Estimating the cumulative incidence of COVID-19 in the United States using influenza surveillance,virologic testing,and mortality data: Four complementary approaches

Effectively designing and evaluating public health responses to the ongoing COVID-19 pandemic requires accurate estimation of the prevalence of COVID-19 across the United States (US). Equipment shortages and varying testing capabilities have however hindered the usefulness of the official reported positive COVID-19 case counts. We introduce four complementary approaches to estimate the cumulative incidence of symptomatic COVID-19 in each state in the US as well as Puerto Rico and the District of Columbia, using a combination of excess influenza-like illness reports, COVID-19 test statistics, COVID-19 mortality reports, and a spatially structured epidemic model. Instead of relying on the estimate from a single data source or method that may be biased, we provide multiple estimates, each relying on different assumptions and data sources. Across our four approaches emerges the consistent conclusion that on April 4, 2020, the estimated case count was 5 to 50 times higher than the official positive test counts across the different states. Nationally, our estimates of COVID-19 symptomatic cases as of April 4 have a likely range of 2.3 to 4.8 million, with possibly as many as 7.6 million cases, up to 25 times greater than the cumulative confirmed cases of about 311,000. Extending our methods to May 16, 2020, we estimate that cumulative symptomatic incidence ranges from 4.9 to 10.1 million, as opposed to 1.5 million positive test counts. The proposed combination of approaches may prove useful in assessing the burden of COVID-19 during resurgences in the US and other countries with comparable surveillance systems.     

Impact of agronomic uncertainty in biomass production and endogenous commodity prices on cellulosic biofuel feedstock composition

This study evaluates the effect of agronomic uncertainty on bioenergy crop production as well as endogenous commodity and biomass prices on the feedstock composition of cellulosic biofuels under a binding mandate in the United States. The county‐level simulation model focuses on both field crops (corn, soybean, and wheat) and biomass feedstocks (corn stover, wheat straw, switchgrass, and Miscanthus). In addition, pasture serves as a potential area for bioenergy crop production. The economic model is calibrated to 2022 in terms of yield, crop demand, and baseline prices and allocates land optimally among the alternative crops given the binding cellulosic biofuel mandate. The simulation scenarios differ in terms of bioenergy crop type (switchgrass and Miscanthus) and yield, biomass production inputs, and pasture availability. The cellulosic biofuel mandates range from 15 to 60 billion L. The results indicate that the 15 and 30 billion L mandates in the high production input scenarios for switchgrass and Miscanthus are covered entirely by agricultural residues. With the exception of the low production input for Miscanthus scenario, the share of agricultural residues is always over 50% for all other scenarios including the 60 billion L mandate. The largest proportion of agricultural land dedicated to either switchgrass or Miscanthus is found in the southern Plains and the southeast. Almost no bioenergy crops are grown in the Midwest across all scenarios. Changes in the prices for the three commodities are negligible for cellulosic ethanol mandates because most of the mandate is met with agricultural residues. The lessons learned are that (1) the share of agricultural residue in the feedstock mix is higher than previously estimated and (2) for a given mandate, the feedstock composition is relatively stable with the exception of one scenario.     

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.     

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.     

Vaccine mandates,value pluralism,and policy diversity

Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms of broader government overreach. But such arguments often obscure or abstract away from the diverse values that are relevant to the ethical justifications of particular political communities’ vaccine‐mandate policies. We argue for an expansive conception of the normative issues relevant to deciding whether and how to establish or reform vaccine mandates, and we propose a schema by which to organize our thoughts about the ways in which different kinds of vaccine‐mandate policies implicate various values.     

A model‐based quantitative assessment of the carbon benefits of introducing iLUC factors in the European Renewable Energy Directive

The European Commission has a mandate from the EU's Renewable Energy and Fuel Quality Directives to propose a methodology, consistent with the best available science, to address indirect land use change (iLUC). One proposed solution to the iLUC problem is the application of iLUC factors in European fuels policy – it is widely expected that should the EU adopt such iLUC factors, they would be based on iLUC modelling using the International Food Policy Research Institute's (IFPRI) MIRAGE model. Taking the iLUC factors from IFPRI MIRAGE as our central estimate, we use Monte Carlo analysis on a simple model of potential biofuel pathways for Europe to assess the likely average carbon saving from three possible European biofuel policy scenarios: no action on iLUC; raised GHG thresholds for direct emissions savings; and the introduction of iLUC factors. We find that without iLUC factors (or some other effective iLUC minimization approach) European biofuel mandates are unlikely to deliver significant GHG emissions benefits in 2020, and have a substantial probability of increasing net GHG emissions. In contrast, the implementation of iLUC factors is likely to significantly increase the carbon savings from EU biofuel policy. With iLUC factors, it is likely that most permitted pathways would conform to the Renewable Energy Directive requirement for a minimum 50% GHG reduction compared to fossil fuels.     

Estimates and implications of the costs of compliance with biosafety regulations in developing countries

Estimating the cost of compliance with biosafety regulations is important as it helps developers focus their investments in producer development. We provide estimates for the cost of compliance for a set of technologies in Indonesia, the Philippines and other countries. These costs vary from US $100,000 to 1.7 million. These are estimates of regulatory costs and do not include product development or deployment costs. Cost estimates need to be compared with potential gains when the technology is introduced in these countries and the gains in knowledge accumulate during the biosafety assessment process. Although the cost of compliance is important, time delays and uncertainty are even more important and may have an adverse impact on innovations reaching farmers.     

A mechanistic spatio-temporal modeling of COVID-19 data

Understanding the evolution of an epidemic is essential to implement timely and efficient preventive measures. The availability of epidemiological data at a fine spatio-temporal scale is both novel and highly useful in this regard. Indeed, having geocoded data at the case level opens the door to analyze the spread of the disease on an individual basis, allowing the detection of specific outbreaks or, in general, of some interactions between cases that are not observable if aggregated data are used. Point processes are the natural tool to perform such analyses. We analyze a spatio-temporal point pattern of Coronavirus disease 2019 (COVID-19) cases detected in Valencia (Spain) during the first 11 months (February 2020 to January 2021) of the pandemic. In particular, we propose a mechanistic spatio-temporal model for the first-order intensity function of the point process. This model includes separate estimates of the overall temporal and spatial intensities of the model and a spatio-temporal interaction term. For the latter, while similar studies have considered different forms of this term solely based on the physical distances between the events, we have also incorporated mobility data to better capture the characteristics of human populations. The results suggest that there has only been a mild level of spatio-temporal interaction between cases in the study area, which to a large extent corresponds to people living in the same residential location. Extending our proposed model to larger areas could help us gain knowledge on the propagation of COVID-19 across cities with high mobility levels.     

Using species distribution models to identify suitable areas for biofuel feedstock production

The 2007 Energy Independence and Security Act mandates a five‐fold increase in US biofuel production by 2022. Given this ambitious policy target, there is a need for spatially explicit estimates of landscape suitability for growing biofuel feedstocks. We developed a suitability modeling approach for two major US biofuel crops, corn (Zea mays) and switchgrass (Panicum virgatum), based upon the use of two presence‐only species distribution models (SDMs): maximum entropy (Maxent) and support vector machines (SVM). SDMs are commonly used for modeling animal and plant distributions in natural environments, but have rarely been used to develop landscape models for cultivated crops. AUC, Kappa, and correlation measures derived from test data indicate that SVM slightly outperformed Maxent in modeling US corn production, although both models produced significantly accurate results. When compared with results from a mechanistic switchgrass model recently developed by Oak Ridge National Laboratory (ORNL), SVM results showed higher correlation than Maxent results with models fit using county‐scale point inputs of switchgrass production derived from expert opinion estimates. However, Maxent results for an alternative switchgrass model developed with point inputs from research trial sites showed higher correlation to the ORNL model than the corresponding results obtained from SVM. Further analysis indicates that both modeling approaches were effective in predicting county‐scale increases in corn production from 2006 to 2007, a time period in which US corn production increased by 24%. We conclude that presence‐only methods are a powerful first‐cut tool for estimating relative land suitability across geographic regions in which candidate biofuel feedstocks can be grown, and may also provide important insight into potential land‐use change patterns likely to be associated with increased biofuel demand.     

Nectar and hostplant scarcity limit populations of an endangered Oregon butterfly

As grassland habitats become degraded, declines in juvenile and adult food resources may limit populations of rare insects. Fender's blue butterfly (Icaricia icarioides fenderi), a species proposed for listing as endangered under the US Endangered Species Act, survives in remnants of upland prairie in western Oregon. We investigated the effects of limited larval hostplants and adult nectar sources on butterfly population size at four sites that encompass a range of resource densities. We used coarse and detailed estimates of resource abundance to test hypotheses relating resource quantity to population size. Coarse estimates of resources (percent cover of hostplant and density of nectar flowers) suggest that butterfly population size is not associated with resource availability. However, more detailed estimates of resources (density of hostplant leaves and quantity of nectar from native nectar sources) suggest that butterfly population size is strongly associated with resource availability. The results of this study suggest that restoring degraded habitat by augmenting adult and larval resources will play an important role in managing populations of this rare butterfly. Received: 20 June 1998 / Accepted: 25 November 1998     

Association between Time on Protease Inhibitors and the Incidence of Squamous Cell Carcinoma of the Anus among U.S. Male Veterans

Protease inhibitors (PIs) have been shown to have anti-tumor activity in addition to their antiretroviral properties. We sought to assess the association between PI use and the incidence of squamous cell carcinoma of the anus (SCCA) in HIV-infected individuals. We performed a retrospective cohort study among male US veterans diagnosed with HIV who were diagnosed between 1985 and 2010, using the Veterans Affairs HIV Clinical Case Registry (CCR). We calculated hazards ratios associated with PI use (both as percent time on PI and as 12-month intervals of PI use), utilizing time-dependent Cox models. We adjusted for risk factors, including age, race, year of enrolment into CCR, recent and nadir CD4, and percent time undetectable HIV viral load. A total of 28, 886 HIV-infected men met inclusion criteria. Of these, 373 were newly diagnosed with SCCA during the study period. In multivariate analysis, increasing percent time on PIs was associated with an increased risk of SCCA (aHR 1.07; 95% CI = 1.03–1.10 per 10% increase in time on PI). Poor immunologic recovery and virologic control, a history of condylomata acuminata, and CCR enrolment in the late combined antiretroviral therapy era were also associated with increased SCCA risk. Increasing percent time on a PI-based combined antiretroviral therapy regimen may be associated with an increased risk of developing SCCA in HIV-infected male US veterans. Future studies, better accounting for HIV control and treatment compliance, are necessary to further clarify this association.     

健康教育在狂犬病预防控制中的价值分析

目的 分析健康教育在狂犬病预防控制中的应用价值.方法 选取2020年1～11月,因动物致伤至我院犬伤处置重点门诊就诊的200例患者作为研究对象,对其开展狂犬病预防相关知识的健康教育,比较健康教育开展前后患者对狂犬病相关知识的知晓情况.结果 经健康教育后,患者对狂犬病相关知识知晓率明显高于健康教育前,差异有统计学意义(P...     

Community-based observational assessment of compliance by the public with COVID19 preventive measures in the south of Saudi Arabia

BackgroundAt the end of August 2020, a surge in the number of cases in the Jazan region has been observed. The number of reported cases by 19th of August in the Jazan region was more than 300, which exceeded the number of reported cases in larger regions such as Riyadh, and Makkah. This study aims to measure compliance by the public with COVID-19 preventive measures.MethodsThis study was a cross-sectional, field-based observational assessment of compliance by individuals in public settings with COVID-19 preventive measures in the Jazan region of Saudi Arabia. The assessment was performed in the last week of July 2020. The assessment was based on observing the actual compliance of individuals and different establishments in the Jazan region with COVID-19 preventive measures. To perform the field observations, a standardised check-list was adopted from COVID-19 preventive measures in the community, which was developed by the Saudi Centre for Disease Prevention and Control (CDC).ResultsA total of 1096 individuals were observed in 69 different locations in the Jazan region. Compliance by the observed individuals was variable depending on the age group, the setting and the recommended preventive practice. The findings indicate very low compliance of specific precautionary measures within public parks in comparison to other measured settings. Proportions of individuals not compliant with mask-wearing instructions varied according to settings and age group from 5% in malls and shopping areas to nearly 83% in public parks. Additionally, Proportions of children not compliant with mask-wearing instructions was higher in comparison to adults in all observed settings.ConclusionsThe findings of this study identified variability in the levels of compliance with specific preventive measures against COVID-19. Further assessment is needed to explore factors associated with the limited observed compliance, in particular with regard to limited compliance to precautionary measures applied in specific settings and compliance of children to mask-wearing instructions.     

Impact of Mobility Impairment on Indirect Costs and Health-Related Quality of Life in Multiple Sclerosis

This study was conducted to estimate the indirect costs and health-related quality of life (HRQoL) (utilities) of multiple sclerosis (MS) patients in the United States (US), and to determine the impact of worsening mobility on these parameters. In collaboration with the North American Research Committee on Multiple Sclerosis (NARCOMS) registry we conducted a cross-sectional study of participants who completed the biannual update and supplemental spring 2010 survey. Demographic, employment status, income, mobility impairment, and health utility data were collected from a sample of registry participants who met the study criteria and agreed to participate in the supplemental Mobility Study. Mean annual indirect costs per participant in 2011US$ and mean utilities for the population and for cohorts reporting different levels of mobility impairment were estimated. Analyses included 3,484 to 3,611 participants, based on survey completeness. Thirty-seven percent of registrants were not working or attending school and 46.7% of these reported retiring early. Indirect costs per participant per year, not including informal caregiver cost, were estimated at $30,601±31,184. The largest relative increase in indirect costs occurred at earlier mobility impairment stages, regardless of the measure used. Participants’ mean utility score (0.73±0.18) was lower than that of a similarly aged sample from the general US population (0.87). As with indirect costs, larger decrements in utility were seen at earlier mobility impairment stages. These results suggest that mobility impairment may contribute to increases in indirect costs and declines in HRQoL in MS patients.     

Survival of Adults with Acute Lymphoblastic Leukemia in Germany and the United States

Background

Adulthood acute lymphoblastic leukemia (ALL) is a rare disease. In contrast to childhood ALL, survival for adults with ALL is poor. Recently, new protocols, including use of pediatric protocols in young adults, have improved survival in clinical trials. Here, we examine population level survival in Germany and the United States (US) to gain insight into the extent to which changes in clinical trials have translated into better survival on the population level.

Methods

Data were extracted from the Surveillance, Epidemiology, and End Results database in the US and 11 cancer registries in Germany. Patients age 15–69 diagnosed with ALL were included. Period analysis was used to estimate 5-year relative survival (RS).

Results

Overall 5-year RS was estimated at 43.4% for Germany and 35.5% for the US (p = 0.004), with a decrease in survival with increasing age. Survival was higher in Germany than the US for men (43.6% versus 37.7%, p = 0.002) but not for women (42.4% versus 40.3%, p>0.1). Five-year RS estimates increased in Germany and the US between 2002 and 2006 by 11.8 and 7.3 percent units, respectively (p = 0.02 and 0.04, respectively).

Conclusions

Survival for adults with ALL continues to be low compared with that for children, but a substantial increase in 5-year survival estimates was seen from 2002 to 2006 in both Germany and the US. The reasons for the survival differences between both countries require clarification.     

不同职业人群对口罩的选择与正确佩戴

口罩是预防呼吸道暴露的重要防线,正确选择和佩戴口罩可以降低新型冠状病毒(2019 novel coronavirus,2019-nCoV)等呼吸道传播病原感染的风险。但是,口罩类型、防护等级、职业性质、工作环境和防护要求以及正确的佩戴方式均会影响防护效果。本文以国家标准、行业标准以及诊疗方案等资料为参照,针对不同职业人群对口罩的选择与佩戴的关键点展开论述,为不同人群正确使用口罩提供参考,降低各类人群的暴露风险,以利于疫情的控制。     

Capitalism and US policy at the Mexican border

Does US policy at the Mexican border—heavily weighted toward immigration and drug law enforcement—help the capitalist system function in North America, and if so, how? And if not, what are the most likely drivers of such policies, and how do they interact with the capitalist context? Four topics are examined: inequalities of rights to border crossing into the United States from Mexico, and the role of such unequal mobility in the maintenance of various privileges in North America; a puzzle in capitalist–functionalist border policy–underinvestment in ports of entry compared to enforcement between such ports; enforcement against unauthorized migrants seen both as labor control and discriminatory politics; and border enforcement and militarization as a system of regional repression and control, addressed at the rapidly growing and important US–Mexico border region. The relationship between US border policies and the functional needs of capitalism is complex, not simple; the article rejects a perfect system view in favor of a richer view of capitalism as filled with contradictory social impulses and political outcomes, shaped in broad contexts of class relations and capital accumulation. The wider context of this essay is the question of how the territorial nation-state relates to capitalism, two fundamental features of our era. Some preliminary thoughts on that question are broached in the conclusion.     

The therapeutic monoclonal antibody market

Since the commercialization of the first therapeutic monoclonal antibody product in 1986, this class of biopharmaceutical products has grown significantly so that, as of November 10, 2014, forty-seven monoclonal antibody products have been approved in the US or Europe for the treatment of a variety of diseases, and many of these products have also been approved for other global markets. At the current approval rate of ∼ four new products per year, ∼70 monoclonal antibody products will be on the market by 2020, and combined world-wide sales will be nearly $125 billion.     

The Effectiveness of Teleglaucoma versus In-Patient Examination for Glaucoma Screening: A Systematic Review and Meta-Analysis

BackgroundGlaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness.MethodsA systematic search was conducted to help locate published and unpublished studies. Studies which evaluate teleglaucoma as a screening device for glaucoma were included. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. The improvements to healthcare service quality and cost data were assessed.ResultsOf 11237 studies reviewed, 45 were included. Our results indicated that, teleglaucoma is more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The relative odds of a positive screen test in glaucoma cases are 18.7 times more likely than a negative screen test in a non-glaucoma cases. Additionally, the mean cost for every case of glaucoma detected was $1098.67 US and of teleglaucoma per patient screened was $922.77 US.ConclusionTeleglaucoma can accurately discriminate between screen test results with greater odds for positive cases. It detects more cases of glaucoma than in-person examination. Both patients and the healthcare systems benefit from early detection, reduction in wait and travel times, increased specialist referral rates, and cost savings. Teleglaucoma is an effective screening tool for glaucoma specifically for remote and under-services communities.