scholarly journals The effect of multiple interventions to balance healthcare demand for controlling COVID-19 outbreaks: a modelling study

2020 ◽  
Author(s):  
Po Yang ◽  
Jun Qi ◽  
Shuhao Zhang ◽  
Xulong Wang ◽  
Gaoshan Bi ◽  
...  
Keyword(s):  
High Intensity ◽  
Optimal Strategy ◽  
European Countries ◽  
Peak Time ◽  
Specific Intervention ◽  
Hospital Beds ◽  
The Uk ◽  
Very High ◽  
Over Time ◽  
Multiple Interventions

SummaryBackgroundRecent outbreak of a novel coronavirus disease 2019 (COVID-19) has led a rapid global spread around the world. For controlling COVID-19 outbreaks, many countries have implemented two non-pharmaceutical interventions: suppression like immediate lock-downs in cities at epicentre of outbreak; or mitigation that slows down but not stopping epidemic for reducing peak healthcare demand. Both interventions have apparent pros and cons; the effectiveness of any one intervention in isolation is limited. It is crucial but hard to know how and when to take which level of interventions tailored to the specific situation in each country. We aimed to conduct a feasibility study for robustly accessing the effect of multiple interventions to control the number and distribution of infections, growth of deaths, peaks and lengths of COVID-19 breakouts in the UK and other European countries, accounting for balance of healthcare demand.MethodsWe developed a model to attempt to infer the impact of mitigation, suppression and multiple rolling interventions for controlling COVID-19 outbreaks in the UK. Our model assumed that each intervention has equivalent effect on the reproduction number R across countries and over time; where its intensity was presented by average-number contacts with susceptible individuals as infectious individuals; early immediate intensive intervention led to increased health need and social anxiety. We considered two important features: direct link between Exposed and Recovered population, and practical healthcare demand by separation of infections into mild, moderate and critical cases. Our model was fitted and calibrated with date on cases of COVID-19 in Wuhan to estimate how suppression intervention impacted on the number and distribution of infections, growth of deaths over time during January 2020, and April 2020. We combined the calibrated model with data on the cases of COVID-19 in London and non-London regions in the UK during February 2020 and April 2020 to estimate the number and distribution of infections, growth of deaths, and healthcare demand by using multiple interventions. We applied the calibrated model to the prediction of infection and healthcare resource changes in other 6 European countries based on actual measures they have implemented during this period.FindingsWe estimated given that 1) By the date (5th March 2020) of the first report death in the UK, around 7499 people would have already been infected with the virus. After taking suppression on 23rd March, the peak of infection in the UK would have occurred between 28th March and 4th April 2020; the peak of death would have occurred between 18th April and 24th April 2020. 2) By 29th April, no significant collapse of health system in the UK have occurred, where there have been sufficient hospital beds for severe and critical cases. But in the Europe, Italy, Spain and France have experienced a 3 weeks period of shortage of hospital beds for severe and critical cases, leading to many deaths outside hospitals. 3) One optimal strategy to control COVID-19 outbreaks in the UK is to take region-level specific intervention. If taking suppression with very high intensity in London from 23rd March 2020 for 100 days, and 3 weeks rolling intervention between very high intensity and high intensity in non-London regions. The total infections and deaths in the UK were limited to 9.3 million and 143 thousand; the peak time of healthcare demand was due to the 96th day (12th May, 2020), where it needs hospital beds for 68.9 thousand severe and critical cases. 4) If taking a simultaneous 3 weeks rolling intervention between very high intensity and high intensity in all regions of the UK, the total infections and deaths increased slightly to 10 million and 154 thousand; the peak time of healthcare occurs at the 97th day (13th May, 2020), where it needs equivalent hospital beds for severe and critical cases of 73.5 thousand. 5) If too early releasing intervention intensity above moderate level and simultaneously implemented them in all regions of the UK, there would be a risk of second wave, where the total infections and deaths in the UK possibly reached to 23.4 million and 897 thousand.InterpretationConsidering social and economic costs in controlling COVID-19 outbreaks, long-term suppression is not economically viable. Our finding suggests that rolling intervention is an optimal strategy to effectively and efficiently control COVID-19 outbreaks in the UK and potential other countries for balancing healthcare demand and morality ratio. As for huge difference of population density and social distancing between different regions in the UK, it is more appropriate to implement regional level specific intervention with varied intensities and maintenance periods. We suggest an intervention strategy to the UK that take a consistent suppression in London for 100 days and 3 weeks rolling intervention in other regions. This strategy would reduce the overall infections and deaths of COVID-19 outbreaks, and balance healthcare demand in the UK.

scholarly journals Feasibility of Controlling COVID-19 Outbreaks in the UK by Rolling Interventions

2020 ◽  
Author(s):  
Po Yang ◽  
Jun Qi ◽  
Shuhao Zhang ◽  
Xulong wang ◽  
Gaoshan Bi ◽  
...  
Keyword(s):  
Optimal Strategy ◽  
Economic Impacts ◽  
Peak Time ◽  
Viral Spread ◽  
Intervention Intensity ◽  
Hospital Beds ◽  
The Uk ◽  
The Impact ◽  
Over Time ◽  
Multiple Interventions

SummaryBackgroundRecent outbreak of a novel coronavirus disease 2019 (COVID-19) has led a rapid global spread around the world. For controlling COVID-19 outbreaks, many countries have implemented two non-pharmaceutical interventions: suppression like immediate lock-downs in cities at epicentre of outbreak; or mitigation that slows down but not stopping epidemic for reducing peak healthcare demand. Both interventions have apparent pros and cons; the effectiveness of any one intervention in isolation is limited. We aimed to conduct a feasibility study for robustly estimating the number and distribution of infections, growth of deaths, peaks and lengths of COVID-19 breakouts by taking multiple interventions in London and the UK, accounting for reduction of healthcare demand.MethodsWe developed a model to attempt to infer the impact of mitigation, suppression and multiple rolling interventions for controlling COVID-19 outbreaks in London and the UK. Our model assumed that each intervention has equivalent effect on the reproduction number R across countries and over time; where its intensity was presented by average-number contacts with susceptible individuals as infectious individuals; early immediate intensive intervention led to increased health need and social anxiety. We considered two important features: direct link between Exposed and Recovered population, and practical healthcare demand by separation of infections into mild and critical cases. Our model was fitted and calibrated with data on cases of COVID-19 in Wuhan to estimate how suppression intervention impacted on the number and distribution of infections, growth of deaths over time during January 2020, and April 2020. We combined the calibrated model with data on the cases of COVID-19 in London and non-London regions in the UK during February 2020 and March 2020 to estimate the number and distribution of infections, growth of deaths, and healthcare demand by using multiple interventions.FindingsWe estimated given that multiple interventions with an intensity range from 3 to 15, one optimal strategy was to take suppression with intensity 3 in London from 23rd March for 100 days, and 3 weeks rolling intervention with intensity between 3 and 5 in non-London regions. In this scenario, the total infections and deaths in the UK were limited to 2.43 million and 33.8 thousand; the peak time of healthcare demand was due to the 65th day (April 11th), where it needs hospital beds for 25.3 thousand severe and critical cases. If we took a simultaneous 3 weeks rolling intervention with intensity between 3 and 5 in all regions of the UK, the total infections and deaths increased slightly to 2.69 million and 37 thousand; the peak time of healthcare kept the same at the 65th day, where it needs equivalent hospital beds for severe and critical cases of 25.3 thousand. But if we released high band of rolling intervention intensity to 6 or 8 and simultaneously implemented them in all regions of the UK, the COVID-19 outbreak would not end in 1 year and distribute a multi-modal mode, where the total infections and deaths in the UK possibly reached to 16.2 million and 257 thousand.InterpretationOur results show that taking rolling intervention is probably an optimal strategy to effectively and efficiently control COVID-19 outbreaks in the UK. As large difference of population density and social distancing between London and non-London regions in the UK, it is more appropriate to implement consistent suppression in London for 100 days and rolling intervention in other regions. This strategy would potentially reduce the overall infections and deaths, and delay and reduce peak healthcare demand.Research in contextEvidence before this studySuppression and mitigation are two common interventions for controlling infectious disease outbreaks. Previous works show rapid suppression is able to immediately reduce infections to low levels by eliminating human-to-human transmission, but needs consistent maintenance; mitigation does not interrupt transmission completely and tolerates some increase of infections, but minimises health and economic impacts of viral spread.3 While current planning in many countries is focused on implementing either suppression or mitigation, it is not clear how and when to take which level of interventions for control COVID-19 breakouts to certain country in light of balancing its healthcare demands and economic impacts.Added value of this studyWe used a mathematical model to access the feasibility of multiple intervention to control COVID-19 outbreaks in the UK. Our model distinguished self-recovered populations, infection with mild and critical cases for estimating healthcare demand. It combined available evidence from available data source in Wuhan. We estimated how suppression, mitigation and multiple rolling interventions impact on controlling outbreaks in London and non-London regions of the UK. We provided an evidence verification point that implementing suppression in London and rolling intervention with high intensity in non-London regions is probably an optimal strategy to control COVID-19 breakouts in the UK with minimised deaths and economic impacts.Implications of all the available evidenceThe effectiveness and impact of suppression and mitigation to control outbreaks of COVID-19 depends on intervention intensity and duration, which remain unclear at the present time. Using the current best understanding of this model, implementing consistent suppression in London for 100 days and 3 weeks rolling intervention with intensity between 3 and 5 in other regions potentially limit the total deaths in the UK to 33.8 thousand. Future research on how to quantify and measure intervention activities could improve precision on control estimates.

scholarly journals The effect of multiple interventions to balance healthcare demand for controlling COVID-19 outbreaks: a modelling study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Po Yang ◽  
Geng Yang ◽  
Jun Qi ◽  
Bin Sheng ◽  
Yun Yang ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Optimal Strategy ◽  
Intervention Strategy ◽  
European Countries ◽  
Direct Link ◽  
The World ◽  
The Uk ◽  
The Impact ◽  
Modelling Study ◽  
Multiple Interventions

AbstractFor controlling recent COVID-19 outbreaks around the world, many countries have implemented suppression and mitigation interventions. This work aims to conduct a feasibility study for accessing the effect of multiple interventions to control the COVID-19 breakouts in the UK and other European countries, accounting for balance of healthcare demand. The model is to infer the impact of mitigation, suppression and multiple rolling interventions for controlling COVID-19 outbreaks in the UK, with two features considered: direct link between exposed and recovered population, and practical healthcare demand by separation of infections. We combined the calibrated model with COVID-19 data in London and non-London regions in the UK during February and April 2020. Our finding suggests that rolling intervention is an optimal strategy to effectively control COVID-19 outbreaks in the UK for balancing healthcare demand and morality ratio. It is better to implement regional based interventions with varied intensities and maintenance periods. We suggest an intervention strategy named as “Besieged and rolling interventions” to the UK that take a consistent suppression in London for 100 days and 3 weeks rolling intervention in other regions. This strategy would reduce the overall infections and deaths of COVID-19 outbreaks, and balance healthcare demand in the UK.

Estimations of unrecorded alcohol consumption levels and trends in 14 European countries

2001 ◽  
Vol 18 (1_suppl) ◽  
pp. 54-70 ◽  
Author(s):  
Håkan Leifman
Keyword(s):  
Alcohol Consumption ◽  
General Population ◽  
Population Survey ◽  
European Countries ◽  
Total Consumption ◽  
General Population Survey ◽  
Mediterranean Countries ◽  
The Mediterranean ◽  
The Uk ◽  
Over Time

Håkan Leifman: Estimations of unrecorded alcohol consumption levels and trends in 14 European countries Aims: To map the extent of unrecorded alcohol consumption in the countries within the EU, including point estimates of the quantity of unrecorded consumption and the development over time. Data and method: The countries under investigation are 13 EU countries (Greece and Luxembourg excluded) and Norway. The study makes use of data collected earlier – mainly survey data – and of a recently completed general population survey directed to random samples of the general population aged 18–64 in six EU member states. An indirect method was used to assess the development of unrecorded consumption over time in each country by estimating the discrepancy between the observed development of alcohol-related mortality and the development that would be expected from changes in recorded consumption only. Findings: The unrecorded consumption is highest in the northern European countries, and has increased from about 1 litre in the 1980s to 2 litres per adult in the second half of the 1990s. The UK, too, shows clear signs of increased unrecorded alcohol consumption as of the mid-1980s. In the remaining countries, the changes in unrecorded alcohol appear to have been more modest over time. The quantities of unrecorded consumption in the Mediterranean countries in the 1990s are roughly estimated at 1 litre pure alcohol per adult and show no signs of increases over time. The general population survey indicated low quantities of personal imports of alcohol in Southern Europe (France and Italy) – one decilitre in France, less than half a decilitre in Italy – compared to about 1 litre or more in Finland, Sweden and the UK. Conclusions: The downward trend in recorded consumption in the Mediterranean countries for the past 20–30 years is most likely a real decrease in alcohol consumption: the large drop in recorded alcohol consumption in these countries has not been accompanied by increases in unrecorded consumption. When the total consumption (recorded plus unrecorded) is taken into account, and not just the recorded alcohol, the higher unrecorded consumption in the “low-consuming” countries would appear slightly to narrow down the differences between the countries. However, despite differences in unrecorded alcohol, the relative position between the countries in their total consumption in the mid-1990s remains to a large extent unchanged.

Teachers’ and pupils’ perspectives on homosexuality: A comparative analysis across European countries

2019 ◽  
Vol 34 (4) ◽  
pp. 471-519
Author(s):  
Kristof De Witte ◽  
Kaat Iterbeke ◽  
Oliver Holz
Keyword(s):  
Comparative Analysis ◽  
The Netherlands ◽  
Large Scale ◽  
European Countries ◽  
Positive Trend ◽  
Unique Data ◽  
The Uk ◽  
Teachers Perspectives ◽  
General Climate ◽  
Over Time

This article offers the first large-scale comparative analysis of pupils’ and teachers’ perspectives on homosexuality using two waves (2013 and 2017) of self-collected data through questionnaires issued in eight European countries: Belgium, the Netherlands, Germany, the UK, Spain, Poland, Hungary and Turkey. Using these unique data, the authors examine to what extent differences prevail across countries, what mechanisms explain the differences, and how the differences change over time. The results indicate significant differences across countries. Moreover, although a positive trend can be observed between the two waves of the survey, in some countries the general climate towards homosexuality is reversing.

Israel’s Ground Forces in the Occupied Territories

2020 ◽  
Vol 35 (2) ◽  
pp. 37-57
Author(s):  
Eyal Ben-Ari ◽  
Uzi Ben-Shalom
Keyword(s):  
High Intensity ◽  
Force Generation ◽  
Institutional Autonomy ◽  
Multiple Forms ◽  
The West ◽  
Occupied Territories ◽  
Media Monitoring ◽  
Israel Defense Forces ◽  
And Control ◽  
Over Time

The Israel Defense Forces (IDF) routinely rotate ground forces in and out of the Occupied Territories in the West Bank. While these troops are trained for soldiering in high-intensity wars, in the Territories they have long had to carry out a variety of policing activities. These activities often exist in tension with their soldierly training and ethos, both of which center on violent encounters. IDF ground forces have adapted to this situation by maintaining a hierarchy of ‘logics of action’, in which handling potentially hostile encounters takes precedence over other forms of policing. Over time, this hierarchy has been adapted to the changed nature of contemporary conflict, in which soldiering is increasingly exposed to multiple forms of media, monitoring, and juridification. To maintain its public legitimacy and institutional autonomy, the IDF has had to adapt to the changes imposed on it by creating multiple mechanisms of force generation and control of soldierly action.

Limits to Dominance?

2017 ◽  
Keyword(s):  
Communication Skills ◽  
Electoral System ◽  
Tony Blair ◽  
Prime Ministers ◽  
Margaret Thatcher ◽  
Capital Building ◽  
Low Levels ◽  
Very High ◽  
Over Time ◽  
Policy Vision

This chapter compares the leadership capital of two long-serving UK prime ministers: Tony Blair and Margaret Thatcher, treble election winners who held office for a decade. Mapping their capital over time reveals two very different patterns. Thatcher began with low levels of capital, building to a mid-term high and final fragile dominance, though her capital fell between elections. Blair possessed very high levels from the outset that gradually declined in a more conventional pattern. Both benefited from electoral dominance and a divided opposition, Thatcher’s strength lay in her policy vision while Blair’s stemmed from his popularity and communication skills. The LCI reveals that both prime ministers were successful without being popular, sustained in office by the electoral system. Towards the end of their tenures, both leaders’ continued dominance masked fragility, ousted when unrest in their parties and policy unpopularity eroded their capital.

UK Fiscal Squeezes over a Century

2017 ◽  
Author(s):  
Christopher Hood ◽  
Rozana Himaz
Keyword(s):  
Data Sources ◽  
Fiscal Consolidation ◽  
Financial Outcomes ◽  
Financial Conditions ◽  
Deficit Reduction ◽  
Before And After ◽  
The Uk ◽  
Changes Over Time ◽  
Spending Cuts ◽  
Over Time

This chapter draws on historical statistics reporting financial outcomes for spending, taxation, debt, and deficit for the UK over a century to (a) identify quantitatively and compare the main fiscal squeeze episodes (i.e. major revenue increases, spending cuts, or both) in terms of type (soft squeezes and hard squeezes, spending squeezes, and revenue squeezes), depth, and length; (b) compare these periods of austerity against measures of fiscal consolidation in terms of deficit reduction; and (c) identify economic and financial conditions before and after the various squeezes. It explores the extent to which the identification of squeeze episodes and their classification is sensitive to which thresholds are set and what data sources are used. The chapter identifies major changes over time that emerge from this analysis over the changing depth and types of squeeze.

scholarly journals Topological and Morphological Controls on Morphodynamics of Salt Marsh Interiors

2021 ◽  
Vol 9 (3) ◽  
pp. 311
Author(s):  
Ben R. Evans ◽  
Iris Möller ◽  
Tom Spencer
Keyword(s):  
Salt Marsh ◽  
Salt Marshes ◽  
East Coast ◽  
Marsh Surface ◽  
Coastal Environments ◽  
Coastal System ◽  
Morphological Segmentation ◽  
The Usa ◽  
The Uk ◽  
Over Time

Salt marshes are important coastal environments and provide multiple benefits to society. They are considered to be declining in extent globally, including on the UK east coast. The dynamics and characteristics of interior parts of salt marsh systems are spatially variable and can fundamentally affect biotic distributions and the way in which the landscape delivers ecosystem services. It is therefore important to understand, and be able to predict, how these landscape configurations may evolve over time and where the greatest dynamism will occur. This study estimates morphodynamic changes in salt marsh areas for a regional domain over a multi-decadal timescale. We demonstrate at a landscape scale that relationships exist between the topology and morphology of a salt marsh and changes in its condition over time. We present an inherently scalable satellite-derived measure of change in marsh platform integrity that allows the monitoring of changes in marsh condition. We then demonstrate that easily derived geospatial and morphometric parameters can be used to determine the probability of marsh degradation. We draw comparisons with previous work conducted on the east coast of the USA, finding differences in marsh responses according to their position within the wider coastal system between the two regions, but relatively consistent in relation to the within-marsh situation. We describe the sub-pixel-scale marsh morphometry using a morphological segmentation algorithm applied to 25 cm-resolution maps of vegetated marsh surface. We also find strong relationships between morphometric indices and change in marsh platform integrity which allow for the inference of past dynamism but also suggest that current morphology may be predictive of future change. We thus provide insight into the factors governing marsh degradation that will assist the anticipation of adverse changes to the attributes and functions of these critical coastal environments and inform ongoing ecogeomorphic modelling developments.

scholarly journals What is the potential cardiovascular risk reduction associated with achieving LDL-C levels recommended in the ESC/EAS guidelines for very high-risk patients? Data from 18 European countries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.K Ray ◽  
S Bray ◽  
A.L Catapano ◽  
N Poulter ◽  
G Villa
Keyword(s):  
High Risk ◽  
Risk Reduction ◽  
Absolute Risk ◽  
European Countries ◽  
Lipid Lowering ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Cardiovascular Risk Reduction ◽  
Private Company ◽  
Very High

Abstract Background/Introduction For patients at very-high risk of cardiovascular (CV) events, the 2016 ESC/EAS dyslipidaemia guidelines recommended lipid-lowering therapy (LLT) to achieve an LDL-C level below 70 mg/dL. This was lowered to an LDL-C level below 55 mg/dL in the 2019 guidelines. Purpose To assess: 1) the risk profile of European patients with established atherosclerotic CV disease (ASCVD) receiving LLT; and 2) the treatment gap between the estimated risk and the population benefits if all patients were to achieve LDL-C levels of 70 mg/dL and 55 mg/dL. Methods We used data from Da Vinci, an observational cross-sectional study conducted across 18 European countries. Data were collected at a single visit between June 2017 and November 2018, for consented adults who had received any LLT in the prior 12 months and had an LDL-C measurement in the prior 14 months. LDL-C level was assessed at least 28 days after starting the most recent LLT (stabilised LLT). For each patient with established ASCVD receiving stabilised LLT, we: 1) calculated their absolute LDL-C reduction required to achieve LDL-C levels of 70 mg/dL and 55 mg/dL; 2) predicted their 10-year CV risk using the REACH score based on demographic and medical history; 3) simulated their relative risk reduction (RRR) by randomly sampling from the probability distribution of the rate ratio per 38.7 mg/dL (1 mmol/L) estimated by the Cholesterol Treatment Trialists Collaboration meta-analysis; and 4) calculated their absolute risk reduction (ARR) achieved by meeting LDL-C levels of 70 mg/dL and 55 mg/dL. Results A total of 2039 patients with established ASCVD were included in the analysis. Mean (SD) LDL-C was 83.1 (35.2) mg/dL. 40.4% and 19.3% of patients achieved LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. Mean (SD) 10-year CV risk calculated using the REACH score was 36.3% (15.4%). Mean absolute LDL-C reductions of 19.6 mg/dL and 30.4 mg/dL were needed to reach LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. When adjusted for the LDL-C reduction required to achieve an LDL-C level of 70 mg/dL, mean ARR was 3.0%, leaving a mean (SD) residual 10-year CV risk of 33.3% (15.5%). When adjusted for the LDL-C reduction required to achieve an LDL-C level of 55 mg/dL, mean ARR was 4.6%, leaving a mean (SD) residual 10-year CV risk of 31.7% (15.2%). Conclusion(s) In a contemporary European cohort with ASCVD receiving LLT, the 10-year risk of CV events is high and many patients do not achieve LDL-C levels of 55 mg/dL or even of 70 mg/dL. Moreover, even if all patients were to achieve recommended LDL-C levels, they would still remain at a high residual risk of CV events. These data suggest these patients require even more intensive LLT. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen

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