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1.
Sci Rep ; 11(1): 5043, 2021 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-33658596

RESUMO

The current COVID-19 pandemic has impacted millions of people and the global economy. Tourism has been one the most affected economic sectors because of the mobility restrictions established by governments and uncoordinated actions from origin and destination regions. The coordination of restrictions and reopening policies could help control the spread of virus and enhance economies, but this is not an easy endeavor since touristic companies, citizens, and local governments have conflicting interests. We propose an evolutionary game model that reflects a collective risk dilemma behind these decisions. To this aim, we represent regions as players, organized in groups; and consider the perceived risk as a strict lock-down and null economic activity. The costs for regions when restricting their mobility are heterogeneous, given that the dependence on tourism of each region is diverse. Our analysis shows that, for both large populations and the EU NUTS2 case study, the existence of heterogeneous costs enhances global agreements. Furthermore, the decision on how to group regions to maximize the regions' agreement of the population is a relevant issue for decision makers to consider. We find out that a layout of groups based on similar costs of cooperation boosts the regions' agreements and avoid the risk of having a total lock-down and a negligible tourism activity. These findings can guide policy makers to facilitate agreements among regions to maximize the tourism recovery.


Assuntos
/economia , Controle de Doenças Transmissíveis/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Doenças Transmissíveis/economia , Transmissão de Doença Infecciosa/economia , Humanos , Modelos Estatísticos , Pandemias/economia , Fatores de Risco , Turismo
2.
Front Public Health ; 9: 620770, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33748065

RESUMO

Various measures have been taken in different countries to mitigate the Covid-19 epidemic. But, throughout the world, many citizens don't understand well how these measures are taken and even question the decisions taken by their government. Should the measures be more (or less) restrictive? Are they taken for a too long (or too short) period of time? To provide some quantitative elements of response to these questions, we consider the well-known SEIR model for the Covid-19 epidemic propagation and propose a pragmatic model of the government decision-making operation. Although simple and obviously improvable, the proposed model allows us to study the tradeoff between health and economic aspects in a pragmatic and insightful way. Assuming a given number of phases for the epidemic (namely, 4 in this paper) and a desired tradeoff between health and economic aspects, it is then possible to determine the optimal duration of each phase and the optimal severity level (i.e., the target transmission rate) for each of them. The numerical analysis is performed for the case of France but the adopted approach can be applied to any country. One of the takeaway messages of this analysis is that being able to implement the optimal 4-phase epidemic management strategy in France would have led to 1.05 million of infected people and a GDP loss of 231 billions € instead of 6.88 millions of infected and a loss of 241 billions €. This indicates that, seen from the proposed model perspective, the effectively implemented epidemic management strategy is good economically, whereas substantial improvements might have been obtained in terms of health impact. Our analysis indicates that the lockdown/severe phase should have been more severe but shorter, and the adjustment phase occurred earlier. Due to the natural tendency of people to deviate from the official rules, updating measures every month over the whole epidemic episode seems to be more appropriate.


Assuntos
Controle de Doenças Transmissíveis/economia , Análise Custo-Benefício/economia , Tomada de Decisões , Governo , Modelos Estatísticos , /economia , França/epidemiologia , Nível de Saúde , Humanos , Quarentena , Fatores de Tempo
4.
Lancet ; 397(10272): 398-408, 2021 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-33516338

RESUMO

BACKGROUND: The past two decades have seen expansion of childhood vaccination programmes in low-income and middle-income countries (LMICs). We quantify the health impact of these programmes by estimating the deaths and disability-adjusted life-years (DALYs) averted by vaccination against ten pathogens in 98 LMICs between 2000 and 2030. METHODS: 16 independent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, and yellow fever. Using standardised demographic data and vaccine coverage, the impact of vaccination programmes was determined by comparing model estimates from a no-vaccination counterfactual scenario with those from a reported and projected vaccination scenario. We present deaths and DALYs averted between 2000 and 2030 by calendar year and by annual birth cohort. FINDINGS: We estimate that vaccination of the ten selected pathogens will have averted 69 million (95% credible interval 52-88) deaths between 2000 and 2030, of which 37 million (30-48) were averted between 2000 and 2019. From 2000 to 2019, this represents a 45% (36-58) reduction in deaths compared with the counterfactual scenario of no vaccination. Most of this impact is concentrated in a reduction in mortality among children younger than 5 years (57% reduction [52-66]), most notably from measles. Over the lifetime of birth cohorts born between 2000 and 2030, we predict that 120 million (93-150) deaths will be averted by vaccination, of which 58 million (39-76) are due to measles vaccination and 38 million (25-52) are due to hepatitis B vaccination. We estimate that increases in vaccine coverage and introductions of additional vaccines will result in a 72% (59-81) reduction in lifetime mortality in the 2019 birth cohort. INTERPRETATION: Increases in vaccine coverage and the introduction of new vaccines into LMICs have had a major impact in reducing mortality. These public health gains are predicted to increase in coming decades if progress in increasing coverage is sustained. FUNDING: Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.


Assuntos
Controle de Doenças Transmissíveis , Doenças Transmissíveis/mortalidade , Doenças Transmissíveis/virologia , Modelos Teóricos , Mortalidade/tendências , Anos de Vida Ajustados por Qualidade de Vida , Vacinação , Pré-Escolar , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/estatística & dados numéricos , Doenças Transmissíveis/economia , Análise Custo-Benefício , Países em Desenvolvimento , Feminino , Saúde Global , Humanos , Programas de Imunização , Masculino , Vacinação/economia , Vacinação/estatística & dados numéricos
6.
Ann Intern Med ; 174(4): 472-483, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33347322

RESUMO

BACKGROUND: Colleges in the United States are determining how to operate safely amid the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To examine the clinical outcomes, cost, and cost-effectiveness of COVID-19 mitigation strategies on college campuses. DESIGN: The Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a dynamic microsimulation model, was used to examine alternative mitigation strategies. The CEACOV model tracks infections accrued by students and faculty, accounting for community transmissions. DATA SOURCES: Data from published literature were used to obtain parameters related to COVID-19 and contact-hours. TARGET POPULATION: Undergraduate students and faculty at U.S. colleges. TIME HORIZON: One semester (105 days). PERSPECTIVE: Modified societal. INTERVENTION: COVID-19 mitigation strategies, including social distancing, masks, and routine laboratory screening. OUTCOME MEASURES: Infections among students and faculty per 5000 students and per 1000 faculty, isolation days, tests, costs, cost per infection prevented, and cost per quality-adjusted life-year (QALY). RESULTS OF BASE-CASE ANALYSIS: Among students, mitigation strategies reduced COVID-19 cases from 3746 with no mitigation to 493 with extensive social distancing and masks, and further to 151 when laboratory testing was added among asymptomatic persons every 3 days. Among faculty, these values were 164, 28, and 25 cases, respectively. Costs ranged from about $0.4 million for minimal social distancing to about $0.9 million to $2.1 million for strategies involving laboratory testing ($10 per test), depending on testing frequency. Extensive social distancing with masks cost $170 per infection prevented ($49 200 per QALY) compared with masks alone. Adding routine laboratory testing increased cost per infection prevented to between $2010 and $17 210 (cost per QALY gained, $811 400 to $2 804 600). RESULTS OF SENSITIVITY ANALYSIS: Results were most sensitive to test costs. LIMITATION: Data are from multiple sources. CONCLUSION: Extensive social distancing with a mandatory mask-wearing policy can prevent most COVID-19 cases on college campuses and is very cost-effective. Routine laboratory testing would prevent 96% of infections and require low-cost tests to be economically attractive. PRIMARY FUNDING SOURCE: National Institutes of Health.


Assuntos
/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Pneumonia Viral/prevenção & controle , Universidades , Adulto , Controle de Doenças Transmissíveis/economia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Máscaras , Programas de Rastreamento/economia , Pandemias , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia
7.
JAMA Netw Open ; 3(12): e2028195, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351082

RESUMO

Importance: Approximately 356 000 people stay in homeless shelters nightly in the United States. They have high risk of contracting coronavirus disease 2019 (COVID-19). Objective: To assess the estimated clinical outcomes, costs, and cost-effectiveness associated with strategies for COVID-19 management among adults experiencing sheltered homelessness. Design, Setting, and Participants: This decision analytic model used a simulated cohort of 2258 adults residing in homeless shelters in Boston, Massachusetts. Cohort characteristics and costs were adapted from Boston Health Care for the Homeless Program. Disease progression, transmission, and outcomes data were taken from published literature and national databases. Surging, growing, and slowing epidemics (effective reproduction numbers [Re], 2.6, 1.3, and 0.9, respectively) were examined. Costs were from a health care sector perspective, and the time horizon was 4 months, from April to August 2020. Exposures: Daily symptom screening with polymerase chain reaction (PCR) testing of individuals with positive symptom screening results, universal PCR testing every 2 weeks, hospital-based COVID-19 care, alternative care sites (ACSs) for mild or moderate COVID-19, and temporary housing were each compared with no intervention. Main Outcomes and Measures: Cumulative infections and hospital-days, costs to the health care sector (US dollars), and cost-effectiveness, as incremental cost per case of COVID-19 prevented. Results: The simulated population of 2258 sheltered homeless adults had a mean (SD) age of 42.6 (9.04) years. Compared with no intervention, daily symptom screening with ACSs for pending tests or confirmed COVID-19 and mild or moderate disease was associated with 37% fewer infections (1954 vs 1239) and 46% lower costs ($6.10 million vs $3.27 million) at an Re of 2.6, 75% fewer infections (538 vs 137) and 72% lower costs ($1.46 million vs $0.41 million) at an Re of 1.3, and 51% fewer infections (174 vs 85) and 51% lower costs ($0.54 million vs $0.26 million) at an Re of 0.9. Adding PCR testing every 2 weeks was associated with a further decrease in infections; incremental cost per case prevented was $1000 at an Re of 2.6, $27 000 at an Re of 1.3, and $71 000 at an Re of 0.9. Temporary housing with PCR every 2 weeks was most effective but substantially more expensive than other options. Compared with no intervention, temporary housing with PCR every 2 weeks was associated with 81% fewer infections (376) and 542% higher costs ($39.12 million) at an Re of 2.6, 82% fewer infections (95) and 2568% higher costs ($38.97 million) at an Re of 1.3, and 59% fewer infections (71) and 7114% higher costs ($38.94 million) at an Re of 0.9. Results were sensitive to cost and sensitivity of PCR and ACS efficacy in preventing transmission. Conclusions and Relevance: In this modeling study of simulated adults living in homeless shelters, daily symptom screening and ACSs were associated with fewer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and decreased costs compared with no intervention. In a modeled surging epidemic, adding universal PCR testing every 2 weeks was associated with further decrease in SARS-CoV-2 infections at modest incremental cost and should be considered during future surges.


Assuntos
/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Custos de Cuidados de Saúde , Pessoas em Situação de Rua , Hospitalização/economia , Habitação/economia , Programas de Rastreamento/métodos , /economia , /transmissão , /métodos , Estudos de Coortes , Controle de Doenças Transmissíveis/economia , Simulação por Computador , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Humanos , Programas de Rastreamento/economia , Avaliação de Sintomas/economia , Avaliação de Sintomas/métodos , Estados Unidos/epidemiologia
11.
Math Biosci ; 330: 108496, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33075364

RESUMO

We introduce a deterministic SEIR model and fit it to epidemiological data for the COVID-19 outbreak in Ireland. We couple the model to economic considerations - we formulate an optimal control problem in which the cost to the economy of the various non-pharmaceutical interventions is minimized, subject to hospital admissions never exceeding a threshold value corresponding to health-service capacity. Within the framework of the model, the optimal strategy of disease control is revealed to be one of disease suppression, rather than disease mitigation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Número Básico de Reprodução/estatística & dados numéricos , Bioestatística , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Simulação por Computador , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/economia , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Modelos Econômicos , Modelos Estatísticos , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle
12.
PLoS One ; 15(10): e0240876, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33108374

RESUMO

Many different countries have been under lockdown or extreme social distancing measures to control the spread of COVID-19. The potentially far-reaching side effects of these measures have not yet been fully understood. In this study we analyse the results of a multi-country survey conducted in Italy (N = 3,504), Spain (N = 3,524) and the United Kingdom (N = 3,523), with two separate analyses. In the first analysis, we examine the elicitation of citizens' concerns over the downplaying of the economic consequences of the lockdown during the COVID-19 pandemic. We control for Social Desirability Bias through a list experiment included in the survey. In the second analysis, we examine the data from the same survey to predict the level of stress, anxiety and depression associated with being economically vulnerable and having been affected by a negative economic shock. To accomplish this, we have used a prediction algorithm based on machine learning techniques. To quantify the size of this affected population, we compare its magnitude with the number of people affected by COVID-19 using measures of susceptibility, vulnerability and behavioural change collected in the same questionnaire. We find that the concern for the economy and for "the way out" of the lockdown is diffuse and there is evidence of minor underreporting. Additionally, we estimate that around 42.8% of the populations in the three countries are at high risk of stress, anxiety, and depression, based on their level of economic vulnerability and their exposure to a negative economic shock.


Assuntos
Betacoronavirus , Infecções por Coronavirus/economia , Recessão Econômica , Transtornos Mentais/etiologia , Pandemias/economia , Pneumonia Viral/economia , Adolescente , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/etiologia , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Análise de Componente Principal , Quarentena/economia , Espanha/epidemiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários , Reino Unido/epidemiologia , Adulto Jovem
13.
Lancet Planet Health ; 4(10): e474-e482, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32976757

RESUMO

BACKGROUND: Exposure to poor air quality leads to increased premature mortality from cardiovascular and respiratory diseases. Among the far-reaching implications of the ongoing COVID-19 pandemic, a substantial improvement in air quality was observed worldwide after the lockdowns imposed by many countries. We aimed to assess the implications of different lockdown measures on air pollution levels in Europe and China, as well as the short-term and long-term health impact. METHODS: For this modelling study, observations of fine particulate matter (PM2·5) concentrations from more than 2500 stations in Europe and China during 2016-20 were integrated with chemical transport model simulations to reconstruct PM2·5 fields at high spatiotemporal resolution. The health benefits, expressed as short-term and long-term avoided mortality from PM2·5 exposure associated with the interventions imposed to control the COVID-19 pandemic, were quantified on the basis of the latest epidemiological studies. To explore the long-term variability in air quality and associated premature mortality, we built different scenarios of economic recovery (immediate or gradual resumption of activities, a second outbreak in autumn, and permanent lockdown for the whole of 2020). FINDINGS: The lockdown interventions led to a reduction in population-weighted PM2·5 of 14·5 µg m-3 across China (-29·7%) and 2·2 µg m-3 across Europe (-17·1%), with unprecedented reductions of 40 µg m-3 in bimonthly mean PM2·5 in the areas most affected by COVID-19 in China. In the short term, an estimated 24 200 (95% CI 22 380-26 010) premature deaths were averted throughout China between Feb 1 and March 31, and an estimated 2190 (1960-2420) deaths were averted in Europe between Feb 21 and May 17. We also estimated a positive number of long-term avoided premature fatalities due to reduced PM2·5 concentrations, ranging from 76 400 (95% CI 62 600-86 900) to 287 000 (233 700-328 300) for China, and from 13 600 (11 900-15 300) to 29 500 (25 800-33 300) for Europe, depending on the future scenarios of economic recovery adopted. INTERPRETATION: These results indicate that lockdown interventions led to substantial reductions in PM2·5 concentrations in China and Europe. We estimated that tens of thousands of premature deaths from air pollution were avoided, although with significant differences observed in Europe and China. Our findings suggest that considerable improvements in air quality are achievable in both China and Europe when stringent emission control policies are adopted. FUNDING: None.


Assuntos
Poluição do Ar/prevenção & controle , Controle de Doenças Transmissíveis/legislação & jurisprudência , Infecções por Coronavirus/prevenção & controle , Modelos Teóricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Betacoronavirus , China/epidemiologia , Controle de Doenças Transmissíveis/economia , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Europa (Continente)/epidemiologia , Humanos , Mortalidade Prematura/tendências , Pandemias/economia , Material Particulado/análise , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia
14.
Lancet ; 396(10261): 1525-1534, 2020 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-32979936

RESUMO

The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.


Assuntos
Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/legislação & jurisprudência , Infecções por Coronavirus/prevenção & controle , Política de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Comércio , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Europa (Continente) , Extremo Oriente , Humanos , Nova Zelândia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia
18.
MEDICC Rev ; 22(3): 16-19, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32812894

RESUMO

Cristian Morales, an economist by training, has dedicated his career to improving health and health equity in the Americas through his work with PAHO/WHO. This has taken him from hurricanes, earthquakes and epidemics in Haiti to PAHO's Washington DC offi ces, where he was instrumental in achieving consensus on a resolution aiming for universal health-coverage plus access-approved by all governments in the Americas. In 2015, he was appointed PAHO/WHO Permanent Representative in Cuba, and in 2018 to the same post in Mexico.


Assuntos
Controle de Doenças Transmissíveis/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , América/epidemiologia , Betacoronavirus , Humanos , México/epidemiologia
19.
Eur J Health Econ ; 21(9): 1329-1350, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32789780

RESUMO

Pandemics and major outbreaks have the potential to cause large health losses and major economic costs. To prioritize between preventive and responsive interventions, it is important to understand the costs and health losses interventions may prevent. We review the literature, investigating the type of studies performed, the costs and benefits included, and the methods employed against perceived major outbreak threats. We searched PubMed and SCOPUS for studies concerning the outbreaks of SARS in 2003, H5N1 in 2003, H1N1 in 2009, Cholera in Haiti in 2010, MERS-CoV in 2013, H7N9 in 2013, and Ebola in West-Africa in 2014. We screened titles and abstracts of papers, and subsequently examined remaining full-text papers. Data were extracted according to a pre-constructed protocol. We included 34 studies of which the majority evaluated interventions related to the H1N1 outbreak in a high-income setting. Most interventions concerned pharmaceuticals. Included costs and benefits, as well as the methods applied, varied substantially between studies. Most studies used a short time horizon and did not include future costs and benefits. We found substantial variation in the included elements and methods used. Policymakers need to be aware of this and the bias toward high-income countries and pharmaceutical interventions, which hampers generalizability. More standardization of included elements, methodology, and reporting would improve economic evaluations and their usefulness for policy.


Assuntos
Cólera/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Epidemias/economia , Viroses/epidemiologia , Cólera/economia , Cólera/terapia , Controle de Doenças Transmissíveis/economia , Análise Custo-Benefício , Humanos , Pandemias , Viroses/economia , Viroses/terapia
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