•Proportion positive tests were positively associated with marginalized statuses.•Low testing and high positivity were associated with public transportation use.•We recommend testing and health care ...resources be directed to eastern Brooklyn.
Identifying areas with low access to testing and high case burden is necessary to understand risk and allocate resources in the COVID-19 pandemic. Using zip code level data for New York City, we analyzed testing rates, positivity rates, and proportion positive. A spatial scan statistic identified clusters of high and low testing rates, high positivity rates, and high proportion positive. Boxplots and Pearson correlations determined associations between outcomes, clusters, and contextual factors. Clusters with less testing and low proportion positive tests had higher income, education, and white population, whereas clusters with high testing rates and high proportion positive tests were disproportionately black and without health insurance. Correlations showed inverse associations of white race, education, and income with proportion positive tests, and positive associations with black race, Hispanic ethnicity, and poverty. We recommend testing and health care resources be directed to eastern Brooklyn, which has low testing and high proportion positives.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•Spatiotemporal clusters of COVID-19 in South Korea were analyzed.•The pattern and duration of clusters changed and reduced over time.•South Korea's containment strategy was effective in early ...detection and mitigation.
The aim of this study was to assess how coronavirus disease 2019 (COVID-19) clustered across districts in South Korea and to assess whether the pattern and duration of clusters changed following the country's containment strategy.
A spatiotemporal analysis of COVID-19 daily confirmed cases by 250 districts in South Korea from January 20 to May 31, 2020, obtained from the Korea Centers for Disease Control and Prevention and each provincial website, was conducted. The global Moran's I statistic was used for spatial autocorrelation analysis, and the retrospective space-time scan statistic was used to analyze spatiotemporal clusters of COVID-19.
The geographical distribution showed strong spatial autocorrelation, with a global Moran's I coefficient of 0.784 (p=0.0001). Twelve statistically significant spatiotemporal clusters were identified by space–time scan statistic using a discrete Poisson model. The spatial pattern of clusters changed and the duration of clusters became shorter over time.
The results indicate that South Korea's containment strategy for COVID-19 was highly effective in both early detection and mitigation, with recent clusters being small in size and duration. Lessons from South Korea should spark a discussion on epidemic response.
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COVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to ...COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease).
From several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities.
The initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs.
In Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly.
None.
For the Portuguese translation of the abstract see Supplementary Materials section.
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Spatiotemporal pattern of COVID-19 spread in Brazil Castro, Marcia C; Kim, Sun; Barberia, Lorena ...
Science (American Association for the Advancement of Science),
05/2021, Volume:
372, Issue:
6544
Journal Article
Peer reviewed
Open access
Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We use daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal ...pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures show that while no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.
Prioritizing COVID-19 vaccination by age Castro, Marcia C; Singer, Burton
Proceedings of the National Academy of Sciences - PNAS,
04/2021, Volume:
118, Issue:
15
Journal Article
Peer reviewed
Open access
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•Degradability and greenwash practices were assessed in commercial plastic products.•Most samples were not degradable in sea water despite claiming a sustainable status.•Greenwashing practices as ...hidden trade-off, no proof and vagueness were detected.•Misleading purchase decision and improper plastic disposal are harmful consequences.•Strategies should be adopted to avoid this environmental rip off.
Concerns about plastic pollution and global public policies have encouraged consumers to acquire environmentally friendly products. Thus, products made of biodegradable plastics have been preferred by the public, despite their costs. However, greenwashing practices, promising more environmental benefits than the products actually offer, has become frequent. Nevertheless, no studies assessing the occurrence of greenwashing in commercial plastic products sold in large world economies have been performed. The present study aimed to experimentally evaluate alterations in structure and chemical composition of selected plastic products marketed in Canada, USA and Brazil. The aging experiments carried out by seawater immersion for 180 days showed no evidence of degradation in 4 out of the 6 studied samples, despite product claims of biodegradability or 100% degradability status. This finding denotes unequivocal greenwashing practices, even including bags made of polyethylene, an ordinary non-biodegradable polymer. Thus, the inadequate adoption of green marketing is deceiving to consumers and may lead to improper disposal of these materials. These practices are highly counterproductive in view of the global public policies recently adopted to control plastic pollution. Therefore, considering the technologies currently available for identification of polymers, a strict control should be exercised over products that claim biodegradable status.
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The use of larval source management is not prioritized by contemporary malaria control programs in sub-Saharan Africa despite historical success. Larviciding, in particular, could be effective in ...urban areas where transmission is focal and accessibility to Anopheles breeding habitats is generally easier than in rural settings. The objective of this study is to assess the effectiveness of a community-based microbial larviciding intervention to reduce the prevalence of malaria infection in Dar es Salaam, United Republic of Tanzania.
Larviciding was implemented in 3 out of 15 targeted wards of Dar es Salaam in 2006 after two years of baseline data collection. This intervention was subsequently scaled up to 9 wards a year later, and to all 15 targeted wards in 2008. Continuous randomized cluster sampling of malaria prevalence and socio-demographic characteristics was carried out during 6 survey rounds (2004-2008), which included both cross-sectional and longitudinal data (N = 64,537). Bayesian random effects logistic regression models were used to quantify the effect of the intervention on malaria prevalence at the individual level. Effect size estimates suggest a significant protective effect of the larviciding intervention. After adjustment for confounders, the odds of individuals living in areas treated with larviciding being infected with malaria were 21% lower (Odds Ratio = 0.79; 95% Credible Intervals: 0.66-0.93) than those who lived in areas not treated. The larviciding intervention was most effective during dry seasons and had synergistic effects with other protective measures such as use of insecticide-treated bed nets and house proofing (i.e., complete ceiling or window screens).
A large-scale community-based larviciding intervention significantly reduced the prevalence of malaria infection in urban Dar es Salaam.
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Summary Background In November, 2015, an epidemic of microcephaly was reported in Brazil, which was later attributed to congenital Zika virus infection. 7830 suspected cases had been reported to the ...Brazilian Ministry of Health by June 4, 2016, but little is known about their characteristics. We aimed to describe these newborn babies in terms of clinical findings, anthropometry, and survival. Methods We reviewed all 1501 liveborn infants for whom investigation by medical teams at State level had been completed as of Feb 27, 2016, and classified suspected cases into five categories based on neuroimaging and laboratory results for Zika virus and other relevant infections. Definite cases had laboratory evidence of Zika virus infection; highly probable cases presented specific neuroimaging findings, and negative laboratory results for other congenital infections; moderately probable cases had specific imaging findings but other infections could not be ruled out; somewhat probable cases had imaging findings, but these were not reported in detail by the local teams; all other newborn babies were classified as discarded cases. Head circumference by gestational age was assessed with InterGrowth standards. First week mortality and history of rash were provided by the State medical teams. Findings Between Nov 19, 2015, and Feb 27, 2015, investigations were completed for 1501 suspected cases reported to the Brazilian Ministry of Health, of whom 899 were discarded. Of the remainder 602 cases, 76 were definite, 54 highly probable, 181 moderately probable, and 291 somewhat probable of congenital Zika virus syndrome. Clinical, anthropometric, and survival differences were small among the four groups. Compared with these four groups, the 899 discarded cases had larger head circumferences (mean Z scores −1·54 vs −3·13, difference 1·58 95% CI 1·45–1·72); lower first-week mortality (14 per 1000 vs 51 per 1000; rate ratio 0·28 95% CI 0·14–0·56); and were less likely to have a history of rash during pregnancy (20·7% vs 61·4%, ratio 0·34 95% CI 0·27–0·42). Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads. One in five definite or probable cases presented head circumferences in the normal range (above −2 SD below the median of the InterGrowth standard) and for one third of definite and probable cases there was no history of a rash during pregnancy. The peak of the epidemic occurred in late November, 2015. Interpretation Zika virus congenital syndrome is a new teratogenic disease. Because many definite or probable cases present normal head circumference values and their mothers do not report having a rash, screening criteria must be revised in order to detect all affected newborn babies. Funding Brazilian Ministry of Health, Pan American Health Organization, and Wellcome Trust.
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