How to Anticipate Public Health Indicators Using Wastewater SARS-CoV-2 Concentration During the COVID-19 Pandemic. Madrid Region Case Study

This study analyzes the presence and dynamics of SARS-CoV-2 in sewage sanitation systems in the Madrid region. The statistical results and data generated are presented daily via a platform as a tool for the early detection of SARS-CoV-2 and its spread based on the WBE (wastewater-based epidemiological) approach. The number of sampled points amounts to a total of 289 sampling points in terms of SARS-CoV-2 concentration that collects over six million and a half inhabitants’ discharges. The project was developed by Canal de Isabel II, the water utility company from Madrid. The research evaluates the correlation found between SARS-CoV-2 concentration in wastewater and the following public health indicators: incidence rate, reported active cases and COVID-19 hospitalization data (regular hospitalization and ICU admission cases).SARS-CoV-2 presence and dynamics in wastewater show a strong connection with both 14-day incidence rates with active infection and reported COVID-19 hospitalizations. A lag varying from 3 to 8 days between wastewater presence and hospitalizations is explained because the infection is found in the feces of patients before symptom onset. The resulting data are available for consultancy on the company’s website (named VIGÍA project) as well as on the regional government’s websites.The results have already been useful to anticipate the second and third COVID-19 waves in Madrid. Information is shared daily with health authorities for consultancy and decision-making. The results are available as an aggregation for the entire region and for each sewershed.

Wild Type and Variants of Sars-Cov-2 in Parisian Sewage: Dynamics in Raw Water and Fate in Wastewater Treatment Plants

The presence of SARS-CoV-2 RNA has been extensively reported at the influent of wastewater treatment plants (WWTPs) worldwide and its monitoring has been proposed as a potential surveillance tool to early alert of epidemic outbreaks. However, the fate of the SARS-CoV-2 RNA in the treatment process of WWTP has not been widely studied yet; therefore in this study, we aimed to evaluate the efficiency of treatment processes in reducing SARS-CoV-2 RNA levels in wastewater. The treatment process of three WWTPs of the Parisian area in France were monitored on six different weeks over a period of two months (from April 14th to June 9th 2021). SARS-CoV-2 RNA copies were detected using digital polymerase chain reaction (dPCR). Investigation on the presence of variants of concern (Del69-70E484 and L452R) was also performed. Additionally, SARS-CoV-2 RNA loads in the WWTPs influents were expressed as the viral charge per population equivalent and showed a good correlation with French public health indicators (incidence rate). SARS-CoV-2 RNA loads were notably reduced along the water treatment lines of the three WWTPs studied (2.5-3.4 log). Finally, very low SARS-CoV-2 RNA loads were detected in effluents (non-detected in over half of the samples) which indicated that the potential health risk of the release of wastewater effluents to the environment is probably insignificant, in the case of WWTPs enabling an efficient biological removal of nitrogen.

Despite wellbeing concerns, US adults are happier

Significance Biles provided a high-profile but not uncommon example of the deterioration of individual wellbeing in the United States. Many public health indicators were pointing in that direction before COVID-19, yet US adults paradoxically reported themselves happier in 2020 than before the pandemic. Impacts The spotlight thrown by the pandemic on mental health issues may not translate into further research and better services. Young people report lower levels of wellbeing than other age groups but are more optimistic about labour market opportunities. Job losses due to automation and digitisation pose a significant long-term risk to wellbeing without pre-emptive interventions.

Emergency teleradiological activity is an epidemiological estimator and predictor of the covid-19 pandemic in mainland France

Background COVID-19 pandemic highlighted the need for real-time monitoring of diseases evolution to rapidly adapt restrictive measures. This prospective multicentric study aimed at investigating radiological markers of COVID-19-related emergency activity as global estimators of pandemic evolution in France. We incorporated two sources of data from March to November 2020: an open-source epidemiological dataset, collecting daily hospitalisations, intensive care unit admissions, hospital deaths and discharges, and a teleradiology dataset corresponding to the weekly number of CT-scans performed in 65 emergency centres and interpreted remotely. CT-scans specifically requested for COVID-19 suspicion were monitored. Teleradiological and epidemiological time series were aligned. Their relationships were estimated through a cross-correlation function, and their extremes and breakpoints were compared. Dynamic linear models were trained to forecast the weekly hospitalisations based on teleradiological activity predictors. Results A total of 100,018 CT-scans were included over 36 weeks, and 19,133 (19%) performed within the COVID-19 workflow. Concomitantly, 227,677 hospitalisations were reported. Teleradiological and epidemiological time series were almost perfectly superimposed (cross-correlation coefficients at lag 0: 0.90–0.92). Maximal number of COVID-19 CT-scans was reached the week of 2020-03-23 (1 086 CT-scans), 1 week before the highest hospitalisations (23,542 patients). The best valid forecasting model combined the number of COVID-19 CT-scans and the number of hospitalisations during the prior two weeks and provided the lowest mean absolute percentage (5.09%, testing period: 2020-11-02 to 2020-11-29). Conclusion Monitoring COVID-19 CT-scan activity in emergencies accurately and instantly predicts hospitalisations and helps adjust medical resources, paving the way for complementary public health indicators.

A warning about measurement and methodological issues associated with coronavirus tracking and evaluation across jurisdictions

As people around the world experience a devastating pandemic, it is critical that policy-makers consider the methodological and measurement issues that might be associated with coronavirus disease 2019 (COVID-19) public health indicators. This commentary uses four primary variables to illustrate measurement and methodological issues that can complicate comparisons between jurisdictions. Jurisdiction refers to a variety of geographic areas, such as a country, a state, or a province/territory. These variables play a critical role in determining how we understand the trajectory of disease spread. These variables also contribute to our understanding of prevention strategies and their associated efficacy, reflecting the impact of COVID-19 on hospitals. It is critical for public health stakeholders and the public to recognize that these four simple variables can vary substantially across jurisdictions.

A multi-level qualitative analysis of sensitive-intervention stunting program: from regulation to action

Objectives : The multisectoral problem of stunting with sensitive interventions is still a public health problem. This problem is due to complex factors that affect stunting programs across sectors to accelerate the stunting program for non-nutrition programs. This study aims to identify challenges in implementing sensitive interventions on stunting from regulation to implementation of activities. Methods : A qualitative multilevel approach was used for this research by conducting in-depth interviews, observation, and document review on the supply and demand aspects of the stunting-sensitive intervention program. The District of Health as the first level in the regulator, the Public health center as the implementer of the activity, and the community as the target of the activity were interviewed about the impact of regional regulatory innovations on stunting prevalence. Results This study explains that the families of stunting infants are not familiar with sensitive intervention activities and are still focused on specific packages. Coordination and collaboration, both intern level and between levels, have not been maximally implemented. The development of innovations in regional regulations has no impact on public health indicators both before and after the design is implemented. Conclusion for practices This research concludes that deploying cadres, transforming regulation inovation to social inovation and program managers trainning are crucial to accelerate sensitive intervention program.

Socio-Environmental Vulnerability Index: An Application to Rio de Janeiro-Brazil

Objectives: The concept of vulnerability has been used more frequently in several studies, in an attempt to better understand the specificities and needs of different population groups, both in environmental and socio-economical terms. The aim of this study is to identify, characterize and analyze populations in situations of socio-environmental vulnerability in the city of Rio de Janeiro, based on social, economic, environmental and public health indicators organized into a summary index – the Socio-Environmental Vulnerability Index.Methods: The methodology integrated 15 indicators in a Multi-Criteria Decision Analysis into a Geographic Information System.Results: According to our results, socio-environmental vulnerability in Rio de Janeiro is aggravated by at-risk situations and environmental degradation. These aspects are jeopardized by the population density in slum areas, where the most disadvantaged groups live in a process of environmental and urban exclusion.Conclusion: The study concludes about the importance of these tools in guiding resource allocation and their contribution to formulating and implementing more effective public policies.

Food and Nutrition Security Theory

Background: Food and nutrition insecurity continue to affect societies in both developed and developing countries even in years of bounty harvest. This confirms that availability of food does not automatically translate to food and nutrition security (FNS). Even when food is available it may not be accessible to everyone who needs it, and sometimes available and accessible food may not provide all the nutrients required to nourish the body to develop, grow, resist diseases, and meet ordinary physiological demands. Sometimes, food is plenty and accessible but not acceptable or sustainable. All such instances constitute potential food and (especially) nutrition insecurity. Objective: We intend to establish a theoretical framework for investigating food and nutrition security. Method: This is a theoretical paper drawing on previous publications within the scope of food security and nutrition security. Results: The review found that it is imperative to consider carefully the definition of FNS to ensure the two concepts (food security and nutrition security) are adequately and sufficiently addressed in the implementation of food policies and strategies without sacrificing one concept over the other. This balance can be achieved through a thorough needs assessment analysis following the livelihood and the vulnerability approaches to FNS. The analysis should take into account the four conceptual dimensions to FNS to holistically cover every aspect of FNS. Conclusions: The information gathered from the analysis will help prioritize and focus food and nutrition support efforts to the people who really need it, yielding impact measured in public health indicators, education, productivity and the broader national/regional economy.

What is the health-related burden of EU-Candidate Countries? A snapshot of public health indicators

Background Various studies have shown the ebb of the political spectrum when determining entry into the European Union. The objective of this study was to determine the key differences between the European Union (EU) and the current EU-candidate countries through the lens of the financial burden of the public healthcare system. Methods The most complete and available EUROSTAT data describing health-related burden (13 indicators) for current EU- candidate countries (Serbia, Turkey, the Republic of North Macedonia and Montenegro) were evaluated and compared. Results Total health expenditures (Purchasing Parity Power) per capita in EU candidate countries is almost one-third of that in the EU. General government health expenditure for all four countries was below the EU average with Montenegro spending the highest and North Macedonia spending the least. Turkey, with a significantly higher gross domestic product (GDP), allocated the smallest percentage of its GDP on health (4.31%), while Serbia the highest percentage (8.55%), both being below the EU average (10%). The private health expenditure for all of the countries was higher than the EU average, with Serbia's proportion being double that of the EU average. Assessing the burden of disease for these countries, Serbia has the highest disability-adjusted life years (DALY) rate per 100,000 (25,468.38), while the average DALY rate of the other three countries was 23,656.33 and the EU average was 16,390. Turkey and North Macedonia tying for the highest infant mortality rate, three times the EU average. Of the candidate countries, Serbia contains the highest density of physicians and nurses and Turkey, the lowest. Conclusions The process of entry to the EU is a varied experience for each country since attaining benchmark standards affects the time needed to achieve them. This study on a selected number of public health indicators contributes to the evidence on the current health-related burden of EU-candidate countries. Key messages All EU candidate countries have a much higher burden of disease and a much lower health workforce and health expenditure than the EU average. The challenge for countries in the accession process is to reach a level of quality and achievement in health care in the EU.