Fueling the Covid-19 pandemic: summer school holidays and incidence rates in German districts

AbstractBackgroundThe Robert-Koch-Institute reports that during the summer holiday period a foreign country is stated as the most likely place of infection for an average of 27 and a maximum of 49% of new SARS-CoV-2 infections in Germany.MethodsCross-sectional study on observational data. In Germany, summer school holidays are coordinated between states and spread out over 13 weeks. Employing a dynamic model with district fixed effects, we analyze the association between these holidays and weekly incidence rates across 401 German districts.ResultsWe find effects of the holiday period of around 45% of the average district incidence rates in Germany during their respective final week of holidays and the 2 weeks after holidays end. Western states tend to experience stronger effects than Eastern states. We also find statistically significant interaction effects of school holidays with per capita taxable income and the share of foreign residents in a district’s population.ConclusionsOur results suggest that changed behavior during the holiday season accelerated the pandemic and made it considerably more difficult for public health authorities to contain the spread of the virus by means of contact tracing. Germany’s public health authorities did not prepare adequately for this acceleration.

Summer School Holidays and the Growth Rate in Sars-CoV-2 Infections Across German Districts

10.1101/2020.10.11.20210773 ◽

2020 ◽

Author(s):

Thomas Plümper ◽

Eric Neumayer

Keyword(s):

Growth Rate ◽

Fixed Effects ◽

Summer School ◽

Cross Sectional Study ◽

International Travel ◽

Contact Tracing ◽

Robert Koch Institute ◽

Cross Sectional ◽

Holiday Period ◽

Holiday Season

ABSTRACTObjectivesTo estimate the effect that summer school holidays had on the growth rate in Sars-CoV-2 infections across German districts. The Robert-Koch-Institute reports that during the summer holiday period a foreign country is stated as the most likely place of infection for an average of 27 and a maximum of 49 percent of new Sars-CoV-2 infections in Germany. Yet, infection may have taken place elsewhere, not all international travel is holiday-related and any impact of holiday-related travel will not be restricted to holidays abroad.DesignCross-sectional study on observational data. In Germany, summer school holidays are coordinated between states and spread out over 13 weeks. We analyse the association between these holidays and the weekly infection growth rate in SARS-CoV-2 infections across 401 German districts. Employing a dynamic model with district fixed effects, we test whether the holiday season results in a statistically significantly higher infection growth rate than the period of two weeks before holidays start, our presumed counterfactual.ResultsWe find effects of the holiday period equal in size to almost 50 percent of the average district growth rate in new infections in Germany during their respective final week of holidays and the two weeks after holidays end. States in the West of Germany tend to experience stronger effects than those in the East. This is consistent with another result, namely that we find statistically significant interaction effects of school holidays with per capita taxable income and the share of foreign residents in a district’s population, with both factors hypothesised to increase holiday-related travels.ConclusionsOur results suggest that changed behaviour during the holiday season accelerated the pandemic and made it considerably more difficult for public health authorities to contain the spread of the virus by means of contact tracing. Governments did not prepare adequately or timely for this acceleration.

Acceptance and Attitudes Toward COVID-19 Vaccines: A Cross-Sectional Study from Jordan

10.1101/2020.12.22.20248676 ◽

2020 ◽

Author(s):

Tamam El-Elimat ◽

Mahmoud M. AbuAlSamen ◽

Basima A. Almomani ◽

Nour A. Al-Sawalha ◽

Feras Q. Alali

Keyword(s):

Public Health ◽

Healthcare Providers ◽

Vaccine Hesitancy ◽

Sources Of Information ◽

Cross Sectional ◽

The Public ◽

Awareness Campaigns ◽

Health Authorities ◽

Public Acceptability ◽

AbstractBackgroundVaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for public health authorities. With the availability of COVID-19 vaccines, little information is available on the public acceptability and attitudes towards the COVID-19 vaccines in Jordan. This study aimed to investigate the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these vaccines among public in Jordan.MethodsAn online, cross-sectional, and self-administered questionnaire was instrumentalized to survey adult participants from Jordan on the acceptability of COVID-19 vaccines. Logistic regression analysis was used to find the predictors of COVID-19 vaccines’ acceptability.ResultsA total of 3,100 participants completed the survey. The public acceptability of COVID-19 vaccines was fairly low (37.4%) in Jordan. Males (OR=2.488, 95CI%=1.834–3.375, p<.001) and those who took the seasonal influenza vaccine (OR=2.036, 95CI%=1.306–3.174, p=.002) were more likely to accept Covid-19 vaccines. Similarly, participants who believed that vaccines are generally safe (OR=9.258, 95CI%=6.020–14.237, p<.001) and those who were willing to pay for vaccines (OR=19.223, 95CI%=13.665–27.042, p<.001), once available, were more likely to accept the COVID-19 vaccines. However, those above 35 years old (OR=0.376, 95CI%=0.233-0.607, p<.001) and employed participants (OR=0.542, 95CI%=0.405-0.725, p<.001) were less likely to accept the COVID-19 vaccines. Moreover, participants who believed that there was a conspiracy behind COVID-19 (OR=0.502, 95CI%=0.356- 0.709, p<.001) and those who do not trust any source of information on COVID-19 vaccines (OR=0.271, 95CI%=0.183 – 0.400, p<.001), were less likely to have acceptance towards them. The most trusted sources of information on COVID-19 vaccines were healthcare providers.ConclusionSystematic interventions are required by public health authorities to reduce the levels of vaccines’ hesitancy and improve their acceptance. We believe these results and specifically the low rate of acceptability is alarming to Jordanian health authorities and should stir further studies on the root causes and the need of awareness campaigns. These interventions should take the form of reviving the trust in national health authorities and structured awareness campaigns that offer transparent information about the safety and efficacy of the vaccines and the technology that was utilized in their production.

The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study

JMIR Formative Research ◽

10.2196/27882 ◽

2021 ◽

Vol 5 (3) ◽

pp. e27882

Author(s):

Britt Elise Bente ◽

Jan Willem Jaap Roderick van 't Klooster ◽

Maud Annemarie Schreijer ◽

Lea Berkemeier ◽

Joris Elmar van Gend ◽

...

Keyword(s):

Public Health ◽

Older Adults ◽

The Netherlands ◽

Health Workers ◽

Contact Tracing ◽

Usability Tests ◽

Health Authorities ◽

Increased Risk ◽

Lower Education

Background Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app.

COVID-19: cross-border contact tracing in Germany, February to April 2020

Eurosurveillance ◽

10.2807/1560-7917.es.2021.26.10.2001236 ◽

2021 ◽

Vol 26 (10) ◽

Author(s):

Inessa Markus ◽

Gyde Steffen ◽

Raskit Lachmann ◽

Adine Marquis ◽

Timm Schneider ◽

...

Keyword(s):

International Health ◽

Contact Tracing ◽

Outbreak Response ◽

Robert Koch Institute ◽

Cross Border ◽

Cruise Ships ◽

Health Authorities ◽

International Contact ◽

Warning Response

Introduction The Robert Koch Institute (RKI) managed the exchange of cross-border contact tracing data between public health authorities (PHA) in Germany and abroad during the early COVID-19 pandemic. Aim We describe the extent of cross-border contact tracing and its challenges. Methods We analysed cross-border COVID-19 contact tracing events from 3 February to 5 April 2020 using information exchanged through the European Early Warning Response System and communication with International Health Regulation national focal points. We described events by PHA, number of contacts and exposure context. Results The RKI processed 467 events, initiating contact to PHA 1,099 times (median = 1; interquartile range (IQR): 1–2) and sharing data on 5,099 contact persons. Of 327 (70%) events with known exposure context, the most commonly reported exposures were aircraft (n = 64; 20%), cruise ships (n = 24; 7%) and non-transport contexts (n = 210; 64%). Cruise ship and aircraft exposures generated more contacts with authorities (median = 10; IQR: 2–16, median = 4; IQR: 2–11) and more contact persons (median = 60; IQR: 9–269, median = 2; IQR: 1–3) than non-transport exposures (median = 1; IQR: 1–6 and median = 1; IQR: 1–2). The median time spent on contact tracing was highest for cruise ships: 5 days (IQR: 3–9). Conclusion In the COVID-19 pandemic, cross-border contact tracing is considered a critical component of the outbreak response. While only a minority of international contact tracing activities were related to exposure events in transport, they contributed substantially to the workload. The numerous communications highlight the need for fast and efficient global outbreak communication channels between PHA.

Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan

PLoS ONE ◽

10.1371/journal.pone.0250555 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250555

Author(s):

Tamam El-Elimat ◽

Mahmoud M. AbuAlSamen ◽

Basima A. Almomani ◽

Nour A. Al-Sawalha ◽

Feras Q. Alali

Keyword(s):

Public Health ◽

Healthcare Providers ◽

Vaccine Hesitancy ◽

Sources Of Information ◽

Cross Sectional ◽

The Public ◽

Awareness Campaigns ◽

Health Authorities ◽

Public Acceptability ◽

Vaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for public health authorities. With the availability of COVID-19 vaccines, little information is available on the public acceptability and attitudes towards the COVID-19 vaccines in Jordan. This study aimed to investigate the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these vaccines among public in Jordan. An online, cross-sectional, and self-administered questionnaire was instrumentalized to survey adult participants from Jordan on the acceptability of COVID-19 vaccines. Logistic regression analysis was used to find the predictors of COVID-19 vaccines’ acceptability. A total of 3,100 participants completed the survey. The public acceptability of COVID-19 vaccines was fairly low (37.4%) in Jordan. Males (OR = 2.488, 95CI% = 1.834–3.375, p < .001) and those who took the seasonal influenza vaccine (OR = 2.036, 95CI% = 1.306–3.174, p = .002) were more likely to accept COVID-19 vaccines. Similarly, participants who believed that vaccines are generally safe (OR = 9.258, 95CI% = 6.020–14.237, p < .001) and those who were willing to pay for vaccines (OR = 19.223, 95CI% = 13.665–27.042, p < .001), once available, were more likely to accept the COVID-19 vaccines. However, those above 35 years old (OR = 0.376, 95CI% = 0.233–0.607, p < .001) and employed participants (OR = 0.542, 95CI% = 0.405–0.725, p < .001) were less likely to accept the COVID-19 vaccines. Moreover, participants who believed that there was a conspiracy behind COVID-19 (OR = 0.502, 95CI% = 0.356–0.709, p < .001) and those who do not trust any source of information on COVID-19 vaccines (OR = 0.271, 95CI% = 0.183–0.400, p < .001), were less likely to have acceptance towards them. The most trusted sources of information on COVID-19 vaccines were healthcare providers. Systematic interventions are required by public health authorities to reduce the levels of vaccines’ hesitancy and improve their acceptance. We believe these results and specifically the low rate of acceptability is alarming to Jordanian health authorities and should stir further studies on the root causes and the need of awareness campaigns. These interventions should take the form of reviving the trust in national health authorities and structured awareness campaigns that offer transparent information about the safety and efficacy of the vaccines and the technology that was utilized in their production.

Clustering and superspreading potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Hong Kong

10.21203/rs.3.rs-29548/v1 ◽

2020 ◽

Cited By ~ 18

Author(s):

Dillon Adam ◽

Peng Wu ◽

Jessica Wong ◽

Eric Lau ◽

Tim Tsang ◽

...

Keyword(s):

Public Health ◽

Hong Kong ◽

High Risk ◽

Severe Acute Respiratory Syndrome ◽

Contact Tracing ◽

Social Environments ◽

Health Authorities ◽

Local Transmission ◽

Terminal Cluster

Abstract Superspreading events have characterised previous epidemics of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections. Using contact tracing data, we identified and characterized SARS-CoV-2 clusters in Hong Kong. Given a superspreading threshold of 6-8 secondary cases, we identified 5-7 probable superspreading events and evidence of substantial overdispersion in transmissibility, and estimated that 20% of cases were responsible for 80% of local transmission. Among terminal cluster cases, 27% (45/167) ended in quarantine. Social exposures produced a greater number of secondary cases compared to family or work exposures (p<0.001) while delays between symptom onset and isolation did not reliably predict the number of individual secondary cases or resulting cluster sizes. Public health authorities should focus on rapid tracing and quarantine of contacts, along with physical distancing to prevent superspreading events in high-risk social environments.

On the Futility of Contact Tracing

Inference: International Review of Science ◽

10.37282/991819.20.31 ◽

2020 ◽

Vol 5 (3) ◽

Author(s):

Jay Bhattacharya ◽

Mikko Packalen

Keyword(s):

Public Health ◽

Central Place ◽

Contact Tracing ◽

Health Authorities ◽

Throughout the COVID-19 epidemic, public health authorities have promoted contact tracing as a key tool to combat the spread of the SARS-CoV-2 virus. Jay Bhattacharya and Mikko Packalen argue that contact tracing does not deserve the central place it has received in the tool kit public health authorities use to control the virus, and that, in some cases, it may make an outbreak worse.

Reported COVID-19 Vaccination Coverage and Associated Factors among Members of Athens Medical Association: Results from a Cross-Sectional Study

Vaccines ◽

10.3390/vaccines9101134 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1134

Author(s):

Georgios Marinos ◽

Dimitris Lamprinos ◽

Panagiotis Georgakopoulos ◽

Georgios Patoulis ◽

Georgia Vogiatzi ◽

...

Keyword(s):

Public Health ◽

Medical Association ◽

Vaccination Coverage ◽

Online Survey ◽

Health Workers ◽

High Reliability ◽

Cross Sectional ◽

Vaccination Uptake ◽

Health Authorities ◽

There are limited data on the prevalence and determinants of COVID-19 vaccination coverage among physicians. A cross-sectional, questionnaire-based, online study was conducted among the members of the Athens Medical Association (I.S.A.) over the period 25 February to 13 March 2021. All members of I.S.A. were invited to participate in the anonymous online survey. A structured, anonymous questionnaire was used. Overall, 1993 physicians participated in the survey. The reported vaccination coverage was 85.3%. The main reasons of no vaccination were pending vaccination appointment followed by safety concerns. Participants being informed about the COVID-19 vaccines by social media resulted in lower COVID-19 vaccination coverage than health workers being informed by other sources. Logistic regression analysis demonstrated that no fear over COVID-19 vaccination-related side effects, history of influenza vaccination for flu season 2020–2021, and the perception that the information on COVID-19 vaccination from the national public health authorities is reliable, were independent factors of reported COVID-19 vaccination coverage. Our results demonstrate a considerable improvement of the COVID-19 vaccination uptake among Greek physicians. The finding that participants reported high reliability of the information related to COVID-19 vaccination provided by the Greek public health authorities is an opportunity which should be broadly exploited by policymakers in order to combat vaccination hesitancy, and further improve COVID-19 vaccination uptake and coverage among physicians/HCWs, and the general population.

A Brief Forewarning Intervention Overcomes Negative Effects of Salient Changes in COVID-19 Guidance

10.31234/osf.io/gbqw3 ◽

2021 ◽

Author(s):

Jeremy David Gretton ◽

Ethan Andrew Meyers ◽

Alexander C. Walker ◽

Jonathan Albert Fugelsang ◽

Derek J. Koehler

Keyword(s):

Public Health ◽

Health Behavior ◽

Scientific Understanding ◽

Contact Tracing ◽

Negative Effects ◽

Health Authorities ◽

Over Time ◽

Health Messaging

During the COVID-19 pandemic, public health messaging, including guidance regarding protective health behavior (e.g., use of non-medical masks), changed over time. Although many revisions were a result of gains in scientific understanding, we nonetheless hypothesized that making changes in guidance salient would negatively impact evaluations of experts and health-protective intentions. In Study 1 (N = 300), we demonstrate that describing COVID-19 guidance in terms of inconsistency (versus consistency) leads people to perceive scientists and public health authorities less favorably (e.g., as less expert). Among a Canadian subsample, making guidance change salient also reduced intentions to download the COVID Alert contact tracing app. In Study 2 (N = 1399), we show that a brief forewarning intervention mitigates detrimental effects of changes in guidance. In the absence of forewarning, emphasizing inconsistency harmed judgments of public health authorities and reduced health-protective intentions, but forewarning eliminated this effect.

Epidemiology of physiotherapy utilization among adults and elderly

Revista de Saúde Pública ◽

10.1590/s0034-89102005000400022 ◽

2005 ◽

Vol 39 (4) ◽

pp. 662-668 ◽

Cited By ~ 10

Author(s):

Fernando Vinholes Siqueira ◽

Luiz Augusto Facchini ◽

Pedro Curi Hallal

Keyword(s):

Public Health ◽

Health Services ◽

Population Based ◽

Cross Sectional Study ◽

Elderly Subjects ◽

Public Health Services ◽

Cross Sectional ◽

Health Authorities ◽

Primary Sample ◽

OBJECTIVE: To analyze the prevalence of physiotherapy utilization and to explore the variables associated to its utilization. METHODS: A population-based cross-sectional study, including 3,100 subjects aged 20 years or more living in the urban area of Pelotas, southern Brazil, was carried out. The sample was selected following a multiple-stage protocol; the census tracts delimited by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics) were the primary sample units. Following descriptive and crude analyses, Poisson regression models taking the clustering of the sample into account were carried out. Data were collected through face-to-face interviews using a standardized and pre-tested questionnaire. RESULTS: The lifetime utilization of physiotherapy was 30.2%; and physiotherapy utilization in the 12 months prior to the interview was reported by 4.9%. Women, elderly subjects, and those from higher socioeconomic levels were more likely to use physiotherapy. Restricting analysis to subjects who attended physiotherapy, 66% used public health services, 25% used insurance health services and 9% had private sessions. CONCLUSIONS: This is the first population-based study on physiotherapy utilization carried out in Brazil. Utilization of physio therapy was lower than reported in both developed and developing countries. The study findings might help public health authorities to organize healthcare service in terms of this important demand.