scholarly journals Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States

2021 ◽  
Vol 9 ◽  
Author(s):  
William K. Pan ◽  
Daniel Fernández ◽  
Stefanos Tyrovolas ◽  
Giné-Vázquez Iago ◽  
Rishav Raj Dasgupta ◽  
...  
Keyword(s):  
New England ◽  
Effect Sizes ◽  
County Level ◽  
Middle Atlantic ◽  
South Central ◽  
The Us ◽  
Central South ◽  
Doubling Times ◽  
East West ◽  
Pharmaceutical Interventions

Background: Attempts to quantify effect sizes of non-pharmaceutical interventions (NPI) to control COVID-19 in the US have not accounted for heterogeneity in social or environmental factors that may influence NPI effectiveness. This study quantifies national and sub-national effect sizes of NPIs during the early months of the pandemic in the US.Methods: Daily county-level COVID-19 cases and deaths during the first wave (January 2020 through phased removal of interventions) were obtained. County-level cases, doubling times, and death rates were compared to four increasingly restrictive NPI levels. Socio-demographic, climate and mobility factors were analyzed to explain and evaluate NPI heterogeneity, with mobility used to approximate NPI compliance. Analyses were conducted separately for the US and for each Census regions (Pacific, Mountain, east/West North Central, East/West South Central, South Atlantic, Middle Atlantic and New England). A stepped-wedge cluster-randomized trial analysis was used, leveraging the phased implementation of policies.Results: Aggressive (level 4) NPIs were associated with slower COVID-19 propagation, particularly in high compliance counties. Longer duration of level 4 NPIs was associated with lower case rates (log beta −0.028, 95% CI −0.04 to −0.02) and longer doubling times (log beta 0.02, 95% CI 0.01–0.03). Effects varied by Census region, for example, level 4 effects on doubling time in Pacific states were opposite to those in Middle Atlantic and New England states. NPI heterogeneity can be explained by differential timing of policy initiation and by variable socio-demographic county characteristics that predict compliance, particularly poverty and racial/ethnic population. Climate exhibits relatively consistent relationships across Census regions, for example, higher minimum temperature and specific humidity were associated with lower doubling times and higher death rates for this period of analysis in South Central, South Atlantic, Middle Atlantic, and New England states.Conclusion and Relevance: Heterogeneity exists in both the effectiveness of NPIs across US Census regions and policy compliance. This county-level variability indicates that control strategies are best designed at community-levels where policies can be tuned based on knowledge of local disparities and compliance with public health ordinances.

scholarly journals COVID-19: Effectiveness of Non-Pharmaceutical Interventions in the United States before Phased Removal of Social Distancing Protections Varies by Region

2020 ◽  
Author(s):  
William Pan ◽  
Stefanos Tyrovolas ◽  
Iago Gine Vazquez ◽  
Rishav Raj ◽  
Daniel Fernandez ◽  
...  
Keyword(s):  
Effect Sizes ◽  
County Level ◽  
Climate Factors ◽  
Death Rates ◽  
North Central ◽  
South Central ◽  
Level 3 ◽  
Us Census ◽  
Doubling Times ◽  
Pharmaceutical Interventions

Although coronavirus disease 2019 (COVID-19) emerged in January 2020, there is no quantified effect size for non-pharmaceutical interventions (NPI) to control the outbreak in the continental US. Objective. To quantify national and sub-national effect sizes of NPIs in the US. Design. This is an observational study for which we obtained daily county level COVID-19 cases and deaths from January 22, 2020 through the phased removal of social distancing protections. A stepped-wedge cluster-randomized trial (SW-CRT) analytical approach is used, leveraging the phased implementation of policies. Data include 3142 counties from all 50 US states and the District of Columbia. Exposures. County-level NPIs were obtained from online county and state policy databases, then classified into four intervention levels: Level 1 (low), declaration of a State of Emergency; Level 2 (moderate), school closures, restricting nursing home access, or closing restaurants and bars; Level 3 (high), non-essential business closures, suspending non-violent arrests, suspending elective medical procedures, suspending evictions, or restricting mass gatherings of at least 10 people; and Level 4 (aggressive). sheltering in place / stay-at-home, public mask requirements, or travel restrictions. Additional county-level data were obtained to record racial (Black, Hispanic), economic (educational level, poverty), demographic (rural/urban) and climate factors (temperature, specific humidity, solar radiation). Main Outcomes. The primary outcomes are rates of COVID-19 cases, deaths and case doubling times. NPI effects are measured separately for nine US Census Region (Pacific, Mountain, West North Central, East North Central, West South Central, East South Central, South Atlantic, Middle Atlantic, New England). Results. Aggressive NPIs (level 4) significantly reduced COVID-19 case and death rates in all US Census Regions, with effect sizes ranging from 4.1% to 25.7% and 5.5% to 25.5%, respectively, for each day they were active. No other intervention level achieved significance across all US Regions. Intervention levels 3 and 4 both increased COVID-19 doubling times, with effects peaking at 25 and 40 days after initiation of each policy, respectively. The effectiveness of level 3 NPIs varied, reducing case rates in all regions except North Central states, but associated with significantly higher death rates in all regions except Pacific states. Intervention levels 1 and 2 did not indicate any effect on COVID-19 propagation and, in some regions, these interventions were associated with increased COVID-19 cases and deaths. Heterogeneity of NPI effects are associated with racial composition, poverty, urban-rural environment, and climate factors. Conclusion. Aggressive NPIs are effective tools to reduce COVID-19 propagation and mortality. Reducing social and environmental disparities may improve NPI effects in regions where less strict policies are in place.

scholarly journals County-Level Estimates of Excess Mortality associated with COVID-19 in the United States

2021 ◽  
Author(s):  
Calvin A. Ackley ◽  
Dielle J. Lundberg ◽  
Irma T. Elo ◽  
Samuel H. Preston ◽  
Andrew C. Stokes
Keyword(s):  
New England ◽  
Urban Areas ◽  
Excess Mortality ◽  
State Level ◽  
The United States ◽  
Middle Atlantic ◽  
South Central ◽  
The Us ◽  
Us Counties ◽  
Excess Deaths

AbstractThe coronavirus disease 2019 (COVID-19) pandemic in the US has been largely monitored on the basis of death certificates containing reference to COVID-19. However, prior analyses reveal that a significant fraction of excess deaths associated with the pandemic were not directly assigned to COVID-19 on the death certificate. The percent of excess deaths not assigned to COVID-19 is also known to vary across US states. However, few studies to date provide information on patterns of excess mortality and excess deaths not assigned to COVID-19 for US counties, despite the importance of this information for health policy and planning. In the present study, we develop and validate a generalized linear model of expected mortality in 2020 based on historical trends in deaths by county of residence between 2011 and 2019. We use the results of the model to generate county estimates of excess mortality and excess deaths not assigned to COVID-19 for each county in the US along with bootstrapped prediction intervals. Overall, the proportion of excess deaths assigned to COVID-19 was 81%, meaning that 19% of excess deaths were not assigned to COVID-19. The proportion assigned to COVID-19 was lower in the South (76%) and West (75%) as compared to counties in the Midwest (81%) and Northeast (94%). Across US Census Divisions, the proportion was especially low in the East South Central Division (67%). Rural counties across all divisions (67%) reported lower proportions of excess deaths assigned to COVID-19 than urban areas (83%). For instance, in the Middle Atlantic and Pacific Divisions respectively, only 47% and 39% of excess deaths were assigned to COVID-19 in nonmetro areas. In contrast, the New England Census Division stood out as the only division where directly assigned COVID-19 deaths actually exceeded excess deaths, meaning there were 1.23 directly assigned COVID-19 deaths for every 1 excess death. However, this finding did not extend to nonmetro areas within New England where only 64% of excess deaths were assigned to COVID-19. The finding that metro areas in New England reported higher direct COVID-19 mortality than excess mortality suggests that reductions in mortality from other causes of death may have occurred in these areas, at least among some populations. Across individual counties, the percentage of excess deaths not assigned to COVID-19 varied substantially, with some counties’ direct COVID-19 tallies capturing only a small fraction of total excess deaths, whereas in other counties the direct COVID-19 death rate far exceeded the number of estimated excess deaths. Taken together, our results suggest that regional inequalities in the mortality burden associated with COVID-19 are not fully revealed by data at the state level and that consideration of excess deaths across US counties is critical for a full accounting of the disparate regional effects of the pandemic on US mortality.

scholarly journals Exposure of Domestic Cats to Three Zoonotic Bartonella Species in the United States

Pathogens ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 354
Author(s):  
Lynn M. Osikowicz ◽  
Kalanthe Horiuchi ◽  
Irina Goodrich ◽  
Edward B. Breitschwerdt ◽  
Bruno Chomel ◽  
...  
Keyword(s):  
New England ◽  
The United States ◽  
Severe Illness ◽  
Domestic Cats ◽  
Bartonella Species ◽  
Serum Samples ◽  
North Central ◽  
Middle Atlantic ◽  
South Central ◽  
Central Regions

Cat-associated Bartonella species, which include B. henselae, B. koehlerae, and B. clarridgeiae, can cause mild to severe illness in humans. In the present study, we evaluated 1362 serum samples obtained from domestic cats across the U.S. for seroreactivity against three species and two strain types of Bartonella associated with cats (B. henselae type 1, B. henselae type 2, B. koehlerae, and B. clarridgeiae) using an indirect immunofluorescent assay (IFA). Overall, the seroprevalence at the cutoff titer level of ≥1:64 was 23.1%. Seroreactivity was 11.1% and 3.7% at the titer level cutoff of ≥1:128 and at the cutoff of ≥1:256, respectively. The highest observation of seroreactivity occurred in the East South-Central, South Atlantic, West North-Central, and West South-Central regions. The lowest seroreactivity was detected in the East North-Central, Middle Atlantic, Mountain, New England, and Pacific regions. We observed reactivity against all four Bartonella spp. antigens in samples from eight out of the nine U.S. geographic regions.

Americans in Britain's Backyard: The Railway Era in Upper Canada, 1850–1880

1981 ◽  
Vol 55 (3) ◽  
pp. 314-336 ◽  
Author(s):  
Peter Baskerville
Keyword(s):  
New England ◽  
Small Population ◽  
Financial Control ◽  
Upper Canada ◽  
Atlantic Seaboard ◽  
American Midwest ◽  
Middle Atlantic ◽  
American Cities ◽  
East West ◽  
Eastern Seaboard

Canadian lines that were spreading out over what would become the Province of Ontario looked forward, in the years before the American Civil War, to becoming important east-west carriers between the rapidly growing American cities of the eastern seaboard and the still-new cities of the American Midwest. Canada's small population and undeveloped industry would force her railroads to rely heavily on traffic going from one American city to another. Lines like the Grand Trunk and the Great Western struggled desperately therefore, to avoid American financial control. With the help of British capital, they succeeded. But America's contribution to Canadian railroading ran much deeper than money. Dominating the skilled engineers and experienced construction contractors who came from south of the border was more difficult for Canadian directors to manage. In the end, however, it was the early failure of top Canadian management to bury their rivalries, ignore their English creditors, emulate Americans like Vanderbilt, Thomson, and Garrett, and consolidate into an integrated line between New England, the Middle Atlantic seaboard, and the Midwest that doomed their railroads to becoming, as one Canadian put it, “side streets to the trade thoroughfare.”

Local Histories/Global Designs

2012 ◽  
Author(s):  
Walter D. Mignolo
Keyword(s):  
Social Sciences ◽  
Central America ◽  
Postcolonial Studies ◽  
The United States ◽  
Philosophy Of History ◽  
South Central ◽  
The Social ◽  
The Caribbean ◽  
Border Thinking ◽  
East West

This book is an extended argument about the “coloniality” of power. In a shrinking world where sharp dichotomies, such as East/West and developing/developed, blur and shift, this book points to the inadequacy of current practices in the social sciences and area studies. It explores the crucial notion of “colonial difference” in the study of the modern colonial world and traces the emergence of an epistemic shift, which the book calls “border thinking.” Further, the book expands the horizons of those debates already under way in postcolonial studies of Asia and Africa by dwelling on the genealogy of thoughts of South/Central America, the Caribbean, and Latino/as in the United States. The book's concept of “border gnosis,” or sensing and knowing by dwelling in imperial/colonial borderlands, counters the tendency of occidentalist perspectives to manage, and thus limit, understanding. A new preface discusses this book as a dialogue with Hegel's Philosophy of History.

The crisis of multilateralism and EU–Russia cooperation

2020 ◽  
Vol 22 (1) ◽  
pp. 54-57
Author(s):  
FRANCO BRUNI ◽  
Keyword(s):  
International Relations ◽  
Careful Consideration ◽  
Modern World ◽  
Multiple Methods ◽  
The Us ◽  
Good For ◽  
East West ◽  
The Eu

The article is devoted to problems in relations between the EU and Russia. Multiple methods are considered that are aimed at solving the problem of multilateralism in current conditions. The author selected and studied specific documents on essential aspects that are devoted to this topic. Studying the arising problems requires careful consideration since, in the modern world, cooperation between global actors such as the EU and Russia cannot be ignored. Despite all the challenges faced by the parties in their fields, all difficulties are conquerable, and the article provides specific methods for its solving. The article discusses some aspects and problems that require particular attention from specialists in this field. The author concludes that strong US–EU coalition could seem more coherent with history and with the traditional East–West divide. However, the recent evolution of the US attitude towards international relations weakens the probability of such coalition and its perceived payoffs. A more or less defensive Russia–China coalition has been tried with limited results; moreover, if it were possible and probable, the two western players would change their strategy to prevent it or to contain its depth. In fact, we live in a world where many talks of a serious possibility of G2 governance, a peculiar type of coalition where the US and China keep hostile and nationalistic attitudes but join forces to set the global stage in their favor, pursuing a qualitatively limited but quantitatively rich payoff. In such world, as a counterpart of this payoff, both the divided Europe and the economically much smaller Russia would lose power and suffer several kinds of economic disadvantages. Therefore, Greater Europe would be good for Russia and for the EU as well.

scholarly journals Effect of specific non-pharmaceutical intervention policies on SARS-CoV-2 transmission in the counties of the United States

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Bingyi Yang ◽  
Angkana T. Huang ◽  
Bernardo Garcia-Carreras ◽  
William E. Hart ◽  
Andrea Staid ◽  
...  
Keyword(s):  
United States ◽  
Home Visiting ◽  
Leisure Activities ◽  
The United States ◽  
Causal Effects ◽  
Basic Reproductive Number ◽  
Reproductive Number ◽  
County Level ◽  
Metapopulation Model ◽  
Pharmaceutical Interventions

AbstractNon-pharmaceutical interventions (NPIs) remain the only widely available tool for controlling the ongoing SARS-CoV-2 pandemic. We estimated weekly values of the effective basic reproductive number (Reff) using a mechanistic metapopulation model and associated these with county-level characteristics and NPIs in the United States (US). Interventions that included school and leisure activities closure and nursing home visiting bans were all associated with a median Reff below 1 when combined with either stay at home orders (median Reff 0.97, 95% confidence interval (CI) 0.58–1.39) or face masks (median Reff 0.97, 95% CI 0.58–1.39). While direct causal effects of interventions remain unclear, our results suggest that relaxation of some NPIs will need to be counterbalanced by continuation and/or implementation of others.

scholarly journals The Genus Lagochilus (Lamiaceae): A Review of Its Diversity, Ethnobotany, Phytochemistry, and Pharmacology

Plants ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 132
Author(s):  
Nilufar Z. Mamadalieva ◽  
Davlat Kh. Akramov ◽  
Ludger A. Wessjohann ◽  
Hidayat Hussain ◽  
Chunlin Long ◽  
...  
Keyword(s):  
Secondary Metabolites ◽  
Chemical Constituents ◽  
Iridoid Glycosides ◽  
Herbal Medicines ◽  
Future Research ◽  
South Central ◽  
Pharmacological Studies ◽  
Central South

The genus Lagochilus (Lamiaceae) is native to Central, South-Central, and Eastern Asia. It comprises 44 species, which have been commonly used as herbal medicines for the treatments of various ailments for thousands of years, especially in Asian countries. This review aims to summarize the chemical constituents and pharmacological activities of species from the genus Lagochilus to unveil opportunities for future research. In addition, we provide some information about their traditional uses, botany, and diversity. More than 150 secondary metabolites have been reported from Lagochilus, including diterpenes, flavonoids, phenolic compounds, triterpenoids, iridoid glycosides, lignans, steroids, alkaloids, polysaccharides, volatile, non-volatile and aromatic compounds, lipids, carbohydrates, minerals, vitamins, and other secondary metabolites. In vitro and in vivo pharmacological studies on the crude extracts, fractions, and isolated compounds from Lagochilus species showed hemostatic, antibacterial, anti-inflammatory, anti-allergic, cytotoxic, enzyme inhibitory, antispasmodic, hypotensive, sedative, psychoactive, and other activities.

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