Singapore’s COVID-19 “circuit breaker” interventions: A description of
individual-level adoptions of precautionary behaviours

ABSTRACT Introduction: Effectiveness of COVID-19 control interventions relies significantly on behavioural modifications of its population. Differing adoption rates impacts subsequent COVID-19 control. Hence, positive and sustained behavioural modification is essential for disease control. We describe the adoption rates of behavioural modifications for Singapore’s “circuit-breaker” (CB), the national public health response to the COVID-19 crisis, among the general population in the community. Methods: We conducted an interrupted-time series study using retrospective secondary data. We compared the proportion of Singaporeans who reported adopting specific behaviour modifications before, during and after CB. Behaviours of interest were working from home, performing hand hygiene, using face mask in public, and avoiding crowded areas. We compared change in incidence rates for community COVID-19 cases among the general population across the same time periods. Results: There was an increase in face mask usage (+46.9%, 95% confidence interval [CI] 34.9–58.8, P<0.01) and working from home (+20.4%, 95% CI 11.7–29.2, P<0.01) during CB than before CB in Singapore. Other self-reported behaviours showed no statistically significant difference. Change in daily incidence rates of community COVID-19 cases decreased from additional 0.73 daily case before CB to 0.55 fewer case per day during CB (P<0.01). There was no significant difference among all behaviour adoption rates after CB. Daily incidence of community cases continued to decrease by 0.11 case daily after CB. Conclusion: Community incidence of COVID-19 in Singapore decreased during CB and remained low after CB. Use of face masks and social-distancing compliance through working from home increased during CB. However, it is unlikely to influence other sources of COVID-19 such as imported cases or within foreign worker dormitories. Keywords: Behaviours, COVID-19, public health

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A Strong Seasonality Pattern for Covid-19 Incidence Rates Modulated by UV Radiation Levels

Viruses ◽

10.3390/v13040574 ◽

2021 ◽

Vol 13 (4) ◽

pp. 574

Author(s):

Christos Karapiperis ◽

Panos Kouklis ◽

Stelios Papastratos ◽

Anastasia Chasapi ◽

Antoine Danchin ◽

...

Keyword(s):

Public Health ◽

Uv Radiation ◽

Initial Conditions ◽

Face Mask ◽

Incidence Rates ◽

Personal Hygiene ◽

Public Health Policies ◽

Community Transmission ◽

Nonpharmaceutical Interventions ◽

Strong Seasonality

The Covid-19 pandemic has required nonpharmaceutical interventions, primarily physical distancing, personal hygiene and face mask use, to limit community transmission, irrespective of seasons. In fact, the seasonality attributes of this pandemic remain one of its biggest unknowns. Early studies based on past experience from respiratory diseases focused on temperature or humidity, with disappointing results. Our hypothesis that ultraviolet (UV) radiation levels might be a factor and a more appropriate parameter has emerged as an alternative to assess seasonality and exploit it for public health policies. Using geographical, socioeconomic and epidemiological criteria, we selected twelve North-equatorial-South countries with similar characteristics. We then obtained UV levels, mobility and Covid-19 daily incidence rates for nearly the entire 2020. Using machine learning, we demonstrated that UV radiation strongly associated with incidence rates, more so than mobility did, indicating that UV is a key seasonality indicator for Covid-19, irrespective of the initial conditions of the epidemic. Our findings can inform the implementation of public health emergency measures, partly based on seasons in the Northern and Southern Hemispheres, as the pandemic unfolds into 2021.

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Outbreak of trichinellosis related to eating imported wild boar meat, Belgium, 2014

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.37.30341 ◽

2016 ◽

Vol 21 (37) ◽

Cited By ~ 10

Author(s):

Peter Messiaen ◽

Annemie Forier ◽

Steven Vanderschueren ◽

Caroline Theunissen ◽

Jochen Nijs ◽

...

Keyword(s):

Public Health ◽

Wild Boar ◽

Sharp Decrease ◽

Incidence Rates ◽

Control Measures ◽

The European Union ◽

Public Health Response ◽

Local Public Health ◽

Large Outbreak ◽

Wild Boar Meat

Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses. In November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients’ muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative. The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.

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The Covid-19 Crisis and the need for suitable face masks for the general population

Chinese Journal of Medical Research ◽

10.37515/cjmr.091x.3108 ◽

2020 ◽

Vol 3 (1) ◽

pp. 28-31

Author(s):

Gerald D Barr ◽

Keyword(s):

Public Health ◽

General Population ◽

Face Mask ◽

Infected People ◽

The Public ◽

Large Numbers ◽

Care Workers ◽

Health Advice ◽

Logistical Problem ◽

The Uk

In relation to SARS-CoVid-2 a theoretical gold standard of face mask use is discussed and a similar principle for lockdown. The use of face masks in the general population is debated in relation to the UK public health advice that face masks are not needed in the general population. There is substantial evidence of ability of SARS-CoVid-2 to spread by aerosol which makes the UK Government’s public health advice and indeed that of the WHO, that social distancing and hand hygiene alone are required in the general population questionable. The question is not should the general public have mask protection but what degree of mask protection is needed? There is a shortage of suitable masks for health care workers in the UK but the need for this demand is driven by the large numbers of infected people in the community. Once the public health advice is adjusted polititians can start to try and solve the enormous logistical problem of protecting the public.

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Reported COVID-19 Incidence in Wisconsin High School Athletes During Fall 2020

10.1101/2021.02.18.21251986 ◽

2021 ◽

Author(s):

Phillip Sasser ◽

Timothy McGuine ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

...

Keyword(s):

High School ◽

General Population ◽

Negative Binomial ◽

Statistical Significance ◽

Negative Binomial Regression ◽

Face Mask ◽

Incidence Rates ◽

High School Athletes ◽

Outdoor Sports ◽

The Difference

ABSTRACTIntroductionThe purpose of this study was to describe the reported incidence of COVID-19 in Wisconsin high school athletes in September 2020, and to investigate the relationship of COVID-19 incidence with sport and face mask use.MethodsSurveys were sent to athletic directors of all Wisconsin high schools regarding sports during September 2020. The association between reported case rates in athletes in each county and the county general population were evaluated with a weighted linear model. Multivariable negative binomial regression models evaluated the associations between COVID-19 incidence and sport type and face mask use by players, adjusting for the county COVID-19 incidence for each school.Results207 schools that had reinitiated sport reported 270 COVID-19 cases among 30,074 players, for case and incidence rates of 809 cases per 100,000 players and 32.6 cases per 100,000 player-days, respectively. The case rates for athletes in each county were positively correlated with the case rates for the county’s general population (β =1.14±0.20, r=0.60, p<0.001). One hundred fifteen (55%) of cases were attributed to household contact, 85 (41%) to contact outside sport or school, 5 (2.4%) to school contact, and 1 (0.5%) to sport contact. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14), although the difference between outdoor and indoor sports approached statistical significance (IRR=0.52 [0.26-1.1], p=0.07). 84% of schools required face masks while playing. For those sports with >50 participating schools, there were no significant associations between COVID-19 incidence and face mask use in cross country (IRR=0.71 [0.2-2.2], p=0.52), football (IRR=1.6 [0.6-5.1], p=0.404), boys soccer (IRR=2.3 [0.5-17], p=0.31), or girls volleyball (IRR=1.4 [0.3-6.6], p=0.64).ConclusionsIncidence of reported COVID-19 among athletes was related to background county incidence and most cases were attributed to household and community contact. Although not statistically significant, reported COVID-19 incidence may be lower in outdoor sports. Face mask use did not have a significant benefit, which may be due to relatively low rates of COVID-19 and the small number of schools that did not report using face masks.

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PEDIATRIC SPORTS INJURY EPIDEMIOLOGY DURING COVID-19 PANDEMIC

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00113 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0011

Author(s):

Mitchell A. Johnson ◽

Nicolas Pascual-Leone ◽

Apurva S. Shah ◽

Joshua T. Bram ◽

Theodore J. Ganley

Keyword(s):

Public Health ◽

Time Window ◽

Pediatric Trauma ◽

Sports Injury ◽

Anterior Talofibular Ligament ◽

Ankle Sprains ◽

Public Health Response ◽

Home Setting ◽

Initial Care ◽

Significant Difference

Background: The COVID-19 pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. A change in the epidemiology of injuries commonly caused by sporting activities is expected. Hypothesis/Purpose: Examine the effect of public health measures on the incidence and characteristics of common pediatric sports injuries. Methods: This is a retrospective cohort study comparing sporting injuries presenting to a level I pediatric trauma hospital during the COVID-19 pandemic to sporting injuries during a pre-pandemic period at the same institution. Nine specific injury types were evaluated including ACL injury, meniscus injury, patellar dislocation, osteochondritis dissecans (OCD), shoulder dislocation, ankle sprain, clavicle fracture, medial epicondyle fracture, and tibial spine fracture. Patients were included if they presented for initial care between 3/15/20 and 4/15/20 for the “pandemic” group and the same time window in 2018 and 2019 for the “pre-pandemic” group. Results: 487 patients were included in our study with an average of 222.5 patients in 2018 and 2019 compared to 42 patients in 2020. The average patient age decreased during the pandemic compared to the pre-pandemic period (9.4 ± 6.0 vs 12.4 ± 4.2, p=0.007). Additionally, a decrease in the proportion of injuries attributed to sports (26.2% vs 47.6%, p=0.005) and those occurring at school/daycare (4.8% vs 10.3%, p<0.001) were observed. During the pandemic there was an increase in the proportion of injuries occurring at the patients home (50.0% vs 16.9%, p<0.001)(Table 1). The distribution was significantly different across the nine injury types included with a decrease in the proportion of ankle sprains (31.0% vs 59.8%, p<0.001) and an increase in the proportion of clavicle fractures (50.0% vs 16.2%, p<0.001)(Figure 1). For ankle sprains, there was no significant difference in the proportion of anterior talofibular ligament injuries to high ankle sprains (p=0.898). There was no delay in presentation in the “pandemic” group compared to the “pre-pandemic” group (6.6 ± 9.6 vs 5.4 ±9.9, p=0.424). Conclusion: At our institution, we observed an over fivefold reduction in presentation for common pediatric musculoskeletal injuries typically associated with sports. The dramatic drop off in injuries occurring across both sports and non-sports injury mechanisms raises concern for presentation of untreated injuries in the future. Additionally, the increased proportion of injuries occurring in the home setting creates an opportunity for emphasis to be placed on basic safety precautions, especially for young children. Tables/Figures: [Table: see text][Figure: see text]

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1724. Characteristics of the Ongoing Measles Outbreak in Greece in the Context of the Recent European-wide Epidemic and Public Health Measures

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.130 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S54-S54

Author(s):

Theano Georgakopoulou ◽

Elina Horefti ◽

Helena Maltezou ◽

Kassiani Gkolfinopoulou ◽

Alexandra Vernardaki ◽

...

Keyword(s):

Public Health ◽

Young Adults ◽

General Population ◽

Measles Virus ◽

Case Definition ◽

Molecular Testing ◽

Mmr Vaccine ◽

Public Health Response ◽

Roma Population ◽

Measles Outbreak

Abstract Background Measles is a highly contagious disease which still remains a cause of severe complications, including deaths worldwide, despite the existence of safe and effective vaccines. In the last 3 decades, the incidence of measles in Greece has constantly declined with only sporadic clusters or outbreaks (last outbreak in 2010–2011). We describe the characteristics of the ongoing measles outbreak and the Public Health response. Methods All measles cases are reported through the mandatory notification system (EU case definition 2012) to the Department of Surveillance and Intervention of the Hellenic Centre for Disease Control and Prevention. For laboratory confirmation patient sera were tested for IgM antibodies and pharyngeal swabs for the presence of measles virus RNA with RT-PCR. Sequencing of the measles nucleoprotein gene was applied in positively tested serological samples. Results From 9 May 2017 to 26 April 2018, 2,659 cases were reported in all 13 regions in Greece; 1,605 (60.4%) were laboratory confirmed. Most cases (n = 1,595; 60%) were Roma (73% children <10 years) followed by nonminority Greek nationals (n = 781; 29.4%, of whom 57% young adults 25–44 years), highlighting the immunity gap in Roma population. The vast majority of cases (80.5%) were unvaccinated. Ninety-four (3.5%) cases were healthcare workers (HCW); all were partially or not vaccinated. Genotype B3 was identified by molecular testing in all 88 cases tested. Severe complications were reported in 429 (16.1%) patients, most frequently pneumonia (43.8%) and hepatitis (21.2%). Three deaths were recorded in an 11-month-old immunocompromised Roma infant, a 17-year-old unvaccinated Roma, and a 35 year olds partially vaccinated individual from the general population. Extensive vaccination in refugee/migrant hosting sites prevented the emergence of a large number of cases. Mitigation efforts focused on closing the immunization gap in Roma population through emergency vaccination and raising awareness among HCWs to prevent further spread. Conclusion The current outbreak highlights the need to achieve high vaccination coverage with 2 doses of MMR vaccine in the general population (children, adolescents, and young adults) and in hard-to-reach vulnerable populations like Roma and refugees. Disclosures All authors: No reported disclosures.

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Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽

10.1024/0301-1526/a000656 ◽

2017 ◽

Vol 46 (6) ◽

pp. 484-489 ◽

Cited By ~ 7

Author(s):

Tom Barker ◽

Felicity Evison ◽

Ruth Benson ◽

Alok Tiwari

Keyword(s):

Venous Thromboembolism ◽

Varicose Vein ◽

Lower Incidence ◽

Varicose Veins ◽

Secondary Data ◽

Foam Sclerotherapy ◽

Increased Risk ◽

Significant Difference ◽

Chi Squared ◽

One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

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