scholarly journals A structured model for COVID-19 spread: modelling age and healthcare inequities

2020 ◽  
Author(s):  
Alex James ◽  
Michael J Plank ◽  
Rachelle N Binny ◽  
Kate Hannah ◽  
Shaun C Hendy ◽  
...  
Keyword(s):  
New Zealand ◽  
Process Model ◽  
Healthcare Access ◽  
Age Groups ◽  
Access To Healthcare ◽  
Contact Tracing ◽  
Infection Rates ◽  
School Closures ◽  
Community Needs ◽  
Socially Isolated

We use a stochastic branching process model, structured by age and level of healthcare access, to look at the heterogeneous spread of COVID-19 within a population. We examine the effect of control scenarios targeted at particular groups, such as school closures or social distancing by older people. Although we currently lack detailed empirical data about contact and infection rates between age groups and groups with different levels of healthcare access within New Zealand, these scenarios illustrate how such evidence could be used to inform specific interventions. We find that an increase in the transmission rates amongst children from reopening schools is unlikely to significantly increase the number of cases, unless this is accompanied by a change in adult behaviour. We also find that there is a risk of undetected outbreaks occurring in communities that have low access to healthcare and that are socially isolated from more privileged communities. The greater the degree of inequity and extent of social segregation, the longer it will take before any outbreaks are detected. Well-established evidence for health inequities, particularly in accessing primary healthcare and testing, indicates that Māori and Pacific peoples are at higher risk of undetected outbreaks in Aotearoa New Zealand. This highlights the importance of ensuring that community needs for access to healthcare, including early proactive testing, rapid contact tracing, and the ability to isolate, are being met equitably. Finally, these scenarios illustrate how information concerning contact and infection rates across different demographic groups may be useful in informing specific policy interventions.

scholarly journals Early intervention is the key to success in COVID-19 control

2020 ◽  
Author(s):  
Rachelle N. Binny ◽  
Michael G. Baker ◽  
Shaun C. Hendy ◽  
Alex James ◽  
Audrey Lustig ◽  
...  
Keyword(s):  
New Zealand ◽  
Process Model ◽  
Peak Load ◽  
Time Frame ◽  
Contact Tracing ◽  
List Type ◽  
Executive Summary ◽  
Response Strategies ◽  
Community Transmission ◽  
At Home

AbstractNew Zealand responded to the COVID-19 pandemic with a combination of border restrictions and an Alert Level system that included strict stay-at-home orders. These interventions were successful in containing the outbreak and ultimately eliminating community transmission of COVID-19. The timing of interventions is crucial to their success. Delaying interventions for too long may both reduce their effectiveness and mean that they need to be maintained for a longer period of time. Here, we use a stochastic branching process model of COVID-19 transmission and control to simulate the epidemic trajectory in New Zealand and the effect of its interventions during its COVID-19 outbreak in March-April 2020. We use the model to calculate key outcomes, including the peak load on the contact tracing system, the total number of reported COVID-19 cases and deaths, and the probability of elimination within a specified time frame. We investigate the sensitivity of these outcomes to variations in the timing of the interventions. We find that a delay to the introduction of Alert Level 4 controls results in considerably worse outcomes. Changes in the timing of border measures have a smaller effect. We conclude that the rapid response in introducing stay-at-home orders was crucial in reducing the number of cases and deaths and increasing the probability of elimination.Executive SummaryEvaluating the effectiveness of New Zealand’s COVID-19 response, relative to hypothetical response scenarios, is important for guiding future response strategies. We assess the importance of early implementation of interventions for controlling COVID-19.We model counterfactual (alternative ‘what-if’) scenarios in which the timings of three policy interventions are varied: border restrictions requiring 14-day quarantine of all international arrivals, border closure except to returning residents and citizens, and Alert Level 4 restrictions.Key measures describing the dynamics of a COVID-19 outbreak (notably peak load on the contact tracing system, the total number of reported COVID-19 cases and deaths, and the probability of elimination within a specified time frame), are used to compare outcomes from each scenario with New Zealand’s actual outcomes.Key measures were more sensitive to the timing of Alert Level 4, than to timing of border restrictions and border closure. Of the three counterfactual scenarios, an earlier start to Alert Level 4 would have resulted in the greatest reduction in numbers of cases and deaths.Delaying the start of Alert Level 4 by 20 days could have led to over 11,500 cases and 200 deaths, and would have substantially reduced the probability of eliminating community transmission of COVID-19, requring a longer period at Alert Level 4 to achieve control.

An Epidemiological Analysis of COVID-19 Confirmed Cases, Reported at National Institute of Health, Pakistan (Preprint)

2020 ◽  
Author(s):  
Ambreen Chaudhry
Keyword(s):  
Age Groups ◽  
Target Population ◽  
Control Measures ◽  
Contact Tracing ◽  
Bivariate Analysis ◽  
Travel History ◽  
Disease Epidemiology ◽  
Hygiene Practices ◽  
Multi Center Study ◽  
Epidemiological Characteristics

BACKGROUND Coronavirus disease (Covid-19) is a zoonotic disease of novel origin that posed a continuous threat to health worldwide after taking the shape of the pandemic. An understanding of disease epidemiology is supportive in timely preventive and control measures as well as contact tracing and curbing surveillance activities. OBJECTIVE The objective of our study was to determine the epidemiological characteristics of COVID-19 confirmed cases reported at the National Institute of Health Pakistan and elements of its spread in Pakistan. METHODS A retrospective record review was conducted at the National Institute of Health (NIH) Islamabad, Pakistan from January 25 to April 4, 2020. Univariate and bivariate analysis was done with 95% CI and p<0.05. RESULTS A total of 14,422 samples of suspected COVID-19 cases were received with a positivity rate of 9% (n=1348). Among all 70% (n=939) were male. The median age was 41years of age (range: 01-99Years). Among all, 19% were from 30-39 years old followed by 50-59 years old (17%). Children remained the least affected by 3% (n=35). Of the total reported cases, 55% (n=735) have reported the travel history within the last 14 days. Among these travelers’ international travelers were 23% (n=166) and domestic travelers were 77% (n=569). Travel history including both international and domestic remained significantly associated with the different age groups and Young adults remained more vulnerable to COVID-19 (P=0.03). Fever, SOB, and Cough remained the most significantly associated (P<0.05) in all age groups. CONCLUSIONS A higher incidence of COVID-19 among elderly men suggests robust quarantine measures for this target population. An escalating incidence of local transmission needs strict social distancing and hygiene practices to help flatten the curve. An extensive multi-center study is also recommended for a full understanding of disease dynamics.

scholarly journals Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043091
Author(s):  
Rikke Siersbaek ◽  
John Alexander Ford ◽  
Sara Burke ◽  
Clíona Ní Cheallaigh ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Healthcare Access ◽  
Grey Literature ◽  
Realist Review ◽  
Access To Healthcare ◽  
Staff Retention ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
Ovid Medline ◽  
High Level

ObjectiveThe objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.DesignA realist review.Data sourcesOvid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019.Eligibility criteria for selecting studiesThe purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer-reviewed articles were identified through a systematic search, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.AnalysisInductive and deductive coding was used to generate context–mechanism–outcome configurations, which were refined and then used to build several iterations of the overarching programme theory.ResultsSystematic searching identified 330 review articles, of which 24 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation. Additional purposive searching of grey literature yielded 50 records, of which 12 were included, for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma, generating trusting relationships between patients and staff/practitioners. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention.ConclusionsWith homelessness on the rise internationally, healthcare systems should focus on high-level factors such as funding stability, building inclusive cultures and setting goals which encourage and support staff to provide flexible, timely and connected services to improve access.

Establishment and Evaluation of a Pilot Child Car Seat Rental Scheme in New Zealand

PEDIATRICS ◽  
1986 ◽  
Vol 77 (2) ◽  
pp. 167-172
Author(s):  
David C. Geddis ◽  
Ian C. Appleton
Keyword(s):  
New Zealand ◽  
Newborn Infant ◽  
Age Groups ◽  
Steady Increase ◽  
National Scale ◽  
Car Seat ◽  
Pilot Scheme ◽  
The City

The method of operation of a pilot car seat rental scheme is described. It is unique in that there are sufficient seats to accommodate every newborn infant in the city. Both infant and child seats are available. The pattern of use since the establishment of the scheme in December 1981 is reported. Currently 60% to 70% of parents rent infant seats and 35% to 40% rent child seats. Yearly roadside observations have shown a steady increase in the number of restrained children. In 1981 no infants traveled in approved restraints. In 1984 66% did so. The 1984 results for other age groups were: 6 to 18 months of age, 88%; 18 months to 2½ years of age, 82%; 2½ to 3½ years of age, 66%; 3½ to 4½ years of age, 62%. At this time no legislation applied to children less than 8 years of age. The success of this pilot scheme suggests it should be expanded on a national scale.

scholarly journals Understanding How Socioeconomic Inequalities Drive Inequalities In COVID-19 Infections

2021 ◽  
Author(s):  
Rachid Laajaj ◽  
Duncan Webb ◽  
Danilo Aristizabal ◽  
Eduardo Behrentz ◽  
Raquel Bernal ◽  
...  
Keyword(s):  
Process Model ◽  
Adult Population ◽  
Policy Implications ◽  
Primary Data ◽  
Socioeconomically Disadvantaged ◽  
Infection Rates ◽  
Middle Income ◽  
Individual Level ◽  
Disadvantaged Groups ◽  
The Poor

Abstract Background: Across the world, the COVID-19 pandemic has disproportionately affected economically disadvantaged groups. This differential impact has numerous possible explanations, each with significantly different policy implications. We examine, for the first time in a low- or middle-income country, which mechanisms best explain the disproportionate impact of the virus on the poor. Methods: We use primary data from the CoVIDA project, including the results of 59,770 RT-PCR tests in Bogotá, targeted on a mostly asymptomatic adult population June 2020 to March 3rd, 2021. This is combined with administrative data that covers all reported cases in Bogotá. We estimate a number of parameters that are likely to drive inequality in COVID-19 infection rates across socioeconomic groups, then use these estimates in an individual-level branching process model of the epidemic. We use counterfactual scenarios to estimate the relative importance of different channels for explaining inequality in infection rates. Findings: Total infections and inequalities in infections are largely driven by inequalities in the ability to work remotely and in within-home secondary attack rates. Inequalities in isolation behavior are less important but non-negligible, while access to testing and contract-tracing plays practically no role. Interventions that mitigate transmission are found to be more effective when targeted on socioeconomically disadvantaged groups.Interpretation: Socioeconomically disadvantaged groups are particularly vulnerable to COVID-19 infections, and this appears to be primarily driven by the need to work out of home, higher transmission within home, and to some extent, the ability to isolate when needed. Policies that can successfully reduce these channels of transmission among the poor are likely to have large benefits.

scholarly journals Modeling the impact of school reopening and contact tracing strategies on Covid-19 dynamics in different epidemiologic settings in Brazil

2021 ◽  
Author(s):  
Marcelo Eduardo Borges ◽  
Leonardo Souto Ferreira ◽  
Silas Poloni ◽  
Ângela Maria Bagattini ◽  
Caroline Franco ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Transmission Rate ◽  
Disease Incidence ◽  
Demographic Data ◽  
School Closure ◽  
Mitigation Measures ◽  
Contact Tracing ◽  
School Closures ◽  
Infection Transmission ◽  
The Impact

Among the various non–pharmaceutical interventions implemented in response to the Covid–19 pandemic during 2020, school closures have been in place in several countries to reduce infection transmission. Nonetheless, the significant short and long–term impacts of prolonged suspension of in–person classes is a major concern. There is still considerable debate around the best timing for school closure and reopening, its impact on the dynamics of disease transmission, and its effectiveness when considered in association with other mitigation measures. Despite the erratic implementation of mitigation measures in Brazil, school closures were among the first measures taken early in the pandemic in most of the 27 states in the country. Further, Brazil delayed the reopening of schools and stands among the countries in which schools remained closed for the most prolonged period in 2020. To assess the impact of school reopening and the effect of contact tracing strategies in rates of Covid–19 cases and deaths, we model the epidemiological dynamics of disease transmission in 3 large urban centers in Brazil under different epidemiological contexts. We implement an extended SEIR model stratified by age and considering contact networks in different settings – school, home, work, and elsewhere, in which the infection transmission rate is affected by various intervention measures. After fitting epidemiological and demographic data, we simulate scenarios with increasing school transmission due to school reopening. Our model shows that reopening schools results in a non–linear increase of reported Covid-19 cases and deaths, which is highly dependent on infection and disease incidence at the time of reopening. While low rates of within[&ndash]school transmission resulted in small effects on disease incidence (cases/100,000 pop), intermediate or high rates can severely impact disease trends resulting in escalating rates of new cases even if other interventions remain unchanged. When contact tracing and quarantining are restricted to school and home settings, a large number of daily tests is required to produce significant effects of reducing the total number of hospitalizations and deaths. Our results suggest that policymakers should carefully consider the epidemiological context and timing regarding the implementation of school closure and return of in-person school activities. Also, although contact tracing strategies are essential to prevent new infections and outbreaks within school environments, our data suggest that they are alone not sufficient to avoid significant impacts on community transmission in the context of school reopening in settings with high and sustained transmission rates.

scholarly journals Simulating the impact of vaccination rates on the initial stages of a COVID-19 outbreak in New Zealand (Aotearoa) with a stochastic model

2021 ◽  
Author(s):  
Leighton M Watson
Keyword(s):  
New Zealand ◽  
Stochastic Model ◽  
Process Model ◽  
Branching Process ◽  
Total Population ◽  
Median Number ◽  
Vaccination Rate ◽  
Vaccination Rates ◽  
The Impact ◽  
Different Levels

Aim: The August 2021 COVID-19 outbreak in Auckland has caused the New Zealand government to transition from an elimination strategy to suppression, which relies heavily on high vaccination rates in the population. As restrictions are eased and as COVID-19 leaks through the Auckland boundary, there is a need to understand how different levels of vaccination will impact the initial stages of COVID-19 outbreaks that are seeded around the country. Method: A stochastic branching process model is used to simulate the initial spread of a COVID-19 outbreak for different vaccination rates. Results: High vaccination rates are effective at minimizing the number of infections and hospitalizations. Increasing vaccination rates from 20% (approximate value at the start of the August 2021 outbreak) to 80% (approximate proposed target) of the total population can reduce the median number of infections that occur within the first four weeks of an outbreak from 1011 to 14 (25th and 75th quantiles of 545-1602 and 2-32 for V=20% and V=80%, respectively). As the vaccination rate increases, the number of breakthrough infections (infections in fully vaccinated individuals) and hospitalizations of vaccinated individuals increases. Unvaccinated individuals, however, are 3.3x more likely to be infected with COVID-19 and 25x more likely to be hospitalized. Conclusion: This work demonstrates the importance of vaccination in protecting individuals from COVID-19, preventing high caseloads, and minimizing the number of hospitalizations and hence limiting the pressure on the healthcare system.

scholarly journals How effective was Newfoundland & Labrador’s travel ban to prevent the spread of COVID-19? An agent-based analysis

2021 ◽  
Author(s):  
Dionne M. Aleman ◽  
Benjamin Z. Tham ◽  
Sean J. Wagner ◽  
Justin Semelhago ◽  
Asghar Mohammadi ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Spatial Location ◽  
Contact Tracing ◽  
Infection Rates ◽  
Case Scenario ◽  
Agent Based ◽  
Individual Level ◽  
Transmission Rates ◽  
Imported Cases ◽  
The Uk

AbstractBackgroundTo prevent the spread of COVID-19 in Newfoundland & Labrador (NL), NL implemented a wide travel ban in May 2020. We estimate the effectiveness of this travel ban using a customized agent-based simulation (ABS).MethodsWe built an individual-level ABS to simulate the movements and behaviors of every member of the NL population, including arriving and departing travellers. The model considers individual properties (spatial location, age, comorbidities) and movements between environments, as well as age-based disease transmission with pre-symptomatic, symptomatic, and asymptomatic transmission rates. We examine low, medium, and high travel volume, traveller infection rates, and traveller quarantine compliance rates to determine the effect of travellers on COVID spread, and the ability of contact tracing to contain outbreaks.ResultsInfected travellers increased COVID cases by 2-52x (8-96x) times and peak hospitalizations by 2-49x (8-94x), with (without) contact tracing. Although contact tracing was highly effective at reducing spread, it was insufficient to stop outbreaks caused by travellers in even the best-case scenario, and the likelihood of exceeding contact tracing capacity was a concern in most scenarios. Quarantine compliance had only a small impact on COVID spread; travel volume and infection rate drove spread.InterpretationNL’s travel ban was likely a critically important intervention to prevent COVID spread. Even a small number of infected travellers can play a significant role in introducing new chains of transmission, resulting in exponential community spread and significant increases in hospitalizations, while outpacing contact tracing capabilities. With the presence of more transmissible variants, e.g., the UK variant, prevention of imported cases is even more critical.

scholarly journals Surveying support for child and youth political participation in Australia and New Zealand

2021 ◽  
Author(s):  
LG Phillips ◽  
Jenny Ritchie ◽  
F Perales
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Political Participation ◽  
Public Support ◽  
Age Groups ◽  
Children And Youth ◽  
Social Survey ◽  
Survey Question ◽  
Party Preference ◽  
United Nations Declaration

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Recent decades have witnessed increased empirical and policy interest in children’s citizenship, particularly since the ratification of the United Nations Declaration of Children’s Rights. However, support for children’s active citizenship is often hindered by the pervasiveness of discourses that characterise children as innocent, developing, and free from responsibility. Public and governmental decision-making largely excludes children’s consultation and contributions, often determined by age alone. To quantifiably assess the amount of public support for children’s political participation, we commissioned a Likert scale survey question on degrees of support for children and youth (across four age groups between 3 and 18 year olds) having the opportunity to influence government decisions, in the Australian and New Zealand 2016 versions of the International Social Survey Programme (ISSP). Analysis of responses to this question in relation to demographic survey data indicate variation in preferences for different age groups, and that age, gender, and political party preference of respondents were variables of significance for both nations. These variables point to potential predictors of attitudes toward political participation of children and youth which have relevance for policymakers and educators in relation to provision of programmes that will increase the engagement of children and youth in government decision-making.

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