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1.
PLoS One ; 16(4): e0248828, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793570

RESUMO

BACKGROUND: On January 30th 2020, the World Health Organization (WHO) declared a international health emergency due to the unprecedented phenomenon of COVID-19. After this declaration countries swiftly implemented a variety of health policies. In this work we examine how rapid countries responded to this pandemic using two events: the day in which the first case of COVID-19 was reported, and first day in which countries used school closure as one of the measures to avoid outbreaks. We also assessed how countries' health systems, globalization, economic development, political systems, and economic integration to China, Republic of Korea and Italy increased the speed of adoption. METHODS: We compiled information from multiple sources, from December 31st 2019 to June 1st 2020, to trace when 172 countries reported their first COVID-19 case and implemented school closure to contain outbreaks. We applied cross-national Weibull survival analysis to evaluate the global speed of detection of first COVID-19 reported cases and school closure. RESULTS: Ten days after WHO declared COVID-19 to be an international emergency, relative to seven days from this declaration, countries were 28 (95% CI: 12-77) times more likely to report first COVID-19 cases and 42 (95% CI: 22-90) times more likely to close schools. One standard deviation increase in the epidemic security index rises the rate of report first cases by 37% (Hazard Ratio (HR) 1.37 (95% CI: 1.09-1.72) and delays the adoption for school closures by 36% (HR 0.64 (95% CI:0.50-0.82). One standard deviation increase in the globalization index augments the adoption for school closures by 74% (HR 1.74 (95% CI:1.34-2.24). CONCLUSION: After the WHO declared a global emergency, countries were unprecedently acting very rapidly. While countries more globally integrated were swifter in closing schools, countries with better designed health systems to tackle epidemics were slower in adopting it. More studies are needed to assess how the speed of school closures and other policies will affect the development of the pandemic.


Assuntos
Saúde Global/estatística & dados numéricos , Regulamento Sanitário Internacional/estatística & dados numéricos , Pandemias , Quarentena/estatística & dados numéricos , Instituições Acadêmicas , /epidemiologia , China , Humanos , Internacionalidade , Itália , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , República da Coreia , Instituições Acadêmicas/organização & administração , Instituições Acadêmicas/estatística & dados numéricos
2.
PLoS One ; 16(4): e0248741, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793579

RESUMO

OBJECTIVES: To characterize psychological distress and factors associated with distress in healthcare practitioners working during a stringent lockdown in a country (Jordan) that had exhibited one of the lowest incidence rates of Covid-19 globally at the time of the survey. METHODS: A cross-sectional online survey sent to healthcare practitioners working in various hospitals and community pharmacies. Demographic, professional and psychological characteristics (distress using Kessler-6 questionnaire, anxiety, depression, burnout, sleep issues, exhaustion) were measured as were sources of fear. Descriptive and multivariable statistics were performed using level of distress as the outcome. RESULTS: We surveyed 937 practitioners (56.1% females). Approximately 68%, 14%, and 18% were nurses/technicians, physicians, and pharmacists (respectively). 32% suffered from high distress while 20% suffered from severe distress. Exhaustion, anxiety, depression, and sleep disturbances were reported (in past seven days) by approximately 34%, 34%, 19%, and 29% of subjects (respectively). Being older or male, a positive perception of communications with peers, and being satisfied at work, were significantly associated with lower distress. Conversely, suffering burnout; reporting sleep-related functional problems; exhaustion; being a pharmacist (relative to a physician); working in a cancer center; harboring fear about virus spreading; fear that the virus threatened life; fear of alienation from family/friends; and fear of workload increases, were significantly associated with higher distress. CONCLUSION: Despite low caseloads, Jordanian practitioners still experienced high levels of distress. Identified demographic, professional and psychological factors influencing distress should inform interventions to improve medical professionals' resilience and distress likelihood, regardless of the variable Covid-19 situation.


Assuntos
Esgotamento Profissional/psicologia , Pessoal de Saúde , Angústia Psicológica , Quarentena , Adulto , Ansiedade/psicologia , /psicologia , Estudos Transversais , Depressão/psicologia , Medo/psicologia , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Jordânia , Masculino , Quarentena/psicologia , Quarentena/estatística & dados numéricos , Inquéritos e Questionários
3.
Proc Natl Acad Sci U S A ; 118(14)2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33741734

RESUMO

Increasing evidence indicates that superspreading plays a dominant role in COVID-19 transmission. Recent estimates suggest that the dispersion parameter k for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is on the order of 0.1, which corresponds to about 10% of cases being the source of 80% of infections. To investigate how overdispersion might affect the outcome of various mitigation strategies, we developed an agent-based model with a social network that allows transmission through contact in three sectors: "close" (a small, unchanging group of mutual contacts as might be found in a household), "regular" (a larger, unchanging group as might be found in a workplace or school), and "random" (drawn from the entire model population and not repeated regularly). We assigned individual infectivity from a gamma distribution with dispersion parameter k We found that when k was low (i.e., greater heterogeneity, more superspreading events), reducing random sector contacts had a far greater impact on the epidemic trajectory than did reducing regular contacts; when k was high (i.e., less heterogeneity, no superspreading events), that difference disappeared. These results suggest that overdispersion of COVID-19 transmission gives the virus an Achilles' heel: Reducing contacts between people who do not regularly meet would substantially reduce the pandemic, while reducing repeated contacts in defined social groups would be less effective.


Assuntos
/epidemiologia , Busca de Comunicante/estatística & dados numéricos , Modelos Estatísticos , Pandemias , Fatores Etários , /virologia , Simulação por Computador , Humanos , Quarentena/estatística & dados numéricos , /fisiologia , Rede Social
4.
Rheumatology (Oxford) ; 60(3): 1474-1479, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33677595

RESUMO

OBJECTIVES: We aimed to estimate what proportion of people with SLE attending UK rheumatology clinics would be categorized as being at high risk from coronavirus disease 2019 (COVID-19) and therefore asked to shield, and explore what implications this has for rheumatology clinical practice. METHODS: We used data from the British Society for Rheumatology multicentre audit of SLE, which included a large, representative cross-sectional sample of patients attending UK Rheumatology clinics with SLE. We calculated who would receive shielding advice using the British Society for Rheumatology's risk stratification guidance and accompanying scoring grid, and assessed whether ethnicity and history of nephritis were over-represented in the shielding group. RESULTS: The audit included 1003 patients from 51 centres across all 4 nations of the UK. Overall 344 (34.3%) patients had a shielding score ≥3 and would have been advised to shield. People with previous or current LN were 2.6 (1.9-3.4) times more likely to be in the shielding group than people with no previous LN (P < 0.001). Ethnicity was not evenly distributed between the groups (chi-squared P < 0.001). Compared with White people, people of Black ethnicity were 1.9 (1.3-2.8) and Asian 1.9 (1.3-2.7) times more likely to be in the shielding group. Increased risk persisted after controlling for LN. CONCLUSION: Our study demonstrates the large number of people with SLE who are likely to be shielding. Implications for clinical practice include considering communication across language and cultural differences, and ways to conduct renal assessment including urinalysis, during telephone and video consultations for patients who are shielding.


Assuntos
/prevenção & controle , Lúpus Eritematoso Sistêmico/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Quarentena/estatística & dados numéricos , Reumatologia/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Lúpus Eritematoso Sistêmico/virologia , Nefrite Lúpica/terapia , Nefrite Lúpica/virologia , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Análise de Regressão , Telemedicina/estatística & dados numéricos , Reino Unido/epidemiologia
5.
Eur Psychiatry ; 64(1): e18, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33686933

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is a major threat to the public. However, the comprehensive profile of suicidal ideation among the general population has not been systematically investigated in a large sample in the age of COVID-19. METHODS: A national online cross-sectional survey was conducted between February 28, 2020 and March 11, 2020 in a representative sample of Chinese adults aged 18 years and older. Suicidal ideation was assessed using item 9 of the Patient Health Questionnaire-9. The prevalence of suicidal ideation and its risk factors was evaluated. RESULTS: A total of 56,679 participants (27,149 males and 29,530 females) were included. The overall prevalence of suicidal ideation was 16.4%, including 10.9% seldom, 4.1% often, and 1.4% always suicidal ideation. The prevalence of suicidal ideation was higher in males (19.1%) and individuals aged 18-24 years (24.7%) than in females (14.0%) and those aged 45 years and older (11.9%). Suicidal ideation was more prevalent in individuals with suspected or confirmed infection (63.0%), frontline workers (19.2%), and people with pre-existing mental disorders (41.6%). Experience of quarantine, unemployed, and increased psychological stress during the pandemic were associated with an increased risk of suicidal ideation and its severity. However, paying more attention to and gaining a better understanding of COVID-19-related knowledge, especially information about psychological interventions, could reduce the risk. CONCLUSIONS: The estimated prevalence of suicidal ideation among the general population in China during COVID-19 was significant. The findings will be important for improving suicide prevention strategies during COVID-19.


Assuntos
/epidemiologia , Pandemias , Ideação Suicida , Adolescente , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Quarentena/psicologia , Quarentena/estatística & dados numéricos , Fatores de Risco , Estresse Psicológico/epidemiologia , Suicídio/prevenção & controle , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Desemprego/psicologia , Desemprego/estatística & dados numéricos , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-33670078

RESUMO

The novel coronavirus disease 2019 (COVID-19) rapidly escalated to a global pandemic. To control the rate of transmission, governments advocated that the public practice social distancing, which included staying at home. However, compliance with stay-at-home orders has varied between countries such as China and the United States, and little is known about the mechanisms underlying the national differences. Based on the health belief model, the theory of reasoned action, and the technology acceptance model, health beliefs and behavioral intention are suggested as possible explanations. A total of 498 Chinese and 292 American college students were recruited to complete an online survey. The structural equation modeling results showed that health beliefs (i.e., perceived susceptibility, severity, and barriers) and behavioral intention played multiple mediating roles in the association between nationality and actual stay-at-home behaviors. Notably, the effect via perceived barriers → behavioral intention was stronger than the effects via perceived susceptibility and severity → behavioral intention. That is, American participants perceived high levels of susceptibility whereas Chinese participants perceived high levels of severity, especially few barriers, which further led to increased behavioral intention and more frequent stay-at-home behaviors. These findings not only facilitate a comprehensive understanding of cross-country differences in compliance with stay-at-home orders during peaks in the COVID-19 pandemic but also lend support for mitigation of the current global crisis and future disease prevention and health promotion efforts.


Assuntos
/prevenção & controle , Pandemias , Quarentena/estatística & dados numéricos , Estudantes/psicologia , China/epidemiologia , Feminino , Humanos , Intenção , Masculino , Pandemias/prevenção & controle , Inquéritos e Questionários , Estados Unidos/epidemiologia , Universidades
7.
Nat Commun ; 12(1): 1655, 2021 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-33712583

RESUMO

Digital contact tracing is a relevant tool to control infectious disease outbreaks, including the COVID-19 epidemic. Early work evaluating digital contact tracing omitted important features and heterogeneities of real-world contact patterns influencing contagion dynamics. We fill this gap with a modeling framework informed by empirical high-resolution contact data to analyze the impact of digital contact tracing in the COVID-19 pandemic. We investigate how well contact tracing apps, coupled with the quarantine of identified contacts, can mitigate the spread in real environments. We find that restrictive policies are more effective in containing the epidemic but come at the cost of unnecessary large-scale quarantines. Policy evaluation through their efficiency and cost results in optimized solutions which only consider contacts longer than 15-20 minutes and closer than 2-3 meters to be at risk. Our results show that isolation and tracing can help control re-emerging outbreaks when some conditions are met: (i) a reduction of the reproductive number through masks and physical distance; (ii) a low-delay isolation of infected individuals; (iii) a high compliance. Finally, we observe the inefficacy of a less privacy-preserving tracing involving second order contacts. Our results may inform digital contact tracing efforts currently being implemented across several countries worldwide.


Assuntos
/prevenção & controle , Busca de Comunicante/métodos , Pandemias , Número Básico de Reprodução/prevenção & controle , Número Básico de Reprodução/estatística & dados numéricos , /transmissão , Simulação por Computador , Busca de Comunicante/estatística & dados numéricos , Humanos , Modelos Estatísticos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Privacidade , Quarentena/métodos , Quarentena/estatística & dados numéricos , Fatores de Risco
8.
Nat Commun ; 12(1): 1634, 2021 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-33712596

RESUMO

While general lockdowns have proven effective to control SARS-CoV-2 epidemics, they come with enormous costs for society. It is therefore essential to identify control strategies with lower social and economic impact. Here, we report and evaluate the control strategy implemented during a large SARS-CoV-2 epidemic in June-July 2020 in French Guiana that relied on curfews, targeted lockdowns, and other measures. We find that the combination of these interventions coincided with a reduction in the basic reproduction number of SARS-CoV-2 from 1.7 to 1.1, which was sufficient to avoid hospital saturation. We estimate that thanks to the young demographics, the risk of hospitalisation following infection was 0.3 times that of metropolitan France and that about 20% of the population was infected by July. Our model projections are consistent with a recent seroprevalence study. The study showcases how mathematical modelling can be used to support healthcare planning in a context of high uncertainty.


Assuntos
/prevenção & controle , Pandemias , Quarentena/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Número Básico de Reprodução/prevenção & controle , Número Básico de Reprodução/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Guiana Francesa/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Quarentena/estatística & dados numéricos , Quarentena/tendências , Adulto Jovem
9.
N Z Med J ; 134(1531): 50-58, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33767476

RESUMO

AIM: To assess the effects of the community lockdown phases on trauma-related admissions to Midland region hospitals over the period 15 February to 10 July 2020, and to compare volume variation with the same period in the previous three years. METHODS: A retrospective, descriptive study of prospectively collected data from the Midland Trauma Registry in New Zealand. RESULTS: There was a 36.7% (p<.00001) reduction in injury admissions during Alert Level 4 ('Lockdown') compared with the same period in 2017, 2018 and 2019. This was in the context of volume increases during the pre-lockdown period (17.8%, p<.00001) and a 'rebound' as restrictions eased. There was an increase in injuries occurring at home (28.3%, p<.00001) and on footpaths (37.9%, p=0.00076), while there was a decline in events on roads (33.0%, p=0.017), at schools (75.0%, p<.00001) and in sports areas (79.7%, p<.00001). Falls remained the dominant mechanism of injury in 2020, contributing 39.9% of all hospitalisations. CONCLUSIONS: The reduction in hospital admissions during alert levels 4 and 3 was short lived, with a rebound evident when restrictions eased. Hospital resources have been strained because this rebound coincided with a planned 'catch up' on healthcare that was delayed during the higher community restriction levels.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Hospitalização/estatística & dados numéricos , Quarentena/estatística & dados numéricos , Ferimentos e Lesões , Adulto , /prevenção & controle , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Índices de Gravidade do Trauma , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
10.
PLoS One ; 16(3): e0248072, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33730055

RESUMO

The spread of COVID-19 and resulting local and national lockdowns have a host of potential consequences for demographic trends. While impacts on mortality and, to some extent, short-term migration flows are beginning to be documented, it is too early to measure actual consequences for family demography. To gain insight into potential future consequences of the lockdown for family demography, we use cross-national Google Trends search data to explore whether trends in searches for words related to fertility, relationship formation, and relationship dissolution changed following lockdowns compared to average, pre-lockdown levels in Europe and the United States. Because lockdowns were not widely anticipated or simultaneous in timing or intensity, we exploit variability over time and between countries (and U.S. states). We use a panel event-study design and difference-in-differences methods, and account for seasonal trends and average country-level (or state-level) differences in searches. We find statistically significant impacts of lockdown timing on changes in searches for terms such as wedding and those related to condom use, emergency contraception, pregnancy tests, and abortion, but little evidence of changes in searches related to fertility. Impacts for union formation and dissolution tended to only be statistically significant at the start of a lockdown with a return to average-levels about 2 to 3 months after lockdown initiation, particularly in Europe. Compared to Europe, returns to average search levels were less evident for the U.S., even 2 to 3 months after lockdowns were introduced. This may be due to the fact, in the U.S., health and social policy responses were less demarcated than in Europe, such that economic uncertainty was likely of larger magnitude. Such pandemic-related economic uncertainty may therefore have the potential to slightly increase already existing polarization in family formation behaviours in the U.S. Alongside contributing to the wider literature on economic uncertainty and family behaviors, this paper also proposes strategies for efficient use of Google Trends data, such as making relative comparisons and testing sensitivity to outliers, and provides a template and cautions for their use in demographic research when actual demographic trends data are not yet available.


Assuntos
/psicologia , Pandemias/estatística & dados numéricos , /prevenção & controle , Europa (Continente) , Características da Família , Humanos , Pandemias/prevenção & controle , Política Pública , Quarentena/psicologia , Quarentena/estatística & dados numéricos , Estados Unidos
11.
Math Biosci Eng ; 18(2): 1833-1844, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33757213

RESUMO

In this paper, we present an SEIIaHR epidemic model to study the influence of recessive infection and isolation in the spread of COVID-19. We first prove that the infection-free equilibrium is globally asymptotically stable with condition R0<1 and the positive equilibrium is uniformly persistent when the condition R0>1. By using the COVID-19 data in India, we then give numerical simulations to illustrate our results and carry out some sensitivity analysis. We know that asymptomatic infections will affect the spread of the disease when the quarantine rate is within the range of [0.3519, 0.5411]. Furthermore, isolating people with symptoms is important to control and eliminate the disease.


Assuntos
/epidemiologia , Epidemias , Modelos Biológicos , Infecções Assintomáticas/epidemiologia , Número Básico de Reprodução/estatística & dados numéricos , /transmissão , Simulação por Computador , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Humanos , Índia/epidemiologia , Cadeias de Markov , Conceitos Matemáticos , Método de Monte Carlo , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Quarentena/estatística & dados numéricos
12.
PLoS One ; 16(3): e0247614, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33788852

RESUMO

Efficient contact tracing and testing are fundamental tools to contain the transmission of SARS-CoV-2. We used multi-agent simulations to estimate the daily testing capacity required to find and isolate a number of infected agents sufficient to break the chain of transmission of SARS-CoV-2, so decreasing the risk of new waves of infections. Depending on the non-pharmaceutical mitigation policies in place, the size of secondary infection clusters allowed or the percentage of asymptomatic and paucisymptomatic (i.e., subclinical) infections, we estimated that the daily testing capacity required to contain the disease varies between 0.7 and 9.1 tests per thousand agents in the population. However, we also found that if contact tracing and testing efficacy dropped below 60% (e.g. due to false negatives or reduced tracing capability), the number of new daily infections did not always decrease and could even increase exponentially, irrespective of the testing capacity. Under these conditions, we show that population-level information about geographical distribution and travel behaviour could inform sampling policies to aid a successful containment, while avoiding concerns about government-controlled mass surveillance.


Assuntos
/estatística & dados numéricos , /epidemiologia , Busca de Comunicante/estatística & dados numéricos , Modelos Estatísticos , Políticas , Quarentena/estatística & dados numéricos , /prevenção & controle , Humanos
13.
J Public Health Manag Pract ; 27(3): 285-294, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33762544

RESUMO

CONTEXT: Local agencies across the United States have identified public health isolation sites for individuals with coronavirus disease 2019 (COVID-19) who are not able to isolate in residence. PROGRAM: We describe logistics of establishing and operating isolation and noncongregate hotels for COVID-19 mitigation and use the isolation hotel as an opportunity to understand COVID-19 symptom evolution among people experiencing homelessness (PEH). IMPLEMENTATION: Multiple agencies in Atlanta, Georgia, established an isolation hotel for PEH with COVID-19 and noncongregate hotel for PEH without COVID-19 but at risk of severe illness. PEH were referred to the isolation hotel through proactive, community-based testing and hospital-based testing. Daily symptoms were recorded prospectively. Disposition location was recorded for all clients. EVALUATION: During April 10 to September 1, 2020, 181 isolation hotel clients (77 community referrals; 104 hospital referrals) were admitted a median 3 days after testing. Overall, 32% of community referrals and 7% of hospital referrals became symptomatic after testing positive; 83% of isolation hotel clients reported symptoms at some point; 93% completed isolation. Among 302 noncongregate hotel clients, median stay was 18 weeks; 61% were discharged to permanent housing or had a permanent housing discharge plan. DISCUSSION: Overall, a high proportion of PEH completed isolation at the hotel, suggesting a high level of acceptability. Many PEH with COVID-19 diagnosed in the community developed symptoms after testing, indicating that proactive, community-based testing can facilitate early isolation. Noncongregate hotels can be a useful COVID-19 community mitigation strategy by bridging PEH at risk of severe illness to permanent housing.


Assuntos
/prevenção & controle , Guias como Assunto , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/normas , Saúde Pública/normas , Quarentena/normas , Isolamento Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Georgia/epidemiologia , Habitação/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/estatística & dados numéricos , Quarentena/estatística & dados numéricos , Adulto Jovem
14.
Front Public Health ; 9: 625778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33718322

RESUMO

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to "flatten the curve" of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20-40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5-10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.


Assuntos
Envelhecimento , Controle de Doenças Transmissíveis , Saúde Pública , Quarentena/estatística & dados numéricos , Fatores Etários , /prevenção & controle , Análise Custo-Benefício , Humanos , Pobreza , Desemprego/tendências
15.
BMC Public Health ; 21(1): 448, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673812

RESUMO

BACKGROUND: COVID-19 continues to represent the single biggest challenge to contemporary community sport globally. Compliance with social distancing policies, strict return-to-play protocols, and COVID-19 specific training has, perhaps, forever changed the way that children and young people engage in organised sport. Within this context, and while many children and families seek to re-engage with community sport, we (researchers and sport practitioners) have an obligation to ask questions about how the pandemic has impacted youth sport, understand the short- and long-term consequences, and explore what (if any) opportunities can be seized to assist and improve future participation and retention. The aim of this paper was to present an in-depth exploration of the impact of COVID-19 on youth sport in South Australia. METHODS: Within an interpretive descriptive methodology, this qualitative investigation draws on rich, individual interview and focus group data with 39 youth (ages 15-18), parents, coaches, and sport administrators. A reflexive thematic analysis was undertaken, leading to the development of four substantive themes. RESULTS: We conceptualised the '4 Rs' to advance theoretical understandings about the pandemic's impact on youth sport, including the themes 'recognising struggle', 'reconnection', 're-engaging after restrictions, and 'reimagining sport'. The themes captured insights about a decline in mental wellbeing and physical activity, an increase in family connectedness, the challenge for sports to attract volunteers and participants back into sport, and the opportunities to reset values and philosophies underpinning the provision of youth sport. CONCLUSION: The findings provide valuable insight into the youth sport setting as a result of the global pandemic and suggest that families, sporting clubs and sporting organisations require additional resources and tools (for example, support for parents to facilitate their children's training at home during lockdown) to aid recovery efforts and to ensure the survival and prosperity of youth sport into the future.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/estatística & dados numéricos , Quarentena/psicologia , Quarentena/estatística & dados numéricos , Esportes Juvenis/psicologia , Esportes Juvenis/estatística & dados numéricos , Adolescente , Austrália , Criança , Feminino , Grupos Focais , Humanos , Masculino , Pandemias/estatística & dados numéricos , Austrália do Sul/epidemiologia , Inquéritos e Questionários
16.
Environ Health Prev Med ; 26(1): 33, 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33691642

RESUMO

BACKGROUND: School closure is one of the main policies of global health care strategies performed worldwide. Despite all benefits, there might be some threats for younger groups spending their time in quarantine. This study aims to determine the impacts of lockdown and school closure on children's major lifestyle aspects, especially their leisure and sleep pattern during the COVID-19 pandemic. METHODS: For the purpose of this study, an online questionnaire was distributed from 14th to 31st of March 2020 among the schools and students from the first grade to the 12th grade (before university) in Fars province, southern Iran. The questionnaire consisted of five sections which included data regarding the students' general information, activity priorities, adherence to quarantine, attitude toward school closure, and sleep patterns. RESULTS: In our study, 20,697 filled questionnaires were received from the participants with an average age of 13.76 years; 29.7% of them were male, 80.6% were from urban areas, and 83.3% were from public schools. The overall first preference of students during school closure was mobile and computer games (30.1%), followed by studying (26.6%) and watching television (13.8%). Our results demonstrated that the majority of students adhered to social distancing and there was also a significant correlation among education levels and desire for schools to be closed till the end of the semester (P = 0.015). Also, regarding sleep patterns, the majority (53.5%) had above 12 h of sleep throughout the day. CONCLUSION: It seems that lockdown following COVID-19 pandemic has changed various aspects of the students' lifestyle remarkably, especially by increasing screen time and even sleep duration and pattern. We believe that certain strategies should be implemented by the Health and Educational Ministry to control not only the visible side effects of the quarantine period, but also the collateral consequences on their psychological and mental health.


Assuntos
/epidemiologia , Quarentena/psicologia , Instituições Acadêmicas , Higiene do Sono , Estudantes/psicologia , Adolescente , Criança , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Estilo de Vida , Masculino , Quarentena/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
18.
BJS Open ; 5(2)2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33688956

RESUMO

BACKGROUND: During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. METHODS: An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). RESULTS: Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7-12, this decreased to 9.2-13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19. CONCLUSION: This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Licença para Cuidar de Pessoa da Família/estatística & dados numéricos , Mão de Obra em Saúde , Quarentena/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Cirurgiões/provisão & distribução , Centro Cirúrgico Hospitalar , Estudos Transversais , Humanos , Internacionalidade
19.
Epidemiol Infect ; 149: e65, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33650470

RESUMO

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) led to a significant disease burden and disruptions in health systems. We describe the epidemiology and transmission characteristics of early coronavirus disease 2019 (COVID-19) cases in Bavaria, Germany. Cases were reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infections, reported from 20 January-19 March 2020. The incubation period was estimated using travel history and date of symptom onset. To estimate the serial interval, we identified pairs of index and secondary cases. By 19 March, 3546 cases were reported. A large proportion was exposed abroad (38%), causing further local transmission. Median incubation period of 256 cases with exposure abroad was 3.8 days (95%CI: 3.5-4.2). For 95% of infected individuals, symptom onset occurred within 10.3 days (95%CI: 9.1-11.8) after exposure. The median serial interval, using 53 pairs, was 3.5 days (95%CI: 3.0-4.2; mean: 3.9, s.d.: 2.2). Travellers returning to Germany had an important influence on the spread of SARS-CoV-2 infections in Bavaria in early 2020. Especially in times of low incidence, public health agencies should identify holiday destinations, and areas with ongoing local transmission, to monitor potential importation of SARS-CoV-2 infections. Travellers returning from areas with ongoing community transmission should be advised to quarantine to prevent re-introductions of COVID-19.


Assuntos
/epidemiologia , /transmissão , Alemanha , Humanos , Saúde Pública , Quarentena/estatística & dados numéricos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estações do Ano , Viagem/estatística & dados numéricos
20.
PLoS Comput Biol ; 17(3): e1008633, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33661888

RESUMO

Existing compartmental mathematical modelling methods for epidemics, such as SEIR models, cannot accurately represent effects of contact tracing. This makes them inappropriate for evaluating testing and contact tracing strategies to contain an outbreak. An alternative used in practice is the application of agent- or individual-based models (ABM). However ABMs are complex, less well-understood and much more computationally expensive. This paper presents a new method for accurately including the effects of Testing, contact-Tracing and Isolation (TTI) strategies in standard compartmental models. We derive our method using a careful probabilistic argument to show how contact tracing at the individual level is reflected in aggregate on the population level. We show that the resultant SEIR-TTI model accurately approximates the behaviour of a mechanistic agent-based model at far less computational cost. The computational efficiency is such that it can be easily and cheaply used for exploratory modelling to quantify the required levels of testing and tracing, alone and with other interventions, to assist adaptive planning for managing disease outbreaks.


Assuntos
/métodos , /epidemiologia , Busca de Comunicante/métodos , Epidemias , Modelos Biológicos , Quarentena/métodos , Número Básico de Reprodução/estatística & dados numéricos , /estatística & dados numéricos , Biologia Computacional , Simulação por Computador , Busca de Comunicante/estatística & dados numéricos , Epidemias/estatística & dados numéricos , Humanos , Conceitos Matemáticos , Modelos Estatísticos , Quarentena/estatística & dados numéricos , Análise de Sistemas
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