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To examine the appropriateness of the decision to quarantine healthcare workers (HCW’s) exposed to COVID-19.
Retrospective cohort study
A tertiary medical center in Israel
HCW’s exposed to a co-worker infected with COVID-19.
Quarantined and non-quarantined HCW’s were followed up for up to one month following exposure and their COVID-19 status determined. The validity of the decision to quarantine was assessed.
A total of 2,595 HCW’s exposed to 419 confirmed index cases were studied. Of the contact cases, 752 HCW’s were quarantined and 1,843 HCWs were not. Of those quarantined, 36 became COVID-19 positive (4.7%). Among those who were not quarantined, only 13 (0.7%) became COVID-19 positive, translated to a sensitivity of 73.5% and a specificity of 71.9% for the decision to quarantine (positive and negative predictive values: 4.7% and 99/3, respectively). Controlling for confounders, the decision to quarantine the HCW by the Israeli Ministry of Health guidelines was associated with a significant risk of becoming COVID-19 positive (RR= 3.83, 95% CI: 1.98-7.36, P=0.001). If a non-selective policy was used, 11,700 working days would have been lost (902 working days lost per one positive case).
Efficient and tight system of HCW contact investigations served its purpose. The study was based on HCWs’ reports and reported adherence to safety regulations and its findings are relevant to the massive waves of the Alpha variant of COVID-19 yet still they demonstrate an effective way of handling risk while not causing damage due to arbitrary risk control measures.
COVID-19 has had a disproportionate and devastating impact on older adults. As health care resources suddenly shifted to emergency response planning, many health and community support services were cancelled, postponed, or shifted to virtual care. This rapid transformation of geriatric care resulted in an immediate need for practical guidance on decision making, planning and delivery of virtual care for older adults and caregivers. This article outlines the rapid co-design process that supported the development of a guidance document intended to support health and community support services providers. Data were collected through consultation sessions, surveys, and a rapid literature review, and analyzed using appropriate qualitative and quantitative methods. Although this work took place within the context of the COVID-19 pandemic, the resulting resources and lessons learned related to collective impact, co-design, population-based planning, and digital technologies can be applied more broadly.
The economic disruption resulting from the pandemic has resulted in suggestions from the business community that these rules should be relaxed. As examples, the grocery industry pressed for the competition rules to be relaxed so that major grocery chains could ensure that stores remained open and stocked in the face of staff shortages and supply chain/logistics disruptions. Relaxing the rules, the industry argued, would allow the public to be better served. The chairman of a retail chain criticised the decision to block that firm’s prosed take over of a rival as being ‘absurd’ given the retail conditions, suggesting that that merger rules be relaxed to allow the retail sector to survive. The grocery industry’s pleas were successful: the government relaxed the competition regime applicable to that industry. This chapter analyses the need for these proposals to relax the competition in the economic context surrounding Covid-19. In particular, it argues that even in the context of this disruption, relaxing the competition rules was the wrong response.
The survival cox analysis is becoming more popular in time to-event data analysis. When there are unobserved/unmeasured individual’s factors, then the results of this model may not be reliable. So, this study aimed to determine the factors associated with covid-19 patient’s survival time with considering frailty factor.
This study conducted at one of the hospitals in Iran. So that, hospitalized patients with confirmed COVID-19 were included. Epidemiological, clinical, laboratory and outcome data on admission were extracted from electronic medical records. Gamma-frailty Cox model was used to identify the effects of the risk factors.
360 patients with COVID-19 enrolled in the study. The median age was 74 years (IQR 61–83); 903 (57·7%) were men and 661 (42·3%) were women, the mortality rate was 17%. The cox frailty model showed that there is at least a latent factor in the model (P = 0.005). Age and platelet count were negatively associated with the length of stay, while red blood cell count was positively associated with the length of stay of patients.
The frailty cox model indicates that in addition to age, the frailty factor is a useful predictor of survival in coved-19 patients.
This article critically examines the proposed waiver of intellectual property (IP) rights for COVID-19 vaccines under the World Trade Organization Agreement's Trade-Related Aspects of Intellectual Property Rights (TRIPS), which was initiated in October 2020 when the pandemic raged and vaccines were unavailable. However, the landscape has now changed and the waiver may no longer be necessary. The Outcome Document, introduced in the TRIPS Council in May 2022, along with Ministerial Decision of June 2022 recognizes this by focusing on easing the requirements to use TRIPS-flexibilities to accomplish wider and cheaper access. In so doing, the Ministerial Decision reinforces the notion that TRIPS flexibilities can be a useful part of the policy toolkit, even in times of crisis. After providing an overview of the context and outlining justifications for the waiver proposal, the article analyses and identifies key implications and possible effects of the Ministerial Decision. The article concludes that while the Document may not be a perfect solution to the issue of access to vaccines, flexible application of TRIPS-flexibilities is a better resolution in the current environment, especially given the need for further innovation to combat COVID-19 and future pandemics.
The COVID-19 pandemic and associated lockdowns were predicted to have a major impact on mental health, however current studies have produced contradictory findings with limited longitudinal data.
Nine years of linked, individual-level administrative data were used to examine changes in psychotropic medication uptake before and during the pandemic.
Medication data from a population-wide prescribing database were linked to demographic and socioeconomic indicators from healthcare registration records (n = 1 801 860). Monthly prescription uptake was split (pre-restrictions: January 2012 to February 2020 and during restrictions: March to October 2020). Auto regressive integrated moving average (ARIMA) models were trained in R taking into consideration trends and seasonal effects. Forecast (‘expected’) monthly values were compared with ‘actual’ values, stratified by demographic factors.
Over the study period 38.5% of the study population were in receipt of ≥1 psychotropic medication. Uptake of these medications have been following a strong upward trend since January 2012. In March 2020 uptake of all medications increased beyond expected values, returning to expected trends from May 2020 for antidepressants, anxiolytics and antipsychotics. In the 8 months during restrictions uptake of hypnotic medication was 12% higher than expected among those <18 years, and anxiolytic medication higher than expected in those >65 years.
Results suggest an initial ‘stockpiling’ of medications in March 2020 before trends mostly returned to expected levels. The anticipated tsunami of mental ill health is not yet manifest in psychotropic medication uptake. There are indications of increased anxiety and sleep difficulties in some subgroups, although these conditions may resolve as we emerge from the pandemic without need for psychiatric intervention.
The chapter summarizes the salient patterns of China’s major-power diplomacy under President Xi Jinping and highlights how it differs from the development-driven, low-profile strategy of the previous era under Hu Jintao and Wen Jiabao. It then discusses how Chinese diplomacy struggles to balance a policy of seeking change within the global order and a revionisim risking a cold or a hot war. The next section addresses how the COVID-19 pandemic tested China’s strategic opportunity. The chapter concludes with a brief discussion of the theoretical and policy implications of the study.
The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists.
A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity.
The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands.
From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity.
The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.
The Covid-19 pandemic has impacted college students’ lifestyles and placed them at a greater risk of obesity and food insecurity. The purpose of the systematic review was to consolidate evidence for the effect of Covid-19 on students’ dietary quality, dietary habits, body weight, and food security status. A comprehensive literature search was conducted utilizing various databases including Google Scholar, MEDLINE, ScienceDirect, Embase, and Scopus to identify relevant studies. To be incorporated in this review, studies had to include higher education students, measure the prevalence of food insecurity, and assess the dietary and body weight changes during the Covid-19 pandemic. The studies showed that the diet quality of college students was compromised during the pandemic in many nations due to the decrease in the intake of whole grains, dairy products, legumes, nuts, fruits, and vegetables and the increase in consumption of alcohol, confectionery products, and refined grains. There was an increase in the frequency of cooking, binge eating, breakfast skipping, and unhealthy snacking. These modifications, in return, were associated with body weight changes, with no less than 20 to 30 % of students gaining weight during the pandemic. The pandemic also impacted food security status of students, with over 30% being food insecure worldwide. The Covid-19 outbreak has exacerbated the students’ diet quality and dietary habits and placed them under high risk of weight gain and food insecurity. Higher education institutions and governments should improve students’ access to nutritious foods and incorporate nutrition education interventions in the curricula.
Social movements have often played an important role in emergencies, mobilising in defence of those rights that they perceive as being at risk or more urgently needed than ever. In general, progressive social movements develop in moments of intense change, mobilising with the aim of turning them to their advantage. the variable mix of challenges and opportunities related to a critical juncture. The specific balance of challenges and opportunities faced by progressive social movements during the Covid-19 crisis is a central question addressed in this volume. Based on existing research on the first phases of the pandemic Covid-19, this Element addresses the ways in with the health emergency had an impact on the repertoire of action, the organizational networks and the collective framing of progressive social movements that adapted to the pandemic conditions and the related crises, but also tried to transform them.
Since the emergence of the COVID-19 pandemic, there has been increased interest in identifying ways of protecting the mental well-being of healthcare workers (HCWs). Much of this has been directed towards promoting and enhancing the resilience of those deemed as frontline workers. Based on a review of the extant literature, this paper seeks to problematise aspects of how ‘frontline work’ and ‘resilience’ are currently conceptualised. Firstly, frontline work is arbitrarily defined and often narrowly focused on acute, hospital-based settings, leading to the needs of HCWs in other sectors of the healthcare system being overlooked. Secondly, dominant narratives are often underpinned by a reductionist understanding of the concept of resilience, whereby solutions are built around addressing the perceived deficiencies of (frontline) HCWs rather than the structural antecedents of distress. The paper concludes by considering what interventions are appropriate to minimise the risk of burnout across all sectors of the healthcare system in a post-pandemic environment.
This study focuses on the role of primary care in China’s response to COVID-19. A retrospective, reflective approach was taken using data available to one of the authors who led the national community response to COVID-19, first in Wuhan and then multiple cities in ten provinces/municipalities across the country. At the peak of the pandemic, primary care providers shoulder various public health responsibilities and work in close partnerships with other key stakeholders in the local communities. Primary care providers keep playing a ‘sentinel’/surveillance role in identifying re-emerging cases after the elimination of community transmissions of COVID-19. Critically, however, the pandemic once again highlights some key limitations of the primary care sector, including the lack of gatekeeping, limited capacity and weak integration between medical care and public health.
Risk is an innate and integral part of everyday life and is present in simple, everyday occupations and complex actions. Age-related stereotypes can mean older people have little opportunity to engage in activities that present some degree of risk. The present study explores the discourse around risk and older people in the context of the COVID-19 pandemic. We investigated news media as a reflection of the dominant public discourse around older people's behaviour to identify how risk is represented in relation to occupational engagement. Texts relating to older people and COVID-19 were sourced from the West Australian newspaper for a period of two months. Seventy texts were subject to Foucauldian discourse analysis to identify subject positions, location of risk and discursive features. Findings indicate that older people were segregated from the rest of society, with their behaviours framed in mostly negative ways. We identified three areas of discourse: vulnerable, and in need of protection; recalcitrant, and in need of management; and resilient, deserving of respect. While we recognise competing representations, implicit within the dominant discourse was the premise that older people were not capable of mediating risks and required ‘management’. These findings highlight the role of surveillance in restricting occupational engagement for older people and carry implications for older people, the public and therapists.
This paper analyzes the effect of the COVID-19 pandemic on the within-household gender gap in relation to paid work hours in full-time employed heterosexual couples in Spain. Using the Spanish Labor Force Survey (2019–2020) and a difference-in-differences method, we analyze three stages of the pandemic: strict lockdown, de-escalation, and partial closures to study the short-term effects and potential medium-term effects on gender inequality in terms of paid work hours. Our results suggest that during the strict lockdown period there was a tendency to fall back on traditional family gendered patterns to manage the work–life balance, especially when young children are present in male-headed households. However, this phenomenon seems to be a short-term consequence of the pandemic. The sector of activity (essential or non-essential) has also played a key role, the gender gap increased in male-headed households with female partners employed in non-essential sectors.
This study explores the depressive symptoms in postpartum women during the coronavirus disease 2019 (COVID-19) crisis in Japan.
An online survey conducted from May 31 to June 6, 2020 resulted in 3073 responses obtained from mothers with infants < 12 mo.
The point prevalence of the Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 9 was 28.66% for primipara and 25.83% for multipara. Logistic regression analysis indicated a negative association between the COVID-19 crisis and EPDS ≥ 9; specifically, decreased social support and financial concern were identified as risk factors. The COVID-19–related experiences significantly increased the score of each factor of EPDS, ie, anxiety, anhedonia, and depression.
During the COVID-19 crisis, the number of mothers who faced depreciation in social support and income had increased. Moreover, spending their perinatal period during the crisis increased the propensity of facing unexpected changes, such as changes of hospitals for delivery, or cancellation of parenting classes. These multiple factors were associated with an elevated risk of depression in postpartum women. In a prolonged crisis, postpartum mental health should be treated carefully with the prevention of infection.
The COVID-19 pandemic has seen health systems adapt and change in response to local and international experiences. This paper describes the experiences and learnings by the Central Adelaide Local Health Network (CALHN) in managing a campaign style, novel public health disaster response.
Disaster preparedness has focussed on acute impact, mass casualty incidents. In early 2020 CALHNs largest hospital the Royal Adelaide Hospital (RAH) was appointed as the state primary COVID-19 adult receiving hospital. Between the period of 1st February 2020 when the first COVID-19 positive patient was admitted, through to 31st December 2020 the RAH had admitted 146 inpatients with COVID-19, 118 admitted to our hospital in the home service, 18 patients admitted to Intensive Care and four patients died whilst inpatients. During this time CALHN has sustained an active (physical and virtual) Network Incident Command Centre (NICC) supported by a Network Incident Management Team (NIMT).
This paper describes our key lessons learnt in relation to the management of a campaign style disaster response including the importance of disaster preparedness, fatigue management and communication. Also described were the challenges of operating in a command model and the role of exercising and education and an overview of our operating rhythm, how we built capability and lessons management.
Undertaking a longer duration disaster response, relating to the COVID-19 pandemic has shown that whilst traditional disaster principles still are important there are many nuances that need to be considered to retain a proportionate response. Our key lessons have revolved around the key tenants of disaster management, communication, capability, and governance.
obesity is a risk factor for various diseases and can affect the disease course. Studies have shown detrimental effects of obesity on patients affected with SARS-CoV-2 including increased hospitalization and more severe disease. This study aims to investigate effects of obesity on symptom duration in patients with COVID-19 and investigate possibility of using BMI as a predictor of symptom duration in outpatient settings.
patients diagnosed with COVID-19 between June and October 2020 who had no other comorbidities and were planned to receive treatment in the outpatient setting were enrolled in the study. Duration of the symptoms was determined based on participants’ self-report of their symptoms. Linear regression was used to create predictive models based on participants’ BMI, age, sex, disease presentation, and their self-reported symptom duration.
210 patients were included in the final analysis. Patients with higher BMI had significantly longer symptom duration. Linear regression models showed highest correlation between BMI and symptom duration compared to other covariates.
low error in predictions and high coverage of data variability showed BMI can be used as a predictive factor for symptom duration in COVID-19 patients treated in outpatient settings.
A common criticism of the competition rules posed by EU authorities is that they are too inflexible, thereby prohibiting adequate responses to economic and industrial shocks. Competition Law in Crisis challenges this suggestion through an examination of competition responses to crises past and present. With an analysis spanning the response of UK and EU competition authorities to the economic and commercial outfall of the 2008 financial crisis, the COVID-19 pandemic, and potential responses to the climate crisis in the context of post-Brexit British industrial policy, the book argues that relaxing the competition regime is precisely the wrong response. The rigidity of competition rules in the UK and EU has both normative and positive implications for not just the methodology used in competition analysis, but also the role of competition law within the legal order of both jurisdictions. The book concludes with a discussion of the place of the competition in the UK's and EU's legal order.