Factors Predicting Progression to Severe COVID-19: A Competing Risk Survival Analysis of 1753 Patients in Community Isolation in Wuhan, China

Most studies of coronavirus disease 2019(COVID-19)progression have focused on the transfer of patients within secondary or tertiary care hospitals from regular wards to intensive care units.Little is known about the risk factors predicting the progression to severe COVID-19 among patients in community iso-lation,who are either asymptomatic or suffer from only mild to moderate symptoms.Using a multivari-able competing risk survival analysis,we identify several important predictors of progression to severe COVID-19—rather than to recovery—among patients in the largest community isolation center in Wuhan,China from 6 February 2020(when the center opened)to 9 March 2020(when it closed).All patients in community isolation in Wuhan were either asymptomatic or suffered from mild to moderate COVID-19 symptoms.We performed competing risk survival analysis on time-to-event data from a cohort study of all COVID-19 patients(n=1753)in the isolation center.The potential predictors we inves-tigated were the routine patient data collected upon admission to the isolation center:age,sex,respira-tory symptoms,gastrointestinal symptoms,general symptoms,and computed tomography(CT)scan signs.The main outcomes were time to severe COVID-19 or recovery.The factors predicting progression to severe COVID-19 were:male sex(hazard ratio(HR)=1.29,95%confidence interval(CI)1.04–1.58,p=0.018),young and old age,dyspnea(HR=1.58,95%CI 1.24–2.01,p<0.001),and CT signs of ground-glass opacity(HR=1.39,95%CI 1.04–1.86,p=0.024)and infiltrating shadows(HR=1.84,95%CI 1.22–2.78,p=0.004).The risk of progression was found to be lower among patients with nausea or vomiting(HR=0.53,95%CI 0.30–0.96,p=0.036)and headaches(HR=0.54,95%CI 0.29–0.99,p=0.046).Our results suggest that several factors that can be easily measured even in resource-poor set-tings(dyspnea,sex,and age)can be used to identify mild COVID-19 patients who are at increased risk of disease progression.Looking for CT signs of ground-glass opacity and infiltrating shadows may be an affordable option to support triage decisions in resource-rich settings.Common and unspecific symptoms(headaches,nausea,and vomiting)are likely to have led to the identification and subsequent community isolation of COVID-19 patients who were relatively unlikely to deteriorate.Future public health and clinical guidelines should build on this evidence to improve the screening,triage,and monitoring of COVID-19 patients who are asymtomatic or suffer from mild to moderate symptoms.

Mathematical Modelling of the COVID-19 Epidemic in Northern Ireland in 2020

In this study, we investigate the dynamics of the COVID-19 epidemic in Northern Ireland from 1st March 2020 up to 25th December 2020, using several copies of a Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model, and compare it to a detailed publicly available dataset. We split the data into 10 time intervals and fit the models on the consecutive intervals to the cumulative number of confirmed positive cases on each interval. Using the fitted parameter estimates, we also provide estimates of the reproduction number. We also discuss the limitations and possible extensions of the employed model.

Estimating the Level of Asymptomatic COVID-19 Infections in Northern Ireland in 2020

The identification and understanding of COVID-19 potential routes of transmission are fundamental to informing policies and strategies to successfully control the outbreak. Various studies highlighted asymptomatic infections as one of the silent drivers of the epidemic. An accurate estimation of the asymptomatic cases and the understanding of their contribution to the spread of the disease could enhance the effectiveness of current control strategies, mainly based on the symptom onset, to curb transmission. We investigate the dynamics of the COVID-19 epidemic in Northern Ireland during the period 1st March 25th to December 2020 to estimate the proportion of the asymptomatic infections in the country. We extended our previous model to include the stage of the asymptomatic infection, and we implement the corresponding deterministic model using a publicly available dataset. We partition the data into 11 sets over the period of study and fit the model parameters on the consecutive intervals using the cumulative number of confirmed positive cases for each interval. Moreover, we assess numerically the impacts of uncertainty in testing and we provide estimates of the reproduction numbers using the fitted parameters. We found that the proportion of asymptomatically infectious subpopulations, in Northern Ireland during the period of study, ranged between 5% and 25% of exposed individuals. Also, the estimate of the basic reproduction number, R0, is 3.3089. The lower and upper estimates for herd immunity are (0.6181, 0.7243) suggesting that around 70% of the population of Northern Ireland should acquire immunity via infection or vaccination, which is in line with estimates reported in other studies.

HIV Counseling and Testing Uptake,Knowledge and Attitude and Influencing Factors among Student Nurses and Midwives in The Gambia:An Institutional-based Cross-sectional Study

HIV counseling and testing(HCT)has become paramount in the prevention and control of HIV/AIDS worldwide.However,the uptake of HCT has been very slow globally,especially in sub-Saharan Africa.Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres.According to WHO,they are part of the most vulnerable group to HIV infection,judging by the fact that they interact more with patients/clients than other healthcare professionals.This study aimed to determine the prevalence of HCT uptake,knowledge,and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools.An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire.Descriptive statistics(percentages,mean and standard deviation)and inferential statistics(chi square,logistics regression,one-way ANOVA and independent samples t-test)were used for data analysis using SPSS version 25.0.A p-value<0.05 was considered for statistical significance.Out of the 305 students recruited for the study,60.98%were females,with a mean age of 25.5 years old.About 58.4%of the participants had tested for HIV in the past.About 95.7%acknowledged the importance of HCT in the prevention and control of HIV/AIDS.HCT uptake among student nurses and midwives was influenced by factors ranging from an individual that are interpersonal challenges(such as concerns of friends),perceived susceptibility to the disease,lack of confidentiality,stigma and discrimination from health service providers.Therefore,these barriers can be addressed through an organized targeted health education intervention and advocacy programs across health training institutions in the Gambia and beyond.

为有效防控新冠病毒肺炎争取时间——抗疫假期政策对疫情传播的影响

在新发突发传染病的早期阶段,快速应对对于疫情防控至关重要。用于控制疫情的公共假期能为大规模、迅速地进行社会隔离和其他举措提供关键的时间窗口期。本研究的目的是探讨抗疫假期的起始时间节点和持续时间对中国早期新冠病毒肺炎疫情传播的影响。我们开发了一个房室模型来模拟从2020年1月开始中国新冠病毒肺炎疫情的动态传播;预测并比较了春节期间在有抗疫假期和没有抗疫假期下的疫情传播;考虑了抗疫假期在不同持续时间、不同起始时间节点,以及在关于病毒传播率的不同假设下的多种情况;估计了在不同情况下达到某些感染阈值所需的天数延迟。结果表明,中国的抗疫假期使新冠病毒肺炎疫情的传播停滞了许多天。与不设抗疫假期的场景相比,基础场景的抗疫假期(湖北省为21 d,中国所有其他省为10 d)可使确诊感染100000例的时间延迟7.54 d。持续时间更长的抗疫假期会对疫情防控产生更大的影响。为期21 d的全国性抗疫假期可使确诊感染100000例的时间延迟近10 d。此外,研究发现,在新发突发传染病较早阶段实施抗疫假期比较晚阶段实施对遏制疫情蔓延更有效,抗疫假期期间采取额外的控制措施可以增强疫情控制效果。总之,抗疫假期能够通过有效地减少人群的社交接触频率及范围,从而减缓疫情的传播。抗疫假期使得新冠病毒肺炎传播暂时停滞,为疫情防控争取了时间,科学家可用争取的时间来发现传播途径并确定有效的公共卫生干预措施,政府可用争取的时间来完善基础设施、调配医疗用品、培训和部署专业人力资源,从而为长期防控做好准备。

Non-Communicable Diseases During the COVID-19 Pandemic and Beyond

1.Introduction The coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has swept the globe as a pandemic[1].As of 1 April 2021,there were about 129.5 million confirmed cases of COVID-19,and 2.8 million deaths attributable to COVID-19[2].While some countries have suppressed COVID-19,most governments worldwide are still mobilizing available resources to contain the spread of SARS-CoV-2 in communities,facilitate COVID-19 treatments in hospitals,expand COVID-19 vaccination,and accelerate drug and vaccine development[3].

Redefining human health:physical wellbeing,mental wellbeing,social wellbeing,and environmental wellbeing

In 1948,the World Health Organization(WHO)identified three dimensions of human health—physical wellbeing,mental wellbeing,and social wellbeing.^([1])Physical wellbeing is distinguished by the absence of disease as well as the active pursuit of fitness,while mental wellbeing is distinguished by a lack of depressive symptoms and the presence of calm and happy mental states.The notion of social wellbeing arose following World War II and emerged from a belief that good health not only entailed wellness of the body and mind but also required a society in which sexism,chauvinism,and extremism ceased to exist.This concept recognized individual responsibility for living in peace and contributing to the welfare of others.The definition of health as a composite of these three facets—physical wellbeing,mental wellbeing,and social wellbeing—has been adopted since then.

Strengthening population medicine to promote public health

As we enter.2022,we are facedwith the fact that coronavirus disease2019(CovID-19)has been devastating the world formore than 2full years.Since the original outbreak of COVID-19in December2019,the disease has proved to be a major threat to global health and,perhaps more importantly,one that is not likely to be resolved soon.Severe_acute respiratory syndrome coronavirus.

Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of São Paulo, Brazil

Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society.In this paper we modelled and simulated a test-trace-andquarantine strategy to control the COVID-19 outbreak in the State of São Paulo,Brasil.The State of São Paulo failed to adopt an effective social distancing strategy,reaching at most 59%in late March and started to relax the measures in late June,dropping to 41%in 08 August.Therefore,São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic.Two alternative strategies combined with economic evaluations were simulated.One strategy included indiscriminately testing the entire population of the State,reaching more than 40 million people at a maximum cost of 2.25 billion USD,that would reduce the total number of cases by the end of 2020 by 90%.The second strategy investigated testing only symptomatic cases and their immediate contacts e this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%.The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st,it would have been possible to reduce the total number of cases by 90%at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts.

A Framework for Assessing Import Costs of Medical Supplies and Results for a Tuberculosis Program in Karakalpakstan,Uzbekistan

Background.Import of medical supplies is common,but limited knowledge about import costs and their structure introduces uncertainty to budget planning,cost management,and cost-effectiveness analysis of health programs.We aimed to estimate the import costs of a tuberculosis(TB)program in Uzbekistan,including the import costs of specific imported items.Methods.We developed a framework that applies costing and cost accounting to import costs.First,transport costs,customs-related costs,cargo weight,unit weights,and quantities ordered were gathered for a major shipment of medical supplies from the Médecins Sans Frontières(MSF)Procurement Unit in Amsterdam,the Netherlands,to a TB program in Karakalpakstan,Uzbekistan,in 2016.Second,air freight,land freight,and customs clearance cost totals were estimated.Third,total import costs were allocated to different cargos(standard,cool,and frozen),items(e.g.,TB drugs),and units(e.g.,one tablet)based on imported weight and quantity.Data sources were order invoices,waybills,the local MSF logistics department,and an MSF standard product list.Results.The shipment contained 1.8 million units of 85 medical items of standard,cool,and frozen cargo.The average import cost for the TB program was 9.0%of the shipment value.Import cost varied substantially between cargos(8.9–28%of the cargo value)and items(interquartile range 4.5–35%of the item value).The largest portion of the total import cost was caused by transport(82–99%of the cargo import cost)and allocated based on imported weight.Ten(14%)of the 69 items imported as standard cargo were associated with 85%of the standard cargo import cost.Standard cargo items could be grouped based on contributing to import costs predominantly through unit weight(e.g.,fluids),imported quantity(e.g.,tablets),or the combination of unit weight and imported quantity(e.g.,items in powder form).Conclusion.The cost of importing medical supplies to a TB program in Karakalpakstan,Uzbekistan,was sizable,variable,and driven by a subset of imported items.The framework used to measure and account import costs can be adapted to other health programs.

Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant diagnosis(EID),economic evaluations are needed to inform program design and implementation.This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases(Embase,MEDLINE and EconLit)and grey literature for economic analyses of HIV EID in low-and middle-income countries published between January 2008 and June 2021.We extracted data on unit costs,cost savings,and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats.We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records,we included 29 studies:17 cost analyses and 12 model-based cost-effectiveness analyses.Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests.All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective.Most studies reported costs of EID testing strategies;however,few studies assessed the same intervention or reported costs in the same way,making comparison of costs across studies challenging.Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV,while not directly comparable across studies,covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving.Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.

Low Concordance Between Blood Pressures Measured in Periodic Health Examinations and in a Workplace-Based Hypertension Management Program

Poor adherence to standard protocols of blood pressure(BP)measurement in routine clinical practice leads to higher readings than“research-quality”measurements.Whether this phenomenon exists in periodic health examinations was unknown.We aimed to explore the concordance between BP measurements in periodic health examinations and those measured following a standard measurement protocol.We used data from the Kailuan Study,an ongoing longitudinal cohort study in China,of which participants received biennial health examinations in health management centers.In addition,BPs were measured following standard protocols in a workplace-based hypertension management program nested in the Kailuan Study.We compared BP readings of the same person between the two settings using generalized linear mixed-effects models.A total of 3988 men(the mean age was 44.9 years)had at least two BP measurements both in health examinations and management program with a time interval between the two settings that less than 90 days.The mean systolic blood pressures(SBP)and diastolic blood pressures(DBP)in health examinations were 4.2(95%CI 3.9–4.5)mm Hg and 3.3(95%CI 3.1–3.5)mm Hg higher than those in the management program,respectively.Bland–Altman analyses showed the wide agreement inter-vals ranging from-27.7-to 36.5-mm Hg for SBP and-18.3-to 24.7-mm Hg for DBP.In conclusion,BP measurements in periodic health examinations were generally higher than BPs measured following a standard protocol.Our findings highlight the importance of standard BP measurement to avoid overestimation of hypertension prevalence and treatment initiation.

Calling for improved pulmonary and critical care medicine in China and beyond

Infectious and chronic respiratory diseases place a high burden on both individual patients and the health system.For instance,lower respiratory infections count among the leading causes of death worldwide.1 The emergence within the past two decades of several newly identified coronaviruses.

Antenatal care positive responses to pregnant women in preventing and controlling malaria in pregnancy:the sub-Saharan African perspective

Background The response to antenatal care(ANC)for maternal and offspring outcomes,especially in pregnant women has been thoroughly studied.However,despite the number of interventional studies on the treatment of sulfadoxine-pyrimethamine combination(IPTp-SP)uptake,the point in point cases of the positive responses of ANC in improving health conditions of pregnant women are not found in the literature.Data sources This review collected ANC responses to the positive health outcomes for pregnant women with malaria,the challenges faced regarding IPTp-SP uptake during ANC visits and the role of ANC in preventing and controlling malaria in sub-Saharan Africa.It elucidated ANC and uptake of optimal intermitent preventive IPTp-SP and further described ANC as a tool for heterogeneity for malaria prevention.Results ANC is seen as a microscope to malaria in pregnacy,maternal iron deficiency and anemia checkpoints,ANC and malaria treatment strategies,and ANC and the use of insecticide treated nets(ITN).The review further discussed ANC attendance influencing factors,limitations to ANC implications and the prospects in ANC visits on preventing malaria in pregnancy.Conclusions A declining trend of malaria transmission in Africa has been observed in recent years.However,the burden of malaria in pregnancy remains a health concern.The rate of SP resistance,low uptake of IPTp-SP,low LLINs distribution,late gestational ANC visits and low turnaround for optimal ANC visits for first time mothers’aggrevated the malaria-endemic settings among pregnant women in sub-Saharan Africa.

Metabolic-associated Fatty Liver Disease as Assessed by the Fatty Liver Index Among Migrant and Non-migrant Ghanaian Populations

Background and Aims:Metabolic-associated fatty liver disease(MAFLD)is driven by high caloric intake and sedentary lifestyle.Migration towards high income countries may induce these driving factors;yet,the influence of such on the prevalence of MAFLD is clearly understudied.Here,we investigated the Fatty Liver Index(FLI),a proxy of steatosis in MAFLD,after migration of Ghanaian subjects.Methods:Cross-sectional data of 5282 rural,urban and migrant participants from the Research on Obesity and Diabetes among African Migrants(also known as RODAM)study were analyzed with logistic regression for geographical differences in FLI and associations with type 2 diabetes mellitus(T2DM),waist-to-hip ratio,and 10-year predicted risk of atherosclerotic cardiovascular disease(ASCVD).Results:Both FLI and the proportion with an FLI indicative of MAFLD steatosis(FLI≥60)were higher in migrants compared with non-migrants.Prevalence of elevated FLI(FLI≥60)in non-migrant males was 4.2%compared to 28.9%in migrants.For females,a similar gradient was observed,from 13.6%to 36.6%respectively.Compared to rural residents,the odds for a FLI≥60 were higher in migrants living in urban Europe(odds ratio[OR]9.02,95%confidence interval[CI]:5.02–16.20 for men,and 4.00,95%CI:3.00–5.34 for women).Compared to controls,the ORs for FLI≥60 were 2.43(95%CI:1.73–3.41)for male T2DM cases and 2.02(95%CI:1.52–2.69)for female T2DM cases.One-unit higher FLI was associated with an elevated(≥7.5%)10-year ASCVD risk(OR:1.051,95%CI:1.041–1.062 for men,and 1.020,95%CI:1.015–1.026 for women).Conclusions:FLI as a proxy for MAFLD increased stepwise in Ghanaians from rural areas,through urban areas,to Europe.Our results clearly warrant awareness for MAFLD in migrant population as well as confirmation with imaging modalities.