Infection rates from Covid-19 in Great Britain by geographical units: A model-based estimation from mortality data

This study estimates cumulative infection rates from Covid-19 in Great Britain by local authority districts (LADs) and council areas (CAs) and investigates spatial patterns in infection rates. We propose a model-based approach to calculate cumulative infection rates from data on observed and expected deaths from Covid-19. Our analysis of mortality data shows that 7% of people in Great Britain were infected by Covid-19 by the last third of June 2020. It is unlikely that the infection rate was lower than 4% or higher than 15%. Secondly, England had higher infection rates than Scotland and especially Wales, although the differences between countries were not large. Thirdly, we observed a substantial variation in virus infection rates in Great Britain by geographical units. Estimated infection rates were highest in the capital city of London where between 11 and 12% of the population might have been infected and also in other major urban regions, while the lowest were in small towns and rural areas. Finally, spatial regression analysis showed that the virus infection rates increased with the increasing population density of the area and the level of deprivation. The results suggest that people from lower socioeconomic groups in urban areas (including those with minority backgrounds) were most affected by the spread of coronavirus from March to June.     

Strategic silences,eroded trust: The impact of divergent COVID-19 vaccine sentiments on healthcare workers' relations with peers and patients

BackgroundPolarized debates about Covid-19 vaccination and vaccine mandates for healthcare workers (HCWs) challenge Belgian HCWs ability to discuss Covid-19 vaccine sentiments with peers and patients. Although studies have identified drivers of HCWs vaccine hesitancy, they do not include effects of workplace interactions and have not addressed consequences beyond vaccine coverage.MethodsInterviews and focus group discussions with 74 HCWs practicing in Belgium addressed Covid-19 vaccine sentiments and experiences of discussing vaccination with peers and patients.ResultsMost participating HCWs reported difficulties discussing Covid-19 vaccination with peers and patients. Unvaccinated HCWs often feared that expressing their vaccine sentiments might upset patients or peers and that they would be suspended. Consequently, they used social cues to evaluate others’ openness to vaccine-skeptical discourses and avoided discussing vaccines. Surprisingly, some vaccine-confident HCWs hid their vaccine sentiments to avoid peer and patient conflicts. Both vaccinated and unvaccinated HCWs observed that unvaccinated patients occasionally received suboptimal care. Suboptimal care was central in unvaccinated HCW unwillingness to express their vaccine sentiments to peers. Both vaccinated and unvaccinated HCWs described loss of trust and ruptured social relations with peers and patients holding divergent vaccine sentiments.DiscussionBelgian HCW perceived Covid-19 vaccines as a risky discussion topic and engaged in “strategic silences” around vaccination to maintain functional work relationships and employment in health institutions. Loss of trust between HCW and peers or patients, along with suboptimal patient care based on vaccination status, threaten to weaken Belgium’s, and by implication, other health systems, and to catalyze preventable disease outbreaks.     

Accessibility of primary health care workforce in rural china

This study aims to develop an accessibility index to illustrate the status of the accessibility of primary health care workers in remote and rural areas in China. Relevant county-level data were used to analyze the number and distribution of primary health care workforce in rural China, and relevant provincial-level data were used to analyze the accessibility index. The study found that the development of rural primary health care workers is suboptimal. The rural Primary Health Care Worker Accessibility index shows that the accessibility to primary health care workers in western rural areas is poor. The correlation between PHCWA index and maternal mortality rate is more significant than that between primary health care workers density and maternal mortality rate. In addition to increasing the number of primary health care workers, strategies addressing the challenge of distance are also required.     

Access to Healthcare in a time of COVID-19: Sex Workers in Crisis in Nairobi,Kenya

ABSTRACT

This paper uses empirical data collected from 117 female sex workers living in informal settlements in Nairobi and 15 healthcare providers to highlight specific effects of COVID-19 and related restrictions on healthcare access for the sex workers. We highlight the existing gender and health inequalities that have now been reinforced by the initial outbreak of the COVID-19 pandemic. Specifically, we focus on the most concerning healthcare needs for the sex workers including HIV prevention, care and treatment and sexual and reproductive healthcare. Our study findings reveal that the various restrictions imposed by the government to help curb the spread of COVID-19 to a large extent made it difficult for the sex workers to access their healthcare needs. The paper discusses the challenges of healthcare service delivery reflecting on some innovative and pioneering responses from health care providers to address the emergency situation.     

一个需要重新认识的问题——对城乡卫生资源比例反差的思考

从城乡居民医疗服务需求出发,结合城乡卫生机构的性质、所承担的任务以及卫生资源利用状况,认为除部分城市医院盲目扩大规模、重复建设等原因外,城市卫生资源高于农村有其合理性,不能一概否定。居民对医疗服务的需求是配置卫生资源的基本前提。改变城乡卫生资源配置的“反差”是一项系统工程,需要很长的过程,只能随着农村经济的发展、农民收入的增加和医疗需求水平的提高而缩小“反差”;只能随着小城镇建设的进程、改变农与非     

Social capital and the spread of covid-19: Insights from european countries

We investigate the effect of social capital on health outcomes during the Covid-19 pandemic in independent analyses for Austria, Germany, Great Britain, Italy, the Netherlands, Sweden and Switzerland. Exploiting detailed geographical variation within countries, we show that a one-standard-deviation increase in social capital leads to between 14% and 34% fewer Covid-19 cases per capita accumulated from mid-March until end of June 2020, as well as between 6% and 35% fewer excess deaths per capita. Our results highlight the positive health returns of strengthening social capital.     

Spatial access to health care in Costa Rica and its equity: a GIS-based study

This study assembles a geographic information system (GIS) to relate the 2000 census population (demand) with an inventory of health facilities (supply). It assesses the equity in access to health care by Costa Ricans and the impact on it by the ongoing reform of the health sector. It uses traditional measurements of access based on the distance to the closest facility and proposes a more comprehensive index of accessibility that results from the aggregation of all facilities weighted by their size, proximity, and characteristics of both the population and the facility. The weighting factors of this index were determined with an econometric analysis of clinic choice in a national household sample. Half Costa Ricans reside less than 1 km away from an outpatient care outlet and 5 km away from a hospital. In equity terms, 12-14% of population are underserved according to three indicators: having an outpatient outlet within 4 km, a hospital within 25 km, and less than 0.2 MD yearly hours per person. The data show substantial improvements in access (and equity) to outpatient care between 1994 and 2000. These improvements are linked to the health sector reform implemented since 1995. The share of the population whose access to outpatient health care (density indicator) was inequitable declined from 30% to 22% in pioneering areas where reform began in 1995-96. By contrast, in areas where reform has not occurred by 2001, the proportion underserved has slightly increased from 7% to 9%. Similar results come from a simpler index based on the distance to the nearest facility. Access to hospital care has held steady in this period. The reform achieved this result by targeting the least privileged population first, and by including such measures as new community medical offices and Basic Teams for Integrated Health Care (EBAIS) to work with these populations. The GIS platform developed for this study allows pinpointing communities with inadequate access to health care, where interventions to improve access would have the greatest impact.     

Excess total mortality in 2021 in Italy was about one third of that observed in 2020

Background:Italy was severely hit by the Covid-19 pandemic with an excess of around 90,000 total deaths in 2020. Comparable data in 2021 are needed for monitoring the effects of the interventions adopted to control its spread and reduce the burden. This study estimates the excess mortality in Italy in the first eight months of 2021, with a focus on the working age population.Methods:Excess mortality was estimated as difference between the number of registered deaths and the expected deaths. Expected deaths in March-December 2020 and January-August 2021 were estimated separately by sex, through an over-dispersed Poisson regression model using mortality and population data for the period 2011-2019 (before the Covid-19 outbreak). The models included terms for calendar year, age group, a smooth function of week of the year and the natural logarithm of the population as offset term.Results:In the first eight months of 2021, we estimated 34,599 excess deaths (+7.9% of the expected deaths), of these 3667 were among individuals of working age (25-64 years). In this age group, mortality was 8.2% higher than expected with higher excesses among men (2972 deaths, +10.7%) than women (695 deaths, +4.1%).Conclusions:The excess deaths in the first eight months of 2021 account for about one third of that registered in 2020. Current data indicate that around 5000 excess deaths are expected by the end of the year, leading to a total excess for 2021 of around 40 thousand deaths. Despite the absence of influenza in January-March 2021, a relevant excess was also observed among the working age population.     

Quality of care provided by mid-level health workers: systematic review and meta-analysis

Objective

To assess the effectiveness of care provided by mid-level health workers.

Methods

Experimental and observational studies comparing mid-level health workers and higher level health workers were identified by a systematic review of the scientific literature. The quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria and data were analysed using Review Manager.

Findings

Fifty-three studies, mostly from high-income countries and conducted at tertiary care facilities, were identified. In general, there was no difference between the effectiveness of care provided by mid-level health workers in the areas of maternal and child health and communicable and noncommunicable diseases and that provided by higher level health workers. However, the rates of episiotomy and analgesia use were significantly lower in women giving birth who received care from midwives alone than in those who received care from doctors working in teams with midwives, and women were significantly more satisfied with care from midwives. Overall, the quality of the evidence was low or very low. The search also identified six observational studies, all from Africa, that compared care from clinical officers, surgical technicians or non-physician clinicians with care from doctors. Outcomes were generally similar.

Conclusion

No difference between the effectiveness of care provided by mid-level health workers and that provided by higher level health workers was found. However, the quality of the evidence was low. There is a need for studies with a high methodological quality, particularly in Africa – the region with the greatest shortage of health workers.     

Assessing socioeconomic effects on different sized populations: To weight or not to weight?

OBJECTIVE: Researchers in health care often use ecological data from population aggregates of different sizes. This paper deals with a fundamental methodological issue relating to the use of such data. This study investigates the question of whether, in doing analyses involving different areas, the estimating equations should be weighted by the populations of those areas. It is argued that the correct answer to that question turns on some deep epistemological issues that have been little considered in the public health literature. DESIGN: To illustrate the issue, an example is presented that estimates entitlements to primary physician visits in Manitoba, Canada based on age/gender and socioeconomic status using both population weighted and unweighted regression analyses. SETTING AND SUBJECTS: The entire population of the province furnish the data. Primary care visits to physicians based on administrative data, demographics and a measure of socioeconomic status (SERI), based on census data, constitute the measures. RESULTS: Significant differences between weighted and unweighted analyses are shown to emerge, with the weighted analyses biasing entitlements towards the more populous and advantaged population. CONCLUSIONS: The authors endorse the position that, in certain problems, data analyses involving population aggregates unweighted by population size are more appropriate and normatively justifiable than are analyses weighted by population. In particular, when the aggregated units make sense, theoretically, as units, it is more appropriate to carry out the analyses without weighting by the size of the units. Unweighted analyses yield more valid estimations.     

One year of SARS-CoV-2 pandemic: comparison of infection between health care workers and general population before and after vaccination

Background:The Covid-19 pandemic in Italy has been characterized by three waves of infection during 2020. Vaccination of healthcare workers started in January 2021, earlier than that of other population groups. The main aim of this study is to compare the spread of the pandemic between HCW and the general population focusing on potential effects of the vaccination.Methods:The study consisted of a retrospective analysis of results of RT-PCR tests performed between 6 March 2020 and 4 April 2021 among HCWs from Bologna, Italy, and those of the general population of Emilia Romagna region. We calculated the crude proportion of positive RT-PCR tests over total tests and the crude prevalence of positive test in population; then, we conducted joinpoint analyses using the Joinpoint Regression Program of the National Cancer Institute.Results:The results of the joinpoint analysis show that both φ and ψ ratio indicators have a similar pattern, with a sharp increase during the early phase of the pandemic, and a strong decrease at the end of the first wave around week 15. In both indicators there are no significant changes in the trend after week 25. Pandemic spread among HCWs appeared earlier than in the general population, but it otherwise appeared to have comparable features. A decline in infection was apparent among HCWs after vaccination.Conclusions:Surveillance of HCWs would inform on the epidemic in the general population. The apparent effectiveness of the anti-SarsCoV2 vaccine will likely occur in the general population.     

Employment Loss in Informal Settlements during the Covid-19 Pandemic: Evidence from Chile

The Covid-19 pandemic has reached almost every corner of the world. Despite the historical development, approval, and distribution of vaccines in some countries, non-pharmaceutical interventions will remain an essential strategy to control the pandemic until a substantial proportion of the population has immunity. There is increasing evidence of the devastating social and economic effects of the pandemic, particularly on vulnerable communities. Individuals living in urban informal settlements are in a structurally disadvantaged position to cope with a health crisis such as the Covid-19 pandemic. Estimates of this impact are needed to inform and prioritize policy decisions and actions. We study employment loss in informal settlements before and during the Covid-19 pandemic in Chile, using a longitudinal panel study of households living in Chile’s informal settlements before and during the health crisis. We show that before the pandemic, 75% of respondents reported being employed. There is a decrease of 30 and 40 percentage points in May and September 2020, respectively. We show that the employment loss is substantially higher for individuals in informal settlements than for the general population and has particularly affected the immigrant population. We also show that the pandemic has triggered neighborhood cooperation within the settlements and that targeted government assistance programs have reached these communities in a limited way. Our results suggest that individuals living in informal settlements are facing severe hardship as a consequence of the pandemic. In addition to providing much-needed support, this crisis presents a unique opportunity for long-term improvements in these marginalized communities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00575-6.     

Older adults living in social housing in Canada: the next COVID-19 hotspot?

Older adults in social housing have high rates of chronic diseases and live in clustered housing, creating the ideal situation for a tragic outbreak in this vulnerable population, which has been largely unrecognized in the public health discourse. It is estimated that two thirds of this population have cardiometabolic conditions that put them at higher risk of poor outcomes from COVID-19. In addition, their social isolation, low mobility, low health literacy, and limited internet access are barriers to accessing basic needs, health information, and health care in a Canadian context where many services have moved to virtual platforms. Since older adults in social housing tend to be clustered in apartment buildings with shared facilities, there is an increased risk of exposure through common spaces (e.g., elevator, laundry room) and high-touch surfaces. Compared to long-term care homes, there is substantial movement in and out of social housing buildings as residents are required to go out to meet their basic needs and individuals providing support enter the buildings without screening (e.g., personal support workers, volunteers delivering groceries). Without a targeted public health strategy to support this vulnerable population, we surmise that social housing will be the next COVID-19 hotspot.     

综合医院医务人员感染SARS情况对比分析

目的：分析在防治SARS工作初期、后期医务人员感染SARS的差异和采取的对策，为减少综合医院内医务人员SARS的感染提供参考。方甚：对本院自2003年3月24日至6月2日SARS诊断治疗任务中发生的医务人员的感染原因和采取的对策进行回顾性分析。结果：防治SARS工作初期，急诊科交叉感染和在SARS隔离病房等与SARS患者密切接触的工作岗位，共有17名医务人员感染，及时隔离治疗，均已痊愈，未造成医护人员的进一步交叉感染：经加强防护培训，改善工作条件，在防治SARS工作后期，仅发生2名护工感染，亦已痊愈，派出非典医疗队实现零感染。结论：综合医院内医务人员感染SARS的问题严峻，加强医院内的全员防护培训，按岗分区管理，改善医务人员的工作条件和病人的隔离观察环境，做好监督检查，积极应对，可以减少医务人员的SARS感染。     

Supporting pandemic disease preparedness: Development of a composite index of area vulnerability

Although pandemics are rare, planning and preparation for responding to them plays a crucial role in preventing their spread. The management and control of pandemics such as COVID-19 relies heavily on a country's health capacity. Measuring vulnerability to pandemics in geographical areas could potentially delay a pandemic's exponential growth and reduce the number of cases, which would alleviate the disease impact on communities and the health care sector. The aim of this study is to generate an area-level COVID-19 Pandemic Vulnerability Index (CPVI) and to assess its correlation with COVID-19 cases. Data were collected for Local Government Areas (LGAs) across Australia from different sources including Australia Bureau of Statistics, Australian Institute of Health and Welfare, and General Transit Feed Specification. Based on recent official reports about the COVID-19 outbreak, 18 factors were identified as influencing vulnerability to the disease within LGAs. Using factor analysis, four latent factors were identified and named as sociodemographic, medical conditions, transportation, and land use. Predicted factor scores were summed to generate a CPVI for each LGA. The CPVI was evaluated by correlating with confirmed cases of COVID-19 standardised by adult population in New South Wales and Victoria, the two Australian states with the highest numbers of confirmed cases. There was a statistically significant correlation between the CPVI and COVID-19 in New South Wales (r = 0.49) and Victoria (r = 0.48). LGAs scoring higher on the CPVI also had a higher absolute number of cases. The CPVI could be used by policymakers to identify at-risk areas and to develop preparedness and response plans to help mitigate the spread of COVID-19 and future pandemics.     

Primary health care reform in Uzbekistan

In recent years, primary health care in Uzbekistan has seen dramatic changes in organization, management and financing. The Soviet multi-tiered system of primary care is being replaced by a two-tiered system, consisting in rural areas of rural physician points (SVPs) and outpatient clinics of central rayon hospitals. A state-guaranteed benefits package of primary care services has been introduced and financing is increasingly based on capitation. In addition, a considerable number of physicians and nurses have been trained in general practice. There are, however, a number of challenges that remain. One of them is the considerable regional differences that exist in health financing. Another challenge is that some rural areas have difficulties attracting primary care workers. Overall, the institutional and financial link between primary and secondary care needs to be strengthened, as at present GPs have an incentive to refer patients to higher levels of care, which is financially inaccessible for large parts of the population.     

Community surveillance of COVID-19 by village health volunteers,Thailand

ProblemTo control the increasing spread of coronavirus disease 2019 (COVID-19), the government of Thailand enforced the closure of public and business areas in Bangkok on 22 March 2020. As a result, large numbers of unemployed workers returned to their hometowns during April 2020, increasing the risk of spreading the virus across the entire country.ApproachIn anticipation of the large-scale movement of unemployed workers, the Thai government trained existing village health volunteers to recognize the symptoms of COVID-19 and educate members of their communities. Provincial health offices assembled COVID-19 surveillance teams of these volunteers to identify returnees from high-risk areas, encourage self-quarantine for 14 days, and monitor and report the development of any relevant symptoms.Local settingDespite a significant and recent expansion of the health-care workforce to meet sustainable development goal targets, there still exists a shortage of professional health personnel in rural areas of Thailand. To compensate for this, the primary health-care system includes trained village health volunteers who provide basic health care to their communities.Relevant changesVillage health volunteers visited more than 14 million households during March and April 2020. Volunteers identified and monitored 809 911 returnees, and referred a total of 3346 symptomatic patients to hospitals by 13 July 2020.Lessons learntThe timely mobilization of Thailand’s trusted village health volunteers, educated and experienced in infectious disease surveillance, enabled the robust response of the country to the COVID-19 pandemic. The virus was initially contained without the use of a costly country-wide lockdown or widespread testing.     

Sustainability of the workforce: government policies and the rural fit

OBJECTIVES: Critical workforce issues among health care workers have raised public concerns about the ability of health care systems to provide adequate service. Services, however, are influenced by geographical and social factors. One important source of variation is rurality. This study evaluated the perception of the applicability of health human resource policies for rural areas. METHODS: An exploratory design was used. Twenty-one nurse administrators and 44 staff nurses from a sampling of 19 rural health care settings were interviewed. Hospitals with less than 100 beds were targeted. RESULTS: The government policies most frequently mentioned by study participants were the goal of 70% full-time employment, the new graduate policy and the late career initiative. Each presented challenges to managers attempting implementation. Urban bias is apparent in health care policy including health human resource policies. Little data is available about rural health care workers because health care statistics tend to be reported regionally. CONCLUSION: Rural institutions have difficulty accessing government funding intended to build sustainable workforces. Policies meant to be broadly implemented across jurisdictions may not fit the needs of rural institutions and their clients. Health care databases should include a rural variable to enhance understanding about this population.     

抗击新冠肺炎医疗队员个人健康及驻地管理实践探讨

截至2020年2月17日,全国累计确诊新型冠状病毒肺炎72 436例,确诊病例主要分布于湖北省。为积极缓解当地医疗机构的诊治压力,全国25 972名医护人员驰援湖北。保护医疗队员身心健康,管理医疗队员驻地,减少与避免医疗队员感染,是诊治工作顺利完成的前提,也是减少该病传播的重要举措。从智能的身心健康评估、科学的驻地区域设置、合理的日常个人防护方面进行总结。