Where Did We Go Wrong with This Pandemic?

Two years into the SARS-CoV-2 pandemic the shining light of hope has been the speed at which vaccines have been developed based on a new platform technology allowing breakthroughs with other novel, neglected and emerging infectious diseases. Lurking in the shadows has been the various health care systems related to surveillance, data collection, access to basic health, fear, nationalism, government distrust, vaccine skepticism, global supply chain shortages, health worker shortages and misinformation. In this paper, I have tried to highlight the areas where lessons learned can make a difference for our response to the next pandemic at the local, state, national, regional, and global level.

Deaths of obstructive lung disease in the Yangpu district of Shanghai from 2003 through 2011： a multiple cause analysis

Background Obstructive lung disease （OLD, chronic obstructive pulmonary disease or asthma） is an important cause of death in older people. There has been no exhaustive population-based mortality study of this subject in Shanghai. The objective of this study was to use a multiple cause of death methodology in the analysis of OLD mortality trends in the Yangpu district of Shanghai, from 2003 through 2011. Methods We analyzed death data from the Shanghai Yangpu District Center for Disease Control and Prevention for Medical Cause of Death database, selecting all death certificates for individuals 40 years or older on which OLD was listed as a cause of death. Results From 2003 to 2011, there were 8 775 deaths with OLD listed, of which 6 005 （68%） were identified as the underlying cause of death. For the entire period, a significantly decreasing trend of age standardized rates of death from OLD was observed in men （-6.2% per year） and in women （-5.7% per year）, similar trends were observed in deaths with OLD. The mean annual rates of deaths from OLD per 100 000 were 161.2 for men and 80.8 for women from 2003 to 2011. While, as the underlying cause of death, the main associated causes of death were as follows： cardiovascular diseases （70.7%）, carebrovascular diseases （13.3%）, diabetes （8.6%）, and cancer （4.3%）. The associated causes and the principal overall underlying causes of death were cardiovascular diseases （37.0%）, cancer （30.3%）, and cerebrovascular disease （15.3%）. A significant seasonal variation, with the highest frequency in winter, occurred in deaths identified with underlying causes of chronic bronchitis, other obstructive pulmonary diseases, and asthma. Conclusions Multiple cause mortality analysis provides a more accurate picture than underlying cause of total mortality attributed on death certificates to OLD. The major comorbidities associated with OLD were cardiovascular disease, cancer, and cerebrovascular disease. From 2003 to 2011, the mortality rate from OLD decreased substantially in the Yangpu district of Shanghai.

Cancer incidence and mortality in Zhejiang Province,Southeast China,2016:a population-based study

Backgrounds:Cancer is one of the main causes of death worldwide,seriously threatening human health and life expectancy.We aimed to analyze the cancer incidence and mortality rates during 2016 in Zhejiang Province,Southeast China.Methods:Data were collected from 14 population-based cancer registries across Zhejiang Province of China.Cancer incidence and mortality rates stratified by sex and region were analyzed.The crude rate,age-standardized rate,age-specific and region-specific rate,and cumulative rate were calculated.The proportions of 10 common cancers in different groups and the incidence and mortality rates of the top five cancers in different age groups were also calculated.The Chinese national census of 2000 and the world Segi population was used for calculating the age-standardized incidence and mortality rates.Results:The 14 cancer registries covered a population of 14,250,844 individuals,accounting for 29.13%of the population of Zhejiang Province.The total reported cancer cases and deathswere 55,835 and 27,013,respectively.The proportion ofmorphological verification(MV%)was 78.95%of the population,and percentage of incident cases identified through death certificates only(DCO%)was 1.23%with a mortality-to-incidence ratio(M/I ratio)of 0.48.The crude incidence rate in Zhejiang cancer registration areas was 391.80/105;the age-standardized incidence rate of the Chinese standard population(ASIRC)and the age-standardized incidence rate of theworld standard population(ASIRW)were 229.76/105 and 220.96/105,respectively.The incidence rate in men was higher than that inwomen.The incidence rate increased rapidly after 45 years of age and peaked in individuals aged 80 to 84 years.The top 10 incidence rates of cancers were lung cancer,female breast cancer,thyroid cancer,colorectal cancer,stomach cancer,liver cancer,prostate cancer,cervical cancer,esophageal cancer,and pancreatic cancer(from highest to lowest).The crude mortality rate in Zhejiang cancer registration areas was 189.55/105;the age-standardized mortality rate of the Chinese standard population(ASMRC)and the agestandardized mortality rate of the world standard population(ASMRW)were 94.46/105 and 93.42/105,respectively.The mortality rate in men was higher than that in women,and the male population in rural areas was higher than that in urban areas.The cancer mortality rate increased rapidly after 50 years of age and peaked in individuals aged 85+years.The top 10 mortality rates of cancers were lung cancer,liver cancer,stomach cancer,colorectal cancer,pancreatic cancer,esophageal cancer,female breast cancer,prostate cancer,lymphoma,and leukemia(from highest to lowest).Conclusions:Lung cancer,female breast cancer,thyroid cancer,colorectal cancer,prostate cancer,liver cancer,and stomach cancer were the most common cancers in Zhejiang Province.Effective prevention and control measures should be established after considering the different characteristics of cancers in urban and rural areas.