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Most downloaded biology preprints, since beginning of last month

in category health policy

399 results found. For more information, click each entry to expand.

1: The potential impact of vaccine passports on inclination to accept COVID-19 vaccinations in the United Kingdom: evidence from a large cross-sectional survey and modelling study
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Posted 01 Jun 2021

The potential impact of vaccine passports on inclination to accept COVID-19 vaccinations in the United Kingdom: evidence from a large cross-sectional survey and modelling study
4,207 downloads medRxiv health policy

Alex de Figueiredo, Heidi J Larson, Stephen D Reicher

Background: Four vaccines against the novel coronavirus 2019 disease (COVID-19) caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2) have currently been approved for use in the United Kingdom. As of 30 April 2021, over 34 million adults have received at least one dose of a COVID-19 vaccine. The UK Government is considering the introduction of vaccine passports for domestic use and to facilitate international travel for UK residents. Although vaccine incentivisation has been cited as a motivating factor for vaccine passports, it is currently unclear whether vaccine passports are likely to increase inclination to accept a COVID-19 vaccine. Methods: We conducted a large-scale national survey in the UK of 17,611 adults between 9 and 27 April 2021. Bayesian multilevel regression and poststratification is used to provide unbiased national-level estimates of the impact of the introduction of vaccine passports on inclination to accept COVID-19 vaccines among all respondents who have not yet had two vaccination doses. Multilevel regressions identify the differential impact of the likely impact of vaccine passports on uptake intent between socio-demographic groups. Gibbs sampling was used for Bayesian model inference, with 95% highest posterior density intervals used to capture uncertainty in all parameter estimates. Findings: We find that the introduction of vaccine passports will likely lower inclination to accept a COVID-19 vaccine once baseline vaccination intent has been adjusted for. Notably, this decrease is larger if passports were required for domestic use rather than for facilitating international travel. The impact of passports while controlling for baseline vaccination intent differentially impacts individuals by socio-demographic status, with being male (OR 0.87, 0.76 to 0.99) and having degree qualifications (OR 0.84, 0.72 to 0.94) associated with a decreased inclination to vaccinate if passports were required for domestic use, while Christians (OR 1.23, 1.08 to 1.41) have an increased inclination over atheists or agnostics. There is a strong association between change in vaccination inclination if passports were introduced and baseline vaccination intent: stated change in vaccination inclination is thus lower among Black or Black British respondents (compared to Whites), younger age groups, and non-English speakers. We find notable sub-national trends, for example, that passports could increase inclination among students and Jewish respondents in London compared to those in full-time education or atheists or agnostics, respectively. Interpretation: To our knowledge, this is the first quantitative assessment of the potential impact of the introduction of vaccine passports on COVID-19 vaccine intention. Our findings should be interpreted in light of sub-national trends in current uptake rates across the UK, as our results suggest that vaccine passports may induce a lower vaccination inclination in socio-demographic groups that cluster geographically in large urban areas. Caution should therefore be exercised in introducing passports as they may result in less positive health-seeking behaviours for the COVID-19 vaccine (as well as other existing or future vaccinations) and may contribute to concentrated areas of low vaccinate uptake, which is an epidemic risk. We call for further evidence on the impact of vaccine certification on confidence in COVID-19 vaccines and in routine immunisations in wider global settings and, in particular, in countries with low overall trust in vaccinations or in authorities that administer or recommend vaccines.

2: Association between City-wide Lockdown and COVID-19 Hospitalization Rates in Multigenerational Households in New York City
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Posted 06 Sep 2021

Association between City-wide Lockdown and COVID-19 Hospitalization Rates in Multigenerational Households in New York City
3,545 downloads medRxiv health policy

Arnab K Ghosh, Sara Venkataraman, Evgeniya Reshetnyak, Mangala Rajan, Anjile An, John K Chae, Mark A Unruh, David Abramson, Charles K DiMaggio, Nathaniel Hupert

Background: City-wide lockdowns and school closures have demonstrably impacted COVID-19 transmission. However, simulation studies have suggested an increased risk of COVID-19 related morbidity for older individuals inoculated by house-bound children. This study examines whether the March 2020 lockdown in New York City (NYC) was associated with higher COVID-19 hospitalization rates in neighborhoods with larger proportions of multigenerational households. Methods: We obtained daily age-segmented COVID-19 hospitalization counts in each of 166 ZIP code tabulation areas (ZCTAs) in NYC. Using Bayesian Poisson regression models that account for spatiotemporal dependencies between ZCTAs, as well as socioeconomic risk factors, we conducted a difference-in-differences study amongst ZCTA-level hospitalization rates from February 23 to May 2, 2020. We compared ZCTAs in the lowest quartile of multigenerational housing to other quartiles before and after the lockdown. Findings: Among individuals over 55 years, the lockdown was associated with higher COVID-19 hospitalization rates in ZCTAs with more multigenerational households. The greatest difference occurred three weeks after lockdown: Q2 vs. Q1: 54% increase (95% Bayesian credible intervals: 22 to 96%); Q3 vs. Q1: 48%, (17 to 89%); Q4 vs. Q1: 66%, (30 to 211%). After accounting for pandemic-related population shifts, a significant difference was observed only in Q4 ZCTAs: 37% (7 to 76%). Interpretation: By increasing house-bound mixing across older and younger age groups, city-wide lockdown mandates imposed during the growth of COVID-19 cases may have inadvertently, but transiently, contributed to increased transmission in multigenerational households.

3: COVID-19 Mitigation Practices and COVID-19 Rates in Schools: Report on Data from Florida, New York and Massachusetts
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Posted 21 May 2021

COVID-19 Mitigation Practices and COVID-19 Rates in Schools: Report on Data from Florida, New York and Massachusetts
2,541 downloads medRxiv health policy

Emily Oster, Rebecca Jack, Clare Halloran, John Schoof, Diana McLeod

This paper reports on the correlation of mitigation practices with staff and student COVID-19 case rates in Florida, New York, and Massachusetts during the 2020-2021 school year. We analyze data collected by the COVID-19 School Response Dashboard and focus on student density, ventilation upgrades, and masking. We find higher student COVID-19 rates in schools and districts with lower in-person density but no correlations in staff rates. Ventilation upgrades are correlated with lower rates in Florida but not in New York. We do not find any correlations with mask mandates. All rates are lower in the spring, after teacher vaccination is underway

4: Acceptance and Attitudes Toward COVID-19 Vaccines: A Cross-Sectional Study from Jordan
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Posted 24 Dec 2020

Acceptance and Attitudes Toward COVID-19 Vaccines: A Cross-Sectional Study from Jordan
1,397 downloads medRxiv health policy

Tamam El-Elimat, Mahmoud M. AbuAlSamen, Basima A. Almomani, Nour A. Al-Sawalha, Feras Q. Alali

BackgroundVaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for public health authorities. With the availability of COVID-19 vaccines, little information is available on the public acceptability and attitudes towards the COVID-19 vaccines in Jordan. This study aimed to investigate the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these vaccines among public in Jordan. MethodsAn online, cross-sectional, and self-administered questionnaire was instrumentalized to survey adult participants from Jordan on the acceptability of COVID-19 vaccines. Logistic regression analysis was used to find the predictors of COVID-19 vaccines acceptability. ResultsA total of 3,100 participants completed the survey. The public acceptability of COVID-19 vaccines was fairly low (37.4%) in Jordan. Males (OR=2.488, 95CI%=1.834-3.375, p<.001) and those who took the seasonal influenza vaccine (OR=2.036, 95CI%=1.306-3.174, p=.002) were more likely to accept Covid-19 vaccines. Similarly, participants who believed that vaccines are generally safe (OR=9.258, 95CI%=6.020-14.237, p<.001) and those who were willing to pay for vaccines (OR=19.223, 95CI%=13.665-27.042, p<.001), once available, were more likely to accept the COVID-19 vaccines. However, those above 35 years old (OR=0.376, 95CI%=0.233-0.607, p<.001) and employed participants (OR=0.542, 95CI%=0.405-0.725, p<.001) were less likely to accept the COVID-19 vaccines. Moreover, participants who believed that there was a conspiracy behind COVID-19 (OR=0.502, 95CI%=0.356- 0.709, p<.001) and those who do not trust any source of information on COVID-19 vaccines (OR=0.271, 95CI%=0.183 - 0.400, p<.001), were less likely to have acceptance towards them. The most trusted sources of information on COVID-19 vaccines were healthcare providers. ConclusionSystematic interventions are required by public health authorities to reduce the levels of vaccines hesitancy and improve their acceptance. We believe these results and specifically the low rate of acceptability is alarming to Jordanian health authorities and should stir further studies on the root causes and the need of awareness campaigns. These interventions should take the form of reviving the trust in national health authorities and structured awareness campaigns that offer transparent information about the safety and efficacy of the vaccines and the technology that was utilized in their production.

5: Multi-organ impairment in low-risk individuals with long COVID
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Posted 16 Oct 2020

Multi-organ impairment in low-risk individuals with long COVID
707 downloads medRxiv health policy

Andrea Dennis, Malgorzata Wamil, Sandeep Kapur, Johann Alberts, Andrew D Badley, Gustav Anton Decker, Stacey A. Rizza, Rajarshi Banerjee, Amitava Banerjee, On behalf of the COVERSCAN study investigators

BackgroundSevere acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection has disproportionately affected older individuals and those with underlying medical conditions. Research has focused on short-term outcomes in hospital, and single organ involvement. Consequently, impact of long COVID (persistent symptoms three months post-infection) across multiple organs in low-risk individuals is yet to be assessed. MethodsAn ongoing prospective, longitudinal, two-centre, observational study was performed in individuals symptomatic after recovery from acute SARS-CoV-2 infection. Symptoms and organ function (heart, lungs, kidneys, liver, pancreas, spleen) were assessed by standardised questionnaires (EQ-5D-5L, Dyspnoea-12), blood investigations and quantitative magnetic resonance imaging, defining single and multi-organ impairment by consensus definitions. FindingsBetween April and September 2020, 201 individuals (mean age 44 (SD 11.0) years, 70% female, 87% white, 31% healthcare workers) completed assessments following SARS-CoV-2 infection (median 140, IQR 105-160 days after initial symptoms). The prevalence of pre-existing conditions (obesity: 20%, hypertension: 6%; diabetes: 2%; heart disease: 4%) was low, and only 18% of individuals had been hospitalised with COVID-19. Fatigue (98%), muscle aches (88%), breathlessness (87%), and headaches (83%) were the most frequently reported symptoms. Ongoing cardiorespiratory (92%) and gastrointestinal (73%) symptoms were common, and 42% of individuals had ten or more symptoms. There was evidence of mild organ impairment in heart (32%), lungs (33%), kidneys (12%), liver (10%), pancreas (17%), and spleen (6%). Single (66%) and multi-organ (25%) impairment was observed, and was significantly associated with risk of prior COVID-19 hospitalisation (p<0.05). InterpretationIn a young, low-risk population with ongoing symptoms, almost 70% of individuals have impairment in one or more organs four months after initial symptoms of SARS-CoV-2 infection. There are implications not only for burden of long COVID but also public health approaches which have assumed low risk in young people with no comorbidities. FundingThis work was supported by the UKs National Consortium of Intelligent Medical Imaging through the Industry Strategy Challenge Fund, Innovate UK Grant 104688, and also through the European Unions Horizon 2020 research and innovation programme under grant agreement No 719445.

6: Additional heterologous versus homologous booster vaccination in immunosuppressed patients without SARS-CoV-2 antibody seroconversion after primary mRNA vaccination: a randomized controlled trial
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Posted 08 Sep 2021

Additional heterologous versus homologous booster vaccination in immunosuppressed patients without SARS-CoV-2 antibody seroconversion after primary mRNA vaccination: a randomized controlled trial
695 downloads medRxiv health policy

Michael Bonelli, Daniel Mrak, Selma Tobudic, Daniela Sieghart, Maximilian Koblischke, Peter Mandl, Barbara Kornek, Elisabeth Simader, Helga Radner, Thomas Perkmann, Helmuth Haslacher, Margareta Mayer, Philipp Hofer, Kurt Redlich, Emma Husar-Memmer, Ruth Fritsch-Stork, Renate Thalhammer, Karin Stiasny, Stefan Winkler, Josef S. Smolen, Judith H. Aberle, Markus Zeitlinger, Leonhard X. Heinz, Daniel Aletaha

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) has led to exponentially rising mortality, particularly in immunosuppressed patients, who inadequately respond to conventional COVID-19 vaccination. In this blinded randomized clinical trial (EudraCT 2021-002348-57) we compare the efficacy and safety of an additional booster vaccination with a vector versus mRNA vaccine in non-seroconverted patients. We assigned 60 patients under rituximab treatment, who did not seroconvert after their primary mRNA vaccination with either BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna), to receive a third dose, either using the same mRNA or the vector vaccine ChAdOx1 nCoV-19 (Oxford-AstraZeneca). Patients were stratified according to the presence of peripheral B-cells. The primary efficacy endpoint was the difference in the SARS-CoV-2 antibody seroconversion rate between vector (heterologous) and mRNA (homologous) vaccinated patients by week four. Key secondary endpoints included the overall seroconversion and cellular immune response; safety was assessed at weeks one and four. Seroconversion rates at week four were comparable between vector (6/27 patients, 22%) and mRNA (9/28, 32%) vaccine (p=0.6). Overall, 27% of patients seroconverted; specific T-cell responses were observed in 20/20 (100%) vector versus 13/16 (81%) mRNA vaccinated patients. Newly induced humoral and/or cellular responses occurred in 9/11 (82%) patients. No serious adverse events, related to immunization, were observed. This enhanced humoral and/or cellular immune response supports an additional booster vaccination in non-seroconverted patients irrespective of a heterologous or homologous vaccination regimen.

7: Who funded the research behind the Oxford-AstraZeneca COVID-19 vaccine? - Approximating the funding to the University of Oxford for the research and development of the ChAdOx vaccine technology
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Posted 10 Apr 2021

Who funded the research behind the Oxford-AstraZeneca COVID-19 vaccine? - Approximating the funding to the University of Oxford for the research and development of the ChAdOx vaccine technology
662 downloads medRxiv health policy

Samuel Cross, Yeanuk Rho, Henna Reddy, Toby Pepperrell, Florence Rodgers, Rhiannon Osborne, Ayolola Eni-Olotu, Rishi Banerjee, Sabrina Wimmer, Sarai Mirjam Keestra

Objectives: The Oxford-AstraZeneca COVID-19 vaccine (ChAdOx1 nCoV-19 or Vaxzevira) builds on nearly two decades of research and development (R&D) into Chimpanzee adenovirus-vectored vaccine (ChAdOx) technology at the University of Oxford. This study aims to approximate the funding for the R&D of the ChAdOx technology and the Oxford-AstraZeneca vaccine, and assess the transparency of funding reporting mechanisms. Design: We conducted a scoping review and publication history analysis of the principal investigators to reconstruct the funding for the R&D of the ChAdOx technology. We matched award numbers with publicly-accessible grant databases. We filed Freedom Of Information (FOI) requests to the University of Oxford for the disclosure of all grants for ChAdOx R&D. Results: We identified 100 peer-reviewed articles relevant to ChAdOx technology published between 01/2002 and 10/2020, extracting 577 mentions of funding bodies from funding acknowledgement statements. Government funders from overseas were mentioned 158 (27.4%), the U.K. government 147 (25.5%) and charitable funders 138 (23.9%) times. Grant award numbers were identified for 215 (37.3%) mentions, amounts were available in the public realm for 121 (21.0%) mentions. Based on the FOIs, until 01/2020, the European Commision (34.0%), Wellcome Trust (20.4%) and CEPI (17.5%) were the biggest funders of ChAdOx R&D. From 01/2020, the U.K. Department of Health and Social Care was the single largest funder (89.3%). The identified R&D funding was GBP104,226,076 reported in the FOIs, and GBP228,466,771 reconstructed from the literature search. Conclusions: Our study identified that public funding accounted for 97.1-99.0% of the funding towards the R&D of ChAdOx and the Oxford-AstraZeneca vaccine. We furthermore encountered a severe lack of transparency in research funding reporting mechanisms.

8: Pandemic Politics: Timing State-Level Social Distancing Responses to COVID-19
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Posted 31 Mar 2020

Pandemic Politics: Timing State-Level Social Distancing Responses to COVID-19
645 downloads medRxiv health policy

Christopher Adolph, Kenya Amano, Bree Bang-Jensen, Nancy Fullman, John Wilkerson

Social distancing policies are critical but economically painful measures to flatten the curve against emergent infectious diseases. As the novel coronavirus that causes COVID-19 spread throughout the United States in early 2020, the federal government issued social distancing recommendations but left to the states the most difficult and consequential decisions restricting behavior, such as canceling events, closing schools and businesses, and issuing stay-at-home orders. We present an original dataset of state-level social distancing policy responses to the epidemic and explore how political partisanship, COVID-19 caseload, and policy diffusion explain the timing of governors decisions to mandate social distancing. An event history analysis of five social distancing policies across all fifty states reveals the most important predictors are political: all else equal, Republican governors and governors from states with more Trump supporters were slower to adopt social distancing policies. These delays are likely to produce significant, on-going harm to public health.

9: State-wise estimates of current hospital beds, intensive care unit (ICU) beds and ventilators in India: Are we prepared for a surge in COVID-19 hospitalizations?
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Posted 18 Jun 2020

State-wise estimates of current hospital beds, intensive care unit (ICU) beds and ventilators in India: Are we prepared for a surge in COVID-19 hospitalizations?
549 downloads medRxiv health policy

Geetanjali Kapoor, Stephanie Hauck, Aditi Sriram, Jyoti Joshi, Emily Schueller, Isabel Frost, Ruchita Balasubramanian, Ramanan Laxminarayan, Arindam Nandi

Background The rapid spread of COVID-19 globally has prompted policymakers to evaluate the capacity of health care infrastructure in their communities. Many hard-hit localities have witnessed a large influx of severe cases that strained existing hospitals. As COVID-19 spreads in India, it is essential to evaluate the country's capacity to treat severe cases. Methods We combined data on public and private sector hospitals in India to produce state level estimates of hospital beds, ICU beds, and mechanical ventilators. Based on the number of public sector hospitals from the 2019 National Health Profile (NHP) of India and the relative proportions of public and private health care facilities from the National Sample Survey (NSS) 75th round (2017-2018), we estimated capacity in each Indian state and union territory (UT). We assumed that 5% of all hospital beds were ICU beds and that 50% of ICU beds were equipped with ventilators. Results We estimated that India has approximately 1.9 million hospital beds, 95,000 ICU beds and 48,000 ventilators. Nationally, resources are concentrated in the private sector (hospital beds: 1,185,242 private vs 713,986 public; ICU beds: 59,262 private vs 35,699 public; ventilators: 29,631 private vs. 17,850 public). Our findings suggest substantial variation in available resources across states and UTs. Conclusion Some projections shave suggested a potential need for approximately 270,000 ICU beds in an optimistic scenario, over 2.8 times the estimated number of total available ICU beds in India. Additional resources will likely be required to accommodate patients with severe COVID-19 infections in India.

10: Women in power: Female leadership and public health outcomes during the COVID-19 pandemic
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Posted 15 Jul 2020

Women in power: Female leadership and public health outcomes during the COVID-19 pandemic
316 downloads medRxiv health policy

Luca Coscieme, Lorenzo Fioramonti, Lars F Mortensen, Kate Pickett, Ida Kubiszewski, Hunter Lovins, Jacqueline McGlade, Kristin Vala Ragnarsdottir, Debra Roberts, Robert Costanza, Roberto De Vogli, Richard Wilkinson

Some countries have been more successful than others at dealing with the COVID-19 pandemic. When we explore the different policy approaches adopted as well as the underlying socio-economic factors, we note an interesting set of correlations: countries led by women leaders have fared significantly better than those led by men on a wide range of dimensions concerning the global health crisis. In this paper, we analyze available data for 35 countries, focusing on the following variables: number of deaths per capita due to COVID-19, number of days with reported deaths, peaks in daily deaths, deaths occurred on the first day of lockdown, and excess mortality. Results show that countries governed by female leaders experienced much fewer COVID-19 deaths per capita and were more effective and rapid at flattening the epidemic's curve, with lower peaks in daily deaths. We argue that there are both contingent and structural reasons that may explain these stark differences. First of all, most women-led governments were more prompt at introducing restrictive measures in the initial phase of the epidemic, prioritizing public health over economic concerns, and more successful at eliciting collaboration from the population. Secondly, most countries led by women are also those with a stronger focus on social equality, human needs and generosity. These societies are more receptive to political agendas that place social and environmental wellbeing at the core of national policymaking.

11: PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis
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Posted 15 Jul 2021

PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis
286 downloads medRxiv health policy

Neal R Haddaway, Matthew J Page, Christopher C Pritchard, Luke A McGuinness

Background Reporting standards, such as PRISMA aim to ensure that the methods and results of systematic reviews are described in sufficient detail to allow full transparency. Flow diagrams in evidence syntheses allow the reader to rapidly understand the core procedures used in a review and examine the attrition of irrelevant records throughout the review process. Recent research suggests that use of flow diagrams in systematic reviews is poor and of low quality and called for standardised templates to facilitate better reporting in flow diagrams. The increasing options for interactivity provided by the Internet gives us an opportunity to support easy-to-use evidence synthesis tools, and here we report on the development of tools for the production of PRISMA 2020-compliant systematic review flow diagrams. Methods and Findings We developed a free-to-use, Open Source R package and web-based Shiny app to allow users to design PRISMA flow diagrams for their own systematic reviews. Our tools allow users to produce standardised visualisations that transparently document the methods and results of a systematic review process in a variety of formats. In addition, we provide the opportunity to produce interactive, web-based flow diagrams (exported as HTML files), that allow readers to click on boxes of the diagram and navigate to further details on methods, results or data files. We provide an interactive example here; https://driscoll.ntu.ac.uk/prisma/. Conclusions We have developed a user-friendly suite of tools for producing PRISMA 2020-compliant flow diagrams for users with coding experience and, importantly, for users without prior experience in coding by making use of Shiny. These free-to-use tools will make it easier to produce clear and PRISMA 2020-compliant systematic review flow diagrams. Significantly, users can also produce interactive flow diagrams for the first time, allowing readers of their reviews to smoothly and swiftly explore and navigate to further details of the methods and results of a review. We believe these tools will increase use of PRISMA flow diagrams, improve the compliance and quality of flow diagrams, and facilitate strong science communication of the methods and results of systematic reviews by making use of interactivity. We encourage the systematic review community to make use of these tools, and provide feedback to streamline and improve their usability and efficiency.

12: Analysis of alternative Covid-19 mitigation measures in school classrooms: an agent-based model of SARS-CoV-2 transmission
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Posted 30 Aug 2021

Analysis of alternative Covid-19 mitigation measures in school classrooms: an agent-based model of SARS-CoV-2 transmission
263 downloads medRxiv health policy

Mark J Woodhouse, Willy P Aspinall, Stephen RJ Sparks, CoMMinS prject "COVID-19 Mapping and Mitigation in Schools"

1.The SARS-CoV-2 epidemic has had major impacts on childrens education, with schools required to implement infection control measures that have led to long periods of absence and classroom closures. We develop an agent-based epidemiological model of SARS-CoV-2 transmission that is applied to model infection within school classrooms, with a contact model constructed using random networks informed by structured expert judgement. Mitigation strategies to control infection are modelled to allow analysis of their effectiveness in supressing infection outbreaks and in limiting pupil absence. The model is applied to re-examine Covid-19 in schools in the UK in autumn 2020, and to forecast infection levels in autumn 2021 when the more infectious Delta-variant is dominant and school transmission is likely to play a major role in a new wave of the epidemic. Our results indicate that testing-based surveillance of infections in the classroom population with isolation of positive cases is a more effective mitigation measure than bubble quarantine both for reducing transmission in schools and for avoiding pupil absence, even accounting for insensitivity of self-administered tests. Bubble quarantine results in large numbers of pupils absent from school, with only modest impact of classroom infection. However, maintaining a reduced contact rate within the classroom has a major beneficial impact for managing Covid-19 in school settings.

13: The Influence of Covid-19 Vaccine on Daily Cases, Hospitalization, and Death Rate in Tennessee: A Case Study in the United States
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Posted 17 Mar 2021

The Influence of Covid-19 Vaccine on Daily Cases, Hospitalization, and Death Rate in Tennessee: A Case Study in the United States
246 downloads medRxiv health policy

Ali Roghani

The COVID-19 outbreak highlights the vulnerability to novel infections, and vaccination remains a foreseeable method to return to normal life. However, infrastructure is inadequate for the whole population to be vaccinated immediately. Therefore, policies have adopted a strategy to vaccinate the elderly and vulnerable population while delaying others. This study uses the Tennessee official statistic from the onset of COVID vaccination (17th of December 2021) to understand how age-specific vaccination strategies reduce daily cases, hospitalization, and death rate. The result shows that vaccination strategy can significantly influence the numbers of patients with COVID-19 in all age groups and lower hospitalization and death rates just in older age groups. The Elderly had a 95% lower death rate from December to March; however, and no change in the death rate in other age groups. The Hospitalization rate was reduced by 80% in this study cohort for people aged 80 or older, while people who were between 50 to 70 had almost the same hospitalization rate. The study indicates that vaccination targeting older age groups is the optimal way to avoid higher transmissions and reduce hospitalization and death rate for older groups.

14: Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020
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Posted 30 May 2021

Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020
246 downloads medRxiv health policy

Kao-Ping Chua, Rena M Conti, Nora V Becker

IMPORTANCE: Many insurers waived cost-sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care, including clinician services. Assessing out-of-pocket spending for COVID-19 hospitalizations in 2020 could demonstrate the financial burden patients may face if insurers allow waivers to expire, as many chose to do during early 2021. OBJECTIVE: To estimate out-of-pocket spending for COVID-19 hospitalizations in 2020 DESIGN: Cross-sectional analysis SETTING: IQVIA PharMetrics Plus for Academics Database, a national claims database PARTICIPANTS: COVID-19 hospitalizations for privately insured and Medicare Advantage patients during March-September 2020 MAIN OUTCOMES/MEASURES: Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (e.g., accommodation charges) and for professional/ancillary services billed by clinicians and ancillary providers (e.g., clinician inpatient evaluation and management, ambulance transport) RESULTS: Analyses included 4,075 hospitalizations. Of the 1,377 hospitalizations for privately insured patients and the 2,698 hospitalizations for Medicare Advantage patients, 981 (71.2%) and 1,324 (49.1%) had out-of-pocket spending for facility services, professional/ancillary services, or both. Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 (1,411) and $277 (363). In contrast, 63 (4.6%) and 36 (1.3%) hospitalizations had out-of-pocket spending for facility services. Among these hospitalizations, mean total out-of-pocket spending was $3,840 (3,186) and $1,536 (1,402). Total out-of-pocket spending exceeded $4,000 for 2.5% of privately insured hospitalizations, compared with 0.2% of Medicare Advantage hospitalizations. CONCLUSIONS: Few COVID-19 hospitalizations in this study had out-of-pocket spending for facility services, suggesting most were covered by insurers with cost-sharing waivers. However, many hospitalizations had out-of-pocket spending for professional/ancillary services. Overall, 7 in 10 privately insured hospitalizations and half of Medicare Advantage hospitalizations had any out-of-pocket spending. Findings suggest insurer cost-sharing waivers may not cover all hospitalization-related care. Moreover, high cost-sharing for some hospitalizations suggests out-of-pocket burden could be substantial if waivers expire, particularly for privately insured patients. Rather than rely on voluntary insurer actions to mitigate this burden, federal policymakers should consider mandating insurers to waive cost-sharing for all COVID-19 hospitalization-related care throughout the pandemic.

15: Financial and Non-financial Conflicts of Interest Among the Japanese Government Advisory Board Members Concerning Coronavirus Disease 2019
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Posted 23 Sep 2021

Financial and Non-financial Conflicts of Interest Among the Japanese Government Advisory Board Members Concerning Coronavirus Disease 2019
245 downloads medRxiv health policy

Hanano Mamada, Anju Murayama, Akihiko Ozaki, Takanao Hashimoto, Hiroaki Saito, Toyoaki Sawano, Divya Bhandari, Sunil Shrestha, Tetsuya Tanimoto

Abstract Objectives: This study aimed to assess the extent of conflicts of interest among the Japanese government COVID-19 advisory board members and elucidate the accuracy of conflicts of interest (COI) disclosure and management strategies. Methods: Using the payment data from all 79 pharmaceutical companies in Japan between 2017 and 2018 and direct research grants from the Japanese government between 2019 and 2020, we evaluated the extent of financial and non-financial COI among all 20 Japanese government COVID-19 advisory board members. Results: Japanese government COVID-19 advisory board members were predominantly male (75.0%) and physicians (50.0%). Between 2019 and 2020, two members (10.0%) received a total of $819,244 in government research funding. Another five members (25.0%) received $419,725 in payments, including $223,183 in personal fees, from 28 pharmaceutical companies between 2017 and 2018. The average value of the pharmaceutical payments was $20,986 (standard deviation: $81,762). Further, neither the Ministry of Health, Labor, and Welfare nor the Japanese Cabinet Secretariat disclosed financial or non-financial COI with industry. Further, the government and had no policies for managing COI among advisory board members. Conclusions: This study found that the Japanese government COVID-19 advisory board had financial and non-financial COI with pharmaceutical companies and the government. Further, there were no rigorous COI management strategies for the COVID-19 advisory board members. Any government must ensure the independence of scientific advisory boards by implementing more rigorous and transparent management strategies that require the declaration and public disclosure of all COI.

16: Effects of non-pharmaceutical interventions on COVID-19: A Tale of Three Models
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Posted 27 Jul 2020

Effects of non-pharmaceutical interventions on COVID-19: A Tale of Three Models
232 downloads medRxiv health policy

Vincent Chin, John Ioannidis, Martin Tanner, Sally Cripps

Objective: To compare the inference regarding the effectiveness of the various non-pharmaceutical interventions (NPIs) for COVID-19 obtained from different SIR models. Study design and setting: We explored two models developed by Imperial College that considered only NPIs without accounting for mobility (model 1) or only mobility (model 2), and a model accounting for the combination of mobility and NPIs (model 3). Imperial College applied models 1 and 2 to 11 European countries and to the USA, respectively. We applied these models to 14 European countries (original 11 plus another 3), over two different time horizons. Results: While model 1 found that lockdown was the most effective measure in the original 11 countries, model 2 showed that lockdown had little or no benefit as it was typically introduced at a point when the time-varying reproductive number was already very low. Model 3 found that the simple banning of public events was beneficial, while lockdown had no consistent impact. Based on Bayesian metrics, model 2 was better supported by the data than either model 1 or model 3 for both time horizons. Conclusions: Inferences on effects of NPIs are non-robust and highly sensitive to model specification. Claimed benefits of lockdown appear grossly exaggerated.

17: Problems with Evidence Assessment in COVID-19 Health Policy Impact Evaluation (PEACHPIE): A systematic review of study design and evidence strength
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Posted 22 Jan 2021

Problems with Evidence Assessment in COVID-19 Health Policy Impact Evaluation (PEACHPIE): A systematic review of study design and evidence strength
222 downloads medRxiv health policy

Noah A. Haber, Emma Clarke-Deelder, Avi Feller, Emily R Smith, Joshua Salomon, Benjamin MacCormack-Gelles, Elizabeth M Stone, Clara Bolster-Foucault, Jamie R Daw, Laura A. Hatfield, Carrie E Fry, Christopher B Boyer, Eli Ben-Michael, Caroline M Joyce, Beth S Linas, Ian Schmid, Eric H Au, Sarah E. Wieten, Brooke A. Jarrett, Cathrine Axfors, Van Thu Nguyen, Beth Ann Griffin, Alyssa Bilinski, Elizabeth A. Stuart

Introduction: Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. This study systematically reviewed the strength of evidence in the published COVID-19 policy impact evaluation literature. Methods: We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on November 26, 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation, assessing what impact evaluation method was used, graphical display of outcomes data, functional form for the outcomes, timing between policy and impact, concurrent changes to the outcomes, and an overall rating. Results: After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. The majority (n=23/36) of studies in our sample examined the impact of stay-at-home requirements. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-section), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 1/27 studies passed all of the above checks, and 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes. Discussion: The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigor to be actionable by policy-makers. This was largely driven by the circumstances under which policies were passed making it difficult to attribute changes in COVID-19 outcomes to particular policies. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.

18: The paradox of the COVID-19 pandemic: the impact on patient demand in Japanese hospitals
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Posted 04 Oct 2021

The paradox of the COVID-19 pandemic: the impact on patient demand in Japanese hospitals
208 downloads medRxiv health policy

Masako Ii, Sachiko Watanabe

Analyzing data from a large, nationally distributed group of Japanese hospitals, we found a dramatic decline in both inpatient and outpatient volumes over the three waves of the COVID-19 pandemic in Japan from February-December 2020. We identified three key reasons for this fall in patient demand. First, COVID-19-related hygiene measures and behavioral changes significantly reduced non-COVID-19 infectious diseases. Second, consultations relating to chronic diseases fell sharply. Third, certain medical investigations and interventions were postponed or cancelled. Despite the drop in hospital attendances and admissions, COVID-19 is said to have brought the Japanese health care system to the brink of collapse. In this context, we explore longstanding systematic issues, finding that Japan's abundant supply of beds and current payment system may have introduced a perverse incentive to overprovide services, creating a mismatch between patient needs and the supply of health care resources. Poor coordination among health care providers and the highly decentralized governance of the health care system have also contributed to the crisis. In order to ensure the long-term sustainability of the Japanese health care system beyond COVID-19, it is essential to promote specialization and differentiation of medical functions among hospitals, to strengthen governance, and to introduce appropriate payment reform.

19: Community Organizing for Indigenous People in the Philippines: A Proposed Approach
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Posted 29 Jun 2021

Community Organizing for Indigenous People in the Philippines: A Proposed Approach
193 downloads medRxiv health policy

Jailah Bamba, Cristela Candelario, Rosarie Gabuya, Lhearnie Manongdo

Cognizant of the special needs of indigenous people in the Philippines, the Republic Act No. 8371 of 1997 was established to promote and protect their rights. Over the years, a number of community organizing efforts for the improvement of these communities were conducted by stakeholders from the private and public sectors. However, resistance has been reported due to poor understanding and integration of these indigenous populations varied cultures and traditions. This study aims to describe the predominant principles and frameworks used for community organizing among indigenous people. Specifically, it seeks to propose a community organizing approach that is culturally sensitive and appropriate for indigenous communities in geographically isolated and disadvantaged areas in the Philippines. A systematic review was conducted on four databases (PubMed, ScienceDirect, ResearchGate, Google Scholar) by four independent researchers. Inclusion criteria involved studies about community organizing protocols in the Philippines, published in peer-reviewed journals from 2010-2020, and written in the English language. Assessment of the quality of included studies was done using the Critical Appraisal Skills Program (CASP) checklist, and narrative synthesis was employed to summarize and report the findings. Thirteen studies met our inclusion criteria out of a total of fifty-five articles searched. Based on the evidence, our proposed approach builds on Groundwork, Indigenous Capacity Building, Community Participation and Ownership, Mobilization, and Sustainability. We highlight the emphasis of harnessing indigenous knowledge and Participatory Monitoring and Evaluation to involve them in all steps of the planning and decision-making processes. Furthermore, we distill tools and methodologies that could strengthen and precipitate successful community organizing endeavors.

20: Social Capital Dimensions are Differentially Associated with COVID-19 Vaccinations, Masks, and Physical Distancing
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Posted 16 Sep 2021

Social Capital Dimensions are Differentially Associated with COVID-19 Vaccinations, Masks, and Physical Distancing
193 downloads medRxiv health policy

Ibtihal Ferwana, Lav R. Varshney

Background Social capital has been associated with health outcomes in communities and can explain variations in different geographic localities. Social capital has also been associated with behaviors that promote better health and reduce the impacts of diseases. During the COVID-19 pandemic, social distancing, face masking, and vaccination have all been essential in controlling contagion. These behaviors have not been uniformly adopted by communities in the United States. Using different facets of social capital to explain the differences in public behaviors among communities during pandemics is lacking. Objective This study examines the relationship among public health behavior, vaccination, face masking, and physical distancing during COVID-19 pandemic and social capital indices in counties in the United States. Methods We used publicly available vaccination data as of June 2021, face masking data in July 2020, and mobility data from mobile phones movements from the end of March 2020. Then, correlation analysis was conducted with county-level social capital index and its subindices (family unity, community health, institutional health, and collective efficacy) that were obtained from the Social Capital Project by the United States Senate. Results We found the social capital index and its subindices differentially correlate with different public health behaviors. Vaccination is associated with institutional health: positively with fully vaccinated population and negatively with vaccination hesitancy. Also, wearing masks negatively associates with community health, whereases reduced mobility associates with better community health. Further, residential mobility positively associates with family unity. By comparing correlation coefficients, we find that social capital and its subindices have largest effect sizes on vaccination and residential mobility. Conclusion Our results show that different facets of social capital are significantly associated with adoption of protective behaviors, e.g., social distancing, face masking, and vaccination. As such, our results suggest that differential facets of social capital imply a Swiss cheese model of pandemic control planning where, e.g., institutional health and community health, provide partially overlapping behavioral benefits.

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