Does holding elections during a Covid-19 pandemic put the lives of politicians at risk?

We estimate the impact of French town hall elections held in mid-March 2020 on the mortality of 163,000 male candidates aged above 60. Their excess mortality during March and April was similar to the general population. We compare candidates in cities with two candidate lists to those in cities with only one list, as elections are more intense in contacts in the former group. We also use a regression discontinuity design and investigate mortality in 2020 depending on how candidates fared in the 2014 election. We cannot detect any causal effect of active participation in the 2020 elections on mortality.     

Reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic

Purpose:To analyze the reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic.Methods:This was a prospective, cross-sectional, multicenter questionnaire study which included patients with mature cataract, nuclear sclerotic cataract grade IV, and cataracts with best corrected visual acuity (BCVA) <5/60, during the COVID-19 pandemic from December 2020 to April 2021. Reasons for delay in presentation to the hospital were analyzed.Results:One thousand four hundred seventy two patients were recruited with advanced cataracts. Absence of ophthalmic care nearby (44.2%), lack of awareness regarding elective surgeries (42.6%), lack of public transportation (37%), fear of contracting COVID-19 (23.4%), and waiting for outreach camps (20.4%) were found to be the reasons behind the delay in cataract surgery. 53.7% of the patients had worsening of defective vision and 55.3% of them had difficulty in carrying out activities of family living. 30.8% of the patients faced difficulty in commuting and 8.4% of the patients suffered a fall during this pandemic due to worsening of the visual acuity.Conclusion:The lockdown imposed during the pandemic has created a significant backlog of patients who are progressing to advanced cataracts due to lack of ophthalmic care nearby, lack of awareness regarding elective surgeries, lack of public transportation, and no outreach camps. Proactive measures to deal with this backlog are of utmost need to prevent blindness due to cataract.     

Association between early initiation of breastfeeding and reduced risk of respiratory infection: Implications for nonseparation of infant and mother in the COVID‐19 context

Early initiation of breastfeeding, within 1 h of birth, is vital for the health of newborns and reduces morbidity and mortality. Secondary analysis of the 2016 Nepal Demographic and Health Survey (DHS) showed that early initiation of breastfeeding significantly reduced the risk of acute respiratory infection (ARI) in children under 2 years. Early initiation of breastfeeding requires maternal proximity. Separation of infant and mother inhibits early initiation of breastfeeding and increases the risk that infants will suffer from ARIs. However, during the COVID‐19 pandemic, guidance varied, with some recommending that infants and mothers with SARS‐CoV‐2 be isolated from one another. Nepal''s Ministry of Health and Population recommended nonseparation, but the adherence to this guidance was inconsistent. Maternal proximity, nonseparation and early initiation of breastfeeding should be promoted in all birthing facilities.     

Factors associated with early uptake of COVID‐19 vaccination among healthcare workers in Azerbaijan, 2021

IntroductionWe evaluated uptake and factors associated with COVID‐19 vaccination among health workers (HWs) in Azerbaijan.ResultsAmong 1575 HWs, 73% had received at least one dose, and 67% received two doses; all received CoronaVac. Factors associated with vaccination uptake included no previous COVID‐19 infection, older age, belief in the vaccine''s safety, previous vaccination for influenza, having patient‐facing roles and good or excellent health by self‐assessment.ConclusionThese findings could inform strategies to increase vaccination uptake as the campaign continues.     

Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China

BackgroundCOVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public’s attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates.ObjectiveThe aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics.MethodsWe conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights.ResultsA total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6%, 95% CI 74.6%-76.5%). Women (3778/4921, 76.8%; odds ratio 1.18, 95% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8%; odds ratio 1.13, 95% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1%, 95% CI 71%-73.1%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3%, 95% CI 76.3%-78.2%).ConclusionsAmong our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers’ actions on COVID-19 vaccine distribution with the preferences of their constituencies.     

Public health implications of opening National Football League stadiums during the COVID-19 pandemic

Using attendance data from the 2020 National Football League (NFL) regular season and local COVID-19 case counts, we estimate the public health impact of opening NFL stadiums to fans during the COVID-19 pandemic. Data are analyzed using robust synthetic control, a statistical method that is employed to obtain counterfactual estimates from observational data. Unlike previous studies [J. Kurland et al., SSRN, 2021], which do not consider confounding factors such as evolving policy landscapes in different states, the synthetic control methodology allows us to account for effects that are county specific and may be changing over time. We find it is likely that opening stadiums had no impact on local COVID-19 case counts; this suggests that, for the 2020 NFL season, the benefits of providing a tightly controlled outdoor spectating environment—including masking and distancing requirements—counterbalanced the risks associated with opening. These results are specific to the 2020 NFL season, and care should be taken in generalizing our conclusions. In particular, 1) these data reflect a period during which earlier strains of COVID-19 were dominant prior to the emergence of more-transmissive strains such as the Delta and Omicron variants, and 2) the data are restricted to outdoor environments; hence our results cannot be applied to small indoor spaces where transmission-restricting controls are essential.

A year and a half into the global COVID-19 pandemic, we have an opportunity to analyze and reflect upon the policies and decisions enacted over the past 18 mo. Given the distributed nature of policy decisions in the United States, we find ourselves in a unique position in which states and municipalities have explored different strategies to combat the virus, and the efficacy of those policies has been imprinted in the local case counts, hospitalizations, and death records. In particular, these data contain a wealth of information about which policies have proven to be effective in preserving the health and safety of our communities.One activity that one may wish to consider is the opening of outdoor sporting events to spectators. This question has recently generated quite a bit of interest as ballparks across the nation open for summer and events such as the 2021 Summer Olympics in Japan take place.^* On the one hand, governing bodies are naturally wary of opening stadiums given the well-documented importance of avoiding large gatherings. On the other hand, sporting events are often held outdoors, where airflow is largely unobstructed (1), and in venues where crowd density can be carefully controlled if the event is properly managed. In the absence of a detailed analysis, it is not immediately obvious which of these effects dominates.Data from the National Football League (NFL) may provide an answer to this question. During the 2020 regular season, teams in the NFL collaborated with local communities to determine whether or not to allow fans in the stadiums during the pandemic. In general, stadiums that opened their doors to fans adopted pandemic requirements for all in attendance (1), which typically include some combination of staggered entry, required masking, health questionnaires, temperature checks for staff, deployment of compliance officers, modified concessions, social distancing in seating and lines, mobile ticketing, enhanced cleaning protocols, amplified health and safety communications, and capacity limitations. The highest capacity that any NFL stadium allowed during the 2020 regular season was 30% (Dallas), with most other stadiums considerably below that limit (2). These policy decisions were made based on local guidelines, local prevalence, community risk tolerance, and other localized considerations; some stadiums ultimately decided to allow fans at the games, while others remained closed, providing perhaps the first set of natural experiments that can be analyzed to investigate the impact of opening stadiums on COVID-19 case rates. In the words of Kurland et al. (3), who recently provided a first look at this data, “Scant evidence has been gathered in the extant literature on the impact of sport venues on local public health, influenza-related mortality rates, or disease contagion more generally. There is a complete absence of any evidence related to the impact of fans gathering at sporting events, or mass gatherings more generally, on incidence of COVID-19 at the local-level.” The natural experiments from the 2020 NFL season and other sports leagues present a golden opportunity to address these questions in the context of the original 2020 COVID-19 strain (4, 5).In the Kurland et al. (3) study, the authors compared COVID-19 case data from NFL stadium counties that allowed fans in the stadium to counties that did not allow fans, and looked for spikes in the data in the weeks following a game; the authors concluded, from this analysis, that the presence of large numbers of fans at NFL games led to “tangible increases” in the local incidence of COVID-19 cases. However, this type of analysis may be problematic: In this context, the control stadiums (i.e., those without fans) tend to be embedded in states with stricter COVID-19 policies—rather than a random control—so the sample of control counties is strongly biased. New York and Dallas, for example, are immersed in very different environments with different pandemic policies, and it is not at all obvious that one can attribute the differences in case spikes to the stadiums, given the enormous number of confounding factors.Fortunately, there exists a rich literature of techniques—longitudinal methods, hierarchical methods, factor model methods, synthetic control, etc.—that we can draw upon to account for these confounding factors. In this particular analysis, we turn to synthetic control (6–9), which has been applied in a diversity of fields—criminology (10), healthcare (11), sports (12), and political science and policy evaluation (13–15), to name a few. At its heart, synthetic control is a method for estimating a counterfactual in the absence of an intervention, in this case, what would have happened if stadiums had not opened. The method provides a systematic way to choose relevant comparison units when randomized controls are not available.To illustrate the power of synthetic control, imagine the ideal experiment one would like to run in order to quantify the impact of opening the Dallas stadium to fans. In principle, we would like to have COVID-19 case counts from Dallas County throughout the season with the stadium open to fans and case counts from a Dallas twin—with identical people and policies to the first Dallas—in which the stadium did not open for comparison. The first set of data (Dallas open to fans) is readily available. The second set of data can be constructed from information from other counties in Texas—hereafter referred to as donor counties—which have policies and characteristics similar to Dallas. Synthetic control provides a methodology to build a weighted combination of these Dallas-like counties, which can then be used as a control group, that is, a “synthetic” Dallas twin. In particular, we seek the linear combination of case counts from other Texas counties that most closely mirrors the Dallas case counts prior to the stadium opening. Given that none of these non-Dallas counties have a stadium, this linear combination can be extended postintervention (i.e., after opening the stadium) to estimate what would have happened in the synthetic Dallas in which no stadium opened. Once it has been established that the stadium county and the synthetically generated county have similar behavior over extended periods of time prior to the intervention, a discrepancy in the number of COVID-19 cases following the intervention may be interpreted as a result of allowing fans in the stadium. One of the advantages of this method is that it can account for the effects of confounding factors that are county specific and may be changing over time, which is crucial in the ever-evolving policy landscape of a pandemic (16). In particular, our methodology allows for correlation between the decision to open the stadium and characteristics that define the county (cultural or political leaning, population density, demographics, etc.), but cannot account for correlations between the decision and exogenous noise.At this point, it is reasonable to speculate whether one should expect linear combinations of donor counties to accurately represent stadium counties (both observed and counterfactual). In general, assuming linearity is appropriate provided there exists an underlying low-dimensional structure to the case count data, that is, if the matrix containing discretized time series of donor county case counts is approximately low rank. Under a such a setting, linearity between counties is an almost immediate consequence (see Materials and Methods for details). This low-rank assumption is common in the matrix completion literature; notably, low-rank matrices have also been shown to naturally arise in modern datasets and emerge from “well-behaved” generative models (e.g., Lipschitz functions) (17–20). This point will be revisited in Results, where we test for low rankedness empirically in the context of our dataset.Finally, the selection of donor units is a critical step in the successful implementation of creating a synthetic control. In particular, donor units (in our case, counties) should have the following characteristics:

• 1)Counties affected by the intervention or by events of a similar nature should be excluded from the donor pool.
• 2)Counties that may have suffered large “idiosyncratic shocks” (7, 21) during the preintervention period should be excluded.
• 3)The donor pool should be restricted to counties with characteristics similar to the stadium county; in this case, we restrict our pool to counties from the same state to maintain some consistency in COVID-19 policies.
• 4)Case counts that cover an extended period of time prior to the intervention are required for both stadium counties and donor counties.

In order to establish which counties satisfy these constraints, the NFL provided us with aggregate attendance data indicating the percentage of fans from each county in each state (2). In general, 10% or more of the fans come from the county in which the stadium is located. Hence, we designate counties that provided more than 10% of the fan base as stadium counties. In addition, there are a number of counties that are home to many fans but not to the same extent as that of the stadium counties. Since there is some ambiguity as to whether these counties should be counted as stadium counties or donor counties, we designate counties that supply between 1% and 10% of the fan base as buffer counties and, in light of the first criterion above, do not include them as either stadium or donor counties. Second, to address criterion 3, we only include counties in the donor pool that come from the same state as the stadium county. Although there is variation at the county level, overarching COVID-19 guidance, in general, comes from the states; hence, we assume that policies are relatively consistent within states and allow that they may vary dramatically from state to state. In addition, we only retain counties in which at least 200 cases have been recorded, in order to eliminate donor counties that are either markedly underreporting or undertesting. Finally, we are fortunate that football season starts in September, which allows us to address criterion 4; given that relatively reliable COVID-19 case count data have been available since approximately April 2020, we have 4 mo of training data at our disposal to learn the weights for the synthetic counties. Criterion 2 is trickier, given that we do not necessarily know, a priori, all events that could cause a shock to the system; however, a posteriori, we can investigate the outcomes and look for signs of such a shock.^†     

广州市居民人禽流感及流感大流行信息需求的电话调查

目的了解广州市公众对人禽流感及流感大流行的信息需求,制定有针对性的沟通信息,为人禽流感及流感大流行发生时,与公众进行有效沟通做准备。方法采用电话问卷调查方法获得所需信息。自制调查表,经预调查修订后,再进行正式调查。结果共拨打4121个电话号码,电话调查有效应答率为52.4%。广州发生动物禽流感及人禽流感疫情后,被调查者49.3%对事件不感兴趣,仅10%关注事件。政府公布信息后,11.6%的公众认为政府隐瞒了信息。在信息沟通方面(健康教育宣传),0.7%的公众认为宣传资料内容太多,分不清主次;3.5%感到宣传资料太专业,看不明白;4.4%认为政府提供的信息不是个人想得到的。假设广州发生流感大流行,害怕这种状况发生的公众优先选择的3项措施为不去人多的地方(51.8%)、不吃鸡肉(50.4%)、勤洗手(44.2%),仅6.2%的公众选择打喷嚏时捂嘴。公众对人禽流感需要的主要信息为一般性的知识问题,如人禽流感的现状是怎样的(66.7%)、与疫苗相关的问题(42.4%)、怎样预防禽流感(36.3%)、是否有治疗和预防的药物(25.8%)、如何消毒(21.9%)等。公众对流感大流行的主要信息需求为与隔离有关的问题(62.2%)、希望得到政府的及时公告(50.9%)、政府的控制措施是什么(35.7%)、个人能做什么准备工作(30.1%)、大流行发生时,公众应该做什么(23.4%)等。结论电话调查应答率较高,广州市居民可以接受电话访问的调查方式。90%的公众不关注禽流感事件,公众对流感大流行的相关信息了解较少。     

Trends in Physical Fitness and Nutritional Status among School-Aged Children and Adolescents during the COVID-19 Pandemic in Shaanxi,China—A Cross-Sectional Study

Background: This study aimed to explore the characteristics of trends in physical fitness and nutritional status among school-aged students during the COVID-19 pandemic, which could help to develop targeted guidelines and policies for students (adolescents) to promote health during lockdowns resulting from public health emergencies. Methods: The physical fitness and nutritional status were measured from 2019 to 2021; the correlation between years and grade were analyzed. Results: a declining trend was found in aerobic fitness, strength fitness, speed fitness, and BMI during this lockdown. Conclusion: The changes in dietary behavior and the decrease in outdoor physical activities may be the reason for the decline. Furthermore, differences in subjects’ growth and limited space at home must be considered in the formulation of exercise and nutritional plans. According to the results of our study, exercise for aerobic fitness should receive more attention when students are enduring a pandemic lockdown. In addition, saying “no” to high-calorie foods in the form of snacking and ultra-processed food was the key to improving subjects’ nutritional status.     

Behavioural insights and the evolving COVID-19 pandemic

Behavioural sciences have complemented medical and epidemiological sciences in the response to the SARS-CoV-2 pandemic. As vaccination uptake continues to increase across the EU/EEA – including booster vaccinations – behavioural science research remains important for both pandemic policy, planning of services and communication. From a behavioural perspective, the following three areas are key as the pandemic progresses: (i) attaining and maintaining high levels of vaccination including booster doses across all groups in society, including socially vulnerable populations, (ii) informing sustainable pandemic policies and ensuring adherence to basic prevention measures to protect the most vulnerable population, and (iii) facilitating population preparedness and willingness to support and adhere to the reimposition of restrictions locally or regionally whenever outbreaks may occur. Based on mixed-methods research, expert consultations, and engagement with communities, behavioural data and interventions can thus be important to prevent and effectively respond to local or regional outbreaks, and to minimise socioeconomic and health disparities. In this Perspective, we briefly outline these topics from a European viewpoint, while recognising the importance of considering the specific context in individual countries.     

基于《内经》遗篇探讨中医对疫病的认识

根据《内经》遗篇《刺法论》《本病论》提出三虚兼“邪鬼”（致病原）致疫说,认为疫疠产生的根本原因是人气不足,天气如虚,人神失守,“邪鬼”（致病原）干人,其对现代疫病防治的意义在于对当地天地之气交特点、个体的体质特点和病情特点的把握。对于突发的新型传染病等流行性疾病,当病因或病原体及其致病特点尚未被现代医学认识清楚之前,以中医学的辨天地之气交、六气六经辨证、温病学疫气理论指导疾病的预防和治疗具有重要的意义,为构建中医药疫病防治体系,重构疫病学科提供借鉴。