Corrigendum to "Modeling vaccination coverage during the 2022 central Ohio measles outbreak: a cross-sectional study" [The Lancet Regional Health-Americas 2023; 23: 100533].

[This corrects the article DOI: 10.1016/j.lana.2023.100533.].

An Epidemic Model for Multi-Intervention Outbreaks.

Modeling is an important tool to utilize at the beginning of an infectious disease outbreak, as it allows estimation of parameters - such as the basic reproduction number, R0-that can be used to postulate how the outbreak may continue to spread. However, there exist many challenges that need to be accounted for, such as an unknown first case date, retrospective reporting of 'probable' cases, changing dynamics between case count and death count trends, and the implementation of multiple control efforts and their delayed or diminished effects. Using the near-daily data provided from the recent outbreak of Sudan ebolavirus in Uganda as a case study, we create a model and present a framework aimed at overcoming these aforementioned challenges. The impact of each challenge is examined by comparing model estimates and fits throughout our framework. Indeed, we found that allowing for multiple fatality rates over the course of an outbreak generally resulted in better fitting models. On the other hand, not knowing the start date of an outbreak appeared to have large and non-uniform effects on parameter estimates, particularly at the beginning stages of an outbreak. While models that did not account for the decaying effect of interventions on transmission underestimated R0, all decay models run on the full dataset yielded precise R0 estimates, demonstrating the robustness of R0 as a measure of disease spread when examining data from the entire outbreak.

Modeling vaccination coverage during the 2022 central Ohio measles outbreak: a cross-sectional study.

Background: Of the eight large (>50 cases) US postelimination outbreaks, the first and last occurred in Ohio. Ohio's vaccination registry is incomplete. Community-level immunity gaps threaten more than two decades of measles elimination in the US. We developed a statistical model, VaxEstim, to rapidly estimate the early-phase vaccination coverage and immunity gap in the exposed population during the 2022 Central Ohio outbreak. Methods: We used reconstructed daily incidence (from publicly available data) and assumptions about the distribution of the serial interval, or the time between symptom onset in successive measles cases, to estimate the effective reproduction number (i.e., the average number of secondary infections caused by an infected individual in a partially immune population). We estimated early-phase measles vaccination coverage by comparing the effective reproduction number to the basic reproduction number (i.e., the average number of secondary infections caused by an infected individual in a fully susceptible population) while accounting for vaccine effectiveness. Finally, we estimated the early-phase immunity gap as the difference between the estimated critical vaccination threshold and vaccination coverage. Findings: VaxEstim estimated the early-phase vaccination coverage as 53% (95% credible interval, 21%-77%), the critical vaccination threshold as 93%, and the immunity gap as 42% (95% credible interval, 18%-74%). Interpretation: This study estimates a significant immunity gap in the exposed population during the early phase of the 2022 Central Ohio measles outbreak, suggesting a robust public health response is needed to identify the susceptible community and develop community-specific strategies to close the immunity gap. Funding: This work was supported in part by the National Institute of General Medical Sciences, National Institutes of Health; the UK Medical Research Council (MRC); the Foreign, Commonwealth and Development Office; the National Institute for Health Research (NIHR) Health Protection Research Unit in Modelling Methodology; Imperial College London, and the London School of Hygiene & Tropical Medicine, Community Jameel; the EDCTP2 programme, supported by the EU; and the Sergei Brin Foundation.

A mixed-methods assessment of off-duty police shootings in a media-curated database.

OBJECTIVE: The aim of this study was to examine rates of killings perpetrated by off-duty police and news coverage of those killings, by victim race and gender, and to qualitatively evaluate the contexts in which those killings occur. DATA SOURCES AND STUDY SETTING: We used the Mapping Police Violence database to curate a dataset of killings perpetrated by off-duty police (2013-2021, N = 242). We obtained data from Media Cloud to assess news coverage of each off-duty police-perpetrated killing. STUDY DESIGN: Our study used a convergent mixed-methods design. We examined off-duty police-perpetrated killings by victim race and gender, comparing absolute rates and rates relative to total police-perpetrated killings. [Correction added on 26 June 2023, after first online publication: 'policy-perpetrated' has been changed to 'police-perpetrated' in the preceding sentence.] We also conducted race-gender comparisons of the frequency of news media reporting of these killings, and whether reporting identified the perpetrator as an off-duty officer. We conducted thematic analysis of the narrative free-text field that accompanied quantitative data using grounded theory. PRINCIPAL FINDINGS: Black men were the most frequent victims killed by off-duty police (39.3%) followed by white men (25.2%), Hispanic men (11.2%), white women (9.1%), men of unknown race (9.1%), and Black women (4.1%). Black women had the highest rate of off-duty/total police-perpetrated killings relative to white men (rate = 12.82%, RR = 8.32, 95% CI: 4.43-15.63). There were threefold higher odds of news reporting of a police-perpetrated killing and the off-duty status of the officer for incidents with Black and Hispanic victims. Qualitative analysis revealed that off-duty officers intervened violently within their own social networks; their presence escalated situations; they intentionally obscured information about their lethal violence; they intervened while impaired; their victims were often in crisis; and their intervention posed harm and potential secondary traumatization to witnesses. CONCLUSIONS: Police perpetrate lethal violence while off duty, compromising public health and safety. Additionally, off-duty police-perpetrated killings are reported differentially by the news media depending on the race of the victim.

Evolving Face Mask Guidance During a Pandemic and Potential Harm to Public Perception: Infodemiology Study of Sentiment and Emotion on Twitter.

BACKGROUND: Throughout the COVID-19 pandemic, US Centers for Disease Control and Prevention policies on face mask use fluctuated. Understanding how public health communications evolve around key policy decisions may inform future decisions on preventative measures by aiding the design of communication strategies (eg, wording, timing, and channel) that ensure rapid dissemination and maximize both widespread adoption and sustained adherence. OBJECTIVE: We aimed to assess how sentiment on masks evolved surrounding 2 changes to mask guidelines: (1) the recommendation for mask use on April 3, 2020, and (2) the relaxation of mask use on May 13, 2021. METHODS: We applied an interrupted time series method to US Twitter data surrounding each guideline change. Outcomes were changes in the (1) proportion of positive, negative, and neutral tweets and (2) number of words within a tweet tagged with a given emotion (eg, trust). Results were compared to COVID-19 Twitter data without mask keywords for the same period. RESULTS: There were fewer neutral mask-related tweets in 2020 (ß=-3.94 percentage points, 95% CI -4.68 to -3.21; P<.001) and 2021 (ß=-8.74, 95% CI -9.31 to -8.17; P<.001). Following the April 3 recommendation (ß=.51, 95% CI .43-.59; P<.001) and May 13 relaxation (ß=3.43, 95% CI 1.61-5.26; P<.001), the percent of negative mask-related tweets increased. The quantity of trust-related terms decreased following the policy change on April 3 (ß=-.004, 95% CI -.004 to -.003; P<.001) and May 13 (ß=-.001, 95% CI -.002 to 0; P=.008). CONCLUSIONS: The US Twitter population responded negatively and with less trust following guideline shifts related to masking, regardless of whether the guidelines recommended or relaxed mask usage. Federal agencies should ensure that changes in public health recommendations are communicated concisely and rapidly.

Measuring concordance of data sources used for infectious disease research in the USA: a retrospective data analysis.

OBJECTIVES: As highlighted by the COVID-19 pandemic, researchers are eager to make use of a wide variety of data sources, both government-sponsored and alternative, to characterise the epidemiology of infectious diseases. The objective of this study is to investigate the strengths and limitations of sources currently being used for research. DESIGN: Retrospective descriptive analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Yearly number of national-level and state-level disease-specific case counts and disease clusters for three diseases (measles, mumps and varicella) during a 5-year study period (2013-2017) across four different data sources: Optum (health insurance billing claims data), HealthMap (online news surveillance data), Morbidity and Mortality Weekly Reports (official government reports) and National Notifiable Disease Surveillance System (government case surveillance data). RESULTS: Our study demonstrated drastic differences in reported infectious disease incidence across data sources. When compared with the other three sources of interest, Optum data showed substantially higher, implausible standardised case counts for all three diseases. Although there was some concordance in identified state-level case counts and disease clusters, all four sources identified variations in state-level reporting. CONCLUSIONS: Researchers should consider data source limitations when attempting to characterise the epidemiology of infectious diseases. Some data sources, such as billing claims data, may be unsuitable for epidemiological research within the infectious disease context.

Evaluating criminal justice reform during COVID-19: The need for a novel sentiment analysis package.

The health and safety of incarcerated persons and correctional personnel have been prominent in the U.S. news media discourse during the COVID-19 pandemic. Examining changing attitudes toward the health of the incarcerated population is imperative to better assess the extent to which the general public favors criminal justice reform. However, existing natural language processing lexicons that underlie current sentiment analysis (SA) algorithms may not perform adequately on news articles related to criminal justice due to contextual complexities. News discourse during the pandemic has highlighted the need for a novel SA lexicon and algorithm (i.e., an SA package) tailored for examining public health policy in the context of the criminal justice system. We analyzed the performance of existing SA packages on a corpus of news articles at the intersection of COVID-19 and criminal justice collected from state-level outlets between January and May 2020. Our results demonstrated that sentence sentiment scores provided by three popular SA packages can differ considerably from manually-curated ratings. This dissimilarity was especially pronounced when the text was more polarized, whether negatively or positively. A randomly selected set of 1,000 manually scored sentences, and the corresponding binary document term matrices, were used to train two new sentiment prediction algorithms (i.e., linear regression and random forest regression) to verify the performance of the manually-curated ratings. By better accounting for the unique context in which incarceration-related terminologies are used in news media, both of our proposed models outperformed all existing SA packages considered for comparison. Our findings suggest that there is a need to develop a novel lexicon, and potentially an accompanying algorithm, for analysis of text related to public health within the criminal justice system, as well as criminal justice more broadly.

Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave.

The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.

A generalizable data assembly algorithm for infectious disease outbreaks.

During infectious disease outbreaks, health agencies often share text-based information about cases and deaths. This information is rarely machine-readable, thus creating challenges for outbreak researchers. Here, we introduce a generalizable data assembly algorithm that automatically curates text-based, outbreak-related information and demonstrate its performance across 3 outbreaks. After developing an algorithm with regular expressions, we automatically curated data from health agencies via 3 information sources: formal reports, email newsletters, and Twitter. A validation data set was also curated manually for each outbreak, and an implementation process was presented for application to future outbreaks. When compared against the validation data sets, the overall cumulative missingness and misidentification of the algorithmically curated data were ≤2% and ≤1%, respectively, for all 3 outbreaks. Within the context of outbreak research, our work successfully addresses the need for generalizable tools that can transform text-based information into machine-readable data across varied information sources and infectious diseases.

Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave.

The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.

Tracking COVID-19 using online search.

Previous research has demonstrated that various properties of infectious diseases can be inferred from online search behaviour. In this work we use time series of online search query frequencies to gain insights about the prevalence of COVID-19 in multiple countries. We first develop unsupervised modelling techniques based on associated symptom categories identified by the United Kingdom's National Health Service and Public Health England. We then attempt to minimise an expected bias in these signals caused by public interest-as opposed to infections-using the proportion of news media coverage devoted to COVID-19 as a proxy indicator. Our analysis indicates that models based on online searches precede the reported confirmed cases and deaths by 16.7 (10.2-23.2) and 22.1 (17.4-26.9) days, respectively. We also investigate transfer learning techniques for mapping supervised models from countries where the spread of the disease has progressed extensively to countries that are in earlier phases of their respective epidemic curves. Furthermore, we compare time series of online search activity against confirmed COVID-19 cases or deaths jointly across multiple countries, uncovering interesting querying patterns, including the finding that rarer symptoms are better predictors than common ones. Finally, we show that web searches improve the short-term forecasting accuracy of autoregressive models for COVID-19 deaths. Our work provides evidence that online search data can be used to develop complementary public health surveillance methods to help inform the COVID-19 response in conjunction with more established approaches.

Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages.

BACKGROUND: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. OBJECTIVE: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. METHODS: We used a machine learning algorithm to identify patients' pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. RESULTS: Our results show a significant increase in the incidence of COVID-19-related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. CONCLUSIONS: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health.

Gender disparities in coronavirus disease 2019 clinical trial leadership.

OBJECTIVES: To compare the gender distribution of clinical trial leadership in coronavirus disease 2019 (COVID-19) clinical trials. METHODS: We searched https://clinicaltrials.gov/ and retrieved all clinical trials on COVID-19 from 1 January 2020 to 26 June 2020. As a comparator group, we have chosen two fields that are not related to emerging infections and infectious diseases: and considered not directly affected by the pandemic: breast cancer and type 2 diabetes mellitus (T2DM) and included studies within the aforementioned study period as well as those registered in the preceding year (pre-study period: 1 January 2019 to 31 December 2019). Gender of the investigator was predicted using the genderize.io application programming interface. The repository of the data sets used to collect and analyse the data are available at https://osf.io/k2r57/. RESULTS: Only 27.8% (430/1548) of principal investigators among COVID-19-related studies were women, which is significantly different compared with 54.9% (156/284) and 42.1% (56/133) for breast cancer (p < 0.005) and T2DM (p < 0.005) trials over the same period, respectively. During the pre-study period, the proportion of principal investigators who were predicted to be women were 49.7% (245/493) and 44.4% (148/333) for breast cancer and T2DM trials, respectively, and the difference was not statistically significant when compared with results from the study period (p > 0.05). CONCLUSION: We demonstrate that less than one-third of COVID-19-related clinical trials are led by women, half the proportion observed in non-COVID-19 trials over the same period, which remained similar to the pre-study period. These gender disparities during the pandemic may not only indicate a lack of female leadership in international clinical trials and involvement in new projects but also reveal imbalances in women's access to research activities and funding during health emergencies.

The role of environmental factors on transmission rates of the COVID-19 outbreak: an initial assessment in two spatial scales.

First identified in Wuhan, China, in December 2019, a novel coronavirus (SARS-CoV-2) has affected over 16,800,000 people worldwide as of July 29, 2020 and was declared a pandemic by the World Health Organization on March 11, 2020. Influenza studies have shown that influenza viruses survive longer on surfaces or in droplets in cold and dry air, thus increasing the likelihood of subsequent transmission. A similar hypothesis has been postulated for the transmission of COVID-19, the disease caused by SARS-CoV-2. It is important to propose methodologies to understand the effects of environmental factors on this ongoing outbreak to support decision-making pertaining to disease control. Here, we examine the spatial variability of the basic reproductive numbers of COVID-19 across provinces and cities in China and show that environmental variables alone cannot explain this variability. Our findings suggest that changes in weather (i.e., increase of temperature and humidity as spring and summer months arrive in the Northern Hemisphere) will not necessarily lead to declines in case counts without the implementation of drastic public health interventions.

Modeling between-population variation in COVID-19 dynamics in Hubei, Lombardy, and New York City.

As the COVID-19 pandemic continues, formulating targeted policy interventions that are informed by differential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission dynamics will be of vital importance to national and regional governments. We develop an individual-level model for SARS-CoV-2 transmission that accounts for location-dependent distributions of age, household structure, and comorbidities. We use these distributions together with age-stratified contact matrices to instantiate specific models for Hubei, China; Lombardy, Italy; and New York City, United States. Using data on reported deaths to obtain a posterior distribution over unknown parameters, we infer differences in the progression of the epidemic in the three locations. We also examine the role of transmission due to particular age groups on total infections and deaths. The effect of limiting contacts by a particular age group varies by location, indicating that strategies to reduce transmission should be tailored based on population-specific demography and social structure. These findings highlight the role of between-population variation in formulating policy interventions. Across the three populations, though, we find that targeted "salutary sheltering" by 50% of a single age group may substantially curtail transmission when combined with the adoption of physical distancing measures by the rest of the population.