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1.
BMC Med ; 19(1): 162, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34253200

RESUMO

BACKGROUND: When three SARS-CoV-2 vaccines came to market in Europe and North America in the winter of 2020-2021, distribution networks were in a race against a major epidemiological wave of SARS-CoV-2 that began in autumn 2020. Rapid and optimized vaccine allocation was critical during this time. With 95% efficacy reported for two of the vaccines, near-term public health needs likely require that distribution is prioritized to the elderly, health care workers, teachers, essential workers, and individuals with comorbidities putting them at risk of severe clinical progression. METHODS: We evaluate various age-based vaccine distributions using a validated mathematical model based on current epidemic trends in Rhode Island and Massachusetts. We allow for varying waning efficacy of vaccine-induced immunity, as this has not yet been measured. We account for the fact that known COVID-positive cases may not have been included in the first round of vaccination. And, we account for age-specific immune patterns in both states at the time of the start of the vaccination program. Our analysis assumes that health systems during winter 2020-2021 had equal staffing and capacity to previous phases of the SARS-CoV-2 epidemic; we do not consider the effects of understaffed hospitals or unvaccinated medical staff. RESULTS: We find that allocating a substantial proportion (>75%) of vaccine supply to individuals over the age of 70 is optimal in terms of reducing total cumulative deaths through mid-2021. This result is robust to different profiles of waning vaccine efficacy and several different assumptions on age mixing during and after lockdown periods. As we do not explicitly model other high-mortality groups, our results on vaccine allocation apply to all groups at high risk of mortality if infected. A median of 327 to 340 deaths can be avoided in Rhode Island (3444 to 3647 in Massachusetts) by optimizing vaccine allocation and vaccinating the elderly first. The vaccination campaigns are expected to save a median of 639 to 664 lives in Rhode Island and 6278 to 6618 lives in Massachusetts in the first half of 2021 when compared to a scenario with no vaccine. A policy of vaccinating only seronegative individuals avoids redundancy in vaccine use on individuals that may already be immune, and would result in 0.5% to 1% reductions in cumulative hospitalizations and deaths by mid-2021. CONCLUSIONS: Assuming high vaccination coverage (>28%) and no major changes in distancing, masking, gathering size, hygiene guidelines, and virus transmissibility between 1 January 2021 and 1 July 2021 a combination of vaccination and population immunity may lead to low or near-zero transmission levels by the second quarter of 2021.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , COVID-19 , Controle de Doenças Transmissíveis/organização & administração , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos/organização & administração , Cobertura Vacinal , Vacinação , Fatores Etários , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Incidência , Massachusetts/epidemiologia , Modelos Teóricos , Saúde Pública/métodos , Saúde Pública/normas , Rhode Island/epidemiologia , SARS-CoV-2 , Vacinação/métodos , Vacinação/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Cobertura Vacinal/provisão & distribuição
2.
S Afr Fam Pract (2004) ; 63(1): e1-e5, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34212748

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a public health crisis that threatens the current health system. The sudden expansion in the need for inpatient and intensive care facilities raised concerns about optimal clinical management and resource allocation. Despite the pressing need for evidence to make context-specific decisions on COVID-19 management, evidence from South Africa remained limited. This study aimed to describe the clinical characteristics and outcomes of COVID-19 hospitalised patients. METHODS: A retrospective cross-sectional study design was used to evaluate the clinical outcomes of hospitalised adult patients (≥ 18 years old) with laboratory-confirmed COVID-19 illness at Mthatha Regional Hospital (MRH), Eastern Cape. RESULTS: Of the 1814 patients tested for COVID-19 between 20 March 2020 and 31 July 2020 at MRH, two-thirds (65.4%) were female. About two-thirds (242) of the 392 patients (21.6%) who tested positive for this disease were hospitalised and one-third (150) were quarantined at home. The mean age of the patients tested for COVID-19 was 42.6 years and there was no difference between males and females. The mean age of hospitalised patients was 55.5 years and the mean age of hospitalised patients who died (61.3 years) was much higher than recovered (49.5 years). Overall, 188 (77.6%) hospitalised patients had clinical comorbidity on admission. Diabetes (36.8%) and hypertension (33.1%) were the most common comorbidities amongst COVID-19 hospitalised patients. CONCLUSION: The majority of the patients who were hospitalised for COVID-19 were elderly and had high baseline comorbidities. Advance age and underlying comorbidities (diabetes, hypertension and HIV) were associated with high mortality in hospitalised COVID-19 patients.


Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Hipertensão/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Comorbidade , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Administração dos Cuidados ao Paciente/métodos , SARS-CoV-2/isolamento & purificação , África do Sul/epidemiologia
3.
S Afr Fam Pract (2004) ; 63(1): e1-e3, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34212751

RESUMO

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the links between poor hygiene, unclean environments and human health cannot be overemphasised, particularly in South Africa with its high incidence of infectious diseases and overburdened health system. One very controllable factor that is often overlooked is the poor disposal of litter and waste management and its adverse effects on public health. By wearing masks, regular handwashing and sanitising, as well as making sure that neighbourhoods and public spaces are clean and safe, the spread of COVID-19 and other diseases can be prevented.


Assuntos
COVID-19 , Controle de Doenças Transmissíveis/organização & administração , Saúde Ambiental/organização & administração , Recuperação e Remediação Ambiental , Saúde Pública/métodos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Higiene/normas , Condições Sociais , Determinantes Sociais da Saúde , África do Sul/epidemiologia
5.
Ann Ig ; 33(5): 521-523, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34223866

RESUMO

Abstract: The differences of the epidemiology (incidence, case-to-death rate, mortality, etc) of COVID-19 between USA and Italy are analyzed taking into account the social, economic and sanitary characteristics of the two countries, both severely hit be the pandemic; and the causes of the so many different behaviors of the disease in each of them are discussed and explained.


Assuntos
COVID-19/mortalidade , Pandemias/estatística & dados numéricos , SARS-CoV-2 , COVID-19/prevenção & controle , COVID-19/terapia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Comorbidade , Europa (Continente)/epidemiologia , Política de Saúde , Recursos em Saúde/provisão & distribuição , Humanos , Imunização Passiva , Itália/epidemiologia , Determinantes Sociais da Saúde , Estados Unidos/epidemiologia
6.
Nat Commun ; 12(1): 4400, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285229

RESUMO

Rapid and widespread testing of severe acute respiratory coronavirus 2 (SARS-CoV-2) is essential for an effective public health response aimed at containing and mitigating the coronavirus disease 2019 (COVID-19) pandemic. Successful health policy implementation relies on early identification of infected individuals and extensive contact tracing. However, rural communities, where resources for testing are sparse or simply absent, face distinctive challenges to achieving this success. Accordingly, we report the development of an academic, public land grant University laboratory-based detection assay for the identification of SARS-CoV-2 in samples from various clinical specimens that can be readily deployed in areas where access to testing is limited. The test, which is a quantitative reverse transcription polymerase chain reaction (RT-qPCR)-based procedure, was validated on samples provided by the state laboratory and submitted for FDA Emergency Use Authorization. Our test exhibits comparable sensitivity and exceeds specificity and inclusivity values compared to other molecular assays. Additionally, this test can be re-configured to meet supply chain shortages, modified for scale up demands, and is amenable to several clinical specimens. Test development also involved 3D engineering critical supplies and formulating a stable collection media that allowed samples to be transported for hours over a dispersed rural region without the need for a cold-chain. These two elements that were critical when shortages impacted testing and when personnel needed to reach areas that were geographically isolated from the testing center. Overall, using a robust, easy-to-adapt methodology, we show that an academic laboratory can supplement COVID-19 testing needs and help local health departments assess and manage outbreaks. This additional testing capacity is particularly germane for smaller cities and rural regions that would otherwise be unable to meet the testing demand.


Assuntos
Teste de Ácido Nucleico para COVID-19/instrumentação , COVID-19/diagnóstico , Kit de Reagentes para Diagnóstico , Serviços de Saúde Rural/organização & administração , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/virologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Desenho de Equipamento , Humanos , Limite de Detecção , Nasofaringe/virologia , Pandemias/prevenção & controle , Impressão Tridimensional , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Sensibilidade e Especificidade , Manejo de Espécimes/instrumentação , Manejo de Espécimes/métodos
8.
PLoS Pathog ; 17(6): e1009583, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34081744

RESUMO

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic reveals a major gap in global biosecurity infrastructure: a lack of publicly available biological samples representative across space, time, and taxonomic diversity. The shortfall, in this case for vertebrates, prevents accurate and rapid identification and monitoring of emerging pathogens and their reservoir host(s) and precludes extended investigation of ecological, evolutionary, and environmental associations that lead to human infection or spillover. Natural history museum biorepositories form the backbone of a critically needed, decentralized, global network for zoonotic pathogen surveillance, yet this infrastructure remains marginally developed, underutilized, underfunded, and disconnected from public health initiatives. Proactive detection and mitigation for emerging infectious diseases (EIDs) requires expanded biodiversity infrastructure and training (particularly in biodiverse and lower income countries) and new communication pipelines that connect biorepositories and biomedical communities. To this end, we highlight a novel adaptation of Project ECHO's virtual community of practice model: Museums and Emerging Pathogens in the Americas (MEPA). MEPA is a virtual network aimed at fostering communication, coordination, and collaborative problem-solving among pathogen researchers, public health officials, and biorepositories in the Americas. MEPA now acts as a model of effective international, interdisciplinary collaboration that can and should be replicated in other biodiversity hotspots. We encourage deposition of wildlife specimens and associated data with public biorepositories, regardless of original collection purpose, and urge biorepositories to embrace new specimen sources, types, and uses to maximize strategic growth and utility for EID research. Taxonomically, geographically, and temporally deep biorepository archives serve as the foundation of a proactive and increasingly predictive approach to zoonotic spillover, risk assessment, and threat mitigation.


Assuntos
Bancos de Espécimes Biológicos/organização & administração , Controle de Doenças Transmissíveis , Doenças Transmissíveis Emergentes/prevenção & controle , Redes Comunitárias/organização & administração , Vigilância em Saúde Pública/métodos , Animais , Animais Selvagens , Biodiversidade , Bancos de Espécimes Biológicos/normas , Bancos de Espécimes Biológicos/provisão & distribuição , Bancos de Espécimes Biológicos/tendências , COVID-19/epidemiologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/virologia , Redes Comunitárias/normas , Redes Comunitárias/provisão & distribuição , Redes Comunitárias/tendências , Planejamento em Desastres/métodos , Planejamento em Desastres/organização & administração , Planejamento em Desastres/normas , Geografia , Saúde Global/normas , Saúde Global/tendências , Humanos , Contramedidas Médicas , Pandemias/prevenção & controle , Saúde Pública , Medição de Risco , SARS-CoV-2/fisiologia , Zoonoses/epidemiologia , Zoonoses/prevenção & controle
9.
Sci Prog ; 104(2): 368504211019854, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34061685

RESUMO

COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) on the 11th of March 2020, leading to some form of lockdown across almost all countries of the world. The extent of the global pandemic due to COVID-19 has a significant impact on our lives that must be studied carefully to combat it. This study highlights the impacts of the COVID-19 pandemic lockdown on crucial aspects of daily life globally, including; Food security, Global economy, Education, Tourism, hospitality, sports and leisure, Gender Relation, Domestic Violence/Abuse, Mental Health and Environmental air pollution through a systematic search of the literature. The COVID-19 global lockdown was initiated to stem the spread of the virus and 'flatten the curve' of the pandemic. However, the impact of the lockdown has had far-reaching effects in different strata of life, including; changes in the accessibility and structure of education delivery to students, food insecurity as a result of unavailability and fluctuation in prices, the depression of the global economy, increase in mental health challenges, wellbeing and quality of life amongst others. This review article highlights the impacts of the COVID-19 pandemic lockdown across the globe. As the global lockdown is being lifted in a phased manner in various countries of the world, it is necessary to explore its impacts to understand its consequences comprehensively. This will guide future decisions that will be made in a possible future wave of the COVID-19 pandemic or other global disease outbreak.


Assuntos
COVID-19/epidemiologia , COVID-19/psicologia , Controle de Doenças Transmissíveis/organização & administração , Violência Doméstica/psicologia , Pandemias , Distanciamento Físico , COVID-19/transmissão , Violência Doméstica/estatística & dados numéricos , Educação/estatística & dados numéricos , Poluição Ambiental/estatística & dados numéricos , Segurança Alimentar/estatística & dados numéricos , Saúde Global/economia , Saúde Global/estatística & dados numéricos , Humanos , Atividades de Lazer/psicologia , Máscaras/provisão & distribuição , Saúde Mental/estatística & dados numéricos , Quarentena/organização & administração , Quarentena/psicologia , SARS-CoV-2/patogenicidade , Esportes/psicologia , Turismo
10.
Nat Commun ; 12(1): 3674, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135335

RESUMO

There is a consensus that mass vaccination against SARS-CoV-2 will ultimately end the COVID-19 pandemic. However, it is not clear when and which control measures can be relaxed during the rollout of vaccination programmes. We investigate relaxation scenarios using an age-structured transmission model that has been fitted to age-specific seroprevalence data, hospital admissions, and projected vaccination coverage for Portugal. Our analyses suggest that the pressing need to restart socioeconomic activities could lead to new pandemic waves, and that substantial control efforts prove necessary throughout 2021. Using knowledge on control measures introduced in 2020, we anticipate that relaxing measures completely or to the extent as in autumn 2020 could launch a wave starting in April 2021. Additional waves could be prevented altogether if measures are relaxed as in summer 2020 or in a step-wise manner throughout 2021. We discuss at which point the control of COVID-19 would be achieved for each scenario.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Vacinação em Massa , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Número Básico de Reprodução , COVID-19/transmissão , Calibragem , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Vacinação em Massa/organização & administração , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos Teóricos , Portugal/epidemiologia , Cobertura Vacinal , Adulto Jovem
12.
PLoS One ; 16(6): e0253237, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34153058

RESUMO

Since January 2020, the COVID-19 outbreak has been progressing at a rapid pace. To keep the pandemic at bay, countries have implemented various measures to interrupt the transmission of the virus from person to person and prevent an overload of their health systems. We analyze the impact of these measures implemented against the COVID-19 pandemic by using a sample of 68 countries, Puerto Rico and the 50 federal states of the United States of America, four federal states of Australia, and eight federal states of Canada, involving 6,941 daily observations. We show that measures are essential for containing the spread of the COVID-19 pandemic. After controlling for daily COVID-19 tests, we find evidence to suggest that school closures, shut-downs of non-essential business, mass gathering bans, travel restrictions in and out of risk areas, national border closures and/or complete entry bans, and nationwide curfews decrease the growth rate of the coronavirus and thus the peak of daily confirmed cases. We also find evidence to suggest that combinations of these measures decrease the daily growth rate at a level outweighing that of individual measures. Consequently, and despite extensive vaccinations, we contend that the implemented measures help contain the spread of the COVID-19 pandemic and ease the overstressed capacity of the healthcare systems.


Assuntos
COVID-19/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Pandemias/prevenção & controle , Política Pública/legislação & jurisprudência , COVID-19/diagnóstico , COVID-19/prevenção & controle , COVID-19/transmissão , Teste para COVID-19/normas , Teste para COVID-19/estatística & dados numéricos , Controle de Doenças Transmissíveis/legislação & jurisprudência , Controle de Doenças Transmissíveis/normas , Controle de Doenças Transmissíveis/estatística & dados numéricos , Pesquisa Empírica , Carga Global da Doença , Humanos , Pandemias/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/patogenicidade , Viagem/legislação & jurisprudência
13.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34128377

RESUMO

PURPOSE: Early on in the COVID-19 pandemic, the scientific community highlighted a potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released, and containment measures were quickly implemented in prisons. This paper aims to describe the spread of COVID-19 in detention facilities within the Lombardy region of Italy during March to July 2020, and the impact of the prevention and control measures implemented. DESIGN/METHODOLOGY/APPROACH: A descriptive retrospective analysis of case distribution was performed for all COVID-19 cases identified among people in detention (PiD) and prison officers (POs). A comparison of the epidemic burden affecting different populations and a correlation analysis between the number of cases that occurred and prevention measures implemented were also carried out. FINDINGS: From this study, it emerged that POs were at a high risk of contracting COVID-19. This study observed a delay in the occurrence of cases among PiD and substantial heterogeneity in the size of outbreaks across different prisons. Correlation between reported cases among PiD and registered sick leave taken by POs suggested the latter contributed to introducing the infection into prison settings. Finally, number of cases among PiD inversely correlated with the capacity of each prison to identify and set up dedicated areas for medical isolation. ORIGINALITY/VALUE: Prevention and control measures when adopted in a timely manner were effective in protecting PiD. According to the findings, POs are a population at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the critical importance of including prison settings within emergency preparedness plans.


Assuntos
COVID-19/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Estabelecimentos Correcionais/organização & administração , Epidemias/estatística & dados numéricos , Coleta de Dados , Humanos , Itália/epidemiologia , Sistema de Registros , Estudos Retrospectivos , SARS-CoV-2
15.
Ital J Pediatr ; 47(1): 122, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078423

RESUMO

BACKGROUND: Numerous studies described the epidemiological link and main clinical features of pediatric COVID-19, during the first pandemic period. Our study encompasses several different phases since the National Lockdown in Italy. The primary outcome is (I) to analyze the prevalence of positive NST (Nasopharyngeal Swab Test) among the largest Italian Pediatric cohort admitted to a single regional PED Hub for COVID-19 during an eight-month period. Secondary outcomes are: (II) the description of trend of admissions in our PED and (III) the categorization of the positive patients according to clinical manifestations and epidemiological link. METHODS: We described 316 patients with a positive NST for SARS-CoV2, on a total of 5001 nasopharyngeal swabs performed among 13,171 admissions at our PED, over a period starting from March 17th, 2020 to December 1st, 2020. Age, epidemiological link, clinical features and hospitalizations were analyzed according to different lockdown phases. Data were collected anonymously from electronic records and analyzed using SPSS 22.00 statistics software (Chicago, IL). RESULTS: Thirty-six percent of total admissions have been tested. During the post lockdown period, we performed the highest percentage of NST (Nasopharyngeal Swab Test) 49.7%, and among them 7.9% were positive. The prevalence of infection during a 10-month period was 2.3%. Mean age was 6.5 years old. Familial Link accounted for the 67.7% of infection, while Extrafamilial and Unknown link accounted for 17 and 14.9%, respectively. Familial link is predominant during all phases. Seventeen patients showed an intra-scholastic link, and the highest prevalence was observed in the 7-10 years age group, with a prevalence of 12.8% (5 patients). Fever was the most frequent symptom (66%), in particular among preschooler children aged 0-6 years (71.9%). Older children were more frequently symptomatic. Seven patients were admitted with MIS-C diagnosis. CONCLUSIONS: Different levels of containment measures caused important changes in number of positive NST for SARS-CoV2. Familial link was predominant in our cohort, during all phases of Lockdown. The risk of being infected at home is four time greater than the risk of being infected from an extra familial individual. Further studies are needed to evaluate the clear impact of intra-scholastic link. The constant improvement in knowledge on onset symptoms and risk factor for SARS-CoV2 infection and its complications (e.g. MIS-C), can impact on number of hospitalizations, ICU admissions and early management.


Assuntos
COVID-19/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Pneumonia Viral/epidemiologia , Adolescente , Teste para COVID-19 , Criança , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/virologia , Prevalência , Fatores de Risco , SARS-CoV-2
16.
JAMA Netw Open ; 4(6): e2110782, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061203

RESUMO

Importance: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. Objective: To assess the association of simulated COVID-19 vaccine efficacy and coverage scenarios with and without NPIs with infections, hospitalizations, and deaths. Design, Setting, and Participants: An established agent-based decision analytical model was used to simulate COVID-19 transmission and progression from March 24, 2020, to September 23, 2021. The model simulated COVID-19 spread in North Carolina, a US state of 10.5 million people. A network of 1 017 720 agents was constructed from US Census data to represent the statewide population. Exposures: Scenarios of vaccine efficacy (50% and 90%), vaccine coverage (25%, 50%, and 75% at the end of a 6-month distribution period), and NPIs (reduced mobility, school closings, and use of face masks) maintained and removed during vaccine distribution. Main Outcomes and Measures: Risks of infection from the start of vaccine distribution and risk differences comparing scenarios. Outcome means and SDs were calculated across replications. Results: In the worst-case vaccination scenario (50% efficacy, 25% coverage), a mean (SD) of 2 231 134 (117 867) new infections occurred after vaccination began with NPIs removed, and a mean (SD) of 799 949 (60 279) new infections occurred with NPIs maintained during 11 months. In contrast, in the best-case scenario (90% efficacy, 75% coverage), a mean (SD) of 527 409 (40 637) new infections occurred with NPIs removed and a mean (SD) of 450 575 (32 716) new infections occurred with NPIs maintained. With NPIs removed, lower efficacy (50%) and higher coverage (75%) reduced infection risk by a greater magnitude than higher efficacy (90%) and lower coverage (25%) compared with the worst-case scenario (mean [SD] absolute risk reduction, 13% [1%] and 8% [1%], respectively). Conclusions and Relevance: Simulation outcomes suggest that removing NPIs while vaccines are distributed may result in substantial increases in infections, hospitalizations, and deaths. Furthermore, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection compared with more efficacious vaccines at lower coverage. These findings highlight the need for well-resourced and coordinated efforts to achieve high vaccine coverage and continued adherence to NPIs before many prepandemic activities can be resumed.


Assuntos
Vacinas contra COVID-19/farmacologia , COVID-19 , Controle de Doenças Transmissíveis , Vacinação em Massa , Cobertura Vacinal , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/estatística & dados numéricos , Simulação por Computador , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Vacinação em Massa/organização & administração , Vacinação em Massa/estatística & dados numéricos , Mortalidade , North Carolina/epidemiologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2 , Resultado do Tratamento , Cobertura Vacinal/organização & administração , Cobertura Vacinal/estatística & dados numéricos
17.
PLoS One ; 16(6): e0252468, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34111163

RESUMO

Japan's government has taken a number of measures, including declaring a state of emergency, to combat the spread COVID-19. We examine the mechanisms through which the government's policies have led to changes in people's behavior. Using smartphone location data, we construct a daily prefecture-level stay-at-home measure to identify the following two effects: (1) the effect that citizens refrained from going out in line with the government's request, and (2) the effect that government announcements reinforced awareness with regard to the seriousness of the pandemic and people voluntarily refrained from going out. Our main findings are as follows. First, the declaration of the state of emergency reduced the number of people leaving their homes by 8.5% through the first channel, which is of the same order of magnitude as the estimates obtained for lockdowns in the United States. Second, a 1% increase in new infections in a prefecture reduces people's outings in that prefecture by 0.027%. Third, the government's requests are responsible for about one quarter of the decrease in outings in Tokyo, while the remaining three quarters are the result of citizens obtaining new information through government announcements and the daily release of the number of infections. The findings suggest that what mattered for containing the spread of COVID-19 was not strong, legally binding measures but the provision of appropriate information that encouraged people to change their behavior.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , COVID-19/diagnóstico , COVID-19/epidemiologia , Controle de Doenças Transmissíveis/métodos , Emergências , Governo , Humanos , Japão/epidemiologia , SARS-CoV-2/isolamento & purificação , Smartphone
18.
Ann R Coll Surg Engl ; 103(7): 524-529, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192498

RESUMO

INTRODUCTION: Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients. METHODS: A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK. RESULTS: Between 28 June and 5 August 2020, a total of 50 patients underwent bariatric surgery of whom 94% were female. Median age was 41 years and median body mass index was 43.8 (interquartile range 40.0-48.8)kg/m2. Half of the patients (n = 25/50) underwent laparoscopic sleeve gastrectomy and half underwent Roux-en-Y gastric bypass (RYGB). Of these 50 patients, 9 (18%) had revisional bariatric surgery. Overall median length of hospital stay was 1 day, with 96% of the study population being discharged within 24h of surgery. The overall rate of readmission was 6% and one patient (2%) returned to theatre with an obstruction proximal to jejuno-jejunal anastomosis. None of the patients exhibited symptoms or tested positive for COVID-19. CONCLUSION: With appropriately implemented measures and precautions, resumption of bariatric surgery during the COVID-19 pandemic appears feasible and safe with no increased risk to patients.


Assuntos
Cirurgia Bariátrica/efeitos adversos , COVID-19/prevenção & controle , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Cirurgia Bariátrica/normas , Cirurgia Bariátrica/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Teste para COVID-19/normas , Teste para COVID-19/estatística & dados numéricos , Protocolos Clínicos/normas , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Recuperação Pós-Cirúrgica Melhorada/normas , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Pandemias/prevenção & controle , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Centro Cirúrgico Hospitalar/organização & administração , Centro Cirúrgico Hospitalar/normas , Centro Cirúrgico Hospitalar/estatística & dados numéricos
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