scholarly journals Engagement and adherence trade-offs for SARS-CoV-2 contact tracing

2021 ◽  
Vol 376 (1829) ◽  
pp. 20200270
Author(s):  
Tim C. D. Lucas ◽  
Emma L. Davis ◽  
Diepreye Ayabina ◽  
Anna Borlase ◽  
Thomas Crellen ◽  
...  
Keyword(s):  
Process Model ◽  
Reporting Rate ◽  
Self Report ◽  
Contact Tracing ◽  
Legal Enforcement ◽  
Trade Offs ◽  
Large Outbreak ◽  
The Uk ◽  
The Cost ◽  
Reporting Rates

Contact tracing is an important tool for allowing countries to ease lockdown policies introduced to combat SARS-CoV-2. For contact tracing to be effective, those with symptoms must self-report themselves while their contacts must self-isolate when asked. However, policies such as legal enforcement of self-isolation can create trade-offs by dissuading individuals from self-reporting. We use an existing branching process model to examine which aspects of contact tracing adherence should be prioritized. We consider an inverse relationship between self-isolation adherence and self-reporting engagement, assuming that increasingly strict self-isolation policies will result in fewer individuals self-reporting to the programme. We find that policies which increase the average duration of self-isolation, or that increase the probability that people self-isolate at all, at the expense of reduced self-reporting rate, will not decrease the risk of a large outbreak and may increase the risk, depending on the strength of the trade-off. These results suggest that policies to increase self-isolation adherence should be implemented carefully. Policies that increase self-isolation adherence at the cost of self-reporting rates should be avoided. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.

scholarly journals Engagement and adherence trade-offs for SARS-CoV-2 contact tracing

2020 ◽  
Author(s):  
Tim C D Lucas ◽  
Emma L Davis ◽  
Diepreye Ayabina ◽  
Anna Borlase ◽  
Thomas Crellen ◽  
...  
Keyword(s):  
Process Model ◽  
Branching Process ◽  
Reporting Rate ◽  
Self Report ◽  
Contact Tracing ◽  
Legal Enforcement ◽  
Trade Offs ◽  
Large Outbreak ◽  
The Cost ◽  
Reporting Rates

Contact tracing is an important tool for allowing countries to ease lockdown policies introduced to combat SARS-CoV-2. For contact tracing to be effective, those with symptoms must self-report themselves while their contacts must self-isolate when asked. However, policies such as legal enforcement of self-isolation can create trade-offs by dissuading individuals from self-reporting. We use an existing branching process model to examine which aspects of contact tracing adherence should be prioritised. We consider an inverse relationship between self-isolation adherence and self-reporting engagement, assuming that increasingly strict self-isolation policies will result in fewer individuals self-reporting to the programme. We find that policies that increase the verage duration of self-isolation, or that increase the probability that people self-isolate at all, at the expense of reduced self-reporting rate, will not decrease the risk of a large outbreak and may increase the risk, depending on the strength of the trade-off. These results suggest that policies to increase self-isolation adherence should be implemented carefully. Policies that increase self-isolation adherence at the cost of self-reporting rates should be avoided.

scholarly journals Using a household-structured branching process to analyse contact tracing in the SARS-CoV-2 pandemic

2021 ◽  
Vol 376 (1829) ◽  
pp. 20200267
Author(s):  
Martyn Fyles ◽  
Elizabeth Fearon ◽  
Christopher Overton ◽  
Tom Wingfield ◽  
Graham F. Medley ◽  
...  
Keyword(s):  
Process Model ◽  
Branching Process ◽  
Household Structure ◽  
Contact Tracing ◽  
Symptom Report ◽  
Primary Model ◽  
Imported Cases ◽  
Strategic Implementation ◽  
Household Members ◽  
The Uk

We explore strategies of contact tracing, case isolation and quarantine of exposed contacts to control the SARS-CoV-2 epidemic using a branching process model with household structure. This structure reflects higher transmission risks among household members than among non-household members. We explore strategic implementation choices that make use of household structure, and investigate strategies including two-step tracing, backwards tracing, smartphone tracing and tracing upon symptom report rather than test results. The primary model outcome is the effect of contact tracing, in combination with different levels of physical distancing, on the growth rate of the epidemic. Furthermore, we investigate epidemic extinction times to indicate the time period over which interventions must be sustained. We consider effects of non-uptake of isolation/quarantine, non-adherence, and declining recall of contacts over time. Our results find that, compared to self-isolation of cases without contact tracing, a contact tracing strategy designed to take advantage of household structure allows for some relaxation of physical distancing measures but cannot completely control the epidemic absent of other measures. Even assuming no imported cases and sustainment of moderate physical distancing, testing and tracing efforts, the time to bring the epidemic to extinction could be in the order of months to years. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.

scholarly journals Reports of myocarditis and pericarditis following mRNA COVID-19 vaccines: A review of spontaneously reported data from the UK, Europe, and the US

2021 ◽  
Author(s):  
Samantha Lane ◽  
Saad Shakir
Keyword(s):  
Clinical Course ◽  
Vaccine Dose ◽  
Reporting Rate ◽  
Full Recovery ◽  
European Economic Area ◽  
The United Kingdom ◽  
Spontaneous Reports ◽  
Reported Data ◽  
The Uk ◽  
Reporting Rates

Background: A signal of myocarditis and pericarditis following mRNA COVID-19 vaccines first emerged in Israel in May 2021. Further cases have since been reported in multiple countries. The reporting rates of these events indicate that they are very rare given the high numbers of vaccinated persons. Males and younger vaccinees appear more frequently affected, more often following the second vaccine dose. As vaccine programmes progress with the focus shifting to younger people, it is possible that more cases of myocarditis and pericarditis will be reported. Objectives: To bring together spontaneously reported data from around the world to estimate the reporting rate in different countries and better understand the risk factors for myocarditis and pericarditis following exposure to COVID-19 mRNA vaccines. Methods: Spontaneous reports from the United Kingdom, United States, and European Economic Area were used to estimate the frequency of myocarditis and pericarditis reported following COVID-19 Vaccine Pfizer/BioNTech and COVID-19 Vaccine Moderna. Cases were stratified by age, sex, and vaccine dose where data were available. Reporting rates amongst vaccinees receiving mRNA vaccines in each region were estimated. Results: A small number of reports of myocarditis and pericarditis had been submitted to each database examined. These events are very rare according to reporting rates of spontaneous adverse reactions. The events were more frequently reported amongst males, and most reports came from vaccinees aged under 30 years. The typical clinical course of these events is mild, with full recovery in most cases. Conclusions: This study provides evidence that younger vaccinees more frequently report myocarditis and pericarditis following mRNA COVID-19 vaccines compared with older vaccinees. These very rare events with mild clinical course followed by full recovery in most cases were more frequent following the second dose. Reporting rates of myocarditis and pericarditis were consistent between the data sources.

scholarly journals Containing Covid-19 outbreaks with spatially targeted short-term lockdowns and mass-testing

2020 ◽  
Author(s):  
Justin Alsing ◽  
Thomas Kirk ◽  
Naïri Usher ◽  
Philip JD Crowley
Keyword(s):  
Process Model ◽  
Interaction Model ◽  
Transmission Dynamics ◽  
Contact Tracing ◽  
Moderate Increase ◽  
Mobility Patterns ◽  
Social Distancing ◽  
Targeted Interventions ◽  
Community Transmission ◽  
The Uk

ABSTRACTWe assess the efficacy of spatially targeted lockdown or mass-testing and case-isolation in individual communities, as a compliment to contact-tracing and social-distancing, for containing SARS-CoV-2 outbreaks. Using the UK as a case study, we construct a stochastic branching process model for the virus transmission, embedded on a network interaction model encoding mobility patterns in the UK. The network model is based on commuter data from the 2011 census, a catchment area model for schools, and a phenomenological model for mobility and interactions outside of work, school, and the home. We show that for outbreak scenarios where contact-tracing and moderate social distancing alone provide suppression but do not contain the spread, targeted lockdowns or mass-testing interventions at the level of individual communities (with just a few thousand inhabitants) can be effective at containing outbreaks. For spatially targeted mass-testing, a moderate increase in testing capacity would be required (typically < 40000 additional tests per day), while for local lockdowns we find that only a small fraction (typically < 0.1%) of the population needs to be locked down at any one time (assuming that one third of transmission occurs in the home, at work or school, and out in the wider community respectively). The efficacy of spatially targeted interventions is contingent on an appreciable fraction of transmission events occurring within (relative to across) communities. Confirming the efficacy of community-level interventions therefore calls for detailed investigation of spatial transmission patterns for SARS-CoV-2, accounting for sub-community-scale transmission dynamics, and changes in mobility patterns due to the presence of other containment measures (such as social distancing and travel restrictions).Disclaimer: We stress that this is a working paper where results are preliminary and subject to change. In particular, we note that the efficacy of spatially targeted interventions are sensitive to the relative proportions of intra-versus inter-community transmission (for a given definition of community boundaries), which in turn is sensitive to the assumptions about the transmission dynamics across different contexts. Whilst the assumptions made here about transmission across contexts are motivated, we are currently updating our model to make the estimated inter- and intra-community transmission rates as robust as possible, as well as running a comprehensive suite of sensitivity tests and different outbreak scenarios.

A Basic Income Trilemma: Affordability, Adequacy, and the Advantages of Radically Simplified Welfare

2019 ◽  
Vol 49 (3) ◽  
pp. 461-482 ◽  
Author(s):  
LUKE MARTINELLI
Keyword(s):  
Conceptual Framework ◽  
Policy Design ◽  
Policy Agenda ◽  
Basic Income ◽  
Trade Off ◽  
Means Testing ◽  
Trade Offs ◽  
Common Objection ◽  
The Uk ◽  
The Cost

AbstractAs basic income (BI) has ascended the policy agenda, so proposals have come under increasing scrutiny for their affordability and adequacy for meeting need. One common objection to BI has been that it is impossible to design a scheme that simultaneously conforms to these two criteria. In this article, I develop a conceptual framework for analysing the trade-offs that afflict BI policy design. I suggest that while the idea of a policy dilemma between affordability and adequacy does indeed afflict ‘full’ BI schemes, it is possible to design an affordable and adequate ‘partial’ BI scheme. However, this comes at the cost of (at least partly) forfeiting some key advantages that motivate interest in BI in the first place, since these only arise as a consequence of the elimination of means testing and related conditionality from the welfare system. Thus, BI proponents face a three-way trade-off in policy design between affordability, adequacy, and securing the full advantages of BI as a radical simplification of existing welfare policy. The trilemma is illustrated with reference to original microsimulation evidence for the UK, which demonstrates that at most two of the three criteria can be achieved in a single scheme.

scholarly journals Should NICE reconsider the 2016 UK guidelines on TB contact tracing? A cost-effectiveness analysis of contact investigations in London

Thorax ◽  
2018 ◽  
Vol 74 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Sean M Cavany ◽  
Emilia Vynnycky ◽  
Charlotte S Anderson ◽  
Helen Maguire ◽  
Frank Sandmann ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Contact Tracing ◽  
National Guidelines ◽  
Cross Sectional ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
Sectional Analysis ◽  
Index Cases

BackgroundIn January 2016, clinical TB guidance in the UK changed to no longer recommend screening contacts of non-pulmonary, non-laryngeal (ETB) index cases. However, no new evidence was cited for this change, and there is evidence that screening these contacts may be worthwhile. The objective of this study was to estimate the cost-effectiveness of screening contacts of adult ETB cases and adult pulmonary or laryngeal TB (PTB) cases in London, UK.MethodsWe carried out a cross-sectional analysis of data collected on TB index cases and contacts in the London TB register and an economic evaluation using a static model describing contact tracing outcomes. Incremental cost-effectiveness ratios (ICERs) were calculated using no screening as the baseline comparator. All adult TB cases (≥15 years old) in London from 2012 to 2015, and their contacts, were eligible (2465/5084 PTB and 2559/6090 ETB index cases were included).ResultsAssuming each contact with PTB infects one person/month, the ICER of screening contacts of ETB cases was £78 000/quality-adjusted life-years (QALY) (95% CI 39 000 to 140 000), and screening contacts of PTB cases was £30 000/QALY (95% CI 18 000 to 50 000). The ICER of screening contacts of ETB cases was £30 000/QALY if each contact with PTB infects 3.4 people/month. Limitations of this study include the use of self-reported symptomatic periods and lack of knowledge about onward transmission from PTB contacts.ConclusionsScreening contacts of ETB cases in London was almost certainly not cost-effective at any conventional willingness-to-pay threshold in England, supporting recent changes to National Institute for Health and Care Excellence national guidelines.

Independent commissions and labour migration: The British MAC

2014 ◽  
Vol 11 (1) ◽  
pp. 23-32
Author(s):  
Philip L. Martin ◽  
Martin Ruhs
Keyword(s):  
Labour Force ◽  
Migration Policy ◽  
Foreign Workers ◽  
Foreign Born ◽  
Independent Evidence ◽  
Trade Offs ◽  
Labour Immigration ◽  
British Labour ◽  
Policy Objectives ◽  
The Uk

The independent Migration Advisory Committee (MAC) was created in 2007 after a decade in which the share of foreign-born workers in the British labour force doubled to 13 per cent. The initial core mandate of the MAC was to provide “independent, evidence-based advice to government on specific skilled occupations in the labour market where shortages exist which can sensibly be filled by migration.” The MAC's answers to these 3-S questions, viz, is the occupation for which employers are requesting foreign workers skilled, are there labour shortages, and is admitting foreign workers a sensible response, have improved the quality of the debate over the “need” for foreign workers in the UK by highlighting some of the important trade-offs inherent in migration policy making. The MAC can clarify migration trade-offs in labour immigration policy, but cannot decide the ultimately political questions about whose interests should be prioritised and how competing policy objectives should be balanced.

Surveillance of adverse events following immunisation in Australia annual report, 2017

2019 ◽  
Vol 43 ◽  
Author(s):  
Aditi Dey ◽  
Han Wang ◽  
Helen Quinn ◽  
Rona Hiam ◽  
Nicholas Wood ◽  
...  
Keyword(s):  
Adverse Events ◽  
Annual Report ◽  
Injection Site Reaction ◽  
Reporting Rate ◽  
Vaccination Programs ◽  
National Immunisation ◽  
National Immunisation Program ◽  
Conjugate Vaccination ◽  
Reporting Rates ◽  
To Receive

This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) for 2017 reported to the Therapeutic Goods Administration and describes reporting trends over the 18-year period 1 January 2000 to 31 December 2017. There were 3,878 AEFI records for vaccines administered in 2017; an annual AEFI reporting rate of 15.8 per 100,000 population. There was a 12% increase in the overall AEFI reporting rate in 2017 compared with 2016. This increase in reported adverse events in 2017 compared to the previous year was likely due to the introduction of the zoster vaccine (Zostavax®) provided free for people aged 70–79 years under the National Immunisation Program (NIP) and also the state- and territory-based meningococcal ACWY conjugate vaccination programs. AEFI reporting rates for most other individual vaccines in 2017 were similar to 2016. The most commonly reported reactions were injection site reaction (34%), pyrexia (17%), rash (15%), vomiting (8%) and pain (7%). The majority of AEFI reports (88%) described non-serious events. Two deaths were reported that were determined to have a causal relationship with vaccination; they occurred in immunocompromised people contraindicated to receive the vaccines.

Neither Victors nor Victims

2017 ◽  
Author(s):  
David Whetham
Keyword(s):  
First Century ◽  
National Interests ◽  
Civil Military Relations ◽  
High Street ◽  
National Survival ◽  
The Uk ◽  
Military Relations ◽  
The Cost ◽  
Realistic Goal

Between 2007 and 2011, Wootton Bassett, a small Wiltshire town in the UK, became the focus of national attention as its residents responded to the regular repatriations of dead soldiers through its High Street. The town’s response came to symbolize the way that broader attitudes developed and changed over that period. As such, it is a fascinating case study in civil–military relations in the twenty-first century. Success may be the same as victory, but victory, at least as it has been traditionally understood, is not a realistic goal in many types of contemporary conflict. Discretionary wars—conflicts in which national survival is not an issue and even vital national interests may not be at stake—pose particular challenges for any government which does not explain why the cost being paid in blood and treasure is ‘worth it’.

scholarly journals 699 Sleep Health Traits and COVID-19: Mortality Risk from the UK Biobank

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A273-A273
Author(s):  
Xi Zheng ◽  
Ma Cherrysse Ulsa ◽  
Peng Li ◽  
Lei Gao ◽  
Kun Hu
Keyword(s):  
Risk Factors ◽  
Sleep Apnea ◽  
Sleep Duration ◽  
Sex Education ◽  
Mortality Risk ◽  
Self Report ◽  
Severe Illness ◽  
Uk Biobank ◽  
Sleep Health ◽  
The Uk

Abstract Introduction While there is emerging evidence for acute sleep disruption in the aftermath of coronavirus disease 2019 (COVID-19), it is unknown whether sleep traits contribute to mortality risk. In this study, we tested whether earlier-life sleep duration, chronotype, insomnia, napping or sleep apnea were associated with increased 30-day COVID-19 mortality. Methods We included 34,711 participants from the UK Biobank, who presented for COVID-19 testing between March and October 2020 (mean age at diagnosis: 69.4±8.3; range 50.2–84.6). Self-reported sleep duration (less than 6h/6-9h/more than 9h), chronotype (“morning”/”intermediate”/”evening”), daytime dozing (often/rarely), insomnia (often/rarely), napping (often/rarely) and presence of sleep apnea (ICD-10 or self-report) were obtained between 2006 and 2010. Multivariate logistic regression models were used to adjust for age, sex, education, socioeconomic status, and relevant risk factors (BMI, hypertension, diabetes, respiratory diseases, smoking, and alcohol). Results The mean time between sleep measures and COVID-19 testing was 11.6±0.9 years. Overall, 5,066 (14.6%) were positive. In those who were positive, 355 (7.0%) died within 30 days (median = 8) after diagnosis. Long sleepers (&gt;9h vs. 6-9h) [20/103 (19.4%) vs. 300/4,573 (6.6%); OR 2.09, 95% 1.19–3.64, p=0.009), often daytime dozers (OR 1.68, 95% 1.04–2.72, p=0.03), and nappers (OR 1.52, 95% 1.04–2.23, p=0.03) were at greater odds of mortality. Prior diagnosis of sleep apnea also saw a two-fold increased odds (OR 2.07, 95% CI: 1.25–3.44 p=0.005). No associations were seen for short sleepers, chronotype or insomnia with COVID-19 mortality. Conclusion Data across all current waves of infection show that prior sleep traits/disturbances, in particular long sleep duration, daytime dozing, napping and sleep apnea, are associated with increased 30-day mortality after COVID-19, independent of health-related risk factors. While sleep health traits may reflect unmeasured poor health, further work is warranted to examine the exact underlying mechanisms, and to test whether sleep health optimization offers resilience to severe illness from COVID-19. Support (if any) NIH [T32GM007592 and R03AG067985 to L.G. RF1AG059867, RF1AG064312, to K.H.], the BrightFocus Foundation A2020886S to P.L. and the Foundation of Anesthesia Education and Research MRTG-02-15-2020 to L.G.

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