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1.
J Stud Alcohol Drugs ; 84(3): 424-433, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36971766

RESUMO

OBJECTIVE: Government alcohol sales data were used to investigate associations between estimates of per capita age 15+ alcohol consumption, policy restrictiveness, and area-level deprivation. METHOD: We analyzed weekly consumption data (expressed as per capita age 15+ Canadian standard drinks [13.45 g of pure ethanol]) collected from all 89 local health areas in British Columbia, Canada, between April 2017 and April 2021. Our analyses were stratified by outlet type (total, on-premise, and off-premise). Our intervention was alcohol policy restrictiveness (operationalized by the Restrictiveness of Alcohol Policy Index), and our moderator was area-level deprivation (Canadian Index of Multiple Deprivation). The Restrictiveness of Alcohol Policy Index included hours of trading, the number of people permitted on site for on-premise venues, the proportion of outlets in operation, and the extent of permissible home delivery. RESULTS: Higher policy restrictiveness was associated with decreased consumption across all outlet types (ps < .001): when the most restrictive policies were implemented, consumption was reduced by 9% and 100% in off- and on-premise outlets, respectively. Area-based deprivation level modified the effect of policy restriction on per capita alcohol consumption (ps < .007): for total and off-premise consumption, the decrease was greatest among more economically deprived areas (ps < .001); for on-premise outlets, areas with a high proportion of racial and ethnic minorities increased their consumption (ps < .001). CONCLUSIONS: Alcohol-specific policy restrictions implemented in response to the COVID-19 pandemic were associated with reduced consumption. However, the magnitude and direction of change was moderated by area-based deprivation level, albeit inconsistently across various deprivation measures.


Assuntos
Consumo de Bebidas Alcoólicas , COVID-19 , Comércio , Etanol , Política de Saúde , Quarentena , COVID-19/epidemiologia , Etanol/economia , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Colúmbia Britânica/epidemiologia , Comércio/estatística & dados numéricos , Humanos , Adolescente , Adulto Jovem , Adulto , Quarentena/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Pessoa de Meia-Idade
2.
Nature ; 610(7930): 154-160, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35952712

RESUMO

The SARS-CoV-2 Delta (Pango lineage B.1.617.2) variant of concern spread globally, causing resurgences of COVID-19 worldwide1,2. The emergence of the Delta variant in the UK occurred on the background of a heterogeneous landscape of immunity and relaxation of non-pharmaceutical interventions. Here we analyse 52,992 SARS-CoV-2 genomes from England together with 93,649 genomes from the rest of the world to reconstruct the emergence of Delta and quantify its introduction to and regional dissemination across England in the context of changing travel and social restrictions. Using analysis of human movement, contact tracing and virus genomic data, we find that the geographic focus of the expansion of Delta shifted from India to a more global pattern in early May 2021. In England, Delta lineages were introduced more than 1,000 times and spread nationally as non-pharmaceutical interventions were relaxed. We find that hotel quarantine for travellers reduced onward transmission from importations; however, the transmission chains that later dominated the Delta wave in England were seeded before travel restrictions were introduced. Increasing inter-regional travel within England drove the nationwide dissemination of Delta, with some cities receiving more than 2,000 observable lineage introductions from elsewhere. Subsequently, increased levels of local population mixing-and not the number of importations-were associated with the faster relative spread of Delta. The invasion dynamics of Delta depended on spatial heterogeneity in contact patterns, and our findings will inform optimal spatial interventions to reduce the transmission of current and future variants of concern, such as Omicron (Pango lineage B.1.1.529).


Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , COVID-19/virologia , Cidades/epidemiologia , Busca de Comunicante , Inglaterra/epidemiologia , Genoma Viral/genética , Humanos , Quarentena/legislação & jurisprudência , SARS-CoV-2/genética , SARS-CoV-2/crescimento & desenvolvimento , SARS-CoV-2/isolamento & purificação , Viagem/legislação & jurisprudência
3.
PLoS One ; 17(3): e0264769, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35294472

RESUMO

Using the synthetic control method, we construct counterfactuals for what would have happened if Sweden had imposed a lockdown during the first wave of the COVID-19 epidemic. We consider eight different indicators, including a novel one that we construct by adjusting recorded daily COVID-19 deaths to account for weakly excess mortality. Correcting for data problems and re-optimizing the synthetic control for each indicator, we find that a lockdown would have had sizable effects within one week. The much longer delay estimated by two previous studies focusing on the number of positives cases is mainly driven by the extremely low testing frequency that prevailed in Sweden in the first months of the epidemic. This result appears relevant for choosing the timing of future lockdowns and highlights the importance of looking at several indicators to derive robust conclusions. We also find that our novel indicator is effective in correcting errors in the COVID-19 deaths series and that the quantitative effects of the lockdown are stronger than previously estimated.


Assuntos
COVID-19/mortalidade , Política de Saúde , Quarentena/legislação & jurisprudência , Atestado de Óbito , Humanos , Suécia/epidemiologia
4.
Sci Rep ; 12(1): 3970, 2022 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35273215

RESUMO

We study the problem of synthesizing lockdown policies-schedules of maximum capacities for different types of activity sites-to minimize the number of deceased individuals due to a pandemic within a given metropolitan statistical area (MSA) while controlling the severity of the imposed lockdown. To synthesize and evaluate lockdown policies, we develop a multiscale susceptible, infected, recovered, and deceased model that partitions a given MSA into geographic subregions, and that incorporates data on the behaviors of the populations of these subregions. This modeling approach allows for the analysis of heterogeneous lockdown policies that vary across the different types of activity sites within each subregion of the MSA. We formulate the synthesis of optimal lockdown policies as a nonconvex optimization problem and we develop an iterative algorithm that addresses this nonconvexity through sequential convex programming. We empirically demonstrate the effectiveness of the developed approach by applying it to six of the largest MSAs in the United States. The developed heterogeneous lockdown policies not only reduce the number of deceased individuals by up to 45 percent over a 100 day period in comparison with three baseline lockdown policies that are less heterogeneous, but they also impose lockdowns that are less severe.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Geografia , Quarentena/métodos , Cidades , Humanos , Quarentena/legislação & jurisprudência , Estados Unidos
6.
Nat Commun ; 13(1): 1012, 2022 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-35197443

RESUMO

Mitigation of SARS-CoV-2 transmission from international travel is a priority. We evaluated the effectiveness of travellers being required to quarantine for 14-days on return to England in Summer 2020. We identified 4,207 travel-related SARS-CoV-2 cases and their contacts, and identified 827 associated SARS-CoV-2 genomes. Overall, quarantine was associated with a lower rate of contacts, and the impact of quarantine was greatest in the 16-20 age-group. 186 SARS-CoV-2 genomes were sufficiently unique to identify travel-related clusters. Fewer genomically-linked cases were observed for index cases who returned from countries with quarantine requirement compared to countries with no quarantine requirement. This difference was explained by fewer importation events per identified genome for these cases, as opposed to fewer onward contacts per case. Overall, our study demonstrates that a 14-day quarantine period reduces, but does not completely eliminate, the onward transmission of imported cases, mainly by dissuading travel to countries with a quarantine requirement.


Assuntos
COVID-19/prevenção & controle , Doenças Transmissíveis Importadas/prevenção & controle , Quarentena/legislação & jurisprudência , SARS-CoV-2/genética , COVID-19/epidemiologia , COVID-19/transmissão , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/transmissão , Busca de Comunicante , Inglaterra/epidemiologia , Genoma Viral/genética , Genômica , Avaliação do Impacto na Saúde , Humanos , SARS-CoV-2/classificação , Viagem/legislação & jurisprudência , Doença Relacionada a Viagens
11.
PLoS One ; 16(9): e0254432, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495962

RESUMO

INTRODUCTION: Community engagement (CE) is an effective public health strategy for improving health outcomes. There is limited published knowledge about effective approaches to CE in ensuring effective responses to COVID-19 throughout lockdowns, travel restrictions and social distancing. In this paper, we contribute to bridging this gap by highlighting experience of CE in Vietnam, specifically focusing on migrant workers in Vietnam. METHODS: A cross-sectional qualitative study design was used with qualitative data collection was carried out during August-October 2020. Two districts were purposefully selected from two large industrial zones. Data was collected using in-depth interviews (n = 36) with individuals and households, migrants and owners of dormitories, industrial zone factory representatives, community representatives and health authorities. Data was analyzed using thematic analysis approach. The study received ethics approval from the Hanoi University Institutional Review Board. RESULTS: The government's response to COVID-19 was spearheaded by the multi-sectoral National Steering Committee for the Prevention and Control of COVID-19, chaired by the Vice Prime Minister and comprised different members from 23 ministries. This structure was replicated throughout the province and local levels and all public and private organizations. Different activities were carried out by local communities, following four key principles of infection control: early detection, isolation, quarantine and hospitalization. We found three key determinants of engagement of migrant workers with COVID-19 prevention and control: availability of resources, appropriate capacity strengthening, transparent and continuous communication and a sense of trust in government legitimacy. DISCUSSION AND CONCLUSION: Our results support the current literature on CE in infection control which highlights the importance of context and suggests that future CE should consider five key components: multi-sectoral collaboration with a whole-of-community approach to strengthen governance structures with context-specific partnerships; mobilization of resources and decentralization of decision making to encourage self-reliance and building of local capacity; capacity building through training and supervision to local institutions; transparent and clear communication of health risks and sensitization of local communities to improve compliance and foster trust in the government measures; and understanding the urgent needs ensuring of social security and engaging all parts of the community, specifically the vulnerable groups.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/legislação & jurisprudência , Participação da Comunidade/legislação & jurisprudência , Adulto , Fortalecimento Institucional/legislação & jurisprudência , Comunicação , Estudos Transversais , Coleta de Dados/legislação & jurisprudência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , SARS-CoV-2/patogenicidade , Confiança , Vietnã , Adulto Jovem
12.
PLoS One ; 16(9): e0256624, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34559821

RESUMO

Laws not only affect behavior due to changes in material payoffs, but they may also change the perception individuals have of social norms, either by shifting them directly or by providing information on these norms. Using detailed daily survey data and exploiting the introduction of lockdown measures in the UK in the context of the COVID-19 health crisis, we provide causal evidence that the law drastically changed the perception of the norms regarding social distancing behaviors. We show that this effect of laws on perceived norms is mostly driven by an informational channel and that the intervention made perceptions of social norms converge to the actual prevalent norm.


Assuntos
COVID-19 , Percepção , Quarentena/legislação & jurisprudência , SARS-CoV-2 , Comportamento Social , Normas Sociais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Reino Unido
15.
Am J Drug Alcohol Abuse ; 47(5): 605-611, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34087086

RESUMO

Background: COVID-19 related stay-at-home (SAH) orders created many economic and social stressors, possibly increasing the risk of drug/alcohol abuse in the community and trauma population.Objectives: Describe changes in alcohol/drug use in traumatically injured patients after SAH orders in California and evaluate demographic or injury pattern changes in alcohol or drug-positive patients.Methods: A retrospective analysis of 11 trauma centers in Southern California (1/1/2020-6/30/2020) was performed. Blood alcohol concentration, urine toxicology results, demographics, and injury characteristics were collected. Patients were grouped based on injury date - before SAH (PRE-SAH), immediately after SAH (POST-SAH), and a historical comparison (3/19/2019-6/30/2019) (CONTROL) - and compared in separate analyses. Groups were compared using chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.Results: 20,448 trauma patients (13,634 male, 6,814 female) were identified across three time-periods. The POST-SAH group had higher rates of any drug (26.2% vs. 21.6% and 24.7%, OR = 1.26 and 1.08, p < .001 and p = .035), amphetamine (10.4% vs. 7.5% and 9.3%, OR = 1.43 and 1.14, p < .001 and p = .023), tetrahydrocannabinol (THC) (13.8% vs. 11.0% and 11.4%, OR = 1.30 and 1.25, p < .001 and p < .001), and 3,4-methylenedioxy methamphetamine (MDMA) (0.8% vs. 0.4% and 0.2%, OR = 2.02 and 4.97, p = .003 and p < .001) positivity compared to PRE-SAH and CONTROL groups. Alcohol concentration and positivity were similar between groups (p > .05).Conclusion: This Southern California multicenter study demonstrated increased amphetamine, MDMA, and THC positivity in trauma patients after SAH, but no difference in alcohol positivity or blood concentration. Drug prevention strategies should continue to be adapted within and outside of hospitals during a pandemic.


Assuntos
COVID-19/epidemiologia , Detecção do Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , California/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quarentena/legislação & jurisprudência , Estudos Retrospectivos , SARS-CoV-2 , Centros de Traumatologia , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-34074233

RESUMO

ABSTRACT: With COVID-19 affecting millions of people around the globe, quarantine of international arrivals is a critical public health measure to prevent further disease transmission in local populations. This measure has also been applied in the repatriation of citizens, undertaken by several countries as an ethical obligation and legal responsibility. This article describes the process of planning and preparing for the repatriation operation in South Australia during the COVID-19 pandemic. Interagency collaboration, development of a COVID-19 testing and quarantining protocol, implementing infection prevention and control, and building a specialised health care delivery model were essential aspects of the repatriation operational planning, with a focus on maintaining dignity and wellbeing of the passengers as well as on effective prevention of COVID-19 transmission. From April 2020 to mid-February 2021, more than 14,000 international arrivals travellers have been repatriated under the South Australian repatriation operations. This paper has implications to inform ongoing repatriation efforts in Australia and overseas in a pandemic situation.


Assuntos
COVID-19/epidemiologia , Controle de Infecções/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , COVID-19/diagnóstico , COVID-19/transmissão , Teste para COVID-19/métodos , Teste para COVID-19/normas , Atenção à Saúde , Humanos , Controle de Infecções/métodos , Regulamento Sanitário Internacional , Pandemias , Saúde Pública/métodos , Quarentena/métodos , Medição de Risco , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Austrália do Sul/epidemiologia , Viagem
17.
PLoS One ; 16(6): e0251722, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34061864

RESUMO

BACKGROUND: Mexican state governments' actions are essential to control the COVID-19 pandemic within the country. However, the type, rigor and pace of implementation of public policies have varied considerably between states. Little is known about the subnational (state) variation policy response to the COVID-19 pandemic in Mexico. MATERIAL AND METHODS: We collected daily information on public policies designed to inform the public, as well as to promote distancing, and mask use. The policies analyzed were: School Closure, Workplace Closure, Cancellation of Public Events, Restrictions on Gatherings, Stay at Home Order, Public Transit Suspensions, Information Campaigns, Internal Travel Controls, International Travel Controls, Use of Face Masks We use these data to create a composite index to evaluate the adoption of these policies in the 32 states. We then assess the timeliness and rigor of the policies across the country, from the date of the first case, February 27, 2020. RESULTS: The national average in the index during the 143 days of the pandemic was 41.1 out of a possible 100 points on our index. Nuevo León achieved the highest performance (50.4); San Luis Potosí the lowest (34.1). The differential between the highest versus the lowest performance was 47.4%. CONCLUSIONS: The study identifies variability and heterogeneity in how and when Mexican states implemented policies to contain COVID-19. We demonstrate the absence of a uniform national response and widely varying stringency of state responses. We also show how these responses are not based on testing and do not reflect the local burden of disease. National health system stewardship and a coordinated, timely, rigorous response to the pandemic did not occur in Mexico but is desirable to contain COVID-19.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Regulamentação Governamental , Política de Saúde/legislação & jurisprudência , Pandemias , Distanciamento Físico , SARS-CoV-2/patogenicidade , COVID-19/transmissão , Humanos , Máscaras/provisão & distribuição , México/epidemiologia , Quarentena/legislação & jurisprudência , Quarentena/organização & administração , Viagem
18.
PLoS One ; 16(6): e0252224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34061912

RESUMO

As countries are lifting restrictions and resuming international travels, the rising risk of COVID-19 importation remains concerning, given that the SARS-CoV-2 virus could be transmitted unintentionally through the global transportation network. To explore and assess the effective strategies for curtailing the epidemic risk from international importation nationwide, we evaluated "the joint prevention and control" mechanism, which made up of 19 containment policies, on how it impacted the change of medical observation and detection time from border arrival to laboratory confirmation of COVID-19 in its burst in China. Based on 1,314 epidemiological-survey cases from February 29 to May 25, 2020, we found that the synchronized approach of implementing multi-dimensional interventional policies, such as a centralized quarantine and nucleic acid testing (NAT), flight service adjustment and border closure, effectively facilitate early identification of infected case. Specifically, the implementation of the international flight service reduction was found to be associated with a reduction of the mean intervals of diagnosis from arrival to lab-confirmation by 0.44 days maximally, and the border closure was associated with a reduction of the diagnosis interval of imported cases by 0.69 days, from arrival to laboratory confirmation. The study suggests that a timely and synchronized implementation of multi-dimensional policies is compelling in preventing domestic spreading from importation.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Regulamentação Governamental , Política de Saúde/legislação & jurisprudência , Pandemias , Distanciamento Físico , SARS-CoV-2/patogenicidade , COVID-19/transmissão , China/epidemiologia , Emigração e Imigração/legislação & jurisprudência , Humanos , Máscaras/provisão & distribuição , Quarentena/legislação & jurisprudência , Quarentena/organização & administração , Viagem/estatística & dados numéricos
19.
Travel Med Infect Dis ; 42: 102084, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34048935

RESUMO

BACKGROUND: The importation of SARS-CoV-2 through air travel poses substantial risks to generate new COVID-19 outbreaks. Timely contact tracing is particularly crucial to limit onwards transmission in settings without established community transmission. METHODS: We conducted an in-depth analysis of the response to a big flight-associated COVID-19 outbreak in Vietnam in March 2020 that involved contact tracing, systematic testing and strict quarantine up to third generation contacts. RESULTS: 183 primary contacts from the flight as well as 1000 secondary and 311 third generation contacts were traced, tested, and quarantined across 15 provinces across Vietnam. The protracted confirmation of the index case at 3 days and 19 h after arrival resulted in isolation/quarantine delays of 6.8 days (IQR 6.3-6.8) and 5.8 days (IQR 5.8-7.0) for primary and secondary cases, respectively, which generated 84.0 and 26.4 person-days of community exposure from primary and secondary cases, respectively. Nevertheless, only 5 secondary cases occurred. CONCLUSIONS: A large flight-related COVID-19 cluster was successfully contained through timely, systematic and comprehensive public health responses despite delayed index case identification. Multiagency collaboration and pre-established mechanisms are crucial for low and middle income countries like Vietnam to limit community transmission after COVID-19 importation through air travel.


Assuntos
Teste para COVID-19 , COVID-19/diagnóstico , COVID-19/prevenção & controle , Busca de Comunicante , Surtos de Doenças/estatística & dados numéricos , Quarentena/legislação & jurisprudência , COVID-19/epidemiologia , COVID-19/transmissão , Governo Federal , Humanos , SARS-CoV-2/isolamento & purificação , Vietnã/epidemiologia
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