International travel in times of the COVID-19 pandemic: The case of German school breaks

The COVID-19 pandemic has triggered severe global restrictions on international travel with the intention of limiting the spread of SARS-CoV-2 across countries. This paper studies the causal effect of the partial relaxation of these travel restrictions in Europe on the COVID-19 incidence in Germany during the summer months of 2020. It exploits the staggered start of the summer school breaks across German states as an exogenous shock to the travel opportunities of the population. While the school breaks also increased mobility within Germany, the event-study type regressions precisely control for domestic mobility and local COVID-19-related restrictions. The intention-to-treat effects of the relaxed travel restrictions show a significant and sizable increase of the COVID-19 incidence in German counties during the later weeks of the school breaks. Part of the increase can be attributed to a mandatory testing regime for travel returnees from high-incidence areas.     

Telehealth Adoption Among Endocrinologists During The Covid-19 Pandemic

Objective: Telehealth is a timely solution for delivering health care during the coronavirus disease 2019 (COVID-19) pandemic. The practice of endocrinology is suited to provide virtual care to patients with a variety of endocrine disorders. In this survey, we aimed to gauge the adoption of telehealth practices during the COVID-19 pandemic among endocrinologists in the United States (U.S.).Methods: This was a cross-sectional, online survey-based study. Members of the Facebook group “Endocrinologists” were invited to participate in the survey. Characteristics of respondents and their rates of adoption of telehealth were described and analyzed for statistically significant associations using the Pearson chi-square test.Results: A total of 181 physicians responded to the survey. The majority of respondents were females (75%), younger than or equal to 40 years of age (51%), employed (72%) either by a private group/hospital or by an academic setting, worked in an urban area (88.4%), and were adult endocrinologists (93%). With the COVID-19 outbreak, more than two-fifths (44.2%) of participants switched to completely virtual visits, and an additional 44.2% switched to a majority of virtual visits, with some in-person visits in the outpatient setting. Additionally, there was a significantly higher adoption rate of telehealth among endocrinologists younger than or equal to 40 years of age (P = .02) and among those who practiced in northeastern, midwestern, and the western geographic regions of the U.S. (P = .04).Conclusion: The majority of the responding endocrinologists from the U.S. appeared to have swiftly adapted by using telehealth within a few weeks of COVID-19 being declared a national emergency.Abbreviations: CMS = Centers for Medicare and Medicaid Services; COVID-19 = coronavirus disease 2019; PPE = personal protective equipment; U.S. = United States     

Mobility restrictions and alcohol use during lockdown: “A still and dry pandemic for the many”?

Unexpected mobility disruptions during lockdown during the first wave of COVID-19 became ’tipping points’ with the potential to alter pre-pandemic routines sensitive to socialisation. This paper investigates the impact of lockdown exposure on alcohol consumption. We document two findings using information from the Google Mobility Report and longitudinal data from the Understanding Society survey (UKHLS) in the United Kingdom. First, we find a sharp reduction in both actual mobility and alcohol use (consistent with a ”still and dry pandemic for the many” hypothesis). However, we document an increase in alcohol use among heavy drinkers, implying a split behavioural response to COVID-19 mobility restrictions based on alcohol use prior to the pandemic. Second, using the predictions of the prevalence-response elasticity theory, we find that the pandemic’s reduction in social contacts is responsible for a 2.8 percentage point reduction in drinking among men.     

Trusting the Health System and COVID 19 Restriction Compliance

We examine the extent to which exposure to higher relative COVID-19 mortality (RM), influences health system trust (HST), and whether changes in HST explain the perceived ease of compliance with pandemic restrictions during the COVID-19 pandemic. Drawing on evidence from two representative surveys covering all regions of 28 European countries before and after the first COVID-19 wave, and using a difference in differences strategy together with Coarsened Exact Matching (CEM), we document that living in a region with higher RM during the first wave of the pandemic increased HST. However, the positive effect of RM on HST is driven by individuals over 45 years of age, and the opposite effect is found among younger cohorts. Furthemore, we find that a higher HST reduces the costs of complying with COVID-19 restrictions, but only so long as excess mortality does not exceed the average by more than 20%, at which point the ease of complying with COVID-19 restrictions significantly declines, offsetting the positive effect of trust in the healthcare system. Our interpretation of these estimates is that a higher RM is interpreted as a risk signal among those over 45, and as a signal of health-care system failure among younger age individuals.     

COVID-19 pandemic lockdown-induced altered sleep/wake circadian rhythm,health complaints and stress among traffic police personnel in India

ABSTRACT

COVID-19 is a highly contagious disease caused by Severe Acute Respiratory Syndrome coronavirus-2, capable of high human transmission. To protect against the COVID-19 pandemic, the World Health Organization proposed intervening guidance that included movement restrictions, isolation, restriction of national and international travel or movement, and full or partial closure of organizations and institutions. Police personnel play a vital role in safeguarding the spread of COVID-19; thus, potentially causing severe stress due to increased consignment and direct exposure to infection during duty. The study aimed to determine the effect of the added stress of the COVID-19 pandemic and population lockdown on the sleep/wake 24 h rhythm of traffic police. A concise online questionnaire survey was conducted among the traffic police personnel of India. Collected data were analyzed statistically. Disorientation of working schedule, fear of being vulnerable to disease, pressure of maintaining law, and orders during lockdown increased stress level. The survey identified discontinuation of sleep, shift of mid-sleep time, increase in depression, plus stress and anxiety among traffic police personnel that affected their chronobiological milieu. Proper awareness of adequate health and safety measures, use of personnel protection equipment, regular conversation with family members, and meditation can help reduce stress during this pandemic situation.     

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has had wide-reaching direct and indirect impacts on population health. In low- and middle-income countries, these impacts can halt progress toward reducing maternal and child mortality. This study estimates changes in health services utilization during the pandemic and the associated consequences for maternal, neonatal, and child mortality.Methods and findingsData on service utilization from January 2018 to June 2021 were extracted from health management information systems of 18 low- and lower-middle-income countries (Afghanistan, Bangladesh, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Guinea, Haiti, Kenya, Liberia, Madagascar, Malawi, Mali, Nigeria, Senegal, Sierra Leone, Somalia, and Uganda). An interrupted time-series design was used to estimate the percent change in the volumes of outpatient consultations and maternal and child health services delivered during the pandemic compared to projected volumes based on prepandemic trends. The Lives Saved Tool mathematical model was used to project the impact of the service utilization disruptions on child and maternal mortality. In addition, the estimated monthly disruptions were also correlated to the monthly number of COVID-19 deaths officially reported, time since the start of the pandemic, and relative severity of mobility restrictions. Across the 18 countries, we estimate an average decline in OPD volume of 13.1% and average declines of 2.6% to 4.6% for maternal and child services. We projected that decreases in essential health service utilization between March 2020 and June 2021 were associated with 113,962 excess deaths (110,686 children under 5, and 3,276 mothers), representing 3.6% and 1.5% increases in child and maternal mortality, respectively. This excess mortality is associated with the decline in utilization of the essential health services included in the analysis, but the utilization shortfalls vary substantially between countries, health services, and over time. The largest disruptions, associated with 27.5% of the excess deaths, occurred during the second quarter of 2020, regardless of whether countries reported the highest rate of COVID-19-related mortality during the same months. There is a significant relationship between the magnitude of service disruptions and the stringency of mobility restrictions. The study is limited by the extent to which administrative data, which varies in quality across countries, can accurately capture the changes in service coverage in the population.ConclusionsDeclines in healthcare utilization during the COVID-19 pandemic amplified the pandemic’s harmful impacts on health outcomes and threaten to reverse gains in reducing maternal and child mortality. As efforts and resource allocation toward prevention and treatment of COVID-19 continue, essential health services must be maintained, particularly in low- and middle-income countries.

Tashrik Ahmed and co-workers study health-care use and maternal and child health outcomes across low- and lower-middle-income countries during the COVID-19 pandemic.     

Pandemic velocity: Forecasting COVID-19 in the US with a machine learning & Bayesian time series compartmental model

Predictions of COVID-19 case growth and mortality are critical to the decisions of political leaders, businesses, and individuals grappling with the pandemic. This predictive task is challenging due to the novelty of the virus, limited data, and dynamic political and societal responses. We embed a Bayesian time series model and a random forest algorithm within an epidemiological compartmental model for empirically grounded COVID-19 predictions. The Bayesian case model fits a location-specific curve to the velocity (first derivative) of the log transformed cumulative case count, borrowing strength across geographic locations and incorporating prior information to obtain a posterior distribution for case trajectories. The compartmental model uses this distribution and predicts deaths using a random forest algorithm trained on COVID-19 data and population-level characteristics, yielding daily projections and interval estimates for cases and deaths in U.S. states. We evaluated the model by training it on progressively longer periods of the pandemic and computing its predictive accuracy over 21-day forecasts. The substantial variation in predicted trajectories and associated uncertainty between states is illustrated by comparing three unique locations: New York, Colorado, and West Virginia. The sophistication and accuracy of this COVID-19 model offer reliable predictions and uncertainty estimates for the current trajectory of the pandemic in the U.S. and provide a platform for future predictions as shifting political and societal responses alter its course.     

The effect of income support programs on job search,workplace mobility and COVID-19: International evidence

This study examines the effect of Income Support Programs (ISPs) on job search effort, work- place mobility, COVID-19 cases, and mortality growth rates. To identify ISPs’ causal effect, I use the variation in their introductions’ timing across countries and implement a difference-in-difference and multi-event analysis method. I find that ISPs led to a 4.4–8.29 percentage points reduction in workplace mobility and a 6.6–11.6 percentage points reduction in job search effort levels. They also caused a 21.8–47.7 and 17.1–29.7 percentage points reduction in the COVID-19 case growth rate and COVID-19 mortality growth rates, respectively. Using the event analysis estimates, I simulated the counterfactual job search effort, workplace mobility, and the number of COVID-19 cases and mortality without income support programs. The average global job search effort and workplace mobility without ISPs would have been 11.12 and 9.26 percent higher than the observed mean job search effort and workplace mobility. However, these would have come at the cost of 3.69 million and 166, 690 additional COVID-19 cases and mortality than the cases and deaths registered by May 15th.     

Early warning of vulnerable counties in a pandemic using socio-economic variables

In the U.S. in early 2020, heterogenous and incomplete county-scale data on COVID-19 hindered effective interventions in the pandemic. While numbers of deaths can be used to estimate actual number of infections after a time lag, counties with low death counts early on have considerable uncertainty about true numbers of cases in the future. Here we show that supplementing county-scale mortality statistics with socioeconomic data helps estimate true numbers of COVID-19 infections in low-data counties, and hence provide an early warning of future concern. We fit a LASSO negative binomial regression to select a parsimonious set of five predictive variables from thirty-one county-level covariates. Of these, population density, public transportation use, voting patterns and % African-American population are most predictive of higher COVID-19 death rates. To test the model, we show that counties identified as under-estimating COVID-19 on an early date (April 17) have relatively higher deaths later (July 1) in the pandemic.     

Return to sports after COVID-19: a position paper from the Dutch Sports Cardiology Section of the Netherlands Society of Cardiology

The coronavirus disease 2019 (COVID-19) pandemic has led to preventive measures worldwide. With the decline of infection rates, less stringent restrictions     

COVID-19 and children: medical impact and collateral damage

Children mostly experience mild SARS-CoV-2 infections, but the extent of paediatric COVID-19 disease differs between geographical regions and the distinct pandemic waves. Not all infections in children are mild, some children even show a strong inflammatory reaction resulting in a multisystem inflammatory syndrome. The assessments of paediatric vaccination depend on the efficacy of protection conferred by vaccination, the risk of adverse reactions and whether children contribute to herd immunity against COVID-19. Children were also the target of consequential public health actions such as school closure which caused substantial harm to children (educational deficits, sociopsychological problems) and working parents. It is, therefore, important to understand the transmission dynamics of SARS-CoV-2 infections by children to assess the efficacy of school closures and paediatric vaccination. The societal restrictions to contain the COVID-19 pandemic had additional negative effects on children’s health, such as missed routine vaccinations, nutritional deprivation and lesser mother–child medical care in developing countries causing increased child mortality as a collateral damage. In this complex epidemiological context, it is important to have an evidence-based approach to public health approaches. The present review summaries pertinent published data on the role of children in the pandemic, whether they are drivers or followers of the infection chains and whether they are (after elderlies) major sufferers or mere bystanders of the COVID-19 pandemic.     

SDN–IoT empowered intelligent framework for industry 4.0 applications during COVID-19 pandemic

Cluster Computing - The industrial ecosystem has been unprecedentedly affected by the COVID-19 pandemic because of its immense contact restrictions. Therefore, the manufacturing and socio-economic...     

An investigation of spatial-temporal patterns and predictions of the coronavirus 2019 pandemic in Colombia, 2020–2021

Colombia announced the first case of severe acute respiratory syndrome coronavirus 2 on March 6, 2020. Since then, the country has reported a total of 5,002,387 cases and 127,258 deaths as of October 31, 2021. The aggressive transmission dynamics of SARS-CoV-2 motivate an investigation of COVID-19 at the national and regional levels in Colombia. We utilize the case incidence and mortality data to estimate the transmission potential and generate short-term forecasts of the COVID-19 pandemic to inform the public health policies using previously validated mathematical models. The analysis is augmented by the examination of geographic heterogeneity of COVID-19 at the departmental level along with the investigation of mobility and social media trends. Overall, the national and regional reproduction numbers show sustained disease transmission during the early phase of the pandemic, exhibiting sub-exponential growth dynamics. Whereas the most recent estimates of reproduction number indicate disease containment, with R_t<1.0 as of October 31, 2021. On the forecasting front, the sub-epidemic model performs best at capturing the 30-day ahead COVID-19 trajectory compared to the Richards and generalized logistic growth model. Nevertheless, the spatial variability in the incidence rate patterns across different departments can be grouped into four distinct clusters. As the case incidence surged in July 2020, an increase in mobility patterns was also observed. On the contrary, a spike in the number of tweets indicating the stay-at-home orders was observed in November 2020 when the case incidence had already plateaued, indicating the pandemic fatigue in the country.     

Potential impacts of COVID-19 on reproductive health: Scientific findings and social dimension

COVID-19 virus is classified as a respiratory disease that can be mainly transmitted via respiratory droplets, however, there are recently published reports suggested its ability to transmit via sexual intercourse, assisted reproductive technology (ART) treatments, pregnancy, and nursing. Although SARS‐CoV‐2 mainly attacks respiratory systems, manifestations of multiple organs have been detected. A significant concern was raised about whether COVID‐19 may affect female and male reproductive functions. These findings imposed more restrictions on social relationships between individuals even if inside the family, adding more physiologic load. In this context, there is a crucial need to identify the biological and behavioral reproductive risk factors associated with COVID­19 disease. Questions regarding the potential risks of sexual transmission during intercourse and/or application of ART, vertical transmission (throughout pregnancy, delivery, and breastfeeding), the health of pregnant and postpartum women, and fetal or postnatal health problems of neonates/children remain largely unanswered. The contribution of individuals to different social and economic activities depends on the maintenance of good quality life and health. The ongoing COVID-19 pandemic raised on the end of December 2019 has drastically affected different aspects of human wellbeing. The pandemic not only affected the health of individuals, but also negatively affected mental health and social interaction. This review illustrates: a) scientific findings related to the impact of the COVID-19 pandemic on the reproductive process, considering gender, hormonal balance, gonad functions, pregnancy, and ART, b) the sociosexual dimension of COVID-19 disease and precautions that should be taken to avoid infection via sexual transmission or vertical transmission, which may alleviate the fear associated with continuing normal social relationships and economic activities.     

La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.     

Visiting parents in times of COVID-19: The impact of parent-adult child contacts on the psychological health of the elderly

Using the 8th wave of the SHARE and the SHARE Corona Survey, we investigated whether the disruption of parent–adult child contacts due to social distancing restrictions increased the symptoms of depression among old age individuals during the first wave of the COVID-19 pandemic. We model the relationship between the disruption of parent–adult child contacts and the mental health of the elderly using a recursive simultaneous equation model for binary variables. Our findings show that the likelihood of disruption of parent–adult child contacts was higher with adult children who do not live with or close to their parents (i.e., in the same household or in the same building) for whom contact disruption increases about 15 %. The duration of restrictions to movement and lockdowns also has a positive and significant effect on parent-child contact disruption: an additional week of lockdown significantly increases the probability of parent-child contact disruption, by about 1.5 %. The interventions deemed essential to reduce the spread of the pandemic, such as the “stay-at-home” order, necessarily disrupted personal parent–child contacts and the social processes that facilitate psychological well-being, increasing the probability of suffering from a deepening depressed mood by about 17 % for elderly parents.     

The impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague

BackgroundAmong the many collaterals of the COVID-19 pandemic is the disruption of health services and vital clinical research. COVID-19 has magnified the challenges faced in research and threatens to slow research for urgently needed therapeutics for Neglected Tropical Diseases (NTDs) and diseases affecting the most vulnerable populations. Here we explore the impact of the pandemic on a clinical trial for plague therapeutics and strategies that have been considered to ensure research efforts continue.MethodsTo understand the impact of the COVID-19 pandemic on the trial accrual rate, we documented changes in patterns of all-cause consultations that took place before and during the pandemic at health centres in two districts of the Amoron’I Mania region of Madagascar where the trial is underway. We also considered trends in plague reporting and other external factors that may have contributed to slow recruitment.ResultsDuring the pandemic, we found a 27% decrease in consultations at the referral hospital, compared to an 11% increase at peripheral health centres, as well as an overall drop during the months of lockdown. We also found a nation-wide trend towards reduced number of reported plague cases.DiscussionCOVID-19 outbreaks are unlikely to dissipate in the near future. Declining NTD case numbers recorded during the pandemic period should not be viewed in isolation or taken as a marker of things to come. It is vitally important that researchers are prepared for a rebound in cases and, most importantly, that research continues to avoid NTDs becoming even more neglected.