scholarly journals MITIGATING THE 4th WAVE OF THE COVID-19 PANDEMIC IN ONTARIO

2021 ◽  
Author(s):  
Lauren E. Cipriano ◽  
Wael M. R. Haddara ◽  
Beate Sander
Keyword(s):  
Public Health ◽  
Critical Care ◽  
Vaccine Coverage ◽  
Grey Literature ◽  
Age Distribution ◽  
Current Level ◽  
Transmission Model ◽  
Health Measures ◽  
Dynamic Transmission Model ◽  
Care Capacity

Background: The goal of this study was to project the number of COVID-19 cases and demand for acute hospital resources for Fall of 2021 in a representative mid-sized community in southwestern Ontario. We sought to evaluate whether current levels of vaccine coverage and contact reduction could mitigate a potential 4th wave fueled by the Delta variant, or whether the reinstitution of more intense public health measures will be required. Methods: We developed an age-stratified dynamic transmission model of COVID-19 in a mid-sized city (population 500,000) currently experiencing a relatively low, but increasing, infection rate in Step 3 of Ontario's Wave 3 recovery. We parameterized the model using the medical literature, grey literature, and government reports. We estimated the current level of contact reduction by model calibration to cases and hospitalizations. We projected the number of infections, number of hospitalizations, and the time to re-instate high intensity public health measures over the fall of 2021 under different levels of vaccine coverage and contact reduction. Results: Maintaining contact reductions at the current level, estimated to be a 17% reduction compared to pre-pandemic contact levels, results in COVID-related admissions exceeding 20% of pre-pandemic critical care capacity by late October, leading to cancellation of elective surgeries and other non-COVID health services. At high levels of vaccination and relatively high levels of mask wearing, a moderate additional effort to reduce contacts (30% reduction compared to pre-pandemic contact levels), is necessary to avoid re-instating intensive public health measures. Compared to prior waves, the age distribution of both cases and hospitalizations shifts younger and the estimated number of pediatric critical care hospitalizations may substantially exceed 20% of capacity. Discussion: High rates of vaccination coverage in people over the age of 12 and mask wearing in public settings will not be sufficient to prevent an overwhelming resurgence of COVID-19 in the Fall of 2021. Our analysis indicates that immediate moderate public health measures can prevent the necessity for more intense and disruptive measures later.

scholarly journals Association Between Pandemic Coronavirus Disease 2019 Public Health Measures and Reduction in Critical Care Utilization Across ICUs in Alberta, Canada

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sean M. Bagshaw ◽  
Danny J. Zuege ◽  
Henry T. Stelfox ◽  
Dawn Opgenorth ◽  
Tracy Wasylak ◽  
...  
Keyword(s):  
Public Health ◽  
Critical Care ◽  
Care Utilization ◽  
Health Measures

scholarly journals Managing Borders During Public Health Emergencies of International Concern: A Proposed Typology of Cross-border Health Measures

2021 ◽  
Author(s):  
Kelley Lee ◽  
Karen A Grépin ◽  
Catherine Worsnop ◽  
Summer Marion ◽  
Julianne Piper ◽  
...  
Keyword(s):  
Public Health ◽  
Research Policy ◽  
Grey Literature ◽  
World Health ◽  
Border Health ◽  
Policy And Practice ◽  
Public Health Emergencies ◽  
Cross Border ◽  
Health Measures ◽  
Starting Point

Abstract BackgroundThe near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. ResultsBased on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently – type of movement (travel and trade), policy goal, level of jurisdiction, use by public versus private sector, stage of journey, and degree of restrictiveness. These categories are then be brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. The typology facilitates evidence-informed decision-making which takes account of policy complexity including trade-offs and externalities. Finally, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). ConclusionsThe widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.

scholarly journals A modeling of a Diphtheria epidemic in the refugees camps

2017 ◽  
Author(s):  
María Torrea ◽  
José Luis Torrea ◽  
Daniel Ortega
Keyword(s):  
Public Health ◽  
Soviet Union ◽  
Vaccine Coverage ◽  
Disease Spread ◽  
Epidemic Outbreak ◽  
High Coverage ◽  
Infected People ◽  
Vaccination Rates ◽  
Health Measures ◽  
The Soviet Union

AbstractBackgroundDiphtheria has a big mortality rate. Vaccination practically eradicated it in industrialized countries. A decrease in vaccine coverage and public health deterioration cause a reemergence in the Soviet Union in 1990. These circumstances seem to be being reproduced in refugee camps with a potential risk of new outbreak.MethodsWe constructed a mathematical model that describes the evolution of the Soviet Union epidemic outbreak. We use it to evaluate how the epidemic would be modified by changing the rate of vaccination, and improving public health conditions.ResultsWe observe that a small decrease of 15% in vaccine coverage, translates an ascent of 47% in infected people. A coverage increase of 15% and 25% decreases a 44% and 66% respectively of infected people. Just improving health care measures a 5%, infected people decreases a 11.31%. Combining high coverage with public health measures produces a bigger reduction in the amount of infected people compare to amelioration of coverage rate or health measures alone.ConclusionsOur model estimates the evolution of a diphtheria epidemic outbreak. Small increases in vaccination rates and in public health measures can translate into large differences in the evolution of a possible epidemic. These estimates can be helpful in socioeconomic instability, to prevent and control a disease spread.

scholarly journals Public Health and Health Systems Impacts of SARS-CoV-2 Variants of Concern: A Rapid Scoping Review

2021 ◽  
Author(s):  
Janet A Curran ◽  
Justine Dol ◽  
Leah Boulos ◽  
Mari Somerville ◽  
Bearach Reynolds ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Grey Literature ◽  
Current Evidence ◽  
Risk Of Death ◽  
Health Measures ◽  
Guidance Documents ◽  
The Impact

Background: As of April 2021, three SARS-CoV-2 variants of concern (VOC: B.1.1.7, B.1.351 and P.1) have been detected in over 132 countries. Increased transmissibility of VOC has implications for public health measures and health system arrangements. This rapid scoping review aims to provide a synthesis of current evidence related to public health measures and health system arrangements associated with VOC. Methods: Rapid scoping review. Seven databases were searched up to April 7, 2021 for terms related to VOC, transmission, public health and health systems. A grey literature search was conducted up to April 14, 2021. Title, abstracts and full text were screened independently by two reviewers. Data were double extracted using a standardized form. Studies were included if they reported on at least one of the VOC and public health or health system outcomes. Results: Of the 2487 articles and 59 grey literature sources retrieved, 37 studies and 21 guidance documents were included. Included studies used a wide range of designs and methods. Most of the studies and guidance documents reported on B.1.1.7, and 18 studies and 4 reports provided data for consideration in relation to public health measures. Public health measures, including lockdowns, physical distancing, testing and contact tracing, were identified as critical adjuncts to a comprehensive vaccination campaign. No studies reported on handwashing or masking procedures related to VOC. For health system arrangements, 17 studies were identified. Some studies found an increase in hospitalization due to B.1.1.7 but no difference in length of stay or ICU admission. Six studies found an increased risk of death ranging from 15-67% with B.1.1.7 compared non-B.1.1.7, but three studies reported no change. One study reported on the effectiveness of personal protective equipment in reducing VOC transmission in the hospital. No studies reported on screening staff and visitors, adjusting service provisions, or adjusting patient accommodations and shared spaces, which is a significant gap in the literature. Guidance documents did not tend to cite any evidence and were thus assumed to be based on expert opinion. Conclusion: While the findings should be interpreted with caution as most of the sources identified were preprints, findings suggest a combination of non-pharmaceutical interventions (e.g., masking, physical distancing, lockdowns, testing) should be employed alongside a vaccine strategy to improve population and health system outcomes. While the findings are mixed on the impact of VOC on health system arrangements, the evidence is trending towards increased hospitalization and death.

scholarly journals The importance of sustained compliance with physical distancing during COVID-19 vaccination rollout

2021 ◽  
Author(s):  
Alexandra Teslya ◽  
Ganna Rozhnova ◽  
Thi Mui Pham ◽  
Daphne A van Wees ◽  
Hendrik Nunner ◽  
...  
Keyword(s):  
Public Health ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Vaccine Uptake ◽  
Transmission Model ◽  
Cumulative Number ◽  
Contact Rates ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Vaccination Campaigns

Mass vaccination campaigns against SARS-CoV-2 are ongoing in many countries with increasing vaccination coverage enabling relaxation of lockdowns. Vaccination rollout is frequently supplemented with advisory from public health authorities for continuation of physical distancing measures. Compliance with these measures is waning while more transmissible virus variants such as Alpha (B.1.1.7) and Delta (B.1.617.2) have emerged. In this work, we considered a population where the waning of compliance depends on vaccine coverage. We used a SARS-CoV-2 transmission model which captures the feedback between compliance, infection incidence, and vaccination coverage to investigate factors that contribute to the increase of the prevalence of infection during the initial stages of the vaccination rollout as compared to no vaccination scenario. We analysed how the vaccine uptake rate affects cumulative numbers of new infections three and six months after the start of vaccination. Our results suggest that the combination of fast waning compliance in non-vaccinated population, low compliance in vaccinated population and more transmissible virus variants may result in a higher cumulative number of new infections than in a situation without vaccination. These adverse effects can be alleviated if vaccinated individuals do not revert to pre-pandemic contact rates, and if non-vaccinated individuals remain compliant with physical distancing measures. Both require convincing, clear and appropriately targeted communication strategies by public health authorities.

scholarly journals Reduced COVID-19-Related Critical Illness and Death, and High Risk of Epidemic Resurgence, After Physical Distancing in Ontario, Canada

2020 ◽  
Author(s):  
Ashleigh Tuite ◽  
Amy L Greer ◽  
Steven De Keninck ◽  
David N Fisman
Keyword(s):  
Public Health ◽  
Disease Activity ◽  
Contact Tracing ◽  
Transmission Model ◽  
Case Detection ◽  
Health Measures ◽  
Initial Wave ◽  
Time Period ◽  
Near Term ◽  
The Impact

We explored the impact of physical distancing measures on COVID-19 transmission in the population of Ontario, Canada using a previously described age- and health-status stratified transmission model. The model was fit to confirmed cases occupying intensive care unit (ICU) beds and mortality among hospitalized COVID-19 cases for the time period 19 March to 26 April 2020. We projected that mortality would have been 4.6-fold what was observed had physical distancing measures not been implemented in the province. Relaxation of physical distancing measures without compensatory increases in case detection, isolation, and/or contact tracing was projected to result in resurgence of disease activity. Return to normal or near-normal levels of contact would rapidly result in cases exceeding ICU capacity. Maintaining physical distancing for a longer period of time, allowing for the initial wave of infections to subside, delayed this resurgence, but the level of contacts post-restrictive distancing was the major factor determining how quickly ICU capacity was expected to be overwhelmed. Using a model, we demonstrate the marked impact strong public health measures had in reducing ICU admissions and mortality in Ontario. We also show that this hard-earned success is tenuous: relaxation of physical distancing measures in the near-term is projected to result in a rapid resurgence of disease activity.

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