Telemedicine,COVID-19, and disparities: Policy implications

While the rapid expansion of telemedicine in response to the COVID-19 pandemic highlights the impressive ability of health systems to adapt quickly to new complexities, it also raises important concerns about how to implement these novel modalities equitably. As the healthcare system becomes increasingly virtual, it risks widening disparities among marginalized populations who have worse health outcomes at baseline and limited access to the resources necessary for the effective use of telemedicine. In this article, we review recent policy changes and outline important recommendations that governments and health care systems can adopt to improve access to telemedicine and to tailor the use of these technologies to best meet the needs of underserved patients. We suggest that by making health equity integral to the implementation of telemedicine now, it will help to ensure that all can benefit from its use going forward and that this will be increasingly integral to care delivery.     

The political cost of sanctions: Evidence from COVID-19

We use survey data to study how trust in government and consensus for the pandemic policy response vary with the propensity for altruistic punishment in Italy, the early epicenter of the pandemic. Approval for the management of the crisis decreases with the size of the penalties that individuals would like to see enforced for lockdown violations. People supporting stronger punishment are more likely to consider the government’s reaction to the pandemic as insufficient. However, after the establishment of tougher sanctions for risky behaviors, we observe a sudden flip in support for the government. Higher amounts of the desired fines become associated with a higher probability of considering the COVID policy response as too extreme, lower trust in government, and lower confidence in the truthfulness of the officially provided information. These results suggest that lockdowns entail a political cost that helps explain why democracies may adopt epidemiologically suboptimal policies.     

Evidence of Stability in Patient-Reported Global Health During the COVID-19 Pandemic

ObjectivesMeasures of health-related quality of life (HRQOL) are collected throughout healthcare systems and used in clinical, economic, and outcomes studies to direct patient-centered care and inform health policy. Studies have demonstrated increases in stressors unique to the COVID-19 pandemic, however, their effect on HRQOL is unknown. Our study aimed to assess the change in self-reported global health during the pandemic for patients receiving care in a large healthcare system compared with 1 year earlier.MethodsAn observational cross-sectional study of 2 periods was conducted including adult patients who had a healthcare appointment and completed the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS GH) as standard care during the COVID-19 pandemic and a year earlier. The effect of time on PROMIS global mental health (GMH) and global physical health (GPH) was evaluated through multiple statistical methods.ResultsThere were 38 037 patients (mean age 56.1 ± 16.6 years; 61% female; 87% white) who completed the PROMIS GH during the pandemic (August 2020) and 33 080 (age 56.7 ± 16.5 years; 61% female; 86% white) who had completed it 1 year earlier (August 2019). GMH was significantly worse, whereas GPH was similar during the pandemic compared with a year earlier (adjusted estimate [standard error]: −1.21 (0.08) and 0.11 (0.08) T-score points, respectively).ConclusionsOur study found modest, nonclinically meaningful decreases in GMH and similar GPH during the COVID-19 pandemic compared with a year earlier in patients cared for in a large healthcare system. Nevertheless, healthcare systems are likely seeing a biased sample of patients during these times. Findings from our study have implications for the interpretation of HRQOL during this pandemic.     

COVID-19 and Routine Childhood and Adolescent Immunizations: Evidence from Louisiana Medicaid

The COVID-19 pandemic disrupted routine vaccinations for children and adolescents. However, it remains unclear whether the impact has been different for children and adolescents from low-income families. To address this, we compared monthly routine vaccination use per 1000 vaccine-eligible children and adolescents enrolled in Louisiana Medicaid in the years before (2017–2019) and during the COVID-19 pandemic (2020). Compared to the 2017–2019 average vaccination rates, we found a 28% reduction in measles, mumps, and rubella (MMR), a 35% reduction in human papillomavirus (HPV), and a 30% reduction in tetanus, diphtheria, pertussis (Tdap) vaccinations in 2020. Vaccine uptake was lower in April 2020 after the declaration of a state of emergency and in late summer when back-to-school vaccinations ordinarily occur. We found little evidence of recovery in later months. Our findings suggest that a substantial number of disadvantaged children may experience longer periods of vulnerability to preventable infections because of missed vaccinations.     

Effectiveness of adenovirus type 5 vectored and inactivated COVID-19 vaccines against symptomatic COVID-19, COVID-19 pneumonia,and severe COVID-19 caused by the B.1.617.2 (Delta) variant: Evidence from an outbreak in Yunnan,China, 2021

BackgroundIn partial response to the coronavirus disease 2019 (COVID-19) pandemic, countries around the world are conducting large-scale vaccination campaigns. Real-world estimates of vaccine effectiveness (VE) against the B.1.617.2 (Delta) variant are still limited. An outbreak in Ruili city of China provided an opportunity to evaluate VE against the Delta variant of two types of COVID-19 vaccines in use in China and globally – inactivated (CoronaVac and BBIBP-CorV) and adenovirus type 5 vectored (Convidecia) vaccines.MethodsWe estimated VE using a retrospective cohort study two months after the Ruili vaccination campaign (median: 63 days). Close contacts of infected people (Chinese nationality, 18 years and above) were included to assess VE against symptomatic Covid-19, COVID-19 pneumonia, and severe COVID-19. We calculated the relative risks (RR) of the outcomes for unvaccinated compared with fully vaccinated individuals. We used logistic regression analyses to estimate adjusted VEs, controlling for gender and age group (18–59 years and 60 years and over).We compared unvaccinated and fully vaccinated individuals on duration of RT-PCR positivity and Ct value.FindingsThere were 686 close contacts eligible for VE estimates. Adjusted VE of ad5-vectored vaccine was 61.5% (95% CI, 9.5–83.6) against symptomatic COVID-19, 67.9% (95%CI: 1.7–89.9) against pneumonia, and 100% (95%CI: 36.6–100) against severe/critical illness. For the two inactivated vaccines, combined VE was 74.6% (95% CI, 36.0–90.0) against symptomatic COVID-19, 76.7% (95% CI: 19.3–93.3) against pneumonia, and 100% (95% CI: 47.6–100) against severe/critical COVID-19. There were no statistically significant differences in VE between two inactivated vaccines for symptomatic COVID-19 and for pneumonia, nor were there statistically significant differences between inactivated and ad5-vectored VE in any of the three outcomes. The median durations of RT-PCR positivity were 17 days for fifteen people vaccinated with an inactivated vaccine, 18 days for forty-four people vaccinated with the Ad5 vectored vaccine, and 26 days for eleven unvaccinated individuals. InterpretationThese results provide reassuring evidence that the three vaccines are effective at preventing Delta-variant COVID-19 in short term following vaccination campaign, and are most effective at preventing more serious illness. The findings of reduced duration of RT-PCR positivity and length of hospital stay associated with full vaccination suggests potential saving of health-care system resources.     

Face masks,public policies and slowing the spread of COVID-19: Evidence from Canada

We estimate the impact of indoor face mask mandates and other non-pharmaceutical interventions (NPI) on COVID-19 case growth in Canada. Mask mandate introduction was staggered from mid-June to mid-August 2020 in the 34 public health regions in Ontario, Canada’s largest province by population. Using this variation, we find that mask mandates are associated with a 22 percent weekly reduction in new COVID-19 cases, relative to the trend in absence of mandate. Province-level data provide corroborating evidence. We control for mobility behaviour using Google geo-location data and for lagged case totals and case growth as information variables. Our analysis of additional survey data shows that mask mandates led to an increase of about 27 percentage points in self-reported mask wearing in public. Counterfactual policy simulations suggest that adopting a nationwide mask mandate in June could have reduced the total number of diagnosed COVID-19 cases in Canada by over 50,000 over the period July–November 2020. Jointly, our results indicate that mandating mask wearing in indoor public places can be a powerful policy tool to slow the spread of COVID-19.     

COVID-19 and counterfeit vaccines: Global implications,new challenges and opportunities

This research note (RN) examines the drivers and consequences of proliferation of counterfeit (substandard and falsified) COVID-19 vaccines. An integrated framework was advanced which sheds light on the domestic contributory factors such a desperation by citizens to “return to normalcy”, institutional impediments, minimum standards of enforcement of laws related to intellectual property rights and lack of access to vaccines in tandem with international environmental drivers such as the growth of online pharmacies, international market intermediaries and vaccine nationalism. Consequently, counterfeit COVID-19 vaccines appear to serve as a disincentive to innovation and investment in research and development activities. The analysis highlights health-related consequences including providing a false sense of security against a dangerous virus and potentially loss of confidence in reliable medicines. This analysis led to the generation of some vital socio-economic implications for public policy and enterprises, which are discussed     

Population migration,confirmed COVID-19 cases,pandemic prevention,and control: evidence and experiences from China

Journal of Public Health - The virulence of the novel coronavirus disease (COVID-19) has facilitated its rapid transition towards becoming a pandemic. Hence, this study aims to investigate the...     

Excess mortality and protected areas during the COVID-19 pandemic: Evidence from Italian municipalities

There is widespread debate on the drivers of heterogeneity of adverse COVID-19 pandemic outcomes and, more specifically, on the role played by context-specific factors. We contribute to this literature by testing the role of environmental factors as measured by environmentally protected areas. We test our research hypothesis by showing that the difference between the number of daily deaths per 1,000 inhabitants in 2020 and the 2018–19 average during the pandemic period is significantly lower in Italian municipalities located in environmentally protected areas such as national parks, regional parks, or Environmentally Protected Zones. After controlling for fixed effects and various concurring factors, municipalities with higher share of environmentally protected areas show significantly lower mortality during the pandemic than municipalities that do not benefit from such environmental amenities.     

Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

ObjectivesThe COVID-19 pandemic has had a major impact on our society, with drastic policy restrictions being implemented to contain the spread of the severe acute respiratory syndrome coronavirus 2. This study aimed to provide an overview of the available evidence on the cost-effectiveness of various coronavirus disease 2019 policy measures.MethodsA systematic literature search was conducted in PubMed, Embase, and Web of Science. Health economic evaluations considering both costs and outcomes were included. Their quality was comprehensively assessed using the Consensus Health Economic Criteria checklist. Next, the quality of the epidemiological models was evaluated.ResultsA total of 3688 articles were identified (March 2021), of which 23 were included. The studies were heterogeneous with regard to methodological quality, contextual factors, strategies’ content, adopted perspective, applied models, and outcomes used. Overall, testing/screening, social distancing, personal protective equipment, quarantine/isolation, and hygienic measures were found to be cost-effective. Furthermore, the most optimal choice and combination of strategies depended on the reproduction number and context. With a rising reproduction number, extending the testing strategy and early implementation of combined multiple restriction measures are most efficient.ConclusionsThe quality assessment highlighted numerous flaws and limitations in the study approaches; hence, their results should be interpreted with caution because the specific context (country, target group, etc) is a key driver for cost-effectiveness. Finally, including a societal perspective in future evaluations is key because this pandemic has an indirect impact on the onset and treatment of other conditions and on our global economy.     

Food Security,Financial Resources,and Mental Health: Evidence during the COVID-19 Pandemic

COVID-19 has negatively impacted many households’ financial well-being, food security, and mental health status. This paper investigates the role financial resources play in understanding the relationship between food security and mental health among U.S. households using data from a survey in June 2020. Results show job loss and savings draw down to pay for household bills had a significant relationship with both lower food security and greater numbers of poor mental health days during the pandemic.     

陕西省咸阳市新型冠状病毒肺炎病例流行病学特征分析

【目的】分析咸阳市2020年1月—2月报告的新型冠状病毒肺炎(COVID-19)病例流行病学特征。【方法】以咸阳市中心医院收治的17例COVID-19确诊病例为研究对象,收集流行病学调查资料和临床资料,对病例的基本情况、临床特征及流行病学特征进行描述性分析。【结果】17例COVID-19确诊病例中男性10例,女性7例;平均年龄(39.59±17.31)岁;发病至确诊时间间隔最短1 d,最长10 d,中位数4 d;病程最短3 d,最长23 d,中位数16 d。17例确诊病例中轻症病例6例,普通肺炎10例,重症肺炎1例;首发症状表现为发热15例,部分患者伴有乏力、咽痛、咳痰、呕吐、肌肉酸痛,首发非发热症状者2例;所有病例均无并发症;患者白细胞、淋巴细胞计数水平偏低;胸部CT检查均可见不同程度的弥漫性玻璃样阴影。11例有武汉地区旅居史,4例有接触过武汉旅居史的人,2例未发现有明确接触史;17例确诊病例中4例为家庭聚集性发病。【结论】COVID-19人群普遍易感,大多具有明确的流行病学接触史,患者白细胞、淋巴细胞计数及CT检查有明显改变。     

儿童新型冠状病毒肺炎疑似病例分析

目的 分析儿童新型冠状病毒肺炎(简称新冠肺炎)疑似病例的流行病学及临床特点. 方法 选取2020年1月23日-2月23日湖南省儿童医院感染科隔离留观病房的46例新冠肺炎疑似病例进行回顾性分析. 结果 疑似病例流行病学史:有湖北旅居史的33例(71.8％),所在社区有确诊病例的7例(15.2％),接触高度疑似病例的2例(...     

Under-reporting of COVID-19 cases in Turkey

Having an accurate account of the number of national COVID-19 cases is essential for understanding the national and global burden of the disease and managing COVID-19 prevention and control efforts. There is also substantial under-reporting of COVID-19 cases and deaths in many countries. In this article, the COVID-19 under-reporting problem in Turkey is addressed, and examples and reasons for the under-reporting are discussed.     

145例新型冠状病毒肺炎病例流行特征分析

目的 对西安市新型冠状病毒肺炎(简称新冠肺炎,COVID-19)疫情流行特征进行分析,为更好地防控疫情提供参考.方法 采用描述性流行病学方法对疫情应急处置期间病例的现场流行病学调查资料进行分析.结果 截至7月25日全市共报告COVID-19病例145例,含确诊病例120例,无症状感染者25例;湖北输入病例42例,其他省...     

Evaluation of Effectiveness of Global COVID-19 Vaccination Campaign

To model estimated deaths averted by COVID-19 vaccines, we used state-of-the-art mathematical modeling, likelihood-based inference, and reported COVID-19 death and vaccination data. We estimated that >1.5 million deaths were averted in 12 countries. Our model can help assess effectiveness of the vaccination program, which is crucial for curbing the COVID-19 pandemic.     

新型冠状病毒肺炎病例流行特征及临床特征分析

目的 分析新型冠状病毒肺炎（COVID-19）流行病学特征、临床特点及CT影像变化,为当地疫情防治提供参考依据。方法 收集商城县人民医院和罗山县人民医院2020年1月23日至2月23日收治的所有COVID-19确诊病例的病历资料及影像学资料。采用描述流行病学分析方法进行分析。结果 共收治确诊COVID-19病例50例,男女性别比为1.38∶1,平均年龄为（50.92 ± 14.63）岁,其中45~64岁31例（占62%）。39例（占78%）具有流行病学暴露史,11例（占22%）无明确的流行病学暴露史。有6起家族聚集发病现象,共涉及13例病例。潜伏期1~23 d,平均为（5.95 ± 4.24）d。发热（占84%）和咳嗽（占72%）是该病例人群主要症状。入院时43例（占86%）白细胞计数正常或者淋巴细胞计数绝对值减少,40例（占80%）红细胞沉降率增快,26例（占52%）C反应蛋白升高。15例（占30%）合并原发基础疾病。40例（占80%）使用2种及以上抗病毒药物。入院2周后40例（占80%）CT显示病灶逐渐吸收。结论 多数患者具有明确的流行病学暴露史,存在家族聚集性发病现象,临床症状以发热、咳嗽为主,白细胞正常或者减少、血沉增快较多见,对临床诊断具有参考价值,CT表现病灶面积呈先扩大后逐渐吸收的变化趋势,积极抗病毒及对症治疗症状多能好转。