scholarly journals Household bubbles and COVID-19 transmission: insights from percolation theory

2021 ◽  
Vol 376 (1829) ◽  
pp. 20200284
Author(s):  
Leon Danon ◽  
Lucas Lacasa ◽  
Ellen Brooks-Pollock
Keyword(s):  
Percolation Threshold ◽  
Network Connectivity ◽  
Configuration Model ◽  
Minimal Impact ◽  
Transmission Potential ◽  
Single Person ◽  
Increased Risk ◽  
Bubble Sizes ◽  
The Uk ◽  
The Impact

In the era of social distancing to curb the spread of COVID-19, bubbling is the combining of two or more households to create an exclusive larger group. The impact of bubbling on COVID-19 transmission is challenging to quantify because of the complex social structures involved. We developed a network description of households in the UK, using the configuration model to link households. We explored the impact of bubbling scenarios by joining together households of various sizes. For each bubbling scenario, we calculated the percolation threshold, that is, the number of connections per individual required for a giant component to form, numerically and theoretically. We related the percolation threshold to the household reproduction number. We find that bubbling scenarios in which single-person households join with another household have a minimal impact on network connectivity and transmission potential. Ubiquitous scenarios where all households form a bubble are likely to lead to an extensive transmission that is hard to control. The impact of plausible scenarios, with variable uptake and heterogeneous bubble sizes, can be mitigated with reduced numbers of contacts outside the household. Bubbling of households comes at an increased risk of transmission; however, under certain circumstances risks can be modest and could be balanced by other changes in behaviours. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK'.

scholarly journals Household bubbles and COVID-19 transmission: insights from percolation theory

2020 ◽  
Author(s):  
Leon Danon ◽  
Lucas Lacasa ◽  
Ellen Brooks-Pollock
Keyword(s):  
Percolation Threshold ◽  
Network Connectivity ◽  
Configuration Model ◽  
Minimal Impact ◽  
Transmission Potential ◽  
Single Person ◽  
Increased Risk ◽  
Bubble Sizes ◽  
The Uk ◽  
The Impact

AbstractBackgroundIn the era of social distancing to curb the spread of COVID-19, bubbling is the combining of two or more households to create an exclusive larger group. The impact of bubbling on COVID-19 transmission is challenging to quantify because of the complex social structures involved.MethodsWe developed a network description of households in the UK, using the configuration model to link households. We explored the impact of bubbling scenarios by joining together households of various sizes. For each bubbling scenario, we calculated the percolation threshold, that is, the number of connections per individual required for a giant component to form, numerically and theoretically. We related the percolation threshold to the household reproduction number.ResultsWe find that bubbling scenarios in which single-person households join with another household has a minimal impact on network connectivity and transmission potential. Ubiquitous scenarios where all households form a bubble are likely to lead to extensive transmission that is hard to control. The impact of plausible scenarios, with variable uptake and heterogeneous bubble sizes, can be mitigated with reduced numbers of contacts outside the household.ConclusionsBubbling of households comes at an increased risk of transmission, however under certain circumstances risks can be modest and could be balanced by other changes in behaviours.

scholarly journals Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

2021 ◽  
Vol 12 ◽  
pp. 204209862098569
Author(s):  
Phyo K. Myint ◽  
Ben Carter ◽  
Fenella Barlow-Pay ◽  
Roxanna Short ◽  
Alice G. Einarsson ◽  
...  
Keyword(s):  
Medical Attention ◽  
Close Monitoring ◽  
Plain Language ◽  
Discharge Data ◽  
Specific Patient ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

scholarly journals P0559AKI SEASONALITY IN ENGLAND

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Esther Wong ◽  
Dorothea Nitsch
Keyword(s):  
Cox Regression ◽  
Winter Season ◽  
Kidney Injury ◽  
Seasonal Effect ◽  
Winter Mortality ◽  
Age Group ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Abstract Background and Aims Incidence of Acute Kidney Injury (AKI) is known to be seasonal, peaking in winter months among hospitalised patients. Previous studies have suggested that the seasonality of AKI is likely to be influenced by the seasonality of the underlying acute illnesses that are associated with AKI. Mortality of patients with AKI has also been reported as being higher in winter, reflecting well-described excess winter mortality associations. Here we describe the seasonal variations of AKI alerts in England and the associated mortality rate using linked national databases. Method Serum creatinine changes compatible with KDIGO AKI stage 1, 2 and 3 are sent by laboratories in England as AKI alerts to the treating clinicians and the UK Renal Registry (UKRR). We linked the electronic AKI alerts to the Hospital Episode Statistics (HES) data, to identify patients who were hospitalised. We carried out descriptive statistics, and investigate the seasonal effect to the 30-day patient mortality from date of getting AKI alert, using multivariable Cox regression and sequentially adjusting for age, sex, Index of multiple deprivation (IMD) and peak AKI stage Results Winter has the highest number of AKI episodes (N=81,276), which is 6% higher than that in summer (N=76,329) (Table 1). For patients who had an AKI episode and admitted to hospitals, the crude 30-day mortality is higher in the winter season when compared to the summer [HR 1.28 (1.25-1.31), p<0.01] (Figure 1). After adjusting season by age, peak AKI stage, IMD and sex, winter season still has significantly higher 30-day mortality than summer [HR 1.24 (1.21-1.27), p<0.01]. Winter mortality peak is confounded by age and AKI severity, which explained the drop of hazard ratio at winter peaks; whereas season is not confounded by deprivation and sex. The pattern of seasonality varies with age, in age group 18-39, there were 26.1% of AKI episodes in summer and 23.3% in winter, whereas in age group >75, there were 23.7% in summer and 27.1% in winter. Conclusion Analysis of England data confirms seasonal peak in AKI during winter months. Additionally it shows increased risk of mortality for patients with AKI in winter months. Future work will investigate the impact of comorbidities and case-mix on outcomes. By understanding the seasonal variation of AKI, we can potentially plan preventive care and improve clinical practice.

scholarly journals The Perceived Impact of Suicide Bereavement on Specific Interpersonal Relationships: A Qualitative Study of Survey Data

2019 ◽  
Vol 16 (10) ◽  
pp. 1801 ◽  
Author(s):  
Valeriya Azorina ◽  
Nicola Morant ◽  
Hedvig Nesse ◽  
Fiona Stevenson ◽  
David Osborn ◽  
...  
Keyword(s):  
Interpersonal Relationships ◽  
Online Survey ◽  
Extended Family ◽  
Social Withdrawal ◽  
Free Text ◽  
Increased Risk ◽  
Suicide Bereavement ◽  
Social Discomfort ◽  
The Uk ◽  
The Impact

People bereaved by suicide have an increased risk of suicide and suicide attempt, yet report receiving less support than people bereaved by other sudden deaths. Reductions in support may contribute to suicide risk, yet their nature is unclear. We explored the impact of suicide bereavement on the interpersonal relationships of young adults in the UK using an online survey to collect qualitative data. We conducted thematic analysis of free-text responses from 499 adults to questions capturing the impact of bereavement on relationships with partners, close friends, close family, extended family, and other contacts. We identified four main themes describing the changes in relationships following the suicide: (1) Social discomfort over the death (stigma and taboo; painfulness for self or others to discuss; socially prescribed grief reactions); (2) social withdrawal (loss of social confidence; withdrawal as a coping mechanism); (3) shared bereavement experience creating closeness and avoidance; (4) attachments influenced by fear of further losses (overprotectiveness towards others; avoiding attachments as protective). These findings contribute to understanding deficits in support and pathways to suicidality after suicide bereavement. Such disrupted attachments add to the burden of grief and could be addressed by public education on how to support those bereaved by suicide.

scholarly journals Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19)

2020 ◽  
pp. jech-2020-214051 ◽  
Author(s):  
Matt J Keeling ◽  
T Deirdre Hollingsworth ◽  
Jonathan M Read
Keyword(s):  
Close Contact ◽  
Control Measure ◽  
Disease Outbreaks ◽  
Contact Tracing ◽  
Public Health Response ◽  
Central Public Health ◽  
Increased Risk ◽  
Novel Coronavirus ◽  
The Uk ◽  
The Impact

ObjectiveContact tracing is a central public health response to infectious disease outbreaks, especially in the early stages of an outbreak when specific treatments are limited. Importation of novel coronavirus (COVID-19) from China and elsewhere into the UK highlights the need to understand the impact of contact tracing as a control measure.DesignDetailed survey information on social encounters from over 5800 respondents is coupled to predictive models of contact tracing and control. This is used to investigate the likely efficacy of contact tracing and the distribution of secondary cases that may go untraced.ResultsTaking recent estimates for COVID-19 transmission we predict that under effective contact tracing less than 1 in 6 cases will generate any subsequent untraced infections, although this comes at a high logistical burden with an average of 36 individuals traced per case. Changes to the definition of a close contact can reduce this burden, but with increased risk of untraced cases; we find that tracing using a contact definition requiring more than 4 hours of contact is unlikely to control spread.ConclusionsThe current contact tracing strategy within the UK is likely to identify a sufficient proportion of infected individuals such that subsequent spread could be prevented, although the ultimate success will depend on the rapid detection of cases and isolation of contacts. Given the burden of tracing a large number of contacts to find new cases, there is the potential the system could be overwhelmed if imports of infection occur at a rapid rate.

scholarly journals The impact of temperature changes on vector-borne disease transmission: Culicoides midges and bluetongue virus

2017 ◽  
Vol 14 (128) ◽  
pp. 20160481 ◽  
Author(s):  
Samuel P. C. Brand ◽  
Matt J. Keeling
Keyword(s):  
Climate Change ◽  
Life Expectancy ◽  
Disease Transmission ◽  
Bluetongue Virus ◽  
Optimal Temperature ◽  
Climatic Fluctuations ◽  
Transmission Potential ◽  
Vector Borne ◽  
The Uk ◽  
The Impact

It is a long recognized fact that climatic variations, especially temperature, affect the life history of biting insects. This is particularly important when considering vector-borne diseases, especially in temperate regions where climatic fluctuations are large. In general, it has been found that most biological processes occur at a faster rate at higher temperatures, although not all processes change in the same manner. This differential response to temperature, often considered as a trade-off between onward transmission and vector life expectancy, leads to the total transmission potential of an infected vector being maximized at intermediate temperatures. Here we go beyond the concept of a static optimal temperature, and mathematically model how realistic temperature variation impacts transmission dynamics. We use bluetongue virus (BTV), under UK temperatures and transmitted by Culicoides midges, as a well-studied example where temperature fluctuations play a major role. We first consider an optimal temperature profile that maximizes transmission, and show that this is characterized by a warm day to maximize biting followed by cooler weather to maximize vector life expectancy. This understanding can then be related to recorded representative temperature patterns for England, the UK region which has experienced BTV cases, allowing us to infer historical transmissibility of BTV, as well as using forecasts of climate change to predict future transmissibility. Our results show that when BTV first invaded northern Europe in 2006 the cumulative transmission intensity was higher than any point in the last 50 years, although with climate change such high risks are the expected norm by 2050. Such predictions would indicate that regular BTV epizootics should be expected in the UK in the future.

scholarly journals Impact of the UK COVID-19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management

2020 ◽  
Author(s):  
David Holland ◽  
Adrian Heald ◽  
Mike Stedman ◽  
Lewis Green ◽  
Jonathan Scargill ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetes Diagnosis ◽  
Long Term Conditions ◽  
Diagnosis And Management ◽  
Increased Risk ◽  
Poor Outcomes ◽  
The Uk ◽  
The Impact

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.

scholarly journals Understanding the impact of systemic lupus erythematosus on work amongst South Asian people in the UK: An explorative qualitative study

Lupus ◽  
2021 ◽  
pp. 096120332110228
Author(s):  
Mandeep Ubhi ◽  
Shirish Dubey ◽  
Caroline Gordon ◽  
Tochukwu Adizie ◽  
Tom Sheeran ◽  
...  
Keyword(s):  
South Asian ◽  
Lupus Erythematosus ◽  
Cultural Barriers ◽  
Structured Interviews ◽  
Ability To Work ◽  
Related Factors ◽  
Work Related ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

SLE has a range of fluctuating symptoms affecting individuals and their ability to work. Although South Asian (SA) patients are at increased risk of developing SLE there is limited knowledge of the impact on employment for these patients in the UK. Understanding ethnicity and disease-specific issues are important to ensure patients are adequately supported at work. Semi-structured interviews were conducted with patients of SA origin to explore how SLE impacted on their employment. Thematic analysis was used to analyse the data which are reported following COREQ guidelines. Ten patients (8 female; 2 male) were recruited from three rheumatology centres in the UK and interviewed between November 2019 and March 2020. Patients were from Indian (n = 8) or Pakistani (n = 2) origin and worked in a range of employment sectors. Four themes emerged from the data: (1) Disease related factors; (2) Employment related factors; (3) Cultural and interpersonal factors impacting on work ability; (4) Recommendations for improvement. Patients’ ability to work was affected by variable work-related support from their hospital clinicians, low awareness of SLE and variable support from their employers, and cultural barriers in their communities that could affect levels of family support received. These findings highlight the need for additional support for SA patients with SLE in the workplace.

scholarly journals A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

2020 ◽  
Author(s):  
Flora Douglas ◽  
Emma MacIver ◽  
Chris Yuill
Keyword(s):  
Health Care ◽  
Food Insecurity ◽  
Health Condition ◽  
Health Conditions ◽  
Ethical Implications ◽  
North East ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Abstract Background As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Methods Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.Results Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

scholarly journals Urology Amidst the War on COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 113-119
Author(s):  
Bishoy Hanna ◽  
Stuart Jackson ◽  
Harry Narroway ◽  
Amanda Chung
Keyword(s):  
Health Care ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Infection Rates ◽  
Testing Procedures ◽  
Care Workers ◽  
Increased Risk ◽  
Hospital Resources ◽  
The Uk ◽  
The Impact

Objectives: We sought to review the impact of the COVID-19 pandemic on the practice of urology internationally, with particular focus on the Australian response. Methods: A literature search of PubMed was conducted using search terms “urology,” “coronavirus,” “COVID-19,”and “surgery.” This generated 165 articles. The abstracts were reviewed for relevance, and 33 articles were selected, reviewed in depth, and information synthesised along with relevant government, surgical college, and urological society policy documents. Results: Extensive health care changes have been implemented worldwide to curb infection rates. Elective surgery cancellations have been widely mandated to curb infection rates with mixed success. Whilst demand on hospital resources was reduced by up to 80%, the estimated cost to clear the surgical backlog in the UK has reached £100 million. Strict perioperative precautions have also been employed with mandatory personal protective equipment for all surgical staff and guidelines fast tracked for safe aerosol-generating procedures. Attempts to reduce exposure to patients and health care workers resulted in compromised operative time, blood loss, and length of hospital stay, with potential increased risk of short- and long-term complications. Systemic changes to education and training have also been made. Clinically, the cancellation of training examinations and a freeze on rotations and elective surgery restrictions have blunted surgical experience and teaching. The effect has rippled through junior doctor positions, with uncertainty remaining for training positions in 2021. Conclusions: The COVID-19 pandemic is the greatest current challenge facing health care worldwide. Amidst elective surgery restrictions, novel preoperative testing procedures and intraoperative precautions, providing safe and appropriate urological care is a major challenge. This review was derived entirely from expert opinion articles. Further research into the virus is needed to bring the world safely through the pandemic, and post-pandemic recovery will likely be the next challenge.

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