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Made available in DSpace on 2022-04-28T19:49:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Several studies have reported the relationship of deforestation with increased incidence of infectious diseases, mainly due to the deregulation caused in these environments. The purpose of this study was to answer the following questions: a) is increased loss of vegetation related to dengue cases in the Brazilian Cerrado? b) how do different regions of the tropical savanna biome present distinct patterns for total dengue cases and vegetation loss? c) what is the projection of a future scenario of deforestation and an increased number of dengue cases in 2030? Thus, this study aimed to assess the relationship between loss of native vegetation in the Cerrado and dengue infection. In this paper, we quantify the entire deforested area and dengue infection cases from 2001 to 2019. For data analyses, we used Poisson generalized linear model, descriptive statistics, cluster analysis, non-parametric statistics, and autoregressive integrated moving average (ARIMA) models to predict loss of vegetation and fever dengue cases for the next decade. Cluster analysis revealed the formation of four clusters among the states. Our results showed significant increases in loss of native vegetation in all states, with the exception of Piauí. As for dengue cases, there were increases in the states of Minas Gerais, São Paulo, and Mato Grosso. Based on projections for 2030, Minas Gerais will register about 4,000 dengue cases per 100,000 inhabitants, São Paulo 750 dengue cases per 100,000 inhabitants, and Mato Grosso 500 dengue cases per 100,000 inhabitants. To reduce these projections, Brazil will need to control deforestation and implement public health, environmental and social policies, requiring a joint effort from all spheres of society. Graduate Program in Agronomy–Cropping Systems São Paulo State University (Unesp), SP Graduate Program in Geography São Paulo State University (Unesp) School of Technology and Sciences, SP Federal University of Mato Grosso do Sul (UFMS), Chapadão do Sul, MS Federal University of Acre (UFAC) Graduate Program in Agronomy State University of Londrina (Uel), PR Graduate Program in Sciences—Nuclear Energy in Agriculture Centro de Energia Nuclear na Agricultura São Paulo University São Paulo State University (Unesp) Engineering School, SP Graduate Program in Geography Federal University of Mato Grosso do Sul (UFMS), Três Lagoas, MS Graduate Program in Agronomy–Cropping Systems São Paulo State University (Unesp), SP Graduate Program in Geography São Paulo State University (Unesp) School of Technology and Sciences, SP São Paulo State University (Unesp) Engineering School, SP CNPq: 303767/2020-0

Objective The Spanish health system is made up of seventeen regional health systems. Through the official reporting systems, some inconsistencies and differences in case fatality rates between Autonomous Communities (CC.AA.) have been observed. Therefore the objective of this paper is to compare COVID-19 case fatality rates across the Spanish CC.AA. Material and methods Observational descriptive study. The COVID-19 case fatality rate (CFR) was estimated according to the official records (CFR-PCR+), the daily mortality monitory system (MoMo) record (CFR-Mo), and the seroprevalence study ENE-COVID-19 (Estudio Nacional de sero Epidemiologia Covid-19) according to sex, age group and CC.AA. between March and June 2020. The main objective is to detect whether there are any differences in CFR between Spanish Regions using two different register systems, i. e., the official register of the Ministry of Health and the MoMo. Results Overall, the CFR-Mo was higher than the CFR-PCR+, 1.59% vs 0.98%. The differences in case fatality rate between both methods were significantly higher in Castilla La Mancha, Castilla y León, Cataluña, and Madrid. The difference between both methods was higher in persons over 74 years of age (CFR-PCR+ 7.5% vs 13.0% for the CFR-Mo) but without statistical significance. There was no correlation of the estimated prevalence of infection with CFR-PCR+, but there was with CFR-Mo (R2 = 0.33). Andalucía presented a SCFR below 1 with both methods, and Asturias had a SCFR higher than 1. Cataluña and Castilla La Mancha presented a SCFR greater than 1 in any scenario of SARS-CoV-2 infection calculated with SCFR-Mo. Conclusions The PCR+ case fatality rate underestimates the case fatality rate of the SARS-CoV- 2 virus pandemic. It is therefore preferable to consider the MoMo case fatality rate. Significant differences have been observed in the information and registration systems and in the severity of the pandemic between the Spanish CC.AA. Although the infection prevalence correlates with case fatality rate, other factors such as age, comorbidities, and the policies adopted to address the pandemic can explain the differences observed between CC.AA.

Antimicrobial resistance (AMR) is a global public health crisis that is now impacted by the COVID-19 pandemic. Little is known how COVID-19 risks influence people to consume antibiotics, particularly in contexts like Bangladesh where these pharmaceuticals can be purchased without a prescription. This paper identifies the social drivers of antibiotics use among home-based patients who have tested positive with SARS-CoV-2 or have COVID-19-like symptoms. Using qualitative telephone interviews, the research was conducted in two Bangladesh cities with 40 participants who reported that they had tested positive for coronavirus (n = 20) or had COVID-19-like symptoms (n = 20). Our analysis identified five themes in antibiotic use narratives: antibiotics as ‘big’ medicine; managing anxiety; dealing with social repercussions of COVID-19 infection; lack of access to COVID-19 testing and healthcare services; and informal sources of treatment advice. Antibiotics were seen to solve physical and social aspects of COVID-19 infection, with urgent ramifications for AMR in Bangladesh and more general implications for global efforts to mitigate AMR.

The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to “prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it”. There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes.

British supermarket-panel data suggest no increases in overall sales and purchases of alcohol following COVID-19 lockdowns, yet survey and mortality data suggest otherwise. This paper attempts to unravel the paradox. Based on purchase data of 79,417 British households from Kantar Worldpanel, we undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 23rd March 2020, and variably applied during 2020, compared to purchases during 2015 to 2019 as controls. We also undertook Poisson regression analyses to estimate if changes in purchases differed by household socio-demographic and economic factors. Excess off-trade household alcohol purchases (expressed as grams of ethanol) following the introduction of confinement, were 29.2% higher (95% CI = 25.8% to 32.5%) for the post-confinement months of 2020, being larger until mid-July 2020 (37.5%, 95%CI = 33.9 to 41.26%) when pubs re-opened with restrictions, and smaller (24.6%, 95%CI = 21.6 to 27.7) thereafter. During the time of complete pub closures, and fully adjusting for no on-trade purchases, household purchases of alcohol did not change when compared with the same time period during 2015–2019 (coefficient = -0.9%, 95%CI = -5.6 to 3.8). Excess purchases from 23rd March to 31st December 2020 varied by region of Great Britain, being higher in the north of England, and lower in Scotland and Wales. Excess purchases were greater in the most deprived households, compared with the least deprived households. Excess purchases increased substantially as the amount of alcohol normally purchased by a household increased, with the top one fifth of households that normally bought the most alcohol increasing their purchases more than 17 times than the bottom one fifth of households that bought the least alcohol. That the heaviest buyers of alcohol increased their purchases the most, with some independent impact of socio-economic disadvantage, might explain why reported alcohol problems and recent alcohol-related death rates might have increased. A conclusion of this is that alcohol policy to reduce high consumption of alcohol, and the availability of help and treatment to reduce alcohol consumption become more important during extraordinary times, such as COVID lockdowns.

The global impact of coronavirus disease 2019 (COVID-19) is unprecedented, and many control and prevention measures have been implemented to test for and trace COVID-19. However, invisible-spreaders, who are associated with nucleic acid detection and asymptomatic infections, have received insufficient attention in the current COVID-19 control efforts. In this paper, we analyze the time series infection data for Italy, Germany, Brazil, India and Sweden since the first wave outbreak to address the following issues through a series of experiments. We conclude that: 1) As of June 1, 2020, the proportion of invisible-spreaders is close to 0.4% in Sweden, 0.8% in early Italy and Germany, and 0.4% in the middle and late stages. However, in Brazil and India, the proportion still shows a gradual upward trend; 2) During the spread of this pandemic, even a slight increase in the proportion of invisible-spreaders could have large implications for the health of the community; and 3) On resuming work, the pandemic intervention measures will be relaxed, and invisible-spreaders will cause a new round of outbreaks.

Introduction The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services. Methods We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics. Results Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19–146 discounted deaths per 10,000 clients. Discussion While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

The importance of implementing new methodologies to study the ever-increasing amount of Covid-19 data is apparent. The aftermath analysis of these data could inform us on how specific political decisions influenced the dynamics of the pandemic outbreak. In this paper we use the Italian outbreak as a case study, to study six different Covid indicators collected in twenty Italian regions. We define a new object, the Covidome, to investigate the network of functional Covid interactions between regions. We analyzed the Italian Covidome over the course of 2020, and found that Covid connectivity between regions follows a sharp North-South community gradient. Furthermore, we explored the Covidome dynamics and individuated differences in regional Covid connectivity between the first and second waves of the pandemic. These differences can be associated to the two different lockdown strategies adopted for the first and the second wave from the Italian government. Finally, we explored to what extent Covid connectivity was associated with the Italian geographical network, and found that Central regions were more tied to the structural constraints than Northern or Southern regions in the spread of the virus. We hope that this approach will be useful in gaining new insights on how political choices shaped Covid dynamics across nations.

Happiness levels often fluctuate from one day to the next, and an exogenous shock such as a pandemic can likely disrupt pre-existing happiness dynamics. This paper fits a Marko Switching Dynamic Regression Model (MSDR) to better understand the dynamic patterns of happiness levels before and during a pandemic. The estimated parameters from the MSDR model include each state’s mean and duration, volatility and transition probabilities. Once these parameters have been estimated, we use the one-step method to predict the unobserved states’ evolution over time. This gives us unique insights into the evolution of happiness. Furthermore, as maximising happiness is a policy priority, we determine the factors that can contribute to the probability of increasing happiness levels. We empirically test these models using New Zealand’s daily happiness data for May 2019 –November 2020. The results show that New Zealand seems to have two regimes, an unhappy and happy regime. In 2019 the happy regime dominated; thus, the probability of being unhappy in the next time period (day) occurred less frequently, whereas the opposite is true for 2020. The higher frequency of time periods with a probability of being unhappy in 2020 mostly correspond to pandemic events. Lastly, we find the factors positively and significantly related to the probability of being happy after lockdown to be jobseeker support payments and international travel. On the other hand, lack of mobility is significantly and negatively related to the probability of being happy.

In 2020, the ongoing COVID-19 pandemic caused major limitations for any aspect of social life and in specific for all events that require a gathering of people. While most events of this kind can be postponed or cancelled, democratic elections are key elements of any democratic regime and should be upheld if at all possible. Consequently, proper planning is required to establish the highest possible level of safety to both voters and scrutineers. In this paper, we present the novel and innovative way how the municipal council and district council elections in Vienna were planned and conducted using an discrete event simulation model. Key target of this process was to avoid queues in front of polling stations to reduce the risk of related infection clusters. In cooperation with a hygiene expert, we defined necessary precautions that should be met during the election in order to avoid the spread of COVID-19. In a next step, a simulation model was established and parametrized and validated using data from previous elections. Furthermore, the planned conditions were simulated to see whether excessive queues in front of any polling stations could form, as these could on the one hand act as an infection herd, and on the other hand, turn voters away. Our simulation identified some polling stations where long queues could emerge. However, splitting up these electoral branches resulted in a smooth election across all of Vienna. Looking back, the election did not lead to a significant increase of COVID-19 incidences. Therefore, it can be concluded that careful planning led to a safe election, despite the pandemic.Author summaryWhy was this study done?The ongoing COVID-19-Pandemic poses a risk for elections, as these could lead to another spread of the disease.Additional hygiene measures, which are inevitable if the election is conducted, could lead to long queues in front of the polling stations on election day.What did the researchers do and find?We describe the defined additional hygiene measures.We modeled the whole election process, including the new hygiene concept, to show where extensive queues could form on the election day.We show that thanks to the additional hygiene measures, the election actually did not cause a temporary upswing of the epidemic.What do these findings mean?Thanks to careful planning, it is possible to safely hold an election during such a pandemic.Our simulation contributed to a safe and smooth election.However, it should be stated, that these findings hold for elections in Austria, where long queues in front of polling stations are comparably rare and short.

Background Public health services and systems research is under-developed in Canada and this is particularly the case with respect to research on local public health unit operational functioning and capacity. The purpose of this paper is to report on a study that will collect retrospective information on the local public health response to COVID-19 throughout Canada between 2020 and 2021. Methods/Design The goal of the study is to develop and implement a study framework that will collect retrospective information on the local public health system response to the COVID-19 pandemic in Canada. This study will involve administering a mixed-method survey to Medical Health Officers/Medical Officers of Health in every local and regional public health unit across the country, followed by a process of coding and grouping these responses in a consistent and comparable way. Coded responses will be assessed for patterns of divergent or convergent roles and approaches of local public health across the country with respect to interventions in their response to COVID-19. The Framework Method of thematic analysis will be applied to assess the qualitative answers to the open-ended questions that speak to public health policy features. Discussion The strengths of the study protocol include the engagement of Medical Health Officers/Medical Officers of Health as research partners and a robust integrated knowledge translation approach to further public health services and systems research in Canada.