The Potential of Digital Symptom-based Screening to Reduce the Transmission of SARS-CoV-2: a Modelling Study (Preprint)

2021 ◽  
Author(s):  
Jan Multmeier ◽  
Maryam Montazeri ◽  
Nicola Vona ◽  
François Bergey ◽  
Alicia Mehl ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Healthcare Providers ◽  
Social Contact ◽  
Screening Tools ◽  
Sensitivity Analyses ◽  
Base Case ◽  
German Population ◽  
Adoption Rate ◽  
The Usa ◽  
The Uk

BACKGROUND Early efforts to control the COVID-19 pandemic have been focused on Non-Pharmaceutical Interventions (NPIs) in the absence of effective treatments or sufficient vaccine supply. While retrospective analyses and modeling studies confirmed that severe restrictions of social contacts, i.e., lockdowns, are most effective in reducing transmission of SARS-CoV-2, they incur large economic costs and mental health risks. Earlier detection of cases has also been proposed as an effective method of control, but studies have so far only considered enhanced laboratory testing. Digital applications have been developed which aim to identify possible cases of COVID-19 based on reported symptoms and risk factors. OBJECTIVE The aim of this study is to explore the effects of digital screening applications for COVID-19 on the transmission of SARS-CoV-2. METHODS Using an established epidemiological Susceptible-Exposed-Infectious-Recovered (SEIR) model for infectious disease transmission, we simulate the transmission of SARS-CoV-2 in Germany, the UK, and the USA for 366 days after the virus was introduced in the population. We study 4 scenarios: 1) no interventions (base case), 2) symptom-based self-isolation after consulting healthcare providers, 3) self-isolation using digital screening applications, and 4) severe social contact limitations (lockdown). We included sensitivity analyses for different ratios of infectiousness of pre-symptomatic cases compared to symptomatic cases, and different rates of adoption of digital screening tools. RESULTS Without any intervention, 74% of the German population would be infected with SARS-CoV-2 within the simulation period (UK: 76%, USA: 77%). Self-isolation of symptomatic cases would already slow the spread of the virus significantly and lead to only 18% of the German population being infected (UK: 17%, USA: 17%). Using a digital application could further reduce the infected population to 10% (UK: 9%, USA: 9%), compared to 3% under lockdown conditions. While the effectiveness of digital screening applications varies with the adoption rate, even a low adoption rate could significantly reduce transmission. In the case that pre-symptomatic cases are less infectious than symptomatic cases, the overall proportion of infected individuals in the population decreases, and the effectiveness of different interventions converges. CONCLUSIONS Digital symptom-based screening tools can substantially impact the transmission of SARS-CoV-2 and might be a viable element in strategies to control COVID-19 through NPIs.

The Potential of Digital Symptom-based Screening to Reduce the Transmission of SARS-CoV-2: a Modelling Study (Preprint)

2021 ◽  
Author(s):  
Jan Multmeier ◽  
Maryam Montazeri ◽  
Nicola Vona ◽  
François Bergey ◽  
Alicia Mehl ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Healthcare Providers ◽  
Social Contact ◽  
Screening Tools ◽  
Sensitivity Analyses ◽  
Base Case ◽  
German Population ◽  
Adoption Rate ◽  
The Usa ◽  
The Uk

BACKGROUND Early efforts to control the COVID-19 pandemic have been focused on Non-Pharmaceutical Interventions (NPIs) in the absence of effective treatments or sufficient vaccine supply. While retrospective analyses and modeling studies confirmed that severe restrictions of social contacts, i.e., lockdowns, are most effective in reducing transmission of SARS-CoV-2, they incur large economic costs and mental health risks. Earlier detection of cases has also been proposed as an effective method of control, but studies have so far only considered enhanced laboratory testing. Digital applications have been developed which aim to identify possible cases of COVID-19 based on reported symptoms and risk factors. OBJECTIVE The aim of this study is to explore the effects of digital screening applications for COVID-19 on the transmission of SARS-CoV-2. METHODS Using an established epidemiological Susceptible-Exposed-Infectious-Recovered (SEIR) model for infectious disease transmission, we simulate the transmission of SARS-CoV-2 in Germany, the UK, and the USA for 366 days after the virus was introduced in the population. We study 4 scenarios: 1) no interventions (base case), 2) symptom-based self-isolation after consulting healthcare providers, 3) self-isolation using digital screening applications, and 4) severe social contact limitations (lockdown). We included sensitivity analyses for different ratios of infectiousness of pre-symptomatic cases compared to symptomatic cases, and different rates of adoption of digital screening tools. RESULTS Without any intervention, 74% of the German population would be infected with SARS-CoV-2 within the simulation period (UK: 76%, USA: 77%). Self-isolation of symptomatic cases would already slow the spread of the virus significantly and lead to only 18% of the German population being infected (UK: 17%, USA: 17%). Using a digital application could further reduce the infected population to 10% (UK: 9%, USA: 9%), compared to 3% under lockdown conditions. While the effectiveness of digital screening applications varies with the adoption rate, even a low adoption rate could significantly reduce transmission. In the case that pre-symptomatic cases are less infectious than symptomatic cases, the overall proportion of infected individuals in the population decreases, and the effectiveness of different interventions converges. CONCLUSIONS Digital symptom-based screening tools can substantially impact the transmission of SARS-CoV-2 and might be a viable element in strategies to control COVID-19 through NPIs.

The cost of consent: why healthcare providers must be compliant with the Montgomery principles

2020 ◽  
Vol 102-B (5) ◽  
pp. 550-555
Author(s):  
Nick Birch ◽  
Nick V. Todd
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
International Comparisons ◽  
Point Of View ◽  
Public Healthcare ◽  
Health Board ◽  
Malpractice Claim ◽  
The Usa ◽  
The Uk ◽  
The Cost

The cost of clinical negligence in the UK has continued to rise despite no increase in claims numbers from 2016 to 2019. In the US, medical malpractice claim rates have fallen each year since 2001 and the payout rate has stabilized. In Germany, malpractice claim rates for spinal surgery fell yearly from 2012 to 2017, despite the number of spinal operations increasing. In Australia, public healthcare claim rates were largely static from 2008 to 2013, but private claims rose marginally. The cost of claims rose during the period. UK and Australian trends are therefore out of alignment with other international comparisons. Many of the claims in orthopaedics occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent. The UK and USA have similar rates (26% and 24% respectively), but in Germany the rate is 14% and in Australia only 2%. This paper considers the drivers for the increased cost of clinical negligence claims in the UK compared to the USA, Germany and Australia, from a spinal and orthopaedic point of view, with a focus on “failure to warn” and lack of compliance with the principles established in February 2015 in the Supreme Court in the case of Montgomery v Lanarkshire Health Board. The article provides a description of the prevailing medicolegal situation in the UK and also calculates, from publicly available data, the cost to the public purse of the failure to comply with the principles established. It shows that compliance with the Montgomery principles would have an immediate and lasting positive impact on the sums paid by NHS Resolution to settle negligence cases in a way that has already been established in the USA. Cite this article: Bone Joint J 2020;102-B(5):550–555.

scholarly journals Vaccinating Adolescents and Children Significantly Reduces COVID-19 Morbidity and Mortality across All Ages: A Popula-Tion-Based Modeling Study Using the UK as an Example

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1180
Author(s):  
Tinevimbo Shiri ◽  
Marc Evans ◽  
Carla A. Talarico ◽  
Angharad R. Morgan ◽  
Maaz Mussad ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Age Groups ◽  
Population Level ◽  
Vital Role ◽  
Morbidity And Mortality ◽  
Transmission Model ◽  
Base Case ◽  
Global Public Health ◽  
The Uk ◽  
The Impact

Debate persists around the risk–benefit balance of vaccinating adolescents and children against COVID-19. Central to this debate is quantifying the contribution of adolescents and children to the transmission of SARS-CoV-2, and the potential impact of vaccinating these age groups. In this study, we present a novel SEIR mathematical disease transmission model that quantifies the impact of different vaccination strategies on population-level SARS-CoV-2 infections and clinical outcomes. The model employs both age- and time-dependent social mixing patterns to capture the impact of changes in restrictions. The model was used to assess the impact of vaccinating adolescents and children on the natural history of the COVID-19 pandemic across all age groups, using the UK as an example. The base case model demonstrates significant increases in COVID-19 disease burden in the UK following a relaxation of restrictions, if vaccines are limited to those ≥18 years and vulnerable adolescents (≥12 years). Including adolescents and children in the vaccination program could reduce overall COVID-related mortality by 57%, and reduce cases of long COVID by 75%. This study demonstrates that vaccinating adolescents and children has the potential to play a vital role in reducing SARS-CoV-2 infections, and subsequent COVID-19 morbidity and mortality, across all ages. Our results have major global public health implications and provide valuable information to inform a potential pandemic exit strategy.

scholarly journals Modelling the Transmission Dynamics of COVID-19 in Six High-Burden Countries

2021 ◽  
Vol 2021 ◽  
pp. 1-17
Author(s):  
Azizur Rahman ◽  
Md Abdul Kuddus
Keyword(s):  
Older People ◽  
Disease Transmission ◽  
Transmission Rate ◽  
Control Strategies ◽  
Rank Correlation ◽  
Critical Parameters ◽  
High Burden ◽  
Susceptibility To Infection ◽  
The Usa ◽  
The Uk

The new Coronavirus Disease 19, officially known as COVID-19, originated in China in 2019 and has since spread worldwide. We presented an age-structured Susceptible-Latent-Mild-Critical-Removed (SLMCR) compartmental model of COVID-19 disease transmission with nonlinear incidence during the pandemic period. We provided the model calibration to estimate parameters with day-wise COVID-19 data, i.e., reported cases by worldometer from 15th February to 30th March 2020 in six high-burden countries, including Australia, Italy, Spain, the USA, the UK, and Canada. We estimate transmission rates for each country and found that the country with the highest transmission rate is Spain, which may increase the new cases and deaths than the other countries. We found that saturation infection negatively impacted the dynamics of COVID-19 cases in all the six high-burden countries. The study used a sensitivity analysis to identify the most critical parameters through the partial rank correlation coefficient method. We found that the transmission rate of COVID-19 had the most significant influence on prevalence. The prediction of new cases in COVID-19 until 30th April 2020 using the developed model was also provided with recommendations to control strategies of COVID-19. We also found that adults are more susceptible to infection than both children and older people in all six countries. However, in Italy, Spain, the UK, and Canada, older people show more susceptibility to infection than children, opposite to the case in Australia and the USA. The information generated from this study would be helpful to the decision-makers of various organisations across the world, including the Ministry of Health in Australia, Italy, Spain, the USA, the UK, and Canada, to control COVID-19.

Morphological and fecundity traits of Culex mosquitoes caught in gravid traps in urban and rural Berkshire, UK

2015 ◽  
Vol 105 (5) ◽  
pp. 615-620 ◽  
Author(s):  
S. Townroe ◽  
A. Callaghan
Keyword(s):  
Disease Transmission ◽  
Culex Pipiens ◽  
Good Condition ◽  
Seasonal Abundance ◽  
Rural Populations ◽  
Seasonal Activity ◽  
Behavioural Characteristics ◽  
The Usa ◽  
Risk Of Disease ◽  
The Uk

AbstractCulex pipiens s.l. is one of the primary vectors of West Nile Virus in the USA and Continental Europe. The seasonal abundance and eco-behavioural characteristics of the typical form, Cx. pipiens pipiens, make it a key putative vector in Britain. Surveillance of Culex larvae and adults is essential to detect any changes to spatial and seasonal activity or morphological traits that may increase the risk of disease transmission. Here we report the use of the modified Reiter gravid box trap, which is commonly used in the USA but scarcely used in the UK, to assess its suitability as a tool for British female Culex mosquito surveillance. Trapping was carried out at 110 sites in urban and rural gardens in Berkshire in May, July and September 2013. We tested if reproductively active adult female Culex are more abundant in urban than rural gardens and if wing characteristic traits and egg raft size are influenced by location and seasonal variations. Gravid traps were highly selective for Culex mosquitoes, on average catching significantly more per trap in urban gardens (32.4 ± 6.2) than rural gardens (19.3 ± 4.0) and more in July than in May or September. The majority of females were caught alive in a good condition. Wing lengths were measured as an indicator of size. Females flying in September were significantly smaller than females in May or July. Further non-significant differences in morphology and fecundity between urban and rural populations were found that should be explored further across the seasons.

scholarly journals Implications of a travel connectivity-based approach for infectious disease transmission risks in Oceania

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046206
Author(s):  
Angela Cadavid Restrepo ◽  
Luis Furuya-Kanamori ◽  
Helen Mayfield ◽  
Eric Nilles ◽  
Colleen L Lau
Keyword(s):  
Infectious Disease ◽  
Disease Transmission ◽  
Control Strategies ◽  
Vulnerability Index ◽  
French Polynesia ◽  
International Travel ◽  
Emerging Pathogens ◽  
The World ◽  
The Usa ◽  
The Uk

IntroductionThe increase in international travel brought about by globalisation has enabled the rapid spread of emerging pathogens with epidemic and pandemic potential. While travel connectivity-based assessments may help understand patterns of travel network-mediated epidemics, such approaches are rarely carried out in sufficient detail for Oceania where air travel is the dominant method of transportation between countries.DesignTravel data from the Australian Bureau of Statistics, Stats NZ and the United Nations World Tourism Organization websites were used to calculate travel volumes in 2018 within Oceania and between Oceania and the rest of the world. The Infectious Disease Vulnerability Index (IDVI) was incorporated into the analysis as an indicator of each country’s capacity to contain an outbreak. Travel networks were developed to assess the spread of infectious diseases (1) into and from Oceania, (2) within Oceania and (3) between each of the Pacific Island Countries and Territories (PICTs) and their most connected countries.ResultsOceania was highly connected to countries in Asia, Europe and North America. Australia, New Zealand and several PICTs were highly connected to the USA and the UK (least vulnerable countries for outbreaks based on the IDVI), and to China (intermediate low vulnerable country). High variability was also observed between the PICTs in the geographical distribution of their international connections. The PICTs with the highest number of international connections were Fiji, French Polynesia, Guam and Papua New Guinea.ConclusionTravel connectivity assessments may help to accurately stratify the risk of infectious disease importation and outbreaks in countries depending on disease transmission in other parts of the world. This information is essential to track future requirements for scaling up and targeting outbreak surveillance and control strategies in Oceania.

scholarly journals Comparative, cross-sectional study of the format, content and timing of medication safety letters issued in Canada, the USA and the UK

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020150 ◽  
Author(s):  
Lise M Bjerre ◽  
Simon Parlow ◽  
David de Launay ◽  
Matthew Hogel ◽  
Cody D Black ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Medication Safety ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Authorities ◽  
The Usa ◽  
The Subject ◽  
The Uk

ObjectivesTo assess consistency in the format and content, and overlap of subject and timing, of medication safety letters issued by regulatory health authorities to healthcare providers in Canada, the USA and the UK.DesignA cross-sectional study comparing medication safety letters issued for the purpose of alerting healthcare providers to newly identified medication problems associated with medications already on the market.SettingOnline databases operated by Health Canada, the US Food and Drug Administration and the UK Medicines and Healthcare products Regulatory Agency were searched to select medication safety letters issued between 1 January 2010 and 31 December 2014. Format, content and timing of each medication safety letter were assessed using an abstraction tool comprising 21 characteristics deemed relevant by consensus of the research team.Main outcome measuresMain outcome measures included, first, characteristics (format and content) of medication safety letters and second, overlap of subject and release date across countries.ResultsOf 330 medication safety letters identified, 227 dealt with unique issues relating to medications available in all three countries. Of these 227 letters, 21 (9%) medication problems were the subject of letters released in all three countries; 40 (18%) in two countries and 166 (73%) in only one country. Only 13 (62%) of the 21 letters issued in all three countries were released within 6 months of each other.ConclusionsSignificant discrepancies in both the subject and timing of medication safety letters issued by health authorities in three countries (Canada, the USA and the UK) where medical practice is otherwise comparable, raising questions about why, how and when medication problems are identified and communicated to healthcare providers by the authorities. More rapid communication of medication problems and better alignment between authorities could enhance patient safety.

scholarly journals Public health impact model estimating the impact of introducing an adjuvanted recombinant zoster vaccine into the UK universal mass vaccination programme

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025553
Author(s):  
Desirée A M van Oorschot ◽  
Manjit Hunjan ◽  
Benjamin Bracke ◽  
Stéphane Lorenc ◽  
Desmond Curran ◽  
...  
Keyword(s):  
Public Health ◽  
Health Impact ◽  
Sensitivity Analyses ◽  
Public Health Impact ◽  
Base Case ◽  
Complication Rates ◽  
Zoster Vaccine ◽  
Recombinant Zoster Vaccine ◽  
The Uk ◽  
The Impact

ObjectivesIn 2013, the herpes zoster (HZ) immunisation programme was introduced in the UK, recommending vaccination of adults 70 years of age (YOA) with the zoster vaccine live (ZVL), the only vaccine available at the time. The recently approved adjuvanted recombinant zoster vaccine (RZV) has a substantially different clinical profile that may offer additional benefits.This study aimed to 1) assess the public health impact (PHI) of introducing RZV in the UK compared with the current vaccination strategy and 2) explore via scenario analyses the optimal age group of vaccination in terms of PHI.DesignA previously developed health economic model was adapted to the UK setting.SettingCalculations were based on efficacy data from pivotal clinical trials, HZ incidence and postherpetic neuralgia (PHN) probability from a UK study and HZ-associated complication rates from published literature.PopulationThe base-case population considered a 2018-projected UK vaccination cohort of individuals 70 YOA.InterventionsVaccination with ZVL or RZV, assuming a first-dose coverage of 48.3% for both vaccines and 70% compliance for the second dose of RZV.Outcome measuresOutcomes included reduction of HZ and PHN cases, complications and the use of healthcare resources over a life-time horizon. The impact of coverage and second-dose compliance was also explored.ResultsCompared with no vaccination, RZV would lead to a reduction of 30 262 HZ and 5409 PHN cases while ZVL would lead to a reduction of 7909 HZ and 3567 PHN cases. The number needed to vaccinate to prevent 1 HZ case is 12 with RZV and 45 with ZVL. The highest PHI with RZV could be achieved in individuals 60 or 65 YOA.ConclusionUnder the model assumptions, RZV is predicted to avert more HZ and PHN cases compared with ZVL. Results were robust under different scenario and sensitivity analyses.

scholarly journals The differential impact of physical distancing strategies on social contacts relevant for the spread of COVID-19: Evidence from a multi-country survey

2020 ◽  
Author(s):  
Emanuele Del Fava ◽  
Jorge Cimentada ◽  
Daniela Perrotta ◽  
André Grow ◽  
Francesco Rampazzo ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Age Groups ◽  
Social Contact ◽  
The United States ◽  
Social Contacts ◽  
Contact Patterns ◽  
The Uk ◽  
Facebook Advertising ◽  
Net Reproduction ◽  
The Impact

AbstractPhysical distancing measures are intended to mitigate the spread of COVID-19, even though their impact on social contacts and disease transmission remains unclear. Obtaining timely data on social contact patterns can help to assess the impact of such protective measures. We conducted an online opt-in survey based on targeted Facebook advertising campaigns across seven European countries (Belgium, France, Germany, Italy, Netherlands, Spain, United Kingdom (UK)) and the United States (US), achieving a sample of 53,708 questionnaires in the period March 13–April 13, 2020. Post-stratification weights were produced to correct for biases. Data on social contact numbers, as well as on protective behaviour and perceived level of threat were collected and used to the expected net reproduction number by week, Rt, with respect to pre-pandemic data. Compared to social contacts reported prior to COVID-19, in mid-April daily social contact numbers had decreased between 49% in Germany and 83% in Italy, ranging from below three contacts per day in France, Spain, and the UK up to four in Germany and the Netherlands. Such reductions were sufficient to bring Rt to one or even below in all countries, except Germany. Evidence from the US and the UK showed that the number of daily social contacts mainly decreased after governments issued the first physical distancing guidelines. Finally, although contact numbers decreased uniformly across age groups, older adults reported the lowest numbers of contacts, indicating higher levels of protection. We provided a comparable set of statistics on social contact patterns during the COVID-19 pandemic for eight high-income countries, disaggregated by week. As these estimates offer a more grounded alternative to the theoretical assumptions often used in epidemiological models, the scientific community could draw on this information for developing more realistic epidemic models of COVID-19.

An early mainstream economist from Hungary: István Varga (1897–1962)

2003 ◽  
Vol 53 (2) ◽  
pp. 195-213 ◽  
Author(s):  
K. Majoros
Keyword(s):  
Austrian Economic ◽  
National Income ◽  
Anglo Saxon ◽  
Turbulent Times ◽  
The Usa ◽  
New Ideas ◽  
Modern Economic ◽  
The Uk ◽  
Economic Thinking ◽  
Lasting Influence

The study introduces a Hungarian economic thinker, István Varga*, whose valuable activity has remained unexplored up to now. He became an economic thinker during the 1920s, in a country that had not long before become independent of Austria. The role played by Austria in the modern economic thinking of that time was a form of competition with the thought adhered to by the UK and the USA. Hungarian economists mainly interpreted and commented on German and Austrian theories, reasons for this being that, for example, the majority of Hungarian economists had studied at German and Austrian universities, while at Hungarian universities principally German and Austrian economic theories were taught. István Varga was familiar not only with contemporary German economics but with the new ideas of Anglo-Saxon economics as well — and he introduced these ideas into Hungarian economic thinking. He lived and worked in turbulent times, and historians have only been able to appreciate his activity in a limited manner. The work of this excellent economist has all but been forgotten, although he was of international stature. After a brief summary of Varga’s profile the study will demonstrate the lasting influence he has had in four areas — namely, business cycle research and national income estimations, the 1946 Hungarian stabilisation program, corporate profit, and consumption economics — and will go on to summarise his most important achievements.

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