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in category health policy

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

41: Governor partisanship explains the adoption of statewide mask mandates in response to COVID-19
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Posted 02 Sep 2020

Governor partisanship explains the adoption of statewide mask mandates in response to COVID-19
1,539 downloads medRxiv health policy

Christopher Adolph, Kenya Amano, Bree Bang-Jensen, Nancy Fullman, Beatrice Magistro, Grace Reinke, John Wilkerson

Public mask use has emerged as a key tool in response to COVID-19. We develop and document a classification of statewide mask mandates that reveals variation in their scope and timing. Some U.S. states quickly mandated the wearing of face coverings in most public spaces, whereas others issued narrow mandates or no mandate at all. We consider how differences in COVID-19 epidemiological indicators and partisan politics affect when states adopted broad mask mandates, starting with the earliest broad public mask mandates in April 2020 and continuing though the end of 2020. The most important predictor is whether a state is led by a Republican governor. These states adopt statewide indoor mask mandates an estimated 98.0 days slower (95% CI: 88.8 to 107.3), if they did so at all (hazard ratio of 7.54, 95% CI: 2.87 to 16.19). COVID-19 indicators such as confirmed cases or deaths per million are much less important predictors of statewide mask mandates. This finding highlights a key challenge to public efforts to increase mask-wearing, one of the most effective tools for preventing the spread of SARS-CoV-2 while restoring economic activity.

42: CoVID-19 in Singapore: Impact of Contact Tracing and Self-awareness on Healthcare Demand
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Posted 05 Jun 2020

CoVID-19 in Singapore: Impact of Contact Tracing and Self-awareness on Healthcare Demand
1,506 downloads medRxiv health policy

Qiuyang Huang, Lin Wang, Yongjian Yang, Liping Huang, Zhanwei Du, Gaoxi Xiao

Background. A great concern around the globe now is to mitigate the COVID-19 pandemic via contact tracing. Analyzing the control strategies during the first five months of 2020 in Singapore is important to estimate the effectiveness of contacting tracing measures. Methods. We developed a mathematical model to simulate the COVID-19 epidemic in Singapore, with local cases stratified into 5 categories according to the conditions of contact tracing and self-awareness. Key parameters of each category were estimated from local surveillance data. We also simulated a set of possible scenarios to predict the effects of contact tracing and self-awareness for the following month. Findings. During January 23 - March 16, 2020, the success probabilities of contact tracing and self-awareness were estimated to be 31% (95% CI 28%-33%) and 54% (95% CI 51%-57%), respectively. During March 17 - April 7, 2020, several social distancing measures (e.g., limiting mass gathering) were introduced in Singapore, which, however, were estimated with minor contribution to reduce the non-tracing reproduction number per local case (R_(l,2)). If contact tracing and self-awareness cannot be further improved, we predict that the COVID-19 epidemic will continue to spread in Singapore if R_(l,2)[≥]1.5. Conclusion. Contact tracing and self-awareness can mitigate the COVID-19 transmission, and can be one of the key strategies to ensure a sustainable reopening after lifting the lockdown.

43: Association of County-Level Socioeconomic and Political Characteristics with Engagement in Social Distancing for COVID-19
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Posted 11 Apr 2020

Association of County-Level Socioeconomic and Political Characteristics with Engagement in Social Distancing for COVID-19
1,494 downloads medRxiv health policy

Nolan M. Kavanagh, Rishi Raj Goel, Atheendar S. Venkataramani

The U.S. is the epicenter of the coronavirus disease 2019 (COVID-19) pandemic. In response, governments have implemented measures to slow transmission through "social distancing." However, the practice of social distancing may depend on prevailing socioeconomic conditions and beliefs. Using 15-17 million anonymized cell phone records, we find that lower per capita income and greater Republican orientation were associated with significantly reduced social distancing among U.S. counties. These associations persisted after adjusting for county-level sociodemographic and labor market characteristics as well as state fixed effects. These results may help policymakers and health professionals identify communities that are most vulnerable to transmission and direct resources and communications accordingly.

44: Discontinuation of isolation for persons with COVID-19: Is 10 days really safe?
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Posted 01 Feb 2021

Discontinuation of isolation for persons with COVID-19: Is 10 days really safe?
1,469 downloads medRxiv health policy

Alvina Clara Felix, Anderson Vincente de Paula, Andreia C Ribeiro, Francini C da Silva, Marta Inemami, Angela A Costa, Cibele OD Leal, Walter M Figueiredo, Claudio S Pannuti, Camila M Romano

Background. The detection of SARS-CoV-2 RNA by real-time polymerase chain reaction (PCR) in respiratory samples from COVID-19 patients is not a direct indication of the presence of viable viruses. The isolation of SARS-CoV-2 in cell culture system however, can acts as surrogate marker of infectiousness. Cell culture based studies performed mostly with hospitalized and moderate/severe COVID-19 claims that no replication competent virus is found after 9 days of the symptoms onset in respiratory samples. Therefore, it is now recommended 10 days isolation before patient discharge. Methods. We cell-cultured 29 SARS-COV-2 RT-PCR positive respiratory samples at the 10th day after the illness in Vero E6 cells. After two passages, cytopathic effect and cycle threshold (CT) lower than the obtained in the original sample were used to determine positivity. Findings. We found viable particles in (7/29) 24% of samples tested. The positivity in cell culture was strongly associated (p<0.0001) to the low cycle thresholds in clinical samples (Ct <21). Conclusion. This data adds important knowledge to the current protocols for de-isolation of patients with non-hospitalized mild COVID-19.

45: A structured open dataset of government interventions in response to COVID-19
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Posted 08 May 2020

A structured open dataset of government interventions in response to COVID-19
1,417 downloads medRxiv health policy

Amélie Desvars-Larrive, Elma Dervic, Nils Haug, Thomas Niederkrotenthaler, Jiaying Chen, Anna Di Natale, Jana Lasser, Diana S Gliga, Alexandra Roux, Abhijit Chakraborty, Alexandr Ten, Alija Dervic, Andrea Pacheco, David Cserjan, Diana Lederhilger, Dorontine Berishaj, Erwin Flores Tames, Huda Takriti, Jan Korbel, Jenny Reddish, Johannes Stangl, Lamija Hadziavdic, Laura Stoeger, Leana Gooriah, Lukas Geyrhofer, Marcia R Ferreira, Rainer Vierlinger, Samantha Holder, Samuel Alvarez, Simon Haberfellner, Verena Ahne, Viktoria Reisch, Vito DP Servedio, Xiao Chen, Xochilt Maria Pocasangre-Orellana, David Garcia, Stefan Thurner

In response to the COVID-19 pandemic, governments have implemented a wide range of nonpharmaceutical interventions (NPIs). Monitoring and documenting government strategies during the COVID-19 crisis is crucial to understand the progression of the epidemic. Following a content analysis strategy of existing public information sources, we developed a specific hierarchical coding scheme for NPIs. We generated a comprehensive structured dataset of government interventions and their respective timelines of implementation. To improve transparency and motivate collaborative validation process, information sources are shared via an open library. We also provide codes that enable users to visualise the dataset. Standardization and structure of the dataset facilitate inter-country comparison and the assessment of the impacts of different NPI categories on the epidemic parameters, population health indicators, the economy, and human rights, among others. This dataset provides an in-depth insight of the government strategies and can be a valuable tool for developing relevant preparedness plans for pandemic. We intend to further develop and update this dataset on a weekly basis until the end of December 2020.

46: More than privacy: Australians' concerns and misconceptions about the COVIDSafe App: a short report
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Posted 09 Jun 2020

More than privacy: Australians' concerns and misconceptions about the COVIDSafe App: a short report
1,368 downloads medRxiv health policy

Rae Thomas, Zoe A Michaleff, Hannah Greenwood, Eman Abukmail, Paul Glasziou

Background: Timely and effective contact tracing is an essential public health role to curb the transmission of COVID-19. App-based contact tracing has the potential to optimise the resources of overstretched public health departments. However, its efficiency is dependent on wide-spread adoption. We aimed to identify the proportion of people who had downloaded the Australian Government COVIDSafe app and examine the reasons why some did not. Method: An online national survey with representative quotas for age and gender was conducted between May 8 and May 11 2020. Participants were excluded if they were a healthcare professional or had been tested for COVID-19. Results: Of the 1802 potential participants contacted, 289 were excluded, 13 declined, and 1500 participated in the survey (response rate 83%). Of survey participants, 37% had downloaded the COVIDSafe app, 19% intended to, 28% refused, and 16% were undecided. Equally proportioned reasons for not downloading the app included privacy (25%) and technical concerns (24%). Other reasons included a belief that social distancing was sufficient and the app is unnecessary (16%), distrust in the Government (11%), and apathy (11%). In addition, COVIDSafe knowledge varied with confusion about its purpose and capabilities. Conclusion: For the COVIDSafe app to be accepted by the public and used correctly, public health messages need to address the concerns of its citizens, specifically in regards to privacy, data storage, and technical capabilities. Understanding the specific barriers preventing the uptake of tracing apps provides the opportunity to design targeted communication strategies aimed at strengthening public health initiatives such as download and correct use.

47: A rapid systematic review and case study on test, contact tracing, testing, and isolation policies for Covid-19 prevention and control
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Posted 07 Jun 2020

A rapid systematic review and case study on test, contact tracing, testing, and isolation policies for Covid-19 prevention and control
1,363 downloads medRxiv health policy

Sheng-Chia Chung, Sushila Marlow, Nicholas Tobias, Ivano Alogna, Alessio Alogna, San-Lin You

Objectives To conduct a rapid review on the efficacy and policy of contact tracing, testing, and isolation (TTI) in Covid-19 prevention and control, including a case study for their delivery. Method Research articles and reviews on the use of contact tracing, testing, self-isolation and quarantine for Covid-19 management published in English within 1 year (2019 to 28th May, 2020) were eligible to the review. We searched MEDLINE (PubMed), Cochrane Library, SCOPUS and JSTOR with search terms included "contact tracing" or "testing" or "self-isolation" or "quarantine" in the title in combination with "Covid-19" or "COVID-19" or "coronavirus" in the title or abstract. Studies not associated with TTI or Covid-19 or being solely commentary were excluded. A narrative synthesis with a tabulation system was used to analyse studies for their diverse research designs, methods, and implications. Information for the case study was obtained from the Centers for Disease Control Taiwan. Results Among the 160 initial publications, 30 eligible studies are included in the review. Included studies applied various designs: experiments, clinical studies, Government Documents, systematic reviews, observational studies, surveys, practice guidelines, technical reports. A case study on TTI delivery is summarised based on policy and procedures in Taiwan. Conclusions The information included in the review may inform the TTI program in the UK.

48: National age and co-residence patterns shape covid-19 vulnerability
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Posted 16 May 2020

National age and co-residence patterns shape covid-19 vulnerability
1,311 downloads medRxiv health policy

Albert Esteve, Inaki Permanyer, Diederik Boertien, James W. Vaupel

Based on harmonized census data from 81 countries, we estimate how age and co-residence patterns shape the vulnerability of countries' populations to outbreaks of covid-19. We estimate variation in deaths arising due to a simulated random infection of 10% of the population living in private households and subsequent within-household transmission of the virus. The age-structures of European and North American countries increase their vulnerability to covid-related deaths in general. The co-residence patterns of elderly persons in Africa and parts of Asia increase these countries' vulnerability to deaths induced by within-household transmission of covid-19. Southern European countries, which have aged populations and relatively high levels of intergenerational co-residence are, all else equal, the most vulnerable to outbreaks of covid-19. In a second step, we estimate to what extent avoiding primary infections for specific age-groups would prevent subsequent deaths due to within-household transmission of the virus. Preventing primary infections among the elderly is the most effective in countries with small households and little intergenerational co-residence such as France, whereas confining younger age groups can have a greater impact in countries with large and inter-generational households such as Bangladesh.

49: Comparative experimental evidence on compliance with social distancing during the COVID-19 pandemic
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Posted 01 Aug 2020

Comparative experimental evidence on compliance with social distancing during the COVID-19 pandemic
1,286 downloads medRxiv health policy

Michael Becher, Daniel Stegmueller, Sylvain Brouard, Eric Kerrouche

Social distancing is a central public health measure in the fight against the COVID-19 pandemic, but individuals' compliance cannot be taken for granted. We use a survey experiment to examine the prevalence of non-compliance with social distancing in nine countries and test pre-registered hypotheses about individual-level characteristics associated with less social distancing. Leveraging a list experiment to control for social desirability bias, we find large cross-national variation in adherence to social distancing guidelines. Compliance varies systematically with COVID-19 fatalities and the strictness of lockdown measures. We also find substantial heterogeneity in the role of individual-level predictors. While there is an ideological gap in social distancing in the US and New Zealand, this is not the case in European countries. Taken together, our results suggest caution when trying to model pandemic health policies on other countries' experiences. Behavioral interventions targeted towards specific demographics that work in one context might fail in another.

50: Trust, threats, and consequences of the COVID-19 pandemic in Norway and Sweden: A comparative survey
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Posted 20 May 2020

Trust, threats, and consequences of the COVID-19 pandemic in Norway and Sweden: A comparative survey
1,264 downloads medRxiv health policy

Lise M. Helsingen, Erle Refsum, Dagryn Kyte Gjostein, Magnus Loberg, Michael Bretthauer, Mette Kalager, Louise Emilsson

Objectives: Norway and Sweden, two neighboring countries with similar populations, health care systems and socioeconomics, have reacted differently to the COVID-19 pandemic. Norway closed all kindergartens, schools and universities, and banned sports and cultural activities, while Sweden kept most institutions and trainings facilities open. We aimed to compare peoples' attitudes towards authorities and control measures, and effects on life in Norway and Sweden. Design: Anonymous web-based surveys for individuals age 15 or older distributed through Facebook using the snowball method. Setting: Norway and Sweden, mid-March to mid-April, 2020. Participants: Altogether, 3,508 individuals participated in the survey; 3000 in Norway and 508 in Sweden. 79% of the participants were women, 60% of the Norwegians and 47% of the Swedes were between 30-49 years, and around 45% of the participants in both countries had more than 4 years of higher education. Outcome measures: Perceived threat of the pandemic, views on infection control measures, and impact on daily life. We performed descriptive analyses of the responses and compared the two countries. Results: People had high trust in the health services in both countries, but differed in the degree of trust in their government (17% had high trust in Norway and 37% in Sweden). More Norwegians than Swedes agreed that school closure was a good measure (66% Norway and 18% in Sweden), and that countries with open schools were irresponsible (65% in Norway and 23% in Sweden). About the same amount responded that COVID-19 was a large to very large threat to the population (53% in Norway and 58% in Sweden), whereas more Norwegians than Swedes responded that the threat from repercussions of the mitigation measures were large or very large (71% in Norway and 56% in Sweden). Compliance with infection preventive measures was high and similar in the two countries (more than 98%). In Norway, 69% lived a more sedentary life during the pandemic versus 50% in Sweden; and Norwegians reported they ate more than Swedes (44% in Norway and 33% in Sweden). Conclusion: Sweden, with less restrictive measures against the COVID-19 pandemic, had a higher level of trust in the authorities, while Norwegians reported a more negative lifestyle during the pandemic. The level of trust in the health care system and self-reported compliance with preventive measures was high in both countries.

51: Assessing the nationwide impact of COVID-19 mitigation policies on the transmission rate of SARS-CoV-2 in Brazil
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Posted 28 Jun 2020

Assessing the nationwide impact of COVID-19 mitigation policies on the transmission rate of SARS-CoV-2 in Brazil
1,256 downloads medRxiv health policy

Daniel C. P. Jorge, Moreno S. Rodrigues, Mateus S. Silva, Luciana L. Cardim, Nivea B. da Silva, Ismael H. Silveira, Vivian A. F. Silva, Felipe A. C. Pereira, Arthur R. de Azevedo, Alan A. S. Amad, Suani T. R. Pinho, Roberto F. S. Andrade, Pablo I. P. Ramos, Juliane Fonseca Oliveira

COVID-19 is now identified in almost all countries in the world, with poorer regions being particularly more disadvantaged to efficiently mitigate the impacts of the pandemic. In the absence of efficient therapeutics or vaccines, control strategies are currently based on non-pharmaceutical interventions, comprising changes in population behavior and governmental interventions, among which the prohibition of mass gatherings, closure of non-essential establishments, quarantine and movement restrictions. In this work we analyzed the effects of 707 published governmental interventions, and population adherence thereof, on the dynamics of COVID-19 cases across all 27 Brazilian states, with emphasis on state capitals and remaining inland cities. A generalized SEIR (Susceptible, Exposed, Infected and Removed) model with a time-varying transmission rate (TR), that considers transmission by asymptomatic individuals, is presented. We analyze the effect of both the extent of enforced measures across Brazilian states and population movement on the changes in the TR and effective reproduction number. The social mobility reduction index, a measure of population movement, together with the stringency index, adapted to incorporate the degree of restrictions imposed by governmental regulations, were used in conjunction to quantify and compare the effects of varying degrees of policy strictness across Brazilian states. Our results show that population adherence to social distance recommendations plays an important role for the effectiveness of interventions and represents a major challenge to the control of COVID-19 in low- and middle-income countries.

52: Variation in Covid-19 Cases Across New York City
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Posted 29 May 2020

Variation in Covid-19 Cases Across New York City
1,233 downloads medRxiv health policy

Awi Federgruen, Sherin R Naha

The number of confirmed COVID-19 cases, relative to population size, has varied greatly throughout the United States and even within the same city. In different zip codes in New York City, the epicentre of the epidemic, the number of cases per 100,000 residents has ranged from 437 to 4227, a 1:10 ratio. To guide policy decisions regarding containment and reopening of the economy, schools, and other institutions, it is vital to identify the factors that drive this large variation. This paper reports on a statistical study of incidence variation by zip code across New York City. Among many socio-economic and demographic measures considered, the average household size emerges as the single most important explanatory variable: an increase in average household size by one member increases the zip code incidence rate, in our final model specification, by at least 876 cases, 23% of the range of incidence rates, at a 95% confidence level. The percentage of the population above the age of 65, the percentage below the poverty line, and their interaction term are also strongly positively associated with zip code incidence rates, In terms of ethnic/racial characteristics, the percentages of African Americans, Hispanics, and Asians within the population, are significantly associated, but the magnitude of the impact is considerably smaller. (The proportion of Asians within a zip code has a negative association.) These significant associations may be explained by comorbidities, known to be more (less) prevalent among the black and Hispanic (Asian) population segments. In turn, the increased prevalence of these comorbidities among the black and Hispanic population, is, in large part, the result of poorer dietary habits and more limited access to healthcare, themselves driven by lower incomes Contrary to popular belief, population density, per se, does not have a significantly positive impact. Indeed, population density and zip code incidence rates are negatively correlated, with a -33% correlation coefficient. Our model specification is based on a well-established epidemiologic model that explains the effects of household sizes on R0, the basic reproductive number of an epidemic. Our findings support implemented and proposed policies to quarantine pre-acute and post-acute patients, as well as nursing home admission policies.

53: The effectiveness of interventions to reduce COVID-19 transmission in a large urban jail
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Posted 18 Jun 2020

The effectiveness of interventions to reduce COVID-19 transmission in a large urban jail
1,223 downloads medRxiv health policy

Giovanni S.P. Malloy, Lisa Puglisi, Margaret L. Brandeau, Tyler D Harvey, Emily A. Wang

Objectives: To estimate the impact of various mitigation strategies on COVID-19 transmission in a U.S. jail beyond those offered in national guidelines. Methods: We developed a stochastic dynamic transmission model of COVID-19 in one large urban U.S. jail among staff and incarcerated individuals. We divided the outbreak into four intervention phases: the start of the outbreak, depopulation of the jail, increased proportion of people in single cells, and asymptomatic testing. We used the next generation method to estimate the basic reproduction ratio, R0, in each phase. We estimated the fraction of new cases, hospitalizations, and deaths averted by these interventions along with the standard measures of sanitization, masking, and social distancing interventions. Results: For the first outbreak phase, the estimated R0 was 8.23 (95% CrI: 5.01-12.90), and for the subsequent phases, R0, phase 2 = 3.58 (95% CrI: 2.46-5.08), R0, phase 3 = 1.72 (95% CrI: 1.41-2.12), and R0, phase 4 = 0.45 (95% CrI: 0.32-0.59). In total, the jail's interventions prevented approximately 83% of projected cases and hospitalizations and 89% of deaths over 83 days. Conclusions: Depopulation, single celling, and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. Policy Implications: Decision-makers should prioritize reductions in the jail population, single celling, and testing asymptomatic populations, as additional measures to manage COVID-19 within correctional settings.

54: England's Lockdown vs. Sweden's Herd Immunity: A Comparison of the Daily New COVID-19 Cases and Related Deaths Using Comparative Interrupted Time Series Analysis
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Posted 15 Aug 2020

England's Lockdown vs. Sweden's Herd Immunity: A Comparison of the Daily New COVID-19 Cases and Related Deaths Using Comparative Interrupted Time Series Analysis
1,218 downloads medRxiv health policy

Moaath Mustafa Ali, Yazan Samhouri, Marwa Sabha, Lynna Alnimer

Background: There is a lack of empirical evidence that lockdowns decrease daily cases of COVID-19 and related mortality compared to herd immunity. England implemented a delayed lockdown on March 23, 2020, but Sweden did not. We aim to examine the effect of lockdown on daily COVID-19 cases and related deaths during the first 100 days post-lockdown. Methods: We compared daily cases of COVID-19 infection and related mortality in England and Sweden before and after lockdown intervention using a comparative-interrupted time series analysis. The period included was from COVID-19 pandemic onset till June 30, 2020. Results: The adjusted-rate of daily COVID-19 infections was eight cases/10,000,000 person higher in England than Sweden before lockdown order (95% CI: 2-14, P=0.01). On the day of intervention (lagged lockdown), England had 693 more COVID-19 cases/10,000,000 person compared to Sweden (95% CI: 467-920, P<0.001). Compared to the pre-intervention period, the adjusted daily confirmed cases rate decreased by 19 cases/ 10,000,000 person compared to Sweden (95% CI: 13-26, P<0.001). There was a rate excess of 1.5 daily deaths/ 10,000,000 person in England compared to Sweden pre-intervention (95% CI: 1-2, P<0.001). The increased mortality rate resulted in 50 excess deaths/ 10,000,000 person related to COVID-19 in England compared to Sweden on the day of lockdown (95% CI: 30-71, P<0.001). Post-intervention, the rate of daily deaths in England decreased by two deaths/ 10,000,000 person compared to Sweden (95% CI: 1-3, P<0.001). During phases one and two of lockdown lifting in England, there was no rebound increase in daily cases or deaths compared to Sweden. Conclusion: The lockdown order implemented in England on March 23, 2020, effectively decreased the daily new cases rate and related mortality compared to Sweden. There was no short-term increase in COVID-19 cases and related-deaths after the phases one and two of the lifting of restrictions in England compared to Sweden. This study provides empirical, comparative evidence that lockdowns slow the spread of COVID-19 in communities compared to herd immunity.

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Posted 12 May 2020

1,195 downloads medRxiv health policy

Ayomide Ilori

This study investigated self-policing COVID-19 and civic responsibilities in Lagos Metropolis, Nigeria adopting an online qualitative interview due to the current lockdown that denied field (face to face) interview. Fifty out of the feedbacks from the online interview were picked randomly to arrive at the conclusion of this study. The feedbacks suggested that there is adequate awareness of the COVID-19 pandemic among the people living in Lagos Metropolis, Nigeria and that they are following the directives of federal and state governments in an effort to reduce the community transmission of the infectious diseases. However, the ban on public gatherings and movements has made it impossible for many homes to meet their basic needs especially feeding. The government provided palliatives have also been largely insufficient to cater for the vulnerable. There could be a crisis (such as hunger) and the breakdown of law and order if the government does not increase their capacity to mitigate the hardship which the ongoing lockdown has imposed on the people.

56: COVID-19 Pandemic in Pakistan: Stages and Recommendations
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Posted 14 May 2020

COVID-19 Pandemic in Pakistan: Stages and Recommendations
1,177 downloads medRxiv health policy

Farhan Saif

We present a real-time forecast of COVID-19 in Pakistan that is important for decision-making to control the spread of the pandemic in the country. The study helps to develop an accurate plan to eradicate the COVID-19 by taking calculated steps at the appropriate time, that are crucial in the absence of a tested medicine. We use four phenomenological mathematical models, namely Discrete Exponential Growth model, the Discrete Generalized Growth model, the Discrete Generalized Logistic Growth, and Discrete Generalize Richards Growth model. Our analysis explains the important characteristics quantitatively. The study leads to understand COVID-19 pandemic in Pakistan in three evolutionary stages, and provides understanding to control its spread in the short time domain and in the long term domain. For the reason the study is helpful in devising the measures to handle the emerging threat of similar outbreaks in other countries.

57: Real-time time-series modelling for prediction of COVID-19 spread and intervention assessment
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Posted 29 Apr 2020

Real-time time-series modelling for prediction of COVID-19 spread and intervention assessment
1,147 downloads medRxiv health policy

Taha Hossein Rashidi, Siroos Shahriari, AKM Azad, Fatemeh Vafaee

Substantial amount of data about the COVID-19 pandemic is generated every day. Yet, data streaming, while considerably visualized, is not accompanied with advanced modelling techniques to provide real-time insights. This study introduces a unified platform which integrates visualization capabilities with advanced statistical methods for predicting the virus spread in the short run, using real-time data. The platform is backed up by advanced time series models to capture any possible non-linearity in the data which is enhanced by the capability of measuring the expected impact of preventive interventions such as social distancing and lockdowns. The platform enables lay users, and experts, to examine the data and develop several customized models with different restriction such as models developed for specific time window of the data. Our policy assessment of the case of Australia, shows that social distancing and travel ban restriction significantly affect the reduction of number of cases, as an effective policy.

58: Lockdown measures in response to COVID-19 in Sub-Saharan Africa: A rapid study of nine countries
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Posted 11 Jul 2020

Lockdown measures in response to COVID-19 in Sub-Saharan Africa: A rapid study of nine countries
1,134 downloads medRxiv health policy

Najmul Haider, Abdinasir Yusuf Osman, Audrey Gadzekpo, George O. Akpede, Danny Asogun, Rashid Ansumana, Richard John Lessells, Palwasha Khan, Muzamil Mahdi Abdel Hamid, Dorothy Yeboah-Manu, Leonard Mboera, Elizabeth H Shayo, Blandina Mmbaga, Mark Urassa, David Musoke, Nathan Kapata, Rashida Abbas Ferrand, Pascalina Chanda-Kapata, Florian Stigler, Thomas Czypionka, Richard A Kock, David McCoy

Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. This paper defines the term lockdown and describes the design, timing and implementation of lockdown in nine countries in Sub Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. It also discusses the manner in which lockdown is enforced, the need to mitigate the harms of lockdown, and the association between lockdown and the reported number of COVID-19 cases and deaths. While there are some commonalities in the implementation of lockdown, a more notable finding is the variation in the design, timing and implementation of lockdown measures across the nine countries. We found that the number of reported cases is heavily dependent on the number of tests done, and that testing rates ranged from 9 to 21,261 per million population. The reported number of COVID-19 deaths per million population also varies, but is generally low when compared to countries in Europe and North America. While lockdown measures may have helped inhibit some community transmission, the pattern and nature of the epidemic remains unclear. Of concern are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic harms. This paper highlights the need for inter-sectoral and trans-disciplinary research capable of providing a rigorous and holistic assessment of the harms and benefits of lockdown.

59: Predicting illness trajectory and hospital resource utilization of COVID-19 hospitalized patients - a nationwide study
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Posted 07 Sep 2020

Predicting illness trajectory and hospital resource utilization of COVID-19 hospitalized patients - a nationwide study
1,125 downloads medRxiv health policy

Michael Roimi, Rom Gutman, Jonathan Somer, Asaf Ben Arie, Ido Calman, Yaron Bar-Lavie, Udi Gelbshtein, Sigal Liverant-Taub, Arnona Ziv, Danny Eytan, Malka Gorfine, Uri Shalit

Background: The spread of COVID-19 has led to a severe strain on hospital capacity in many countries. There is a need for a model to help planners assess expected COVID-19 hospital resource utilization. Methods: Retrospective nationwide cohort study following the day-by-day clinical status of all hospitalized COVID-19 patients in Israel from March 1st to May 2nd, 2020. Patient clinical course was modelled with a machine learning approach based on a set of multistate Cox regression-based mod- els with adjustments for right censoring, recurrent events, competing events, left truncation, and time-dependent covariates. The model predicts the patient's entire disease course in terms of clinical states, from which we derive the patient's hospital length-of-stay, length-of-stay in critical state, the risk of in-hospital mortality, and total and critical care hospital-bed utilization. Accuracy assessed over eight cross-validation cohorts of size 330, using per-day Mean Absolute Error (MAE) of predicted hospital utilization averaged over 64 days; and area under the receiver operating characteristics (AUROC) for individual risk of critical illness and in-hospital mortality, assessed on the first day of hospitalization. We present predicted hospital utilization under hypothetical incoming patient scenarios. Findings: During the study period, 2,703 confirmed COVID-19 patients were hospitalized in Israel. The per-day MAEs for total and critical-care hospital- bed utilization, were 4.72 {+/-} 1.07 and 1.68 {+/-} 0.40 respectively; the AUROCs for prediction of the probabilities of critical illness and in-hospital mortality were 0.88 {+/-} 0.04 and 0.96 {+/-} 0.04, respectively. We further present the impact of several scenarios of patient influx on healthcare system utilization, and provide an R software package for predicting hospital-bed utilization. Interpretation: We developed a model that, given basic easily obtained data as input, accurately predicts total and critical care hospital utilization. The model enables evaluating the impact of various patient influx scenarios on hospital utilization and planning ahead of hospital resource allocation.

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Posted 23 Apr 2020

1,121 downloads medRxiv health policy

Alpamys Issanov, Yerlan Amanbek, Anara Abbay, Shalkar Adambekov, Mohamad Aljofan, Ardak Kashkynbayev, Abduzhappar Gaipov

Background: COVID-19 pandemic has presented extreme challenges to developing countries across the world. Post-Soviet states are facing unique challenges due to their developing healthcare systems and unstable economy. The aim of this paper was to provide estimates for current development COVID-19 pandemic in the Post-Soviet states and forecast potential best and worst scenarios for spread of this deadly infection. Methods: The data on confirmed cases and deaths were extracted from official governmental sources for a period from beginning of outbreak dates for each country until April 18, 2020. A modified SEIR (Susceptible-Exposed-Infected-Recovered) modelling was used to plot the parameters of epidemic in 10 post-Soviet states and forecast the number of cases over a period of 10, 30 and 60 days. We also estimated the numbers of cases based on the optimal measures (best scenario) and suboptimal measures (worst scenarios) of potential spread of COVID-19 in these countries. Results: It was estimated that Armenia and Azerbaijan have reached their peaks, Kazakhstan, Kyrgyzstan, Moldova and Uzbekistan are expected to reach their peaks in the coming week (April 29 - May 7, 2020), with comparatively low cases of COVID-19 and loss of lives in the best-case scenario. In contrast, Belarus, Russia, and Ukraine would likely see the outbreaks with the largest number of COVID-19 cases amongst the studied Post-Soviet States in the worst scenario during the next 30 and 60 days. Geographical remoteness and small number of international travelers from the countries heavily affected by the pandemic could also have contributed to delay in the spread of COVID-19. Conclusion: Governmental response was shown to be as an important determining factor responsible for the development of COVID-19 epidemic in Post-Soviet states. The current protection rates should be maintained to reduce active cases during upcoming 30 and 60 days. The estimated possible scenarios based on the proposed model can potentially be used by healthcare professionals from each studied Post-Soviet States as well as others to improve plans to contain the current and future epidemic.

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