 2019 (COVID-19). However, quantitative information on the relative importance of transmission pathways of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains limited. To evaluate the relative importance of multiple transmission routes for SARS-CoV-2, we developed a modeling framework and leveraged detailed information available from the Diamond Princess cruise ship outbreak that occurred in early 2020. We modeled 21,600 scenarios to generate a matrix of solutions across a full range of assumptions for eight unknown or uncertain epidemic and mechanistic transmission factors. A total of 132 model iterations met acceptability criteria (R 2 > 0.95 for modeled vs. reported cumulative daily cases and R 2 > 0 for daily cases). Analyzing only these successful model iterations quantifies the likely contributions of each defined mode of transmission. Mean estimates of the contributions of short-range, long-range, and fomite transmission modes to infected cases across the entire simulation period were 35%, 35%, and 30%, respectively. Mean estimates of the contributions of larger respiratory droplets and smaller respiratory aerosols were 41% and 59%, respectively. Our results demonstrate that aerosol inhalation was likely the dominant contributor to COVID-19 transmission among the passengers, even considering a conservative assumption of high ventilation rates and no air recirculation conditions for the cruise ship. Moreover, close-range and long-range transmission likely contributed similarly to disease progression aboard the ship, with fomite transmission playing a smaller role. The passenger quarantine also affected the importance of each mode, demonstrating the impacts of the interventions.


Asunto(s)
Aerosoles , Brotes de Enfermedades/estadística & datos numéricos , Modelos Teóricos , Cuarentena/normas , Navíos/estadística & datos numéricos , /diagnóstico , /virología , Humanos , Cuarentena/métodos , Cuarentena/estadística & datos numéricos
4.
MMWR Morb Mortal Wkly Rep ; 70(1): 12-13, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33411700

RESUMEN

On May 8, 2020, the Vermont Department of Health (VDH) issued a Health Update* recommending shortening the duration of quarantine for persons exposed to SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Exposed persons who were in quarantine could be tested by polymerase chain reaction (PCR) on or after quarantine day 7. Those who had remained asymptomatic throughout quarantine and who received a negative SARS-CoV-2 PCR test result on or after day 7 could end quarantine. This policy was based on a report suggesting that symptom onset occurs within this time frame in approximately three quarters of COVID-19 cases (1) and on consultation of the Vermont Health Commissioner with the U.S. Surgeon General. VDH implemented this policy to minimize restrictions on state residents, recognizing that some reduction could occur in the prevention benefit of quarantine to contain the spread of SARS-CoV-2. State-run SARS-CoV-2 testing sites were made available to increase access to no-cost testing and facilitate implementation of this policy. During August 1-December 1, among persons seeking testing at a VDH SARS-CoV-2 testing site, 36% stated that their reason for seeking testing was to end quarantine early (VDH, unpublished data, December 7, 2020), indicating that persons were aware of and following the policy and using the testing services provided. To assess the effectiveness of this policy, VDH analyzed testing data for contacts of persons with a COVID-19 diagnosis. During May 8-November 16, VDH identified 8,798 exposed contacts of COVID-19 patients; 3,983 (45%) had sought testing within 14 days of their exposure, with day 0 defined as the date of last exposure noted in the case investigation record. Among these persons, 2,200 (55%) who received testing on days 7-10 were included in this analysis; 977 (44.9%) of these contacts had a specimen collected for testing on day 7. Among these, 34 (3%) had test results that were positive, 940 (96%) had results that were negative, and three (<1%) had results that were indeterminate (Table). Among the 34 contacts who received a positive SARS-CoV-2 PCR test result on day 7 after exposure, 12 (35%) were asymptomatic. The remaining 22 contacts with positive test results were symptomatic at the time of testing; approximately one half had developed symptoms on days 4-7 after exposure. Among the 940 contacts who received negative test results on specimens collected on day 7 after exposure, 154 (16%) had a subsequent test within the next 7 days (i.e., days 8-14); among these, 152 (99%) had tests that remained negative, and two (1%) had results that were indeterminate.


Asunto(s)
Enfermedades Asintomáticas , /prevención & control , Trazado de Contacto , Cuarentena/estadística & datos numéricos , Atletas , /epidemiología , Adhesión a Directriz/estadística & datos numéricos , Guías como Asunto , Humanos , Política Pública , Factores de Tiempo , Universidades , Vermont/epidemiología , Adulto Joven
5.
MMWR Morb Mortal Wkly Rep ; 70(1): 7-11, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33417591

RESUMEN

To safely resume sports, college and university athletic programs and regional athletic conferences created plans to mitigate transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Mitigation measures included physical distancing, universal masking, and maximizing outdoor activity during training; routine testing; 10-day isolation of persons with COVID-19; and 14-day quarantine of athletes identified as close contacts* of persons with confirmed COVID-19. Regional athletic conferences created testing and quarantine policies based on National Collegiate Athletic Association (NCAA) guidance (1); testing policies varied by conference, school, and sport. To improve compliance with quarantine and reduce the personal and economic burden of quarantine adherence, the quarantine period has been reduced in several countries from 14 days to as few as 5 days with testing (2) or 10 days without testing (3). Data on quarantined athletes participating in NCAA sports were used to characterize COVID-19 exposures and assess the amount of time between quarantine start and first positive SARS-CoV-2 test result. Despite the potential risk for transmission from frequent, close contact associated with athletic activities (4), more athletes reported exposure to COVID-19 at social gatherings (40.7%) and from roommates (31.7%) than they did from exposures associated with athletic activities (12.7%). Among 1,830 quarantined athletes, 458 (25%) received positive reverse transcription-polymerase chain reaction (RT-PCR) test results during the 14-day quarantine, with a mean of 3.8 days from quarantine start (range = 0-14 days) until the positive test result. Among athletes who had not received a positive test result by quarantine day 5, the probability of having a positive test result decreased from 27% after day 5 to <5% after day 10. These findings support new guidance from CDC (5) in which different options are provided to shorten quarantine for persons such as collegiate athletes, especially if doing so will increase compliance, balancing the reduced duration of quarantine against a small but nonzero risk for postquarantine transmission. Improved adherence to mitigation measures (e.g., universal masking, physical distancing, and hand hygiene) at all times could further reduce exposures to SARS-CoV-2 and disruptions to athletic activities because of infections and quarantine (1,6).


Asunto(s)
Atletas/estadística & datos numéricos , /diagnóstico , Cuarentena/estadística & datos numéricos , /epidemiología , Humanos , Estudios Retrospectivos , Factores de Tiempo , Estados Unidos/epidemiología , Universidades
6.
Clin Med (Lond) ; 21(1): e9-e13, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33479077

RESUMEN

A cohort of the first 50 COVID-19 patients in East Tyrol, a region in the southwest of Austria, were monitored in home quarantine. Specific viral ribonucleic acid was detected in throat swabs and stool samples. Analysis indicated a median virus shedding duration of 13 days; however, statistical outliers highlight the importance of consequent testing. This underlines the need of negative throat swabs prior to removing quarantine. We monitored the disease's characteristics via an in-house score called Corona Severity Index, in order to predict an aggravation of the disease. Special attention was paid to early symptoms, such as headache, which appeared to be significantly more common in younger patients (p=0.019). Anosmia and ageusia showed a predominance in female patients (p=0.028). Investigation revealed seven relapses and viral shedding fluctuation in four cases. A follow-up examination shed light on seroconversion which could be observed in 35 of 40 participants. This further clarifies the necessity of establishing discharge standards and follow-up management for COVID-19 patients.


Asunto(s)
/epidemiología , Control de Infecciones/métodos , Cuarentena/estadística & datos numéricos , Adolescente , Adulto , Austria/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Adulto Joven
7.
BMC Public Health ; 21(1): 152, 2021 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-33461508

RESUMEN

BACKGROUND: The first case of COVID-19 infection was diagnosed in Brazil 26th February 2020. By March 16th, physical distancing and confinement measures were implemented by the Brazilian government. Little is known about how these measures were followed up by the Brazilian people and their impact on daily routine. METHODS: In early April 2020, using an online platform, we organized an online survey among adults living in Brazil about their COVID-19 preventive behavior and impact on their daily routine. RESULTS: Data from 23,896 respondents were analyzed (mean age: 47.4 years). Due to COVID-19 restrictions, half (51.1%) of the professionals reported working from home. Regular handwashing was practiced by 98.7% of participants; 92.6% reported adhering to the 1.5-2 m physical distancing rule, but only 45.5% wore a face mask when going outside. While 29.3% of respondents found it relatively easy to stay at home, indoor confinement was extremely difficult for 7.9% of participants. Moreover, 11% of participants were extremely worried about their health during the COVID-19 epidemic. Younger people, male, persons living in a rural area/village or popular neighbourhoods, students and workers reported less preventive behaviour. CONCLUSION: Restrictive measures markedly affected the daily and professional routines of Brazilians. Participants showed a satisfactory level of adherence to national COVID-19 prevention guidelines. Qualitative and follow-up studies are needed to monitor the impact of COVID-19 in the Brazilian society.


Asunto(s)
/epidemiología , Brotes de Enfermedades , Adhesión a Directriz/estadística & datos numéricos , Actividades Cotidianas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Guías como Asunto , Humanos , Internet , Masculino , Persona de Mediana Edad , Cuarentena/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
8.
Soc Sci Med ; 270: 113645, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33388621

RESUMEN

This paper employs Autoregressive Integrated Moving Average (ARIMA) modelling and doubling time to assess the effect of lockdown and reopening on the active COVID-19 cases (ACC) based on a sample from 29 February to July 3, 2020. Two models are estimated: one with a sample covering post-lockdown period only and another spanning both post-lockdown and post-reopening periods. The first model reveals that the lockdown caused an immediate fall in the daily growth rate of the ACC by 14.30% and 33.26% fall in the long run. The parameters of the second model show that the lockdown had an impact effect of 8.56% and steady state effect of 20.88% reduction in the growth rate of the ACC. The effect of reopening on the ACC is insignificant. However, the doubling time of the ACC has increased after reopening. The study warns against complete reopening until sufficient post-reopening data series is available for exact estimation. The findings in this study can be useful in determining the hospitalisation needs and effectiveness of similar health-related policies.


Asunto(s)
Cuarentena , /epidemiología , Humanos , Modelos Estadísticos , Nigeria/epidemiología , Cuarentena/estadística & datos numéricos
9.
Sci Rep ; 11(1): 2425, 2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33510274

RESUMEN

Countries worldwide have adopted various strategies to minimize the socio-economic impact of the ongoing COVID-19 pandemic. Stringency of imposed measures universally reflects the standpoint from which protecting public health and avoiding damage to economy are seen as contradictory objectives. Based on epidemic trajectories of 25 highly developed countries and 10 US states in the (mobility reduction)-(reproduction number) plane we showed that delay in imposition of nation-wide quarantine elevates the number of infections and deaths, surge of which inevitably has to be suppressed by stringent and sustained lockdown. As a consequence, cumulative mobility reduction and population-normalized cumulative number of COVID-19-associated deaths are significantly correlated and this correlation increases with time. Overall, we demonstrated that, as long as epidemic suppression is the aim, the trade-off between the death toll and economic loss is illusory: high death toll correlates with deep and long-lasting lockdown causing a severe economic downturn.


Asunto(s)
/epidemiología , Cuarentena/economía , /economía , Control de Enfermedades Transmisibles/métodos , Países Desarrollados/estadística & datos numéricos , Humanos , Pandemias/economía , Pandemias/prevención & control , Salud Pública , Cuarentena/estadística & datos numéricos , Estados Unidos/epidemiología
10.
RMD Open ; 7(1)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33402443

RESUMEN

AIMS: In Danish patients with inflammatory rheumatic diseases to explore self-protection strategies and health behaviour including adherence to disease-modifying antirheumatic treatment (DMARD) during the initial phase of the COVID-19 pandemic and again after the reopening of the society started. Furthermore, to identify characteristics of patients with high levels of anxiety and self-isolation. METHODS: Patients in routine care followed prospectively in the nationwide DANBIO registry were invited to answer an online questionnaire regarding disease activity and COVID-19 infection, behaviour in March and June 2020. Responses were linked to patient data in DANBIO. Characteristics potentially associated with anxiety, self-isolation and medication adherence (gender/age/diagnosis/education/work status/comorbidity/DMARD/smoking/EQ-5D/disease activity) were explored with multivariable logistic regression analyses. RESULTS: We included 12 789 patients (8168 rheumatoid arthritis/2068 psoriatic arthritis/1758 axial spondyloarthritis/795 other) of whom 65% were women and 36% treated with biological DMARD. Self-reported COVID-19 prevalence was 0.3%. Patients reported that they were worried to get COVID-19 infection (March/June: 70%/45%) and self-isolated more than others of the same age (48%/38%). The fraction of patients who changed medication due to fear of COVID-19 were 4.1%/0.6%. Female gender, comorbidities, not working, lower education, biological treatment and poor European Quality of life, 5 dimensions were associated with both anxiety and self-isolation. CONCLUSION: In >12 000 patients with inflammatory arthritis, we found widespread anxiety and self-isolation, but high medication adherence, in the initial phase of the COVID-19 pandemic. This persisted during the gradual opening of society during the following months. Attention to patients' anxiety and self-isolation is important during this and potential future epidemics.


Asunto(s)
/epidemiología , Conductas Relacionadas con la Salud , Pandemias , Enfermedades Reumáticas/psicología , Adulto , Anciano , Anciano de 80 o más Años , Antirreumáticos/uso terapéutico , Ansiedad/epidemiología , Artritis Psoriásica/tratamiento farmacológico , Artritis Psoriásica/epidemiología , Artritis Psoriásica/psicología , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/epidemiología , Artritis Reumatoide/psicología , /psicología , Dinamarca/epidemiología , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Cuarentena/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/epidemiología , Espondiloartropatías/tratamiento farmacológico , Espondiloartropatías/epidemiología , Espondiloartropatías/psicología
11.
MMWR Morb Mortal Wkly Rep ; 70(4): 130-135, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33507889

RESUMEN

The National Football League (NFL) and the NFL Players Association (NFLPA) began the 2020 football season in July, implementing extensive mitigation and surveillance measures in facilities and during travel and gameplay. Mitigation protocols* were evaluated and modified based on data from routine reverse transcription-polymerase chain reaction (RT-PCR) tests for SARS-CoV-2, the virus that causes coronavirus 2019 (COVID-19); proximity tracking devices; and detailed interviews. Midseason, transmission was observed in persons who had cumulative interactions of <15 minutes' duration, leading to a revised definition of high-risk contacts that required consideration of mask use, setting and room ventilation in addition to proximity and duration of interaction. The NFL also developed an intensive protocol that imposed stricter infection prevention precautions when a case was identified at an NFL club. The intensive protocol effectively prevented the occurrence of high-risk interactions, with no high-risk contacts identified for 71% of traced cases at clubs under the intensive protocol. The incorporation of the nature and location of the interaction, including mask use, indoor versus outdoor setting, and ventilation, in addition to proximity and duration, likely improved identification of exposed persons at higher risk for SARS-CoV-2 infection. Quarantine of these persons, along with testing and intensive protocols, can reduce spread of infection.


Asunto(s)
/prevención & control , Trazado de Contacto , Fútbol Americano , /epidemiología , Humanos , Máscaras/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Medición de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología , Ventilación/estadística & datos numéricos
12.
Emerg Infect Dis ; 27(2): 452-462, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33496221

RESUMEN

Greece imposed a nationwide lockdown in March 2020 to mitigate transmission of severe acute respiratory syndrome coronavirus 2 during the first epidemic wave. We conducted a survey on age-specific social contact patterns to assess effects of physical distancing measures and used a susceptible-exposed-infectious-recovered model to simulate the epidemic. Because multiple distancing measures were implemented simultaneously, we assessed their overall effects and the contribution of each measure. Before measures were implemented, the estimated basic reproduction number (R0) was 2.38 (95% CI 2.01-2.80). During lockdown, daily contacts decreased by 86.9% and R0 decreased by 81.0% (95% credible interval [CrI] 71.8%-86.0%); each distancing measure decreased R0 by 10%-24%. By April 26, the attack rate in Greece was 0.12% (95% CrI 0.06%-0.26%), one of the lowest in Europe, and the infection fatality ratio was 1.12% (95% CrI 0.55%-2.31%). Multiple social distancing measures contained the first epidemic wave in Greece.


Asunto(s)
/epidemiología , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Modelos Estadísticos , Cuarentena/estadística & datos numéricos , Adolescente , Adulto , Anciano , /transmisión , Niño , Preescolar , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Grecia/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Cuarentena/legislación & jurisprudencia , Adulto Joven
13.
BMJ Open ; 11(1): e043356, 2021 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-33462101

RESUMEN

OBJECTIVES: We aimed to assess the level of adherence to COVID-19 preventive measures in the Democratic Republic of the Congo (DRC) and to identify factors associated with non-adherence. DESIGN: A cross-sectional population-based online survey. SETTINGS: The study was conducted in 22 provinces of the DRC. Five provinces with a satisfactory number of respondents were included in the analysis: Haut Katanga, Kasaï-Central, Kasaï-Oriental, Kinshasa and North Kivu. PARTICIPANTS: The participants were people aged ≥18 years, living in the DRC. A total of 3268 participants were included in the study analysis. INTERVENTIONS: Both convenience sampling (surveyors themselves contacted potential participants in different districts) and snowball sampling (the participants were requested to share the link of the questionnaire with their contacts) methods were used. PRIMARY AND SECONDARY OUTCOME MEASURES: We computed adherence scores using responses to 10 questions concerning COVID-19 preventive measures recommended by the WHO and the DRC Ministry of Health. We used logistic regression analysis with generalised estimating equations to identify factors of poor adherence. We also asked about the presence or absence of flu-like symptoms during the preceding 14 days, whether a COVID-19 test was done and the test result. RESULTS: Data from 3268 participants were analysed. Face masks were not used by 1789 (54.7%) participants. Non-adherence to physical distancing was reported by 1364 (41.7%) participants. 501 (15.3%) participants did not observe regular handwashing. Five variables were associated with poor adherence: lower education level, living with other people at home, being jobless/students, living with a partner and not being a healthcare worker. CONCLUSION: Despite compulsory restrictions imposed by the government, only about half of the respondents adhered to COVID-19 preventive measures in the DRC. Disparities across the provinces are remarkable. There is an urgent need to further explore the reasons for these disparities and factors associated with non-adherence.


Asunto(s)
/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , República Democrática del Congo , Femenino , Guías como Asunto , Desinfección de las Manos , Humanos , Modelos Logísticos , Masculino , Máscaras , Persona de Mediana Edad , Cuarentena/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
14.
JAMA Netw Open ; 4(1): e2035281, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33492377

RESUMEN

Importance: Public health initiatives that include shelter-in-place orders are expensive and unpopular. Demonstrating the success of these initiatives is essential to justify their systemic or individual cost. Objective: To examine the association of a shelter-in-place order with lower rates of seasonal respiratory viral activity. Design, Setting, and Participants: This cohort study with interrupted time series analysis obtained monthly counts of respiratory virus testing results at UC Davis Health from August 1, 2014, to July 31, 2020. Patients of all ages underwent testing conducted by the laboratory at UC Davis Health, a referral center for a 65 000-square-mile area that includes 33 counties and more than 6 million Northern California residents. Exposures: A statewide shelter-in-place order was instituted on March 19, 2020, restricting residents to their homes except for traveling for essential activities. Large social gatherings were prohibited, schools were closed, and nonessential personnel worked remotely. Those who had to leave their homes were mandated to wear face masks, engage in frequent handwashing, and maintain physical distancing. Main Outcomes and Measures: Positivity rates of common respiratory viruses within the community served by UC Davis Health. Results: A total of 46 128 tests for viral respiratory pathogens over a 6-year period were included in the analysis. For the postexposure period (March 25-July 31), approximately 168 positive test results occurred for the studied organisms in the 2020 virus year, a positivity rate of 9.88 positive results per 100 tests that was much lower than the positivity rate of 29.90 positive results per 100 tests observed for this date range in the previous 5 virus years. In contrast, the positivity rates were similar for the preexposure time frame (August 1-March 24) in the 2020 virus year and for the same time periods in the 5 previous years (30.40 vs 33.68 positive results per 100 tests). In the regression analyses, statistically significant decreases in viral activity were observed in the postexposure period for influenza (93% decrease; incidence rate ratio [IRR], 0.07; 95% CI, 0.02-0.33) and for rhinovirus or enterovirus (81% decrease; IRR, 0.19; 95% CI, 0.09-0.39) infections. Lower rates of postexposure viral activity were seen for respiratory syncytial virus, parainfluenzavirus, coronaviruses, and adenoviruses; however, these associations were not statistically significant. Conclusions and Relevance: Using interrupted time series analysis of testing for viral respiratory pathogens, this study found that statistically significant lower rates of common community respiratory viruses appeared to be associated with a shelter-in-place order during the coronavirus disease 2019 pandemic.


Asunto(s)
/prevención & control , Cuarentena/normas , Infecciones del Sistema Respiratorio/virología , Estaciones del Año , Adolescente , Adulto , California/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuarentena/métodos , Cuarentena/estadística & datos numéricos , Infecciones del Sistema Respiratorio/epidemiología
15.
JAMA Netw Open ; 4(1): e2032101, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33471117

RESUMEN

Importance: To prepare for future coronavirus disease 2019 (COVID-19) waves, Nigerian policy makers need insights into community spread of COVID-19 and changes in rates of infection associated with government-mandated closures and restrictions. Objectives: To measure the association of closures and restrictions with aggregate mobility and the association of mobility with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and to characterize community spread of COVID-19. Design, Setting, and Participants: This cross-sectional study used aggregated anonymized mobility data from smartphone users in Nigeria who opted to provide location history (from a pool of up to 40 million individuals) collected between February 27 and July 21, 2020. The analyzed data included daily counts of confirmed SARS-CoV-2 infections and daily changes in aggregate mobility across 6 categories: retail and recreation, grocery and pharmacy, parks, transit stations, workplaces, and residential. Closures and restrictions were initiated on March 30, 2020, and partially eased on May 4, 2020. Main Outcomes and Measures: Interrupted time series were used to measure associations of closures and restrictions with aggregate mobility. Negative binomial regression was used to evaluate associations between confirmed SARS-CoV-2 infections and mobility categories. Averted infections were estimated by subtracting cumulative confirmed infections from estimated infections assuming no closures and restrictions. Results: Closures and restrictions had negative associations with mean change in daily aggregate mobility in retail and recreation (-46.87 [95% CI, -55.98 to -37.76] percentage points; P < .001), grocery and pharmacy (-28.95 [95% CI, -40.12 to -17.77] percentage points; P < .001), parks (-43.59 [95% CI, -49.89 to -37.30] percentage points; P < .001), transit stations (-47.44 [95% CI, -56.70 to -38.19] percentage points; P < .001), and workplaces (-53.07 [95% CI, -67.75 to -38.39] percentage points; P < .001) and a positive association with mobility in residential areas (24.10 [95% CI, 19.14 to 29.05] percentage points; P < .001). Most of these changes reversed after closures and restrictions were partially eased (retail and recreation: 14.63 [95% CI, 10.95 to 18.30] percentage points; P < .001; grocery and pharmacy: 15.29 [95% CI, 10.90 to 19.67] percentage points; P < .001; parks: 6.48 [95% CI, 3.98 to 8.99] percentage points; P < .001; transit stations: 17.93 [95% CI, 14.03 to 21.83] percentage points; P < .001; residential: -5.59 [95% CI, -9.08 to -2.09] percentage points; P = .002). Additionally, every percentage point increase in aggregate mobility was associated with higher incidences of SARS-CoV-2 infection in residential areas (incidence rate ratio [IRR], 1.03 [95% CI, 1.00 to 1.07]; P = .04), transit stations (IRR, 1.02 [95% CI, 1.00 to 1.03]; P = .008), and workplaces (IRR, 1.01 [95% CI, 1.00 to 1.02]; P = .04). Lastly, closures and restrictions may have been associated with averting up to 5.8 million SARS-CoV-2 infections over the study period. Conclusions and Relevance: In this cross-sectional study, closures and restrictions had significant associations with aggregate mobility and were associated with decreased SARS-CoV-2 infections. These findings suggest that future anticontagion measures need better infection control and contact tracing in residential areas, transit stations, and workplaces.


Asunto(s)
/epidemiología , Monitoreo Epidemiológico , Programas Obligatorios/organización & administración , Cuarentena/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nigeria , Salud Pública , Viaje
16.
Medicina (Kaunas) ; 57(1)2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429989

RESUMEN

Background and objectives: It has been suggested that the COVID-19 pandemic impaired people's moods and general levels of physical activity, but the way in which each country is coping with the situation may result in different outcomes. The aim of the present study was to compare the mental health and physical activity levels between residents of Brazil and Switzerland during the social distancing period associated with COVID-19 pandemic. Materials and Methods: A self-administered questionnaire aiming to assess personal, quarantine, physical activity, and mood state disorders data was answered by 114 participants (57 from each country) of both sexes. Results: Swiss participants presented a higher frequency of people (47.4%) not abiding by social distancing measures compared to Brazilian participants (1.8%; p < 0.001, effect size = 0.56). There were no significant differences between the participants from the two countries regarding physical activity levels (p = 0.09). The Swiss presented a higher frequency (78.9%) of people without symptoms of depression compared to Brazilians (31.6%; p < 0.001, effect size = 0.48). The Swiss also presented a higher frequency (77.2%) of people without symptoms of anxiety compared to Brazilians (35.1%; p < 0.001, effect size = 0.43). There was a significant association between the restriction level and depression symptoms (p = 0.01, effect size = 0.25) but not with anxiety symptoms (p = 0.21, effect size = 0.16). Conclusions: According to the preliminary results, Brazilians presented a much higher frequency of depression and anxiety symptoms, which can be explained by characteristics other than the restriction level.


Asunto(s)
/psicología , Ejercicio Físico , Trastornos Mentales/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Brasil/epidemiología , Depresión/epidemiología , Femenino , Humanos , Masculino , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Cuarentena/psicología , Cuarentena/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Suiza/epidemiología
17.
Am J Prev Med ; 60(3): 318-326, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33309450

RESUMEN

INTRODUCTION: Previously estimated effects of social distancing do not account for changes in individual behavior before the implementation of stay-at-home policies or model this behavior in relation to the burden of disease. This study aims to assess the asynchrony between individual behavior and government stay-at-home orders, quantify the true impact of social distancing using mobility data, and explore the sociodemographic variables linked to variation in social distancing practices. METHODS: This study was a retrospective investigation that leveraged mobility data to quantify the time to behavioral change in relation to the initial presence of COVID-19 and the implementation of government stay-at-home orders. The impact of social distancing that accounts for both individual behavior and testing data was calculated using generalized mixed models. The role of sociodemographics in accounting for variation in social distancing behavior was modeled using a 10-fold cross-validated elastic net (linear machine learning model). Analysis was conducted in April‒July 2020. RESULTS: Across all the 1,124 counties included in this analysis, individuals began to socially distance at a median of 5 days (IQR=3-8) after 10 cumulative cases of COVID-19 were confirmed in their state, with state governments taking a median of 15 days (IQR=12-19) to enact stay-at-home orders. Overall, people began social distancing at a median of 12 days (IQR=8-17) before their state enacted stay-at-home orders. Of the 16 studies included in the review, 13 exclusively used government dates as a proxy for social distancing behavior, and none accounted for both testing and mobility. Using government stay-at-home dates as a proxy for social distancing (10.2% decrease in the number of daily cases) accounted for only 55% of the true impact of the intervention when compared with estimates using mobility (18.6% reduction). Using 10-fold cross-validation, 23 of 43 sociodemographic variables were significantly and independently predictive of variation in individual social distancing, with delays corresponding to an increase in a county's proportion of people without a high school diploma and proportion of racial and ethnic minorities. CONCLUSIONS: This retrospective analysis of mobility patterns found that social distancing behavior occurred well before the onset of government stay-at-home dates. This asynchrony leads to the underestimation of the impact of social distancing. Sociodemographic characteristics associated with delays in social distancing can help explain the disproportionate case burden and mortality among vulnerable communities.


Asunto(s)
/prevención & control , Comportamiento del Consumidor/estadística & datos numéricos , Cuarentena/normas , Poblaciones Vulnerables/psicología , Factores de Edad , Anciano , Costo de Enfermedad , Femenino , Geografía , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Distribución de Poisson , Política Pública , Cuarentena/psicología , Cuarentena/estadística & datos numéricos , Estudios Retrospectivos , Factores Socioeconómicos , Factores de Tiempo , Estados Unidos/epidemiología , Poblaciones Vulnerables/estadística & datos numéricos
18.
Psychiatry Res ; 295: 113631, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33310417

RESUMEN

Since the onset of the COVID-19 pandemic, many jurisdictions, including Canada, have made use of public health measures such as COVID-19 quarantine to reduce the transmission of the virus. To examine associations between these periods of quarantine and mental health, including suicidal ideation and deliberate self-harm, we examined data from a national survey of 3000 Canadian adults distributed between May 14-29, 2020. Notably, participants provided the reason(s) for quarantine. When pooling all reasons for quarantine together, this experience was associated with higher odds of suicidal ideation and deliberate self-harm in the two weeks preceding the survey. These associations remained even after controlling for age, household income, having a pre-existing mental health condition, being unemployed due to the pandemic, and living alone. However, the associations with mental health differed across reasons for quarantine; those who were self-isolating specifically due to recent travel were not found to have higher odds of suicidal ideation or deliberate self-harm. Our research suggests the importance of accounting for the reason(s) for quarantine in the implementation of this critical public health measure to reduce the mental health impacts of this experience.


Asunto(s)
Trastornos Mentales/epidemiología , Salud Mental/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Conducta Autodestructiva/epidemiología , Factores Socioeconómicos , Ideación Suicida , Desempleo/estadística & datos numéricos , Adulto , Canadá/epidemiología , Femenino , Humanos , Masculino
19.
Prev Med ; 143: 106371, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33321121

RESUMEN

The initial response to COVID-19 included quarantine policies. This study aims to determine the infection containment proportions and cost of two variations of quarantine policies based on geographic travel and close contact with infected individuals within deployed US military populations. Special Operations Command Africa (SOCAF) records of individuals quarantined between March 1, 2020 and June 1, 2020 were examined. The infection containment proportion and cost in containment hours were compared between types of quarantine and between geographic areas. Geographic quarantine contained 2 cases out of 63 quarantined individuals in West Africa (3.2%) compared to 0 out of 221 in East Africa (p = 0.0486). Close contact quarantine contained 3 cases out of 31 quarantined individuals in West Africa compared to 4 out of 55 in East Africa (7.3%, p = 0.6989). Total confinement was 42,048 h for each contained infection using geographic quarantine compared to 4076 h using close contact quarantine. In the US military population deployed to Africa for COVID-19, quarantining based on geographic movement is an order of magnitude more costly in terms of time for each contained infection then quarantining based on close contact with infected individuals. There is not a statistical difference between East and West Africa. The associated costs of quarantine must be carefully weighed against the risk of disease spread.


Asunto(s)
/economía , Geografía/estadística & datos numéricos , Política de Salud/economía , Personal Militar/estadística & datos numéricos , Cuarentena/economía , Cuarentena/psicología , Cuarentena/estadística & datos numéricos , Adulto , África Oriental , África Occidental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
20.
MMWR Morb Mortal Wkly Rep ; 69(5152): 1633-1637, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33382676

RESUMEN

To prevent further transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), CDC currently recommends that persons who have been in close contact with someone with SARS-CoV-2 infection should quarantine (stay away from other persons) for 14 days after the last known contact.* However, quarantine might be difficult to maintain for a prolonged period. A shorter quarantine might improve compliance, and CDC recommends two options to reduce the duration of quarantine for close contacts without symptoms, based on local circumstances and availability of testing: 1) quarantine can end on day 10 without a test or 2) quarantine can end on day 7 after receiving a negative test result.† However, shorter quarantine might permit ongoing disease transmission from persons who develop symptoms or become infectious near the end of the recommended 14-day period. Interim data from an ongoing study of household transmission of SARS-CoV-2 were analyzed to understand the proportion of household contacts that had detectable virus after a shortened quarantine period. Persons who were household contacts of index patients completed a daily symptom diary and self-collected respiratory specimens for 14 days. Specimens were tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR). Among 185 household contacts enrolled, 109 (59%) had detectable SARS-CoV-2 at any time; 76% (83/109) of test results were positive within 7 days, and 86% (94 of 109) were positive within 10 days after the index patient's illness onset date. Among household contacts who received negative SARS-CoV-2 test results and were asymptomatic through day 7, there was an 81% chance (95% confidence interval [CI] = 67%-90%) of remaining asymptomatic and receiving negative RT-PCR test results through day 14; this increased to 93% (95% CI = 78%-98%) for household members who were asymptomatic with negative RT-PCR test results through day 10. Although SARS-CoV-2 quarantine periods shorter than 14 days might be easier to adhere to, there is a potential for onward transmission from household contacts released before day 14.


Asunto(s)
/diagnóstico , Trazado de Contacto , Composición Familiar , Cuarentena/estadística & datos numéricos , Humanos , Tennessee/epidemiología , Factores de Tiempo , Wisconsin/epidemiología
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