Abstract
Background
Research suggests that human mobility is associated with the spread of Dengue Fever 1. The gold-standard in estimating a causal effect are randomized experiments. As these are ...neither feasible nor ethical in estimating mobility's impact on Dengue, we rely on methods that make use of observational data. During the COVID-19 pandemic, most of the world saw a sudden drop in long- and short-distance travel. In March 2020, inner- and inter-city transit dropped severely and uniformly across cities in Brazil. The drop was random (in time) and is not linked to any of the other factors that affect Dengue, such as the mosquito population size. This gives rise to a quasi-experimental situation to assess the impact of mobility reduction on Dengue Fever in Brazilian cities.
The potential impact of the COVID-19 pandemic on Dengue Fever has been recognized globally 2, 3 and first attempts at estimating this impact have been published. Conceição et al. (2021) 4 find an association between social isolation and Dengue in the Brazilian state of São Paulo using a negative binomial regression model. Risk of Dengue infection in São Paulo decreases by 9% twenty days after isolation, defined as mobility reduction of 1-30% relative to baseline mobility prior to the pandemic. Lim et al. (2020) 5 use a Regression Discontinuity Design (RDD) to estimate the causal effect of social distancing policies on Dengue at the state-level in three South-East Asian countries. Results for Thailand indicate that social distancing raises Dengue incidence by 0.431 cases per 10,000 people. The authors explain this effect by referring to the increased time spent at home, where the risk of infection is higher than in other locations, such as workplaces. No significant effect was found for Singapore and Malaysia.
Figure 1 shows the time series of Dengue cases in cities in São Paulo over time. The top panel compares the evolution during the pandemic year 2020 with the average of prior distributions. We note that early 2020 saw greater incidence and an earlier peak than in prior years. This could be due to the stark mobility reduction that occurred in March (epidemiological weeks 11-13). However, the evolution of Dengue cases from 2020 is not unprecedented, as can be seen in the lower panel. Here we compare the time series in individual years and note that 2020 had a similar distribution as the year 2016. The peak in these years occurred earlier than in the years 2015 and 2019. In the following analysis, we aim to better understand the possible causal impact of mobility reduction on Dengue.
1222 Figure 1:
Dengue cases over epidemiological week, mean and 95% confidence interval across cities
Methods
We implement propensity score matching to assess the causal effect of mobility on Dengue during the COVID-19 pandemic in São Paulo state in Brazil. We match weeks during the peak pandemic period (March-June 2020) to comparable previous periods based instruments for the mosquito population size and human susceptibility to Dengue. The breeding conditions and thus mosquito population size is approximated using climate factors. We estimate the level of susceptibility within the human population by taking the average number of infections in the same month of the past three years, so as to approximate the duration of partial immunity after Dengue infection. By matching within a given city, we also control for city-level characteristics that may affect Dengue, such as landscape and environment factors, socio-economic situation, or population density.
We use weekly data on Dengue cases and climate (rainfall, temperature, humidity) in 37 cities in the state of São Paulo, Brazil, from 2015 until 2020. The peak isolation period (March - June 2020) was determined using monthly traffic volume at toll stations, where isolation is the period in which passenger traffic was consistently below the pre-pandemic (2011-2019) minimum. We also leverage the regional COVID-19 Community Mobility Reports published by Google to assess the change in mobility due to the pandemic.
We compute the propensity score using both a logistic regression model and a 100-tree Random Forest model with five-fold cross-validation. In both cases, we observe good overlap in the propensity scores among treated and control groups, suggesting that conditions for matching are met (see figure 2).
1222 Figure 2:
Propensity score distributions among treatment and control groups
We implement both one-to-one and one-to-many matching with calipers. After matching, we observe similar distributions of the control variables among the treated and matched control periods. Figure 3 illustrates this using the distributions of the one-to-one matching based on propensity scores of the logistic regression models.
1222 Figure 3:
Covariate distributions of treated and matched control units (one-to-one matching on propensity scores computed using logistic regression)
Results
We compare the Sample Average Treatment Effect on the Treated (SATT) across the four models and find variation in the direction of the causal effect. In 12 cities, mobility reductions are linked to more Dengue cases with results being robust to the propensity score estimation method and matching type. Fewer Dengue cases are reported in 9 cities during the pandemic, regardless of which model is chosen. The remaining cities are sensitive to the model chosen: in 6 cases, three of the four models produced a positive effect, while the majority indicated lower Dengue incidence in 5 cities.
The diversity of results may be attributed to differing travel patterns across cities. Long-distance travel hubs like São Paulo (the state capital) and São Carlos (university city with flux of students across the country) demonstrate a negative relationship of a SATT of -18.0 and -18.8 cases per week, respectively. Cities that experience mostly local travel demonstrate the converse effect. This role of different mobility types should be explored further.
Additional robustness checks should be performed to understand the role of additional control variables or varying time series length.
Conclusions
The SATT of mobility on Dengue varies across the cities in our sample, with more cities experiencing an increase in cases during the COVID-19 pandemic.
Key messages
The travel reduction due to the COVID-19 pandemic enables a quasi-experimental analysis of mobility on Dengue. Our results suggest that there is a a causal effect of mobility on Dengue that varies across cities in São Paulo state. Specific characteristics of cities may help explain where mobility leads to Dengue spreading and where home-based infections are the primary disease drivers.
Background
Due to its high attack rate, COVID 19 is responsible for a high number of deaths despite its relatively low lethality rate. This study was conducted to assess the relationship between time ...to consultation, presence of respiratory complications at hospital admission and fatal outcome of COVID 19 cases.
Methods
This was a case control design study which collected data from records of all COVID 19 patients admitted in Bafoussam Regional Hospital from March 2020 to April 2021. The association between the delay in seeking care, dyspnoea and blood oxygen level at admission, and fatal outcome was assessed by estimating crude and adjusted odd ratio.
Results
Of 400 included patients, 239 (59.75%) were male, 84 (23.73%) health professionals and 144 (36.0%) aged 64 years and above. The mean duration of hospitalization was 11.39 days and 120 (30.0%) admitted patient died. Seeking care during or before the end of the first day of symptom onset significantly reduced the risk (Adjusted (A) OR = 0.4 (0.16-0.98)) of fatal outcome, whereas waiting three (AOR=0.6(0.31-1.16))or seven days (AOR=0.91(0.47-1.75)) did not change this risk. Dyspnoea (AOR=2.71(1.38-5.29)) or oxygen level <95% (AOR=22.87(2.99-174.76)) significantly increased the risk of fatal outcome.
Conclusions
Health interventions contributing for early detection and connection of COVID 19 cases to care before respiratory complications occur are expected to reduce mortality in COVID 19 patients.
Focus of Presentation
During pandemic the social life has been transformed by new regimes of social distancing, face masks, and altered online education. The aim of this presentation is to review the ...recent philosophical concepts of biopolitics that bring an additional perspective to the COVID-19 pandemic.
Findings
The most important critical response was brought from the philosopher and cultural theorist Giorgio Agamben who in the book entitled “Where are we now? Epidemic as politics” evoked again, known from his previous writings, the figure of bare life. The epidemic restrictions have shown, that humanity no longer believes in anything but bare existence, to be preserved as such at any cost. There were no reliable risk-benefit analysis that took into account all other aspects of human condition except statistical data on positive test results or “asymptomatic illness”. The concepts of another Italian philosopher Roberto Esposito became more than relevant during pandemic. In his book entitled “Immmunitas: the Protection and Negation of Life” he assumes that the more we feel at risk of being infiltrated and infected by foreign elements, the more the life of the individual and society closes off within its protective boundaries, reminding us of the situations during lockdowns.
Conclusions/Implications
According to biopolitical interpretation of epidemic, the risk of infection can be considered as a “pretext” for ramping up political control on citizens.
Key messages
Epidemiologists should be aware what are the consequences of the decisions they recommended for governments when the social relations and the power structure are affected.
Background
Considering the current COVID-19 pandemic due to SARS-CoV-2, it is necessary to estimate the role of health awareness, severity of disease impact on coronavirus patients and follow the ...approved disease preventive practices to improve the quality of health. This study aims to provide a systematic literature review on the health literacy awareness among the general population about SARS-CoV-2 and its impact on COVID-19 prevention.
Methods
We performed an extensive literature search on health literacy among public related to COVID-19. Relevant articles from PubMed and Cochrane databases were extracted and evaluated by applying appropriate key search terms to obtain the information published from January 2020 to April 2021. We included data based on observational and questionnaire-based studies and gathered information on participant's characteristics, health literacy and awareness, fear of COVID-19, and health-related behaviours.
Results
The most eligible studies were identified from the available literature (N = 39) searched through using appropriate key terms. The literature analysis showed that social media and interacting personally with a community of friends are the primary sources that spread pandemic information related COVID-19 pandemic and its severity.
Conclusion
Globally, social media is a major platform for disseminating and promoting health literacy about COVID-19 among the general population. It is suggestable to bring a more robust approach for a larger population who have educational disparity for better prevention of this communicable disease.
Key Message
A rapid health awareness among the general public unaware of the seriousness of the COVID-19 pandemic is imperative and also to encourage COVID appropriate behaviors for better control of COVID-19.
Background
In April 2020, the Japanese government requested that people stay home except when unavoidable for their livelihood, as a COVID-19 emergency measure. Especially, elderly people refrained ...from going out. We investigated mortality rates from external causes in 2020 among Japanese elderly people.
Methods
The monthly mortality rates from accidents (V01-X59), traffic accidents (V01-V99) and suicides (X60-X84) among elderly from 2015 to November 2020 were analyzed. Ordinary monthly expected values and reference ranges (RR: 95% range) were calculated by cause and sex and compared with the observed values.
Results
All accidents: Abnormal increases (beyond the RR) occurred in August for both sexes.
Traffic accidents: Extreme decreases (below the RR) occurred in at least 3 months from March to October for each sex.
Suicides: Extreme decreases occurred in at least 2 months from February to May for each sex. Abnormal increases occurred in November for males, and in September to November for females.
Conclusions
Extreme decreases in traffic accident mortalities can be explained by people staying home. Abnormal increases in accident mortalities in summer might be explained by the heat. The increases might also be related to wearing face masks. Suicide results suggest that females are especially vulnerable to the social environment created by the preventive measures against COVID-19.
Key messages
COVID-19 measures might have affected the physical, mental, and social well-being of elderly people.
Acknowledgements
This study was supported by Mitsui Sumitomo Insurance Welfare Foundation.
Background
The COVID-19 pandemic is a massive health crisis affecting our planet, with over 166,346,635 confirmed cases and 3,449,117 deaths globally till 24 May 2021. The COVID-19 pandemic is a ...massive health crisis which has brought enormous physical and psychological pressure. Mental health care for health care workers (HCWs), should receive serious consideration. The aim of this study was to determine mental health outcomes of HCWs and to examine known predictors of outcomes during the first pandemic wave.
Methods
1,556 HCWs who participated in the COVID-19 IMPACT project, an international online survey examining the behavioral and psychological impacts of COVID-19 among 9,565 people from 78 countries/regions and 18 languages. Outcomes assessed were stress, depression symptoms and sleep changes. Predictors examined included sociodemographic factors, and perceived social support.
Results
Results demonstrated that, half of the HCWs had moderate levels of perceived stress and depression symptoms. Predictors associated with higher HCWs’ stress and depression symptoms included female gender, not having children, living with parents, lower educational background and having lower social support. Half of the HCWs (n = 800, 51.4%) continued to sleep about the same and one in four slept more or slept less. Positive predictors of sleep changes were being older, widower, not working, living with parents, and having children. Surprisingly, HCWs had less perceived stress and depression and higher levels of perceived social support than the general population.
Conclusions
The need for establishing ways to mitigate mental health risks and adjust psychological intervention and support of HCWs, seems to be significant as the pandemic continues.
Keywords: health care workers, COVID – 19, pandemic, mental health, psychological problems
Background
Studies have shown a higher mortality due to COVID-19 amongst certain professions. The risk of becoming infected with SARS-CoV-2 and the occupational conditions associated with this, have ...not been studied extensively. This study aimed to develop and validate a Job Exposure Matrix (JEM) to assess the risk of COVID-19 in the workplace.
Methods
Researchers from three European countries defined six dimensions (four transmission determinants, two mitigation measures) to classify occupational risk. A combination of national statistics and expert judgement was used to classify ISCO-08 codes in no, low, elevated, or high risk for each dimension. Two data driven aspects of precarious work were also included and classified in four categories. The JEM was translated to SOC2010-codes and validated by comparing it to UK infection survey data and ONS estimates of exposure based on ONET data.
Results
A slightly increasing proportion of COVID-19 cases was observed with increasing risk scores in each dimension of the JEM. There was a high correlation between the JEM and the ONS estimates for physical proximity (r = 0.71) and exposure to COVID-19 or SARS-CoV-2 infection (r = 0.80)
Conclusions
Successful development and initial validation of this JEM has resulted in a useful tool for risk assessment of COVID-19 in the workplace. Further validation exercises will continue.
Key messages
This publicly available JEM can play a key role in the essential assessment of occupational contribution to the total burden of the COVID-19 pandemic.
Background
Shoulder stiffness is a common health issue in Japan. During the COVID-19 pandemic, people were forced to stay home which possibly escalated the development of shoulder stiffness. We aimed ...to assess associations of lifestyle changes and newly developed neck and shoulder pain (NSP) during the pandemic.
Methods
A cross-sectional study was conducted, analyzing the data from the Japan COVID-19 and Society Internet Survey (JACSIS), an internet survey conducted from August to September 2020. Data included sociodemographic, lifestyle and health measures related to NSP during the pandemic. Multivariable logistic regression models were fitted to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI) for newly developed NSP with adjustment for lifestyle, physiological and psychosocial changes.
Results
After exclusion of participants with existing pain, 25,482 participants (12,673 male, 12,809 female) aged 15-79 years were included in the analysis. Of these, 4.1% reported newly developed NSP. Weight gain and long sedentary time were strongly associated with the NSP (AOR (95%CI): 2.4 (2.0-2.8) and 1.81 (1.4-2.3)). Stratified analyses of 1,751 students and 4,211 teleworkers showed significant associations (AOR (95%CI): 2.1 (1.4-2.8) and 2.5 (1.9-3.2)) compared to non-workers and non-teleworkers, respectively.
Conclusions
Students and teleworkers became prone to NSP during the pandemic. However, factors which were associated to pain did not differ during the pandemic compared with the previous studies.
Key messages
Preventive measures for NSP should be taken in students and teleworkers.
Background
The COVID-19 pandemic changed the functioning of several health services. This work aimed to understand how different countries, especially Latin Americans, dealt with legal abortion ones.
...Methods
Narrative review on abortion and COVID-19 from January 1st, 2020 to March 10th, 2021. Databases searched included MEDLINE (through LitCOVID), Global Index Medicus, Virtual Health Library, and Journal Storage, complemented by gray literature.
Results
Of the 668 documents found, 111 were duplicated. After thematic screening, 75 were included. The vast majority reinforced the importance of abortion as a reproductive right and the maintenance of abortion services during the pandemic as essentials. Medical protocols without prior testing and supported by telemedicine were proposed to respect the distance measures. The pandemic amplified existing problems and restricted access to sexual and reproductive health services, such as legal abortion. This impact may be even stronger in low- and middle-income countries, especially in Latin America, where access to legal abortion is usually restricted. However, empirical peer-reviewed studies in this region are still scarce.
Conclusions
Latin American countries must place reproductive rights as a priority on their agendas and adapt legislation to accommodate alternative models of abortion care, or else they are at risk of increasing rates of unsafe abortions and maternal mortality, especially among the most vulnerable women.
Key messages
Maintaining legal abortion services during the pandemic is essential, at the risk of increasing maternal mortality, especially in contexts where access to these services is already restricted, such as in Latin America.
Background
Personal health behaviours, which rely on community characteristics, could affect individual vulnerability on disease infection. Due to insufficient study to examine health behaviours as ...risk factors of COVID-19 infection, we conducted municipal level spatial analysis to investigate association between health behaviours and COVID-19 incidence.
Methods
We extracted cumulative COVID-19 incidence data from January 20th 2020 to February 25th 2021, health behaviours, health condition, socio-economic factors, and covariates in municipal level from publicly available dataset. We chose variables, which were standardized, considering multicollinearity (VIF<10). Further, we employed bayesian hierarchical negative binomial model with intrinsic conditional autoregressive (iCAR) and Besag, York and Mollié (BYM) model, and used deviance information criterion (DIC) for final model selection.
Results
The mean cumulative COVID-19 incidence per 10,000 population among 229 municipality was 13.73 (Standard deviation=11.43). iCAR model (DIC=2,825.3) outperformed BYM model (DIC=14,009.4). The results of iCAR model highlighted that incidence was associated with dental hygiene practice (incidence risk ratios IRR=0.92, 95% Credible Interval CI=0.85–1.00), whether tried to be thin (IRR=1.10, 95% CI = 1.00–1.20), proportion of medical personnel (IRR=1.09, 95% CI = 1.01–1.17), and volume of public transportation (IRR=1.19, 95% CI = 1.05–1.35), even after adjusting for various confounding factors.
Conclusions
Municipality with lower cumulative incidence was likely to have more people who practiced to keep dental hygiene and less people who tried to be thin.
Key messages
Municipal level spatial analysis resulted that health behaviours were associated with COVID-19 incidence in South Korea.
PDF
