Search

Having been experiencing years of political fragmentation and military conflict, Libya was poorly prepared to meet the challenges of the COVId-19 pandemic. Nevertheless, restriction of travel and social distancing rules were put in place days before the first case was detected. During the next two months, the number of cases grew gradually to 77 cases, followed by a rapid spread that has produced 3691 confirmed cases and 80 deaths by the end of July 2020. The turning point on 26 May 2020 was preceded three weeks earlier by the arrival of the first of a series of flights repatriating Libyans who became stranded abroad when air travel was suspended. In the first weeks of the surge, the number of cases was particularly high in the less densely populated southern region, raising questions about the implementation of social distancing and other protective measures in that region. The epidemic in Libya was modeled using the classical Susceptible-Exposed-Infected-Recovered (SEIR) mathematical model of infectious disease epidemics. Three scenarios were developed based on three estimates of the fraction of the population exposed to the disease (1.5, 2.5 and 3.5%). The modeling portrays the peak of the epidemic around early August and estimates that the number of deaths will flatten out around early November at between 250 and 600, depending on the parameter employed. More deaths than those estimated implies that it is more widespread than assumed. Greater promotion of awareness and understanding of social distancing practices and their value is needed, particularly in the south, and better protection of the elderly should decrease mortality.

IntroductionAcute clinical stroke trials are challenging to communicate to patients and families considering participation. Response adaptive randomization (RAR) is a technique that alters the proportion of trial subjects receiving active treatment, based on the outcomes of previous subjects. We aimed to determine how well interactive videos would improve understanding of a simulated acute stroke trial scenario that incorporated a design with RAR.MethodsWe performed a cross-sectional study of emergency department patients who were without stroke, altered mental status, or critical illness. Subjects viewed a hypothetical stroke and clinical trial scenario. They were randomized into one of four groups with either an RAR or fixed randomization clinical trial design and with either a standard consent video, or an interactive video.Results:We enrolled 720 participants. In the RAR group with interactive video, 128 out of 149 (85.9%) of the subjects were able to correctly identify the allocation method, compared to the 172 out of 285 (61.6%) in the RAR group with the uninterrupted video for an absolute increase of 25.6% (95% Cl 17-33%). The RAR group with interactive video had a higher odds of correct identification of allocation method (O.R. 2.767, 95% Cl [1.011 – 7.570] while controlling for age, sex, ethnicity, education, self-reported understanding of protocol, stroke awareness and agreement to participate in trial.Conclusions:The interactive video increased participant understanding of an RAR design in a simulated stroke scenario. Future research should focus on whether acute trial recruitment can be enhanced using similar techniques.