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JAMA
Authors Alexandra L. Potter, BS; Vedha Vaddaraju; Shivaek Venkateswaran; Arian Mansur, BS; Simar S. Bajaj; Mathew V. Kiang, MPH, ScD; Anupam B. Jena, MD, PhD; Chi-Fu Jeffrey Yang
Abstract Importance With the ongoing relaxation of guidelines to prevent COVID-19 transmission, particularly in hospital settings, medically vulnerable groups, such as patients with cancer, may experience a disparate burden of COVID-19 mortality compared with the general population. Objective To evaluate COVID-19 mortality among US patients with cancer compared with the general US population during different waves of the pandemic. Design, Setting, and Participants This cross-sectional study used data from the Center for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research database to examine COVID-19 mortality among US patients with cancer and the general population from March 1, 2020, to May 31, 2022. The number of deaths due to COVID-19 during the 2021 to 2022 winter Omicron surge was compared with deaths during the preceding year’s COVID-19 winter surge (when the wild-type SARS-CoV-2 variant was predominant) using mortality ratios. Data were analyzed from July 21 through August 31, 2022. Exposures Pandemic wave during which the wild-type variant (December 2020 to February 2021), Delta variant (July 2021 to November 2021), or Omicron variant (December 2021 to February 2022) was predominant.
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THE BMJ
Authors Kayoko Shioda
Authors John P. A. Ioannidis, MD, DSc1,2,3; Francesco Zonta, PhD4; Michael Levitt, PhD5
THE LANCET
Authors Nieves Derqui, Aleksandra Koycheva*, Jie Zhou*, Timesh D Pillay*, Michael A Crone†, Seran Hakki†, Joe Fenn†, Rhia Kundu†, Robert Varro, Emily Conibear, Kieran J Madon, Jack L Barnett, Hamish Houston, Anika Singanayagam, Janakan S Narean, Mica R Tolosa-Wright, Lucy Mosscrop, Carolina Rosadas, Patricia Watber, Charlotte Anderson, Eleanor Parker, Paul S Freemont, Neil M Ferguson, Maria Zambon, Myra O McClure, Richard Tedder, Wendy S Barclay, Jake Dunning, Graham P Taylor, Ajit Lalvani
MEDRXIV
Authors Alexandria B. Boehm, Bridgette Hughes, Dorothea Duong, Vikram Chan-Herur, Anna Buchman, Marlene K. Wolfe, Bradley J. White
Abstract Background Respiratory disease is a major cause of morbidity and mortality; however, current surveillance for circulating respiratory viruses is passive and biased. Seasonal circulation of respiratory viruses changed dramatically during the COVID-19 pandemic. More active methods for understanding respiratory disease dynamics are needed to better inform public health response and to guide clinical decision making. Wastewater-based epidemiology has been used to understand COVID-19, influenza A, and RSV infection rates at a community level, but has not been used to investigate other respiratory viruses. Methods We measured concentrations of influenza A and B, RSV A and B, human parainfluenza (1-4), rhinovirus, seasonal human coronaviruses, and human metapneumovirus RNA in wastewater solids three times per week for 17 months spanning the COVID-19 pandemic at a wastewater treatment plant in California, USA. Novel probe-based assays were developed and validated for non-influenza viral targets. We compared viral concentrations to positivity rates for viral infections from clinical specimens submitted to sentinel laboratories. Findings We detected RNA from all target viruses in wastewater solids. Human rhinovirus and seasonal coronaviruses were found at highest concentrations. Concentrations of viruses correlated significantly and positively with positivity rates of associated viral diseases from sentinel laboratories. Measurements from wastewater indicated limited circulation of RSV A and influenza B, and human coronavirus OC43 dominated the seasonal human coronavirus infections while human parainfluenza 1 and 4A dominated among parainfluenza infections. Interpretation Wastewater-based epidemiology can be used to obtain information on circulation of respiratory viruses at a community level without the need to test many individuals because a single sample of wastewater represents the entire contributing community. Results from wastewater can be available within 24 hours of sample collection, allowing real time information to inform public health response, clinical decision making, and individual behavior modifications.
Authors COVID-19 Forecasting Team
Authors Mathew V. Kiang, Lindsey E. Carlasare, Sonoo Thadaney Israni, John J. Norcini, Junaid A. B. Zaman, Kirsten Bibbins-Domingo
NATURE
Authors Enrique Acosta
Authors Alyssa Bilinski, Kathryn Thompson, Ezekiel Emanuel
Authors Justin Kurland, PhD; Wanda E. Leal, PhD; Erin M. Sorrell, PhD; Nicole Leeper Piquero
Abstract Importance The 2020-2021 National Football League (NFL) season had some games with fans and others without. Thus, the exposed group (ie, games with fans) and the unexposed group (games without fans) could be examined to better understand the association between fan attendance and local incidence of COVID-19. Objective To assess whether NFL football games with varying degrees of in-person attendance were associated with increased COVID-19 cases in the counties where the games were held, as well as in contiguous counties, compared with games without in-person attendance for 7-, 14-, and 21-day follow-ups. Design, Setting, and Participants This cross-sectional study used data for all 32 NFL teams across the entirety of the 2020-2021 season. Separate daily time-series of COVID-19 total cases and case rates were generated using 7-, 14-, and 21-day simple moving averages for every team and were plotted against the actuals to detect potential spikes (outliers) in incidence levels following games for the county in which games took place, contiguous counties, and a combination. Outliers flagged in the period following games were recorded. Poisson exact tests were evaluated for differences in spike incidence as well across games with different rates of attendance. The data were analyzed between February 2021 and March 2021. Exposures Games with fan attendance vs games with no fan attendance, as well as the number of fans in attendance for games with fans. Main Outcomes and Measures The main outcome was estimation of COVID-19 cases and rates at the county and contiguous county level at 7-, 14-, and 21-day intervals for in-person attended games and non–fan attended games, which was further investigated by stratifying by the number of persons in fan-attended games. Results This included a total of 269 NFL game dates. Of these games, 117 were assigned to an exposed group (fans attended), and the remaining 152 games comprised the unexposed group (unattended). Fan attendance ranged from 748 to 31 700 persons. Fan attendance was associated with episodic spikes in COVID-19 cases and rates in the 14-day window for the in-county (cases: rate ratio [RR], 1.36; 95% CI, 1.00-1.87), contiguous counties (cases: RR, 1.31; 95% CI, 1.00-1.72; rates: RR, 1.41; 95% CI, 1.13-1.76), and pooled counties groups (cases: RR, 1.34; 95% CI, 1.01-1.79; rates: RR, 1.72; 95% CI, 1.29-2.28) as well as for the 21-day window in-county (cases: RR, 1.49; 95% CI, 1.21-1.83; rates: RR, 1.50; 95% CI, 1.26-1.78), in contiguous counties(cases: RR, 1.37; 95% CI, 1.14-1.65; rates: RR, 1.45; 95% CI, 1.24-1.71), and pooled counties groups (cases: RR, 1.41; 95% CI, 1.11-1.79; rates: RR, 1.70; 95% CI, 1.35-2.15). Games with fewer than 5000 fans were not associated with any spikes, but in counties where teams had 20 000 fans in attendance, there were 2.23 times the rate of spikes in COVID-19 (95% CI, 1.53 to ∞). Conclusions and Relevance In this cross-sectional study of the presence of fans at NFL home games during the 2020-2021 season, results indicated that fan attendance was associated with increased levels of COVID-19 in the counties in which the venues are nested within, as well as in surrounding counties. The spikes in COVID-19 for crowds of over 20 000 people suggest that large events should be handled with extreme caution during public health event(s) where vaccines, on-site testing, and various countermeasures are not readily available to the public.
Authors Sheikh Taslim Ali*, Yiu Chung Lau*, Songwei Shan*, Sukhyun Ryu*, Zhanwei Du, Lin Wang, Xiao-Ke Xu, Dongxuan Chen, Jiaming Xiong, Jungyeon Tae, Tim K Tsang, Peng Wu, Eric H Y Lau, Benjamin J Cowling
Authors Louis Dron, Vinusha Kalatharan, Alind Gupta, Jonas Haggstrom, Nevine Zariffa, Andrew D Morris,Paul Arora,Jay Park
SCIENCE
Authors Lucia Illari1 , Nicholas J. Restrepo2 , Neil F. Johnson
Authors AA.VV.
Authors Joren Raymenants, Caspar Geenen, Jonathan Thibaut, Klaas Nelissen, Sarah Gorissen, Emmanuel Andre
Abstract Standard contact tracing practice for COVID-19 is to identify persons exposed to an infected person during the contagious period, assumed to start two days before symptom onset or diagnosis. In the first large cohort study on backward contact tracing for COVID-19, we extended the contact tracing window by 5 days, aiming to identify the source of the infection and persons infected by the same source. The risk of infection amongst these additional contacts was similar to contacts exposed during the standard tracing window and significantly higher than symptomatic individuals in a control group, leading to 42% more cases identified as direct contacts of an index case. Compared to standard practice, backward traced contacts required fewer tests and shorter quarantine. However, they were identified later in their infectious cycle if infected. Our results support implementing backward contact tracing when rigorous suppression of viral transmission is warranted.
Authors Ashleigh Myall, James R Price, Robert L Peach, Mohamed Abbas, Sid Mookerjee, Nina Zhu, Isa Ahmad, Damien Ming, Farzan Ramzan, Daniel Teixeira, Christophe Graf, Andrea Y Weiße, Stephan Harbarth, Alison Holmes, Mauricio Barahona
Authors June Young Chun, Hwichang Jeong, Yongdai Kim
Abstract Importance The Delta variant (B.1.617.2) is estimated to be more transmissible than previous strains of SARS-CoV-2, especially among children and adolescents. However, to our knowledge, there are no reports confirming this to date. Objective To gain a better understanding of the association of age with susceptibility to the Delta variant of SARS-CoV-2. Design, Setting, and Participants This decision analytic model used an age-structured compartmental model using the terms symptom onset (S), exposure (E), infectious (I), and quarantine (Q) (SEIQ) to estimate the age-specific force of infection, combining age-specific contact matrices and observed distribution of periods between each stage of infection (E to I [ie, latent period], I given S, and S to Q [ie, diagnostic delay]) developed in a previous contact tracing study. A bayesian inference method was used to estimate the age-specific force of infection (S to E) and, accordingly, age-specific susceptibility. The age-specific susceptibility during the third wave (ie, before Delta, from October 15 to December 22, 2020, when the COVID-19 vaccination campaign was not yet launched) and the fourth wave (ie, the Delta-driven wave, from June 27 to August 21, 2021) in Korea were compared. As vaccine uptake increased, individuals who were vaccinated were excluded from the susceptible population in accordance with vaccine effectiveness against the Delta variant. This nationwide epidemiologic study included individuals who were diagnosed with COVID-19 during the study period in Korea. Data were analyzed from September to November 2021. Exposures Age group during the third wave (ie, before Delta) and fourth wave (ie, Delta-driven) of the COVID-19 pandemic in South Korea. Main Outcomes and Measures Age-specific susceptibility during the third and fourth waves was estimated. Results Among 106 866 confirmed COVID-19 infections (including 26 597 infections and 80 269 infections during the third and fourth waves of COVID-19 in Korea, respectively), a significant difference in age-specific susceptibility to the Delta vs pre-Delta variant was found in the younger age group. After adjustment for contact pattern and vaccination status, the increase in susceptibility to the Delta vs pre-Delta variant was estimated to be highest in the group aged 10 to 15 years, approximately doubling (1.92-fold increase [95% CI, 1.86-fold to 1.98-fold]), whereas in the group aged 50 years or more, susceptibility to the Delta vs pre-Delta variant remained stable at an approximately 1-fold change (eg, among individuals aged 50-55 years: 0.997-fold [95% CI, 0.989-fold to 1.001-fold). Conclusions and Relevance In this study, the Delta variant of SARS-CoV-2 was estimated to propagate more easily among children and adolescents than pre-Delta strains, even after adjusting for contact pattern and vaccination status.
Authors Chadi M. Saad-Roy, C. Jessica E. Metcalf, Bryan T. Grenfell
Authors Khitam Muhsena, *, Wasef Na’aminha , Yelena Lapidota , Sophy Gorena , Yonatan Amira , Saritte Perlmana , Manfred S. Greenb , Gabriel Chodicka,c , Dani Cohena
Authors Joseph Waogodo Cabore, Humphrey Cyprian Karamagi, Hillary Kipchumba Kipruto, Joseph Kyalo Mungatu, James Avoka Asamani, Benson Droti, Regina Titi-ofei, Aminata Binetou Wahebine Seydi, Solyana Ngusbrhan Kidane, Thierno Balde, Abdou Salam Gueye, Lindiwe Makubalo, Matshidiso R Moeti
Authors Paul Elliott*, Oliver Eales†, Nicholas Steyn†, David Tang†, Barbara Bodinier, Haowei Wang, Joshua Elliott, Matthew Whitaker, Christina Atchison, Peter J. Diggle, Andrew J. Page, Alexander J. Trotter, Deborah Ashby, Wendy Barclay, Graham Taylor, Helen Ward, Ara Darzi, Graham S. Cooke, Christl A. Donnell, Marc Chadeau-Hyam
Authors Carl Firle, Anke Steinmetz, Oliver Stier, Dirk Stengel, Axel Ekkernkamp
Abstract The pandemic of COVID-19 led to restrictions in all kinds of music activities. Airborne transmission of SARS-CoV-2 requires risk assessment of wind instrument playing in various situations. Previous studies focused on short-range transmission, whereas long-range transmission risk has not been assessed. The latter requires knowledge of aerosol emission rates from wind instrument playing. We measured aerosol concentrations in a hermetically closed chamber of 20 m3 in an operating theatre as resulting from 20 min standardized wind instrument playing (19 flute, 11 oboe, 1 clarinet, 1 trumpet players). We calculated aerosol emission rates showing uniform distribution for both instrument groups. Aerosol emission from wind instrument playing ranged from 11 ± 288 particles/second (P/s) up to 2535 ± 195 P/s, expectation value ± uncertainty standard deviation. The analysis of aerosol particle size distributions shows that 70–80% of emitted particles had a size of 0.25–0.8 µm and thus are alveolar. Masking the bell with a surgical mask did not reduce aerosol emission. Aerosol emission rates were higher from wind instrument playing than from speaking or breathing. Differences between instrumental groups could not be found but high interindividual variance, as expressed by uniform distribution of aerosol emission rates. Our findings indicate that aerosol emission depends on physiological factors and playing techniques rather than on the type of instrument, in contrast to some previous studies. Based on our results, we present transmission risk calculations for long-range transmission of COVID-19 for three typical woodwind playing situations.
Authors Mari E. K. Niemi, Mark J. Daly, Andrea Ganna
Abstract Human genetics can inform the biology and epidemiology of coronavirus disease 2019 (COVID-19) by pinpointing causal mechanisms that explain why some individuals become more severely affected by the disease upon infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Large-scale genetic association studies, encompassing both rare and common genetic variants, have used different study designs and multiple disease phenotype definitions to identify several genomic regions associated with COVID-19. Along with a multitude of follow-up studies, these findings have increased our understanding of disease aetiology and provided routes for management of COVID-19. Important emergent opportunities include the clinical translatability of genetic risk prediction, the repurposing of existing drugs, exploration of variable host effects of different viral strains, study of inter-individual variability in vaccination response and understanding the long-term consequences of SARS-CoV-2 infection. Beyond the current pandemic, these transferrable opportunities are likely to affect the study of many infectious diseases.
Authors Owen Dyer
Authors Sara Mazzilli, Lara Tavoschi, Alessandro Soria, Marco Fornili, Giorgia Cocca, Teresa Sebastiani, Giuditta Scardina, Cristina Cairone, Guglielmo Arzilli, Giuseppe Lapadula, Luca Ceccarelli, Nicola Cocco, Raffaella Bartolotti, Stefano De Vecchi, Giacomo Placidi, Leonardo Rezzonico, Laura Baglietto, Ruggero Giuliani, Roberto Ranieri
Abstract Importance Owing to infrastructural and population characteristics, the prison setting is at increased risk for transmission of SARS-CoV-2 and for severe clinical outcomes. Because of structural and operational reasons, research in prison settings is challenging and available studies are often monocentric and have limited temporal coverage; broader-based research is necessary. Objectives To assess the extent and dynamics of the COVID-19 pandemic within the prison system of a large Italian region, Lombardy, and report the infection prevention and control measures implemented. Design, Setting, and Participants This repeated cross-sectional study was carried out from March 1, 2020, through February 28, 2021 (first wave, March-June 2020; second wave, October 2020-February 2021) in the prison system of Lombardy, which includes 18 detention facilities for adults. All incarcerated persons and the prison staff of the penitentiary system of the Lombardy region participated in the study. Exposures The main exposures of interest were the weekly average number of incarcerated individuals placed in quarantine in single or shared isolation rooms, the rate of sick leave by symptomatic and asymptomatic prison staff reported to the prison occupational medicine department on a weekly basis, and the level of overcrowding. Main Outcomes and Measures The primary outcome measures were weekly COVID-19 crude case rates, weekly test positivity rate, and the relative risk of acquiring the infection for prison staff, incarcerated persons, and the general population. Results The study population comprised a mean of 7599 incarcerated individuals and 4591 prison staff. Approximately 5.1% of the prison population were women; demographic characteristics of the prison staff were not available. During the study, COVID-19 occurred in 1564 incarcerated individuals and 661 prison staff. Most of these cases were reported during the second wave (1474 in incarcerated individuals, 529 in prison staff), when stringent measures previously enforced were relaxed. During both epidemic waves, incarcerated individuals and prison staff had a higher relative risk for COVID-19 infection than the general population during both the first wave (incarcerated individuals: 1.30; 95% CI, 1.06-1.58; prison staff: 3.23; 95% CI, 2.74-3.84) and the second wave (incarcerated individuals: 3.91; 95% CI, 3.73-4.09; prison staff: 2.61; 95% CI, 2.41-2.82). Conclusions and Relevance The findings of this study suggest that the prison setting was an element of fragility during COVID-19 pandemic, with a high burden of COVID-19 cases among both the incarcerated individuals and prison staff. The prison setting and prison population need to be included and possibly prioritized in the response during epidemic events.
Authors Chris Baraniuk
Authors COVID-19 Excess Mortality Collaborators
Authors Vanessa Schorer, Julian Haas, Robert Stach, Vjekoslav Kokoric, Rüdiger Groß, Jan Muench, Tim Hummel, Harald Sobek, Jan Mennig, Boris Mizaikoff
Abstract The ongoing COVID-19 pandemic represents a considerable risk for the general public and especially for health care workers. To avoid an overloading of the health care system and to control transmission chains, the development of rapid and cost-effective techniques allowing for the reliable diagnosis of individuals with acute respiratory infections are crucial. Uniquely, the present study focuses on the development of a direct face mask sampling approach, as worn (i.e., used) disposable face masks contain exogenous environmental constituents, as well as endogenously exhaled breath aerosols. Optical techniques—and specifically infrared (IR) molecular spectroscopic techniques—are promising tools for direct virus detection at the surface of such masks. In the present study, a rapid and non-destructive approach for monitoring exposure scenarios via medical face masks using attenuated total reflection infrared spectroscopy is presented. Complementarily, IR external reflection spectroscopy was evaluated in comparison for rapid mask analysis. The utility of a face mask-based sampling approach was demonstrated by differentiating water, proteins, and virus-like particles sampled onto the mask. Data analysis using multivariate statistical algorithms enabled unambiguously classifying spectral signatures of individual components and biospecies. This approach has the potential to be extended towards the rapid detection of SARS-CoV-2—as shown herein for the example of virus-like particles which are morphologically equivalent to authentic virus—without any additional sample preparation or elaborate testing equipment at laboratory facilities. Therefore, this strategy may be implemented as a routine large-scale monitoring routine, e.g., at health care institutions, nursing homes, etc. ensuring the health and safety of medical personnel.
Authors Ettore Bidoli, Federica Toffolutti, Stefania Del Zotto, Diego Serraino
Abstract The impact of specific risk factors for SARS-CoV-2 infection spread was investigated among the 215 municipalities in north-eastern Italy. SARS-CoV-2 incidence was gathered fortnightly since April 1, 2020 (21 consecutive periods) to depict three indicators of virus spreading from hierarchical Bayesian maps. Eight explanatory features of the municipalities were obtained from official databases (urbanicity, population density, active population on total, hosting schools or nursing homes, proportion of commuting workers or students, and percent of > 75 years population on total). Multivariate Odds Ratios (ORs), and corresponding 95% Confidence Intervals (CIs), quantified the associations between municipality features and virus spreading. The municipalities hosting nursing homes showed an excess of positive tested cases (OR = 2.61, ever versus never, 95% CI 1.37;4.98), and displayed repeated significant excesses: OR = 5.43, 3–4 times versus 0 (95% CI 1.98;14.87) and OR = 6.10, > 5 times versus 0 (95% CI 1.60;23.30). Municipalities with an active population > 50% were linked to a unique statistical excess of cases (OR = 3.06, 1 time versus 0, 95% CI 1.43;6.57) and were inversely related to repeated statistically significant excesses (OR = 0.25, > 5 times versus 0; 95% CI 0.06;0.98). We highlighted specific municipality features that give clues about SARS-CoV-2 prevention.
Authors Garyfallos Konstantinoudis, Michela Cameletti, Virgilio Gómez-Rubio, Inmaculada León Gómez, Monica Pirani, Gianluca Baio, Amparo Larrauri, Julien Riou, Matthias Egger, Paolo Vineis, Marta Blangiardo
Abstract The impact of the COVID-19 pandemic on excess mortality from all causes in 2020 varied across and within European countries. Using data for 2015–2019, we applied Bayesian spatio-temporal models to quantify the expected weekly deaths at the regional level had the pandemic not occurred in England, Greece, Italy, Spain, and Switzerland. With around 30%, Madrid, Castile-La Mancha, Castile-Leon (Spain) and Lombardia (Italy) were the regions with the highest excess mortality. In England, Greece and Switzerland, the regions most affected were Outer London and the West Midlands (England), Eastern, Western and Central Macedonia (Greece), and Ticino (Switzerland), with 15–20% excess mortality in 2020. Our study highlights the importance of the large transportation hubs for establishing community transmission in the first stages of the pandemic. Here, we show that acting promptly to limit transmission around these hubs is essential to prevent spread to other regions and countries.
Authors Chad R. Wells, Abhishek Pandey, Meagan C. Fitzpatrick, William S. Crystal, Burton H. Singer, Seyed M. Moghadas, Alison P. Galvani, Jeffrey P. Townsend
Authors Simon Cauchemez, Paolo Bosetti
Authors Jessica T. Davis, Matteo Chinazzi, Nicola Perra, Kunpeng Mu, Ana Pastore y Piontti, Marco Ajelli, Natalie E. Dean, Corrado Gioannini, Maria Litvinova, Stefano Merler, Luca Rossi, Kaiyuan Sun, Xinyue Xiong, Ira M. Longini Jr, M. Elizabeth Halloran, Cécile Viboud , Alessandro Vespignani
Abstract Considerable uncertainty surrounds the timeline of introductions and onsets of local transmission of SARS-CoV-2 globally1–7. Although a limited number of SARS-CoV-2 introductions were reported in January and February 20208,9, the narrowness of the initial testing criteria, combined with a slow growth in testing capacity and porous travel screening10, left many countries vulnerable to unmitigated, cryptic transmission. Here we use a global metapopulation epidemic model to provide a mechanistic understanding of the early dispersal of infections, and the temporal windows of the introduction and onset of SARS-CoV-2 local transmission in Europe and the United States. We find that community transmission of SARS-CoV-2 was likely in several areas of Europe and the United States by January 2020, and estimate that by early March, only 1 to 3 in 100 SARS-CoV-2 infections were detected by surveillance systems. The modelling results highlight international travel as the key driver of the introduction of SARS-CoV-2 with possible introductions and transmission events as early as December 2019–January 2020. We find a heterogeneous, geographic distribution of cumulative infection attack rates by 4 July 2020, ranging from 0.78%–15.2% across US states and 0.19%–13.2% in European countries. Our approach complements phylogenetic analyses and other surveillance approaches and provides insights that can be used to design innovative, model-driven surveillance systems that guide enhanced testing and response strategies.
Authors Jens Nielse, Sarah K. Nørgaard, Giampaolo Lanzieri ,Lasse S.Vestergaard, Kaare Moelbak
Abstract Europe experienced excess mortality from February through June, 2020 due to the COVID-19 pandemic, with more COVID-19-associated deaths in males compared to females. However, a difference in excess mortality among females compared to among males may be a more general phenomenon, and should be investigated in none-COVID-19 situations as well. Based on death counts from Eurostat, separate excess mortalities were estimated for each of the sexes using the EuroMOMO model. Sex-differential excess mortality were expressed as differences in excess mortality incidence rates between the sexes. A general relation between sex-differential and overall excess mortality both during the COVID-19 pandemic and in preceding seasons were investigated. Data from 27 European countries were included, covering the seasons 2016/17 to 2019/20. In periods with increased excess mortality, excess was consistently highest among males. From February through May 2020 male excess mortality was 52.7 (95% PI: 56.29; 49.05) deaths per 100,000 person years higher than for females. Increased male excess mortality compared to female was also observed in the seasons 2016/17 to 2018/19. We found a linear relation between sex-differences in excess mortality and overall excess mortality, i.e., 40 additional deaths among males per 100 excess deaths per 100,000 population. This corresponds to an overall female/male mortality incidence ratio of 0.7. In situations with overall excess mortality, excess mortality increases more for males than females. We suggest that the sex-differences observed during the COVID-19 pandemic reflects a general sex-disparity in excess mortality.
Authors Alejandro Fontal, Menno J. Bouma, Adrià San-José, Leonardo López, Mercedes Pascual, Xavier Rodó
Abstract The roles of climate and true seasonal signatures in the epidemiology of emergent pathogens, and that of SARS-CoV-2 in particular, remain poorly understood. With a statistical method designed to detect transitory associations, we show, for COVID-19 cases, strong consistent negative effects of both temperature and absolute humidity at large spatial scales. At finer spatial resolutions, we substantiate these connections during the seasonal rise and fall of COVID-19. Strong disease responses are identified in the first two waves, suggesting clear ranges for temperature and absolute humidity that are similar to those formerly described for seasonal influenza. For COVID-19, in all studied regions and pandemic waves, a process-based model that incorporates a temperature-dependent transmission rate outperforms baseline formulations with no driver or a sinusoidal seasonality. Our results, so far, classify COVID-19 as a seasonal low-temperature infection and suggest an important contribution of the airborne pathway in the transmission of SARS-CoV-2, with implications for the control measures we discuss.
Abstract The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants.
Authors Feifei Zhang, Humphrey Karamagi, Ngoy Nsenga, Miriam Nanyunja, Miriam Karinja, Seth Amanfo, Margo Chase-Topping, Giles Calder-Gerver, Miles McGibbon, Alexandra Huber, Tara Wagner-Gamble, Chuan-Guo Guo, Samuel Haynes, Alistair Morrison, Miranda Ferguson, Gordon A. Awandare, Francisca Mutapi, Zabulon Yoti, Joseph Cabore, Matshidiso R. Moeti, Mark E. J. Woolhouse
Abstract Countries of the World Health Organization (WHO) African Region have experienced a wide range of coronavirus disease 2019 (COVID-19) epidemics. This study aimed to identify predictors of the timing of the first COVID-19 case and the per capita mortality in WHO African Region countries during the first and second pandemic waves and to test for associations with the preparedness of health systems and government pandemic responses. Using a region-wide, country-based observational study, we found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity but later in island nations. Predictors of a high first wave per capita mortality rate included a more urban population, higher pre-pandemic international connectivity and a higher prevalence of HIV. Countries rated as better prepared and having more resilient health systems were worst affected by the disease, the imposition of restrictions or both, making any benefit of more stringent countermeasures difficult to detect. Predictors for the second wave were similar to the first. Second wave per capita mortality could be predicted from that of the first wave. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning. Main
Authors Tobia Boschi, Jacopo Di Iorio, Lorenzo Testa, Marzia A. Cremona, Francesca Chiaromonte
Abstract We investigate patterns of COVID-19 mortality across 20 Italian regions and their association with mobility, positivity, and socio-demographic, infrastructural and environmental covariates. Notwithstanding limitations in accuracy and resolution of the data available from public sources, we pinpoint significant trends exploiting information in curves and shapes with Functional Data Analysis techniques. These depict two starkly different epidemics; an “exponential” one unfolding in Lombardia and the worst hit areas of the north, and a milder, “flat(tened)” one in the rest of the country—including Veneto, where cases appeared concurrently with Lombardia but aggressive testing was implemented early on. We find that mobility and positivity can predict COVID-19 mortality, also when controlling for relevant covariates. Among the latter, primary care appears to mitigate mortality, and contacts in hospitals, schools and workplaces to aggravate it. The techniques we describe could capture additional and potentially sharper signals if applied to richer data.
THE NEW ENGLAND JOURNAL OF MEDICINE
Authors Moriah Bergwerk, Tal Gonen, Yaniv Lustig, Sharon Amit, Marc Lipsitch, Carmit Cohen, Michal Mandelboim, Einav Gal Levin, Carmit Rubin, Victoria Indenbaum, Ilana Tal, Malka Zavitan, Neta Zuckerman, Adina Bar-Chaim, Yitshak Kreiss, Gili Regev-Yochay
Abstract BACKGROUND Despite the high efficacy of the BNT162b2 messenger RNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rare breakthrough infections have been reported, including infections among health care workers. Data are needed to characterize these infections and define correlates of breakthrough and infectivity. METHODS At the largest medical center in Israel, we identified breakthrough infections by performing extensive evaluations of health care workers who were symptomatic (including mild symptoms) or had known infection exposure. These evaluations included epidemiologic investigations, repeat reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays, antigen-detecting rapid diagnostic testing (Ag-RDT), serologic assays, and genomic sequencing. Correlates of breakthrough infection were assessed in a case–control analysis. We matched patients with breakthrough infection who had antibody titers obtained within a week before SARS-CoV-2 detection (peri-infection period) with four to five uninfected controls and used generalized estimating equations to predict the geometric mean titers among cases and controls and the ratio between the titers in the two groups. We also assessed the correlation between neutralizing antibody titers and N gene cycle threshold (Ct) values with respect to infectivity. RESULTS Among 1497 fully vaccinated health care workers for whom RT-PCR data were available, 39 SARS-CoV-2 breakthrough infections were documented. Neutralizing antibody titers in case patients during the peri-infection period were lower than those in matched uninfected controls (case-to-control ratio, 0.361; 95% confidence interval, 0.165 to 0.787). Higher peri-infection neutralizing antibody titers were associated with lower infectivity (higher Ct values). Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks). The B.1.1.7 (alpha) variant was found in 85% of samples tested. A total of 74% of case patients had a high viral load (Ct value, <30) at some point during their infection; however, of these patients, only 17 (59%) had a positive result on concurrent Ag-RDT. No secondary infections were documented. CONCLUSIONS Among fully vaccinated health care workers, the occurrence of breakthrough infections with SARS-CoV-2 was correlated with neutralizing antibody titers during the peri-infection period. Most breakthrough infections were mild or asymptomatic, although persistent symptoms did occur.
Authors Mattia Manica, Giorgio Guzzetta, Flavia Riccardo, Antonio Valenti, Piero Poletti, Valentina Marziano, Filippo Trentini, Xanthi Andrianou, Alberto Mateo-Urdiales, Martina del Manso, Massimo Fabiani, Maria Fenicia Vescio, Matteo Spuri, Daniele Petrone, Antonino Bella, Sergio Iavicoli, Marco Ajelli, Silvio Brusaferro, Patrizio Pezzotti & Stefano Merler
Abstract To counter the second COVID-19 wave in autumn 2020, the Italian government introduced a system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to real-time epidemiological risk assessments. We leverage the data from the Italian COVID-19 integrated surveillance system and publicly available mobility data to evaluate the impact of the three-tiered regional restriction system on human activities, SARS-CoV-2 transmissibility and hospitalization burden in Italy. The individuals’ attendance to locations outside the residential settings was progressively reduced with tiers, but less than during the national lockdown against the first COVID-19 wave in the spring. The reproduction number R(t) decreased below the epidemic threshold in 85 out of 107 provinces after the introduction of the tier system, reaching average values of about 0.95-1.02 in the yellow tier, 0.80-0.93 in the orange tier and 0.74-0.83 in the red tier. We estimate that the reduced transmissibility resulted in averting about 36% of the hospitalizations between November 6 and November 25, 2020. These results are instrumental to inform public health efforts aimed at preventing future resurgence of cases.
Authors Jennifer Abbasi
Authors Philippe Lemey, Nick Ruktanonchai, Samuel L. Hong, Vittoria Colizza, Chiara Poletto, Frederik Van den Broeck, Mandev S. Gill, Xiang Ji, Anthony Levasseur, Bas B. Oude Munnink, Marion Koopmans, Adam Sadilek, Shengjie Lai, Andrew J. Tatem, Guy Baele, Marc A. Suchard, Simon Dellicour
Abstract Following the first wave of SARS-CoV-2 infections in spring 2020, Europe experienced a resurgence of the virus starting in late summer 2020 that was deadlier and more difficult to contain1. Relaxed intervention measures and summer travel have been implicated as drivers of the second wave2. Here, we build a phylogeographic model to evaluate how newly introduced lineages, as opposed to the rekindling of persistent lineages, contributed to the COVID-19 resurgence in Europe. We inform this model using genomic, mobility and epidemiological data from 10 European countries and estimate that in many countries over half of the lineages circulating in late summer resulted from new introductions since June 15th. The success in onward transmission of newly introduced lineages was negatively associated with local COVID-19 incidence during this period. The pervasive spread of variants in summer 2020 highlights the threat of viral dissemination when restrictions are lifted, and this needs to be carefully considered by strategies to control the current spread of variants that are more transmissible and/or evade immunity. Our findings indicate that more effective and coordinated measures are required to contain spread through cross-border travel even as vaccination begins to reduce disease burden.
Authors Yiqun Ma, Sen Pei, Jeffrey Shaman, Robert Dubrow, Kai Chen
Abstract Improved understanding of the effects of meteorological conditions on the transmission of SARS-CoV-2, the causative agent for COVID-19 disease, is needed. Here, we estimate the relationship between air temperature, specific humidity, and ultraviolet radiation and SARS-CoV-2 transmission in 2669 U.S. counties with abundant reported cases from March 15 to December 31, 2020. Specifically, we quantify the associations of daily mean temperature, specific humidity, and ultraviolet radiation with daily estimates of the SARS-CoV-2 reproduction number (Rt) and calculate the fraction of Rt attributable to these meteorological conditions. Lower air temperature (within the 20–40 °C range), lower specific humidity, and lower ultraviolet radiation were significantly associated with increased Rt. The fraction of Rt attributable to temperature, specific humidity, and ultraviolet radiation were 3.73% (95% empirical confidence interval [eCI]: 3.66–3.76%), 9.35% (95% eCI: 9.27–9.39%), and 4.44% (95% eCI: 4.38–4.47%), respectively. In total, 17.5% of Rt was attributable to meteorological factors. The fractions attributable to meteorological factors generally were higher in northern counties than in southern counties. Our findings indicate that cold and dry weather and low levels of ultraviolet radiation are moderately associated with increased SARS-CoV-2 transmissibility, with humidity playing the largest role.
Authors Aziz Sheikh, Jim McMenamin, Bob Taylor, Chris Robertson
Authors Christopher D. Cappa, Sima Asadi, Santiago Barreda, Anthony S. Wexler, Nicole M. Bouvier, William D. Ristenpart
Abstract Wearing surgical masks or other similar face coverings can reduce the emission of expiratory particles produced via breathing, talking, coughing, or sneezing. Although it is well established that some fraction of the expiratory airflow leaks around the edges of the mask, it is unclear how these leakage airflows affect the overall efficiency with which masks block emission of expiratory aerosol particles. Here, we show experimentally that the aerosol particle concentrations in the leakage airflows around a surgical mask are reduced compared to no mask wearing, with the magnitude of reduction dependent on the direction of escape (out the top, the sides, or the bottom). Because the actual leakage flowrate in each direction is difficult to measure, we use a Monte Carlo approach to estimate flow-corrected particle emission rates for particles having diameters in the range 0.5–20 μm. in all orientations. From these, we derive a flow-weighted overall number-based particle removal efficiency for the mask. The overall mask efficiency, accounting both for air that passes through the mask and for leakage flows, is reduced compared to the through-mask filtration efficiency, from 93 to 70% for talking, but from only 94–90% for coughing. These results demonstrate that leakage flows due to imperfect sealing do decrease mask efficiencies for reducing emission of expiratory particles, but even with such leakage surgical masks provide substantial control.
Authors Katarzyna Jabłońska, Samuel Aballéa, Mondher Toumi
Abstract OBJECTIVES This study aimed at estimating the real-life impact of vaccination on COVID-19 mortality, with adjustment for SARS-CoV-2 variants spread and other factors across Europe and Israel. METHODS Time series analysis of daily number of COVID-19 deaths was performed using non-linear Poisson mixed regression models. Variants’ frequency, demographic, climate, health and mobility characteristics of thirty-two countries were considered as potentially relevant adjustment factors between January 2020 and April 2021. RESULTS The analysis revealed that vaccination efficacy in terms of protection against deaths was equal to 72%, with a lower reduction of number of deaths for B.1.1.7 versus non-B.1.1.7 variants (70% and 78%, respectively). Other factors significantly related to mortality were arrivals at airports, mobility change from the pre-pandemic level and temperature. CONCLUSIONS Our study confirms a strong effectiveness of COVID-19 vaccination based on real-life public data, although lower than expected from clinical trials. This suggests the absence of indirect protection for non-vaccinated individuals. Results also show that vaccination effectiveness against mortality associated with the B.1.1.7 variant is slightly lower compared with other variants. Lastly, this analysis confirms the role of mobility reduction, within and between countries, as an effective way to reduce COVID-19 mortality and suggests the possibility of seasonal variations in COVID-19 incidence.
Authors Josè Vitale, Nicola Mumoli, Pierangelo Clerici, Massimo De Paschale, Isabella Evangelista, Marco Cei, Antonino Mazzone
EUROSURVEILLANCE
Authors David Hodgson, Stefan Flasche, Mark Jit , Adam J Kucharski
ABSTRACT We assess the feasibility of reaching the herd immunity threshold against SARS-CoV-2 through vaccination, considering vaccine effectiveness (VE), transmissibility of the virus and the level of pre-existing immunity in populations, as well as their age structure. If highly transmissible variants of concern become dominant in areas with low levels of naturally-acquired immunity and/or in populations with large proportions of < 15 year-olds, control of infection without non-pharmaceutical interventions may only be possible with a VE ≥ 80%, and coverage extended to children.
Authors Nick Wilson, Michael G. Baker, Tony Blakely, Martin Eichner
Abstract We aimed to estimate the risk of COVID-19 outbreaks associated with air travel to a COVID-19-free country [New Zealand (NZ)]. A stochastic version of the SEIR model CovidSIM v1.1, designed specifically for COVID-19 was utilised. We first considered historical data for Australia before it eliminated COVID-19 (equivalent to an outbreak generating 74 new cases/day) and one flight per day to NZ with no interventions in place. This gave a median time to an outbreak of 0.2 years (95% range of simulation results: 3 days to 1.1 years) or a mean of 110 flights per outbreak. However, the combined use of a pre-flight PCR test of saliva, three subsequent PCR tests (on days 1, 3 and 12 in NZ), and various other interventions (mask use and contact tracing) reduced this risk to one outbreak after a median of 1.5 years (20 days to 8.1 years). A pre-flight test plus 14 days quarantine was an even more effective strategy (4.9 years; 2,594 flights). For a much lower prevalence (representing only two new community cases per week in the whole of Australia), the annual risk of an outbreak with no interventions was 1.2% and had a median time to an outbreak of 56 years. In contrast the risks associated with travellers from Japan and the United States was very much higher and would need quarantine or other restrictions. Collectively, these results suggest that multi-layered interventions can markedly reduce the risk of importing the pandemic virus via air travel into a COVID-19-free nation. For some low-risk source countries, there is the potential to replace 14-day quarantine with alternative interventions. However, all approaches require public and policy deliberation about acceptable risks, and continuous careful management and evaluation.
Authors Nazrul Islam, Vladimir M Shkolnikov, Rolando J Acosta, Ilya Klimkin, Ichiro Kawachi, Rafael A Irizarry, Gianfranco Alicandro, Kamlesh Khunti, Tom Yates, Dmitri A Jdanov, Martin White, Sarah Lewington, Ben Lacey
Abstract Objective To estimate the direct and indirect effects of the covid-19 pandemic on mortality in 2020 in 29 high income countries with reliable and complete age and sex disaggregated mortality data. Design Time series study of high income countries. Setting Austria, Belgium, Czech Republic, Denmark, England and Wales, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Lithuania, the Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Scotland, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, and United States. Participants Mortality data from the Short-term Mortality Fluctuations data series of the Human Mortality Database for 2016-20, harmonised and disaggregated by age and sex. Interventions Covid-19 pandemic and associated policy measures. Main outcome measures Weekly excess deaths (observed deaths versus expected deaths predicted by model) in 2020, by sex and age (0-14, 15-64, 65-74, 75-84, and ≥85 years), estimated using an over-dispersed Poisson regression model that accounts for temporal trends and seasonal variability in mortality. Results An estimated 979 000 (95% confidence interval 954 000 to 1 001 000) excess deaths occurred in 2020 in the 29 high income countries analysed. All countries had excess deaths in 2020, except New Zealand, Norway, and Denmark. The five countries with the highest absolute number of excess deaths were the US (458 000, 454 000 to 461 000), Italy (89 100, 87 500 to 90 700), England and Wales (85 400, 83 900 to 86 800), Spain (84 100, 82 800 to 85 300), and Poland (60 100, 58 800 to 61 300). New Zealand had lower overall mortality than expected (−2500, −2900 to −2100). In many countries, the estimated number of excess deaths substantially exceeded the number of reported deaths from covid-19. The highest excess death rates (per 100 000) in men were in Lithuania (285, 259 to 311), Poland (191, 184 to 197), Spain (179, 174 to 184), Hungary (174, 161 to 188), and Italy (168, 163 to 173); the highest rates in women were in Lithuania (210, 185 to 234), Spain (180, 175 to 185), Hungary (169, 156 to 182), Slovenia (158, 132 to 184), and Belgium (151, 141 to 162). Little evidence was found of subsequent compensatory reductions following excess mortality. Conclusion Approximately one million excess deaths occurred in 2020 in these 29 high income countries. Age standardised excess death rates were higher in men than women in almost all countries. Excess deaths substantially exceeded reported deaths from covid-19 in many countries, indicating that determining the full impact of the pandemic on mortality requires assessment of excess deaths. Many countries had lower deaths than expected in children <15 years. Sex inequality in mortality widened further in most countries in 2020.
ELSEVIER
Authors Zezhun Chen, Angelos Dassios, Valerie Kuan, Jia Wei Lim, Yan Qu, Budhi Surya, Hongbiao Zhao
Abstract In this paper, we propose a continuous-time stochastic intensity model, namely, two-phase dynamic contagion process (2P-DCP), for modelling the epidemic contagion of COVID-19 and investigating the lockdown effect based on the dynamic contagion model introduced by Dassios and Zhao [24]. It allows randomness to the infectivity of individuals rather than a constant reproduction number as assumed by standard models. Key epidemiological quantities, such as the distribution of final epidemic size and expected epidemic duration, are derived and estimated based on real data for various regions and countries. The associated time lag of the effect of intervention in each country or region is estimated. Our results are consistent with the incubation time of COVID-19 found by recent medical study. We demonstrate that our model could potentially be a valuable tool in the modeling of COVID-19. More importantly, the proposed model of 2P-DCP could also be used as an important tool in epidemiological modelling as this type of contagion models with very simple structures is adequate to describe the evolution of regional epidemic and worldwide pandemic.
Authors Robert H Shaw, Arabella Stuart, Melanie Greenland, Xinxue Liu, Jonathan S Nguyen Van-Tam, Matthew D Snape
Authors Chris Wymant, Luca Ferretti, Daphne Tsallis, Marcos Charalambides, Lucie Abeler-Dörner, David Bonsall, Robert Hinch, Michelle Kendall, Luke Milsom, Matthew Ayres, Chris Holmes, Mark Briers, Christophe Fraser
Abstract The COVID-19 pandemic has seen digital contact tracing emerge around the world to help prevent spread of the disease. A mobile phone app records proximity events between app users, and when a user tests positive for COVID-19, their recent contacts can be notified instantly. Theoretical evidence has supported this new public health intervention1–6, but its epidemiological impact has remained uncertain7. Here we investigated the impact of the NHS COVID-19 app for England and Wales, from its launch on 24 September 2020 through to the end of December 2020. It was used regularly by approximately 16.5 million users (28% of the total population), and sent approximately 1.7 million exposure notifications: 4.4 per index case consenting to contact tracing. We estimated that the fraction of app-notified individuals subsequently showing symptoms and testing positive (the secondary attack rate, SAR) was 6.0%, comparable to the SAR for manually traced close contacts. We estimated the number of cases averted by the app using two complementary approaches. Modelling based on the notifications and SAR gave 284,000 (108,000-450,000), and statistical comparison of matched neighbouring local authorities gave 594,000 (317,000-914,000). Roughly one case was averted for each case consenting to notification of their contacts. We estimated that for every percentage point increase in app users, the number of cases can be reduced by 0.8% (modelling) or 2.3% (statistical analysis). These findings provide evidence for continued development and deployment of such apps in populations that are awaiting full protection from vaccines.
PNAS (PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA)
Authors Qing Yang, Tassa K. Saldi, Patrick K. Gonzales, Erika Lasda, Carolyn J. Decker, Kimngan L. Tat, Morgan R. Fink, Cole R. Hager, Jack C. Davis, Christopher D. Ozeroff, Denise Muhlrad, Stephen K. Clark, Will T. Fattor, Nicholas R. Meyerson, Camille L. Paige, Alison R. Gilchrist, Arturo Barbachano-Guerrero, Emma R. Worden-Sapper, Sharon S. Wu, Gloria R. Brisson, Matthew B. McQueen, Robin D. Dowell, Leslie Leinwand, Roy Parker, Sara L. Sawyer
Abstract We analyze data from the fall 2020 pandemic response efforts at the University of Colorado Boulder, where more than 72,500 saliva samples were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using qRT-PCR. All samples were collected from individuals who reported no symptoms associated with COVID-19 on the day of collection. From these, 1,405 positive cases were identified. The distribution of viral loads within these asymptomatic individuals was indistinguishable from what has been previously observed in symptomatic individuals. Regardless of symptomatic status, ∼50% of individuals who test positive for SARS-CoV-2 seem to be in noninfectious phases of the disease, based on having low viral loads in a range from which live virus has rarely been isolated. We find that, at any given time, just 2% of individuals carry 90% of the virions circulating within communities, serving as viral “supercarriers” and possibly also superspreaders. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that emerged into the human population in late 2019 (1), presumably from animal reservoirs (2, 3). During the ensuing world-wide pandemic, already more than 3 million lives have been lost due to the virus. Spread of SARS-CoV-2 has thus far been extremely difficult to contain. One key reason for this is that both presymptomatic and asymptomatic infected individuals can transmit the virus to others (4⇓⇓⇓⇓⇓⇓⇓⇓–13). Further, it is becoming clear that certain individuals play a key role in seeding superspreading events (14⇓⇓–17). Here, we analyzed data from a large university surveillance program. Viral loads were measured in saliva, which has proven to be an accessible and reliable biospecimen in which to identify carriers of this respiratory pathogen, and the most likely medium for SARS-CoV-2 transmission (18⇓–20). Our dataset is unique in that all SARS-CoV-2−positive individuals reported no symptoms at the time of saliva collection, and therefore were infected but asymptomatic or presymptomatic. We find that the distribution of SARS-CoV-2 viral loads on our campus is indistinguishable from what has previously been observed in symptomatic and hospitalized individuals. Strikingly, these datasets demonstrate dramatic differences in viral levels between individuals, with a very small minority of the infected individuals harboring the vast majority of the infectious virions.
SCIENCE DIRECT
Authors Kanika Tyagi, Amerta Ghosh, Dipti Nair, Koel Dutta, Prakash Singh Bhandari, Irshad Ahmed Ansari, Anoop Misra
Abstract Background and aims Vaccinations for COVID19 are now open to all adults in India. However, spread of COVID19 infection continues unabated. We aimed to ascertain number of breakthrough COVID19 infections after vaccinations in a chronic care, diabetes-centric healthcare facility. Methods We reviewed rigorously maintained data of vaccinations, health status, symptoms of COVID19 & RT-PCR testing of all staff (doctors, nurses, paramedical workers, and other staff) in our health care facility from January 16, 2021 till date. Results Out of 123 employees, 113 were vaccinated (Covaxin, 28, Covishield, 85). Second dose was completed in 107 (94.7%) and first dose in 6 persons (5.3%). Symptomatic COVD19 infections occurred in 19 persons (16.9%) post any dose of vaccine. Symptomatic breakthrough infections > 14 days after second dose occurred in 15 persons (13.3%). Except one (required hospitalization), all 14 had mild COVID19 disease. Conclusions We report mild symptomatic breakthrough infections as seen in our health care facility. Research in breakthrough infections in India should be extended to other institutions and community to obtain larger data.
Authors Swetaprovo Chaudhuri, Abhishek Saha, Saptarshi Basu
Abstract Recognizing the multiscale, interdisciplinary nature of the Covid-19 transmission dynamics, we discuss some recent developments concerning an attempt to construct a disease spread model from the flow physics of infectious droplets and aerosols and the frequency of contact between susceptible individuals with the infectious aerosol cloud. Such an approach begins with the exhalation event–specific, respiratory droplet size distribution (both airborne/aerosolized and ballistic droplets), followed by tracking its evolution in the exhaled air to estimate the probability of infection and the rate constants of the disease spread model. The basic formulations and structure of submodels, experiments involved to validate those submodels, are discussed. Finally, in the context of preventive measures, respiratory droplet–face mask interactions are described.
Authors Kamala Thiagarajan
Authors Yu Wu, Wenzhan Jing, Jue Liu, Qiuyue Ma, Jie Yuan, Yaping Wang, Min Du, Min Liu
Abstract The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time and the greatest challenge facing the world. Meteorological parameters are reportedly crucial factors affecting respiratory infectious disease epidemics; however, the effect of meteorological parameters on COVID-19 remains controversial. This study investigated the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, which has useful implications for policymakers and the public. Daily data on meteorological conditions, new cases and new deaths of COVID-19 were collected for 166 countries (excluding China) as of March 27, 2020. Log-linear generalized additive model was used to analyze the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, with potential confounders controlled for, including wind speed, median age of the national population, Global Health Security Index, Human Development Index and population density. Our findings revealed that temperature and relative humidity were both negatively related to daily new cases and deaths. A 1 °C increase in temperature was associated with a 3.08% (95% CI: 1.53%, 4.63%) reduction in daily new cases and a 1.19% (95% CI: 0.44%, 1.95%) reduction in daily new deaths, whereas a 1% increase in relative humidity was associated with a 0.85% (95% CI: 0.51%, 1.19%) reduction in daily new cases and a 0.51% (95% CI: 0.34%, 0.67%) reduction in daily new deaths. The results remained robust when different lag structures and the sensitivity analysis were used. These findings provide preliminary evidence that the COVID-19 pandemic may be partially suppressed with temperature and humidity increases. However, active measures must be taken to control the source of infection, block transmission and prevent further spread of COVID-19.
Authors Simiao Chen, Klaus Prettner, Michael Kuhn, Pascal Geldsetzer, Chen Wang, Till Bärnighausen, David E. Bloom
Abstract Visual inspection of world maps shows that coronavirus disease 2019 (COVID-19) is less prevalent in countries closer to the equator, where heat and humidity tend to be higher. Scientists disagree how to interpret this observation because the relationship between COVID-19 and climatic conditions may be confounded by many factors. We regress the logarithm of confirmed COVID-19 cases per million inhabitants in a country against the country’s distance from the equator, controlling for key confounding factors: air travel, vehicle concentration, urbanization, COVID-19 testing intensity, cell phone usage, income, old-age dependency ratio, and health expenditure. A one-degree increase in absolute latitude is associated with a 4.3% increase in cases per million inhabitants as of January 9, 2021 (p value < 0.001). Our results imply that a country, which is located 1000 km closer to the equator, could expect 33% fewer cases per million inhabitants. Since the change in Earth’s angle towards the sun between equinox and solstice is about 23.5°, one could expect a difference in cases per million inhabitants of 64% between two hypothetical countries whose climates differ to a similar extent as two adjacent seasons. According to our results, countries are expected to see a decline in new COVID-19 cases during summer and a resurgence during winter. However, our results do not imply that the disease will vanish during summer or will not affect countries close to the equator. Rather, the higher temperatures and more intense UV radiation in summer are likely to support public health measures to contain SARS-CoV-2.
MDPI
Authors Claudio Zanettini, Mohamed Omar, Wikum Dinalankara, Eddie Luidy Imada, Elizabeth Colantuoni, Giovanni Parmigiani, Luigi Marchionni
Abstract The COVID-19 mortality rate is higher in the elderly and in those with pre-existing chronic medical conditions. The elderly also suffer from increased morbidity and mortality from seasonal influenza infections; thus, an annual influenza vaccination is recommended for them. In this study, we explore a possible county-level association between influenza vaccination coverage in people aged 65 years and older and the number of deaths from COVID-19. To this end, we used COVID-19 data up to 14 December 2020 and US population health data at the county level. We fit quasi-Poisson regression models using influenza vaccination coverage in the elderly population as the independent variable and the COVID-19 mortality rate as the outcome variable. We adjusted for an array of potential confounders using different propensity score regression methods. Results show that, on the county level, influenza vaccination coverage in the elderly population is negatively associated with mortality from COVID-19, using different methodologies for confounding adjustment. These findings point to the need for studying the relationship between influenza vaccination and COVID-19 mortality at the individual level to investigate any underlying biological mechanisms.
Authors Steven Riley, Kylie E. C. Ainslie, Oliver Eales, Caroline E. Walters, Haowei Wang, Christina Atchison, Claudio Fronterre, Peter J. Diggle, Deborah Ashby, Christl A. Donnelly, Graham Cooke, Wendy Barclay, Helen Ward, Ara Darzi, Paul Elliott
Abstract Surveillance of the SARS-CoV-2 epidemic has mainly relied on case reporting which is biased by health service performance, test availability and test-seeking behaviors. We report a community-wide national representative surveillance program in England involving self-administered swab results from 594,000 individuals tested for SARS-CoV-2, regardless of symptoms, from May to beginning of September 2020. The epidemic declined between May and July 2020 but then increased gradually from mid-August, accelerating into early September 2020 at the start of the second wave. When compared to cases detected through routine surveillance, we report here a longer period of decline and a younger age distribution. Representative community sampling for SARS-CoV-2 can substantially improve situational awareness and feed into the public health response even at low prevalence.
BMJ JOURNALS
Authors Hagai Rossman, Smadar Shilo, Tomer Meir, Malka Gorfine, Uri Shalit, Eran Segal
Abstract Studies on the real-life effect of the BNT162b2 vaccine for Coronavirus Disease 2019 (COVID-19) prevention are urgently needed. In this study, we conducted a retrospective analysis of data from the Israeli Ministry of Health collected between 28 August 2020 and 24 February 2021. We studied the temporal dynamics of the number of new COVID-19 cases and hospitalizations after the vaccination campaign, which was initiated on 20 December 2020. To distinguish the possible effects of the vaccination on cases and hospitalizations from other factors, including a third lockdown implemented on 8 January 2021, we performed several comparisons: (1) individuals aged 60 years and older prioritized to receive the vaccine first versus younger age groups; (2) the January lockdown versus the September lockdown; and (3) early-vaccinated versus late-vaccinated cities. A larger and earlier decrease in COVID-19 cases and hospitalization was observed in individuals older than 60 years, followed by younger age groups, by the order of vaccination prioritization. This pattern was not observed in the previous lockdown and was more pronounced in early-vaccinated cities. Our analysis demonstrates the real-life effect of a national vaccination campaign on the pandemic dynamics.
Authors Giulia Giordano, Marta Colaneri, Alessandro Di Filippo, Franco Blanchini, Paolo Bolzern, Giuseppe De Nicolao, Paolo Sacchi, Patrizio Colaneri, Raffaele Bruno
Abstract Despite progress in clinical care for patients with coronavirus disease 2019 (COVID-19)1, population-wide interventions are still crucial to manage the pandemic, which has been aggravated by the emergence of new, highly transmissible variants. In this study, we combined the SIDARTHE model2, which predicts the spread of SARS-CoV-2 infections, with a new data-based model that projects new cases onto casualties and healthcare system costs. Based on the Italian case study, we outline several scenarios: mass vaccination campaigns with different paces, different transmission rates due to new variants and different enforced countermeasures, including the alternation of opening and closure phases. Our results demonstrate that non-pharmaceutical interventions (NPIs) have a higher effect on the epidemic evolution than vaccination alone, advocating for the need to keep NPIs in place during the first phase of the vaccination campaign. Our model predicts that, from April 2021 to January 2022, in a scenario with no vaccine rollout and weak NPIs (R0 = 1.27), as many as 298,000 deaths associated with COVID-19 could occur. However, fast vaccination rollouts could reduce mortality to as few as 51,000 deaths. Implementation of restrictive NPIs (R0 = 0.9) could reduce COVID-19 deaths to 30,000 without vaccinating the population and to 18,000 with a fast rollout of vaccines. We also show that, if intermittent open–close strategies are adopted, implementing a closing phase first could reduce deaths (from 47,000 to 27,000 with slow vaccine rollout) and healthcare system costs, without substantive aggravation of socioeconomic losses.
CNBC
Authors Berkeley Lovelace Jr.
Authors Rachel Kidman, Rachel Margolis, Emily Smith-Greenaway, Ashton M. Verdery
Authors Steven H. Woolf, Derek A. Chapman, Roy T. Sabo, Emily B. Zimmerman
Authors Javier Perez-Saez, Stephen A Lauer, Laurent Kaiser, Simon Regard, Elisabeth Delaporte, Idris Guessous, Silvia Stringhini, Andrew S Azman
MAYO CLINIC
Authors Rickey E. Carter, Elitza S. Theel, Laura E. Breeher, Melanie D. Swift, Nathan A. Van Brunt, Windell R. Smith, Lorrie L. Blanchfield, Elizabeth A. Daugherty, Alyssa B. Chapital, Kathleen M. Matson, Katherine A. Bews, Patrick W. Johnson, Robert A. Domnick, Diane E. Joyce, Holly L. Geyer, Dane Granger, Heather R. Hilgart, Coleman T. Turgeon, Karen A. Sanders, Dietrich Matern, Aziza Nassar, Priya Sampathkumar, Caitlin M. Hainy, Robert R. Orford, Celine M. Vachon, Roshanak Didehban, William G. Morice, Henry H. Ting, Amy W. Williams, Richard J. Gray, Kent R. Thielen, Gianrico Farruggia
Abstract Objective To estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in health care personnel. Methods The Mayo Clinic Serology Screening Program was created to provide a voluntary, two-stage testing program for SARS-CoV-2 antibodies to health care personnel. The first stage used a dried blood spot screening test initiated on June 15, 2020. Those participants identified as reactive were advised to have confirmatory testing via a venipuncture. Venipuncture results through August 8, 2020, were considered. Consent and authorization for testing was required to participate in the screening program. This report, which was conducted under an institutional review board–approved protocol, only includes employees who have further authorized their records for use in research. Results A total of 81,113 health care personnel were eligible for the program, and of these 29,606 participated in the screening program. A total of 4284 (14.5%) of the dried blood spot test results were “reactive” and warranted confirmatory testing. Confirmatory testing was completed on 4094 (95.6%) of the screen reactive with an overall seroprevalence rate of 0.60% (95% CI, 0.52% to 0.69%). Significant variation in seroprevalence was observed by region of the country and age group. Conclusion The seroprevalence for SARS-CoV-2 antibodies through August 8, 2020, was found to be lower than previously reported in other health care organizations. There was an observation that seroprevalence may be associated with community disease burden.
Authors Stephanie J Salyer, Justin Maeda, Senga Sembuche, Yenew Kebede, Akhona Tshangela, Mohamed Moussif, Chikwe Ihekweazu, Natalie Mayet, Ebba Abate, Ahmed Ogwell Ouma, John Nkengasong
Authors Mathew V Kiang, Elizabeth T Chin, Benjamin Q Huynh, Lloyd A C Chapman, Isabel Rodríguez-Barraquer, Bryan Greenhouse, George W Rutherford, Kirsten Bibbins-Domingo, Diane Havlir, Sanjay Basu, Nathan C Lo
Authors Daniel J Grint, Kevin Wing, Elizabeth Williamson, Helen I McDonald, Krishnan Bhaskaran, David Evans, Stephen JW Evans, Alex J Walker, George Hickman, Emily Nightingale, Anna Schultze, Christopher T Rentsch, Chris Bates, Jonathan Cockburn, Helen J Curtis, Caroline E Morton, Sebastian Bacon, Simon Davy, Angel YS Wong, Amir Mehrkar, Laurie Tomlinson, Ian J Douglas, Rohini Mathur, Paula Blomquist, Brian MacKenna, Peter Ingelsby, Richard Croker, John Parry, Frank Hester, Sam Harper, Nicholas J DeVito, Will Hulme, John Tazare, Ben Goldacre, Liam Smeeth, Rosalind M Eggo
Authors Harriet Forbes, Caroline E Morton, Seb Bacon, Helen I McDonald, Caroline Minassian, Jeremy P Brown, Christopher T Rentsch, Rohini Mathur, Anna Schultze, Nicholas J DeVito, Brian MacKenna, William J Hulme, Richard Croker, Alex J Walker, Elizabeth J Williamson, Chris Bates, Amir Mehrkar, Helen J Curtis, David Evans, Kevin Wing, Peter Inglesby, Henry Drysdale, Angel Y S Wong, Jonathan Cockburn, Robert McManus, John Parry, Frank Hester, Sam Harper, Ian J Douglas, Liam Smeeth, Stephen J W Evans, Krishnan Bhaskaran, Rosalind M Eggo, Ben Goldacre, Laurie A Tomlinson
Search covid-19 Research Education News & Views Campaigns Jobs Archive For authors Hosted CCBY Open access Research Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n628 (Published 18 March 2021) Cite this as: BMJ 2021;372:n628 Read our latest coverage of the coronavirus outbreak Linked Opinion A bird’s eye view of the risk of covid-19 infection from children Article Related content Metrics Responses Peer review This article has a correction. Please see: Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England - March 22, 2021 Harriet Forbes, assistant professor1, Caroline E Morton, epidemiologist2, Seb Bacon, chief technical officer2, Helen I McDonald, assistant professor1, Caroline Minassian, assistant professor1, Jeremy P Brown, research degree student1, Christopher T Rentsch, assistant professor1, Rohini Mathur, assistant professor1, Anna Schultze, research fellow1, Nicholas J DeVito, researcher2, Brian MacKenna, honorary research fellow pharmacist2, William J Hulme, statistician2, Richard Croker, pharmaceutical adviser2, Alex J Walker, epidemiologist2, Elizabeth J Williamson, professor1, Chris Bates, director of research and analytics3, Amir Mehrkar, senior clinical researcher2, Helen J Curtis, researcher2, David Evans, software developer2, Kevin Wing, assistant professor1, Peter Inglesby, consultant programmer2, Henry Drysdale, research fellow2, Angel Y S Wong, assistant professor1, Jonathan Cockburn, software developer3, Robert McManus, software developer3, John Parry, clinical director3, Frank Hester, founder and chief, executive officer3, Sam Harper, software developer3, Ian J Douglas, professor1, Liam Smeeth, professor1, Stephen J W Evans, professor1, Krishnan Bhaskaran, professor1, Rosalind M Eggo, associate professor1 4, Ben Goldacre, director2, Laurie A Tomlinson, associate professor1 Author affiliations Correspondence to: B Goldacre ben.goldacre@phc.ox.ac.uk (or @bengoldacre on Twitter) Accepted 7 March 2021 Abstract Objective To investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic. Design Population based cohort study, on behalf of NHS England. Setting Primary care data and pseudonymously linked hospital and intensive care admissions and death records from England, during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020). Participants Two cohorts of adults (18 years and over) registered at a general practice on 1 February 2020 and 1 September 2020. Main outcome measures Adjusted hazard ratios for SARS-CoV-2 infection, covid-19 related admission to hospital or intensive care, or death from covid-19, by presence of children in the household. Results Among 9 334 392adults aged 65 years and under, during wave 1, living with children was not associated with materially increased risks of recorded SARS-CoV-2 infection, covid-19 related hospital or intensive care admission, or death from covid-19. In wave 2, among adults aged 65 years and under, living with children of any age was associated with an increased risk of recorded SARS-CoV-2 infection (hazard ratio 1.06 (95% confidence interval 1.05 to 1.08) for living with children aged 0-11 years; 1.22 (1.20 to 1.24) for living with children aged 12-18 years) and covid-19 related hospital admission (1.18 (1.06 to 1.31) for living with children aged 0-11; 1.26 (1.12 to 1.40) for living with children aged 12-18). Living with children aged 0-11 was associated with reduced risk of death from both covid-19 and non-covid-19 causes in both waves; living with children of any age was also associated with lower risk of dying from non-covid-19 causes. For adults 65 years and under during wave 2, living with children aged 0-11 years was associated with an increased absolute risk of having SARS-CoV-2 infection recorded of 40-60 per 10 000 people, from 810 to between 850 and 870, and an increase in the number of hospital admissions of 1-5 per 10 000 people, from 160 to between 161 and 165. Living with children aged 12-18 years was associated with an increase of 160-190 per 10 000 in the number of SARS-CoV-2 infections and an increase of 2-6 per 10 000 in the number of hospital admissions. Conclusions In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.
Authors Christian Holm Hansen, Daniela Michlmayr, Sophie Madeleine Gubbels, Kåre Mølbak, Steen Ethelberg
OXFORD ACADEMY
Authors Iolanda Jordan, Mariona Fernandez de Sevilla, Victoria Fumado, Quique Bassat, Elisenda Bonet-Carne, Claudia Fortuny, Aleix Garcia-Miquel, Cristina Jou, Cristina Adroher, María Melé Casas, Mònica Girona-Alarcon, María Hernández Garcia, Gemma Pons Tomas, Sara Ajanovic, Sara Arias, Núria Balanza, Bárbara Baro, Pere Millat-Martinez, Rosauro Varo, Sergio Alonso, Enric Álvarez-Lacalle, Daniel López, Joana Claverol, Marta Cubells, N, Pedro Brotons, Anna Codina, Daniel Cuadras, Patricia Bruijning-Verhagen, Saul Faust, Alasdair Munro, Carmen Muñoz-Almagro, Martí Català, Clara Prats, Juan José Garcia-Garcia, Eduard Gratacós
Abstract Background Understanding the role of children in SARS-CoV-2 transmission is critical to guide decision-making for schools in the pandemic. We aimed to describe the transmission of SARS-CoV-2 among children and adult staff in summer schools. Methods During July 2020 we prospectively recruited children and adult staff attending summer schools in Barcelona who had SARS-CoV-2 infection. Primary SARS-CoV-2 infections were identified through: (1) surveillance program in 22 summer schools’ of 1905 participants, involving weekly saliva sampling for SARS-CoV-2 RT-PCR during 2-5 weeks; (2)cases identified through the Catalonian Health Surveillance System of children diagnosed with SARS-CoV-2 infection by nasopharyngeal RT-PCR. All centres followed prevention protocols: bubble groups, hand washing, facemasks and conducting activities mostly outdoors. Contacts of a primary case within the same bubble were evaluated by nasopharyngeal RT-PCR. Secondary attack rates and effective reproduction number in summer schools(R*) were calculated. Results Among the over 2000 repeatedly screened participants, 30children and 9adults were identified as primary cases. A total of 253 close contacts of these primary cases were studied (median 9 (IQR 5-10) for each primary case), among which twelve new cases (4.7%) were positive for SARS-CoV-2. The R* was 0.3, whereas the contemporary rate in the general population from the same areas in Barcelona was 1.9. Conclusions The transmission rate of SARS-CoV-2 infection among children attending school-like facilities under strict prevention measures was lower than that reported for the general population. This suggests that under preventive measures schools are unlikely amplifiers of SARS-CoV-2 transmission and supports current recommendations for school opening.
Authors Smadar Shilo, Hagai Rossman, Eran Segal
Authors Lee Kennedy-Shaffer, Michael Baym, William P Hanage
Authors Christian Benedict, Jonathan Cedernaes
Authors Michael Klompas, Meghan A Baker, Diane Griesbach, Robert Tucker, Glen R Gallagher, Andrew S Lang, Timelia Fink, Melissa Cumming, Sandra Smole, Lawrence C Madoff, Chanu Rhee
Abstract We describe 3 instances of SARS-CoV-2 transmission despite medical masks and eye protection, including transmission despite the source person being masked, transmission despite the exposed person being masked, and transmission despite both parties being masked. Whole genome sequencing confirmed perfect homology between source and exposed persons’ viruses in all cases.
Authors Robert Challen, Ellen Brooks-Pollock, Jonathan M Read, Louise Dyson, Krasimira Tsaneva-Atanasova, Leon Danon
Abstract Objective To establish whether there is any change in mortality from infection with a new variant of SARS-CoV-2, designated a variant of concern (VOC-202012/1) in December 2020, compared with circulating SARS-CoV-2 variants. Design Matched cohort study. Setting Community based (pillar 2) covid-19 testing centres in the UK using the TaqPath assay (a proxy measure of VOC-202012/1 infection). Participants 54 906 matched pairs of participants who tested positive for SARS-CoV-2 in pillar 2 between 1 October 2020 and 29 January 2021, followed-up until 12 February 2021. Participants were matched on age, sex, ethnicity, index of multiple deprivation, lower tier local authority region, and sample date of positive specimens, and differed only by detectability of the spike protein gene using the TaqPath assay. Main outcome measure Death within 28 days of the first positive SARS-CoV-2 test result. Results The mortality hazard ratio associated with infection with VOC-202012/1 compared with infection with previously circulating variants was 1.64 (95% confidence interval 1.32 to 2.04) in patients who tested positive for covid-19 in the community. In this comparatively low risk group, this represents an increase in deaths from 2.5 to 4.1 per 1000 detected cases. Conclusions The probability that the risk of mortality is increased by infection with VOC-202012/01 is high. If this finding is generalisable to other populations, infection with VOC-202012/1 has the potential to cause substantial additional mortality compared with previously circulating variants. Healthcare capacity planning and national and international control policies are all impacted by this finding, with increased mortality lending weight to the argument that further coordinated and stringent measures are justified to reduce deaths from SARS-CoV-2.
Authors Kim Sneppen, Bjarke Frost Nielsen, Robert J. Taylor, Lone Simonsen
Abstract 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.
Authors Nicole E. Kogan, Leonardo Clemente, Parker Liautaud, Justin Kaashoek, Nicholas B. Link, Andre T. Nguyen, Fred S. Lu, Peter Huybers, Bernd Resch, Clemens Havas, Andreas Petutschnig, Jessica Davis, Matteo Chinazzi, Backtosch Mustafa, William P. Hanage, Alessandro Vespignani, Mauricio Santillana
Abstract Given still-high levels of coronavirus disease 2019 (COVID-19) susceptibility and inconsistent transmission-containing strategies, outbreaks have continued to emerge across the United States. Until effective vaccines are widely deployed, curbing COVID-19 will require carefully timed nonpharmaceutical interventions (NPIs). A COVID-19 early warning system is vital for this. Here, we evaluate digital data streams as early indicators of state-level COVID-19 activity from 1 March to 30 September 2020. We observe that increases in digital data stream activity anticipate increases in confirmed cases and deaths by 2 to 3 weeks. Confirmed cases and deaths also decrease 2 to 4 weeks after NPI implementation, as measured by anonymized, phone-derived human mobility data. We propose a means of harmonizing these data streams to identify future COVID-19 outbreaks. Our results suggest that combining disparate health and behavioral data may help identify disease activity changes weeks before observation using traditional epidemiological monitoring.
Authors Sebastian Stockmaier, Nathalie Stroeymeyt, Eric C. Shattuck, Dana M. Hawley, Lauren Ancel Meyers, Daniel I. Bolnick
Abstract Spread of contagious pathogens critically depends on the number and types of contacts between infectious and susceptible hosts. Changes in social behavior by susceptible, exposed, or sick individuals thus have far-reaching downstream consequences for infectious disease spread. Although “social distancing” is now an all too familiar strategy for managing COVID-19, nonhuman animals also exhibit pathogen-induced changes in social interactions. Here, we synthesize the effects of infectious pathogens on social interactions in animals (including humans), review what is known about underlying mechanisms, and consider implications for evolution and epidemiology.
Authors Natalie Dean
Authors Max A. Schumm, Joseph E. Hadaya, Nisha Mody, Bethany A. Myers, Melinda Maggard-Gibbons
Abstract Importance The COVID-19 pandemic has resulted in a persistent shortage of personal protective equipment; therefore, a need exists for hospitals to reprocess filtering facepiece respirators (FFRs), such as N95 respirators. Objective To perform a systematic review to evaluate the evidence on effectiveness and feasibility of different processes used for decontaminating N95 respirators. Evidence Review A search of PubMed and EMBASE (through January 31, 2021) was completed for 5 types of respirator-decontaminating processes including UV irradiation, vaporized hydrogen peroxide, moist-heat incubation, microwave-generated steam, and ethylene oxide. Data were abstracted on process method, pathogen removal, mask filtration efficiency, facial fit, user safety, and processing capability. Findings Forty-two studies were included that examined 65 total types of masks. All were laboratory studies (no clinical trials), and 2 evaluated respirator performance and fit with actual clinical use of N95 respirators. Twenty-seven evaluated UV germicidal irradiation, 19 vaporized hydrogen peroxide, 9 moist-heat incubation, 10 microwave-generated steam, and 7 ethylene oxide. Forty-three types of N95 respirators were treated with UV irradiation. Doses of 1 to 2 J/cm2 effectively sterilized most pathogens on N95 respirators (>103 reduction in influenza virus [4 studies], MS2 bacteriophage [3 studies], Bacillus spores [2 studies], Escherichia virus MS2 [1 study], vesicular stomatitis virus [1 study], and Middle East respiratory syndrome virus/SARS-CoV-1 [1 study]) without degrading respirator components. Doses higher than 1.5 to 2 J/cm2 may be needed based on 2 studies demonstrating greater than 103 reduction in SARS-CoV-2. Vaporized hydrogen peroxide eradicated the pathogen in all 7 efficacy studies (>104 reduction in SARS-CoV-2 [3 studies] and >106 reduction of Bacillus and Geobacillus stearothermophilus spores [4 studies]). Pressurized chamber systems with higher concentrations of hydrogen peroxide caused FFR damage (6 studies), while open-room systems did not degrade respirator components. Moist heat effectively reduced SARS-CoV-2 (2 studies), influenza virus by greater than 104 (2 studies), vesicular stomatitis virus (1 study), and Escherichia coli (1 study) and preserved filtration efficiency and facial fit for 11 N95 respirators using preheated containers/chambers at 60 °C to 85 °C (5 studies); however, diminished filtration performance was seen for the Caron incubator. Microwave-generated steam (1100-W to 1800-W devices; 40 seconds to 3 minutes) effectively reduced pathogens by greater than 103 (influenza virus [2 studies], MS2 bacteriophage [3 studies], and Staphylococcus aureus [1 study]) and maintained filtration performance in 10 N95 respirators; however, damage was noted in least 1 respirator type in 4 studies. In 6 studies, ethylene oxide preserved respirator components in 16 N95 respirator types but left residual carcinogenic by-product (1 study). Conclusions and Relevance Ultraviolet germicidal irradiation, vaporized hydrogen peroxide, moist heat, and microwave-generated steam processing effectively sterilized N95 respirators and retained filtration performance. Ultraviolet irradiation and vaporized hydrogen peroxide damaged respirators the least. More research is needed on decontamination effectiveness for SARS-CoV-2 because few studies specifically examined this pathogen.
Authors Matthew A Crane, Aleksandra Popovic, Andrew I Stolbach, Khalil G Ghanem
Authors Roberto Burioni, Eric J. Topol
GOV.UK
Authors Public Health England
Authors Jacqui Wise
CDC (CENTERS FOR DISEASE CONTROL AND PREVENTION)
Authors Frances R. Lendacki, Richard A. Teran, Stephanie Gretsch, Marielle J. Fricchione, Janna L. Kerins
Authors Dyani Lewis
Authors Smriti Mallapaty
Authors Murat O ̈zkaya, Burhaneddin Izgi
Abstract In this study, we analyze the general or self-quarantine effects to the spread of the first wave of Covid-19 pandemic in the view of the game-theoretical approach. As in some other applications of game theory in different aspects of the literature, we focus on only the application of game theory to present the effects of quarantine during the three different stages -the start, the spread, the end- of the pandemic. We first choose three countries such as South Korea for self-quarantine, Italy, and Turkey for general quarantine during the analysis of the different stages of the spread. Then, we present a formula that will be an important tool for the creation of the payoff matrices and give the general procedure for the creation of the payoff matrix for each stage of the pandemic process. After that, we generate the payoff bimatrix for each stage of the pandemic by using the average of the daily diagnosis number/number of tests for each country. Moreover, we try to find the optimal strategy of the game. Additionally, to determine the necessity of the continuity of the quarantine, we use the repeated game approach in our analysis, as well. Therefore, we convert the game only for the spread stage to the repeated game for each country. Finally, we obtain the Nash equilibrium of all games for each level of the pandemic. The results show that the quarantine has important effects to be infected or not, and the spread of the pandemic at each level. In addition to these analysis results, we compare the death rates of the considered countries and show that the results are almost parallel to that are obtained for the quarantine requirement of each country by game-theoretical approaches.
Authors DONALD THEA
Abstract Objective To directly measure the fatal impact of coronavirus disease 2019 (covid-19) in an urban African population. Design Prospective systematic postmortem surveillance study. Setting Zambia’s largest tertiary care referral hospital. Participants Deceased people of all ages at the University Teaching Hospital morgue in Lusaka, Zambia, enrolled within 48 hours of death. Main outcome measure Postmortem nasopharyngeal swabs were tested via reverse transcriptase quantitative polymerase chain reaction (PCR) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Deaths were stratified by covis-19 status, location, age, sex, and underlying risk factors. Results 372 participants were enrolled between June and September 2020; PCR results were available for 364 (97.8%). SARS-CoV-2 was detected in 58/364 (15.9%) according to the recommended cycle threshold value of <40 and in 70/364 (19.2%) when expanded to any level of PCR detection. The median age at death among people with a positive test for SARS-CoV-2 was 48 (interquartile range 36-72) years, and 69% (n=48) were male. Most deaths in people with covid-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV-2 before death. Among the 19/70 people who died in hospital, six were tested before death. Among the 52/70 people with data on symptoms, 44/52 had typical symptoms of covid-19 (cough, fever, shortness of breath), of whom only five were tested before death. Covid-19 was identified in seven children, only one of whom had been tested before death. The proportion of deaths with covid-19 increased with age, but 76% (n=53) of people who died were aged under 60 years. The five most common comorbidities among people who died with covid-19 were tuberculosis (22; 31%), hypertension (19; 27%), HIV/AIDS (16; 23%), alcohol misuse (12; 17%), and diabetes (9; 13%). Conclusions Contrary to expectations, deaths with covid-19 were common in Lusaka. Most occurred in the community, where testing capacity is lacking. However, few people who died at facilities were tested, despite presenting with typical symptoms of covid-19. Therefore, cases of covid-19 were under-reported because testing was rarely done not because covid-19 was rare. If these data are generalizable, the impact of covid-19 in Africa has been vastly underestimated.
Authors Jesse Greiner, Hiten Naik, Michael R. Johnson, Dong Liu, Bruno Silvestre, Hamza Ballouk, Ian P. McCarthy
Abstract We report the successful implementation of a modified Traffic Control Bundling (TCB) protocol called “Red, Yellow and Green” on the inpatient medical units at St. Paul's Hospital in Vancouver, Canada during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. The modified TCB protocol demonstrates an important example on how hospitals can rapidly reorganize operational and clinical processes to reallocate existing capacity to minimize exposure, improve traffic flow and reduce nosocomial transmissions of COVID-19 to health care workers (HCWs) and other patients. Preliminary evidence demonstrates the benefits on how an existing facility can be redesigned for adjustable ward capacity to provide disease containment under a context of uncertainty of disease transmission and varying patient load. Important lessons in preparation for the evolution of the pandemic fall into categories of risk management, capacity and demand management.
MORBIDITY AND MORTALITY WEEKLY REPORT
Authors Heesoo Joo, Gabrielle F. Miller, Gregory Sunshine, Maxim Gakh, Jamison Pike, Fiona P. Havers, Lindsay Kim, Regen Weber, Sebnem Dugmeoglu, Christina Watson, Fátima Coronado
Authors Lisa Rosenbaum
Authors Kimberly H. Nguyen, Anup Srivastav, Hilda Razzaghi, Walter Williams, Megan C. Lindley, Cynthia Jorgensen, Neetu Abad, James A. Singleton
Authors Laura Shallcross, Danielle Burke, Owen Abbott, Alasdair Donaldson, Gemma Hallatt, Andrew Hayward, Susan Hopkins, Maria Krutikov, Katie Sharp, Leone Wardman, Sapphira Thorne
Authors Kai Kupferschmidt
Authors Michaël Schwarzinger, Verity Watson, Pierre Arwidson, François Alla, Stéphane Luchini
Authors Michael Marks, Pere Millat-Martinez, Dan Ouchi, Chrissy h Roberts, Andrea Alemany, Marc Corbacho-Monné, Maria Ubals, Aurelio Tobias, Cristian Tebé, Ester Ballana, Quique Bassat, Bàrbara Baro, Martí Vall-Mayans,Camila G-Beiras, Nuria Prat, Jordi Ara, Bonaventura Clotet, Oriol Mitjà
Authors Mélodie Monod, Alexandra Blenkinsop, Xiaoyue Xi, Daniel Hebert, Sivan Bershan, Simon Tietze, Marc Baguelin, Valerie C. Bradley, Yu Chen, Helen Coupland, Sarah Filippi, Jonathan Ish-Horowicz, Martin McManus, Thomas Mellan, Axel Gandy, Michael Hutchinson, H. Juliette T Unwin, Sabine L. van Elsland, Michaela A. C. Vollmer, Sebastian Weber, Harrison Zhu, Anne Bezancon, Neil M. Ferguson, Swapnil Mishra, Seth Flaxman, Samir Bhatt, Oliver Ratmann
Abstract Following initial declines, in mid 2020 a resurgence in transmission of novel coronavirus disease (COVID-19) occurred in the US and Europe. As COVID19 disease control efforts are re-intensified, understanding the age demographics driving transmission and how these affect the loosening of interventions is crucial. We analyze aggregated, age-specific mobility trends from more than 10 million individuals in the US and link these mechanistically to age-specific COVID-19 mortality data. We estimate that as of October 2020, individuals aged 20-49 are the only age groups sustaining resurgent SARS-CoV-2 transmission with reproduction numbers well above one, and that at least 65 of 100 COVID-19 infections originate from individuals aged 20-49 in the US. Targeting interventions – including transmission-blocking vaccines – to adults aged 20-49 is an important consideration in halting resurgent epidemics and preventing COVID-19-attributable deaths.
PUBLMED
Authors R A Armstrong, A D Kane, E Kursumovic, F C Oglesby, T M Cook
Abstract The COVID-19 pandemic continues to cause critical illness and deaths internationally. Up to 31 May 2020, mortality in patients admitted to intensive care units (ICU) with COVID-19 was 41.6%. Since then, changes in therapeutics and management may have improved outcomes. Also, data from countries affected later in the pandemic are now available. We searched MEDLINE, Embase, PubMed and Cochrane databases up to 30 September 2020 for studies reporting ICU mortality among adult patients with COVID-19 and present an updated systematic review and meta-analysis. The primary outcome measure was death in intensive care as a proportion of completed ICU admissions, either through discharge from intensive care or death. We identified 52 observational studies including 43,128 patients, and first reports from the Middle East, South Asia and Australasia, as well as four national or regional registries. Reported mortality was lower in registries compared with other reports. In two regions, mortality differed significantly from all others, being higher in the Middle East and lower in a single registry study from Australasia. Although ICU mortality (95%CI) was lower than reported in June (35.5% (31.3-39.9%) vs. 41.6% (34.0-49.7%)), the absence of patient-level data prevents a definitive evaluation. A lack of standardisation of reporting prevents comparison of cohorts in terms of underlying risk, severity of illness or outcomes. We found that the decrease in ICU mortality from COVID-19 has reduced or plateaued since May 2020 and note the possibility of some geographical variation. More standardisation in reporting would improve the ability to compare outcomes from different reports.
Authors Nathan D. Grubaugh, Emma B. Hodcroft, Joseph R. Fauver, Alexandra L. Phelan, Muge Cevik
Abstract Recent reports suggest that some SARS-CoV-2 genetic variants, such as B.1.1.7, may be more transmissible, and are quickly spreading around the world. As the emergence of more transmissible variants may exacerbate the pandemic, we provide public health guidance for increased surveillance and measures to reduce community transmission
Authors Ji Lu, Jianhua Guo
Authors Catharina Boehme, Emma Hannay, Rangarajan Sampath
Authors Joshua R. Goldsteina, Thomas Cassidy , Kenneth W. Wachter
Abstract Many competing criteria are under consideration for prioritizing COVID-19 vaccination. Two criteria based on age are demographic: lives saved and years of future life saved. Vaccinating the very old against COVID-19 saves the most lives, but, since older age is accompanied by falling life expectancy, it is widely supposed that these two goals are in conflict. We show this to be mistaken. The age patterns of COVID-19 mortality are such that vaccinating the oldest first saves the most lives and, surprisingly, also maximizes years of remaining life expectancy. We demonstrate this relationship empirically in the United States, Germany, and South Korea and with mathematical analysis of life tables. Our age-risk results, under usual conditions, also apply to health risks.
Authors Ester C Sabino, Lewis F Buss, Maria P S Carvalho, Carlos A Prete Jr, Myuki A E Crispim, Nelson A Fraiji, Rafael H M Pereira, Kris V Parag, Pedro da Silva Peixoto, Moritz U G Kraemer, Marcio K Oikawa, Tassila Salomon, Zulma M Cucunuba, Márcia C Castro, Andreza Aruska de Souza Santos, Vítor H Nascimento, Henrique S Pereira, Neil M Ferguson, Oliver G Pybus, Adam Kucharski, Michael P Busch, Christopher Dye, Nuno R Faria
Authors Thomas H. Lee, Alice H. Chen
Authors Hugo Zeberg, Svante Pääbo
Abstract It was recently shown that the major genetic risk factor associated with becoming severely ill with COVID-19 when infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is inherited from Neandertals. New, larger genetic association studies now allow additional genetic risk factors to be discovered. Using data from the Genetics of Mortality in Critical Care (GenOMICC) consortium, we show that a haplotype at a region on chromosome 12 associated with requiring intensive care when infected with the virus is inherited from Neandertals. This region encodes proteins that activate enzymes that are important during infections with RNA viruses. In contrast to the previously described Neandertal haplotype that increases the risk for severe COVID-19, this Neandertal haplotype is protective against severe disease. It also differs from the risk haplotype in that it has a more moderate effect and occurs at substantial frequencies in all regions of the world outside Africa. Among ancient human genomes in western Eurasia, the frequency of the protective Neandertal haplotype may have increased between 20,000 and 10,000 y ago and again during the past 1,000 y.
Authors Viola Priesemann, Rudi Balling, Melanie M Brinkmann, Sandra Ciesek, Thomas Czypionka, Isabella Eckerle, Giulia Giordano, Claudia Hanson, Zdenek Hel, Pirta Hotulainen, Peter Klimek, Armin Nassehi, Andreas Peichl, Matjaz Perc, Elena Petelos, Barbara Prainsack, Ewa Szczurek
Authors Billy J Quilty, Samuel Clifford, Joel Hellewell, Timothy W Russell†, Adam J Kucharski, Stefan Flasche, W John Edmunds
VIROLOGICAL
Authors Moritz Gerstung
Authors Lewis F. Buss, Carlos A. Prete Jr., Claudia M. M. Abrahim, Alfredo Mendrone Jr, Tassila Salomon, Cesar de Almeida-Neto, Rafael F. O. França, Maria C. Belotti, Maria P. S. S. Carvalho, Allyson G. Costa, Myuki A. E. Crispim, Suzete C. Ferreira, Nelson A. Fraiji, Susie Gurzenda, Charles Whittaker, Leonardo T. Kamaura, Pedro L. Takecian, Pedro da Silva Peixoto, Marcio K. Oikawa, Anna S. Nishiya, Vanderson Rocha, Nanci A. Salles, Andreza Aruska de Souza Santos, Martirene A. da Silva, Brian Custer, Kris V. Parag, Manoel Barral-Netto, Moritz U. G. Kraemer, Rafael H. M. Pereira, Oliver G. Pybus, Michael P. Busch, Márcia C. Castro, Christopher Dye, Vitor H. Nascimento, Nuno R. Faria, Ester C. Sabino
Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly in Manaus, the capital of Amazonas state in northern Brazil. The attack rate there is an estimate of the final size of the largely unmitigated epidemic that occurred in Manaus. We use a convenience sample of blood donors to show that by June 2020, 1 month after the epidemic peak in Manaus, 44% of the population had detectable immunoglobulin G (IgG) antibodies. Correcting for cases without a detectable antibody response and for antibody waning, we estimate a 66% attack rate in June, rising to 76% in October. This is higher than in São Paulo, in southeastern Brazil, where the estimated attack rate in October was 29%. These results confirm that when poorly controlled, COVID-19 can infect a large proportion of the population, causing high mortality.
Authors Sebastian Contreras, Jonas Dehning, Matthias Loidolt, Johannes Zierenberg, F. Paul Spitzner, Jorge H. Urrea-Quintero, Sebastian B. Mohr, Michael Wilczek, Michael Wibral, Viola Priesemann
Abstract Without a cure, vaccine, or proven long-term immunity against SARS-CoV-2, test-trace-and-isolate (TTI) strategies present a promising tool to contain its spread. For any TTI strategy, however, mitigation is challenged by pre- and asymptomatic transmission, TTI-avoiders, and undetected spreaders, which strongly contribute to ”hidden" infection chains. Here, we study a semi-analytical model and identify two tipping points between controlled and uncontrolled spread: (1) the behavior-driven reproduction number RHt of the hidden chains becomes too large to be compensated by the TTI capabilities, and (2) the number of new infections exceeds the tracing capacity. Both trigger a self-accelerating spread. We investigate how these tipping points depend on challenges like limited cooperation, missing contacts, and imperfect isolation. Our results suggest that TTI alone is insufficient to contain an otherwise unhindered spread of SARS-CoV-2, implying that complementary measures like social distancing and improved hygiene remain necessary.
BMC
Authors Susanna Esposito, Nicola Cotugno, Nicola Principi
Abstract Background Although several studies have tried to evaluate the real efficacy of school closure for pandemic control over time, no definitive answer to this question has been given. Moreover, it has not been clarified whether children or teenagers could be considered a problem for SARS-CoV-2 diffusion or, on the contrary, whether parents and school workers play a greater role. The aims of this review are to discuss about children’s safety at school and the better strategies currently able to reduce the risk of SARS-CoV-2 infection at school. Main aim Compared to adults, very few cases of COVID-19 were diagnosed in children, who generally suffered from an asymptomatic infection or a mild disease. Moreover, school closure is systematically associated with the development of problems involving students, teachers and parents, particularly among populations with poor resources. Although several researches have tried to evaluate the real efficacy of school closure for pandemic control over time, no definitive answer to this question has been given. Available findings seem to confirm that to ensure adequate learning and to avoid social and economic problems, schools must remain open, provided that the adults who follow children at home and at school absolutely comply with recommendations for prevention measures and that school facilities can be optimized in order to significantly reduce the spread of infection. In this regard, the universal use of face masks in addition to hand hygiene and safe distancing in schools, at least starting from the age of 6 years, seems extremely useful. Moreover, since the beginning of the COVID-19 outbreak the use of telemedicine to manage suspected SARS-CoV-2-infected individuals in the community has appeared to be an easy and effective measure to solve many paediatric problems and could represent a further support to schools . Conclusions We think that schools must remain open, despite COVID-19 pandemic. However, several problems strictly related to school frequency and reduction of infectious risk must be solved before school attendance can be considered completely safe. A single more in-depth guideline agreed between countries with the same school problems could be very useful in eliminating doubts and fostering the compliance of students, teachers and non-teaching school staff reducing errors and misinterpretations.
Authors Aaloke Mody, Kristin Pfeifauf, Elvin H. Geng
Authors Angela L. Rasmussen, Saskia V. Popescu
Abstract Importance Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiology of coronavirus disease 2019 (COVID-19), is readily transmitted person to person. Optimal control of COVID-19 depends on directing resources and health messaging to mitigation efforts that are most likely to prevent transmission, but the relative importance of such measures has been disputed. Objective To assess the proportion of SARS-CoV-2 transmissions in the community that likely occur from persons without symptoms. Design, Setting, and Participants This decision analytical model assessed the relative amount of transmission from presymptomatic, never symptomatic, and symptomatic individuals across a range of scenarios in which the proportion of transmission from people who never develop symptoms (ie, remain asymptomatic) and the infectious period were varied according to published best estimates. For all estimates, data from a meta-analysis was used to set the incubation period at a median of 5 days. The infectious period duration was maintained at 10 days, and peak infectiousness was varied between 3 and 7 days (−2 and +2 days relative to the median incubation period). The overall proportion of SARS-CoV-2 was varied between 0% and 70% to assess a wide range of possible proportions. Main Outcomes and Measures Level of transmission of SARS-CoV-2 from presymptomatic, never symptomatic, and symptomatic individuals. Results The baseline assumptions for the model were that peak infectiousness occurred at the median of symptom onset and that 30% of individuals with infection never develop symptoms and are 75% as infectious as those who do develop symptoms. Combined, these baseline assumptions imply that persons with infection who never develop symptoms may account for approximately 24% of all transmission. In this base case, 59% of all transmission came from asymptomatic transmission, comprising 35% from presymptomatic individuals and 24% from individuals who never develop symptoms. Under a broad range of values for each of these assumptions, at least 50% of new SARS-CoV-2 infections was estimated to have originated from exposure to individuals with infection but without symptoms. Conclusions and Relevance In this decision analytical model of multiple scenarios of proportions of asymptomatic individuals with COVID-19 and infectious periods, transmission from asymptomatic individuals was estimated to account for more than half of all transmissions. In addition to identification and isolation of persons with symptomatic COVID-19, effective control of spread will require reducing the risk of transmission from people with infection who do not have symptoms. These findings suggest that measures such as wearing masks, hand hygiene, social distancing, and strategic testing of people who are not ill will be foundational to slowing the spread of COVID-19 until safe and effective vaccines are available and widely used.
Authors Michael A. Johansson, Talia M. Quandelacy, Sarah Kada, Pragati Venkata Prasad, Molly Steele, John T. Brooks, Rachel B. Slayton, Matthew Biggerstaff, Jay C. Butler
CCDC WEEKLY
Authors Fengjuan Chen, Bosheng Li, Peter Hao, Yang Song, Wenbo Xu, Nankun Liu, Chunliang Lei, Changwen Ke
Authors Paolo Bosetti, Cécile Tran Kiem, Yazdan Yazdanpanah, Arnaud Fontanet, Bruno Lina, Vittoria Colizza, Simon Cauchemez
ABSTRACT We used a mathematical model to evaluate the impact of mass testing in the control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Under optimistic assumptions, one round of mass testing may reduce daily infections by up to 20–30%. Consequently, very frequent testing would be required to control a quickly growing epidemic if other control measures were to be relaxed. Mass testing is most relevant when epidemic growth remains limited through a combination of interventions.
Authors Kathy Leung, Marcus HH Shum, Gabriel M Leung, Tommy TY Lam, Joseph T Wu
ABSRACT Two new SARS-CoV-2 lineages with the N501Y mutation in the receptor-binding domain of the spike protein spread rapidly in the United Kingdom. We estimated that the earlier 501Y lineage without amino acid deletion Δ69/Δ70, circulating mainly between early September and mid-November, was 10% (6–13%) more transmissible than the 501N lineage, and the 501Y lineage with amino acid deletion Δ69/Δ70, circulating since late September, was 75% (70–80%) more transmissible than the 501N lineage
Authors Jonas F. Ludvigsson, Lars Engerström, Charlotta Nordenhäll, Emma Larsson
Authors Tomoya Sagawa, Takahiro Tsujikawa, Akiko Honda, Natsuko Miyasaka, Michitaka Tanaka, Takashi Kida, Koichi Hasegawa, Tomoaki Okuda, Yutaka Kawahito, Hirohisa Takano
ISTAT (ISTITUTO NAZIONALE DI STATISTICA)
Authors ISTAT (ISTITUTO NAZIONALE DI STATISTICA)
Authors L.R. Baden, H.M. El Sahly, B. Essink, K. Kotloff, S. Frey, R. Novak, D. Diemert, S.A. Spector, N. Rouphael, C.B. Creech, J. McGettigan, S. Khetan, N. Segall, J. Solis, A. Brosz, C. Fierro, H. Schwartz, K. Neuzil, L. Corey, P. Gilbert, H. Janes, D. Follmann, M. Marovich, J. Mascola, L. Polakowski, J. Ledgerwood, B.S. Graham, H. Bennett, R. Pajon, C. Knightly, B. Leav, W. Deng, H. Zhou, S. Han, M. Ivarsson, J. Miller, T. Zaks
ABSTRACT BACKGROUND Vaccines are needed to prevent coronavirus disease 2019 (Covid-19) and to protect persons who are at high risk for complications. The mRNA-1273 vaccine is a lipid nanoparticle–encapsulated mRNA-based vaccine that encodes the prefusion stabi- lized full-length spike protein of the severe acute respiratory syndrome corona- virus 2 (SARS-CoV-2), the virus that causes Covid-19. METHODS This phase 3 randomized, observer-blinded, placebo-controlled trial was conducted at 99 centers across the United States. Persons at high risk for SARS-CoV-2 infec- tion or its complications were randomly assigned in a 1:1 ratio to receive two intra- muscular injections of mRNA-1273 (100 μg) or placebo 28 days apart. The pri- mary end point was prevention of Covid-19 illness with onset at least 14 days after the second injection in participants who had not previously been infected with SARS-CoV-2. RESULTS The trial enrolled 30,420 volunteers who were randomly assigned in a 1:1 ratio to receive either vaccine or placebo (15,210 participants in each group). More than 96% of participants received both injections, and 2.2% had evidence (serologic, virologic, or both) of SARS-CoV-2 infection at baseline. Symptomatic Covid-19 ill- ness was confirmed in 185 participants in the placebo group (56.5 per 1000 person- years; 95% confidence interval [CI], 48.7 to 65.3) and in 11 participants in the mRNA- 1273 group (3.3 per 1000 person-years; 95% CI, 1.7 to 6.0); vaccine efficacy was 94.1% (95% CI, 89.3 to 96.8%; P<0.001). Efficacy was similar across key secondary analyses, including assessment 14 days after the first dose, analyses that included participants who had evidence of SARS-CoV-2 infection at baseline, and analyses in participants 65 years of age or older. Severe Covid-19 occurred in 30 partici- pants, with one fatality; all 30 were in the placebo group. Moderate, transient re- actogenicity after vaccination occurred more frequently in the mRNA-1273 group. Serious adverse events were rare, and the incidence was similar in the two groups. CONCLUSIONS The mRNA-1273 vaccine showed 94.1% efficacy at preventing Covid-19 illness, including severe disease. Aside from transient local and systemic reactions, no safety concerns were identified. (Funded by the Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases; COVE ClinicalTrials.gov number, NCT04470427.
Authors Belinda Hengel, Louise Causer, Susan Matthews, Kirsty Smith, Kelly Andrewartha, Steven Badman, Brooke Spaeth, Annie Tangey, Phillip Cunningham, Emily Phillips, James Ward, Caroline Watts, Jonathan King, Tanya Applegate, Mark Shephard, Rebecca Guy
PNAS
Authors Nadège Néant, Guillaume Lingas, Quentin Le Hingrat, Jade Ghosn, Ilka Engelmann, Quentin Lepiller, Alexandre Gaymard, Virginie Ferré, ViCédric Hartard, Jean-Christophe Plantier, Vincent Thibault, Julien Marlet, Brigitte Montes, Kevin Bouiller, François-Xavier Lescure, Jean-François Timsit, Emmanuel Faure, Julien Poissy, Christian Chidiac, François Raffi, Antoine Kimmoun, Manuel Etienne, Jean-Christophe Richard, Pierre Tattevin, Denis Garot, Vincent Le Moing, Delphine Bachelet, Coralie Tardivon, Xavier Duval, Yazdan Yazdanpanah, France Mentré, Cédric Laouénan, Benoit Visseaux, Jérémie Guedj
Authors Agne Ulyte, Thomas Radtke, Irene A. Abela, Sarah R. Haile, Christoph Berger, Michael Huber, Merle Schanz, Magdalena Schwarzmueller, Alexandra Trkola, Jan Fehr, Milo A. Puhan, Susi Kriemler
Abstract Background and aims The facilitating role of schools in SARS-CoV-2 infection spread is still debated and the potential of school closures to mitigate transmission unclear. In autumn 2020, Switzerland experienced one of the highest second waves of the SARS-CoV-2 pandemic in Europe while keeping schools open, thus offering a high-exposure environment to study SARS-CoV-2 infections in schools. The aim of this study was to examine longitudinal change in SARS-CoV-2 seroprevalence in children and the evolution of clustering within classes and schools from June to November, 2020, in a prospective cohort study of school children in the canton of Zurich, Switzerland. Methods Children from randomly selected schools and classes, stratified by district, were invited to participate in serological testing of SARS-CoV-2 in June-July and October-November 2020. Parents of children filled questionnaires on sociodemographic and health-related questions. 55 schools and 275 classes within them were enrolled, with 2603 children participating in the first, and 2552 in the second testing (age range 6-16 years). We evaluated longitudinal changes of seroprevalence in districts and investigated clustering of seropositive cases within classes and schools. Results Overall SARS-CoV-2 seroprevalence was 2.4% (95% CrI 1.4%-3.6%) in summer and 4.5% (95% CrI 3.2%-6.0%) in not previously seropositive children in late autumn, leading to estimated 7.8% (95% CrI 6.2%-9.5%) of ever seropositive children, without significant differences among lower, middle and upper school levels. Among the 2223 children with serology tested twice, 28 (40%) of previously seropositive were negative, and 109 (5%) previously negative became seropositive. Seroprevalence was not different between school levels or sexes, but varied across districts (1.7% to 15.0%). Between June-July and October-November 2020, the ratio of diagnosed to newly seropositive children was 1 to 8. At least one newly seropositive child was detected in 47 of 55 schools and 90 of 275 classes. Among 130 classes with high participation rate, 0, 1-2 or ≥3 seropositive children were present in 73 (56%), 50 (38%) and 7 (5%) classes, respectively. Class level explained slightly more variation of individual serological results (standard deviation of random effects (SD) 0.97) than school level (SD 0.61) in the multilevel logistic regression models. Symptoms were reported for 22% of seronegative and 29% of newly seropositive children since summer. Conclusions Under a regimen of open schools with some preventive measures in place since August, clustering of seropositive cases occurred in very few classes and not across entire schools despite a clear increase in seropositive children during a period of high transmission of SARS-CoV-2.
Authors Michael G Baker, Nick Wilson, Tony Blakely
Authors Yea-Hung Chen, M. Maria Glymour, Ralph Catalano, Alicia Fernandez, Tung Nguyen, Margot Kushel, Kirsten Bibbins-Domingo
CELL
Authors Angela L. Rasmussen
HARVARD T.H. CHAN
Authors Marc Lipsitch
Authors Jan M. Brauner, Sören Mindermann, Mrinank Sharma, David Johnston, John Salvatier, Tomáš Gavenčiak, Anna B. Stephenson, Gavin Leech, George Altman, Vladimir Mikulik, Alexander John Norman, Joshua Teperowski Monrad, Tamay Besiroglu, Hong Ge, Meghan A. Hartwick, Yee Whye Teh, Leonid Chindelevitch, Yarin Gal, Jan Kulveit
Abstract Governments are attempting to control the COVID-19 pandemic with nonpharmaceutical interventions (NPIs). However, the effectiveness of different NPIs at reducing transmission is poorly understood. We gathered chronological data on the implementation of NPIs for several European, and other, countries between January and the end of May 2020. We estimate the effectiveness of NPIs, ranging from limiting gathering sizes, business closures, and closure of educational institutions to stay-at-home orders. To do so, we used a Bayesian hierarchical model that links NPI implementation dates to national case and death counts and supported the results with extensive empirical validation. Closing all educational institutions, limiting gatherings to 10 people or less, and closing face-to-face businesses each reduced transmission considerably. The additional effect of stay-at-home orders was comparatively small.
Authors Valentina Marziano, Giorgio Guzzetta, Bruna Maria Rondinone, Fabio Boccuni, Flavia Riccardo, Antonino Bella, Piero Poletti, Filippo Trentini, Patrizio Pezzotti, Silvio Brusaferro, Giovanni Rezza, Sergio Iavicoli, Marco Ajelli, Stefano Merler
Abstract After the national lockdown imposed on March 11, 2020, the Italian government has gradually resumed the suspended economic and social activities since May 4, while maintaining the closure of schools until September 14. We use a model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission to estimate the health impact of different exit strategies. The strategy adopted in Italy kept the reproduction number Rt at values close to one until the end of September, with marginal regional differences. Based on the estimated postlockdown transmissibility, reopening of workplaces in selected industrial activities might have had a minor impact on the transmissibility. Reopening educational levels in May up to secondary schools might have influenced SARS-CoV-2 transmissibility only marginally; however, including high schools might have resulted in a marked increase of the disease burden. Earlier reopening would have resulted in disproportionately higher hospitalization incidence. Given community contacts in September, we project a large second wave associated with school reopening in the fall.
Authors Elisabetta Larosa, Olivera Djuric, Mariateresa Cassinadri, Silvia Cilloni, Eufemia Bisaccia, Massimo Vicentini, Francesco Venturelli, Paolo Giorgi Rossi, Patrizio Pezzotti, Emanuela Bedeschi
We report epidemiological investigations of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 41 classes of 36 schools in Reggio Emilia province, northern Italy, from their reopening on 1 September to 15 October 2020. The overall secondary case attack rate was 3.2%, reaching 6.6% in middle and high schools. More timely isolation and testing of classmates could be effective in reducing virus transmission in this setting.
Authors Jacob E. Lemieux, Katherine J. Siddle, Bennett M. Shaw, Christine Loreth, Stephen F. Schaffner, Adrianne Gladden-Young, Gordon Adams, Timelia Fink, Christopher H. Tomkins-Tinch, Lydia A. Krasilnikova, Katherine C. DeRuff, Melissa Rudy, Matthew R. Bauer, Kim A. Lagerborg, Erica Normandin, Sinéad B. Chapman, Steven K. Reilly, Melis N. Anahtar, Aaron E. Lin, Amber Carter, Cameron Myhrvold, Molly E. Kemball, Sushma Chaluvadi, Caroline Cusick, Katelyn Flowers, Anna Neumann, Felecia Cerrato, Maha Farhat, Damien Slater, Jason B. Harris, John A. Branda, David Hooper, Jessie M. Gaeta, Travis P. Baggett, James O’Connell, Andreas Gnirke, Tami D. Lieberman, Anthony Philippakis, Meagan Burns, Catherine M. Brown, Jeremy Luban, Edward T. Ryan, Sarah E. Turbett, Regina C. LaRocque, William P. Hanage, Glen R. Gallagher, Lawrence C. Madoff, Sandra Smole, Virginia M. Pierce, Eric Rosenberg, Pardis C. Sabeti, Daniel J. Park, Bronwyn L. MacInnis
Analysis of 772 complete SARS-CoV-2 genomes from early in the Boston area epidemic revealed numerous introductions of the virus, a small number of which led to most cases. The data revealed two superspreading events. One, in a skilled nursing facility, led to rapid transmission and significant mortality in this vulnerable population but little broader spread, while other introductions into the facility had little effect. The second, at an international business conference, produced sustained community transmission and was exported, resulting in extensive regional, national, and international spread. The two events also differed significantly in the genetic variation they generated, suggesting varying transmission dynamics in superspreading events. Our results show how genomic epidemiology can help understand the link between individual clusters and wider community spread.
Authors Benjamin J Cowling, Gabriel M Leung
Authors Phillip W. Clapp, Emily E. Sickbert-Bennett, James M. Samet, Jon Berntsen, Kirby L. Zeman, Deverick J. Anderson, David J. Weber, William D. Bennett
Importance During the coronavirus disease 2019 (COVID-19) pandemic, the general public has been advised to wear masks or improvised face coverings to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there has been considerable confusion and disagreement regarding the degree to which masks protect the wearer from airborne particles.
Objectives To evaluate the fitted filtration efficiency (FFE) of various consumer-grade and improvised face masks, as well as several popular modifications of medical procedure masks that are intended to improve mask fit or comfort.
Design, Setting, and Participants For this study conducted in a research laboratory between June and August 2020, 7 consumer-grade masks and 5 medical procedure mask modifications were fitted on an adult male volunteer, and FFE measurements were collected during a series of repeated movements of the torso, head, and facial muscles as outlined by the US Occupational Safety and Health Administration Quantitative Fit Testing Protocol. The consumer-grade masks tested included (1) a 2-layer woven nylon mask with ear loops that was tested with an optional aluminum nose bridge and nonwoven filter insert in place, (2) a cotton bandana folded diagonally once (ie, “bandit” style) or in a (3) multilayer rectangle according to the instructions presented by the US Surgeon General, (4) a single-layer woven polyester/nylon mask with ties, (5) a nonwoven polypropylene mask with fixed ear loops, (6) a single-layer woven polyester gaiter/neck cover balaclava bandana, and (7) a 3-layer woven cotton mask with ear loops. Medical procedure mask modifications included (1) tying the mask’s ear loops and tucking in the side pleats, (2) fastening ear loops behind the head with 3-dimensional–printed ear guards, (3) fastening ear loops behind the head with a claw-type hair clip, (4) enhancing the mask/face seal with rubber bands over the mask, and (5) enhancing the mask/face seal with a band of nylon hosiery over the fitted mask.
Main Outcomes and Measures The primary study outcome was the measured FFE of common consumer-grade and improvised face masks, as well as several popular modifications of medical procedure masks.
Results The mean (SD) FFE of consumer grade masks tested on 1 adult male with no beard ranged from 79.0% (4.3%) to 26.5% (10.5%), with the 2-layer woven nylon mask having the highest FFE. Unmodified medical procedure masks with ear loops had a mean (SD) FFE of 38.5% (11.2%). All modifications evaluated in this study increased procedure mask FFE (range [SD], 60.3% [11.1%] to 80.2% [3.1%]), with a nylon hosiery sleeve placed over the procedure mask producing the greatest improvement.
Conclusions and Relevance While modifications to improve medical procedure mask fit can enhance the filtering capability and reduce inhalation of airborne particles, this study demonstrates that the FFEs of consumer-grade masks available to the public are, in many cases, nearly equivalent to or better than their non-N95 respirator medical mask counterparts.
Authors Flavia Riccardo, Marco Ajelli, Xanthi D Andrianou, Antonino Bella, Martina Del Manso, Massimo Fabiani, Stefania Bellino, Stefano Boros, Alberto Mateo Urdiales, Valentina Marziano, Maria Cristina Rota, Antonietta Filia, Fortunato D’Ancona, Andrea Siddu, Ornella Punzo, Filippo Trentini, Giorgio Guzzetta, Piero Poletti, Paola Stefanelli, Maria Rita Castrucci, Alessandra Ciervo, Corrado Di Benedetto, Marco Tallon, Andrea Piccioli, Silvio Brusaferro, Giovanni Rezza, Stefano Merler, Patrizio Pezzotti
On 20 February 2020, a locally acquired coronavirus disease (COVID-19) case was detected in Lombardy, Italy. This was the first signal of ongoing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the country. The number of cases in Italy increased rapidly and the country became the first in Europe to experience a SARS-CoV-2 outbreak.
Our aim was to describe the epidemiology and transmission dynamics of the first COVID-19 cases in Italy amid ongoing control measures.
We analysed all RT-PCR-confirmed COVID-19 cases reported to the national integrated surveillance system until 31 March 2020. We provide a descriptive epidemiological summary and estimate the basic and net reproductive numbers by region.
Of the 98,716 cases of COVID-19 analysed, 9,512 were healthcare workers. Of the 10,943 reported COVID-19-associated deaths (crude case fatality ratio: 11.1%) 49.5% occurred in cases older than 80 years. Male sex and age were independent risk factors for COVID-19 death. Estimates of R0 varied between 2.50 (95% confidence interval (CI): 2.18–2.83) in Tuscany and 3.00 (95% CI: 2.68–3.33) in Lazio. The net reproduction number Rt in northern regions started decreasing immediately after the first detection.
The COVID-19 outbreak in Italy showed a clustering onset similar to the one in Wuhan, China. R0 at 2.96 in Lombardy combined with delayed detection explains the high case load and rapid geographical spread. Overall, Rt in Italian regions showed early signs of decrease, with large diversity in incidence, supporting the importance of combined non-pharmacological control measures.
Authors Koen B Pouwels*, Thomas House*, Emma Pritchard, Julie V Robotham, Paul J Birrell, Andrew Gelman, Karina-Doris Vihta, Nikola Bowers, Ian Boreham, Heledd Thomas, James Lewis, Iain Bell, John I Bell, John N Newton, Jeremy Farrar, Ian Diamond, Pete Benton, Ann Sarah Walker
CAMBRIDGE UNIVERSITY PRESS
Authors C.F. Yung, E. Saffari, C. Liew
Abstract:
The epidemiological target of lockdowns is to drive down the effective reproduction number (Rt) to less than 1. A key unknown is the duration that lockdowns need to be in place to achieve this and which lockdown measures are effective. Daily number of laboratory confirmed community COVID-19 cases were extracted from regular reports from the Ministry of Health Singapore (3) from March 20, 2020 to May 4, 2020. We generated daily Rt to estimate the time needed for these public health lockdown measures to control the spread of SARS-CoV-2 as demonstrated by Rt <1. It took about 14 days of nationwide lockdown for the Rt trend to change and start falling. The upper limit of the 95% confidence interval for time to Rt < 1 was day 15 of lockdown. We have shown that it is possible to start ‘bending the Rt curve’ about 2 weeks after implementation of specific lockdown measures with strict compliance.
Authors Martin Reichert, Massimo Sartelli, Markus A. Weigand, Christoph Doppstadt, Matthias Hecker, Alexander Reinisch-Liese, Fabienne Bender, Ingolf Askevold, Winfried Padberg, Federico Coccolini, Fausto Catena, Andreas Hecker
The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now.
A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients.
Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients.
The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.
Authors Antonella Amendola, Silvia Bianchi, Maria Gori, Daniela Colzani, Marta Canuti, Elisa Borghi, Mario C. Raviglione, Gian Vincenzo Zuccotti, Elisabetta Tanzi
We identified severe acute respiratory syndrome coronavirus 2 RNA in an oropharyngeal swab specimen collected from a child with suspected measles in early December 2019, ≈3 months before the first identified coronavirus disease case in Italy. This finding expands our knowledge on timing and mapping of novel coronavirus transmission pathways.
Authors Timothy W Russell, Joseph T Wu, Sam Clifford, W John Edmunds, Adam J Kucharski, Mark Jit
Authors Simiao Chen, Qiushi Chen, Juntao Yang, Lin Lin, Linye Li, Lirui Jiao, Pascal Geldsetzer, Chen Wang, Annelies Wilder-Smith, Till Bärnighausen
Abstract Background In many countries, patients with mild coronavirus disease 2019 (COVID-19) are told to self-isolate at home, but imperfect compliance and shared living space with uninfected people limit the effectiveness of home-based isolation. We aim to examine the impact of facility-based isolation compared to self-isolation at home on the continuing epidemic in the United States. Methods We developed a compartment model to simulate the dynamic transmission of COVID-19 and calibrated it to key epidemic measures in the United States from March to September. We simulated facility-based isolation strategies with various capacities and starting times under different diagnosis rates. The primary model outcomes included the reduction of new infections and deaths over two months from October onwards. We further explored different effects of facility-based isolation under different epidemic burdens by major US Census Regions, and performed sensitivity analyses by varying key model assumptions and parameters. Results We projected that facility-based isolation with moderate capacity of 5 beds per 10 000 total population could avert 4.17 (95% Credible Interval 1.65–7.11) million new infections and 16 000 (8000-23 000) deaths in two months compared with home-based isolation, equivalent to relative reductions of 57% (44–61%) in new infections and 37% (27–40%) in deaths. Facility-based isolation with high capacity of 10 beds per 10 000 population would achieve greater reduction of 76% (62–84%) in new infections and 52% (37–64%) in deaths when supported by the expanded testing with a 20% daily diagnosis rate. Delays in implementation would substantially reduce the impact of facility-based isolation. The effective capacity and the impact of facility-based isolation varied by epidemic stage across regions. Conclusion Timely facility-based isolation for mild COVID-19 cases could substantially reduce the number of new infections and effectively curb the continuing epidemic compared to home-based isolation. The local epidemic burden should determine the effective scale of facility-based isolation strategies.
Authors Ruiyuan Zhang, Huiying Liang, Jinling Tang
Authors Tommaso Celeste Bulfone, Mohsen Malekinejad, George W Rutherford, Nooshin Razani
Abstract Background While risk of outdoor transmission of respiratory viral infections is hypothesized to be low, there is limited data of SARS-CoV-2 transmission in outdoor compared to indoor settings. Methods We conducted a systematic review of peer-reviewed papers indexed in PubMed, EMBASE and Web of Science and pre-prints in Europe PMC through August 12 th, 2020 that described cases of human transmission of SARS-CoV-2. Reports of other respiratory virus transmission were included for reference. Results Five identified studies found that a low proportion of reported global SARS-CoV-2 infections have occurred outdoors (<10%) and the odds of indoor transmission was very high compared to outdoors (18.7 times; 95% CI 6.0, 57.9). Five studies described influenza transmission outdoors and two described adenovirus transmission outdoors. There was high heterogeneity in study quality and individual definitions of outdoor settings which limited our ability to draw conclusions about outdoor transmission risks. In general, factors such as duration and frequency of personal contact, lack of personal protective equipment and occasional indoor gathering during a largely outdoor experience were associated with outdoor reports of infection. Conclusion Existing evidence supports the wide-held belief that the the risk of SARS-CoV-2 transmission is lower outdoors but there are significant gaps in our understanding of specific pathways.
Authors ANDREW GREEN
JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY
Authors Chaya Pitman-Hunt, Jacqueline Leja, Zahra M Jiwani, Dominique Rondot, Jocelyn Ang, Nirupama Kannikeswaran
Abstract This is a single center US retrospective study of infection patterns among household sick contacts of children with confirmed Severe Acute Respiratory Syndrome – Coronavirus 2 (SARS-CoV-2) infection in an urban setting. A household sick contact (HHSC) was identified in fewer than half (42%) of patients and no child-to-adult transmission was identified.
Authors Kristina L. Bajema, Ryan E. Wiegand, Kendra Cuffe, Sadhna V. Patel, Ronaldo Iachan, Travis Lim, Adam Lee, Davia Moyse, Fiona P. Havers, Lee Harding, Alicia M. Fry, Aron J. Hall, Kelly Martin, Marjorie Biel, Yangyang Deng, William A. Meyer III, Mohit Mathur, Tonja Kyle, Adi V. Gundlapalli, Natalie J. Thornburg, Lyle R. Petersen, Chris Edens
Abstract Importance Case-based surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely underestimates the true prevalence of infections. Large-scale seroprevalence surveys can better estimate infection across many geographic regions. Objective To estimate the prevalence of persons with SARS-CoV-2 antibodies using residual sera from commercial laboratories across the US and assess changes over time. Design, Setting, and Participants This repeated, cross-sectional study conducted across all 50 states, the District of Columbia, and Puerto Rico used a convenience sample of residual serum specimens provided by persons of all ages that were originally submitted for routine screening or clinical management from 2 private clinical commercial laboratories. Samples were obtained during 4 collection periods: July 27 to August 13, August 10 to August 27, August 24 to September 10, and September 7 to September 24, 2020. Exposures Infection with SARS-CoV-2. Main Outcomes and Measures The proportion of persons previously infected with SARS-CoV-2 as measured by the presence of antibodies to SARS-CoV-2 by 1 of 3 chemiluminescent immunoassays. Iterative poststratification was used to adjust seroprevalence estimates to the demographic profile and urbanicity of each jurisdiction. Seroprevalence was estimated by jurisdiction, sex, age group (0-17, 18-49, 50-64, and ≥65 years), and metropolitan/nonmetropolitan status. Results Of 177 919 serum samples tested, 103 771 (58.3%) were from women, 26 716 (15.0%) from persons 17 years or younger, 47 513 (26.7%) from persons 65 years or older, and 26 290 (14.8%) from individuals living in nonmetropolitan areas. Jurisdiction-level seroprevalence over 4 collection periods ranged from less than 1% to 23%. In 42 of 49 jurisdictions with sufficient samples to estimate seroprevalence across all periods, fewer than 10% of people had detectable SARS-CoV-2 antibodies. Seroprevalence estimates varied between sexes, across age groups, and between metropolitan/nonmetropolitan areas. Changes from period 1 to 4 were less than 7 percentage points in all jurisdictions and varied across sites. Conclusions and Relevance This cross-sectional study found that as of September 2020, most persons in the US did not have serologic evidence of previous SARS-CoV-2 infection, although prevalence varied widely by jurisdiction. Biweekly nationwide testing of commercial clinical laboratory sera can play an important role in helping track the spread of SARS-CoV-2 in the US.
JKMS (THE KOREAN ACADEMY OF MEDICAL SCIENCES)
Authors Keun-Sang Kwon, Jung-Im Park, Young Joon Park, Don-Myung Jung, Ki-Wahn Ryu, Ju-Hyung Lee
Abstract Background The transmission mode of severe acute respiratory syndrome coronavirus 2 is primarily known as droplet transmission. However, a recent argument has emerged about the possibility of airborne transmission. On June 17, there was a coronavirus disease 2019 (COVID-19) outbreak in Korea associated with long distance droplet transmission. Methods The epidemiological investigation was implemented based on personal interviews and data collection on closed-circuit television images, and cell phone location data. The epidemic investigation support system developed by the Korea Disease Control and Prevention Agency was used for contact tracing. At the restaurant considered the site of exposure, air flow direction and velocity, distances between cases, and movement of visitors were investigated. Results A total of 3 cases were identified in this outbreak, and maximum air flow velocity of 1.2 m/s was measured between the infector and infectee in a restaurant equipped with ceiling-type air conditioners. The index case was infected at a 6.5 m away from the infector and 5 minutes exposure without any direct or indirect contact. Conclusion Droplet transmission can occur at a distance greater than 2 m if there is direct air flow from an infected person. Therefore, updated guidelines involving prevention, contact tracing, and quarantine for COVID-19 are required for control of this highly contagious disease.
Authors Marion Koopmans
Authors Shiyi Cao, Yong Gan, Chao Wang, Max Bachmann, Shanbo Wei, Jie Gong, Yuchai Huang, Tiantian Wang, Liqing Li, Kai Lu, Heng Jiang, Yanhong Gong, Hongbin Xu, Xin Shen, Qingfeng Tian, Chuanzhu Lv, Fujian Song, Xiaoxv Yin, Zuxun Lu
Abstract Stringent COVID-19 control measures were imposed in Wuhan between January 23 and April 8, 2020. Estimates of the prevalence of infection following the release of restrictions could inform post-lockdown pandemic management. Here, we describe a city-wide SARS-CoV-2 nucleic acid screening programme between May 14 and June 1, 2020 in Wuhan. All city residents aged six years or older were eligible and 9,899,828 (92.9%) participated. No new symptomatic cases and 300 asymptomatic cases (detection rate 0.303/10,000, 95% CI 0.270–0.339/10,000) were identified. There were no positive tests amongst 1,174 close contacts of asymptomatic cases. 107 of 34,424 previously recovered COVID-19 patients tested positive again (re-positive rate 0.31%, 95% CI 0.423–0.574%). The prevalence of SARS-CoV-2 infection in Wuhan was therefore very low five to eight weeks after the end of lockdown.
PLOS ONE
Authors Valeria Cento,Claudia Alteri,Marco Merli,Federica Di Ruscio,Livia Tartaglione,Roberto Rossotti,Giovanna Travi,Marta Vecchi,Alessandro Raimondi,Alice Nava,Luna Colagrossi,Roberto Fumagalli,Nicola Ughi,Oscar Massimiliano Epis,Diana Fanti,Andrea Beretta,Filippo Galbiati,Francesco Scaglione,Chiara Vismara,Massimo Puoti,Daniela Campisi,Carlo Federico Perno
Abstract Objective Through a hospital-based SARS-CoV-2 molecular and serological screening, we evaluated the effectiveness of two months of lockdown and two of surveillance, in Milan, Lombardy, the first to be overwhelmed by COVID-19 pandemics during March-April 2020. Methods All subjects presenting at the major hospital of Milan from May-11 to July-5, 2020, underwent a serological screening by chemiluminescent assays. Those admitted were further tested by RT-PCR. Results The cumulative anti-N IgG seroprevalence in the 2753 subjects analyzed was of 5.1% (95%CI = 4.3%-6.0%), with a peak of 8.4% (6.1%-11.4%) 60–63 days since the peak of diagnoses (March-20). 31/106 (29.2%) anti-N reactive subjects had anti-S1/S2 titers >80 AU/mL. Being tested from May-18 to June-5, or residing in the provinces with higher SARS-CoV-2 circulation, were positively and independently associated with anti-N IgG reactivity (OR [95%CI]: 2.179[1.455–3.264] and 3.127[1.18–8.29], respectively). In the 18 RT-PCR positive, symptomatic subjects, anti-N seroprevalence was 33.3% (95% CI: 14.8%-56.3%). Conclusion SARS-CoV-2 seroprevalence in Milan is low, and in a downward trend after only 60–63 days since the peak of diagnoses. Italian confinement measures were effective, but the risk of contagion remains concrete. In hospital-settings, the performance of molecular and serological screenings upon admission remains highly advisable.
Authors Jingwen Li, Xinyi Wang, Chunli Zhu, Zhicheng Lin, Nian Xiong
Authors Angeliki Melidou, Dmitriy Pereyaslov, Olav Hungnes, Katarina Prosenc, Erik Alm, Cornelia Adlhoch, James Fielding, Miriam Sneiderman, Oksana Martinuka, Lucia Pastore Celentano, Richard Pebody
ABSTRACT The COVID-19 pandemic negatively impacted the 2019/20 WHO European Region influenza surveillance. Compared with previous 4-year averages, antigenic and genetic characterisations decreased by 17% (3,140 vs 2,601) and 24% (4,474 vs 3,403). Of subtyped influenza A viruses, 56% (26,477/47,357) were A(H1)pdm09, 44% (20,880/47,357) A(H3). Of characterised B viruses, 98% (4,585/4,679) were B/Victoria. Considerable numbers of viruses antigenically differed from northern hemisphere vaccine components. In 2020/21, maintaining influenza virological surveillance, while supporting SARS-CoV-2 surveillance is crucial.
Authors Cathal Roarty, Claire Tonry, Lisa McFetridge, Hannah Mitchell, Chris Watson, Thomas Waterfield
ROYAL SOCIETY OPEN SCIENCE
Authors Steven J. Phipps, R. Quentin Grafton, Tom Kompas
Abstract Differences in COVID-19 testing and tracing across countries, as well as changes in testing within each country over time, make it difficult to estimate the true (population) infection rate based on the confirmed number of cases obtained through RNA viral testing. We applied a backcasting approach to estimate a distribution for the true (population) cumulative number of infections (infected and recovered) for 15 developed countries. Our sample comprised countries with similar levels of medical care and with populations that have similar age distributions. Monte Carlo methods were used to robustly sample parameter uncertainty. We found a strong and statistically significant negative relationship between the proportion of the population who test positive and the implied true detection rate. Despite an overall improvement in detection rates as the pandemic has progressed, our estimates showed that, as at 31 August 2020, the true number of people to have been infected across our sample of 15 countries was 6.2 (95% CI: 4.3–10.9) times greater than the reported number of cases. In individual countries, the true number of cases exceeded the reported figure by factors that range from 2.6 (95% CI: 1.8–4.5) for South Korea to 17.5 (95% CI: 12.2–30.7) for Italy.
Authors Marta Paterlini
Authors Davide Ferrari, Jovana Milic, Roberto Tonelli, Francesco Ghinelli, Marianna Meschiari, Sara Volpi, Matteo Faltoni, Giacomo Franceschi, Vittorio Iadisernia, Dina Yaacoub, Giacomo Ciusa, Erica Bacca, Carlotta Rogati, Marco Tutone, Giulia Burastero, Alessandro Raimondi, Marianna Menozzi, Erica Franceschini, Gianluca Cuomo, Luca Corradi, Gabriella Orlando, Antonella Santoro, Margherita Digaetano, Cinzia Puzzolante, Federica Carli, Vanni Borghi, Andrea Bedini, Riccardo Fantini, Luca Tabbì, Ivana Castaniere, Stefano Busani, Enrico Clini, Massimo Girardis, Mario Sarti, Andrea Cossarizza, Cristina Mussini, Federica Mandreoli, Paolo Missier , Giovanni Guaraldi
SAGE JOURNALS
Authors Giovanni Apolone, Emanuele Montomoli, Alessandro Manenti, Mattia Boeri, Federica Sabia, Inesa Hyseni, Livia Mazzini, Donata Martinuzzi, Laura Cantone, Gianluca Milanese, Stefano Sestini, Paola Suatoni, Alfonso Marchianò, Valentina Bollati, Gabriella Sozzi, Ugo Pastorino
Abstract There are no robust data on the real onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and spread in the prepandemic period worldwide. We investigated the presence of SARS-CoV-2 receptor-binding domain (RBD)–specific antibodies in blood samples of 959 asymptomatic individuals enrolled in a prospective lung cancer screening trial between September 2019 and March 2020 to track the date of onset, frequency, and temporal and geographic variations across the Italian regions. SARS-CoV-2 RBD-specific antibodies were detected in 111 of 959 (11.6%) individuals, starting from September 2019 (14%), with a cluster of positive cases (>30%) in the second week of February 2020 and the highest number (53.2%) in Lombardy. This study shows an unexpected very early circulation of SARS-CoV-2 among asymptomatic individuals in Italy several months before the first patient was identified, and clarifies the onset and spread of the coronavirus disease 2019 (COVID-19) pandemic. Finding SARS-CoV-2 antibodies in asymptomatic people before the COVID-19 outbreak in Italy may reshape the history of pandemic.
Authors A.G. Letizia, I. Ramos, A. Obla, C. Goforth, D.L. Weir, Y. Ge, M.M. Bamman, J. Dutta, E. Ellis, L. Estrella, M.-C. George, A.S. Gonzalez-Reiche, W.D. Graham, A. van de Guchte, R. Gutierrez, F. Jones, A. Kalomoiri, R. Lizewski, S. Lizewski, J. Marayag, N. Marjanovic, E.V. Millar, V.D. Nair, G. Nudelman, E. Nunez, B.L. Pike, C. Porter, J. Regeimbal, S. Rirak, E. Santa Ana, R.S.G. Sealfon, R. Sebra, M.P. Simons, A. Soares-Schanoski, V. Sugiharto, M. Termini, S. Vangeti, C. Williams, O.G. Troyanskaya, H. van Bakel, S.C. Sealfon
Abstract BACKGROUND The efficacy of public health measures to control the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been well studied in young adults. METHODS We investigated SARS-CoV-2 infections among U.S. Marine Corps recruits who underwent a 2-week quarantine at home followed by a second supervised 2-week quarantine at a closed college campus that involved mask wearing, social distancing, and daily temperature and symptom monitoring. Study volunteers were tested for SARS-CoV-2 by means of quantitative polymerase-chain-reaction (qPCR) assay of nares swab specimens obtained between the time of arrival and the second day of supervised quarantine and on days 7 and 14. Recruits who did not volunteer for the study underwent qPCR testing only on day 14, at the end of the quarantine period. We performed phylogenetic analysis of viral genomes obtained from infected study volunteers to identify clusters and to assess the epidemiologic features of infections. RESULTS A total of 1848 recruits volunteered to participate in the study; within 2 days after arrival on campus, 16 (0.9%) tested positive for SARS-CoV-2, 15 of whom were asymptomatic. An additional 35 participants (1.9%) tested positive on day 7 or on day 14. Five of the 51 participants (9.8%) who tested positive at any time had symptoms in the week before a positive qPCR test. Of the recruits who declined to participate in the study, 26 (1.7%) of the 1554 recruits with available qPCR results tested positive on day 14. No SARS-CoV-2 infections were identified through clinical qPCR testing performed as a result of daily symptom monitoring. Analysis of 36 SARS-CoV-2 genomes obtained from 32 participants revealed six transmission clusters among 18 participants. Epidemiologic analysis supported multiple local transmission events, including transmission between roommates and among recruits within the same platoon. CONCLUSIONS Among Marine Corps recruits, approximately 2% who had previously had negative results for SARS-CoV-2 at the beginning of supervised quarantine, and less than 2% of recruits with unknown previous status, tested positive by day 14. Most recruits who tested positive were asymptomatic, and no infections were detected through daily symptom monitoring. Transmission clusters occurred within platoons. (Funded by the Defense Health Agency and others.)
Authors Nelson L. Michael
Authors Matthew R. Kasper, Jesse R. Geibe, Christine L. Sears, Asha J. Riegodedios, Tina Luse, Annette M. Von Thun, Michael B. McGinnis, Niels Olson, Daniel Houskamp, Robert Fenequito, Timothy H. Burgess, Adam W. Armstrong, Gerald DeLong, Robert J. Hawkins, Bruce L. Gillingham
Abstract BACKGROUND An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel. METHODS We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms. RESULTS The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected. CONCLUSIONS SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt. Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms.
Authors Gareth Iacobucci
Authors Alexander F. Siegenfeld, Yaneer Bar-Yam
Abstract While the spread of communicable diseases such as coronavirus disease 2019 (COVID-19) is often analyzed assuming a well-mixed population, more realistic models distinguish between transmission within and between geographic regions. A disease can be eliminated if the region-to-region reproductive number—i.e., the average number of other regions to which a single infected region will transmit the disease—is reduced to less than one. Here we show that this region-to-region reproductive number is proportional to the travel rate between regions and exponential in the length of the time-delay before region-level control measures are imposed. If, on average, infected regions (including those that become re-infected in the future) impose social distancing measures shortly after experiencing community transmission, the number of infected regions, and thus the number of regions in which such measures are required, will exponentially decrease over time. Elimination will in this case be a stable fixed point even after the social distancing measures have been lifted from most of the regions.
GOVERNMENT OF CANADA
Authors Emerging Sciences Group of the Public Health Agency of Canada
CHEST
Authors Jennifer L. Taylor-Cousar, Lisa Maier, Gregory P. Downey, Michael E. Wechsler
ABSTRACT The clinical research we do to improve our understanding of disease and development of new therapies has temporarily been paused or delayed as the global healthcare enterprise has focused its attention on those impacted by COVID-19. While rates of SARS-CoV-2 infection are decreasing in many areas, many locations continue to have a high prevalence of infection. Nonetheless, research must continue and institutions are considering approaches to re-starting non-COVID related clinical investigation. Those restarting respiratory research must navigate the added planning challenges that take into account outcome measures that require aerosol generating procedures. Such procedures potentially increase risk of transmission of SARS-CoV2 to research staff, utilize limited personal protective equipment, and require conduct in negative pressure rooms. One must also be prepared to address the potential for COVID-19 resurgence. With research subject and staff safety and maintenance of clinical trial data integrity as the guiding principles, here we review key considerations and suggest a step-wise approach for resuming respiratory clinical research.
Authors Young Sup Shin, Jun Young Lee, Soojin Noh, Yoonna Kwak, Sangeun Jeon, Sunoh Kwon, Young-hee Jin, Min Seong Jang, Seungtaek Kim, Jong Hwan Song, Hyoung Rae Kim, Chul Min Park
Abstract Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) continues to spread worldwide, with 25 million confirmed cases and 800 thousand deaths. Effective treatments to target SARS-CoV-2 are urgently needed. In the present study, we have identified a class of cyclic sulfonamide derivatives as novel SARS-CoV-2 inhibitors. Compound 13c of the synthesized compounds exhibited robust inhibitory activity (IC50 = 0.88 μM) against SARS-CoV-2 without cytotoxicity (CC50 > 25 μM), with a selectivity index (SI) of 30.7. In addition, compound 13c exhibited high oral bioavailability (77%) and metabolic stability with good safety profiles in hERG and cytotoxicity studies. The present study identified that cyclic sulfonamide derivatives are a promising new template for the development of anti-SARS-CoV-2 agents.
Authors Roy M Anderson, Carolin Vegvari, James Truscott, Benjamin S Collyer
Authors Gabriele Sorci, Bruno Faivre, Serge Morand
Abstract While the epidemic of SARS-CoV-2 has spread worldwide, there is much concern over the mortality rate that the infection induces. Available data suggest that COVID-19 case fatality rate had varied temporally (as the epidemic has progressed) and spatially (among countries). Here, we attempted to identify key factors possibly explaining the variability in case fatality rate across countries. We used data on the temporal trajectory of case fatality rate provided by the European Center for Disease Prevention and Control, and country-specific data on different metrics describing the incidence of known comorbidity factors associated with an increased risk of COVID-19 mortality at the individual level. We also compiled data on demography, economy and political regimes for each country. We found that temporal trajectories of case fatality rate greatly vary among countries. We found several factors associated with temporal changes in case fatality rate both among variables describing comorbidity risk and demographic, economic and political variables. In particular, countries with the highest values of DALYs lost to cardiovascular, cancer and chronic respiratory diseases had the highest values of COVID-19 CFR. CFR was also positively associated with the death rate due to smoking in people over 70 years. Interestingly, CFR was negatively associated with share of death due to lower respiratory infections. Among the demographic, economic and political variables, CFR was positively associated with share of the population over 70, GDP per capita, and level of democracy, while it was negatively associated with number of hospital beds ×1000. Overall, these results emphasize the role of comorbidity and socio-economic factors as possible drivers of COVID-19 case fatality rate at the population level.
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
Authors Giuseppe Ippolito, Francesco Nicola Lauria, Franco Locatelli, Nicola Magrini, Chiara Montaldo, Raffaella Sadun, Markus Maeurer, Gino Strada, Francesco Vairo, Salvatore Curiale, Antoine Lafont, Antonino di Caro, Maria Rosaria Capobianchi, Rainer Meilicke, Eskild Petersen, Alimuddin Zumla, Michel Pletschette
Authors Anita K. Kambhampati, Alissa C. O’Halloran, Michael Whitaker, Shelley S. Magill, Nora Chea, Shua J. Chai, Pam Daily Kirley, Rachel K. Herlihy, Breanna Kawasaki, James Meek, Kimberly Yousey-Hindes, Evan J. Anderson, Kyle P. Openo, Maya L. Monroe, Patricia A. Ryan, Sue Kim, Libby Reeg, Kathryn Como-Sabetti, Richard Danila, Sarah Shrum Davis, Salina Torres, Grant Barney, Nancy L. Spina, Nancy M. Bennett, Christina B. Felsen, Laurie M. Billing, Jessica Shiltz, Melissa Sutton, Nicole West, William Schaffner, H. Keipp Talbot, Ryan Chatelain, Mary Hill, Lynnette Brammer, Alicia M. Fry, Aron J. Hall, Jonathan M. Wortham, Shikha Garg, Lindsay Kim
Authors Helena J. Hutchins, Brent Wolff, Rebecca Leeb, Jean Y. Ko, Erika Odom, Joe Willey, Allison Friedman, Rebecca H. Bitsko
Authors Eva Leidman, Noemi B. Hall, Amy E. Kirby, Amanda G. Garcia-Williams, Jose Aponte, Jonathan S. Yoder, Rick Hong, Anthony Albence, Fátima Coronado, Greta M. Massetti
Authors Parsa Erfani, Nishant Uppal, Caroline H. Lee, Ranit Mishori, Katherine R. Peeler
IEEEXPLORE
Authors Michael Zgurovsky, Kostiantyn Yefremov, Maria Perestyuk, Victor Putrenko, Ivan Pyshnograiev
Authors THE LANCET RESPIRATORY MEDICINE
Authors Mary Chris Jaklevic
Authors Chris Kenyon
Authors Bridget M. Kuehn
FRONTIERS IN MEDICINE
Authors Danfei Liu, Tongyue Zhang, Yijun Wang, Limin Xia
Authors Elizabeth C. Lee, Nikolas I. Wada, M. Kate Grabowski, Emily S. Gurley, Justin Lessler
Authors You Li, Harry Campbell, Durga Kulkarni, Alice Harpur, Madhurima Nundy, Xin Wang, Harish Nair
Authors Ash K Clift, Carol A C Coupland, Ruth H Keogh, Karla Diaz-Ordaz, Elizabeth Williamson, Ewen M Harrison, Andrew Hayward, Harry Hemingway, Peter Horby, Nisha Mehta, Jonathan Benger, Kamlesh Khunti, David Spiegelhalter, Aziz Sheikh, Jonathan Valabhji, Ronan A Lyons, John Robson, Malcolm G Semple, Frank Kee, Peter Johnson, Susan Jebb, Tony Williams, Julia Hippisley-Cox
Abstract Objective To derive and validate a risk prediction algorithm to estimate hospital admission and mortality outcomes from coronavirus disease 2019 (covid-19) in adults. Design Population based cohort study. Setting and participants QResearch database, comprising 1205 general practices in England with linkage to covid-19 test results, Hospital Episode Statistics, and death registry data. 6.08 million adults aged 19-100 years were included in the derivation dataset and 2.17 million in the validation dataset. The derivation and first validation cohort period was 24 January 2020 to 30 April 2020. The second temporal validation cohort covered the period 1 May 2020 to 30 June 2020. Main outcome measures The primary outcome was time to death from covid-19, defined as death due to confirmed or suspected covid-19 as per the death certification or death occurring in a person with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the period 24 January to 30 April 2020. The secondary outcome was time to hospital admission with confirmed SARS-CoV-2 infection. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance, including measures of discrimination and calibration, was evaluated in each validation time period. Results 4384 deaths from covid-19 occurred in the derivation cohort during follow-up and 1722 in the first validation cohort period and 621 in the second validation cohort period. The final risk algorithms included age, ethnicity, deprivation, body mass index, and a range of comorbidities. The algorithm had good calibration in the first validation cohort. For deaths from covid-19 in men, it explained 73.1% (95% confidence interval 71.9% to 74.3%) of the variation in time to death (R2); the D statistic was 3.37 (95% confidence interval 3.27 to 3.47), and Harrell’s C was 0.928 (0.919 to 0.938). Similar results were obtained for women, for both outcomes, and in both time periods. In the top 5% of patients with the highest predicted risks of death, the sensitivity for identifying deaths within 97 days was 75.7%. People in the top 20% of predicted risk of death accounted for 94% of all deaths from covid-19. Conclusion The QCOVID population based risk algorithm performed well, showing very high levels of discrimination for deaths and hospital admissions due to covid-19. The absolute risks presented, however, will change over time in line with the prevailing SARS-C0V-2 infection rate and the extent of social distancing measures in place, so they should be interpreted with caution. The model can be recalibrated for different time periods, however, and has the potential to be dynamically updated as the pandemic evolves.
Authors Angel N. Desai, Maimuna S. Majumder
Authors Saad B. Omer, MBBS, Inci Yildirim, Howard P. Forman
Authors Wan Yang, Sasikiran Kandula, Mary Huynh, Sharon K Greene, Gretchen Van Wye, Wenhui Li, Hiu Tai Chan, Emily McGibbon, Alice Yeung, Don Olson, Anne Fine, Jeffrey Shaman
Authors Elizabeth M. White, Christopher M. Santostefano, Richard A. Feifer, Cyrus M. Kosar, Carolyn Blackman, Stefan Gravenstein, Vincent Mor
BMC INFECTIOUS DISEASES
Authors Giulia De Angelis, Brunella Posteraro, Federico Biscetti, Gianluca Ianiro, Lorenzo Zileri Dal Verme, Paola Cattani, Francesco Franceschi, Maurizio Sanguinetti, Antonio Gasbarrini
Abstract Background Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as a novel etiologic agent of viral pneumonia. We aimed to compare clinical features of 165 Italian patients with laboratory confirmed or unconfirmed 2019-nCoV pneumonia. Methods On March 31, 2020, hospitalized patients who presented with fever and/or respiratory symptoms, exposures, and presence of lung imaging features consistent with 2019-nCoV pneumonia were included. Before admission to a hospital ward, patients underwent RT-PCR based SARS-CoV-2 RNA detection in their nasopharyngeal swab samples. Results Of 165 patients studied, 119 had positive RT-PCR results and 46 were RT-PCR negative for 2 days or longer (i.e., when the last swab sample was obtained). The median age was 70 years (IQR, 58–78), and 123 (74.6%) of 165 patients had at least one comorbidity. The majority of patients (101/165, 61.2%) had a mild pneumonia, and the remaining patients (64/165, 38.8%) a severe/critical pneumonia. We did not find any substantial difference in symptoms, incubation periods, and radiographic/CT abnormalities as well as in many of the biological abnormalities recorded. However, at multivariable analysis, higher concentrations of hemoglobin (OR, 1.34; 95% CI, 1.11–1.65; P = 0.003) and lower counts of leukocytes (OR, 0.81; 95% CI, 0.72–0.90; P < 0.001) were statistically associated with confirmed COVID-19 diagnosis. While mortality rates were similar, patients with confirmed diagnosis were more likely to receive antivirals (95% vs 19.6%, P < 0.001) and to develop ARDS (63% vs 37%, P = 0.003) than those with unconfirmed COVID-19 diagnosis. Conclusions Our findings suggest that unconfirmed 2019-nCoV pneumonia cases may be actually COVID-19 cases and that clinicians should be cautious when managing patients with presentations compatible with COVID-19.
Authors Howard Bauchner, Phil B. Fontanarosa
Authors Harvey V. Fineberg
Authors Canelle Poirier, Wei Luo, Maimuna S. Majumder, Dianbo Liu, Kenneth D. Mandl, Todd A. Mooring, Mauricio Santillana
Abstract First identified in Wuhan, China, in December 2019, a novel coronavirus (SARS-CoV-2) has affected over 16,800,000 people worldwide as of July 29, 2020 and was declared a pandemic by the World Health Organization on March 11, 2020. Influenza studies have shown that influenza viruses survive longer on surfaces or in droplets in cold and dry air, thus increasing the likelihood of subsequent transmission. A similar hypothesis has been postulated for the transmission of COVID-19, the disease caused by SARS-CoV-2. It is important to propose methodologies to understand the effects of environmental factors on this ongoing outbreak to support decision-making pertaining to disease control. Here, we examine the spatial variability of the basic reproductive numbers of COVID-19 across provinces and cities in China and show that environmental variables alone cannot explain this variability. Our findings suggest that changes in weather (i.e., increase of temperature and humidity as spring and summer months arrive in the Northern Hemisphere) will not necessarily lead to declines in case counts without the implementation of drastic public health interventions.
Authors Steven H. Woolf, Derek A. Chapman, Roy T. Sabo, Daniel M. Weinberger, Latoya Hill, DaShaunda D. H. Taylor
Authors Alyssa Bilinski, Ezekiel J. Emanuel
Authors Alexandra M. Oster, Elise Caruso, Jourdan DeVies, Kathleen P. Hartnett, Tegan K. Boehmer
Authors Joe Hasell, Edouard Mathieu, Diana Beltekian, Bobbie Macdonald, Charlie Giattino, Esteban Ortiz-Ospina, Max Roser, Hannah Ritchie
Abstract Our understanding of the evolution of the COVID-19 pandemic is built upon data concerning confirmed cases and deaths. This data, however, can only be meaningfully interpreted alongside an accurate understanding of the extent of virus testing in different countries. This new database brings together official data on the extent of PCR testing over time for 94 countries. We provide a time series for the daily number of tests performed, or people tested, together with metadata describing data quality and comparability issues needed for the interpretation of the time series. The database is updated regularly through a combination of automated scraping and manual collection and verification, and is entirely replicable, with sources provided for each observation. In providing accessible cross-country data on testing output, it aims to facilitate the incorporation of this crucial information into epidemiological studies, as well as track a key component of countries’ responses to COVID-19.
Authors Mario Coccia
Abstract The pandemic of coronavirus disease 2019 (COVID-19) is generating a high number of infected individuals and deaths. One of the current questions is how climatological factors and environmental pollution can affect the diffusion of COVID-19 in human society. This study endeavours to explain the relation between wind speed, air pollution and the diffusion of COVID-19 to provide insights to constrain and/or prevent future pandemics and epidemics. The statistical analysis here focuses on case study of Italy and reveals two main findings: 1) cities with high wind speed have lower numbers of COVID-19 related infected individuals; 2) cities located in hinterland zones (mostly those bordering large urban conurbations) with little wind speed and frequently high levels of air pollution had higher numbers of COVID-19 related infected individuals. Results here suggest that high concentrations of air pollutants, associated with low wind speeds, may promote a longer permanence of viral particles in polluted air of cities, thus favouring an indirect means of diffusion of the novel coronavirus (SARS-CoV-2), in addition to the direct diffusion with human-to-human transmission dynamics.
Authors Philippe Gautreta, Philippe Colsona, Jean Christophe Lagiera, Laurence Camoin-Jaua, Audrey Giraud-Gatineaua, Sophia Boudjema, Julie Financea, Hervé Chaudeta, Didier Raoulta
Abstract Objective To describe the characteristics of COVID-19 patients seen in March-April and June-August 2020 in Marseille, France with the aim to investigate possible changes in the disease between these two time periods. Methods Demographics, hospitalization rate, transfer to intensive care unit (ICU), lethality, clinical and biological parameters were investigated. Results Compared to those seen in March-April, COVID-19 patients seen in June-August were significantly younger (39.2 vs. 45.3 years), more likely to be male (52.9% vs. 45.6%), and less likely to be hospitalized (10.7 vs. 18.0%), to be transferred to ICU (0.9% vs. 1.8%) and to die (0.1% vs. 1.1%). Their mean fibrinogen and D-dimer blood levels were lower (1.0 vs. 1.5 g/L and 0.6 vs. 1.1 μg/mL, respectively). By contrast, their viral load was higher (cycle threshold ≤16 = 5.1% vs. 3.7%). Conclusions Patients in the two periods did not present marked age and sex differences, but markers of severity were undoubtedly less prevalent in the summer period, associating with a 10 times decrease in the lethality rate.
Authors Liang Wang, Xavier Didelot, Jing Yang, Gary Wong, Yi Shi, Wenjun Liu, George F. Gao, Yuhai Bi
Abstract Coronavirus disease 2019 (COVID-19) was first identified in late 2019 in Wuhan, Hubei Province, China and spread globally in months, sparking worldwide concern. However, it is unclear whether super-spreading events occurred during the early outbreak phase, as has been observed for other emerging viruses. Here, we analyse 208 publicly available SARS-CoV-2 genome sequences collected during the early outbreak phase. We combine phylogenetic analysis with Bayesian inference under an epidemiological model to trace person-to-person transmission. The dispersion parameter of the offspring distribution in the inferred transmission chain was estimated to be 0.23 (95% CI: 0.13–0.38), indicating there are individuals who directly infected a disproportionately large number of people. Our results showed that super-spreading events played an important role in the early stage of the COVID-19 outbreak.
Authors John N. Nkengasong, Nicaise Ndembi, Akhona Tshangela, Tajudeen Raji
Authors Noah G. Schwartz, Anne C. Moorman, Anna Makaretz, Karen T. Chang, Victoria T. Chu, Christine M. Szablewski, Anna R. Yousaf, Marie M. Brown, Ailis Clyne, Amanda DellaGrotta, Jan Drobeniuc, Jacqueline Korpics, Adam Muir, Cherie Drenzek, Utpala Bandy, Hannah L. Kirking, Jacqueline E. Tate, Aron J. Hall, Tatiana M. Lanzieri, Rebekah J. Stewart
Authors Eli S Rosenberg, David R Holtgrave
Authors Ryohei Hirose, Hiroshi Ikegaya, Yuji Naito, Naoto Watanabe, Takuma Yoshida, Risa Bandou, Tomo Daidoji, Yoshito Itoh, Takaaki Nakaya
Abstract Background The stability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on human skin remains unknown, considering the hazards of viral exposure to humans. We generated a model that allows the safe reproduction of clinical studies on the application of pathogens to human skin and elucidated the stability of SARS-CoV-2 on the human skin. Methods We evaluated the stability of SARS-CoV-2 and influenza A virus (IAV), mixed with culture medium or upper respiratory mucus, on human skin surfaces and the dermal disinfection effectiveness of 80% (w/w) ethanol against SARS-CoV-2 and IAV. Results SARS-CoV-2 and IAV were inactivated more rapidly on skin surfaces than on other surfaces (stainless steel/glass/plastic); the survival time was significantly longer for SARS-CoV-2 than for IAV [9.04 h (95% confidence interval: 7.96–10.2 h) vs. 1.82 h (1.65–2.00 h)]. IAV on other surfaces was inactivated faster in mucus versus medium conditions, while SARS-CoV-2 showed similar stability in the mucus and medium; the survival time was significantly longer for SARS-CoV-2 than for IAV [11.09 h (10.22–12.00 h) vs. 1.69 h (1.57–1.81 h)]. Moreover, both SARS-CoV-2 and IAV in the mucus/medium on human skin were completely inactivated within 15 s by ethanol treatment. Conclusions The 9-h survival of SARS-CoV-2 on human skin may increase the risk of contact transmission in comparison with IAV, thus accelerating the pandemic. Proper hand hygiene is important to prevent the spread of SARS-CoV-2 infections.
Authors Erica Wilson, Catherine V. Donovan, Margaret Campbell, Thevy Chai, Kenneth Pittman, Arlene C. Seña, Audrey Pettifor, David J. Weber, Aditi Mallick, Anna Cope, Deborah S. Porterfield, Erica Pettigrew, Zack Moore
Authors Tegan K. Boehmer, Jourdan DeVies, Elise Caruso, Katharina L. van Santen, Shichao Tang, Carla L. Black, Kathleen P. Hartnett, Aaron Kite-Powell, Stephanie Dietz, Matthew Lozier, Adi V. Gundlapalli
Authors Grace Chung-Yan Lui, Terry Cheuk-Fung Yip, Vincent Wai-Sun Wong, Viola Chi-Ying Chow, Tracy Hang-Yee Ho, Timothy Chun-Man Li, Yee-Kit Tse, Henry Lik-Yuen Chan, David Shu-Cheong Hui, Grace Lai-Hung Wong
Abstract Background The case-fatality ratios (CFR) of coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) appeared to differ substantially. We aimed to compare the CFR and its predictors of COVID-19 and SARS patients using a territory-wide cohort in Hong Kong. Methods This was a territory-wide retrospective cohort study using data captured from all public hospitals in Hong Kong. Laboratory-confirmed COVID-19 and SARS patients were identified. The primary endpoint was a composite endpoint of intensive care unit admission, use of mechanical ventilation, and/or death. Results We identified 1013 COVID-19 patients (mean age, 38.4 years; 53.9% male) diagnosed from 23 January to 14 April 2020 and 1670 SARS patients (mean age, 44.4 years; 44.0% male) from March to June 2003. Fifty-five (5.4%) COVID-19 patients and 432 (25.9%) SARS patients had reached the primary endpoint in 30 days. By 30 June 2003, 286 SARS patients had died (CFR, 17.1%). By 7 June 2020, 4 COVID-19 patients had died (CFR, 0.4%). After adjusting for demographic and clinical parameters, COVID-19 was associated with a 71% lower risk of primary endpoint compared with SARS (adjusted hazard ratio, 0.29; 95% confidence interval, .21–.40; P < .0001). Age, diabetes mellitus, and laboratory parameters (high lactate dehydrogenase, high C-reactive protein, and low platelet count) were independent predictors of the primary endpoint in COVID-19 patients, whereas use of antiviral treatments was not associated with primary endpoint. Conclusions The CFR of COVID-19 was 0.4%. Age and diabetes were associated with worse outcomes, whereas antiviral treatments were not.
Authors Arjun S Yadaw, Yan-chak Li, Sonali Bose, Ravi Iyengar, Supinda Bunyavanich, Gaurav Pandey
Abstract A recent genetic association study1 identified a gene cluster on chromosome 3 as a risk locus for respiratory failure upon SARS-CoV-2 infection. A new study2 comprising 3,199 hospitalized COVID-19 patients and controls finds that this is the major genetic risk factor for severe SARS-CoV-2 infection and hospitalization (COVID-19 Host Genetics Initiative). Here, we show that the risk is conferred by a genomic segment of ~50 kb that is inherited from Neanderthals and is carried by ~50% of people in South Asia and ~16% of people in Europe today.
Authors Michael J. Mina, Roy Parker, Daniel B. Larremore
Authors Daniele Focosi, Maria Carla Iorio, Maria Lanza
Authors Phillip P. Salvatore, Erisa Sula, Jayme P. Coyle, Elise Caruso, Amanda R. Smith, Rebecca S. Levine, Brittney N. Baack, Roger Mir, Edward R. Lockhart, Tejpratap S.P. Tiwari, Deborah L. Dee, Tegan K. Boehmer, Brendan R. Jackson, Achuyt Bhattara
Authors Henry T. Walke, Margaret A. Honein, Robert R. Redfield
Authors Mario U Mondelli, Marta Colaneri, Elena M Seminari, Fausto Baldanti, Raffaele Bruno
Authors Simon Cauchemez, Cécile Tran, Kiem Juliette Paireau, Patrick Rolland, Arnaud Fontanet
Authors Hollie Speake, Anastasia Phillips, Tracie Chong, Chisha Sikazwe, Avram Levy, Jurissa Lang, Benjamin Scalley, David J. Speers, David W. Smith, Paul Effler, Suzanne P. McEvoy
Abstract To investigate potential transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a domestic flight within Australia, we performed epidemiologic analyses with whole-genome sequencing. Eleven passengers with PCR-confirmed SARS-CoV-2 infection and symptom onset within 48 hours of the flight were considered infectious during travel; 9 had recently disembarked from a cruise ship with a retrospectively identified SARS-CoV-2 outbreak. The virus strain of those on the cruise and the flight was linked (A2-RP) and had not been previously identified in Australia. For 11 passengers, none of whom had traveled on the cruise ship, PCR-confirmed SARS-CoV-2 illness developed between 48 hours and 14 days after the flight. Eight cases were considered flight associated with the distinct SARS-CoV-2 A2-RP strain; the remaining 3 cases (1 with A2-RP) were possibly flight associated. All 11 passengers had been in the same cabin with symptomatic persons who had primary, culture-positive, A2-RP cases. This investigation provides evidence of flight-associated SARS-CoV-2 transmission.
Authors Robert Moss, James Wood, Damien Brown, Freya M. Shearer, Andrew J. Black, Kathryn Glass, Allen C. Cheng, James M. McCaw, Jodie McVernon
Abstract The ability of health systems to cope with coronavirus disease (COVID-19) cases is of major concern. In preparation, we used clinical pathway models to estimate healthcare requirements for COVID-19 patients in the context of broader public health measures in Australia. An age- and risk-stratified transmission model of COVID-19 demonstrated that an unmitigated epidemic would dramatically exceed the capacity of the health system of Australia over a prolonged period. Case isolation and contact quarantine alone are insufficient to constrain healthcare needs within feasible levels of expansion of health sector capacity. Overlaid social restrictions must be applied over the course of the epidemic to ensure systems do not become overwhelmed and essential health sector functions, including care of COVID-19 patients, can be maintained. Attention to the full pathway of clinical care is needed, along with ongoing strengthening of capacity.
Authors Steffanie A Strathdee Sally C Davies Jasmine R Marcelin
Authors Gideon Meyerowitz-Katz, Lea Merone
Abstract An important unknown during the COVID-19 pandemic has been the infection-fatality rate (IFR). This differs from the case-fatality rate (CFR) as an estimate of the number of deaths as a proportion of the total number of cases, including those who are mild and asymptomatic. While the CFR is extremely valuable for experts, IFR is increasingly being called for by policy-makers and the lay public as an estimate of the overall mortality from COVID-19. Methods Pubmed, Medline, SSRN, and Medrxiv were searched using a set of terms and Boolean operators on 25/04/2020 and re-searched 14/05/2020, 21/05/2020, and 16/06/2020. Articles were screened for inclusion by both authors. Meta-analysis was performed in Stata 15.1 using the metan command, based on IFR and confidence intervals extracted from each study. Google/Google Scholar was used to assess the grey literature relating to government reports. Results After exclusions, there were 24 estimates of IFR included in the final meta-analysis, from a wide range of countries, published between February and June 2020. The meta-analysis demonstrated a point-estimate of IFR of 0.68% (0.53-0.82%) with high heterogeneity (p < 0.001). Conclusion Based on a systematic review and meta-analysis of published evidence on COVID-19 until July, 2020, the IFR of the disease across populations is 0.68% (0.53-0.82%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents a wholly unbiased point estimate. It is likely that, due to age and perhaps underlying comorbidities in the population, different places will experience different IFRs due to the disease. Given issues with mortality recording, it is also likely that this represents an underestimate of the true IFR figure. More research looking at age-stratified IFR is urgently needed to inform policy-making on this front.
Authors Andrew E Clark, Francesca M Lee
Authors Laurys Boudin, Fabien Dutasta
Authors Neftali Eduardo Antonio-Villa, Omar Yaxmehen Bello-Chavolla, Arsenio Vargas-Vázquez, Carlos A Fermín-Martínez, Alejandro Márquez-Salinas, Jessica Paola Bahena-López
Abstract Background Health-care workers (HCWs) could be at increased occupational risk for SARS-CoV-2 infection. Information regarding prevalence and risk factors for adverse outcomes in HCWs is scarce in Mexico. Here, we aimed to explore prevalence of SARS-CoV-2, symptoms, and risk factors associated with adverse outcomes in HCWs in Mexico City. Methods We explored data collected by the National Epidemiological Surveillance System in Mexico City. All cases underwent real-time RT-PCR test. We explored outcomes related to severe COVID-19 in HCWs and the diagnostic performance of symptoms to detect SARS-CoV-2 infection in HCWs. Results As of July 5 th, 2020, 35,095 HCWs were tested for SARS-CoV-2 and 11,226 were confirmed (31.9%). Overall, 4,322 were nurses (38.5%), 3,324 physicians (29.6%), 131 dentists (1.16%) and 3,449 laboratory personnel and other HCWs (30.8%). After follow-up, 1,009 HCWs required hospitalization (9.00%), 203 developed severe outcomes (1.81%), and 93 required mechanical-ventilatory support (0.82%). Lethality was recorded in 226 (2.01%) cases. Symptoms associated with SARS-CoV-2 positivity were fever, cough, malaise, shivering, myalgias at evaluation but neither had significant predictive value. We also identified 341 asymptomatic SARS-CoV-2 infections (3.04%). Older HCWs with chronic non-communicable diseases, pregnancy, and severe respiratory symptoms were associated with higher risk for adverse outcomes. Physicians had higher risk for hospitalization and for severe outcomes compared with nurses and other HCWs. Conclusions We report a high prevalence of SARS-CoV-2 infection in HCWs in Mexico City. No symptomatology can accurately discern HCWs with SARS-CoV-2 infection. Particular attention should focus on HCWs with risk factors to prevent adverse outcomes and reduce infection risk.
Authors Phillip P Salvatore, Patrick Dawson, Ashutosh Wadhwa, Elizabeth M Rabold, Sean Buono, Elizabeth A Dietrich, Hannah E Reses, Jeni Vuong, Lucia Pawloski, Trivikram Dasu, Sanjib Bhattacharyya, Eric Pevzner, Aron J Hall, Jacqueline E Tate, Hannah L Kirking
Abstract Background Detection of SARS-CoV-2 infection has principally been performed through the use of real-time reverse-transcription PCR (rRT-PCR) testing. Results of such tests can be reported as cycle threshold (Ct) values, which may provide semi-quantitative or indirect measurements of viral load. Previous reports have examined temporal trends in Ct values over the course of a SARS-CoV-2 infection. Methods Using testing data collected during a prospective household transmission investigation of outpatient and mild COVID-19 cases, we examined the relationship between Ct values of the viral RNA N1 target and demographic, clinical, and epidemiological characteristics collected through participant interviews and daily symptom diaries. Results We found Ct values are lowest (corresponding to higher viral RNA concentration) soon after symptom onset and are significantly correlated with time elapsed since onset (p<0.001); within 7 days after symptom onset, the median Ct value was 26.5 compared with a median Ct value of 35.0 occurring 21 days after onset. Ct values were significantly lower among participants under 18 years of age (p=0.01) and those reporting upper respiratory symptoms at the time of sample collection (p=0.001) and were higher among participants reporting no symptoms (p=0.05). Conclusions These results emphasize the importance of early testing for SARS-CoV-2 among individuals with symptoms of respiratory illness and allows cases to be identified and isolated when their viral shedding may be highest.
Authors Rita Jaafar, Sarah Aherfi, Nathalie Wurtz, Clio Grimaldier, Van Thuan Hoang, Philippe Colson, Didier Raoult, Bernard La Scola
Authors Nobuaki Matsunaga, Kayoko Hayakaw, Mari Terada, M.Pharm, Hiroshi Ohtsu, Yusuke Asai, Shinya Tsuzuki, Setsuko Suzuki, Ako Toyoda, Kumiko Suzuki, Mio Endo, Naoki Fujii, Michiyo Suzuki, Sho Saito, Yukari Uemura, Taro Shibata, M.Sc, Masashi Kondo, Kazuo Izumi, Junko Terada-Hirashima, Ayako Mikami, Wataru Sugiura, Norio Ohmagari
Abstract Background There is limited understanding of the characteristics of coronavirus disease 2019 (COVID-19) patients requiring hospitalization in Japan. Methods This study included 2638 cases enrolled from 227 health care facilities that participated in the COVID-19 Registry Japan (COVIREGI-JP). The inclusion criteria for enrollment of a case in COVIREGI-JP are both (1) a positive SARS-CoV-2 test and (2) inpatient treatment at a health care facility. Results The median age of hospitalized patients with COVID-19 was 56 years (interquartile range [IQR]: 40-71). More than half of the cases were male (58.9%, 1542/2619). Nearly 60% of the cases had close contact to confirmed or suspected cases of COVID-19. The median duration of symptoms before admission was 7 days (IQR: 4-10). The most common comorbidities were hypertension (15%, 396/2638) and diabetes without complications (14.2%, 374/2638). The number of non-severe cases (68.2%, n=1798) was twice the number of severe cases (31.8%, n=840) at admission. The respiratory support during hospitalization includes those who received no oxygen support (61.6%, 1623/2636), followed by those who received supplemental oxygen (29.9%, 788/2636), and IMV/ECMO (mechanical ventilation or extracorporeal membrane oxygenation) (8.5%, 225/2636). Overall, 66.9% (1762/2634) of patients were discharged home, while 7.5% (197/2634) died. Conclusions We identified the clinical epidemiological features of COVID-19 in hospitalized patients in Japan. When compared with existing inpatient studies in other countries, these results demonstrated less comorbidities and a trend towards lower mortality.
INTERNATIONAL ASSOCIATION OF APPLIED PSYCHOLOGY
Authors Lisa S. Moussaoui, Nana D. Ofosu, Olivier Desrichard
Abstract Background A clear picture of people’s adoption of protective behaviours, and a thorough understanding of psychosocial correlates in the context of contagious diseases such as COVID‐19, is essential for the development of communication strategies, and can contribute to the fight against epidemics. Methods In this paper, we report a survey on the adoption of the recommended protective behaviours before and during the epidemic. We also assessed demographic correlates, and beliefs (towards COVID‐19 and protective behaviours, towards SARS‐CoV‐2 transmission, social dilemma variables, and perceived external cues) of a representative sample of British residents. Data were collected during the early stage of the COVID‐19 epidemic that spread worldwide in 2020. Results Results showed a marked increase in the adoption of protective behaviour. We also identified targets for intervention in variables related to transmission of the virus and social dilemma‐related beliefs. Sex differences in the adoption of protective measures, as well as differences associated with the frequency of social contacts, were associated with differences in beliefs. Conclusions These findings suggest changeable determinants, which could be targeted in global communication about COVID‐19, or in interventions targeting specific sub‐groups not following the protective measures.
TAYLOR & FRANCIS ONLINE
Authors Angela M. Jackson-Morris, Rachel Nugent Johanna Ralston, Olivia Barata Cavalcanti, John Wilding
ABSTRACT Initial observations showed that people with chronic noncommunicable diseases were at heightened risk of severe COVID-19 and adverse outcomes. Subsequently, data from various countries have revealed obesity as an independent and significant factor, with people who are overweight/have obesity significantly more likely to be hospitalized, require ICU treatment, and to die. Notably, this additional risk applies to younger people relative to the general COVID-19 risk profile. This paper sets out the evidence of greater risk of poor COVID outcomes for people who are overweight/have obesity, indication of reduced treatment and support for obesity self-management where it existed prior to COVID-19, and highlights the dearth of specific guidance and measures to mitigate the impacts of COVID-19 upon people with obesity. We identify the health, social and economic impacts that this specific vulnerability creates relative to COVID-19 outcomes. Reduced national and global pandemic resilience due to high obesity prevalence should spur governments and funders to provide urgent specific protection and support for people with overweight/obesity, and to commission rapid research to identify effective prevention and reduction measures. We set out priorities for action on obesity to begin compensating for years of underfunding and inadequate policy attention in the face of escalating obesity across countries of all income groups and world regions.
Authors Arielle Lasry Roberta Horth
Authors Richard Horton
Authors Barnaby Flower Christina Atchison
Authors Isao Yokota, PhD, MPH Kazufumi Okada, Yoko Unoki, Yichi Yang, Tasuku Inao, Kentaro Sakamaki, Sumio Iwasaki, Kasumi Hayasaka, Junichi Sugita,, Mutsumi Nishida, Shinichi Fujisawa, Takanori Teshima
Abstract Background COVID-19 has rapidly evolved to become a global pandemic due largely to the transmission of its causative virus through asymptomatic carriers. Detection of SARS-CoV-2 in asymptomatic people is an urgent priority for the prevention and containment of disease outbreaks in communities. However, few data are available in asymptomatic persons regarding the accuracy of PCR testing. Additionally, although self-collected saliva has significant logistical advantages in mass screening, its utility as an alternative specimen in asymptomatic persons is yet to be determined. Methods We conducted a mass-screening study to compare the utility of nucleic acid amplification, such as reverse transcriptase polymerase chain reaction (RT-PCR) testing, using nasopharyngeal swabs (NPS) and saliva samples from each individual in two cohorts of asymptomatic persons: the contact tracing cohort and the airport quarantine cohort. Results In this mass-screening study including 1,924 individuals, the sensitivity of nucleic acid amplification testing with nasopharyngeal and saliva specimens were 86% (90%CI:77-93%) and 92% (90%CI:83-97%), respectively, with specificities greater than 99.9%. The true concordance probability between the nasopharyngeal and saliva tests was estimated at 0.998 (90%CI:0.996-0.999) on the estimated airport prevalence at 0.3%. In positive individuals, viral load was highly correlated between NPS and saliva. Conclusion Both nasopharyngeal and saliva specimens had high sensitivity and specificity. Self-collected saliva is a valuable specimen to detect SARS-CoV-2 in mass screening of asymptomatic persons.
IDSE (INFECTION DISEASE SPECIAL EDITION)
Authors IDSE News Staff
Authors Emeline Han*, Melisa Mei Jin Tan*, Eva Turk, Devi Sridhar, Gabriel M Leung, Kenji Shibuya, Nima Asgari, Juhwan Oh, Alberto L García-Basteiro, Johanna Hanefeld, Alex R Cook, Li Yang Hsu, Yik Ying Teo, David Heymann, Helen Clark, Martin McKee, Helena Legido-Quigley
Authors Roland R. Netz, William A. Eaton
Abstract To make the physics of person-to-person virus transmission from emitted droplets of oral fluid while speaking easily understood, we present simple and transparent algebraic equations that capture the essential physics of the problem. Calculations with these equations provide a straightforward way of determining whether emitted droplets remain airborne or rapidly fall to the ground, after accounting for the decrease in droplet size from water evaporation. At a relative humidity of 50%, for example, droplets with initial radii larger than about 50 μm rapidly fall to the ground, while smaller, potentially virus-containing droplets shrink in size from water evaporation and remain airborne for many minutes. Estimates of airborne virion emission rates while speaking strongly support the proposal that mouth coverings can help contain the COVID-19 pandemic.
Authors Giacomo Cacciapaglia, Corentin Cot, Francesco Sannino
Abstract A second wave pandemic constitutes an imminent threat to society, with a potentially immense toll in terms of human lives and a devastating economic impact. We employ the epidemic Renormalisation Group (eRG) approach to pandemics, together with the first wave data for COVID-19, to efficiently simulate the dynamics of disease transmission and spreading across different European countries. The framework allows us to model, not only inter and extra European border control effects, but also the impact of social distancing for each country. We perform statistical analyses averaging on different level of human interaction across Europe and with the rest of the World. Our results are neatly summarised as an animation reporting the time evolution of the first and second waves of the European COVID-19 pandemic. Our temporal playbook of the second wave pandemic can be used by governments, financial markets, the industries and individual citizens, to efficiently time, prepare and implement local and global measures.
Authors Massimiliano Fazzini, Claudia Baresi, Carlo Bisci, Claudio Bna, Alessandro Cecili, Andrea Giuliacci, Sonia Illuminati, Fabrizio Pregliasco, Enrico Miccadei
Abstract The coronavirus disease 2019 (COVID-19) pandemic is the most severe global health and socioeconomic crisis of our time, and represents the greatest challenge faced by the world since the end of the Second World War. The academic literature indicates that climatic features, specifically temperature and absolute humidity, are very important factors affecting infectious pulmonary disease epidemics - such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS); however, the influence of climatic parameters on COVID-19 remains extremely controversial. The goal of this study is to individuate relationships between several climate parameters (temperature, relative humidity, accumulated precipitation, solar radiation, evaporation, and wind direction and intensity), local morphological parameters, and new daily positive swabs for COVID-19, which represents the only parameter that can be statistically used to quantify the pandemic. The daily deaths parameter was not considered, because it is not reliable, due to frequent administrative errors. Daily data on meteorological conditions and new cases of COVID-19 were collected for the Lombardy Region (Northern Italy) from 1 March, 2020 to 20 April, 2020. This region exhibited the largest rate of official deaths in the world, with a value of approximately 1700 per million on 30 June 2020. Moreover, the apparent lethality was approximately 17% in this area, mainly due to the considerable housing density and the extensive presence of industrial and craft areas. Both the Mann–Kendall test and multivariate statistical analysis showed that none of the considered climatic variables exhibited statistically significant relationships with the epidemiological evolution of COVID-19, at least during spring months in temperate subcontinental climate areas, with the exception of solar radiation, which was directly related and showed an otherwise low explained variability of approximately 20%. Furthermore, the average temperatures of two highly representative meteorological stations of Molise and Lucania (Southern Italy), the most weakly affected by the pandemic, were approximately 1.5 °C lower than those in Bergamo and Brescia (Lombardy), again confirming that a significant relationship between the increase in temperature and decrease in virulence from COVID-19 is not evident, at least in Italy.
Authors Vanessa R. Barrs, Malik Peiris, Karina W.S. Tam, Pierra Y.T. Law, Christopher J. Brackman, Esther M.W. To, Veronica Y.T. Yu, Daniel K.W. Chu, Ranawaka A.P.M. Perera, Thomas H.C. Sit
Abstract We tested 50 cats from coronavirus disease households or close contacts in Hong Kong, China, for severe acute respiratory syndrome coronavirus 2 RNA in respiratory and fecal samples. We found 6 cases of apparent human-to-feline transmission involving healthy cats. Virus genomes sequenced from 1 cat and its owner were identical.
AIP (PHYSICS OF FLUIDS)
Authors Talib Dbouka, Dimitris Drikakisb
ABSTRACT The contribution of this paper toward understanding of airborne coronavirus survival is twofold: We develop new theoretical correlations for the unsteady evaporation of coronavirus (CoV) contaminated saliva droplets. Furthermore, we implement the new correlations in a three-dimensional multiphase Eulerian–Lagrangian computational fluid dynamics solver to study the effects of weather conditions on airborne virus transmission. The new theory introduces a thermal history kernel and provides transient Nusselt (Nu) and Sherwood (Sh) numbers as a function of the Reynolds (Re), Prandtl (Pr), and Schmidt numbers (Sc). For the first time, these new correlations take into account the mixture properties due to the concentration of CoV particles in a saliva droplet. We show that the steady-state relationships induce significant errors and must not be applied in unsteady saliva droplet evaporation. The classical theory introduces substantial deviations in Nu and Sh values when increasing the Reynolds number defined at the droplet scale. The effects of relative humidity, temperature, and wind speed on the transport and viability of CoV in a cloud of airborne saliva droplets are also examined. The results reveal that a significant reduction of virus viability occurs when both high temperature and low relative humidity occur. The droplet cloud’s traveled distance and concentration remain significant at any temperature if the relative humidity is high, which is in contradiction with what was previously believed by many epidemiologists. The above could explain the increase in CoV cases in many crowded cities around the middle of July (e.g., Delhi), where both high temperature and high relative humidity values were recorded one month earlier (during June). Moreover, it creates a crucial alert for the possibility of a second wave of the pandemic in the coming autumn and winter seasons when low temperatures and high wind speeds will increase airborne virus survival and transmission.
CDC (CENTERS FOR DISEASE CONTROL PREVENTION)
Authors Xutong Wang, Zhanwei Du, George Huang, Remy F. Pasco, Spencer J. Fox, Alison P. Galvani, Michael Pignone, S. Claiborne Johnston, Lauren Ancel Meyers
Abstract As coronavirus disease spreads throughout the United States, policymakers are contemplating reinstatement and relaxation of shelter-in-place orders. By using a model capturing high-risk populations and transmission rates estimated from hospitalization data, we found that postponing relaxation will only delay future disease waves. Cocooning vulnerable populations can prevent overwhelming medical surges.
Authors Edward M. Choi, Daniel K.W. Chu, Peter K.C. Cheng, Dominic N.C. Tsang, Malik Peiris, Daniel G. Bausch, Leo L.M, Deborah Watson-Jones
Abstract Four persons with severe acute respiratory syndrome coronavirus 2 infection had traveled on the same flight from Boston, Massachusetts, USA, to Hong Kong, China. Their virus genetic sequences are identical, unique, and belong to a clade not previously identified in Hong Kong, which strongly suggests that the virus can be transmitted during air travel.
Authors Danae Bixler, Allison D. Miller, Claire P. Mattison, Burnestine Taylor, Kenneth Komatsu, Xandy Peterson Pompa, Steve Moon, Ellora Karmarkar, Caterina Y. Liu, MD5; John J. Openshaw, MD5; Rosalyn E. Plotzker, MD5; Hilary E. Rosen, Nisha Alden, Breanna Kawasaki, Alan Siniscalchi, Andrea Leapley, Cherie Drenzek, Melissa Tobin-D’Angelo, Judy Kauerauf, Heather Reid, Eric Hawkins, Kelly White, Farah Ahmed, Julie Hand, Gillian Richardson, Theresa Sokol, Seth Eckel, Jim Collins, Stacy Holzbauer; Leslie Kollmann, Linnea Larson, Elizabeth Schiffman, Theresa S. Kittle, Kimberly Hertin, Vit Kraushaar, Devin Raman, Victoria LeGarde, Lindsey Kinsinger, Melissa Peek-Bullock, Jenna Lifshitz19; Mojisola Ojo, Robert J Arciuolo, Alexander Davidson, Mary Huynh, Maura K. Lash, Julia Latash, Ellen H. Lee, Lan Li, Emily McGibbon, Natasha McIntosh-Beckles, Renee Pouchet, Jyotsna S. Ramachandran, Kathleen H. Reilly, Elizabeth Dufort, Wendy Pulver, Ariela Zamcheck, Erica Wilson, Sietske de Fijter, Ozair Naqvi, Kumar Nalluwami, Kirsten Waller, Linda J. Bell, Anna-Kathryn Burch, Rachel Radcliffe, Michelle D. Fiscus, Adele Lewis, Jonathan Kolsin, Stephen Pont, Andrea Salinas, Kelsey Sanders, Bree Barbeau, Sandy Althomsons, Sukhshant Atti, Jessica S. Brown, Arthur Chang, Kevin R. Clarke, S. Deblina Datta, John Iskander, Brooke Leitgeb, Talia Pindyck, Lalita Priyamvada, Sarah Reagan-Steiner, Nigel A. Scott, Laura J. Viens, Jonathan Zhong, Emilia H. Koumans
Authors Sonja J. Olsen, Eduardo Azziz-Baumgartner, Alicia P. Budd, Lynnette Brammer, Sheena Sullivan, Rodrigo Fasce Pineda, Cheryl Cohen, Alicia M. Fry
Authors Adriana S. Lopez, Mary Hill, Jessica Antezano, Dede Vilven, Tyler Rutner, Linda Bogdanow, Carlene Claflin, Ian T. Kracalik, Victoria L. Fields, Angela Dunn, Jacqueline E. Tate, Hannah L. Kirking, Tair Kiphibane, Ilene Risk, Cuc H. Tran
EUREKALERT!
Authors EUROPEAN SOCIETY OF CLINICAL MICROBIOLOGY AND INFECTIOUS DISEASES
Authors Thomas S. Higgins, Arthur W. Wu, Jonathan Y. Ting,
Authors Jules Mesnier, Yves Cottin, Pierre Coste, Emile Ferrari, François Schiele, Gilles Lemesle, Christophe Thuaire, Denis Angoulvant, Guillaume Cayla, Claire Bouleti, Romain Gallet de Saint Aurin, Pascal Goube, Thibault Lhermusier, Jean-Guillaume Dillinger, Franck Paganelli, Anis Saib, Fabrice Prunier, Gerald Vanzetto, Olivier Dubreuil, Etienne Puymirat, Franck Boccara, Hélène Eltchaninoff, Marine Cachanado, Alexandra Rousseau, Elodie Drouet, Philippe-Gabriel Steg, Tabassome Simon, Nicolas Danchin
Authors Stephen M. Kissler, Nishant Kishore, Malavika Prabhu, Dena Goffman, Yaakov Beilin, Ruth Landau, Cynthia Gyamfi-Bannerman, Brian T. Bateman, Jon Snyder, Armin S. Razavi, Daniel Katz, Jonathan Gal, Angela Bianco, Joanne Stone, Daniel Larremore, Caroline O. Buckee, Yonatan H. Grad
Abstract SARS-CoV-2-related mortality and hospitalizations differ substantially between New York City neighborhoods. Mitigation efforts require knowing the extent to which these disparities reflect differences in prevalence and understanding the associated drivers. Here, we report the prevalence of SARS-CoV-2 in New York City boroughs inferred using tests administered to 1,746 pregnant women hospitalized for delivery between March 22nd and May 3rd, 2020. We also assess the relationship between prevalence and commuting-style movements into and out of each borough. Prevalence ranged from 11.3% (95% credible interval [8.9%, 13.9%]) in Manhattan to 26.0% (15.3%, 38.9%) in South Queens, with an estimated city-wide prevalence of 15.6% (13.9%, 17.4%). Prevalence was lowest in boroughs with the greatest reductions in morning movements out of and evening movements into the borough (Pearson R = −0.88 [−0.52, −0.99]). Widespread testing is needed to further specify disparities in prevalence and assess the risk of future outbreaks.
Authors Jennifer B. Nuzzo, Jessica A. Bell, Elizabeth E. Cameron
Authors Mauro Amato, José Pablo Werba, Beatrice Frigerio, Daniela Coggi, Daniela Sansaro, Alessio Ravani, Palma Ferrante, Fabrizio Veglia, Elena Tremoli, Damiano Baldassarre
Abstract Background: The lack of specific vaccines or drugs against coronavirus disease 2019 (COVID-19) warrants studies focusing on alternative clinical approaches to reduce the spread of this pandemic disease. In this study, we investigated whether anti-influenza vaccination plays a role in minimizing the diffusion of COVID-19 in the Italian population aged 65 and over. Methods: Four COVID-19 outcomes were used: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence, hospitalizations for COVID-19 symptoms, admissions to intensive care units for reasons related to SARS-CoV-2, and deaths attributable to COVID-19. Results: At univariate analyses, the influenza vaccination coverage rates correlated negatively with all COVID-19 outcomes (Beta ranging from −134 to −0.61; all p < 0.01). At multivariable analyses, influenza vaccination coverage rates correlated independently with SARS-CoV-2 seroprevalence (Beta (95% C.I.): −130 (−198, −62); p = 0.001), hospitalizations for COVID-19 symptoms (Beta (95% C.I.): −4.16 (−6.27, −2.05); p = 0.001), admission to intensive care units for reasons related to SARS-CoV-2 (Beta (95% C.I.): −0.58 (−1.05, −0.12); p = 0.017), and number of deaths attributable to COVID-19 (Beta (95% C.I.): −3.29 (−5.66, −0.93); p = 0.010). The R2 observed in the unadjusted analysis increased from 82% to 159% for all the considered outcomes after multivariable analyses. Conclusions: In the Italian population, the coverage rate of the influenza vaccination in people aged 65 and over is associated with a reduced spread and a less severe clinical expression of COVID-19. This finding warrants ad hoc studies to investigate the role of influenza vaccination in preventing the spread of COVID-19.
Authors David Michaels, Gregory R. Wagner
Authors RITA RUBIN
Authors Gary S Collins, Richard D Riley, Maarten van Smeden
Authors Megan L. Evans, Margo Lindauer, Maureen E. Farrell
KARGER
Authors Corrado Girmeni, Giuseppe Gentile, Alessandra Micozzi, Luigi Petrucci, Francesco Malaspina, Alessio Di Prima, Erminia Baldacci, Simona Bianchi, Pellegrina Pugliese, Ombretta Turriziani, Guido Antonelli, Vincenzo Tombolini, Robin Foà, Maurizio Martelli
ABSTRACT Introduction: Patients with cancer may be more susceptible to and have higher morbidity and mortality rates from COVID-19 than the general population, while epidemiologic data specifically addressed to hematologic patients are limited. To investigate whether patients with hematologic diseases undergoing therapy are at increased risk for acquiring SARS CoV-2 infection compared to the general population, a retrospective study was carried out at a referral hematologic center in Rome, Italy, during the period of the greatest epidemic spread (March 8 to May 14, 2020). Methods: All adult and pediatric patients with a diagnosis of a neoplastic or a nonneoplastic hematologic disease who underwent treatment (chemotherapy or immunosuppressive or supportive therapy) during the study period or in the previous 6 months were considered. The prevalence of COVID-19 in the overall outpatient and inpatient population undergoing hematologic treatment compared to that of the general population was analyzed. The measures taken to manage patients during the epidemic period are described. Results: Overall, 2,513 patients with hematological diseases were considered. Out of 243 (9.7%) patients who were screened for SARS CoV-2, three of 119 (2.5%) outpatients with fever or respiratory symptoms and none of 124 asymptomatic patients were diagnosed with COVID-19. Three further patients were diagnosed with COVID-19 and managed in other hospitals in Rome. As of May 14, 2020, the prevalence of COVID-19 in our hematologic population accounted for 0.24% (95% CI 0.23–0.25; 6 of 2,513 patients: 1 case in every 419 patients) as compared to 0.12% (7,280 of 5,879,082 residents; 1 case in every 807 residents) in the general population (p = 0.14). Three of 6 patients diagnosed with COVID-19 required critical care and 2 died while still positive for SARS CoV-2. Out of 225 healthcare providers on duty at our Institution during the study period, 2 (0.9%) symptomatic cases were diagnosed with COVID-19. Conclusion: In our experience, the prevalence of COVID-19 in hematologic patients, mainly affected by malignancies, was not significantly higher compared to that of the general population. Definition of adapted strategies for healthcare services, while continuing to administer the standard hematologic treatments, represents the crucial challenge for the management of hematologic diseases in the COVID-19 era.
Authors Jerry Avorn, Aaron S. Kesselheim
Authors Anthea Rhodes, Monsurul Hoq, Mary-Anne Measey, Margie Danchin
Authors Roger Y. Dodd, Meng Xu, Susan L. Stramer
Authors Pawinee Doung-ngern, Repeepong Suphanchaimat, Apinya Panjangampatthana, Chawisar Janekrongtham, Duangrat Ruampoom, Nawaporn Daochaeng, Napatchakorn Eungkanit, Nichakul Pisitpayat, Nuengruethai Srisong, Oiythip Yasopa, Patchanee Plernprom, Pitiphon Promduangsi, Panita Kumphon, Paphanij Suangtho, Peeriya Watakulsin, Sarinya Chaiya, Somkid Kripattanapong, Thanawadee Chantian, Emily Bloss, Chawetsan Namwat
Abstract We evaluated effectiveness of personal protective measures against severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection. Our case-control study included 211 cases of coronavirus disease (COVID-19) and 839 controls in Thailand. Cases were defined as asymptomatic contacts of COVID-19 patients who later tested positive for SARS-CoV-2; controls were asymptomatic contacts who never tested positive. Wearing masks all the time during contact was independently associated with lower risk for SARS-CoV-2 infection compared with not wearing masks; wearing a mask sometimes during contact did not lower infection risk. We found the type of mask worn was not independently associated with infection and that contacts who always wore masks were more likely to practice social distancing. Maintaining >1 m distance from a person with COVID-19, having close contact for <15 minutes, and frequent handwashing were independently associated with lower risk for infection. Our findings support consistent wearing of masks, handwashing, and social distancing to protect against COVID-19.
Authors Matthew Biggerstaff, Benjamin J. Cowling, Zulma M. Cucunubá, Linh Dinh, Neil M. Ferguson, Huizhi Gao, Verity Hill, Natsuko Imai, Michael A. Johansson, Sarah Kada, Oliver Morgan, Ana Pastore y Piontti, Jonathan A. Polonsky, Pragati Venkata Prasad, Talia M. Quandelacy, Andrew Rambaut, Jordan W. Tappero, Katelijn A. VandemaeleComments to Author , Alessandro Vespignani, K. Lane Warmbrod, Jessica Y. Wong
Abstract We report key epidemiologic parameter estimates for coronavirus disease identified in peer-reviewed publications, preprint articles, and online reports. Range estimates for incubation period were 1.8–6.9 days, serial interval 4.0–7.5 days, and doubling time 2.3–7.4 days. The effective reproductive number varied widely, with reductions attributable to interventions. Case burden and infection fatality ratios increased with patient age. Implementation of combined interventions could reduce cases and delay epidemic peak up to 1 month. These parameters for transmission, disease severity, and intervention effectiveness are critical for guiding policy decisions. Estimates will likely change as new information becomes available.
Authors Ana M. Rule
Authors Giovanni Battista Migliori, Pei Min Thong, Onno Akkerman, Jan-Willem Alffenaar, Fernando Álvarez-Navascués, Mourtala Mohamed Assao-Neino, Pascale Valérie Bernard, Joshua Sorba Biala, François-Xavier Blanc, Elena M Bogorodskaya, Sergey Borisov, Danilo Buonsenso, Marianne Calnan, Paola Francesca Castellotti, Rosella Centis, Jeremiah Muhwa Chakaya, Jin-Gun Cho, Luigi Ruffo Codecasa, Lia D'Ambrosio, Justin Denholm, Martin Enwerem, Maurizio Ferrarese, Tatiana Galvão, Marta García-Clemente, José-María García-García, Gina Gualano, José Antonio Gullón-Blanco, Sandra Inwentarz, Giuseppe Ippolito, Heinke Kunst, Andrei Maryandyshev, Mario Melazzini, Fernanda Carvalho de Queiroz Mello, Marcela Muñoz-Torrico, Patrick Bung Njungfiyini, Domingo Juan Palmero, Fabrizio Palmieri, Pavilio Piccioni, Alberto Piubello, Adrian Rendon, Josefina Sabriá, Matteo Saporiti, Paola Scognamiglio, Samridhi Sharma, Denise Rossato Silva, Mahamadou Bassirou Souleymane, Antonio Spanevello, Eva Tabernero, Marina Tadolini, Michel Eke Tchangou, Alice Boi Yatta Thornton, Simon Tiberi, Zarir F Udwadia, Giovanni Sotgiu, Catherine Wei Min Ong, Delia Goletti
Abstract Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.
Authors Kiva A. Fisher; Mark W. Tenforde; Leora R. Feldstein; Christopher J. Lindsell; Nathan I. Shapiro; D. Clark Files; Kevin W. Gibb; Heidi L. Erickson; Matthew E. Prekker; Jay S. Steingrub; Matthew C. Exline; Daniel J. Henning; Jennifer G. Wilson; Samuel M. Brown; Ithan D. Peltan; Todd W. Rice; David N. Hager; Adit A. Ginde; H. Keipp Talbot; Jonathan D. Casey; Carlos G. Grijalva; Brendan Flannery; Manish M. Patel; Wesley H. Self; IVY Network Investigators; CDC COVID-19 Response Team
Authors Michael Worobey, Jonathan Pekar, Brendan B. Larsen, Martha I. Nelson, Verity Hill, Jeffrey B. Joy, Andrew Rambaut, Marc A. Suchard, Joel O. Wertheim, Philippe Lemey
Abstract Accurate understanding of the global spread of emerging viruses is critically important for public health responses and for anticipating and preventing future outbreaks. Here, we elucidate when, where and how the earliest sustained SARS-CoV-2 transmission networks became established in Europe and North America. Our results suggest that rapid early interventions successfully prevented early introductions of the virus into Germany and the US from taking hold. Other, later introductions of the virus from China to both Italy and to Washington State founded the earliest sustained European and North America transmission networks. Our analyses demonstrate the effectiveness of public health measures in preventing onward transmission and show that intensive testing and contact tracing could have prevented SARS-CoV-2 from becoming established.
SPRINGER LINK
Authors Adam W. Gaffney, David Himmelstein, David Bor, Danny McCormick, Steffie Woolhandler
Authors Trevor Bedford, Alexander L. Greninger, Pavitra Roychoudhury, Lea M. Starita, Michael Famulare, Meei-Li Huang, Arun Nalla, Gregory Pepper, Adam Reinhardt, Hong Xie, Lasata Shrestha, Truong N. Nguyen, Amanda Adler, Elisabeth Brandstetter, Shari Cho, Danielle Giroux, Peter D. Han, Kairsten Fay, Chris D. Frazar, Misja Ilcisin, Kirsten Lacombe, Jover Lee, Anahita Kiavand, Matthew Richardson, Thomas R. Sibley, Melissa Truong, Caitlin R. Wolf, Deborah A. Nickerson, Mark J. Rieder, Janet A. Englund, The Seattle Flu Study Investigators, James Hadfield, Emma B. Hodcroft, John Huddleston, Louise H. Moncla, Nicola F. Müller, Richard A. Neher, Xianding Deng, Wei Gu, Scot Federman, Charles Chiu, Jeff S. Duchin, Romesh Gautom, Geoff Melly, Brian Hiatt, Philip Dykema, Scott Lindquist, Krista Queen, Ying Tao, Anna Uehara, Suxiang Tong, Duncan MacCannell, Gregory L. Armstrong, Geoffrey S. Baird, Helen Y. Chu, Jay Shendure, Keith R. Jerome
Following its emergence in Wuhan, China, in late November or early December 2019, the SARS-CoV-2 virus has rapidly spread globally. Genome sequencing of SARS-CoV-2 allows reconstruction of its transmission history, although this is contingent on sampling. We have analyzed 453 SARS-CoV-2 genomes collected between 20 February and 15 March 2020 from infected patients in Washington State, USA. We find that most SARS-CoV-2 infections sampled during this time derive from a single introduction in late January or early February 2020 which subsequently spread locally before active community surveillance was implemented.
BJS SOCIETY
Authors Chloe Shu‐Hui Ong, Marc Weijie Ong, Frederick H Koh, Kok‐Yang Tan, Min‐Hoe Chew
Authors Sean L. Wu, Andrew N. Mertens, Yoshika S. Crider, Anna Nguyen, Nolan N. Pokpongkiat, Stephanie Djajadi, Anmol Seth, Michelle S. Hsiang, John M. Colford Jr., Art Reingold, Benjamin F. Arnold, Alan Hubbard, Jade Benjamin-Chung
ABSTRACT Accurate estimates of the burden of SARS-CoV-2 infection are critical to informing pandemic response. Confirmed COVID-19 case counts in the U.S. do not capture the total burden of the pandemic because testing has been primarily restricted to individuals with moderate to severe symptoms due to limited test availability. Here, we use a semi-Bayesian probabilistic bias analysis to account for incomplete testing and imperfect diagnostic accuracy. We estimate 6,454,951 cumulative infections compared to 721,245 confirmed cases (1.9% vs. 0.2% of the population) in the United States as of April 18, 2020. Accounting for uncertainty, the number of infections during this period was 3 to 20 times higher than the number of confirmed cases. 86% (simulation interval: 64–99%) of this difference is due to incomplete testing, while 14% (0.3–36%) is due to imperfect test accuracy. The approach can readily be applied in future studies in other locations or at finer spatial scale to correct for biased testing and imperfect diagnostic accuracy to provide a more realistic assessment of COVID-19 burden.
Authors Tessa Tan-Torres Edejer, Odd Hanssen, Andrew Mirelman, Paul Verboom, Glenn Lolong, Oliver John Watson, Lucy Linda Boulanger, Agnès Soucat
Authors Arnaud Fontanet, Simon Cauchemez
Authors Noam Barda, Dan Riesel, Amichay Akriv, Joseph Levy, Uriah Finkel, Gal Yona, Daniel Greenfeld, Shimon Sheiba, Jonathan Somer, Eitan Bachmat, Guy N. Rothblum, Uri Shalit, Doron Netzer, Ran Balicer, Noa Dagan
ABSTRACT At the COVID-19 pandemic onset, when individual-level data of COVID-19 patients were not yet available, there was already a need for risk predictors to support prevention and treatment decisions. Here, we report a hybrid strategy to create such a predictor, combining the development of a baseline severe respiratory infection risk predictor and a post-processing method to calibrate the predictions to reported COVID-19 case-fatality rates. With the accumulation of a COVID-19 patient cohort, this predictor is validated to have good discrimination (area under the receiver-operating characteristics curve of 0.943) and calibration (markedly improved compared to that of the baseline predictor). At a 5% risk threshold, 15% of patients are marked as high-risk, achieving a sensitivity of 88%. We thus demonstrate that even at the onset of a pandemic, shrouded in epidemiologic fog of war, it is possible to provide a useful risk predictor, now widely used in a large healthcare organization.
Authors Georgios Peros , Ferda Gronki , Nadine Molitor , Michael Streit , Kiyoshi Sugimoto , Urs Karrer , Fabian Lunger , Michel Adamina , Stefan Breitenstein, Tenzin Lamdark
ABSTRACT Background: With the rapid global spread of the acute respiratory syndrome coronavirus 2, urgent health-care measures have been implemented. We describe the organizational process in setting up a coronavirus disease 2019 triage unit in a Swiss tertiary care hospital. Methods: Our triage unit was set-up outside of the main hospital building and consists of three areas: 1. Pre-triage, 2. Triage, and 3. Triage plus. The Pre-triage check-points identify any potential COVID-19-infected patients and re-direct them to the main Triage area where trained medical staff screen which patients undergo diagnostic testing. If testing is indicated, nasopharyngeal swabs are performed. If patients require further investigations, they are referred to Triage plus. At this stage, patients are then discharged home after additional testing or admitted to the hospital for management. Observations: A total of 1265 patients were screened between 10 March 2020 and 12 April 2020 at our Triage unit. Of these, 112 (8.9%) tested positive. 73 (65%) of the positively-tested patients were female and 39 (35%) were male. The mean age for all patients was 43.8 years (SD 16.3 years). Distinguishing between genders, mean age for females was 41.1 (SD 16.5) and mean age for males was 48.6 (SD 14.9), with females being significantly younger than males (p < 0.001). Conclusion: Our triage unit was set-up as part of a large-scale restructuring process. Current challenges include low sensitivity for test results as well as limited staff and resources. We hope that our experience will help other health care institutions develop similar triage systems.
Authors Veena S Raleigh
CDC
Authors Wesley H. Self, Mark W. Tenforde, William B. Stubblefield, Leora R. Feldstein, Jay S. Steingrub, Nathan I. Shapiro, Adit A. Ginde, Matthew E. Prekker, Samuel M. Brown, Ithan D. Peltan, Michelle N. Gong, Michael S. Aboodi, Akram Khan, Matthew C. Exline, D. Clark Files, Kevin W. Gibbs, Christopher J. Lindsell, Todd. W. Rice, Ian D. Jones, Natasha Halasa, H. Keipp Talbot, Carlos G. Grijalva, Jonathan D. Casey, David N. Hager, Nida Qadir, Daniel J. Henning, Melissa M. Coughlin, Jarad Schiffer, Vera Semenova, Han Li, Natalie J. Thornburg, Manish M. Patel
Authors Gianfranco Alicandro, Giuseppe Remuzzi, Carlo La Vecchia
Authors The national COVID-19 outbreak monitoring group
Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied.
Authors Galit Alter, Robert Seder
Authors Ye Shen, Changwei Li, Hongjun Dong, Zhen Wang, Leonardo Martinez, Zhou Sun, Andreas Handel, Zhiping Chen, Enfu Chen, Mark H. Ebell, Fan Wang, Bo Yi, Haibin Wang, Xiaoxiao Wang, Aihong Wang, Bingbing Chen, Yanling Qi, Lirong Liang, Yang Li, Feng Ling, Junfang Chen,; Guozhang Xu
Importance Evidence of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can be transmitted as an aerosol (ie, airborne) has substantial public health implications. Objective To investigate potential transmission routes of SARS-CoV-2 infection with epidemiologic evidence from a COVID-19 outbreak. Design, Setting, and Participants This cohort study examined a community COVID-19 outbreak in Zhejiang province. On January 19, 2020, 128 individuals took 2 buses (60 [46.9%] from bus 1 and 68 [53.1%] from bus 2) on a 100-minute round trip to attend a 150-minute worship event. The source patient was a passenger on bus 2. We compared risks of SARS-CoV-2 infection among at-risk individuals taking bus 1 (n = 60) and bus 2 (n = 67 [source patient excluded]) and among all other individuals (n = 172) attending the worship event. We also divided seats on the exposed bus into high-risk and low-risk zones according to the distance from the source patient and compared COVID-19 risks in each zone. In both buses, central air conditioners were in indoor recirculation mode. Main Outcomes and Measures SARS-CoV-2 infection was confirmed by reverse transcription polymerase chain reaction or by viral genome sequencing results. Attack rates for SARS-CoV-2 infection were calculated for different groups, and the spatial distribution of individuals who developed infection on bus 2 was obtained. Results Of the 128 participants, 15 (11.7%) were men, 113 (88.3%) were women, and the mean age was 58.6 years. On bus 2, 24 of the 68 individuals (35.3% [including the index patient]) received a diagnosis of COVID-19 after the event. Meanwhile, none of the 60 individuals in bus 1 were infected. Among the other 172 individuals at the worship event, 7 (4.1%) subsequently received a COVID-19 diagnosis. Individuals in bus 2 had a 34.3% (95% CI, 24.1%-46.3%) higher risk of getting COVID-19 compared with those in bus 1 and were 11.4 (95% CI, 5.1-25.4) times more likely to have COVID-19 compared with all other individuals attending the worship event. Within bus 2, individuals in high-risk zones had moderately, but nonsignificantly, higher risk for COVID-19 compared with those in the low-risk zones. The absence of a significantly increased risk in the part of the bus closer to the index case suggested that airborne spread of the virus may at least partially explain the markedly high attack rate observed. Conclusions and Relevance In this cohort study and case investigation of a community outbreak of COVID-19 in Zhejiang province, individuals who rode a bus to a worship event with a patient with COVID-19 had a higher risk of SARS-CoV-2 infection than individuals who rode another bus to the same event. Airborne spread of SARS-CoV-2 seems likely to have contributed to the high attack rate in the exposed bus. Future efforts at prevention and control must consider the potential for airborne spread of the virus.
Authors Vijay Shankar Balakrishnan
Authors GIULIANA VIGLIONE
Authors Nisreen A Alwan
MPDI
Authors Marianna Noale, Caterina Trevisan, Stefania Maggi, Raffaele Antonelli Incalzi , Claudio Pedone, Mauro Di Bari, Fulvio Adorni, Nithiya Jesuthasan, Aleksandra Sojic, Massimo Galli, Andrea Giacomelli , Sabrina Molinaro, Fabrizio Bianchi , Claudio Mastroianni , Federica Prinelli
Authors Alyssa Bilinski; Farzad Mostashari; Joshua A. Salomon
Authors Christina D Chambers, Paul Krogstad, Kerri Bertrand, Deisy Contreras, Lars Bode, Nicole Tobin, Grace Aldrovandi
ABSTRACT To The Editor, Currently, the U.S. Centers for Disease Control and Prevention, American Academy of Pediatrics and the World Health Organization advise that women who are infected with SARS-CoV-2 may choose to breastfeed with appropriate protections to prevent transmission of the virus through respiratory droplets. However, the potential for exposure to SARS-CoV-2 through breastfeeding is currently unknown. To date, case reports on breastmilk samples from a total of 24 SARS-CoV-2-infected women have been published. Of those, viral RNA was detected in ten breastmilk samples from four women. In some but not all cases, environmental contamination as the source of the virus or retrograde flow from an infected infant could not be ruled out. We established a quantitative RT-PCR assay for SARS-CoV-2 in breastmilk with a limit of detection of 250 copies per mL and validated it by spiking breastmilk from uninfected women with known amounts of viral RNA. In addition, we established tissue culture methods to detect replication-competent SARS-CoV-2 in breastmilk. No viral RNA nor culturable virus was detected after Holder pasteurization of breastmilk samples that had been spiked with replication-competent SARS-CoV-2 (see Supplement). Between March 27 and May 6, 2020, we collected and analyzed 64 serial breastmilk samples from 18 SARS-CoV-2-infected women residing in the U.S. (see Supplement for clinical characteristics). Breastmilk samples were collected before and after women had a positive SARS-CoV-2 RT-PCR test and all but one woman had symptomatic disease (see Figure). One of the 64 breastmilk samples had detectable SARS-CoV-2 RNA by RT-PCR. The positive sample was collected on the day of symptom onset but one sample 2 days prior to symptom onset and two subsequent samples, collected 12 and 41 days later, tested negative for viral RNA. In addition, a subset of 26 breastmilk samples from nine women were tested for the presence of replication-competent virus using our established culture methods, and all were negative including the one sample that tested positive for viral RNA by RT-PCR. Although SARS-CoV-2 RNA was detected in one milk sample from one of eighteen infected women, the viral culture for that sample was negative. This suggests that SARS-CoV-2 RNA does not represent replication-competent virus and that breastmilk itself is likely not a source of infection for the infant. Furthermore, when control breastmilk samples spiked with replication-competent SARS-CoV-2 virus were treated by Holder pasteurization, a process commonly performed by donor milk banks, no replication-competent virus nor viral RNA was detectable. Further research to confirm these findings is needed, as well as an examination of convalescent milk for the presence of antibodies against SARS-CoV-2.
Authors Lisa A. Grohskopf, Leandris C. Liburd, Robert R. Redfield
Authors Bin Wan, Xinlian Zhang, Dongxia Luo, Tong Zhang, Xi Chen, Yuhan Yao, Xia Zhao, Limei Lei, Chunmei Liu, Wang Zhao, Lin Zhou, Yuqing Ge, Hongju Mao, Sixiu Liu, Jianmin Chen, Xunjia Cheng, Jianlong Zhao, Guodong Sui
SARS-Cov-2 has erupted across the globe, and confirmed cases of COVID-19 pose a high infection risk. Infected patients typically receive their treatment in specific isolation wards, where they are confined for at least 14 days. The virus may contaminate any surface of the room, especially frequently touched surfaces. Therefore, surface contamination in wards should be monitored for disease control and hygiene purposes. Herein, surface contamination in the ward was detected on-site using an RNA extraction-free rapid method. The whole detection process, from surface sample collection to readout of the detection results, was finished within 45 min. The nucleic acid extraction-free method requires minimal labor. More importantly, the tests were performed on-site and the results were obtained almost in real-time. The test confirmed that 31 patients contaminated seven individual sites. Among the sampled surfaces, the electrocardiogram fingertip presented a 72.7% positive rate, indicating that this surface is an important hygiene site. Meanwhile, the bedrails showed the highest correlation with other surfaces, so should be detected daily. Another surface with high contamination risk was the door handle in the bathroom. To our knowledge, we present the first on-site analysis of COVID-19 surface contamination in wards. The results and applied technique provide a potential further reference for disease control and hygiene suggestions.
Authors Zhen Ding, Hua Qian, Bin Xu, Ying Huang, Te Miao, Hui-Ling Yen, Shenglan Xiao, Lunbiao Cui, Xiaosong Wu, Wei Shao, Yan Song, Li Sha, Lian Zhou, Yan Xu, Baoli Zhu, Yuguo Li
Abstract Respiratory and fecal aerosols play confirmed and suspected roles, respectively, in transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An extensive environmental sampling campaign of both toilet and non-toilet environments was performed in a dedicated hospital building for patients with coronavirus disease 2019 (COVID-19), and the associated environmental factors were analyzed. In total, 107 surface samples, 46 air samples, two exhaled condensate samples, and two expired air samples were collected within and beyond four three-bed isolation rooms. The data of the COVID-19 patients were collected. The building environmental design and the cleaning routines were reviewed. Field measurements of airflow and CO2 concentrations were conducted. The 107 surface samples comprised 37 from toilets, 34 from other surfaces in isolation rooms, and 36 from other surfaces outside the isolation rooms in the hospital. Four of these samples were positive, namely two ward door handles, one bathroom toilet seat cover, and one bathroom door handle. Three were weakly positive, namely one bathroom toilet seat, one bathroom washbasin tap lever, and one bathroom ceiling exhaust louver. Of the 46 air samples, one collected from a corridor was weakly positive. The two exhaled condensate samples and the two expired air samples were negative. The fecal-derived aerosols in patients' toilets contained most of the detected SARS-CoV-2 in the hospital, highlighting the importance of surface and hand hygiene for intervention.
JOURNAL OF THE ROYAL SOCIETY OF MEDICINE
Authors Eric J W Orlowski, David J A Goldsmith
OXFORD ACACDEMY
Authors Z Chagla, S Hota, S Khan, D Mertz
Authors A. Tcharkhtchi, N. Abbasnezhad, M. Zarbini Seydani, N. Zirak, S. Farzaneh, M. Shirinbayan
Abstract The masks have always been mentioned as an effective tool against environmental threats. They are considered as protective equipment to preserve the respiratory system against the non-desirable air droplets and aerosols such as the viral or pollution particles. The aerosols can be pollution existence in the air, or the infectious airborne viruses initiated from the sneezing, coughing of the infected people. The filtration efficiency of the different masks against these aerosols are not the same, as the particles have different sizes, shapes, and properties. Therefore, the challenge is to fabricate the filtration masks with higher efficiency to decrease the penetration percentage at the nastiest conditions. To achieve this concept, knowledge about the mechanisms of the penetration of the aerosols through the masks at different effective environmental conditions is necessary. In this paper, the literature about the different kinds of face masks and respiratory masks, common cases of their application, and the advantages and disadvantages of them in this regard have been reviewed. Moreover, the related mechanisms of the penetration of the aerosols through the masks are discussed. The environmental conditions affecting the penetration as well as the quality of the fabrication are studied. Finally, special attention was given to the numerical simulation related to the different existing mechanisms.
Authors Sonja A. Rasmussen; Muin J. Khoury; Carlos del Rio
CDC (CENTER FOR DISEASE CONTROL AND PREVENTION)
Authors Christine M. Szablewski, Karen T. Chang, Marie M. Brown, Victoria T. Chu, Anna R. Yousaf, Ndubuisi Anyalechi, Peter A. Aryee, MBA; Hannah L. Kirking, Maranda Lumsden; Erin Mayweather; Clinton J. McDaniel, Robert Montierth, Pharm; Asfia Mohammed; Noah G. Schwartz, Jaina A. Shah, Jacqueline E. Tate, Emilio Dirlikov, Cherie Drenzek, Tatiana M. Lanzieri, Rebekah J. Stewart
Authors William Marciel de Souza, Lewis Fletcher Buss, Darlan da Silva Candido, Jean-Paul Carrera, Sabrina Li, Alexander E. Zarebski, Rafael Henrique Moraes Pereira, Carlos A. Prete Jr, Andreza Aruska de Souza-Santos, Kris V. Parag, Maria Carolina T. D. Belotti, Maria F. Vincenti-Gonzalez, Janey Messina, Flavia Cristina da Silva Sales, Pamela dos Santos Andrade, Vítor Heloiz Nascimento, Fabio Ghilardi, Leandro Abade, Bernardo Gutierrez, Moritz U. G. Kraemer, Carlos K. V. Braga, Renato Santana Aguiar, Neal Alexander, Philippe Mayaud, Oliver J. Brady, Izabel Marcilio, Nelson Gouveia, Guangdi Li, Adriana Tami, Silvano Barbosa de Oliveira, Victor Bertollo Gomes Porto, Fabiana Ganem, Walquiria Aparecida Ferreira de Almeida, Francieli Fontana Sutile Tardetti Fantinato, Eduardo Marques Macário, Wanderson Kleber de Oliveira, Mauricio L. Nogueira, Oliver G. Pybus, Chieh-Hsi Wu, Julio Croda, Ester C. Sabino, Nuno Rodrigues Faria
ABSTRACT The first case of COVID-19 was detected in Brazil on 25 February 2020. We report and contextualize epidemiological, demographic and clinical findings for COVID-19 cases during the first 3 months of the epidemic. By 31 May 2020, 514,200 COVID-19 cases, including 29,314 deaths, had been reported in 75.3% (4,196 of 5,570) of municipalities across all five administrative regions of Brazil. The R0 value for Brazil was estimated at 3.1 (95% Bayesian credible interval = 2.4–5.5), with a higher median but overlapping credible intervals compared with some other seriously affected countries. A positive association between higher per-capita income and COVID-19 diagnosis was identified. Furthermore, the severe acute respiratory infection cases with unknown aetiology were associated with lower per-capita income. Co-circulation of six respiratory viruses was detected but at very low levels. These findings provide a comprehensive description of the ongoing COVID-19 epidemic in Brazil and may help to guide subsequent measures to control virus transmission.
Authors Taylor Heald-Sargent, William J. Muller, Xiaotian Zheng, Jason Rippe, Ami B. Patel, Larry K. Kociolek
BMJ OPEN
Authors Ermengol Coma Redon, , Nuria Mora, Albert Prats-Uribe, Francesc Fina Avilés, Daniel Prieto-Alhambra, Manuel Medina
ABSTRACT Objectives There is uncertainty about when the first cases of COVID-19 appeared in Spain. We aimed to determine whether influenza diagnoses masked early COVID-19 cases and estimate numbers of undetected COVID-19 cases. Design Time-series study of influenza and COVID-19 cases, 2010–2020. Setting Primary care, Catalonia, Spain. Participants People registered in primary-care practices, covering >6 million people and >85% of the population. Main outcome measures Weekly new cases of influenza and COVID-19 clinically diagnosed in primary care. Analyses Daily counts of both cases were computed using the total cases recorded over the previous 7 days to avoid weekly effects. Epidemic curves were characterised for the 2010–2011 to 2019–2020 influenza seasons. Influenza seasons with a similar epidemic curve and peak case number as the 2019–2020 season were used to model expected case numbers with Auto Regressive Integrated Moving Average models, overall and stratified by age. Daily excess influenza cases were defined as the number of observed minus expected cases. Results Four influenza season curves (2011–2012, 2012–2013, 2013–2014 and 2016–2017) were used to estimate the number of expected cases of influenza in 2019–2020. Between 4 February 2020 and 20 March 2020, 8017 (95% CI: 1841 to 14 718) excess influenza cases were identified. This excess was highest in the 15–64 age group. Conclusions COVID-19 cases may have been present in the Catalan population when the first imported case was reported on 25 February 2020. COVID-19 carriers may have been misclassified as influenza diagnoses in primary care, boosting community transmission before public health measures were taken. The use of clinical codes could misrepresent the true occurrence of the disease. Serological or PCR testing should be used to confirm these findings. In future, this surveillance of excess influenza could help detect new outbreaks of COVID-19 or other influenza-like pathogens, to initiate early public health responses.
Authors Katherine A. Auger, Samir S. Shah, Troy Richardson, David Hartley, Matthew Hall, Amanda Warniment, Kristen Timmons, Dianna Bosse, Sarah A. Ferris, Patrick W. Brady, Amanda C. Schondelmeyer, Joanna E. Thomson
ABSTRACT Importance In the US, states enacted nonpharmaceutical interventions, including school closure, to reduce the spread of coronavirus disease 2019 (COVID-19). All 50 states closed schools in March 2020 despite uncertainty if school closure would be effective. Objective To determine if school closure and its timing were associated with decreased COVID-19 incidence and mortality. Design, Setting, and Participants US population–based observational study conducted between March 9, 2020, and May 7, 2020, using interrupted time series analyses incorporating a lag period to allow for potential policy-associated changes to occur. To isolate the association of school closure with outcomes, state-level nonpharmaceutical interventions and attributes were included in negative binomial regression models. States were examined in quartiles based on state-level COVID-19 cumulative incidence per 100 000 residents at the time of school closure. Models were used to derive the estimated absolute differences between schools that closed and schools that remained open as well as the number of cases and deaths if states had closed schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile. Exposures Closure of primary and secondary schools. Main Outcomes and Measures COVID-19 daily incidence and mortality per 100 000 residents. Results COVID-19 cumulative incidence in states at the time of school closure ranged from 0 to 14.75 cases per 100 000 population. School closure was associated with a significant decline in the incidence of COVID-19 (adjusted relative change per week, −62% [95% CI, −71% to −49%]) and mortality (adjusted relative change per week, −58% [95% CI, −68% to −46%]). Both of these associations were largest in states with low cumulative incidence of COVID-19 at the time of school closure. For example, states with the lowest incidence of COVID-19 had a −72% (95% CI, −79% to −62%) relative change in incidence compared with −49% (95% CI, −62% to −33%) for those states with the highest cumulative incidence. In a model derived from this analysis, it was estimated that closing schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile was associated with 128.7 fewer cases per 100 000 population over 26 days and with 1.5 fewer deaths per 100 000 population over 16 days. Conclusions and Relevance Between March 9, 2020, and May 7, 2020, school closure in the US was temporally associated with decreased COVID-19 incidence and mortality; states that closed schools earlier, when cumulative incidence of COVID-19 was low, had the largest relative reduction in incidence and mortality. However, it remains possible that some of the reduction may have been related to other concurrent nonpharmaceutical interventions.
Authors Fatimah S Dawood, Philip Ricks, Gibril J Njie, Michael Daugherty, William Davis, James A Fuller, Alison Winstead, Margaret McCarron, Lia C Scott, Diana Chen, Amy E Blain, Ron Moolenaar, Chaoyang Li, Adebola Popoola, Cynthia Jones, Puneet Anantharam, Natalie Olson, Barbara J Marston, Sarah D Bennett
Authors Michael Riediker, Dai-Hua Tsai
Authors Janice Hopkins Tanne
Authors Li-Lin Liang, Ching-Hung Tseng, Hsiu J. Ho, Chun-Ying Wu
ABSTRACT A question central to the Covid-19 pandemic is why the Covid-19 mortality rate varies so greatly across countries. This study aims to investigate factors associated with cross-country variation in Covid-19 mortality. Covid-19 mortality rate was calculated as number of deaths per 100 Covid-19 cases. To identify factors associated with Covid-19 mortality rate, linear regressions were applied to a cross-sectional dataset comprising 169 countries. We retrieved data from the Worldometer website, the Worldwide Governance Indicators, World Development Indicators, and Logistics Performance Indicators databases. Covid-19 mortality rate was negatively associated with Covid-19 test number per 100 people (RR = 0.92, P = 0.001), government effectiveness score (RR = 0.96, P = 0.017), and number of hospital beds (RR = 0.85, P < 0.001). Covid-19 mortality rate was positively associated with proportion of population aged 65 or older (RR = 1.12, P < 0.001) and transport infrastructure quality score (RR = 1.08, P = 0.002). Furthermore, the negative association between Covid-19 mortality and test number was stronger among low-income countries and countries with lower government effectiveness scores, younger populations and fewer hospital beds. Predicted mortality rates were highly associated with observed mortality rates (r = 0.77; P < 0.001). Increasing Covid-19 testing, improving government effectiveness and increasing hospital beds may have the potential to attenuate Covid-19 mortality.
Authors C. Jessica E. Metcalf, Dylan H. Morris, Sang Woo Park
Authors Darlan S. Candido, Ingra M. Claro, Jaqueline G. de Jesus, William M. Souza, Filipe R. R. Moreira, Simon Dellicour, Thomas A. Mellan, Louis du Plessis, Rafael H. M. Pereira, Flavia C. S. Sales, Erika R. Manuli, Julien Thézé, Luiz Almeida, Mariane T. Menezes, Carolina M. Voloch, Marcilio J. Fumagalli, Thaís M. Coletti, Camila A. M. da Silva, Mariana S. Ramundo, Mariene R. Amorim, Henrique H. Hoeltgebaum, Swapnil Mishra, Mandev S. Gill, Luiz M. Carvalho, Lewis F. Buss, Carlos A. Prete Jr, Jordan Ashworth, Helder I. Nakaya, Pedro S. Peixoto, Oliver J. Brady, Samuel M. Nicholls, Amilcar Tanuri, Átila D. Rossi, Carlos K.V. Braga, Alexandra L. Gerber, Ana Paula de C. Guimarães, Nelson Gaburo Jr, Cecila Salete Alencar, Alessandro C.S. Ferreira, Cristiano X. Lima, José Eduardo Levi, Celso Granato, Giulia M. Ferreira, Ronaldo S. Francisco Jr, Fabiana Granja, Marcia T. Garcia, Maria Luiza Moretti, Mauricio W. Perroud Jr, Terezinha M. P. P. Castiñeiras, Carolina S. Lazari, Sarah C. Hill, Andreza Aruska de Souza Santos, Camila L. Simeoni, Julia Forato, Andrei C. Sposito, Angelica Z. Schreiber, Magnun N. N. Santos, Camila Zolini de Sá, Renan P. Souza, Luciana C. Resende-Moreira, Mauro M. Teixeira, Josy Hubner, Patricia A. F. Leme, Rennan G Moreira, Maurício L. Nogueira, Brazil-UK Centre for Arbovirus Discovery, Diagnosis, Genomics and Epidemiology (CADDE) Genomic Network, Neil M Ferguson, Silvia F. Costa, José Luiz Proenca-Modena, Ana Tereza R. Vasconcelos, Samir Bhatt, Philippe Lemey, Chieh-Hsi Wu, Andrew Rambaut, Nick J. Loman, Renato S. Aguiar, Oliver G. Pybus, Ester C. Sabino, Nuno Rodrigues Faria
ABSTRACT Brazil currently has one of the fastest growing SARS-CoV-2 epidemics in the world. Owing to limited available data, assessments of the impact of non-pharmaceutical interventions (NPIs) on virus spread remain challenging. Using a mobility-driven transmission model, we show that NPIs reduced the reproduction number from >3 to 1–1.6 in São Paulo and Rio de Janeiro. Sequencing of 427 new genomes and analysis of a geographically representative genomic dataset identified >100 international virus introductions in Brazil. We estimate that most (76%) of the Brazilian strains fell in three clades that were introduced from Europe between 22 February11 March 2020. During the early epidemic phase, we found that SARS-CoV-2 spread mostly locally and within-state borders. After this period, despite sharp decreases in air travel, we estimated multiple exportations from large urban centers that coincided with a 25% increase in average travelled distances in national flights. This study sheds new light on the epidemic transmission and evolutionary trajectories of SARS-CoV-2 lineages in Brazil, and provide evidence that current interventions remain insufficient to keep virus transmission under control in the country.
PREVENT EPIDEMICS
Authors PREVENT EPIDEMICS
Authors Mary A Sinnathamby, Heather Whitaker, Laura Coughlan, Jamie Lopez Bernal, Mary Ramsay, Nick Andrews
ABSTRACT England has experienced one of the highest excess in all-cause mortality in Europe during the current COVID-19 pandemic. As COVID-19 emerged, the excess in all-cause mortality rapidly increased, starting in March 2020. The excess observed during the pandemic was higher than excesses noted in the past 5 years. It concerned all regions and all age groups, except the 0–14 year olds, but was more pronounced in the London region and in those aged ≥ 85 years.
Authors Mirjam E Kretzschmar, Ganna Rozhnova, Martin C J Bootsma, Michiel van Boven, Janneke H H M van de Wijgert, Marc J M Bonten
Authors Shaun Griffin
Authors Nazrul Islam, Stephen J Sharp, Gerardo Chowell, Sharmin Shabnam, Ichiro Kawachi, Ben Lacey, Joseph M Massaro, Ralph B D’Agostino Sr, Martin White
ABSTRACT Objective To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally. Design Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis. Setting 149 countries or regions, with data on daily reported cases of covid-19 from the European Centre for Disease Prevention and Control and data on the physical distancing policies from the Oxford covid-19 Government Response Tracker. Participants Individual countries or regions that implemented one of the five physical distancing interventions (closures of schools, workplaces, and public transport, restrictions on mass gatherings and public events, and restrictions on movement (lockdowns)) between 1 January and 30 May 2020. Main outcome measure Incidence rate ratios (IRRs) of covid-19 before and after implementation of physical distancing interventions, estimated using data to 30 May 2020 or 30 days post-intervention, whichever occurred first. IRRs were synthesised across countries using random effects meta-analysis. Results On average, implementation of any physical distancing intervention was associated with an overall reduction in covid-19 incidence of 13% (IRR 0.87, 95% confidence interval 0.85 to 0.89; n=149 countries). Closure of public transport was not associated with any additional reduction in covid-19 incidence when the other four physical distancing interventions were in place (pooled IRR with and without public transport closure was 0.85, 0.82 to 0.88; n=72, and 0.87, 0.84 to 0.91; n=32, respectively). Data from 11 countries also suggested similar overall effectiveness (pooled IRR 0.85, 0.81 to 0.89) when school closures, workplace closures, and restrictions on mass gatherings were in place. In terms of sequence of interventions, earlier implementation of lockdown was associated with a larger reduction in covid-19 incidence (pooled IRR 0.86, 0.84 to 0.89; n=105) compared with a delayed implementation of lockdown after other physical distancing interventions were in place (pooled IRR 0.90, 0.87 to 0.94; n=41). Conclusions Physical distancing interventions were associated with reductions in the incidence of covid-19 globally. No evidence was found of an additional effect of public transport closure when the other four physical distancing measures were in place. Earlier implementation of lockdown was associated with a larger reduction in the incidence of covid-19. These findings might support policy decisions as countries prepare to impose or lift physical distancing measures in current or future epidemic waves.
PEDIATRICS
Authors Stefania Bellino, PhD, Ornella Punzo, MD, PhD, Maria Cristina Rota, MD, Martina Del Manso, DStat, Alberto Mateo Urdiales, MD, Xanthi Andrianou, PhD, Massimo Fabiani, DStat, Stefano Boros, Mr, Fenicia Vescio, MD, Flavia Riccardo, MD, Antonino Bella, DStat, Antonietta Filia, MD, PhD, Giovanni Rezza, MD, Alberto Villani, MD, PhD, Patrizio Pezzotti
ABSTRACT Objective: To describe the epidemiological and clinical characteristics of Coronavirus disease2019 (COVID-19) pediatric cases aged below 18 years in Italy. Methods: Data from the national case-based surveillance system of confirmed COVID-19 infections until May 8, 2020, were analyzed. Demographic and clinical characteristics of subjects were summarized by age groups (0-1, 2-6, 7-12, 13-18 years), and risk factors for disease severity were evaluated using a multilevel (clustered by region) multivariable logistic regression model. Furthermore, a comparison among children, adults and elderly was performed. Results: Pediatric cases (3,836) accounted for 1.8% of total infections (216,305), the median age was 11 years, 51.4% were males, 13.3% were hospitalized, and 5.4% presented underlying medical conditions. The disease was mild in 32.4% of cases and severe in 4.3%, particularly in children ≤6 years old (10.8%); among 511 hospitalized patients, 3.5% were admitted in Intensive Care Unit (ICU), and four deaths occurred. Lower risk of disease severity was associated with increasing age and calendar time, whereas a higher risk was associated with pre-existing underlying medical conditions (OR=2.80, 95% CI 1.74-4.48). Hospitalization rate, admission in ICU, disease severity, and days from symptoms onset to recovery significantly increased with age among children, adults and elderly. Conclusions: Data suggest that pediatric cases of COVID-19 are less severe than adults, however, age ≤1 year and the presence of underlying conditions represent severity risk factors. A better understanding of the infection in children may give important insights into disease pathogenesis, health care practices and public health policies.
Authors Michael Klompas, Meghan A. Baker; Chanu Rhee
Authors THE LANCET
Authors Jonas Dehning, Johannes Zierenberg, F. Paul Spitzner, Michael Wibral, Joao Pinheiro Neto, Michael Wilczek, Viola Priesemann
ABSTRACT INTRODUCTION When faced with the outbreak of a novel epidemic such as coronavirus disease 2019 (COVID-19), rapid response measures are required by individuals, as well as by society as a whole, to mitigate the spread of the virus. During this initial, time-critical period, neither the central epidemiological parameters nor the effectiveness of interventions such as cancellation of public events, school closings, or social distancing is known. RATIONALE As one of the key epidemiological parameters, we inferred the spreading rate λ from confirmed SARS-CoV-2 infections using the example of Germany. We apply Bayesian inference based on Markov chain Monte Carlo sampling to a class of compartmental models [susceptible-infected-recovered (SIR)]. Our analysis characterizes the temporal change of the spreading rate and allows us to identify potential change points. Furthermore, it enables short-term forecast scenarios that assume various degrees of social distancing. A detailed description is provided in the accompanying paper, and the models, inference, and forecasts are available on GitHub (https://github.com/Priesemann-Group/covid19_inference_forecast). Although we apply the model to Germany, our approach can be readily adapted to other countries or regions. RESULTS In Germany, interventions to contain the COVID-19 outbreak were implemented in three steps over 3 weeks: (i) Around 9 March 2020, large public events such as soccer matches were canceled; (ii) around 16 March 2020, schools, childcare facilities, and many stores were closed; and (iii) on 23 March 2020, a far-reaching contact ban (Kontaktsperre) was imposed by government authorities; this included the prohibition of even small public gatherings as well as the closing of restaurants and all nonessential stores. From the observed case numbers of COVID-19, we can quantify the impact of these measures on the disease spread using change point analysis. Essentially, we find that at each change point the spreading rate λ decreased by ~40%. At the first change point, assumed around 9 March 2020, λ decreased from 0.43 to 0.25, with 95% credible intervals (CIs) of [0.35, 0.51] and [0.20, 0.30], respectively. At the second change point, assumed around 16 March 2020, λ decreased to 0.15 (CI [0.12, 0.20]). Both changes in λ slowed the spread of the virus but still implied exponential growth (see red and orange traces in the figure). To contain the disease spread, i.e., to turn exponential growth into a decline of new cases, the spreading rate has to be smaller than the recovery rate μ = 0.13 (CI [0.09, 0.18]). This critical transition was reached with the third change point, which resulted in λ = 0.09 (CI [0.06, 0.13]; see blue trace in the figure), assumed around 23 March 2020. From the peak position of daily new cases, one could conclude that the transition from growth to decline was already reached at the end of March. However, the observed transient decline can be explained by a short-term effect that originates from a sudden change in the spreading rate (see Fig. 2C in the main text). As long as interventions and the concurrent individual behavior frequently change the spreading rate, reliable short- and long-term forecasts are very difficult. As the figure shows, the three example scenarios (representing the effects up to the first, second, and third change point) quickly diverge from each other and, consequently, span a considerable range of future case numbers. Inference and subsequent forecasts are further complicated by the delay of ~2 weeks between an intervention and the first useful estimates of the new λ (which are derived from the reported case numbers). Because of this delay, any uncertainty in the magnitude of social distancing in the previous 2 weeks can have a major impact on the case numbers in the subsequent 2 weeks. Beyond 2 weeks, the case numbers depend on our future behavior, for which we must make explicit assumptions. In sum, future interventions (such as lifting restrictions) should be implemented cautiously to respect the delayed visibility of their effects. CONCLUSION We developed a Bayesian framework for the spread of COVID-19 to infer central epidemiological parameters and the timing and magnitude of intervention effects. With such an approach, the effects of interventions can be assessed in a timely manner. Future interventions and lifting of restrictions can be modeled as additional change points, enabling short-term forecasts for case numbers. In general, our approach may help to infer the efficiency of measures taken in other countries and inform policy-makers about tightening, loosening, and selecting appropriate measures for containment of COVID-19.
Authors John Middleton, Ralf Reintjes, Henrique Lopes
Authors Prof Marina Pollán, Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Jesús Oteo, Miguel A Hernán, Mayte Pérez-Olmeda, Jose L Sanmartín, Aurora Fernández-García, Israel Cruz, Nerea Fernández de Larrea, Marta Molina, Francisco Rodríguez-Cabrera, Mariano Martín, Paloma Merino-Amador, Jose León Paniagua, Juan F Muñoz-Montalvo, Faustino Blanco, Raquel Yotti
Authors Marina Pollán, Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Jesús Oteo, Miguel A Hernán, Mayte Pérez-Olmeda , Jose L Sanmartín, Aurora Fernández-García, Israel Cruz, Nerea Fernández de Larrea, Marta Molina, Francisco Rodríguez-Cabrera, Mariano Martín, Paloma Merino-Amador, Jose León Paniagua, Juan F Muñoz-Montalvo, Faustino Blanco, Raquel Yotti,
Authors Lidia Morawska, Donald K Milton
CORNELL UNIVERSITY
ABSTRACT Non-pharmaceutical interventions (NPIs) have been crucial in curbing COVID-19 in the United States (US). Consequently, relaxing NPIs through a phased re-opening of the US amid still-high levels of COVID-19 susceptibility could lead to new epidemic waves. This calls for a COVID-19 early warning system. Here we evaluate multiple digital data streams as early warning indicators of increasing or decreasing state-level US COVID-19 activity between January and June 2020. We estimate the timing of sharp changes in each data stream using a simple Bayesian model that calculates in near real-time the probability of exponential growth or decay. Analysis of COVID-19-related activity on social network microblogs, Internet searches, point-of-care medical software, and a metapopulation mechanistic model, as well as fever anomalies captured by smart thermometer networks, shows exponential growth roughly 2- 3 weeks prior to comparable growth in confirmed COVID-19 cases and 3-4 weeks prior to comparable growth in COVID-19 deaths across the US over the last 6 months. We further observe exponential decay in confirmed cases and deaths 5-6 weeks after implementation of NPIs, as measured by anonymized and aggregated human mobility data from mobile phones. Finally, we propose a combined indicator for exponential growth in multiple data streams that may aid in developing an early warning system for future COVID-19 outbreaks. These efforts represent an initial exploratory framework, and both continued study of the predictive power of digital indicators as well as further development of the statistical approach are needed.
Authors Lasse S Vestergaard, Jens Nielsen, Lukas Richter, Daniela Schmid Natalia Bustos, Toon Braeye, Gleb Denissov, Tatjana Veideman, Oskari Luomala, Teemu Möttönen, Anne Fouillet, Céline Caserio-Schönemann, Matthias an der Heiden, Helmut Uphoff, Theodore Lytras, Kassiani Gkolfinopoulou, Anna Pald, Lisa Domegan, Joan O'Donnell, Francesca de’ Donat, Fiammetta Noccioli, Patrick Hoffmann, Telma Vele, Kathleen England, Liselotte van Asten, Richard A White, Ragnhild Tønnessen Susana P da Silva, Ana P Rodrigues, Amparo Larrauri, Concepción Delgado-Sanz, Ahmed Farah, Ilias Galanis, Christoph Junker, Damir Perisa, Mary Sinnathamby, Nick Andrews, Mark O'Doherty, Diogo FP Marques, Sharon Kennedy, Sonja J Olsen, Richard Pebody, Tyra G Krause, Kåre Mølbak
ABSTRACT A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March–April 2020. Excess mortality particularly affected ≥ 65 year olds (91% of all excess deaths), but also 45–64 (8%) and 15–44 year olds (1%). No excess mortality was observed in 0–14 year olds.
ECDC
Authors ECDC
ABSTRACT Since 31 December 2019 and as of 30 June 2020, 10 273 001 cases of coronavirus disease 2019 (COVID-19) have been reported worldwide, including 505 295 deaths. EU/EEA countries and the UK have reported 1 556 709 cases (15 % of all cases), including 176 800 deaths (35% of all deaths), while EU candidate and potential candidate countries reported 229 112 cases (2% of all cases), including 5 988 deaths (1% of all deaths). The COVID-19 pandemic is posing an unprecedented threat to EU/EEA countries and the UK as well as countries worldwide, many of which have been experiencing widespread transmission of the virus in the community for several months. There is still community transmission reported in most EU/EEA countries, the UK and EU candidate and potential candidate countries. Additionally, some countries are reporting a resurgence of observed cases or large localised outbreaks. The reasons behind this apparent increase in the number or resurgence of cases observed in these countries vary. The increase in the number of cases may reflect changes in case ascertainment (e.g. increasing testing, changes in the case definition) that does not necessarily indicate increased rates of transmission, or may reflect genuine increases in transmission (e.g. associated with the easing of non-pharmaceutical interventions (NPI), large localised outbreaks), or may be due to importation of cases. Some of the observed increases, particularly in countries with a small population, are associat
Authors Joshua Nazareth, Jatinder S Minhas, David R Jenkins, Amandip Sahota, Kamlesh Khunti, Pranab Haldar, Manish Pareek
Authors Jody W. Zylke, Howard Bauchner
Authors Elisabeth Mahase
Authors Hamada S Badr, Hongru Du, Maximilian Marshall, Ensheng Dong, Marietta M Squire, Lauren M Gardner
Authors Günther Fink, Nina Orlova-Fink, Tobias Schindler, Sandra Grisi, Ana Paula Ferrer, Claudia Daubenberger, Alexandra Brentani
ABSTRACT We analyzed data from 92,664 clinically and molecularly confirmed Covid-19 cases in Brazil to understand the potential associations between influenza vaccination and Covid-19 outcomes. Controlling for health facility of treatment, comorbidities as well as an extensive range of sociodemographic factors, we show that patients who received a recent influenza vaccine experienced on average 8% lower odds of needing intensive care treatment (95% CIs [0.86, 0.99]), 18% lower odds of requiring invasive respiratory support (0.74, 0.88) and 17% lower odds of death (0.75, 0.89). Large scale promotion of influenza vaccines seems advisable, especially in populations at high risk of severe SARS-CoV-2 infectio
BMJ
Authors Katja Radon, Elmar Saathoff, Michael Pritsch, Jessica Michelle Guggenbühl Noller, Inge Kroidl, Laura Olbrich, Verena Thiel, Max Diefenbach, Friedrich Riess, Felix Forster, Fabian Theis, Andreas Wieser, Michael Hoelscher
ABSTRACT Background Due to the SARS-CoV-2 pandemic, public health interventions have been introduced globally in order to prevent the spread of the virus and avoid the overload of health care systems, especially for the most severely affected patients. Scientific studies to date have focused primarily on describing the clinical course of patients, identifying treatment options and developing vaccines. In Germany, as in many other regions, current tests for SARS-CoV2 are not conducted on a representative basis and in a longitudinal design. Furthermore, knowledge about the immune status of the population is lacking. Nonetheless, these data are needed to understand the dynamics of the pandemic and hence to appropriately design and evaluate interventions. For this purpose, we recently started a prospective population-based cohort in Munich, Germany, with the aim to develop a better understanding of the state and dynamics of the pandemic. Methods In 100 out of 755 randomly selected constituencies, 3000 Munich households are identified via random route and offered enrollment into the study. All household members are asked to complete a baseline questionnaire and subjects ≥14 years of age are asked to provide a venous blood sample of ≤3 ml for the determination of SARS-CoV-2 IgG/IgA status. The residual plasma and the blood pellet are preserved for later genetic and molecular biological investigations. For twelve months, each household member is asked to keep a diary of daily symptoms, whereabouts and contacts via WebApp. If symptoms suggestive for COVID-19 are reported, family members, including children < 14 years, are offered a pharyngeal swab taken at the Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, for molecular testing for SARS-CoV-2. In case of severe symptoms, participants will be transferred to a Munich hospital. For one year, the study teams re-visits the households for blood sampling every six weeks. Discussion With the planned study we will establish a reliable epidemiological tool to improve the understanding of the spread of SARS-CoV-2 and to better assess the effectiveness of public health measures as well as their socio-economic effects. This will support policy makers in managing the epidemic based on scientific evidence.
Authors Rachael H Dodd, Erin Cvejic, Carissa Bonner, Kristen Pickles, Kirsten J McCaffery
Authors Jiang Zhang, Lei Dong, Yanbo Zhang, Xinyue Chen, Guiqing Yao, Zhangang Han
ABSTRACT Policy makers around the world are facing unprecedented challenges in making decisions on when and what degrees of measures should be implemented to tackle the COVID-19 pandemic. Here, using a nationwide mobile phone dataset, we developed a networked meta-population model to simulate the impact of intervention in controlling the spread of the virus in China by varying the effectiveness of transmission reduction and the timing of intervention start and relaxation. We estimated basic reproduction number and transition probabilities between health states based on reported cases. Our model demonstrates that both the time of initiating an intervention and its effectiveness had a very large impact on controlling the epidemic, and the current Chinese intense social distancing intervention has reduced the impact substantially but would have been even more effective had it started earlier. The optimal duration of the control measures to avoid resurgence was estimated to be 2 months, although would need to be longer under less effective controls.
Authors Florian Götzinger, Begoña Santiago-García, Antoni Noguera-Julián, Miguel Lanaspa, Laura Lancella, Francesca I Calò Carducci, Natalia Gabrovska, Svetlana Velizarova, Petra Prunk, Veronika Osterman, Uros Krivec, Andrea Lo Vecchio, Delane Shingadia, Antoni Soriano-Arandes, Susana Melendo, Marcello Lanari, Luca Pierantoni, Noémie Wagner, Arnaud G L’Huillier, Ulrich Heininger, Nicole Ritz, Srini Bandi, Nina Krajcar, Srđan Roglić, Mar Santos, Christelle Christiaens, Marine Creuven, Danilo Buonsenso, Steven B Welch, Matthias Bogyi, Folke Brinkmann, Marc Tebruegge
Authors Ralf Reintjes
Authors Leonardo López, Xavier Rodó
ABSTRACT The lack of effective pharmaceutical interventions for SARS-CoV-2 raises the possibility of COVID-19 recurrence. We explore different post-confinement scenarios by using a stochastic modified SEIR (susceptible–exposed–infectious–recovered) model that accounts for the spread of infection during the latent period and also incorporates time-decaying effects due to potential loss of acquired immunity, people’s increasing awareness of social distancing and the use of non-pharmaceutical interventions. Our results suggest that lockdowns should remain in place for at least 60 days to prevent epidemic growth, as well as a potentially larger second wave of SARS-CoV-2 cases occurring within months. The best-case scenario should also gradually incorporate workers in a daily proportion at most 50% higher than during the confinement period. We show that decaying immunity and particularly awareness and behaviour have 99% significant effects on both the current wave of infection and on preventing COVID-19 re-emergence. Social distancing and individual non-pharmaceutical interventions could potentially remove the need for lockdowns.
Authors Xiao-Ming Zhang, Hui-Er Zhou, Wen-Wu Zhang, Qing-Li Dou, Ye Li, Jian Wei, Rui Hu, Jiangping Liu, Andy S. K. Cheng
ABSTRACT Importance A new outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 in Wuhan, China, is spreading rapidly around the globe. Limited information on control in community settings is available. Objective To detail measures enacted within a community to prevent the spread of coronavirus disease 2019 (COVID-19) and to evaluate the spread of COVID-19 associated with implementation of the program. Design, Setting, and Participants This case series study details the implementation of prevention measures in a specific community setting among community-dwelling individuals exposed to or at risk of COVID-19 in Haiyu, Shenzhen, China, from January 23 to April 10, 2020. Exposures Community containment strategies for tracking, quarantine, and management were strictly, cooperatively, and effectively implemented by a team that included a general practitioner, a community manager, and public safety bureau officials. Main Outcomes and Measures Number of locally acquired cases with indirect links to confirmed COVID-19 cases. Diagnosis with COVID-19 was confirmed when throat swab samples tested positive for severe acute respiratory syndrome coronavirus 2 on reverse transcription–polymerase chain reaction. Results Approximately 34 686 individuals live in Haiyu, including 2382 residents aged 65 years or older. Seven individuals with COVID-19 acquired outside the community (age, 20-70 years; 3 [42%] women) were moved from quarantine to a hospital for standard isolation treatment. A total of 20 people who were asymptomatic and who had had direct contact with these individuals were closely observed by health care workers at a nearby hotel. Additionally, 800 individuals considered to be at higher risk were moved from quarantine to home isolation for 14 days. There were no locally acquired cases of COVID-19 with indirect links reported in the Haiyu community from the time that the study began on January 23, 2020, to April 10, 2020. Conclusions and Relevance These findings suggest that cooperation among the authorities of multiple sectors allowed for the implementation of preventive measures that were associated with limited community transmission.
Authors SHARMILA DEVI
Authors Xiao-Ke Xu, Xiao-Fan Liu, Ye Wu, Sheikh Taslim Ali, Zhanwei Du, Paolo Bosetti, Eric H Y Lau, Benjamin J Cowling, Lin Wang
ABSTRACT Background Knowledge on the epidemiological features and transmission patterns of COVID-19 is accumulating. Detailed line-list data with household settings can advance the understanding of COVID-19 transmission dynamics. Methods A unique database with detailed demographic characteristics, travel history, social relationships, and epidemiological timelines for 1,407 transmission pairs that formed 643 transmission clusters in mainland China was reconstructed from 9,120 COVID-19 confirmed cases reported during January 15 - February 29, 2020. Statistical model fittings were used to identify the super-spreaders and estimate serial interval distributions. Age and gender-stratified hazard of infection were estimated for household versus non-household transmissions. Results There were 34 primary cases identified as super-spreaders, with 5 super-spreading events occurred within households. Mean and standard deviation of serial intervals were estimated as 5.0 (95% CrI: 4.4, 5.5) and 5.2 (95% CrI: 4.9, 5.7) days for household transmissions and 5.2 (95% CrI: 4.6, 5.8) and 5.3 (95% CrI: 4.9, 5.7) days for non-household transmissions, respectively. Hazard of being infected outside of households is higher for age between 18 and 64 years, whereas hazard of being infected within households is higher for young and old people. Conclusions Non-negligible frequency of super-spreading events, short serial intervals, and a higher risk of being infected outside of households for male people of working age indicate a significant barrier to the identification and management of COVID-19 cases, which requires enhanced non-pharmaceutical interventions to mitigate this pandemic.
EUROSERVILLANCE
Authors Elena Percivalle, Giuseppe Cambiè, Irene Cassaniti, Edoardo Vecchio Nepita, Roberta Maserati, Alessandro Ferrari, Raffaella Di Martino, Paola Isernia, Francesco Mojoli, Raffaele Bruno, Marcello Tirani, Danilo Cereda, Carlo Nicora, Massimo Lombardo , Fausto Baldanti
ABSTRACT We evaluated SARS-CoV-2 RNA and neutralising antibodies in blood donors (BD) residing in the Lodi Red Zone, Italy. Of 390 BDs recruited after 20 February 2020 − when the first COVID-19 case in Lombardy was identified, 91 (23%) aged 19–70 years were antibody positive. Viral RNA was detected in an additional 17 (4.3%) BDs, yielding ca 28% (108/390) with evidence of virus exposure. Five stored samples collected as early as 12 February were seropositive.
Authors Huilan Tu, Sheng Tu, Shiqi Gao, Anwen Shao, Jifang Sheng
ABSTRACT Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and represents a potentially fatal disease of great global public health importance. As of March 26, 2020, the outbreak of COVID-19 has resulted in 462,801 confirmed cases and 20,839 deaths globally, which is more than those caused by SARS and Middle East respiratory syndrome (MERS) in 2003 and 2013, respectively. The epidemic has posed considerable challenges worldwide. Under a strict mechanism of massive prevention and control, China has seen a rapid decrease in new cases of coronavirus; however, the global situation remains serious. Additionally, the origin of COVID-19 has not been determined and no specific antiviral treatment or vaccine is currently available. Based on the published data, this review systematically discusses the etiology, epidemiology, clinical characteristics, and current intervention measures related to COVID-19 in the hope that it may provide a reference for future studies and aid in the prevention and control of the COVID-19 epidemic.
Authors Qin-Long Jing,Ming-Jin Liu, Zhou-Bin Zhang, Li-Qun Fang, Jun Yuan, An-Ran Zhang, Natalie E Dean, Lei Luo, Meng-Meng Ma, Ira Longini, Eben Kenah, Ying Lu, Yu Ma, Neda Jalali, Zhi-Cong Yang, Yang Yang
Authors Yann Sweeney
Authors Andrew Clark, Mark Jit, Charlotte Warren-Gash, Bruce Guthrie, Harry H X Wang, Stewart W Mercer, Colin Sanderson, Martin McKee, Christopher Troeger, Kanyin L Ong, Francesco Checchi, Pablo Perel, Sarah Joseph, Hamish P Gibbs, Amitava Banerjee, Rosalind M Eggo
Authors Jacqui Thornton
Authors Florian Kurth, Maria Roennefarth, Charlotte Thibeault, Victor M. Corman, Holger Müller-Redetzky, Mirja Mittermaier, Christoph Ruwwe-Glösenkamp, Katrin M. Heim, Alexander Krannich, Saskia Zvorc, Sein Schmidt, Lucie Kretzler, Chantip Dang-Heine, Matthias Rose, Michael Hummel, Andreas Hocke, Ralf H. Hübner, Bastian Opitz, Marcus A. Mall, Jobst Röhmel, Ulf Landmesser, Burkert Pieske, Samuel Knauss, Matthias Endres, Joachim Spranger, Frank P. Mockenhaupt, Frank Tacke, Sascha Treskatsch, Stefan Angermair, Britta Siegmund, Claudia Spies, Steffen Weber-Carstens, Kai-Uwe Eckardt, Dirk Schürmann, Alexander Uhrig, Miriam S. Stegemann, Thomas Zoller, Christian Drosten, Norbert Suttorp, Martin Witzenrath, Stefan Hippenstiel, Christof von Kalle, Leif Erik Sander
ABSTRACT Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global health emergency. Pa-COVID-19 aims to provide comprehensive data on clinical course, pathophysiology, immunology and outcome of COVID-19, to identify prognostic biomarkers, clinical scores, and therapeutic targets for improved clinical management and preventive interventions. Methods Pa-COVID-19 is a prospective observational cohort study of patients with confirmed SARS-CoV-2 infection treated at Charité - Universitätsmedizin Berlin. We collect data on epidemiology, demography, medical history, symptoms, clinical course, and pathogen testing and treatment. Systematic, serial blood sampling will allow deep molecular and immunological phenotyping, transcriptomic profiling, and comprehensive biobanking. Longitudinal data and sample collection during hospitalization will be supplemented by long-term follow-up. Results Outcome measures include the WHO clinical ordinal scale on day 15 and clinical, functional, and health-related quality-of-life assessments at discharge and during follow-up. We developed a scalable dataset to (i) suit national standards of care, (ii) facilitate comprehensive data collection in medical care facilities with varying resources, and (iii) allow for rapid implementation of interventional trials based on the standardized study design and data collection. We propose this scalable protocol as blueprint for harmonized data collection and deep phenotyping in COVID-19 in Germany. Conclusion We established a basic platform for harmonized, scalable data collection, pathophysiological analysis, and deep phenotyping of COVID-19, which enables rapid generation of evidence for improved medical care and identification of candidate therapeutic and preventive strategies. The electronic database accredited for interventional trials allows fast trial implementation for candidate therapeutic agents.
Authors Heba Habib
Authors Lucy C Okell, Robert Verity, Oliver J Watson, Swapnil Mishra, Patrick Walker, Charlie Whittaker, Aris Katzourakis, Christl A Donnelly, Steven Riley, Azra C Ghani, Axel Gandy, Seth Flaxman, Neil M Ferguson, Samir Bhatt
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL
Authors European Centre for Disease Prevention and Control
Authors Georg M. N. Behrens, Anne Cossmann, Metodi V. Stankov, Torsten Witte, Diana Ernst, Christine Happle, Alexandra Jablonka
ABSTRACT There have been concerns about high rates of thus far undiagnosed SARS-CoV-2 infections in the health-care system. The COVID-19 Contact (CoCo) Study follows 217 frontline health-care professionals at a university hospital with weekly SARS- CoV-2-specifc serology (IgA/IgG). Study participants estimated their personal likelihood of having had a SARS-CoV-2 infection with a mean of 21% [median 15%, interquartile range (IQR) 5–30%]. In contrast, anti-SARS-CoV-2 IgG prevalence was about 1–2% at baseline. Regular anti-SARS-CoV-2 IgG testing of health-care professionals may aid in directing resources for protective measures and care of COVID-19 patients in the long run.
OXFORD UNIVERSITY
Authors Najmul Haider, Alexei Yavlinsky, Richard Kock
Authors Solomon Hsiang, Daniel Allen, Sébastien Annan-Phan, Kendon Bell, Ian Bolliger, Trinetta Chong, Hannah Druckenmiller, Luna Yue Huang, Andrew Hultgren, Emma Krasovich, Peiley Lau, Jaecheol Lee, Esther Rolf, Jeanette Tseng, Tiffany Wu
ABSTRACT Governments around the world are responding to the novel coronavirus (COVID-19) pandemic1 with unprecedented policies designed to slow the growth rate of infections. Many actions, such as closing schools and restricting populations to their homes, impose large and visible costs on society, but their benefits cannot be directly observed and are currently understood only through process-based simulations2–4. Here, we compile new data on 1,717 local, regional, and national non-pharmaceutical interventions deployed in the ongoing pandemic across localities in China, South Korea, Italy, Iran, France, and the United States (US). We then apply reduced-form econometric methods, commonly used to measure the effect of policies on economic growth5,6, to empirically evaluate the effect that these anti-contagion policies have had on the growth rate of infections. In the absence of policy actions, we estimate that early infections of COVID-19 exhibit exponential growth rates of roughly 38% per day. We find that anti-contagion policies have significantly and substantially slowed this growth. Some policies have different impacts on different populations, but we obtain consistent evidence that the policy packages now deployed are achieving large, beneficial, and measurable health outcomes. We estimate that across these six countries, interventions prevented or delayed on the order of 62 million confirmed cases, corresponding to averting roughly 530 million total infections. These findings may help inform whether or when these policies should be deployed, intensified, or lifted, and they can support decision-making in the other 180+ countries where COVID-19 has been reported7.
Authors Seth Flaxman, Swapnil Mishra, Axel Gandy, H. Juliette T. Unwin, Thomas A. Mellan, Helen Coupland, Charles Whittaker, Harrison Zhu, Tresnia Berah, Jeffrey W. Eaton, Mélodie Monod, Imperial College COVID-19 Response Team, Azra C. Ghani, Christl A. Donnelly, Steven M. Riley, Michaela A. C. Vollmer, Neil M. Ferguson, Lucy C. Okell, Samir Bhatt
ABSTRACT Following the emergence of a novel coronavirus1 (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics. In response, many European countries have implemented unprecedented non-pharmaceutical interventions such as closure of schools and national lockdowns. We study the impact of major interventions across 11 European countries for the period from the start of COVID-19 until the 4th of May 2020 when lockdowns started to be lifted. Our model calculates backwards from observed deaths to estimate transmission that occurred several weeks prior, allowing for the time lag between infection and death. We use partial pooling of information between countries with both individual and shared effects on the reproduction number. Pooling allows more information to be used, helps overcome data idiosyncrasies, and enables more timely estimates. Our model relies on fixed estimates of some epidemiological parameters such as the infection fatality rate, does not include importation or subnational variation and assumes that changes in the reproduction number are an immediate response to interventions rather than gradual changes in behavior. Amidst the ongoing pandemic, we rely on death data that is incomplete, with systematic biases in reporting, and subject to future consolidation. We estimate that, for all the countries we consider, current interventions have been sufficient to drive the reproduction number Rt below 1 (probability Rt< 1.0 is 99.9%) and achieve epidemic control. We estimate that, across all 11 countries, between 12 and 15 million individuals have been infected with SARS-CoV-2 up to 4th May, representing between 3.2% and 4.0% of the population. Our results show that major non-pharmaceutical interventions and lockdown in particular have had a large effect on reducing transmission. Continued intervention should be considered to keep transmission of SARS-CoV-2 under control.
Authors Chandi C. Mandal, M.S. Panwar
ABSTRACT Objective Despite huge global, national, and local preventive measures including travel restriction, social distancing, and quarantines, the outbreak of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develops the coronavirus disease 2019 (COVID-19) worldwide pandemic. SARS-CoV-2 emerging from Wuhan, China, took only three months to cover >200 countries worldwide by infecting more than 2.4 million people and killing more than 150,000 people. Although this infection at the early stage creates seasonal flu-like symptoms with a higher illness, it eventually causes a higher mortality. Epidemiological studies not only find the causes of many health issues but also suggest preventive measures. This study aimed to see the link between environment temperature and COVID-19 cases. Study design The monthly average environment temperature (MAET) and various COVID-19 cases of a country were collected and analyzed to see the relationship between these parameters. Methods Univariate analysis and statistical modeling were used to determine the relationship between environment temperature and different COVID-19 cases. Results This study found that the majorities of the countries having higher COVID-19 cases are located in the higher latitude (colder region) in the globe. As of 20th April data available, statistical analyses by various methods have found that strong negative correlations with statistical significance exist between MAET and several COVID-19 cases including total cases, active cases, and cases per million of a country (Spearman correlation coefficients were −0.45, −0.42, and −0.50 for total cases, active cases, and cases/per million, respectively). Analysis by the statistical log-linear regression model further supports that the chance of patients to contract COVID-19 is less in warmer countries than in colder countries. Conclusion This pilot study proposes that cold environment may be an additional risk factor for COVID-19 cases.
Authors Nida F. Degesys, Ralph C. Wang, Elizabeth Kwan, Jahan Fahimi, Jeanne A. Noble, MA Maria C. Raven
The Lancet
Authors Kelvin Kai-Wang To, Vincent Chi-Chung Cheng, Jian-Piao Cai, Kwok-Hung Chan, Lin-Lei Chen, Lok-Hin Wong, Charlotte Yee-Ki Choi, Carol Ho-Yan Fong, Anthony Chin-Ki Ng, Lu Lu, Cui-Ting Luo, Jianwen Situ, Tom Wai-Hin Chung, Shuk-Ching Wong, Grace See-Wai Kwan, Siddharth Sridhar, Jasper Fuk-Woo Chan, Cecilia Yuen-Man Fan, Vivien W M Chuang, Kin-Hang Kok, Ivan Fan-Ngai Hung, Kwok-Yung Yuen
Authors Enrico Lavezzo, Elisa Franchin, Constanze Ciavarella, Gina Cuomo-Dannenburg, Luisa Barzon, Claudia Del Vecchio, Lucia Rossi, Riccardo Manganelli, Arianna Loregian, Nicolò Navarin, Davide Abate, Manuela Sciro, Stefano Merigliano, Ettore De Canale, Maria Cristina Vanuzzo, Valeria Besutti, Francesca Saluzzo, Francesco Onelia, Monia Pacenti, Saverio Parisi, Giovanni Carretta, Daniele Donato, Luciano Flor, Silvia Cocchio, Giulia Masi, Alessandro Sperduti, Lorenzo Cattarino, Renato Salvador, Michele Nicoletti, Federico Caldart, Gioele Castelli, Eleonora Nieddu, Beatrice Labella, Ludovico Fava, Matteo Drigo, Katy A. M. Gaythorpe, Imperial College COVID-19 Response Team, Alessandra R. Brazzale, Stefano Toppo, Marta Trevisan, Vincenzo Baldo, Christl A. Donnelly, Neil M. Ferguson, Ilaria Dorigatti, Andrea Crisanti
ABSTRACT On the 21st of February 2020 a resident of the municipality of Vo’, a small town near Padua, died of pneumonia due to SARS-CoV-2 infection1. This was the first COVID-19 death detected in Italy since the emergence of SARS-CoV-2 in the Chinese city of Wuhan, Hubei province2. In response, the regional authorities imposed the lockdown of the whole municipality for 14 days3. We collected information on the demography, clinical presentation, hospitalization, contact network and presence of SARS-CoV-2 infection in nasopharyngeal swabs for 85.9% and 71.5% of the population of Vo’ at two consecutive time points. On the first survey, which was conducted around the time the town lockdown started, we found a prevalence of infection of 2.6% (95% confidence interval (CI) 2.1-3.3%). On the second survey, which was conducted at the end of the lockdown, we found a prevalence of 1.2% (95% Confidence Interval (CI) 0.8-1.8%). Notably, 42.5% (95% CI 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (i.e. did not have symptoms at the time of swab testing and did not develop symptoms afterwards). The mean serial interval was 7.2 days (95% CI 5.9-9.6). We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (p-values 0.62 and 0.74 for E and RdRp genes, respectively, Exact Wilcoxon-Mann-Whitney test). This study sheds new light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides new insights into its transmission dynamics and the efficacy of the implemented control measures.
Authors Edward A. Nardell, Ruvandhi R. Nathavitharana
Authors Giorgio Buonanno, Lidia Morawska, Luca Stabile
ABSTRACT Airborne transmission is a recognized pathway of contagion; however, it is rarely quantitatively evaluated. This study presents a novel approach for quantitative assessment of the individual infection risk of susceptible subjects exposed in indoor microenvironments in the presence of an asymptomatic infected SARS-CoV-2 subject. The approach allowed the maximum risk for an exposed healthy subject to be evaluated or, starting from an acceptable risk, the maximum exposure time. We applied the proposed approach to four distinct scenarios for a prospective assessment, highlighting that, in order to guarantee an acceptable individual risk of 10-3 for exposed subjects in naturally ventilated indoor environments, the exposure time should be shorter than 20 min. The proposed approach was used for retrospective assessment of documented outbreaks in a restaurant in Guangzhou (China) and at a choir rehearsal in Mount Vernon (USA), showing that, in both cases, the high attack rate values can be justified only assuming the airborne transmission as the main route of contagion. Moreover, we shown that such outbreaks are not caused by the rare presence of a superspreader, but can be likely explained by the co-existence of conditions, including emission and exposure parameters, leading to a highly probable event, which can be defined as a superspreading event.
ANESTHESIA & ANALGESIA
Authors Bong, Choon-Looi, Brasher Christopher, Chikumba, Edson, McDougall, Robert, Mellin-Olsen Jannicke, Enright, Angel
ABSTRACT Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.
BIORXIV
ABSTRACT Accurate understanding of the global spread of emerging viruses is critically important for public health response and for anticipating and preventing future outbreaks. Here, we elucidate when, where and how the earliest sustained SARS-CoV-2 transmission networks became established in Europe and the United States (US). Our results refute prior findings erroneously linking cases in January 2020 with outbreaks that occurred weeks later. Instead, rapid interventions successfully prevented onward transmission of those early cases in Germany and Washington State. Other, later introductions of the virus from China to both Italy and Washington State founded the earliest sustained European and US transmission networks. Our analyses reveal an extended period of missed opportunity when intensive testing and contact tracing could have prevented SARS-CoV-2 from becoming established in the US and Europe. Competing Interest Statement JOW has received funding from Gilead Sciences, LLC (completed) and the CDC (ongoing) via grants and contracts to his institution unrelated to this research. MAS receives funding from Janssen Research & Development, IQVIA and Private Health Management via contracts unrelated to this research.
Authors Adrian Cho
RESOURCE IN PUBLIC HEALTH
Authors Giovenale Moirano, Lorenzo Richiardi, Carlo Novara, Milena Maule
Authors Rita Rubin
Authors Sarah A Hopkins, Roberta Lovick, Louisa Polak, Ben Bowers, Tessa Morgan, Michael P Kelly, Stephen Barclay
Authors Inga Holmdahl, S.M., and Caroline Buckee, D.Phil
Authors SARAH COBEY
Authors Paolo Immovilli, Nicola Morelli, Elio Antonucci, Guido Radaelli, Mario Barbera & Donata Guidetti
JMIR
Authors Michael Krausz, Jean Nicolas Westenberg ,Daniel Vigo, Richard Trafford Spence, Damon Ramsey
ABSTRACT Background: Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. Objective: The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. Methods: An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system’s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. Results: The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. Conclusions: Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies
Authors Jeremy Samuel Faust, Carlos del Rio
The BMJ
Authors Marco Piccininni, Jessica L Rohmann, Luca Foresti, Caterina Lurani, Tobias Kurth
ABSTRACT OBJECTIVE To quantify the impact of coronavirus disease 2019 (covid-19) on all cause mortality in Nembro, an Italian city severely affected by the covid-19 pandemic. DESIGN Descriptive study. SETTING Nembro, in the Bergamo province of Lombardy, northern Italy. POPULATION Residents of Nembro. MAIN OUTCOME MEASURES Monthly all cause mortality between January 2012 and April 2020 (data to 11 April), number of confirmed deaths from covid-19 to 11 April 2020, and weekly absolute number of deaths between 1 January and 4 April across recent years by age group and sex. RESULTS Nembro had 11505 residents as of 1 January 2020. Monthly all cause mortality between January 2012 and February 2020 fluctuated around 10 per 1000 person years, with a maximum of 21.5 per 1000 person years. In March 2020, monthly all cause mortality reached a peak of 154.4 per 1000 person years. For the first 11 days in April, this rate decreased to 23.0 per 1000 person years. The observed increase in mortality was driven by the number of deaths among older people (≥65 years), especially men. From the outbreak onset until 11 April 2020, only 85 confirmed deaths from covid-19 in Nembro were recorded, corresponding to about half of the 166 deaths from all causes observed in that period. CONCLUSIONS The study findings show how covid-19 can have a considerable impact on the health of a small community. Furthermore, the results suggest that the full implications of the covid-19 pandemic can only be completely understood if, in addition to confirmed deaths related to covid-19, consideration is also given to all cause mortality in a given region and time frame.
EUROPEAN RESPIRATORY JOURNAL
Authors F.A. Klok, G.J.A.M. Boon, S. Barco, M. Endres, J.J.M. Geelhoed, S. Knauss, S.A. Rezek, M.A. Spruit, J. Vehreschild, B. Siegerink
Authors Rodrigo de Oliveira Andrade
ERS
Authors Stefano Nava, Roberto Tonelli, Enrico Clini
Authors Thomas A Treibel, Charlotte Manisty, Maudrian Burton, Áine McKnight, Jonathan Lambourne, João B Augusto, Xosé Couto-Parada, Teresa Cutino-Moguel, Mahdad Noursadeghi, James C Moon
Authors Myron S. Cohen, Lawrence Corey
Authors Yen-Chin Liu, Rei-Lin Kuo, Shin-Ru Shih
ABSTRACT The novel human coronavirus disease COVID-19 has become the fifth documented pandemic since the 1918 flu pandemic. COVID-19 was first reported in Wuhan, China, and subsequently spread worldwide. The coronavirus was officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses based on phylogenetic analysis. SARS-CoV-2 is believed to be a spillover of an animal coronavirus and later adapted the ability of human-to-human transmission. Because the virus is highly contagious, it rapidly spreads and continuously evolves in the human population. In this review article, we discuss the basic properties, potential origin, and evolution of the novel human coronavirus. These factors may be critical for studies of pathogenicity, antiviral designs, and vaccine development against the virus.
Authors Harald Walach & Stefan Hockertz
BIOMEDICAL JOURNAL
ISTAT/ISS
Authors ISTAT/ISS
Authors Thomas V. Inglesby
NCBI
Authors Giulia Lorenzoni, Corrado Lanera, Danila Azzolina, Paola Berchialla, Dario Gregori
Authors Anna Odone, Davide Delmonte, Thea Scognamiglio, Carlo Signorelli
FRONTIERS IN PUBLIC HEALTH
Authors Mariangela Valentina Puci, Federica Loi, Ottavia Eleonora Ferraro, Stefano Cappai, Sandro Rolesu, Cristina Montomoli
Authors Thushara Galbadage, Brent M. Peterson, Richard S. Gunasekera
Authors Sangchul Park, Gina Jeehyun Choi, Haksoo Ko
Authors Zeynep Ceylan
ABSTRACT At the end of December 2019, coronavirus disease 2019 (COVID-19) appeared in Wuhan city, China. As of April 15, 2020, >1.9 million COVID-19 cases were confirmed worldwide, including >120,000 deaths. There is an urgent need to monitor and predict COVID-19 prevalence to control this spread more effectively. Time series models are significant in predicting the impact of the COVID-19 outbreak and taking the necessary measures to respond to this crisis. In this study, Auto-Regressive Integrated Moving Average (ARIMA) models were developed to predict the epidemiological trend of COVID-19 prevalence of Italy, Spain, and France, the most affected countries of Europe. The prevalence data of COVID-19 from 21 February 2020 to 15 April 2020 were collected from the World Health Organization website. Several ARIMA models were formulated with different ARIMA parameters. ARIMA (0,2,1), ARIMA (1,2,0), and ARIMA (0,2,1) models with the lowest MAPE values (4.7520, 5.8486, and 5.6335) were selected as the best models for Italy, Spain, and France, respectively. This study shows that ARIMA models are suitable for predicting the prevalence of COVID-19 in the future. The results of the analysis can shed light on understanding the trends of the outbreak and give an idea of the epidemiological stage of these regions. Besides, the prediction of COVID-19 prevalence trends of Italy, Spain, and France can help take precautions and policy formulation for this epidemic in other countries.
ANNALS OF INTERNAL MEDICINE
Authors David A Leon, Vladimir M Shkolnikov, Liam Smeeth, Per Magnus, Markéta Pechholdová, Christopher I Jarvis
Authors John Appleby
Authors Sarah Ee Fang Yong, Danielle Elizabeth Anderson, Wycliffe E Wei, Junxiong Pang, Wan Ni Chia, Chee Wah Tan, Yee Leong Teoh, Priyanka Rajendram, Matthias Paul Han Sim Toh, Cuiqin Poh, Valerie T J Koh, Joshua Lum, Nur-Afidah Md Suhaimi, Po Ying Chia, Mark I-Cheng Chen, Shawn Vasoo, Benjamin Ong, Yee Sin Leo, Linfa Wang, Vernon J M Lee
ABSTRACT Background Elucidation of the chain of disease transmission and identification of the source of coronavirus disease 2019 (COVID-19) infections are crucial for effective disease containment. We describe an epidemiological investigation that, with use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays, established links between three clusters of COVID-19. Methods In Singapore, active case-finding and contact tracing were undertaken for all COVID-19 cases. Diagnosis for acute disease was confirmed with RT-PCR testing. When epidemiological information suggested that people might have been nodes of disease transmission but had recovered from illness, SARS-CoV-2 IgG serology testing was used to establish past infection. Findings Three clusters of COVID-19, comprising 28 locally transmitted cases, were identified in Singapore; these clusters were from two churches (Church A and Church B) and a family gathering. The clusters in Church A and Church B were linked by an individual from Church A (A2), who transmitted SARS-CoV-2 infection to the primary case from Church B (F1) at a family gathering they both attended on Jan 25, 2020. All cases were confirmed by RT-PCR testing because they had active disease, except for A2, who at the time of testing had recovered from their illness and tested negative. This individual was eventually diagnosed with past infection by serological testing. ELISA assays showed an optical density of more than 1·4 for SARS-CoV-2 nucleoprotein and receptor binding domain antigens in titres up to 1/400, and viral neutralisation was noted in titres up to 1/320. Interpretation Development and application of a serological assay has helped to establish connections between COVID-19 clusters in Singapore. Serological testing can have a crucial role in identifying convalescent cases or people with milder disease who might have been missed by other surveillance methods. Funding National Research Foundation (Singapore), National Natural Science Foundation (China), and National Medical Research Council (Singapore).
Authors Tim K Tsang, Peng Wu, Yun Lin, Eric H Y Lau, Gabriel M Leung, Benjamin J Cowling
ABSTRACT Background When a new infectious disease emerges, appropriate case definitions are important for clinical diagnosis and for public health surveillance. Tracking case numbers over time is important to establish the speed of spread and the effectiveness of interventions. We aimed to assess whether changes in case definitions affected inferences on the transmission dynamics of coronavirus disease 2019 (COVID-19) in China. Methods We examined changes in the case definition for COVID-19 in mainland China during the first epidemic wave. We used exponential growth models to estimate how changes in the case definitions affected the number of cases reported each day. We then inferred how the epidemic curve would have appeared if the same case definition had been used throughout the epidemic. Findings From Jan 15 to March 3, 2020, seven versions of the case definition for COVID-19 were issued by the National Health Commission in China. We estimated that when the case definitions were changed, the proportion of infections being detected as cases increased by 7·1 times (95% credible interval [CrI] 4·8–10·9) from version 1 to 2, 2·8 times (1·9–4·2) from version 2 to 4, and 4·2 times (2·6–7·3) from version 4 to 5. If the fifth version of the case definition had been applied throughout the outbreak with sufficient testing capacity, we estimated that by Feb 20, 2020, there would have been 232 000 (95% CrI 161 000–359 000) confirmed cases in China as opposed to the 55 508 confirmed cases reported. Interpretation The case definition was initially narrow and was gradually broadened to allow detection of more cases as knowledge increased, particularly milder cases and those without epidemiological links to Wuhan, China, or other known cases. These changes should be taken into account when making inferences on epidemic growth rates and doubling times, and therefore on the reproductive number, to avoid bias. Funding Health and Medical Research Fund, Hong Kong.
Authors Benjamin J Cowling, Sheikh Taslim Ali, Tiffany W Y Ng, Tim K Tsang, Julian C M Li, Min Whui Fong, Qiuyan Liao, Mike YW Kwan, So Lun Lee, Susan S Chiu, Joseph T Wu, Peng Wu, Gabriel M Leung
Summary Background A range of public health measures have been implemented to suppress local transmission of coronavirus disease 2019 (COVID-19) in Hong Kong. We examined the effect of these interventions and behavioural changes of the public on the incidence of COVID-19, as well as on influenza virus infections, which might share some aspects of transmission dynamics with COVID-19. Methods We analysed data on laboratory-confirmed COVID-19 cases, influenza surveillance data in outpatients of all ages, and influenza hospitalisations in children. We estimated the daily effective reproduction number (Rt) for COVID-19 and influenza A H1N1 to estimate changes in transmissibility over time. Attitudes towards COVID-19 and changes in population behaviours were reviewed through three telephone surveys done on Jan 20–23, Feb 11–14, and March 10–13, 2020.
Findings COVID-19 transmissibility measured by Rt has remained at approximately 1 for 8 weeks in Hong Kong. Influenza transmission declined substantially after the implementation of social distancing measures and changes in population behaviours in late January, with a 44% (95% CI 34–53%) reduction in transmissibility in the community, from an estimated Rt of 1·28 (95% CI 1·26–1·30) before the start of the school closures to 0·72 (0·70–0·74) during the closure weeks. Similarly, a 33% (24–43%) reduction in transmissibility was seen based on paediatric hospitalisation rates, from an Rt of 1·10 (1·06–1·12) before the start of the school closures to 0·73 (0·68–0·77) after school closures. Among respondents to the surveys, 74·5%, 97·5%, and 98·8% reported wearing masks when going out, and 61·3%, 90·2%, and 85·1% reported avoiding crowded places in surveys 1 (n=1008), 2 (n=1000), and 3 (n=1005), respectively. Interpretation Our study shows that non-pharmaceutical interventions (including border restrictions, quarantine and isolation, distancing, and changes in population behaviour) were associated with reduced transmission of COVID-19 in Hong Kong, and are also likely to have substantially reduced influenza transmission in early February, 2020. Funding Health and Medical Research Fund, Hong Kong.
THE NEW ENGLAND JOUNAL OF MEDICINE
Authors Wafaa M. El‐Sadr, Jessica Justman
COCHRANE LIBRARY
Authors Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci
ABSTRACT Background In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID‐19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. Objectives To evaluate which type of full‐body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. Search methods We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. Selection criteria We included all controlled studies that evaluated the effect of full‐body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. Data collection and analysis Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random‐effects meta‐analyses were appropriate. Main results Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi‐RCT and nine had a non‐randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air‐purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non‐compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants), people with a long gown had less contamination than those with a coverall, and coveralls were more difficult to doff (low‐certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) −10.28, 95% CI −14.77 to −5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI −0.15 to 3.35) compared to more water‐repellent material but may have greater user satisfaction (MD −0.46, 95% CI −0.84 to −0.08, scale of 1 to 5). Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown‐wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low‐certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD −5.44, 95% CI −7.43 to −3.45). One‐step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double‐gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD −0.9, 95% CI −1.4 to −0.4) and to fewer contamination spots (MD −5, 95% CI −8.08 to −1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol‐based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD −1.2, 95% CI −1.6 to −0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face‐to‐face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. Authors' conclusions We found low‐ to very low‐certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort, and may therefore even lead to more contamination. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one‐step glove and gown removal, double‐gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face‐to‐face training in PPE use may reduce errors more than folder‐based training. We still need RCTs of training with long‐term follow‐up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real‐life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
Authors Gionata Fiorino, Matteo Colombo, Carmela Natale, Elena Azzolini, Michele Lagioia
Asian Pacific Journal of Tropical Medicine
Authors Marli C Cupertino, Graziela A Cupertino, Andréia P Gomes, Nicholas AJ Mayers, R Siqueira-Batista
THE NEW JOURNAL OF MEDICINE
Authors D.F. Gudbjartsson, A. Helgason, H. Jonsson, O.T. Magnusson, P. Melsted, G.L. Norddahl, J. Saemundsdottir, A. Sigurdsson, P. Sulem, A.B. Agustsdottir, B. Eiriksdottir, R. Fridriksdottir, E.E. Gardarsdottir, G. Georgsson, O.S. Gretarsdottir, K.R. Gudmundsson, T.R. Gunnarsdottir, A. Gylfason, H. Holm, B.O. Jensson, A. Jonasdottir, F. Jonsson, K.S. Josefsdottir, T. Kristjansson, D.N. Magnusdottir, L. le Roux, G. Sigmundsdottir, G. Sveinbjornsson, K.E. Sveinsdottir, M. Sveinsdottir, E.A. Thorarensen, B. Thorbjornsson, A. Löve, G. Masson, I. Jonsdottir, A.D. Möller, T. Gudnason, K.G. Kristinsson, U. Thorsteinsdottir, and K. Stefansson
ABSTRACT BACKGROUND During the current worldwide pandemic, coronavirus disease 2019 (Covid-19) was first diagnosed in Iceland at the end of February. However, data are limited on how SARS-CoV-2, the virus that causes Covid-19, enters and spreads in a population. METHODS We targeted testing to persons living in Iceland who were at high risk for infection (mainly those who were symptomatic, had recently traveled to high-risk countries, or had contact with infected persons). We also carried out population screening us- ing two strategies: issuing an open invitation to 10,797 persons and sending random invitations to 2283 persons. We sequenced SARS-CoV-2 from 643 samples. RESULTS As of April 4, a total of 1221 of 9199 persons (13.3%) who were recruited for tar- geted testing had positive results for infection with SARS-CoV-2. Of those tested in the general population, 87 (0.8%) in the open-invitation screening and 13 (0.6%) in the random-population screening tested positive for the virus. In total, 6% of the population was screened. Most persons in the targeted-testing group who received positive tests early in the study had recently traveled internationally, in contrast to those who tested positive later in the study. Children under 10 years of age were less likely to receive a positive result than were persons 10 years of age or older, with percentages of 6.7% and 13.7%, respectively, for targeted testing; in the population screening, no child under 10 years of age had a positive result, as compared with 0.8% of those 10 years of age or older. Fewer females than males received positive results both in targeted testing (11.0% vs. 16.7%) and in population screening (0.6% vs. 0.9%). The haplotypes of the sequenced SARS-CoV-2 viruses were diverse and changed over time. The percentage of infected participants that was determined through population screening remained stable for the 20-day duration of screening. CONCLUSIONS In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males. The proportion of infected persons identified through population screening did not change substantially during the screening period, which was consistent with a beneficial effect of containment efforts. (Funded by deCODE Genetics–Amgen.)
Science
Authors Stephen M. Kissler, Christine Tedijanto, Edward Goldstein, Yonatan H. Grad, Marc Lipsitch
ABSTRACT It is urgent to understand the future of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission. We used estimates of seasonality, immunity, and cross-immunity for betacoronaviruses OC43 and HKU1 from time series data from the USA to inform a model of SARS-CoV-2 transmission. We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022. Additional interventions, including expanded critical care capacity and an effective therapeutic, would improve the success of intermittent distancing and hasten the acquisition of herd immunity. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to SARS-CoV-2. Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.
Authors James M. Sanders, Marguerite L. Monogue, Tomasz Z. Jodlowski, James B. Cutrell
SIMIT
Authors SIMIT (Società Italiana Malattie Infettive e Tropicali)
Authors K. Barroa, A. Malone b, A. Mokedea, C. Chevancec
Authors David M. Hartley, Eli N. Perencevich
The New England Journal of Medicine
Authors Erin P. Fraher, Patricia Pittman, Bianca K. Frogner, Joanne Spetz, Jean Moore, Angela J. Beck, David Armstrong, Peter I. Buerhaus
Authors Marzia Lazzerini, Egidio Barbi, Andrea Apicella, Federico Marchetti, Fabio Cardinale, Gianluca Trobia
Authors Tom McEnery, Ciara Gough, Richard W Costello
Authors David M. Studdert, L.L.B., Sc.D., and Mark A. Hall, J.D.
Authors Kathy Leung, Joseph T Wu, Di Liu, Gabriel M Leung
Summary Background As of March 18, 2020, 13 415 confirmed cases and 120 deaths related to coronavirus disease 2019 (COVID-19) in mainland China, outside Hubei province—the epicentre of the outbreak—had been reported. Since late January, massive public health interventions have been implemented nationwide to contain the outbreak. We provide an impact assessment of the transmissibility and severity of COVID-19 during the first wave in mainland Chinese locations outside Hubei. Methods We estimated the instantaneous reproduction number (Rt) of COVID-19 in Beijing, Shanghai, Shenzhen, Wenzhou, and the ten Chinese provinces that had the highest number of confirmed COVID-19 cases; and the confirmed case-fatality risk (cCFR) in Beijing, Shanghai, Shenzhen, and Wenzhou, and all 31 Chinese provinces. We used a susceptible–infectious–recovered model to show the potential effects of relaxing containment measures after the first wave of infection, in anticipation of a possible second wave.
Findings In all selected cities and provinces, the Rt decreased substantially since Jan 23, when control measures were implemented, and have since remained below 1. The cCFR outside Hubei was 0·98% (95% CI 0·82–1·16), which was almost five times lower than that in Hubei (5·91%, 5·73–6·09). Relaxing the interventions (resulting in Rt >1) when the epidemic size was still small would increase the cumulative case count exponentially as a function of relaxation duration, even if aggressive interventions could subsequently push disease prevalence back to the baseline level. Interpretation The first wave of COVID-19 outside of Hubei has abated because of aggressive non-pharmaceutical interventions. However, given the substantial risk of viral reintroduction, particularly from overseas importation, close monitoring of Rt and cCFR is needed to inform strategies against a potential second wave to achieve an optimal balance between health and economic protection. Funding Health and Medical Research Fund, Hong Kong, China.
Authors Benjamin F. Maier, Dirk Brockmann
ABSTRACT The recent outbreak of COVID-19 in Mainland China was characterized by a distinctive subexponential increase of confirmed cases during the early phase of the epidemic, contrasting an initial exponential growth expected for an unconstrained outbreak. We show that this effect can be explained as a direct consequence of containment policies that effectively deplete the susceptible population. To this end, we introduce a parsimonious model that captures both, quarantine of symptomatic infected individuals as well as population-wide isolation practices in response to containment policies or behavioral changes and show that the model captures the observed growth behavior accurately. The insights provided here may aid the careful implementation of containment strategies for ongoing secondary outbreaks of COVID-19 or similar future outbreaks of other emergent infectious diseases.
AMA
Authors Boccia, Ricciardi, Ioannidis
Authors Ned Stafford
IJBS
Authors Annoor Awadasseid, Yanling Wu, Yoshimasa Tanaka, Wen Zhang
ABSTRACT Coronavirus (CoV) has been one of the major pandemic threats to human health in the last two decades. The human coronavirus was first identified in 1960s. CoVs 229E, NL63, OC43, HKU1, SARS-CoV, and MERS-CoV have caused numerous disasters or human deaths worldwide. Recently, an outbreak of the previously unknown deadly CoV disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV 2 (SARS-CoV-2, early named 2019-nCoV) occurred in Wuhan, China, and it had caused 81238 cases of confirmed infection, including 3250 deaths until March 19, 2020. Its risks and pandemic potential have brought global consideration. We summarized epidemiology, virological characteristics, clinical symptoms, diagnostic methods, clinical treatments, and prevention methods for COVID-19 to present a reference for the future wave of probable CoV outbreaks.
Authors Russell M Viner, Simon J Russell, Helen Croker, Jessica Packer, Joseph Ward, Claire Stansfield, Oliver Mytton, Chris Bonell, Robert Booy
ABSTRACT In response to the coronavirus disease 2019 (COVID-19) pandemic, 107 countries had implemented national school closures by March 18, 2020. It is unknown whether school measures are effective in coronavirus outbreaks (eg, due to severe acute respiratory syndrome [SARS], Middle East respiratory syndrome, or COVID-19). We undertook a systematic review by searching three electronic databases to identify what is known about the effectiveness of school closures and other school social distancing practices during coronavirus outbreaks. We included 16 of 616 identified articles. School closures were deployed rapidly across mainland China and Hong Kong for COVID-19. However, there are no data on the relative contribution of school closures to transmission control. Data from the SARS outbreak in mainland China, Hong Kong, and Singapore suggest that school closures did not contribute to the control of the epidemic. Modelling studies of SARS produced conflicting results. Recent modelling studies of COVID-19 predict that school closures alone would prevent only 2–4% of deaths, much less than other social distancing interventions. Policy makers need to be aware of the equivocal evidence when considering school closures for COVID-19, and that combinations of social distancing measures should be considered. Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods.
Authors Joon-Young Song, Jin-Gu Yun, Ji-Yun Noh, Hee-Jin Cheong, Woo-Joo Kim
Authors Aurelio Tobías
ABSTRACT From the end of February, the SARS-CoV-2 epidemic in Spain has been following the footsteps of that in Italy very closely. We have analyzed the trends of incident cases, deaths, and intensive care unit admissions (ICU) in both countries before and after their respective national lockdowns using an interrupted time-series design. Data was analyzed with quasi-Poisson regression using an interaction model to estimate the change in trends. After the first lockdown, incidence trends were considerably reduced in both countries. However, although the slopes have been flattened for all outcomes, the trends kept rising. During the second lockdown, implementing more restrictive measures for mobility, it has been a change in the trend slopes for both countries in daily incident cases and ICUs. This improvement indicates that the efforts overtaken are being successful in flattening the epidemic curve, and reinforcing the belief that we must hold on.
European Medicines Agency Science Medicines Health
Authors European Medicines Agency
Authors Simiao Chen, Zongjiu Zhang, Juntao Yang, Jian Wang, Xiaohui Zhai, Till Bärnighausen, Chen Wang
ABSTRACT Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.
ICMRA
Authors ICMRA
Authors Michael Klompas, Charles A. Morris, Julia Sinclair, Madelyn Pearson, Erica S. Shenoy
Authors Rene Niehus, Pablo M De Salazar, Aimee R Taylor, Marc Lipsitch
Summary Background The incidence of coronavirus disease 2019 (COVID-19) in Wuhan, China, has been estimated using imported case counts of international travellers, generally under the assumptions that all cases of the disease in travellers have been ascertained and that infection prevalence in travellers and residents is the same. However, findings indicate variation among locations in the capacity for detection of imported cases. Singapore has had very strong epidemiological surveillance and contact tracing capacity during previous infectious disease outbreaks and has consistently shown high sensitivity of case-detection during the COVID-19 outbreak. Methods We used a Bayesian modelling approach to estimate the relative capacity for detection of imported cases of COVID-19 for 194 locations (excluding China) compared with that for Singapore. We also built a simple mathematical model of the point prevalence of infection in visitors to an epicentre relative to that in residents.
Findings The weighted global ability to detect Wuhan-to-location imported cases of COVID-19 was estimated to be 38% (95% highest posterior density interval [HPDI] 22–64) of Singapore’s capacity. This value is equivalent to 2·8 (95% HPDI 1·5–4·4) times the current number of imported and reported cases that could have been detected if all locations had had the same detection capacity as Singapore. Using the second component of the Global Health Security index to stratify likely case-detection capacities, the ability to detect imported cases relative to Singapore was 40% (95% HPDI 22–67) among locations with high surveillance capacity, 37% (18–68) among locations with medium surveillance capacity, and 11% (0–42) among locations with low surveillance capacity. Treating all travellers as if they were residents (rather than accounting for the brief stay of some of these travellers in Wuhan) contributed modestly to underestimation of prevalence. Interpretation Estimates of case counts in Wuhan based on assumptions of 100% detection in travellers could have been underestimated by several fold. Furthermore, severity estimates will be inflated several fold since they also rely on case count estimates. Finally, our model supports evidence that underdetected cases of COVID-19 have probably spread in most locations around the world, with greatest risk in locations of low detection capacity and high connectivity to the epicentre of the outbreak. Funding US National Institute of General Medical Sciences, and Fellowship Foundation Ramon Areces
Authors Tim Baker, Carl Otto Schell, Dan Brun Petersen, Hendry Sawe, Karima Khalid, Samson Mndolo, Jamie Rylance, Daniel F McAuley, Nobhojit Roy, John Marshall, Lee Wallis, Elizabeth Molyneux
Authors Gavin Yamey, Marco Schäferhoff, Richard Hatchett, Muhammad Pate, Feng Zhao, Kaci Kennedy McDade
Authors Derek C. Angus
Authors Ashleigh R Tuite, Victoria Ng, Erin Rees, David Fisman, Annelies Wilder-Smith, Kamran Khan, Isaac I Bogoch
OSFPREPRINTS
Authors Boris Bibkov, Alexander Bibkov
ABSTRACT The manuscript highlights available data on gap in public awareness about recent clinical and scientific facts about COVID-19, insufficient community knowledge about symptoms and preventive measures during COVID-19 and previous MERS-CoV epidemic, and lack of monitoring the community perception and adherence to preventive measures. We also summarize literature evidence about reluctance to change social behavior and disregard recommendations for social distancing among persons who percept to having low risk of infection or complications, and briefly describe destructive psychological response and misleading communications. Our analysis could be translated into important policy changes in two directions: (1) to communicate recent scientific discoveries about COVID-19 pathophysiology to better prepare public opinion to longer period of extraordinary measures; (2) to implement sociological feedback on knowledge, attitudes and practices among general public and some vulnerable social groups.
NEJM
Authors Mirco Nacoti, Andrea Ciocca, Angelo Giupponi, Pietro Brambillasca, Federico Lussana, Michele Pisano, Giuseppe Goisis, Daniele Bonacina, Francesco Fazzi, Richard Naspro, Luca Longhi, Maurizio Cereda, Carlo Montaguti
In a pandemic, patient-centered care is inadequate and must be replaced by community-centered care. Solutions for Covid-19 are required for the entire population, not only for hospitals. The catastrophe unfolding in wealthy Lombardy could happen anywhere. Clinicians at a hospital at the epicenter call for a long-term plan for the next pandemic.
Morbidity and Mortality Weekly Report
Authors Kensaku Kakimoto, Hajime Kamiya, Takuya Yamagishi, Tamano Matsui, Motoi Suzuki, Takaji Wakita
JAMA Network
Authors Giacomo Grasselli, Antonio Pesenti, Maurizio Cecconi
Authors Adam J Kucharski, Timothy W Russell, Charlie Diamond, Yang Liu, John Edmunds, Sebastian Funk, Rosalind M Eggo
Background An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to 95333 confirmed cases as of March 5, 2020. Understanding the early transmission dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Combining a mathematical model of severe SARS-CoV-2 transmission with four datasets from within and outside Wuhan, we estimated how transmission in Wuhan varied between December, 2019, and February, 2020. We used these estimates to assess the potential for sustained human-to-human transmission to occur in locations outside Wuhan if cases were introduced. Methods We combined a stochastic transmission model with data on cases of coronavirus disease 2019 (COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how transmission had varied over time during January, 2020, and February, 2020. Based on these estimates, we then calculated the probability that newly introduced cases might generate outbreaks in other areas. To estimate the early dynamics of transmission in Wuhan, we fitted a stochastic transmission dynamic model to multiple publicly available datasets on cases in Wuhan and internationally exported cases from Wuhan. The four datasets we fitted to were: daily number of new internationally exported cases (or lack thereof), by date of onset, as of Jan 26, 2020; daily number of new cases in Wuhan with no market exposure, by date of onset, between Dec 1, 2019, and Jan 1, 2020; daily number of new cases in China, by date of onset, between Dec 29, 2019, and Jan 23, 2020; and proportion of infected passengers on evacuation flights between Jan 29, 2020, and Feb 4, 2020. We used an additional two datasets for comparison with model outputs: daily number of new exported cases from Wuhan (or lack thereof) in countries with high connectivity to Wuhan (ie, top 20 most at-risk countries), by date of confirmation, as of Feb 10, 2020; and data on new confirmed cases reported in Wuhan between Jan 16, 2020, and Feb 11, 2020. Findings We estimated that the median daily reproduction number (Rt) in Wuhan declined from 2·35 (95% CI 1·15–4·77) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1·05 (0·41–2·39) 1 week after. Based on our estimates of Rt, assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population. Interpretation Our results show that COVID-19 transmission probably declined in Wuhan during late January, 2020, coinciding with the introduction of travel control measures. As more cases arrive in international locations with similar transmission potential to Wuhan before these control measures, it is likely many chains of transmission will fail to establish initially, but might lead to new outbreaks eventually. Funding Wellcome Trust, Health Data Research UK, Bill & Melinda Gates Foundation, and National Institute for Health Research.
Authors Luca Cabrini, Giovanni Landoni, Alberto Zangrillo
Authors Fabrizio Carinci
“Menarini Pills of Art” Il nuovo progetto multimediale di Menarini legato al mondo dell’arte
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