Impact of Human Mobility Trends on the Outbreak of COVID-19 Across Different States of India

The explosion of coronavirus has posed challenges to public health infrastructure in India. This pandemic can be contained with social distancing and isolation. The analysis of human mobility trends plays a decisive role in the spread of the pandemic. These movement patterns are extracted from Google COVID-19 Community Mobile Reports. These reports help to analyze the human mobility trends to various frequently visited places across different states of India. This work focuses on analyzing mobility trends in India and their effect on the spread of pandemic in terms of number of active cases and death rate. The mobility patterns, number of tests conducted, population density across different states in India are explored to understand their effect on the severity of epidemic. These features are correlated using statistical methods. This study lays the foundation in building a framework to contain the contributors for the spread of pandemics and provide insights to the regulatory bodies to strategize enforcing or revoking lockdown restrictions across regions in the country.

Hospitales sustentables: partidas críticas para su construcción y el rol de la inspección técnica

Currently, the public health infrastructure in Chile, at its different scales, has made important advances in determining sustainability design criteria. However, it is possible to see that, during its construction, there are no standardized verification processes on sustainability aspects, and that the work of technical inspection focuses on the administrative compliance of construction contracts, rather than on checking technical aspects. This research proposes a list of critical items and activities to supervise hospital construction, to guarantee sustainable criteria in their operation. A survey was also made to professionals involved in the design, construction, and supervision of hospital construction, ranking the results with a multi-criteria methodology (AHP), which showed a preference in the thermal envelope (20%) and thermal and ventilation installations (17%). Finally, based on the weaknesses stated by the professionals, a control and monitoring process of these items and activities is proposed, redesigning the work of the Worksite’ Technical Inspector.

Early signals of Omicron severity in sentinel UK hospitals

On 26th November 2021, a novel SARS-CoV-2 variant B.1.1.529 (Omicron variant) was designated as a variant of concern by the World Health Organisation. Using data from the Virology laboratory at the Manchester Medical Microbiology Partnership (MMMP, a partnership between UKHSA and the Manchester Foundation Trust), we have extracted a real-time feed of Omicron samples from hospitals across Greater Manchester, an area of the United Kingdom with a population size of approximately three million individuals. Omicron hospital samples are growing exponentially across Greater Manchester (doubling time 2.7 days (95% CI: 2.1, 3.7)). The proportion of Omicron in hospital samples follows a similar trajectory to the SGTF proportion in cases, but with a two-day offset. This is consistent with the delay from testing positive to hospital admission, implying a similar proportion of Omicron cases are converting to hospital admissions as for Delta cases. Comparing the Greater Manchester data to national hospitalisation data, similar tends are observed. Therefore, there is no signal of a substantial reduction in hospital admission risk with Omicron, and Omicron epidemics are likely to place a substantial burden on public health infrastructure.

Social Determinants of Health and 30-Day Readmissions Among Adults Hospitalized for Heart Failure in the REGARDS Study

Background: It is not known which social determinants of health (SDOH) impact 30-day readmission after a heart failure (HF) hospitalization among older adults. We examined the association of 9 individual SDOH with 30-day readmission after an HF hospitalization. Methods and Results: Using the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), we included Medicare beneficiaries who were discharged alive after an HF hospitalization between 2003 and 2014. We assessed 9 SDOH based on the Healthy People 2030 Framework: race, education, income, social isolation, social network, residential poverty, Health Professional Shortage Area, rural residence, and state public health infrastructure. The primary outcome was 30-day all-cause readmission. For each SDOH, we calculated incidence per 1000 person-years and multivariable-adjusted hazard ratios of readmission. Among 690 participants, the median age was 76 years at hospitalization (interquartile range, 71–82), 44.3% were women, 35.5% were Black, 23.5% had low educational attainment, 63.0% had low income, 21.0% had zip code–level poverty, 43.5% resided in Health Professional Shortage Areas, 39.3% lived in states with poor public health infrastructure, 13.1% were socially isolated, 13.3% had poor social networks, and 10.2% lived in rural areas. The 30-day readmission rate was 22.4%. In an unadjusted analysis, only Health Professional Shortage Area was significantly associated with 30-day readmission; in a fully adjusted analysis, none of the 9 SDOH were individually associated with 30-day readmission. Conclusions: In this modestly sized national cohort, although prevalent, none of the SDOH were associated with 30-day readmission after an HF hospitalization. Policies or interventions that only target individual SDOH to reduce readmissions after HF hospitalizations may not be sufficient to prevent readmission among older adults.

Health care experiences during the COVID-19 pandemic by race and social determinants of health among adults age ≥ 58 years in the REGARDS study

Background Understanding health care experiences during the COVID-19 pandemic may provide insights into patient needs and inform policy. The objective of this study was to describe health care experiences by race and social determinants of health. Methods We conducted a telephone survey (July 6, 2020-September 4, 2021) among 9492 Black and White participants in the longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, age 58–105 years, from the continental United States. Among participants with symptoms of COVID-19, outcomes were: 1. Sought care or advice for the illness; 2. Received a SARS-CoV-2 test for the illness; and 3. Tested positive. Among participants without symptoms of COVID-19, outcomes were: 1. Wanted a test; 2. Wanted and received a test; 3. Did not want but received a test; and 4. Tested positive. We examined these outcomes overall and in subgroups defined by race, household income, marital status, education, area-level poverty, rural residence, Medicaid expansion, public health infrastructure ranking, and residential segregation. Results The average age of participants was 76.8 years, 36% were Black, and 57% were female. Among participants with COVID-19 symptoms (n = 697), 74% sought care or advice for the illness, 50% received a SARS-CoV-2 test, and 25% had a positive test (50% of those tested). Among participants without potential COVID-19 symptoms (n = 8795), 29% wanted a SARS-CoV-2 test, 22% wanted and received a test, 8% did not want but received a test, and 1% tested positive; a greater percentage of participants who were Black compared to White wanted (38% vs 23%, p < 0.001) and received tests (30% vs 18%, p < 0.001) and tested positive (1.4% vs 0.8%, p = 0.005). Conclusions In this national study of older US adults, many participants with potential COVID-19 symptoms and asymptomatic participants who desired testing did not receive COVID-19 testing.

Politics, Power, and Money

This chapter investigates how politics and power shape health outcomes, with special emphasis on how these forces intersect with economic inequality and the disproportionate burden of sickness experienced by low-income populations. During the spread of COVID-19, American political leadership faced a test of its ability to respond to sudden crisis. Rising to such a difficult occasion requires detailed plans for what to do in such a scenario, robust public health infrastructure, and leadership which takes decisive, data-informed action, listening to experts and communicating clearly and consistently with the public. Tragically, COVID-19 found the United States lacking in all these areas. Political leaders are in a position to mold public opinion, nudging the public mind towards new ways of thinking. The precise term for this is “shifting the Overton window.” By helping to mainstream a cavalier attitude towards COVID-19, the Trump administration shifted the Overton window towards greater acceptance of behaviors which create poorer health. The chapter then looks at the failure to adequately address race in the US. Among the factors that shape health, the area of race is particularly sensitive to political dynamics.

Differences in Accessibility of Public Health Facilities in Hierarchical Municipalities and the Spatial Pattern Characteristics of Their Services in Doumen District, China

This study used the two-step floating catchment area method and potential model to calculate facility accessibility and potential service scope of public health infrastructure distribution, and to evaluate its spatial equity. We applied the Gini coefficient to measure the spatial equilibrium at each level of public health infrastructure in Doumen District, Guangdong, China, from different perspectives. The following results were obtained: (1) Significant spatial differences were observed in the accessibility of public health facilities among different levels; the higher the health facility level, the greater the difference in spatial accessibility. Spatial differences in the accessibility of public health infrastructure at the primary level and higher were distributed in a block-like pattern, while spatial differences in the accessibility of rural health stations were distributed in a circular pattern. Administrative villages tended to have the highest and lowest accessibility of tertiary and secondary hospitals, but not of primary hospitals and rural health stations. The frequencies for administrative villages with the highest and lowest accessibility were 32.8% and 49.6% of the total number of villages in the district, respectively, for tertiary hospitals; 39.2% and 48.8% for secondary hospitals; 19.2% and 24.8% for primary hospitals; 16.8% and 21.6% for rural health stations. (2) The potential service scope was spatially dissociative for tertiary hospitals, and differed more significantly in terms of space for secondary hospitals; the potential service scope of the two overlapped. The potential service scope of primary hospitals was relatively balanced, with strong spatial continuity, while that of rural health service centers was spatially fragmented. The service scope of rural health service centers was mostly consistent with their respective village-level administrative divisions. (3) The higher the level of public health infrastructure, the less balanced its spatial layout. Conversely, the lower the level of public health infrastructure, the more balanced its spatial layout.

Parallel Pandemics Illustrate the Need for One Health Solutions

African Swine Fever (ASF) was reported in domestic pigs in China in 2018. This highly contagious viral infection with no effective vaccine reached pandemic proportions by 2019, substantially impacting protein availability in the same region where the COVID-19 pandemic subsequently emerged. We discuss the genesis, spread, and wide-reaching impacts of this epidemic in a vital livestock species, noting parallels and potential contributions to ignition of COVID-19. We speculate about impacts of these pandemics on global public health infrastructure and suggest intervention strategies using a cost: benefit approach for low-risk, massive-impact events. We note that substantive changes in how the world reacts to potential threats will be required to overcome catastrophes driven by climate change, food insecurity, lack of surveillance infrastructure, and other gaps. A One Health approach creating collaborative processes connecting expertise in human, animal, and environmental health is essential for combating future global health crises.