Developments at Dadhaleh Institute

Currently Displaying: clinical public health29 Posts. 3 Pages.

Research: Clinical Public Health and Diagnosis

Preliminary estimates of the prevalence of selected underlying health conditions among patients with COVID-19 — United States, [ ... ]

Some say there is a trade-off: save lives or save jobs – this is a false dilemma

Some say there is a trade-off: save lives or save jobs – this is a false dilemma [ ... ]

Commentary: Action Imperatives for COVID-19 in Africa

Reflections by Dr. Andrew Nevin, Price Waterhouse Cooper Nigeria, 5 April 2020 The Dahdaleh Institute invited Dr. [ ... ]

Research: Substantial undocumented infection facilitates the rapid dissemination of COVID-19

Substantial undocumented infection facilitates the rapid dissemination of COVID-19 (Li et al, Science) Findings Using a model-inference framework, [ ... ]

Research: Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions

Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions [ ... ]

Research: Canada Needs to Rapidly Escalate Public Health Interventions for Its COVID-19 Mitigation Strategies

Canada Needs to Rapidly Escalate Public Health Interventions for Its COVID-19 Mitigation Strategies (Wu et al, SSRN) [ ... ]

Research: Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European countries

Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European [ ... ]

Government of Canada accelerates approval for diagnostic tests

The Government of Canada has accelerated approval for the Cepheid and Abbott diagnostic tests, following the issuance [ ... ]

Increasing diagnostic testing

Many countries are experiencing shortages in diagnostic testing kits, as the development, production and distribution remain critical [ ... ]

Auxiliary health facilities set up in major urban centres

With the outbreak expected to spread more widely across the continent over the next two weeks, there [ ... ]

More countries are adopting the WHO’s number advice to “test, test, test”

Countries are increasingly adopting the WHO’s main advice to “test, test, test,” with total number of tests [ ... ]

Research: Surface stability and possible fomite transmission

CDC: Public Health Responses to COVID-19 Outbreaks on Cruise Ships (March 23) NEJM: Aerosol and Surface Stability [ ... ]

ngq, you sexy beast! Here is a sanity check for that clean meta. ;)

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                    [post_content] => Preliminary estimates of the prevalence of selected underlying health conditions among patients with COVID-19 — United States, February 12–March 28, 2020
US CDC, WMWR Early Release, 3 April 2020
https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm?s_cid=mm6913e2_w
Findings
Of the 7,162 patients with reported data on underlying factors, 37.6% had at least one underlying condition or risk factor, including diabetes mellitus (11%), chronic lung disease (9%), cardiovascular disease (9%). Underlying conditions and risk factors were significantly higher among ICU admissions (78%), while at least one underlying condition was reported in 94% of patients that died.
Interpretation
Preliminary estimates suggest that underlying risk factors and co-morbidities can play a significant role, particularly among severe cases that require ICU admission. It remains unknown, however, whether severity or level of control of underlying health conditions affects the risk for severe disease with COVID-19.
Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection
Menni et al, 7 April 2020, NOT YET PEER REVIEWED
https://www.medrxiv.org/content/10.1101/2020.04.05.20048421v1
Findings
This paper in pre-press shows preliminary evidence that anosmia (loss of smell) and ageusia (loss of taste) may be early symptoms of COVID-19. The study suggests that loss of taste and smell is a strong predictor of having been infected by the COVID-19 virus. Also, the combination of symptoms that could be used to identify and isolate individuals includes anosmia, fever, persistent cough, diarrhoea, fatigue, abdominal pain and loss of appetite. This is particularly relevant to healthcare and other key workers in constant contact with the public who have not yet been tested for COVID-19.

                    [post_title] => Research: Clinical Public Health and Diagnosis
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                    [post_content] => Some say there is a trade-off: save lives or save jobs – this is a false dilemma (Heads of the IMF & WHO, Telegraph, 3 April 2020)
Commentary by the IMF Managing Director and the WHO Director General about the false dichotomy of save lives or save livelihoods. The argue that getting the virus under control is a prerequisite to saving livelihoods. Their joint appeal to policymakers, particularly in low- and middle-income countries, is to recognize that “protecting public health and putting people back to work go hand-in-hand.” In addition to the WHO, which is actively providing technical assistance to its Member States, at least 85 countries have requested emergency financing from the IMF. As financing reaches the countries in need, the authors furthermore extend a joint plea “to place health expenditures at the top of the priority list,” including paying salaries to healthcare workers, supporting hospitals, establishing field clinics, investing in medical and protective equipment, as well as carrying out public awareness campaigns such as hand washing.”

                    [post_title] => Some say there is a trade-off: save lives or save jobs – this is a false dilemma
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                    [post_content] => Reflections by Dr. Andrew Nevin, Price Waterhouse Cooper Nigeria, 5 April 2020
The Dahdaleh Institute invited Dr. Andrew Nevin, a Partner and Chief Economist at PWC Nigeria, to offer his views on core structural imperatives in dealing with COVID-19 in Africa beyond healthcare responses.
In the absence of a climate effect, Dr. Nevin warns African countries are headed for a humanitarian crisis in part due to weak healthcare systems, vulnerable populations, limited risk messaging, overcrowded housing and other difficulties with socially distancing. He anticipates the impacts in Africa could include:

Significant reduction in daily wages;
Breakdown of food supply chains;
Inability of the public sector to function virtually;
Strong private sector response in managing their businesses;
Confusion about who is in charge, and
Lack of information.

Based on these anticipated impacts, Dr. Nevin identified the following non-health system related priorities for African countries for COVID-19:

Direct transfers to the bottom of the pyramid to replace purchasing power;
Ensuring that food supply chains keep working;
Getting organized private sector to support the public sector (e.g. national emergency committees as decision-making bodies with government and industry partners);
Rapid and coordinated economic support and debt relief by international finance institutions; and
Reflect on possible structural change (e.g. economic decentralization) following response


                    [post_title] => Commentary: Action Imperatives for COVID-19 in Africa
                    [post_excerpt] => 
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                    [post_date] => 2020-04-03 12:42:50
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                    [post_content] => Substantial undocumented infection facilitates the rapid dissemination of COVID-19 (Li et al, Science)
Findings
Using a model-inference framework, the authors estimates the contagiousness and proportion of undocumented infections of COVID-19 in 375 cities in China before (Jan 10-23) and after (Jan 24-Feb 8) implementation of control measures in Wuhan (including: travel restrictions self-quarantine and contact precautions, access to rapid testing and PPE). The effective reproduction number (Re), i.e. number of secondary infections per index infection, was 2.4. The authors estimate that before control measures, 86% of all infections were undocumented, estimated to be about half (55%) as contagious as reported infections. After Control Measures, the proportion of undocumented infections fell to 31-35%, while the Re decreased to 0.99-1.4.
Interpretation
Although inference results should be interpreted with caution, the study suggests that control measures in Wuhan as of Jan 23 altered the epidemiological characteristics of the outbreak.

                    [post_title] => Research: Substantial undocumented infection facilitates the rapid dissemination of COVID-19 
                    [post_excerpt] => 
                    [post_status] => publish
                    [comment_status] => closed
                    [ping_status] => closed
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                    [post_name] => research-substantial-undocumented-infection-facilitates-the-rapid-dissemination-of-covid-19
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                    [post_modified] => 2020-08-13 22:42:39
                    [post_modified_gmt] => 2020-08-14 02:42:39
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                    [post_date] => 2020-04-03 12:41:50
                    [post_date_gmt] => 2020-04-03 16:41:50
                    [post_content] => Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions (De Salazar et al, CDC Early Release)
Findings
The aim was to identify locations with likely undetected or under-detected imported cases of COVID-19. The results suggest that locations above the 95% PI of imported-and-reported cases could have higher case-detection capacity. Locations below the 95% PI might have undetected cases because of expected imported-and-reported case counts under high surveillance. Under-detection of cases could increase the international spread of the outbreak because the transmission chain could be lost, reducing opportunities to deploy case-based control strategies.
Interpretation
They recommend rapid strengthening of outbreak surveillance and control efforts in locations below the 95% PI lower bound to curb potential local transmission. Early detection of cases and implantation of appropriate control measures can reduce the risk for self-sustained transmission in all locations

                    [post_title] => Research: Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions
                    [post_excerpt] => 
                    [post_status] => publish
                    [comment_status] => closed
                    [ping_status] => closed
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                    [post_name] => research-identifying-locations-with-possible-undetected-imported-severe-acute-respiratory-syndrome-coronavirus-2-cases-by-using-importation-predictions
                    [to_ping] => 
                    [pinged] => 
                    [post_modified] => 2020-08-13 22:42:39
                    [post_modified_gmt] => 2020-08-14 02:42:39
                    [post_content_filtered] => 
                    [post_parent] => 0
                    [guid] => https://covid19.dighr.org/developments/research-identifying-locations-with-possible-undetected-imported-severe-acute-respiratory-syndrome-coronavirus-2-cases-by-using-importation-predictions/
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                    [post_date] => 2020-04-03 12:40:50
                    [post_date_gmt] => 2020-04-03 16:40:50
                    [post_content] => Canada Needs to Rapidly Escalate Public Health Interventions for Its COVID-19 Mitigation Strategies (Wu et al, SSRN)
Findings
The initial growth rate in Italy (0.22) has reduced to 0.1 two weeks after the lockdown (8 Mar 2020). This corresponds to an extension of the doubling time from about 3.15 to almost 7 days. In comparison, the growth rate in Canada has increased from 0.13 from 1 March to 13 March up to 0.25 between 13 March to 22 March. This current growth rate corresponds to a doubling time of 2.7 days, and unless public health interventions escalate in Canada, we project 15,000 cases by March 31st. The case number can be reduced to 4,000 if escalated public health interventions can be implemented instantly to reduce the growth rate to 0.1, the same level achieved in Italy.
Interpretation
Intervention measures implemented by different countries have had various effects in reducing the growth rate and extending the doubling time, but their impacts come with a substantial delay (up to two weeks). Prompt and farsighted interventions are critical to counteract the very rapid initial growth of the COVID-19 epidemic. Mitigation plans must take into account the delayed effect of interventions by up to two weeks and the short doubling time of 3 to 4 days.

                    [post_title] => Research: Canada Needs to Rapidly Escalate Public Health Interventions for Its COVID-19 Mitigation Strategies
                    [post_excerpt] => 
                    [post_status] => publish
                    [comment_status] => closed
                    [ping_status] => closed
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                    [post_name] => research-canada-needs-to-rapidly-escalate-public-health-interventions-for-its-covid-19-mitigation-strategies
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                    [post_modified] => 2020-08-13 22:42:39
                    [post_modified_gmt] => 2020-08-14 02:42:39
                    [post_content_filtered] => 
                    [post_parent] => 0
                    [guid] => https://covid19.dighr.org/developments/research-canada-needs-to-rapidly-escalate-public-health-interventions-for-its-covid-19-mitigation-strategies/
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                    [ID] => 2577
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                    [post_date] => 2020-04-03 12:39:50
                    [post_date_gmt] => 2020-04-03 16:39:50
                    [post_content] => Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European countries (Flaxman et al, Imperial College London)
Findings
This study attempts to infer the impact of different interventions across 11 European countries using a semi-mechanistic Bayesian hierarchical model. The authors estimate that through the end of March, interventions taken by countries likely averted 59,000 deaths while reducing reproduction numbers. During this period, the authors also estimate that 7-43 million people may have been infected across the 11 countries (or approx. 2-11% of total population). Spain and Italy are estimated to have the highest attack rate, with Germany and Norway on the lower end (possibly reflecting the relative stages of the epidemics.
Interpretation
While the two to three-week delay between transmission changes and observed impact on mortality make it difficult to evaluate the effectiveness of recent interventions, the authors urge that preliminary evidence suggests that current interventions remain in place and that trends in cases and deaths be closely monitored to provide reassurance that transmission is slowing.

                    [post_title] => Research: Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European countries
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                    [guid] => https://covid19.dighr.org/developments/research-estimating-the-number-of-infections-and-the-impact-of-non-pharmaceutical-interventions-on-covid-19-in-11-european-countries/
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                    [post_date] => 2020-04-03 12:32:50
                    [post_date_gmt] => 2020-04-03 16:32:50
                    [post_content] => The Government of Canada has accelerated approval for the Cepheid and Abbott diagnostic tests, following the issuance of an Interim Order by the Minister of Health on March 18 to expedite access to COVID-19-related medical devices. The COVID-19 Emergency Response Act (Bill C-13) also received royal assent on March 25. Among the sweeping number and scope of measures, the COVID-19 Emergency Response Act amends the Patent Act in order to allow the Government of Canada to issue compulsory licenses to respond to a “public health emergency that is a matter of national concern,” which could apply to diagnostic kits but also personal protective equipment, medical devices and therapeutic products.

                    [post_title] => Government of Canada accelerates approval for diagnostic tests
                    [post_excerpt] => 
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                    [post_name] => government-of-canada-accelerates-approval-for-diagnostic-tests
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                    [post_modified] => 2020-08-13 22:42:39
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                    [guid] => https://covid19.dighr.org/developments/government-of-canada-accelerates-approval-for-diagnostic-tests/
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                    [post_date] => 2020-04-03 12:31:50
                    [post_date_gmt] => 2020-04-03 16:31:50
                    [post_content] => Many countries are experiencing shortages in diagnostic testing kits, as the development, production and distribution remain critical challenges that impede early detection and access to care. There are also reports of significant backlogs, in some cases taking over a week to provide results. Further efforts are needed in the development and scaling up of rapid (real-time) diagnostic tests.
The Foundation for Innovative New Diagnostics (FIND), a WHO Collaborating Centre for Laboratory Strengthening and Diagnostic Technology Evaluation, has curated a list of the current Diagnostic Pipeline, while the U.S. FDA has now issued Emergency Use Authorizations to at least three COVID-19 rapid diagnostic tests over the last week, including:

Cepheid Xpert Xpress SARS-Cov-2 Test (45min)
Mesa Biotech Accula SARS-Cov-2 Test (30min)
Abbott ID NOW COVID-19 Rapid Test (5-15min)


                    [post_title] => Increasing diagnostic testing
                    [post_excerpt] => 
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                    [post_name] => increasing-diagnostic-testing
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                    [post_modified] => 2020-08-13 22:42:39
                    [post_modified_gmt] => 2020-08-14 02:42:39
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                    [guid] => https://covid19.dighr.org/developments/increasing-diagnostic-testing/
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                    [post_date] => 2020-04-03 12:29:50
                    [post_date_gmt] => 2020-04-03 16:29:50
                    [post_content] => With the outbreak expected to spread more widely across the continent over the next two weeks, there are increasing concerns over health care system capacities. Auxiliary health facilities such as the U.S. Navy Hospital Ship Comfort deployed to the port of New York City (which is the largest affected city globally with over 50,000 cases), and field hospitals have been set up in major urban centres, including New York City’s Central Park and in Toronto, Canada.

                    [post_title] => Auxiliary health facilities set up in major urban centres
                    [post_excerpt] => 
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                    [post_modified] => 2020-08-13 22:42:38
                    [post_modified_gmt] => 2020-08-14 02:42:38
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                    [guid] => https://covid19.dighr.org/developments/auxiliary-health-facilities-set-up-in-major-urban-centres/
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                    [post_date] => 2020-04-03 12:24:50
                    [post_date_gmt] => 2020-04-03 16:24:50
                    [post_content] => Countries are increasingly adopting the WHO’s main advice to “test, test, test,” with total number of tests performed increasing 42% over the past week, as of April 1. Limited availability of diagnostic kits and laboratories in many low- and middle-income countries remain a critical concern and is almost certainly masking more widespread local transmission.
Similar to prior pandemics, high initial Case Fatality Rates for COVID-19 are expected to trend downwards over time as countries adopt more wide-spread population testing (i.e. recording those dying with as opposed to from the virus). This is reflected in these CFR figures (in order of countries with the highest number of deaths), as of 3 April: Italy (12%), Spain (9.1%), U.S. (2.4%), France (7.1%), China (4.1%), Iran (6.3%)

                    [post_title] => More countries are adopting the WHO's number advice to "test, test, test"
                    [post_excerpt] => 
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                    [post_modified] => 2020-08-13 22:42:38
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                    [guid] => https://covid19.dighr.org/developments/more-countries-are-adopting-the-whos-number-advice-to-test-test-test/
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                    [post_author] => 1
                    [post_date] => 2020-03-29 11:00:16
                    [post_date_gmt] => 2020-03-28 14:59:16
                    [post_content] => CDC: Public Health Responses to COVID-19 Outbreaks on Cruise Ships (March 23)
NEJM: Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 (March 17)

                    [post_title] => Research: Surface stability and possible fomite transmission
                    [post_excerpt] => 
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                    [post_name] => research-surface-stability-and-possible-fomite-transmission
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                    [post_modified] => 2020-08-13 22:45:49
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                    [guid] => https://covid19.dighr.org/developments/research-surface-stability-and-possible-fomite-transmission-2/
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            [post_date] => 2020-04-12 10:02:11
            [post_date_gmt] => 2020-04-12 14:02:11
            [post_content] => Preliminary estimates of the prevalence of selected underlying health conditions among patients with COVID-19 — United States, February 12–March 28, 2020
US CDC, WMWR Early Release, 3 April 2020
https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm?s_cid=mm6913e2_w
Findings
Of the 7,162 patients with reported data on underlying factors, 37.6% had at least one underlying condition or risk factor, including diabetes mellitus (11%), chronic lung disease (9%), cardiovascular disease (9%). Underlying conditions and risk factors were significantly higher among ICU admissions (78%), while at least one underlying condition was reported in 94% of patients that died.
Interpretation
Preliminary estimates suggest that underlying risk factors and co-morbidities can play a significant role, particularly among severe cases that require ICU admission. It remains unknown, however, whether severity or level of control of underlying health conditions affects the risk for severe disease with COVID-19.
Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection
Menni et al, 7 April 2020, NOT YET PEER REVIEWED
https://www.medrxiv.org/content/10.1101/2020.04.05.20048421v1
Findings
This paper in pre-press shows preliminary evidence that anosmia (loss of smell) and ageusia (loss of taste) may be early symptoms of COVID-19. The study suggests that loss of taste and smell is a strong predictor of having been infected by the COVID-19 virus. Also, the combination of symptoms that could be used to identify and isolate individuals includes anosmia, fever, persistent cough, diarrhoea, fatigue, abdominal pain and loss of appetite. This is particularly relevant to healthcare and other key workers in constant contact with the public who have not yet been tested for COVID-19.

            [post_title] => Research: Clinical Public Health and Diagnosis
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            [post_modified] => 2020-08-13 22:41:14
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            [guid] => https://covid19.dighr.org/developments/research-clinical-public-health-and-diagnosis/
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