scholarly journals Modelling the impact of lockdown-easing measures on cumulative COVID-19 cases and deaths in England

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e042483
Author(s):  
Hisham Ziauddeen ◽  
Naresh Subramaniam ◽  
Deepti Gurdasani
Keyword(s):  
Bayesian Model ◽  
Primary Outcome ◽  
Reproduction Number ◽  
Healthcare Services ◽  
Baseline Scenario ◽  
Time Points ◽  
Community Transmission ◽  
Incident Cases ◽  
The Impact ◽  
Death Data

ObjectivesTo assess the potential impacts of successive lockdown-easing measures in England, at a point in the COVID-19 pandemic when community transmission levels were relatively high.DesignWe developed a Bayesian model to infer incident cases and reproduction number (R) in England, from incident death data. We then used this to forecast excess cases and deaths in multiple plausible scenarios in which R increases at one or more time points.SettingEngland.ParticipantsPublicly available national incident death data for COVID-19 were examined.Primary outcomeExcess cumulative cases and deaths forecast at 90 days, in simulated scenarios of plausible increases in R after successive easing of lockdown in England, compared with a baseline scenario where R remained constant.ResultsOur model inferred an R of 0.75 on 13 May when England first started easing lockdown. In the most conservative scenario modelled where R increased to 0.80 as lockdown was eased further on 1 June and then remained constant, the model predicted an excess 257 (95% CI 108 to 492) deaths and 26 447 (95% CI 11 105 to 50 549) cumulative cases over 90 days. In the scenario with maximal increases in R (but staying ≤1), the model predicts 3174 (95% CI 1334 to 6060) excess cumulative deaths and 421 310 (95% CI 177 012 to 804 811) cases. Observed data from the forecasting period aligned most closely to the scenario in which R increased to 0.85 on 1 June, and 0.9 on 4 July.ConclusionsWhen levels of transmission are high, even small changes in R with easing of lockdown can have significant impacts on expected cases and deaths, even if R remains ≤1. This will have a major impact on population health, tracing systems and healthcare services in England. Following an elimination strategy rather than one of maintenance of R ≤1 would substantially mitigate the impact of the COVID-19 epidemic within England.

scholarly journals Modelling the impact of lockdown easing measures on cumulative COVID-19 cases and deaths in England

2020 ◽  
Author(s):  
H Ziauddeen ◽  
N Subramaniam ◽  
D Gurdasani
Keyword(s):  
Bayesian Model ◽  
Added Value ◽  
Reproductive Number ◽  
Baseline Scenario ◽  
Community Transmission ◽  
Uk Government ◽  
The Uk ◽  
Incident Cases ◽  
The Impact ◽  
Death Data

AbstractBackgroundAs countries begin to ease the lockdown measures instituted to control the COVID-19 pandemic, there is a risk of a resurgence of the pandemic. The UK started easing lockdown in England when levels of community transmission remained high, which could have a major impact on case numbers and deaths. Using a Bayesian model we assessed the potential impacts of successive lockdown easing measures in England, focussing on scenarios where the reproductive number (R) remains ≤1 in line with the UK government’s stated aim.MethodsWe developed a Bayesian model to infer incident cases and R in England, from incident death data from the Office of National Statistics. We then used this to forecast excess cases and deaths in multiple plausible scenarios in which R increases at one or more time points, compared to a baseline scenario where R remains unchanged by the easing of lockdown.FindingsThe model inferred an R of 0.81 on the 13th May when England first started easing lockdown. In the most conservative scenario where R increases to 0.85 as lockdown was eased further on 1st June and then remained constant, the model predicts an excess 400 (95% CI 34-1988) deaths and 56,019 (95% CI 4768-278,083) cumulative cases over 90 days. In the scenario with maximal increases in R (but staying ≤1) with successive easing of lockdown, the model predicts 1,946 (95% CI 165-9,667) excess cumulative deaths and 351,460 (95% CI 29,894-1,747,026) excess cases.InterpretationWhen levels of transmission are high, even small changes in R with easing of lockdown can have significant impacts on expected cases and deaths, even if R remains ≤1. This will have a major impact on tracing systems and health care services in England. This model can be updated with incoming death data to refine predictions over time.FundingNone.Research in contextEvidence before this studyThe impact of social distancing and lockdown measures on controlling the COVID-19 pandemic has been studied extensively over the last few months. However there has been little examination of the likely impact of easing lockdown measures in a staged manner as is being currently carried out in England, UK. We searched PubMed, medRxiv, bioRxiv, arXiv, and Wellcome Open Research for peer-reviewed articles, preprints, and research reports using the terms “COVID-19”, “United Kingdom” and “lockdown” for research examining these impacts, but found no relevant research that could inform the impact of phased easing of lockdown within England, UK.Added value of this studyDecisions around timing of easing lockdown need to be informed by current scientific evidence. In this context, this study provides urgently needed information about the potential impact of lockdown easing at this point within the COVID-19 pandemic in England. Using an epidemiological approach with Bayesian inference, we specifically assess several plausible scenarios of increase in R from baseline as a result of easing lockdown measures at levels of current community transmission, even when the R is maintained ≤1, which is the stated aim of the UK government. We provide a comparison of these scenarios, with a baseline scenario where R remains constant, as well as against elimination strategies, where transmission is aggressively suppressed to the lowest level possible. As our code is publicly available, these methods can be easily applied to accruing data, and to any number of scenarios to better understand the implications for public health policy.Implications of all the available evidenceEasing lockdown at a point of relatively high community transmission within the UK would lead to substantial excesses of deaths, and cases, even if R is maintained at ≤1. As expected, these increases are more marked, when R rises above 1, which is a distinct possibility, given recent estimates of R by a UK government advisory group.1 Our findings suggest that an elimination strategy would be more appropriate at this point, to allow suppression of community transmission to a point where easing of lockdown would not have the same impact, as with current transmission, and would likely not overwhelm systems of test, trace and isolate, and health services within England.

scholarly journals Model-based evaluation of school- and non-school-related measures to control the COVID-19 pandemic

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ganna Rozhnova ◽  
Christiaan H. van Dorp ◽  
Patricia Bruijning-Verhagen ◽  
Martin C. J. Bootsma ◽  
Janneke H. H. M. van de Wijgert ◽  
...  
Keyword(s):  
Reproduction Number ◽  
Additional Benefit ◽  
Transmission Model ◽  
Time Points ◽  
School Based ◽  
Admission Data ◽  
Age Structured ◽  
The Impact ◽  
Pandemic Wave

AbstractThe role of school-based contacts in the epidemiology of SARS-CoV-2 is incompletely understood. We use an age-structured transmission model fitted to age-specific seroprevalence and hospital admission data to assess the effects of school-based measures at different time points during the COVID-19 pandemic in the Netherlands. Our analyses suggest that the impact of measures reducing school-based contacts depends on the remaining opportunities to reduce non-school-based contacts. If opportunities to reduce the effective reproduction number (Re) with non-school-based measures are exhausted or undesired and Re is still close to 1, the additional benefit of school-based measures may be considerable, particularly among older school children. As two examples, we demonstrate that keeping schools closed after the summer holidays in 2020, in the absence of other measures, would not have prevented the second pandemic wave in autumn 2020 but closing schools in November 2020 could have reduced Re below 1, with unchanged non-school-based contacts.

scholarly journals The effects of non-pharmaceutical interventions on SARS-CoV-2 transmission in different socioeconomic populations in Kuwait: a modeling study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatima Khadadah ◽  
Abdullah A. Al-Shammari ◽  
Ahmad Alhashemi ◽  
Dari Alhuwail ◽  
Bader Al-Saif ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Reproduction Number ◽  
Transmission Model ◽  
Socioeconomic Groups ◽  
Before And After ◽  
Cross Transmission ◽  
Community Transmission ◽  
The Impact ◽  
Pharmaceutical Interventions ◽  
The Basic Reproduction Number

Abstract Background Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2. The extent to which these interventions are successful in stopping the spread have not been characterized in countries with distinct socioeconomic groups. We compared the effects of a partial lockdown on disease transmission among Kuwaitis (P1) and non-Kuwaitis (P2) living in Kuwait. Methods We fit a modified metapopulation SEIR transmission model to reported cases stratified by two groups to estimate the impact of a partial lockdown on the effective reproduction number ($$ {\mathcal{R}}_e $$ R e ). We estimated the basic reproduction number ($$ {\mathcal{R}}_0 $$ R 0 ) for the transmission in each group and simulated the potential trajectories of an outbreak from the first recorded case of community transmission until 12 days after the partial lockdown. We estimated $$ {\mathcal{R}}_e $$ R e values of both groups before and after the partial curfew, simulated the effect of these values on the epidemic curves and explored a range of cross-transmission scenarios. Results We estimate $$ {\mathcal{R}}_e $$ R e at 1·08 (95% CI: 1·00–1·26) for P1 and 2·36 (2·03–2·71) for P2. On March 22nd, $$ {\mathcal{R}}_e $$ R e for P1 and P2 are estimated at 1·19 (1·04–1·34) and 1·75 (1·26–2·11) respectively. After the partial curfew had taken effect, $$ {\mathcal{R}}_e $$ R e for P1 dropped modestly to 1·05 (0·82–1·26) but almost doubled for P2 to 2·89 (2·30–3·70). Our simulated epidemic trajectories show that the partial curfew measure greatly reduced and delayed the height of the peak in P1, yet significantly elevated and hastened the peak in P2. Modest cross-transmission between P1 and P2 greatly elevated the height of the peak in P1 and brought it forward in time closer to the peak of P2. Conclusion Our results indicate and quantify how the same lockdown intervention can accentuate disease transmission in some subpopulations while potentially controlling it in others. Any such control may further become compromised in the presence of cross-transmission between subpopulations. Future interventions and policies need to be sensitive to socioeconomic and health disparities.

scholarly journals Model-based evaluation of school- and non-school-related measures to control the COVID-19 pandemic

2021 ◽  
Author(s):  
Ganna Rozhnova ◽  
Christiaan van Dorp ◽  
Patricia Bruijning-Verhagen ◽  
Martin Bootsma ◽  
Janneke van de Wijgert ◽  
...  
Keyword(s):  
Reproduction Number ◽  
Additional Benefit ◽  
Transmission Model ◽  
Time Points ◽  
School Based ◽  
Admission Data ◽  
Age Structured ◽  
The Impact ◽  
Pandemic Wave

Abstract The role of school-based contacts in the epidemiology of SARS-CoV-2 is incompletely understood. We used an age-structured transmission model fitted to age-specific seroprevalence and hospital admission data to assess the effects of school-based measures at different time points during the COVID-19 pandemic in the Netherlands. Our analyses suggest that the impact of measures reducing school-based contacts depends on the remaining opportunities to reduce non-school-based contacts. If opportunities to reduce the effective reproduction number (Re) with non-school-based measures are exhausted or undesired and Re is still close to 1, the additional benefit of school-based measures may be considerable, particularly among older school children. As two examples, we demonstrate that keeping schools closed after the summer holidays in 2020, in the absence of other measures, would not have prevented the second pandemic wave in autumn 2020 but closing schools in November 2020 could have reduced Re below 1, with unchanged non-school-based contacts.

scholarly journals The effects of non-pharmaceutical interventions on SARS-CoV-2 transmission in different socioeconomic populations in Kuwait: A modelling study

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Fatima Khadadah ◽  
Abdullah A. Al-Shammari ◽  
Ahmad Alhashemi ◽  
Dari Alhuwail ◽  
Bader Al-Saif ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Reproduction Number ◽  
Public Health Intervention ◽  
Population Level ◽  
Socioeconomic Groups ◽  
Before And After ◽  
Cross Transmission ◽  
Community Transmission ◽  
The Impact ◽  
Pharmaceutical Interventions

Background: Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV2. The extent to which these interventions are successful in stopping the spread have not been characterized in countries with distinct socioeconomic groups. We compared the effects of a partial lockdown on disease transmission among Kuwaitis (P1) and non-Kuwaitis (P2) living in Kuwait. Methods: We fit a metapopulation Susceptible-Exposed-Infectious-Recovered (SEIR) model to reported cases stratified by two groups to estimate the impact of a lockdown on the effective reproduction number (Re). We estimated the basic reproduction number (R0) for the transmission in each group and simulated the potential trajectories of an outbreak from the first recorded case of community transmission until 12 days after the lockdown. We estimated R­e values of both groups before and after the lockdown, simulated the effect of these values on epidemic curves and explored a range of cross-transmission scenarios. Results: We estimate R0 at 1·06 (95% CI: 1·05-1·28) for P1 and 1·83 (1·58-2·33) for P2. On March 22nd, Re for P1 and P2 are estimated at 1·13 (1·07-1·17) and 1·38 (1·25-1·63) respectively. After the curfew had taken effect, Re for P1 dropped modestly to 1·04 (1·02-1·06) but almost doubled for P2 to 2·47 (1·98-3·45). Our simulated epidemic trajectories show that the partial curfew measure modestly reduced and delayed the height of the peak in P1, yet significantly elevated and hastened the peak in P2. Modest cross-transmission from P2 to P1 elevated the height of the peak in P1 and brought it forward in time closer to the peak of P2.    Conclusion: Our results demonstrate that a lockdown can reduce SARS-CoV2 transmission in one subpopulation but accelerate it in another. At the population level, the consequences of lockdowns may vary across the socioeconomic spectrum. Any public health intervention needs to be sensitive to disparities within populations.

scholarly journals The Impact of COVID-19 Vaccination on California's Return to Normalcy

2021 ◽  
Author(s):  
Maria L Daza-Torres ◽  
Yury Elena Garcia Puerta ◽  
Alec J Schmidt ◽  
James L Sharpnack ◽  
Bradley H Pollock ◽  
...  
Keyword(s):  
Transmission Rate ◽  
Realistic Model ◽  
Vaccine Uptake ◽  
Model Parameters ◽  
Baseline Scenario ◽  
Effective Population ◽  
Vaccination Rates ◽  
Population Sizes ◽  
Incident Cases ◽  
The Impact

SARS-CoV-2 has infected nearly 3.7 million and killed 61,722 Californians, as of May 22, 2021. Non-pharmaceutical interventions have been instrumental in mitigating the spread of the coronavirus. However, as we ease restrictions, widespread implementation of COVID-19 vaccines is essential to prevent its resurgence. In this work, we addressed the adequacy and deficiency of vaccine uptake within California and the possibility and severity of resurgence of COVID-19 as restrictions are lifted given the current vaccination rates. We implemented a real-time Bayesian data assimilation approach to provide projections of incident cases and deaths in California following the reopening of its economy on June 15, 2021. We implemented scenarios that vary vaccine uptake prior to reopening, and transmission rates and effective population sizes following the reopening. For comparison purposes, we adopted a baseline scenario using the current vaccination rates, which projects a total 11,429 cases and 429 deaths in a 15-day period after reopening. We used posterior estimates based on CA historical data to provide realistic model parameters after reopening. When the transmission rate is increased after reopening, we projected an increase in cases by 21.8% and deaths by 4.4% above the baseline after reopening. When the effective population is increased after reopening, we observed an increase in cases by 51.8% and deaths by 12.3% above baseline. A 30% reduction in vaccine uptake alone has the potential to increase cases and deaths by 35% and 21.6%, respectively. Conversely, increasing vaccine uptake by 30% could decrease cases and deaths by 26.1% and 17.9%, respectively. As California unfolds its plan to reopen its economy on June 15, 2021, it is critical that social distancing and public behavior changes continue to be promoted, particularly in communities with low vaccine uptake. The Centers of Disease Control's (CDC) recommendation to ease mask-wearing for fully vaccinated individuals despite major inequities in vaccine uptake in counties across the state highlights some of the logistical challenges that society faces as we enthusiastically phase out of this pandemic.

scholarly journals Modelling the impact of shutdowns on resurging SARS-CoV-2 transmission in Canada

2021 ◽  
Vol 8 (5) ◽  
Author(s):  
Victoria Ng ◽  
Aamir Fazil ◽  
Lisa A. Waddell ◽  
Patricia Turgeon ◽  
Ainsley Otten ◽  
...  
Keyword(s):  
Public Health ◽  
Negative Relationship ◽  
Local Context ◽  
Socioeconomic Impact ◽  
Baseline Scenario ◽  
Agent Based ◽  
Health Measures ◽  
Trade Offs ◽  
Community Transmission ◽  
The Impact

Background: Shutdowns are enacted when alternative public health measures are insufficient to control the epidemic and the population is largely susceptible. An age-stratified agent-based model was developed to explore the impact of shutdowns to control SARS-CoV-2 transmission in Canada under the assumption that current efforts to control the epidemic remains insufficient and in the absence of a vaccine. Methods: We estimated the current levels of interventions in Canada to generate a baseline scenario from 7 February to 7 September 2020. Four aspects of shutdowns were explored in scenarios that ran from 8 September 2020 to 7 January 2022, these included the impact of how quickly shutdowns are implemented, the duration of shutdowns, the minimum break (delays) between shutdowns and the types of sectors to shutdown. Comparisons among scenarios were made using cases, hospitalizations, deaths and shutdown days during the 700-day model runs. Results: We found a negative relationship between reducing SARS-CoV-2 transmission and the number of shutdown days. However, we also found that for shutdowns to be optimally effective, they need to be implemented fast with minimal delay, initiated when community transmission is low, sustained for an adequate period and be stringent and target multiple sectors, particularly those driving transmission. By applying shutdowns in this manner, the total number of shutdown days could be reduced compared to delaying the shutdowns until further into the epidemic when transmission is higher and/or implementing short insufficient shutdowns that would require frequent re-implementation. This paper contrasts a range of shutdown strategies and trade-offs between health outcomes and economic metrics that need to be considered within the local context. Interpretation: Given the immense socioeconomic impact of shutdowns, they should be avoided where possible and used only when other public health measures are insufficient to control the epidemic. If used, the time it buys to delay the epidemic should be used to enhance other equally effective, but less disruptive, public health measures.

International Remittances and Private Healthcare in Kerala, India

2020 ◽  
Vol 17 (3) ◽  
pp. 445-460
Author(s):  
Mohd Imran Khan ◽  
Valatheeswaran C.
Keyword(s):  
Instrumental Variable ◽  
Capital Investment ◽  
Healthcare Expenditure ◽  
Healthcare Services ◽  
Private Healthcare ◽  
International Remittances ◽  
Variable Approach ◽  
Using Data ◽  
The Impact ◽  
Instrumental Variable Approach

The inflow of international remittances to Kerala has been increasing over the last three decades. It has increased the income of recipient households and enabled them to spend more on human capital investment. Using data from the Kerala Migration Survey-2010, this study analyses the impact of remittance receipts on the households’ healthcare expenditure and access to private healthcare in Kerala. This study employs an instrumental variable approach to account for the endogeneity of remittances receipts. The empirical results show that remittance income has a positive and significant impact on households’ healthcare expenditure and access to private healthcare services. After disaggregating the sample into different heterogeneous groups, this study found that remittances have a greater effect on lower-income households and Other Backward Class (OBC) households but not Scheduled Caste (SC) and Scheduled Tribe (ST) households, which remain excluded from reaping the benefit of international migration and remittances.

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

Healthcare System in the Arctic Zone of Russia. Known and Emerging Issues and Solutions to Them

2019 ◽  
pp. 3-20
Author(s):  
V.N. Leksin
Keyword(s):  
Metallurgical Industry ◽  
Healthcare Services ◽  
The Arctic ◽  
Russian Arctic ◽  
Arctic Zone ◽  
Shift Workers ◽  
The North ◽  
Medical Institutions ◽  
Emerging Issues ◽  
The Impact

The impact on healthcare organization on the territory of Russian Arctic of unique natural and climatic, demographic, ethnic, settlement and professional factors of influencing the health of population, constantly or temporarily living on this territory is studied. The necessity is substantiated of various forms and resource provision with healthcare services such real and potential patients of Arctic medical institutions, as representatives of indigenous small peoples of the North, workers of mining and metallurgical industry, military personnel, sailors and shift workers. In this connection a correction of a number of All-Russian normative acts is proposed.

Sign in / Sign up

Export Citation Format

Share Document