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10. Results from the International Halocarbons in Air Comparison Experiment (IHALACE)

Author

Hall, B. D, Engel, A., Mühle, J., Elkins, J. W, Artuso, F., Atlas, E., Aydin, M., Blake, D., Brunke, E.-G., Chiavarini, S., Fraser, P. J, Happell, J., Krummel, P. B, Levin, I., Loewenstein, M., Maione, M., Montzka, S. A, O'Doherty, S., Reimann, S., Rhoderick, G., Saltzman, E. S, Scheel, H. E, Steele, L. P, Vollmer, M. K, Weiss, R. F, Worthy, D., and Yokouchi, Y.

Subjects
international comparison, climate change, halocarbons, atmospheric measurements
Abstract

The International Halocarbons in Air Comparison Experiment (IHALACE) was conducted to document relationships between calibration scales among various laboratories that measure atmospheric greenhouse and ozone depleting gases. Six stainless steel cylinders containing natural and modified natural air samples were circulated among 19 laboratories. Results from this experiment reveal relatively good agreement among commonly used calibration scales for a number of trace gases present in the unpolluted atmosphere at pmol mol−1 (parts per trillion) levels, such as chlorofluorocarbons (CFCs), hydrochlorofluorocarbons (HCFCs), and hydrofluorocarbons (HFCs). Some scale relationships were found to be consistent with those derived from bi-lateral experiments or from analysis of atmospheric data, while others revealed discrepancies. The transfer of calibration scales among laboratories was found to be problematic in many cases, meaning that measurements tied to a common scale may not, in fact, be compatible. These results reveal substantial improvements in calibration over previous comparisons. However there is room for improvement in communication and coordination of calibration activities with respect to the measurement of halogenated and related trace gases.

Published
2013

12. Time resolved insights into abnormal grain growth by in situ synchrotron measurements

Author

Universitat Politècnica de Catalunya. Departament de Ciència i Enginyeria de Materials, Universitat Politècnica de Catalunya. CIEFMA-PROCOMAME - Disseny Microestructural i Fabricació Avançada de Materials, Vollmer, M, Degener, S, Bolender, A, Bauer, A, Liehr, A, Stark, Andreas, Schell, Norbert, Barriobero Vila, Pere, Requena, Guillermo, Niendorf, T, Universitat Politècnica de Catalunya. Departament de Ciència i Enginyeria de Materials, Universitat Politècnica de Catalunya. CIEFMA-PROCOMAME - Disseny Microestructural i Fabricació Avançada de Materials, Vollmer, M, Degener, S, Bolender, A, Bauer, A, Liehr, A, Stark, Andreas, Schell, Norbert, Barriobero Vila, Pere, Requena, Guillermo, and Niendorf, T

Abstract

Large oligo-crystalline or single-crystalline metallic materials are of great interest for numerous applications, and a recently developed strategy for promoting abnormal grain growth induced by a cyclic heat treatment opens up new opportunities to manufacture single crystals with a size of several centimeters. So far, the entire available knowledge on this kind of abnormal grain growth has been elaborated based on time discrete observations and, thus, detailed insights into the interplay of elementary mechanisms are still lacking in open literature. The present study reveals time resolved insights into this kind of abnormal grain growth for the first time. It was possible to break down the influence of the individual heat treatment phases by in situ synchrotron high energy X-ray diffraction analysis during cyclic heat treatment. The results obtained not only help to gain a deep understanding of the abnormal grain growth mechanisms, they will also be the basis for an adjustment of the cyclic heat treatment process to improve its efficiency and to eventually obtain even larger single crystals., Peer Reviewed, Postprint (author's final draft)

Published
2023

20. Growing Atmospheric Emissions of Sulfuryl Fluoride

Author

Massachusetts Institute of Technology. Center for Global Change Science, Gressent, A., Rigby, M., Ganesan, A. L., Prinn, R. G., Manning, A. J., Mühle, J., Salameh, P. K., Krummel, P. B., Fraser, P. J., Steele, L. P., Mitrevski, B., Weiss, R. F., Harth, C. M., Wang, R. H., O'Doherty, S., Young, D., Park, S., Li, S., Yao, B., Reimann, S., Vollmer, M. K., Maione, M., Arduini, J., Lunder, C. R., Massachusetts Institute of Technology. Center for Global Change Science, Gressent, A., Rigby, M., Ganesan, A. L., Prinn, R. G., Manning, A. J., Mühle, J., Salameh, P. K., Krummel, P. B., Fraser, P. J., Steele, L. P., Mitrevski, B., Weiss, R. F., Harth, C. M., Wang, R. H., O'Doherty, S., Young, D., Park, S., Li, S., Yao, B., Reimann, S., Vollmer, M. K., Maione, M., Arduini, J., and Lunder, C. R.

Published
2022

23. Report 44: Recent trends in SARS-CoV-2 variants of concern in England

Author

Mishra, S, Mindermann, S, Sharma, M, Whittaker, C, Mellan, T, Wilton, T, Klapsa, D, Mate, R, Fritzsche, M, Zambon, M, Ahuja, J, Howes, A, Miscouridou, X, Nason, G, Ratmann, O, Leech, G, Fabienne Sandkühler, J, Rogers-Smith, C, Vollmer, M, Unwin, H, Gal, Y, Chand, M, Gandy, A, Martin, J, Volz, E, Ferguson, N, Bhatt, S, Brauner, J, Flaxman, S, and Medical Research Council (MRC)

Subjects
coronavirus, COVID-19
Abstract

Since its emergence in Autumn 2020, the SARS-CoV-2 Variant of Concern (VOC) B.1.1.7 rapidly became the dominant lineage across much of Europe. Simultaneously, several other VOCs were identified globally. Unlike B.1.1.7, some of these VOCs possess mutations thought to confer partial immune escape. Understanding when, whether, and how these additional VOCs pose a threat in settings where B.1.1.7 is currently dominant is vital. This is particularly true for England, which has high coverage from vaccines that are likely more protective against B.1.1.7 than some other VOCs. We examine trends in B.1.1.7’s prevalence in London and other English regions using passive-case detection PCR data, cross-sectional community infection surveys, genomic surveillance, and wastewater monitoring. Our results suggest shifts in the composition of SARS-CoV-2 lineages driving transmission in England between March and April 2021. Local transmission of non-B.1.1.7 VOCs may be increasing; this warrants urgent further investigation.

Published
2021

25. ESICM LIVES 2016: part one: Milan, Italy. 1-5 October 2016

Author

Bos, L., Schouten, L., van Vught, L., Wiewel, M., Ong, D., Cremer, O., Artigas, A., Martin-Loeches, I., Hoogendijk, A., van der Poll, T., Horn, J., Juffermans, N., Schultz, M., de Prost, N., Pham, T., Carteaux, G., Dessap, A. Mekontso, Brun-Buisson, C., Fan, E., Bellani, G., Laffey, J., Mercat, A., Brochard, L., Maitre, B., Howells, P. A., Thickett, D. R., Knox, C., Park, D. P., Gao, F., Tucker, O., Whitehouse, T., McAuley, D. F., Perkins, G. D., Pham, T., Laffey, J., Bellani, G., Fan, E., Pisani, L., Roozeman, J. P., Simonis, F. D., Giangregorio, A., Schouten, L. R., Van der Hoeven, S. M., Horn, J., Neto, A. Serpa, Festic, E., Dondorp, A. M., Grasso, S., Bos, L. D., Schultz, M. J., Koster-Brouwer, M., Verboom, D., Scicluna, B., van de Groep, K., Frencken, J., Schultz, M., van der Poll, T., Bonten, M., Cremer, O., Ko, J. I., Kim, K. S., Suh, G. J., Kwon, W. Y., Kim, K., Shin, J. H., Ranzani, O. T., Prina, E., Menendez, R., Ceccato, A., Mendez, R., Cilloniz, C., Gabarrus, A., Ferrer, M., Torres, A., Urbano, A., Zhang, L. A., Swigon, D., Pike, F., Parker, R. S., Clermont, G., Scheer, C., Kuhn, S. O., Modler, A., Vollmer, M., Fuchs, C., Hahnenkamp, K., Rehberg, S., Gründling, M., Taggu, A., Darang, N., Öveges, N., László, I., Tánczos, K., Németh, M., Lebák, G., Tudor, B., Érces, D., Kaszaki, J., Huber, W., Trásy, D., Molnár, Z., Ferrara, G., Edul, V. S. Kanoore, Canales, H. S., Martins, E., Canullán, C., Murias, G., Pozo, M. O., Eguillor, J. F. Caminos, Buscetti, M. G., Ince, C., Dubin, A., Aya, H. D., Rhodes, A., Fletcher, N., Grounds, R. M., Cecconi, M., Jacquet-Lagrèze, M., Riche, M., Schweizer, R., Portran, P., Fornier, W., Lilot, M., Neidecker, J., Fellahi, J. L., Escoresca-Ortega, A., Gutiérrez-Pizarraya, A., Charris-Castro, L., Corcia-Palomo, Y., Fernandez-Delgado, E., Garnacho-Montero, J., Roger, C., Muller, L., Elotmani, L., Lipman, J., Lefrant, J. Y., Roberts, J. A., Muñoz-Bermúdez, R., Samper, M., Climent, C., Vasco, F., Sara, V., Luque, S., Campillo, N., Cerrato, S. Grau, Masclans, J. R., Alvarez-Lerma, F., Brugger, S. Carvalho, Jimenez, G. Jimenez, Torner, M. Miralbés, Cabello, J. Trujillano, Garrido, B. Balsera, Casals, X. Nuvials, Gaite, F. Barcenilla, Vidal, M. Vallverdú, Martínez, M. Palomar, Gusarov, V., Shilkin, D., Dementienko, M., Nesterova, E., Lashenkova, N., Kuzovlev, A., Zamyatin, M., Demoule, A., Carreira, S., Lavault, S., Palancca, O., Morawiec, E., Mayaux, J., Arnulf, I., Similowski, T., Rasmussen, B. S., Maltesen, R. G., Hanifa, M., Pedersen, S., Kristensen, S. R., Wimmer, R., Panigada, M., Bassi, G. Li, Ranzani, O. T., Kolobow, T., Zanella, A., Cressoni, M., Berra, L., Parrini, V., Kandil, H., Salati, G., Livigni, S., Amatu, A., Andreotti, A., Tagliaferri, F., Moise, G., Mercurio, G., Costa, A., Vezzani, A., Lindau, S., Babel, J., Cavana, M., Consonni, D., Pesenti, A., Gattinoni, L., Torres, A., Mansouri, P., Zand, F., Zahed, L., Dehghanrad, F., Bahrani, M., Ghorbani, M., Cambiaghi, B., Moerer, O., Mauri, T., Kunze-Szikszay, N., Ritter, C., Pesenti, A., Quintel, M., Vilander, L. M., Kaunisto, M. A., Vaara, S. T., Pettilä, V., Mulier, J. L. G. Haitsma, Rozemeijer, S., Spoelstra-de Man, A. M. E., Elbers, P. E., Tuinman, P. R., de Waard, M. C., Oudemans-van Straaten, H. M., Liberatore, A. M. A., Souza, R. B., Martins, A. M. C. R. P. F., Vieira, J. C. F., Koh, I. H. J., Martínez, M. Galindo, Sánchez, R. Jiménez, Gascón, L. Martínez, Mulero, M. D. Rodríguez, Freire, A. Ortín, Muñoz, A. Ojados, Acebes, S. Rebollo, Martínez, Á. Fernández, Aliaga, S. Moreno, Para, L. Herrera, Payá, J. Murcia, Mulero, F. Rodríguez, Guerci, P., Ince, Y., Heeman, P., Ergin, B., Ince, C., Uz, Z., Massey, M., Ince, Y., Papatella, R., Bulent, E., Guerci, P., Toraman, F., Ince, C., Longbottom, E. R., Torrance, H. D., Owen, H. C., Hinds, C. J., Pearse, R. M., O’Dywer, M. J., Trogrlic, Z., van der Jagt, M., Lingsma, H., Ponssen, H. H., Schoonderbeek, J. F., Schreiner, F., Verbrugge, S. J., Duran, S., van Achterberg, T., Bakker, J., Gommers, D. A. M. P. J., Ista, E., Krajčová, A., Waldauf, P., Duška, F., Shah, A., Roy, N., McKechnie, S., Doree, C., Fisher, S., Stanworth, S. J., Jensen, J. F., Overgaard, D., Bestle, M. H., Christensen, D. F., Egerod, I., Pivkina, A., Gusarov, V., Zhivotneva, I., Pasko, N., Zamyatin, M., Jensen, J. F., Egerod, I., Bestle, M. H., Christensen, D. F., Alklit, A., Hansen, R. L., Knudsen, H., Grode, L. B., Overgaard, D., Hravnak, M., Chen, L., Dubrawski, A., Clermont, G., Pinsky, M. R., Parry, S. M., Knight, L. D., Connolly, B. C., Baldwin, C. E., Puthucheary, Z. A., Denehy, L., Hart, N., Morris, P. E., Mortimore, J., Granger, C. L., Jensen, H. I., Piers, R., Van den Bulcke, B., Malmgren, J., Metaxa, V., Reyners, A. K., Darmon, M., Rusinova, K., Talmor, D., Meert, A. P., Cancelliere, L., Zubek, L., Maia, P., Michalsen, A., Decruyenaere, J., Kompanje, E., Vanheule, S., Azoulay, E., Vansteelandt, S., Benoit, D., Van den Bulcke, B., Piers, R., Jensen, H. I., Malmgren, J., Metaxa, V., Reyners, A. K., Darmon, M., Rusinova, K., Talmor, D., Meert, A. P., Cancelliere, L., Zubek, L., Maia, P., Michalsen, A., Decruyenaere, J., Kompanje, E., Vanheule, S., Azoulay, E., Vansteelandt, S., Benoit, D., Ryan, C., Dawson, D., Ball, J., Noone, K., Aisling, B., Prudden, S., Ntantana, A., Matamis, D., Savvidou, S., Giannakou, M., Gouva, M., Nakos, G., Koulouras, V., Aron, J., Lumley, G., Milliken, D., Dhadwal, K., McGrath, B. A., Lynch, S. J., Bovento, B., Sharpe, G., Grainger, E., Pieri-Davies, S., Wallace, S., McGrath, B., Lynch, S. J., Bovento, B., Grainger, E., Pieri-Davies, S., Sharpe, G., Wallace, S., Jung, M., Cho, J., Park, H., Suh, G., Kousha, O., Paddle, J., Gripenberg, L. Gamrin, Rehal, M. Sundström, Wernerman, J., Rooyackers, O., de Grooth, H. J., Choo, W. P., Spoelstra-de Man, A. M., Swart, E. L., Oudemans-van Straaten, H. M., Talan, L., Güven, G., Altıntas, N. D., Padar, M., Uusvel, G., Starkopf, L., Starkopf, J., Blaser, A. Reintam, Kalaiselvan, M. S., Arunkumar, A. S., Renuka, M. K., Shivkumar, R. L., Volbeda, M., ten Kate, D., Hoekstra, M., van der Maaten, J. M., Nijsten, M. W., Komaromi, A., Rooyackers, O., Wernerman, J., Norberg, Å., Smedberg, M., Mori, M., Pettersson, L., Norberg, Å., Rooyackers, O., Wernerman, J., Theodorakopoulou, M., Christodoulopoulou, T., Diamantakis, A., Frantzeskaki, F., Kontogiorgi, M., Chrysanthopoulou, E., Lygnos, M., Diakaki, C., Armaganidis, A., Gundogan, K., Dogan, E., Coskun, R., Muhtaroglu, S., Sungur, M., Ziegler, T., Guven, M., Kleyman, A., Khaliq, W., Andreas, D., Singer, M., Meierhans, R., Schuepbach, R., De Brito-Ashurst, I., Zand, F., Sabetian, G., Nikandish, R., Hagar, F., Masjedi, M., Maghsudi, B., Vazin, A., Ghorbani, M., Asadpour, E., Kao, K. C., Chiu, L. C., Hung, C. Y., Chang, C. H., Li, S. H., Hu, H. C., El Maraghi, S., Ali, M., Rageb, D., Helmy, M., Marin-Corral, J., Vilà, C., Masclans, J. R., Vàzquez, A., Martín-Loeches, I., Díaz, E., Yébenes, J. C., Rodriguez, A., Álvarez-Lerma, F., Varga, N., Cortina-Gutiérrez, A., Dono, L., Martínez-Martínez, M., Maldonado, C., Papiol, E., Pérez-Carrasco, M., Ferrer, R., Nweze, K., Morton, B., Welters, I., Houard, M., Voisin, B., Ledoux, G., Six, S., Jaillette, E., Nseir, S., Romdhani, S., Bouneb, R., Loghmari, D., Aicha, N. Ben, Ayachi, J., Meddeb, K., Chouchène, I., Khedher, A., Boussarsar, M., Chan, K. S., Yu, W. L., Marin-Corral, J., Vilà, C., Masclans, J. R., Nolla, J., Vidaur, L., Bonastre, J., Suberbiola, B., Guerrero, J. E., Rodriguez, A., Coll, N. Ramon, Jiménez, G. Jiménez, Brugger, S. Carvalho, Calero, J. Codina, Garrido, B. Balsera, García, M., Martínez, M. Palomar, Vidal, M. Vallverdú, de la Torre, M. C., Vendrell, E., Palomera, E., Güell, E., Yébenes, J. C., Serra-Prat, M., Bermejo-Martín, J. F., Almirall, J., Tomas, E., Escoval, A., Froe, F., Pereira, M. H. Vitoria, Velez, N., Viegas, E., Filipe, E., Groves, C., Reay, M., Chiu, L. C., Hu, H. C., Hung, C. Y., Chang, C. H., Li, S. H., Kao, K. C., Ballin, A., Facchin, F., Sartori, G., Zarantonello, F., Campello, E., Radu, C. M., Rossi, S., Ori, C., Simioni, P., Umei, N., Shingo, I., Santos, A. C., Candeias, C., Moniz, I., Marçal, R., e Silva, Z. Costa, Ribeiro, J. M., Georger, J. F., Ponthus, J. P., Tchir, M., Amilien, V., Ayoub, M., Barsam, E., Martucci, G., Panarello, G., Tuzzolino, F., Capitanio, G., Ferrazza, V., Carollo, T., Giovanni, L., Arcadipane, A., Sánchez, M. López, González-Gay, M. A., Díaz, F. J. Llorca, López, M. I. Rubio, Zogheib, E., Villeret, L., Nader, J., Bernasinski, M., Besserve, P., Caus, T., Dupont, H., Morimont, P., Habran, S., Hubert, R., Desaive, T., Blaffart, F., Janssen, N., Guiot, J., Pironet, A., Dauby, P., Lambermont, B., Zarantonello, F., Ballin, A., Facchin, F., Sartori, G., Campello, E., Pettenuzzo, T., Citton, G., Rossi, S., Simioni, P., Ori, C., Kirakli, C., Ediboglu, O., Ataman, S., Yarici, M., Tuksavul, F., Keating, S., Gibson, A., Gilles, M., Dunn, M., Price, G., Young, N., Remeta, P., Bishop, P., Zamora, M. D. Fernández, Muñoz-Bono, J., Curiel-Balsera, E., Aguilar-Alonso, E., Hinojosa, R., Gordillo-Brenes, A., Arboleda-Sánchez, J. A., Skorniakov, I., Vikulova, D., Whiteley, C., Shaikh, O., Jones, A., Ostermann, M., Forni, L., Scott, M., Sahatjian, J., Linde-Zwirble, W., Hansell, D., Laoveeravat, P., Srisawat, N., Kongwibulwut, M., Peerapornrattana, S., Suwachittanont, N., Wirotwan, T. O., Chatkaew, P., Saeyub, P., Latthaprecha, K., Tiranathanagul, K., Eiam-ong, S., Kellum, J. A., Berthelsen, R. E., Perner, A., Jensen, A. E. K., Jensen, J. U., Bestle, M. H., Gebhard, D. J., Price, J., Kennedy, C. E., Akcan-Arikan, A., Liberatore, A. M. A., Souza, R. B., Martins, A. M. C. R. P. F., Vieira, J. C. F., Kang, Y. R., Nakamae, M. N., Koh, I. H. J., Hamed, K., Khaled, M. M., Soliman, R. Aly, Mokhtar, M. Sherif, Seller-Pérez, G., Arias-Verdú, D., Llopar-Valdor, E., De-Diós-Chacón, I., Quesada-García, G., Herrera-Gutierrez, M. E., Hafes, R., Carroll, G., Doherty, P., Wright, C., Vera, I. G. Guerra, Ralston, M., Gemmell, M. L., MacKay, A., Black, E., Wright, C., Docking, R. I., Appleton, R., Ralston, M. R., Gemmell, L., Appleton, R., Wright, C., Docking, R. I., Black, E., Mackay, A., Rozemeijer, S., Mulier, J. L. G. Haitsma, Röttgering, J. G., Elbers, P. W. G., Spoelstra-de Man, A. M. E., Tuinman, P. R., de Waard, M. C., Oudemans-van Straaten, H. M., Mejeni, N., Nsiala, J., Kilembe, A., Akilimali, P., Thomas, G., Egerod, I., Andersson, A. E., Fagerdahl, A. M., Knudsen, V., Meddeb, K., Cheikh, A. Ben, Hamdaoui, Y., Ayachi, J., Guiga, A., Fraj, N., Romdhani, S., Sma, N., Bouneb, R., Chouchene, I., Khedher, A., Bouafia, N., Boussarsar, M., Amirian, A., Ziaian, B., Masjedi, M., Fleischmann, C., Thomas-Rueddel, D. O., Schettler, A., Schwarzkopf, D., Stacke, A., Reinhart, K., Filipe, E., Escoval, A., Martins, A., Sousa, P., Velez, N., Viegas, E., Tomas, E., Snell, G., Matsa, R., Paary, T. T. S., Kalaiselvan, M. S., Cavalheiro, A. M., Rocha, L. L., Vallone, C. S., Tonilo, A., Lobato, M. D. S., Malheiro, D. T., Sussumo, G., Lucino, N. M., Zand, F., Rosenthal, V. D., Masjedi, M., Sabetian, G., Maghsudi, B., Ghorbani, M., Dashti, A. Sanaei, Yousefipour, A., Goodall, J. R., Williamson, M., Tant, E., Thomas, N., Balci, C., Gonen, C., Haftacı, E., Gurarda, H., Karaca, E., Paldusová, B., Zýková, I., Šímová, D., Houston, S., D’Antona, L., Lloyd, J., Garnelo-Rey, V., Sosic, M., Sotosek-Tokmazic, V., Kuharic, J., Antoncic, I., Dunatov, S., Sustic, A., Chong, C. T., Sim, M., Lyovarin, T., Díaz, F. M. Acosta, Galdó, S. Narbona, Garach, M. Muñoz, Romero, O. Moreno, Bailón, A. M. Pérez, Pinel, A. Carranza, Colmenero, M., Gritsan, A., Gazenkampf, A., Korchagin, E., Dovbish, N., Lee, R. M., Lim, M. P. P., Chong, C. T., Lim, B. C. L., See, J. J., Assis, R., Filipe, F., Lopes, N., Pessoa, L., Pereira, T., Catorze, N., Aydogan, M. S., Aldasoro, C., Marchio, P., Jorda, A., Mauricio, M. D., Guerra-Ojeda, S., Gimeno-Raga, M., Colque-Cano, M., Bertomeu-Artecero, A., Aldasoro, M., Valles, S. L., Tonon, D., Triglia, T., Martin, J. C., Alessi, M. C., Bruder, N., Garrigue, P., Velly, L., Spina, S., Scaravilli, V., Marzorati, C., Colombo, E., Savo, D., Vargiolu, A., Cavenaghi, G., Citerio, G., Andrade, A. H. V., Bulgarelli, P., Araujo, J. A. P., Gonzalez, V., Souza, V. A., Costa, A., Massant, C., Filho, C. A. C. Abreu, Morbeck, R. A., Burgo, L. E., van Groenendael, R., van Eijk, L. T., Leijte, G. P., Koeneman, B., Kox, M., Pickkers, P., García-de la Torre, A., de la Torre-Prados, M., Fernández-Porcel, A., Rueda-Molina, C., Nuevo-Ortega, P., Tsvetanova-Spasova, T., Cámara-Sola, E., García-Alcántara, A., Salido-Díaz, L., Liao, X., Feng, T., Zhang, J., Cao, X., Wu, Q., Xie, Z., Li, H., Kang, Y., Winkler, M. S., Nierhaus, A., Mudersbach, E., Bauer, A., Robbe, L., Zahrte, C., Schwedhelm, E., Kluge, S., Zöllner, C., Morton, B., Mitsi, E., Pennington, S. H., Reine, J., Wright, A. D., Parker, R., Welters, I. D., Blakey, J. D., Rajam, G., Ades, E. W., Ferreira, D. M., Wang, D., Kadioglu, A., Gordon, S. B., Koch, R., Kox, M., Rahamat-Langedoen, J., Schloesser, J., de Jonge, M., Pickkers, P., Bringue, J., Guillamat-Prats, R., Torrents, E., Martinez, M. L., Camprubí-Rimblas, M., Artigas, A., Blanch, L., Park, S. Y., Park, Y. B., Song, D. K., Shrestha, S., Park, S. H., Koh, Y., Park, M. J., Hong, C. W., Lesur, O., Coquerel, D., Sainsily, X., Cote, J., Söllradl, T., Murza, A., Dumont, L., Dumaine, R., Grandbois, M., Sarret, P., Marsault, E., Salvail, D., Auger-Messier, M., Chagnon, F., Lauretta, M. P., Greco, E., Dyson, A., Singer, M., Preau, S., Ambler, M., Sigurta, A., Saeed, S., Singer, M., Sarıca, L. Topcu, Zibandeh, N., Genc, D., Gul, F., Akkoc, T., Kombak, E., Cinel, L., Akkoc, T., Cinel, I., Pollen, S. J., Arulkumaran, N., Singer, M., Torrance, H. D., Longbottom, E. R., Warnes, G., Hinds, C. J., Pennington, D. J., Brohi, K., O’Dwyer, M. J., Kim, H. Y., Na, S., Kim, J., Chang, Y. F., Chao, A., Shih, P. Y., Lee, C. T., Yeh, Y. C., Chen, L. 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R., Parlevliet, K., Boer, C., Elbers, P. W., Tuinman, P. R., Reina, Á. J. Roldán, Palomo, Y. Corcia, Bermúdez, R. Martín, Villén, L. Martín, García, I. Palacios, Izurieta, J. R. Naranjo, Bernal, J. B. Pérez, Jiménez, F. J. Jiménez, Cota-Delgado, F., de la Torre-Prados, M. V., Fernández-Porcel, A., Nuevo-Ortega, P., Cámara-Sola, E., Tsvetanova-Spasova, T., Rueda-Molina, C., Salido-Díaz, L., García-Alcántara, A., Kaneko, T., Tanaka, H., Kamikawa, M., Karashima, R., Iwashita, S., Irie, H., Kasaoka, S., Arola, O., Laitio, R., Saraste, A., Airaksinen, J., Pietilä, M., Hynninen, M., Wennervirta, J., Bäcklund, M., Ylikoski, E., Silvasti, P., Nukarinen, E., Grönlund, J., Harjola, V. P., Niiranen, J., Korpi, K., Varpula, M., Roine, R. O., Laitio, T., Salah, S., Hassen, B. G., Fehmi, A. Mohamed, Kim, S., Hsu, Y. C., Barea-Mendoza, J., García-Fuentes, C., Castillo-Jaramillo, M., Dominguez-Aguado, H., Viejo-Moreno, R., Terceros-Almanza, L., Aznárez, S. Bermejo, Mudarra-Reche, C., Xu, W., Chico-Fernández, M., Montejo-González, J. C., Crewdson, K., Thomas, M., Merghani, M., Fenner, L., Morgan, P., Lockey, D., van Lieshout, E. J., Oomen, B., Binnekade, J. M., Dongelmans, D. A., de Haan, R. J., Juffermans, N. P., Vroom, M. B., Algarte, R., Martínez, L., Sánchez, B., Romero, I., Martínez, F., Quintana, S., Trenado, J., Sheikh, O., Pogson, D., Clinton, R., Riccio, F., Gemmell, L., MacKay, A., Arthur, A., Young, L., Sinclair, A., Markopoulou, D., Venetsanou, K., Filippou, L., Salla, E., Stratouli, S., Alamanos, I., Guirgis, A. H., Rodriguez, R. Gutiérrez, Lorente, M. J. Furones, Guarasa, I. Macias, Ukere, A., Meisner, S., Greiwe, G., Opitz, B., Benten, D., Nashan, B., Fischer, L., Trepte, C. J. C., Reuter, D. A., Haas, S. A., Behem, C. R., Tavazzi, G., Ana, B., Vazir, A., Gibson, D., Price, S., Masjedi, M., Hadavi, M. R., alam, M. Riahi, Sasani, M. R., Parenti, N., Agrusta, F., Palazzi, C., Pifferi, B., Sganzerla, R., Tagliazucchi, F., Luciani, A., Möller, M., Müller-Engelmann, J., Montag, G., Adams, P., Lange, C., Neuzner, J., Gradaus, R., Wodack, K. H., Thürk, F., Waldmann, A. D., Grässler, M. F., Nishimoto, S., Böhm, S. H., Kaniusas, E., Reuter, D. A., Trepte, C. J., Sigmundsson, T., Öhman, T., Redondo, E., Hallbäck, M., Wallin, M., Sipman, F. Suarez, Oldner, A., Sander, C. Hällsjö, Björne, H., Colinas, L., Hernandez, G., Vicho, R., Serna, M., Cuena, R., Canabal, A., Chaari, A., Hakim, K. Abdel, Etman, M., El Bahr, M., El Sakka, A., Bousselmi, K., Arali, A., Kauts, V., Casey, W. F., Bond, O., De Santis, P., Iesu, E., Franchi, F., Vincent, J. L., Creteur, J., Scolletta, S., Taccone, F. S., Marutyan, Z., Hamidova, L., Shakotko, A., Movsisyan, V., Uysupova, I., Evdokimov, A., Petrikov, S., Gonen, C., Haftacı, E., Balci, C., Calvo, F. J. Redondo, Bejarano, N., Baladron, V., Villazala, R., Redondo, J., Padilla, D., Villarejo, P., Akcan-Arikan, A., Kennedy, C. E., Arzapalo, M. F. Aguilar, Gomez-Gonzalez, C., Mas-Font, S., Puppo-Moreno, A., Herrera-Gutierrez, M., Garcia-Garcia, M., Aldunate-Calvo, S., Plata-Menchaca, E. P., Pérez-Fernández, X. L., Estruch, M., Betbese-Roig, A., Campos, P. Cárdenas, Lora, M. Rojas, Gaibor, N. D. Toapanta, Medina, R. S. Contreras, Sanguino, V. D. Gumucio, Casanova, E. J., Riera, J. Sabater, Kritmetapak, K., Peerapornratana, S., Kittiskulnam, P., Dissayabutra, T., Tiranathanagul, K., Susantithapong, P., Praditpornsilpa, K., Tungsanga, K., Eiam-Ong, S., Srisawat, N., Winkelmann, T., Busch, T., Meixensberger, J., Bercker, S., Cabeza, E. M. Flores, Sánchez, M. Sánchez, Giménez, N. Cáceres, Melón, C. Gutierrez, de Lucas, E. Herrero, Estañ, P. Millán, Bernal, M. Hernández, de Lorenzo y Mateos, A. Garcia, Ergin, B., Guerci, P., Specht, P. A. C., Ince, Y., Ince, C., Balik, M., Zakharchenko, M., Los, F., Brodska, H., de Tymowski, C., Augustin, P., Desmard, M., Montravers, P., Stapel, S. N., de Boer, R., Oudemans, H. M., Hollinger, A., Schweingruber, T., Jockers, F., Dickenmann, M., Siegemund, M., Runciman, N., Ralston, M., Appleton, R., Mauri, T., Alban, L., Turrini, C., Sasso, T., Langer, T., Panigada, M., Taccone, P., Carlesso, E., Marenghi, C., Grasselli, G., Pesenti, A., Wibart, P., Reginault, T., Garcia, M., Barbrel, B., Benard, A., Bader, C., Vargas, F., Bui, H. N., Hilbert, G., Simón, J. M. Serrano, Sánchez, P. Carmona, Ferrón, F. Ruiz, de Acilu, M. García, Marin, J., Antonia, V., Ruano, L., Monica, M., Ferrer, R., Masclans, J. R., Roca, O., Hong, G., Kim, D. H., Kim, Y. S., Park, J. S., Jee, Y. K., xiang, Z. Yu, Jia-xing, W., dan, W. Xiao, long, N. Wen, Yu, W., Yan, Z., Cheng, X., Kobayashi, T., Onodera, Y., Akimoto, R., Sugiura, A., Suzuki, H., Iwabuchi, M., Nakane, M., Kawamae, K., Sanchez, P. Carmona, Rodriguez, M. D. Bautista, Delgado, M. Rodriguez, Sánchez, V. Martínez de Pinillos, Gómez, A. Mula, Simón, J. M. Serrano, Beuret, P., Fortes, C., Lauer, M., Reboul, M., Chakarian, J. C., Fabre, X., Philippon-Jouve, B., Devillez, S., Clerc, M., Rittayamai, N., Sklar, M., Dres, M., Rauseo, M., Campbell, C., West, B., Tullis, D. E., Brochard, L., Onodera, Y., Akimoto, R., Suzuki, H., Okada, M., Nakane, M., Kawamae, K., Ahmad, N., Wood, M., Glossop, A., Lucas, J. Higuera, Ortiz, A. Blandino, Alonso, D. Cabestrero, De Pablo Sánchez, R., González, L. Rey, Costa, R., Spinazzola, G., Pizza, A., Ferrone, G., Rossi, M., Antonelli, M., Conti, G., Ribeiro, H., Alves, J., Sousa, M., Reis, P., Socolovsky, C. S., Cauley, R. P., Frankel, J. E., Beam, A. L., Olaniran, K. O., Gibbons, F. K., Christopher, K. B., Pennington, J., Zolfaghari, P., King, H. S., Kong, H. H. Y., Shum, H. P., Yan, W. W., Kaymak, C., Okumus, N., Sari, A., Erdogdu, B., Aksun, S., Basar, H., Ozcan, A., Ozcan, N., Oztuna, D., Malmgren, J. A., Lundin, S., Torén, K., Eckerström, M., Wallin, A., Waldenström, A. C., Riccio, F. C., Pogson, D., Antonio, A. C. P., Leivas, A. F., Kenji, F., James, E., Morgan, P., Carroll, G., Gemmell, L., MacKay, A., Wright, C., Ballantyne, J., Jonnada, S., Gerrard, C. S., Jones, N., Salciccioli, J. D., Marshall, D. C., Komorowski, M., Hartley, A., Sykes, M. C., Goodson, R., Shalhoub, J., Villanueva, J. R. Fernández, Garda, R. Fernández, Lago, A. M. López, Ruiz, E. Rodríguez, Vaquero, R. Hernández, Rodríguez, C. Galbán, Pérez, E. Varo, Hilasque, C., Oliva, I., Sirgo, G., Martin, M. C., Olona, M., Gilavert, M. C., Bodí, M., Ebm, C., Aggarwal, G., Huddart, S., Quiney, N., Cecconi, M., Fernandes, S. M., Silva, J. Santos, Gouveia, J., Silva, D., Marques, R., Bento, H., Alvarez, A., Silva, Z. Costa, Diaz, D. Díaz, Martínez, M. Villanova, Herrejon, E. Palencia, de la Gandara, A. Martinez, Gonzalo, G., Lopez, M. A., de Gopegui Miguelena, P. Ruíz, Matilla, C. I. Bernal, Chueca, P. Sánchez, Longares, M. D. C. Rodríguez, Abril, R. Ramos, Aguilar, A. L. Ruíz, de Murillas, R. Garrido López, Fernández, R. Fernández, Laborías, P. Morales, Castellanos, M. A. Díaz, Laborías, M. E. Morales, Cho, J., Kim, J., Park, J., Woo, S., West, T., Powell, E., Rimmer, A., Orford, C., Jones, N., Williams, J., Matilla, C. I. Bernal, de Gopegui Miguelena, P. Ruiz, Chueca, P. Sánchez, Abril, R. Ramos, Longares, M. D. C. Rodríguez, Aguilar, A. L. Ruíz, de Murillas, R. Garrido López, Bourne, R. S., Shulman, R., Tomlin, M., Mills, G. H., Borthwick, M., Berry, W., Huertas, D. García, Manzano, F., Villagrán-Ramírez, F., Ruiz-Perea, A., Rodríguez-Mejías, C., Santiago-Ruiz, F., Colmenero-Ruiz, M., König, C., Matt, B., Kortgen, A., Hartog, C. S., Wong, A., Balan, C., Barker, G., Srisawat, N., Peerapornratana, S., Laoveeravat, P., Tachaboon, S., Eiam-ong, S., Paratz, J., Kayambu, G., Boots, R., Arzapalo, M. F. Aguilar, Vlasenko, R., Gromova, E., Loginov, S., Kiselevskiy, M., Dolgikova, Y., Tang, K. B., Chau, C. M., Lam, K. N., Gil, E., Suh, G. Y., Park, C. M., Park, J., Chung, C. R., Lee, C. T., Chao, A., Shih, P. Y., Chang, Y. F., Lai, C. H., Hsu, Y. C., Yeh, Y. C., Cheng, Y. J., Colella, V., Zarrillo, N., D’Amico, M., Forfori, F., Pezza, B., Laddomada, T., Beltramelli, V., Pizzaballa, M. L., Doronzio, A., Balicco, B., Kiers, D., van der Heijden, W., Gerretsen, J., de Mast, Q., el Messaoudi, S., Rongen, G., Gomes, M., Kox, M., Pickkers, P., Riksen, N. P., Kashiwagi, Y., Okada, M., Hayashi, K., Inagaki, Y., Fujita, S., Nakamae, M. N., Kang, Y. R., Souza, R. B., Liberatore, A. M. A., Koh, I. H. J., Blet, A., Sadoune, M., Lemarié, J., Bihry, N., Bern, R., Polidano, E., Merval, R., Launay, J. M., Lévy, B., Samuel, J. L., Mebazaa, A., Hartmann, J., Harm, S., and Weber, V.

Published
2016
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27. Gaussian Process Nowcasting: Application to COVID-19 Mortality Reporting

Author

Hawryluk, I, Hoeltgebaum, H, Mishra, S, Miscouridou, X, Schnekenberg, RP, Whittaker, C, Vollmer, M, Flaxman, S, Bhatt, S, Mellan, TA, and Medical Research Council (MRC)

Subjects
FOS: Computer and information sciences, Statistics - Machine Learning, Applications (stat.AP), Machine Learning (stat.ML), stat.AP, stat.ML, Statistics - Applications
Abstract

Updating observations of a signal due to the delays in the measurement process is a common problem in signal processing, with prominent examples in a wide range of fields. An important example of this problem is the nowcasting of COVID-19 mortality: given a stream of reported counts of daily deaths, can we correct for the delays in reporting to paint an accurate picture of the present, with uncertainty? Without this correction, raw data will often mislead by suggesting an improving situation. We present a flexible approach using a latent Gaussian process that is capable of describing the changing auto-correlation structure present in the reporting time-delay surface. This approach also yields robust estimates of uncertainty for the estimated nowcasted numbers of deaths. We test assumptions in model specification such as the choice of kernel or hyper priors, and evaluate model performance on a challenging real dataset from Brazil. Our experiments show that Gaussian process nowcasting performs favourably against both comparable methods, and against a small sample of expert human predictions. Our approach has substantial practical utility in disease modelling -- by applying our approach to COVID-19 mortality data from Brazil, where reporting delays are large, we can make informative predictions on important epidemiological quantities such as the current effective reproduction number., Comment: 26 pages, 31 figures

Published
2021
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29. Report on challenges for SCIs

Author

Walther, G, Jovanovic, M., Vollmer, M., Desmond, G, Choudhary, A., Székely, Z., Sanne, Johan, Klimek, P., Bezrukov, D., Koivisto, R., Molarius, R., Macsári, I., Stumphauser, I., Knape, T., Bergfors, L., Buhr, K., Jovanovic, A., Albrecht, N., Warkentin, S., Devarajan, J., Tetlak, K., Auerkari, P., Tuurna, S., Pohja, R., Santamaria, N., Nikolic, M., Blazevic, D., Eremic, S., Walther, G, Jovanovic, M., Vollmer, M., Desmond, G, Choudhary, A., Székely, Z., Sanne, Johan, Klimek, P., Bezrukov, D., Koivisto, R., Molarius, R., Macsári, I., Stumphauser, I., Knape, T., Bergfors, L., Buhr, K., Jovanovic, A., Albrecht, N., Warkentin, S., Devarajan, J., Tetlak, K., Auerkari, P., Tuurna, S., Pohja, R., Santamaria, N., Nikolic, M., Blazevic, D., and Eremic, S.

Abstract

This report discusses the challenges posed by four types of threats – terrorist attacks, cyber-attacks, extreme weather and social unrest – on the following eight smart critical infrastructure systems:a. ALPHA - Finance (financial system): The analysis focuses on disturbed information flow and disabling/manipulating IT and communication systems, including attacks on the “physical layer” using the example of IEMI/HPEM threats, as well as the software layer.b. BRAVO - Energy supply (system): The analysis focuses on disruption of “smart” energy supply in a “smart city”, caused by natural hazards, in this case flooding, leading to cascading effects and severe consequences for other energy-depending SCIs.c. CHARLIE - Health care (system): Focus of the analysis is on all threats that might cause large increases in the numbers of injuries or sick patients within a densely populated area. This will include indirect impacts, e.g. large numbers of injuries caused by a disaster or terrorist attacks or disease epidemics, but also direct impacts, e.g. service disruptions in critical health infrastructures, such as hospitals, due to attacks or disasters hitting the infrastructure itself.d. DELTA - Transportation (system) – airports: According to the framework situation, threats on Smart Airports will be assessed under circumstances of (i) blocked traffic, (ii) passenger and airplane traffic exceeding capacity (iii) flood.e. ECHO - Industry (in zones in cities) "Industrial Production Plants": The analysis focuses mainly on technological accidents within the refinery complex, but also accidents caused by natural hazards affecting refinery property outside the main refinery complex, e.g. accident on jetty belonging to refinery on the river Danube during unloading/loading oil products from barge to a tank, damages by a gale or storm on process installations (pipes, hoses) resulting in river pollution. Both scenarios could lead to cascading effects for other SCIs in close vicinity.f., SmartResilience: Smart Resilience Indicators for Smart Critical Infrastructures

Published
2021

30. Report 33: Modelling the allocation and impact of a COVID-19 vaccine

Author

Hogan, A, Winskill, P, Watson, O, Walker, P, Whittaker, C, Baguelin, M, Haw, D, Lochen, A, Gaythorpe, K, Ainslie, K, Bhatt, S, Boonyasiri, A, Boyd, O, Brazeau, N, Cattarino, L, Charles, G, Cooper, L, Coupland, H, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Donnelly, C, Dorigatti, I, Eales, O, Van Elsland, S, Ferreira Do Nascimento, F, Fitzjohn, R, Flaxman, S, Green, W, Hallett, T, Hamlet, A, Hinsley, W, Imai, N, Jauneikaite, E, Jeffrey, B, Knock, E, Laydon, D, Lees, J, Mellan, T, Mishra, S, Nedjati Gilani, G, Nouvellet, P, Ower, A, Parag, K, Ragonnet-Cronin, M, Siveroni, I, Skarp, J, Thompson, H, Unwin, H, Verity, R, Vollmer, M, Volz, E, Walters, C, Wang, H, Wang, Y, Whittles, L, Xi, X, Muhib, F, Smith, P, Hauck, K, Ferguson, N, Ghani, A, Medical Research Council (MRC), and Abdul Latif Jameel Foundation

Subjects
Coronavirus, COVID19, COVID-19, Vaccine
Abstract

Several SARS-CoV-2 vaccine candidates are now in late-stage trials, with efficacy and safety results expected by the end of 2020. Even under optimistic scenarios for manufacture and delivery, the doses available in 2021 are likely to be limited. Here we identify optimal vaccine allocation strategies within and between countries to maximise health (avert deaths) under constraints on dose supply. We extended an existing mathematical model of SARS-CoV-2 transmission across different country settings to model the public health impact of potential vaccines, using a range of target product profiles developed by the World Health Organization. We show that as supply increases, vaccines that reduce or block infection – and thus transmission – in addition to preventing disease have a greater impact than those that prevent disease alone, due to the indirect protection provided to high-risk groups. We further demonstrate that the health impact of vaccination will depend on the cumulative infection incidence in the population when vaccination begins, the duration of any naturally acquired immunity, the likely trajectory of the epidemic in 2021 and the level of healthcare available to effectively treat those with disease. Within a country, we find that for a limited supply (doses for

Published
2020

31. Report 32: Targeting interventions to age groups that sustain COVID-19 transmission in the United States

Author

Monod, M, Blenkinsop, A, Xi, X, Herbert, D, Bershan, S, Tietze, S, Bradley, V, Chen, Y, Coupland, H, Filippi, S, Ish-Horowicz, J, McManus, M, Mellan, T, Gandy, A, Hutchinson, M, Unwin, H, Vollmer, M, Weber, S, Zhu, H, Bezancon, A, Ferguson, N, Mishra, S, Flaxman, S, Bhatt, S, Ratmann, O, Ainslie, K, Baguelin, M, Boonyasiri, A, Boyd, O, Cattarino, L, Cooper, L, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Djaafara, A, Dorigatti, I, Van Elsland, S, Fitzjohn, R, Gaythorpe, K, Geidelberg, L, Green, W, Hamlet, A, Jeffrey, B, Knock, E, Laydon, D, Nedjati Gilani, G, Nouvellet, P, Parag, K, Siveroni, I, Thompson, H, Verity, R, Walters, C, Donnelly, C, Okell, L, Bhatia, S, Brazeau, N, Eales, O, Haw, D, Imai, N, Jauneikaite, E, Lees, J, Mousa, A, Olivera Mesa, D, Skarp, J, Whittles, L, Medical Research Council (MRC), and Abdul Latif Jameel Foundation

Subjects
Coronavirus, COVID19, COVID-19, USA
Abstract

Following ini􀀂al declines, in mid 2020, a resurgence in transmission of novel coronavirus disease (COVID-19) has occurred in the United States and parts of Europe. Despite the wide implementa􀀂on of non-pharmaceu􀀂cal inter-ven􀀂ons, it is s􀀂ll not known how they are impacted by changing contact pa􀀁erns, age and other demographics. As COVID-19 disease control becomes more localised, understanding the age demographics driving transmission and how these impact the loosening of interven􀀂ons such as school reopening is crucial. Considering dynamics for the United States, we analyse aggregated, age-specific mobility trends from more than 10 million individuals and link these mechanis􀀂cally to age-specific COVID-19 mortality data. In contrast to previous approaches, we link mobility to mortality via age specific contact pa􀀁erns and use this rich rela􀀂onship to reconstruct accurate trans-mission dynamics. Contrary to anecdotal evidence, we find li􀀁le support for age-shi􀀃s in contact and transmission dynamics over 􀀂me. We es􀀂mate that, un􀀂l August, 63.4% [60.9%-65.5%] of SARS-CoV-2 infec􀀂ons in the United States originated from adults aged 20-49, while 1.2% [0.8%-1.8%] originated from children aged 0-9. In areas with con􀀂nued, community-wide transmission, our transmission model predicts that re-opening kindergartens and el-ementary schools could facilitate spread and lead to considerable excess COVID-19 a􀀁ributable deaths over a 90-day period. These findings indicate that targe􀀂ng interven􀀂ons to adults aged 20-49 are an important con-sidera􀀂on in hal􀀂ng resurgent epidemics, and preven􀀂ng COVID-19-a􀀁ributable deaths when kindergartens and elementary schools reopen.

Published
2020
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32. Report 31: Estimating the burden of COVID-19 in Damascus, Syria: an analysis of novel data sources to infer mortality under-ascertainment

Author

Van Elsland, S, Watson, O, Alhaffar, M, Mehchy, Z, Whittaker, C, Akil, Z, Ainslie, K, Baguelin, M, Bhatt, S, Boonyasiri, A, Boyd, O, Brazeau, N, Cattarino, L, Charles, G, Ciavarella, C, Cooper, L, Coupland, H, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Djaafara, A, Donnelly, C, Dorigatti, I, Eales, O, Nascimento, F, Fitzjohn, R, Flaxman, S, Forna, A, Fu, H, Gaythorpe, K, Green, W, Hamlet, A, Hauck, K, Haw, D, Hayes, S, Hinsley, W, Imai, N, Jeffrey, B, Johnson, R, Jorgensen, D, Knock, E, Laydon, D, Lees, J, Mellan, T, Mishra, S, Nedjati Gilani, G, Nouvellet, P, Okell, L, Olivera Mesa, D, Pons Salort, M, Ragonnet-Cronin, M, Siveroni, I, Stopard, I, Thompson, H, Unwin, H, Verity, R, Vollmer, M, Volz, E, Walters, C, Wang, H, Wang, Y, Whittles, L, Winskill, P, Xi, X, Ferguson, N, Beals, E, Walker, P, Anonymous Authors, Medical Research Council (MRC), and Abdul Latif Jameel Foundation

Subjects
Coronavirus, Syria, COVID19, COVID-19
Abstract

The COVID-19 pandemic has resulted in substantial mortality worldwide. However, to date, countries in the Middle East and Africa have reported substantially lower mortality rates than in Europe and the Americas. One hypothesis is that these countries have been ‘spared’, but another is that deaths have been under-ascertained (deaths that have been unreported due to any number of reasons, for instance due to limited testing capacity). However, the scale of under-ascertainment is difficult to assess with currently available data. In this analysis, we estimate the potential under-ascertainment of COVID-19 mortality in Damascus, Syria, where all-cause mortality data has been reported between 25th July and 1st August. We fit a mathematical model of COVID-19 transmission to reported COVID-19 deaths in Damascus since the beginning of the pandemic and compare the model-predicted deaths to reported excess deaths. Exploring a range of different assumptions about under-ascertainment, we estimate that only 1.25% of deaths (sensitivity range 1% - 3%) due to COVID-19 are reported in Damascus. Accounting for under-ascertainment also corroborates local reports of exceeded hospital bed capacity. To validate the epidemic dynamics inferred, we leverage community-uploaded obituary certificates as an alternative data source, which confirms extensive mortality under-ascertainment in Damascus between July and August. This level of under-ascertainment suggests that Damascus is at a much later stage in its epidemic than suggested by surveillance reports, which have repo. We estimate that 4,340 (95% CI: 3,250 - 5,540) deaths due to COVID-19 in Damascus may have been missed as of 2nd September 2020. Given that Damascus is likely to have the most robust surveillance in Syria, these findings suggest that other regions of the country could have experienced similar or worse mortality rates due to COVID-19.

Published
2020

33. Clinical characteristics and predictors of outcomes of hospitalized patients with COVID-19 in a multi-ethnic London NHS Trust: a retrospective cohort study

Author

Perez Guzman, PN, Daunt, A, Mukherjee, S, Crook, P, Forlano, R, Kont, M, Lochen, A, Vollmer, M, Middleton, P, Judge, R, Harlow, C, Soubieres, A, Cooke, G, White, PJ, Hallett, T, Aylin, P, Ferguson, N, Hauck, K, Thursz, M, Nayagam, S, Medical Research Council (MRC), National Institute for Health Research, Dr Foster Ltd, and Imperial College Healthcare NHS Trust: Research Capability Funding (RCF)

Subjects
ethnic minority groups, COVID-19, 06 Biological Sciences, mortality, Microbiology, 11 Medical and Health Sciences
Abstract

Background: Emerging evidence suggests ethnic minorities are disproportionatelyaffected by COVID-19. Detailed clinical analyses of multi-cultural hospitalized patientcohorts remain largely undescribed.Methods: We performed regression, survival andcumulative competing risk analyses to evaluate factors associated with mortality inpatients admitted for COVID-19 in three large London hospitals between February 25and April 5, censored as of May 1, 2020.Results: Of 614 patients (median age 69years, (IQR 25) and 62% male), 381 (62%) had been discharged alive, 178 (29%)died and 55 (9%) remained hospitalized at censoring. Severe hypoxemia (aOR 4.25,95%CI 2.36-7.64), leukocytosis (aOR 2.35, 95%CI 1.35-4.11), thrombocytopenia (aOR1.01, 95%CI 1.00-1.01, increase per 10x9decrease), severe renal impairment (aOR5.14, 95%CI 2.65-9.97), and low albumin (aOR 1.06, 95%CI 1.02-1.09, increase per gdecrease) were associated with death. Forty percent (244) were from black, Asian andother minority ethnic (BAME) groups, 38% (235) white and for 22% (135) ethnicity wasunknown. BAME patients were younger and had fewer comorbidities. Whilst theunadjusted odds of death did not differ by ethnicity, when adjusting for age, sex andcomorbidities, black patients were at higher odds of death compared to whites (aOR1.69, 95%CI 1.00-2.86). This association was stronger when further adjusting foradmission severity (aOR 1.85 95% CI 1.06-3.24). Conclusions: BAME patients were over-represented in our cohort and, whenaccounting for demographic and clinical profile of admission, black patients were atincreased odds of death. Further research is needed into biologic drivers of differencesin COVID-19 outcomes by ethnicity.

Published
2020

34. Report 30: The COVID-19 epidemic trends and control measures in mainland China

Author

Fu, H, Xi, X, Wang, H, Boonyasiri, A, Wang, Y, Hinsley, W, Fraser, K, McCabe, R, Olivera Mesa, D, Skarp, J, Ledda, A, Dewe, T, Dighe, A, Winskill, P, Van Elsland, S, Ainslie, K, Baguelin, M, Bhatt, S, Boyd, O, Brazeau, N, Cattarino, L, Charles, G, Coupland, H, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Donnelly, C, Dorigatti, I, Green, W, Hamlet, A, Hauck, K, Haw, D, Jeffrey, B, Laydon, D, Lees, J, Mellan, T, Mishra, S, Nedjati Gilani, G, Nouvellet, P, Okell, L, Parag, K, Ragonnet-Cronin, M, Riley, S, Schmit, N, Thompson, H, Unwin, H, Verity, R, Vollmer, M, Volz, E, Walker, P, Walters, C, Watson, O, Whittaker, C, Whittles, L, Imai, N, Bhatia, S, Ferguson, N, and Medical Research Council (MRC)

Subjects
Coronavirus, China, COVID19, COVID-19
Published
2020

35. Report 29: The impact of the COVID-19 epidemic on all-cause attendances to emergency departments in two large London hospitals: an observational study

Author

Vollmer, M, Radhakrishnan, S, Kont, M, Flaxman, S, Bhatt, S, Costelloe, C, Honeyford, C, Aylin, P, Cooke, G, Redhead, J, White, P, Ferguson, N, Hauck, K, Nayagam, AS, Perez Guzman, PN, and Medical Research Council (MRC)

Subjects
Coronavirus, A&E attendance, COVID19, COVID-19, Hospital attendance
Abstract

The health care system in England has been highly affected by the surge in demand due to patients afflicted by COVID-19. Yet the impact of the pandemic on the care seeking behaviour of patients and thus on Emergency department (ED) services is unknown, especially for non-COVID-19 related emergencies. In this report, we aimed to assess how the reorganisation of hospital care and admission policies to respond to the COVID-19 epidemic affected ED attendances and emergency hospital admissions. We performed time-series analyses of present year vs historic (2015-2019) trends of ED attendances between March 12 and May 31 at two large central London hospitals part of Imperial College Healthcare NHS Trust (ICHNT) and compared these to regional and national trends. Historic attendances data to ICHNT and publicly available NHS situation reports were used to calibrate time series auto-regressive integrated moving average (ARIMA) forecasting models. We thus predicted the (conterfactual) expected number of ED attendances between March 12 (when the first public health measure leading to lock-down started in England) to May 31, 2020 (when the analysis was censored) at ICHNT, at all acute London Trusts and nationally. The forecasted trends were compared to observed data for the same periods of time. Lastly, we analysed the trends at ICHNT disaggregating by mode of arrival, distance from postcode of patient residence to hospital and primary diagnosis amongst those that were subsequently admitted to hospital and compared these data to an average for the same period of time in the years 2015 to 2019. During the study period (January 1 to May 31, 2020) there was an overall decrease in ED attendances of 35% at ICHNT, of 50% across all London NHS Trusts and 53% nationally. For ICHNT, the decrease in attendances was mainly amongst those aged younger than 65 and those arriving by their own means (e.g. personal or public transport). Increasing distance (km) from postcode of residence to hospital was a significant predictor of reduced attendances, which could not be explained by weighted (for population numbers) mean index of multiple deprivation. Non-COVID emergency admissions to hospital after March 12 fell by 48% at ICHNT compared to previous years. This was seen across all disease areas, including acute coronary syndromes, stroke and cancer-related emergencies. The overall non-COVID-19 hospitalisation mortality risk did not differ (RR 1.13, 95%CI 0.94-1.37, p=0.19), also in comparison to previous years. Our findings suggest emergency healthcare seeking to hospitals drastically changed amongst the population within the catchment area of ICHNT. This trend was echoed regionally and nationally, suggesting those suffering a medical emergency may not have attended other (i.e. closer-to-home) hospitals. Furthermore, our time-series analyses showed that, even after COVID-19 cases and deaths decreased (i.e. from early April), non-COVID-19 ED attendances did not increase. The impact of emergency triaging systems (e.g. 111 calls) and alternative (e.g. private hospital, chemist) health services on these trends remains unknown. However, another recent report found increased non-COVID excess deaths in the community, which may be partially explained by people experiencing an emergency and not attending health services at all. Whether those that attended ED services have done so with longer delays from the moment of emergency onset also remains unknown. National analyses into the factors causing reduced attendances to ED services and strategies to revert these negative trends are urgently needed.

Published
2020
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36. Potential impact of the COVID-19 pandemic on HIV, TB and malaria in low- and middle-income countries: a modelling study

Author

Hogan, A, Jewell, B, Sherrard-Smith, E, Watson, O, Whittaker, C, Hamlet, A, Smith, J, Winskill, P, Verity, R, Baguelin, M, Lees, J, Whittles, L, Ainslie, K, Bhatt, S, Boonyasiri, A, Brazeau, N, Cattarino, L, Cooper, L, Coupland, H, Cuomo-Dannenburg, G, Dighe, A, Djaafara, A, Donnelly, C, Eaton, J, Van Elsland, S, Fitzjohn, R, Fu, H, Gaythorpe, K, Green, W, Haw, D, Hayes, S, Hinsley, W, Imai, N, Laydon, D, Mangal, T, Mellan, T, Mishra, S, Parag, K, Thompson, H, Unwin, H, Vollmer, M, Walters, C, Wang, H, Ferguson, N, Okell, L, Churcher, T, Arinaminpathy, N, Ghani, A, Walker, P, Hallett, T, Medical Research Council (MRC), Bill & Melinda Gates Foundation, Wellcome Trust, Imperial College Healthcare NHS Trust- BRC Funding, The Academy of Medical Sciences, National Institute for Health Research, Imperial College LOndon, Medical Research Council, and The Royal Society

Subjects
Pneumonia, Viral, Humans, Tuberculosis, HIV Infections, Models, Theoretical, Coronavirus Infections, Developing Countries, Pandemics, Health Services Accessibility, Malaria, 0605 Microbiology, 1117 Public Health and Health Services
Abstract

Background: COVID-19 has the potential to cause substantial disruptions to health services, including by cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions in services for human immunodeficiency virus (HIV), tuberculosis (TB) and malaria in low- and middle-income countries with high burdens of those disease could lead to additional loss of life. Methods: We constructed plausible scenarios for the disruptions that could be incurred during the COVID-19 pandemic and used established transmission models for each disease to estimate the additional impact on health that could be caused in selected settings. Findings: In high burden settings, HIV-, TB- and malaria-related deaths over five years may increase by up to 10%, 20% and 36%, respectively, compared to if there were no COVID-19 pandemic. We estimate the greatest impact on HIV to be from interruption to antiretroviral therapy, which may occur during a period of high health system demand. For TB, we estimate the greatest impact is from reductions in timely diagnosis and treatment of new cases, which may result from any prolonged period of COVID-19 suppression interventions. We estimate that the greatest impact on malaria burden could come from interruption of planned net campaigns. These disruptions could lead to loss of life-years over five years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV/TB epidemics. Interpretation: Maintaining the most critical prevention activities and healthcare services for HIV, TB and malaria could significantly reduce the overall impact of the COVID-19 pandemic. Funding: Bill & Melinda Gates Foundation, The Wellcome Trust, DFID, MRC

Published
2020

37. Report 26: Reduction in mobility and COVID-19 transmission

Author

Nouvellet, P, Bhatia, S, Cori, A, Ainslie, K, Baguelin, M, Bhatt, S, Boonyasiri, A, Brazeau, N, Cattarino, L, Cooper, L, Coupland, H, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Dighe, A, Djaafara, A, Dorigatti, I, Eales, O, Van Elsland, S, Nscimento, F, Fitzjohn, R, Gaythorpe, K, Geidelberg, L, Grassly, N, Green, W, Hamlet, A, Hauck, K, Hinsley, W, Imai, N, Jeffrey, B, Knock, E, Laydon, D, Lees, J, Mangal, T, Mellan, T, Nedjati Gilani, G, Parag, K, Pons Salort, M, Ragonnet-Cronin, M, Riley, S, Unwin, H, Verity, R, Vollmer, M, Volz, E, Walker, P, Walters, C, Wang, H, Watson, O, Whittaker, C, Whittles, L, Xi, X, Ferguson, N, Donnelly, C, and Medical Research Council (MRC)

Subjects
Mobility, COVID19, Transmissibility, COVID-19
Abstract

In response to the COVID-19 pandemic, countries have sought to control transmission of SARS-CoV-2 by restricting population movement through social distancing interventions, reducing the number of contacts. Mobility data represent an important proxy measure of social distancing. Here, we develop a framework to infer the relationship between mobility and the key measure of population-level disease transmission, the reproduction number (R). The framework is applied to 53 countries with sustained SARS-CoV-2 transmission based on two distinct country-specific automated measures of human mobility, Apple and Google mobility data. For both datasets, the relationship between mobility and transmission was consistent within and across countries and explained more than 85% of the variance in the observed variation in transmissibility. We quantified country-specific mobility thresholds defined as the reduction in mobility necessary to expect a decline in new infections (R

Published
2020

38. Report 24: Mobility data from mobile phones suggests that initial compliance with COVID-19 social distancing interventions was high and geographically consistent across the UK

Author

Jeffrey, B, Walters, C, Ainslie, K, Eales, O, Ciavarella, C, Bhatia, S, Hayes, S, Baguelin, M, Boonyasiri, A, Brazeau, N, Cuomo-Dannenburg, G, Fitzjohn, R, Gaythorpe, K, Green, W, Imai, N, Mellan, T, Mishra, S, Nouvellet, P, Unwin, H, Verity, R, Vollmer, M, Whittaker, C, Ferguson, N, Donnelly, C, Riley, S, and Medical Research Council (MRC)

Subjects
Mobility, COVID19, COVID-19, United Kingdom
Abstract

Since early March 2020, the COVID-19 epidemic across the United Kingdom has led to a range of social distancing policies, which have resulted in reduced mobility across different regions. Crowd level data on mobile phone usage can be used as a proxy for actual population mobility patterns and provide a way of quantifying the impact of social distancing measures on changes in mobility. Here, we use two mobile phone-based datasets (anonymised and aggregated crowd level data from O2 and from the Facebook app on mobile phones) to assess changes in average mobility, both overall and broken down into high and low population density areas, and changes in the distribution of journey lengths. We show that there was a substantial overall reduction in mobility with the most rapid decline on the 24th March 2020, the day after the Prime Minister’s announcement of an enforced lockdown. The reduction in mobility was highly synchronized across the UK. Although mobility has remained low since 26th March 2020, we detect a gradual increase since that time. We also show that the two different datasets produce similar trends, albeit with some location-specific differences. We see slightly larger reductions in average mobility in high-density areas than in low-density areas, with greater variation in mobility in the high-density areas: some high-density areas eliminated almost all mobility. We are only able to observe populations living in locations where sufficient number of people use Facebook or a device connected to the relevant provider’s network such that no individual is identifiable. These analyses form a baseline with which to monitor changes in behaviour in the UK as social distancing is eased.

Published
2020
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39. Report 23: State-level tracking of COVID-19 in the United States

Author

Unwin, H, Mishra, S, Bradley, VC, Gandy, A, Vollmer, M, Mellan, T, Coupland, H, Ainslie, K, Whittaker, C, Ish-Horowicz, J, Filippi, S, Xi, X, Monod, M, Ratmann, O, Hutchinson, M, Valka, F, Zhu, H, Hawryluk, I, Milton, P, Baguelin, M, Boonyasiri, A, Brazeau, N, Cattarino, L, Charles, G, Cooper, L, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Djaafara, A, Dorigatti, I, Eales, O, Eaton, J, Van Elsland, S, Fitzjohn, R, Gaythorpe, K, Green, W, Hallett, T, Hinsley, W, Imai, N, Jeffrey, B, Knock, E, Laydon, D, Lees, J, Nedjati Gilani, G, Nouvellet, P, Okell, L, Ower, A, Parag, K, Siveroni, I, Thompson, H, Verity, R, Walker, P, Walters, C, Wang, Y, Watson, O, Whittles, L, Ghani, A, Ferguson, N, Riley, S, Donnelly, C, Bhatt, S, Flaxman, S, and Medical Research Council (MRC)

Subjects
Coronavirus, COVID19, COVID-19, United States
Abstract

our estimates show that the percentage of individuals that have been infected is 4.1% [3.7%-4.5%], with wide variation between states. For all states, even for the worst affected states, we estimate that less than a quarter of the population has been infected; in New York, for example, we estimate that 16.6% [12.8%-21.6%] of individuals have been infected to date. Our attack rates for New York are in line with those from recent serological studies [1] broadly supporting our choice of infection fatality rate. There is variation in the initial reproduction number, which is likely due to a range of factors; we find a strong association between the initial reproduction number with both population density (measured at the state level) and the chronological date when 10 cumulative deaths occurred (a crude estimate of the date of locally sustained transmission). Our estimates suggest that the epidemic is not under control in much of the US: as of 17 May 2020 the reproduction number is above the critical threshold (1.0) in 24 [95% CI: 20-30] states. Higher reproduction numbers are geographically clustered in the South and Midwest, where epidemics are still developing, while we estimate lower reproduction numbers in states that have already suffered high COVID-19 mortality (such as the Northeast). These estimates suggest that caution must be taken in loosening current restrictions if effective additional measures are not put in place. We predict that increased mobility following relaxation of social distancing will lead to resurgence of transmission, keeping all else constant. We predict that deaths over the next two-month period could exceed current cumulative deaths by greater than two-fold, if the relationship between mobility and transmission remains unchanged. Our results suggest that factors modulating transmission such as rapid testing, contact tracing and behavioural precautions are crucial to offset the rise of transmission associated with loosening of social distancing. Overall, we show that while all US states have substantially reduced their reproduction numbers, there is little evidence that any states are approaching herd immunity and thus the epidemic is close to over in any state.

Published
2020
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40. Report 21: Estimating COVID-19 cases and reproduction number in Brazil

Author

Mellan, T, Hoeltgebaum, H, Mishra, S, Whittaker, C, Schnekenberg, R, Gandy, A, Unwin, H, Vollmer, M, Coupland, H, Hawryluk, I, Rodrigues Faria, N, Vesga, J, Zhu, H, Hutchinson, M, Ratmann, O, Monod, M, Ainslie, K, Baguelin, M, Bhatia, S, Boonyasiri, A, Brazeau, N, Charles, G, Cooper, L, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Dighe, A, Djaafara, A, Eaton, J, Van Elsland, S, Fitzjohn, R, Fraser, K, Gaythorpe, K, Green, W, Hayes, S, Imai, N, Jeffrey, B, Knock, E, Laydon, D, Lees, J, Mangal, T, Mousa, A, Nedjati Gilani, G, Nouvellet, P, Olivera Mesa, D, Parag, K, Pickles, M, Thompson, H, Verity, R, Walters, C, Wang, H, Wang, Y, Watson, O, Whittles, L, Xi, X, Okell, L, Dorigatti, I, Walker, P, Ghani, A, Riley, S, Ferguson, N, Donnelly, C, Flaxman, S, Bhatt, S, and Medical Research Council (MRC)

Subjects
Coronavirus, 0303 health sciences, 03 medical and health sciences, 0302 clinical medicine, COVID19, COVID-19, 030212 general & internal medicine, Brazil, 3. Good health, 030304 developmental biology
Abstract

Brazil is an epicentre for COVID-19 in Latin America. In this report we describe the Brazilian epidemic using three epidemiological measures: the number of infections, the number of deaths and the reproduction number. Our modelling framework requires sufficient death data to estimate trends, and we therefore limit our analysis to 16 states that have experienced a total of more than fifty deaths. The distribution of deaths among states is highly heterogeneous, with 5 states—São Paulo, Rio de Janeiro, Ceará, Pernambuco and Amazonas—accounting for 81% of deaths reported to date. In these states, we estimate that the percentage of people that have been infected with SARS-CoV-2 ranges from 3.3% (95% CI: 2.8%-3.7%) in São Paulo to 10.6% (95% CI: 8.8%-12.1%) in Amazonas. The reproduction number (a measure of transmission intensity) at the start of the epidemic meant that an infected individual would infect three or four others on average. Following non-pharmaceutical interventions such as school closures and decreases in population mobility, we show that the reproduction number has dropped substantially in each state. However, for all 16 states we study, we estimate with high confidence that the reproduction number remains above 1. A reproduction number above 1 means that the epidemic is not yet controlled and will continue to grow. These trends are in stark contrast to other major COVID19 epidemics in Europe and Asia where enforced lockdowns have successfully driven the reproduction number below 1. While the Brazilian epidemic is still relatively nascent on a national scale, our results suggest that further action is needed to limit spread and prevent health system overload.

Published
2020

41. Report 20: A sub-national analysis of the rate of transmission of Covid-19 in Italy

Author

Vollmer, M, Mishra, S, Unwin, H, Gandy, A, Melan, T, Bradley, V, Zhu, H, Coupland, H, Hawryluk, I, Hutchinson, M, Ratmann, O, Monod, M, Walker, P, Whittaker, C, Cattarino, L, Ciavarella, C, Cilloni, L, Ainslie, K, Baguelin, M, Bhatia, S, Boonyasiri, A, Brazeau, N, Charles, G, Cooper, L, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Dighe, A, Djaafara, A, Eaton, J, Van Elsland, S, Fitzjohn, R, Fraser, K, Gaythorpe, K, Green, W, Hayes, S, Imai, N, Jeffrey, B, Knock, E, Laydon, D, Lees, J, Mangal, T, Mousa, A, Nedjati Gilani, G, Nouvellet, P, Olivera Mesa, D, Parag, K, Pickles, M, Thompson, H, Verity, R, Walters, C, Wang, H, Wang, Y, Watson, O, Whittles, L, Xi, X, Ghani, A, Riley, S, Okell, L, Donnelly, C, Ferguson, N, Dorigatti, I, Flaxman, S, Bhatt, S, and Medical Research Council (MRC)

Subjects
Coronavirus, Italy, COVID19, Lockdown, COVID-19, Transmission
Abstract

Italy was the first European country to experience sustained local transmission of COVID-19. As of 1st May 2020, the Italian health authorities reported 28; 238 deaths nationally. To control the epidemic, the Italian government implemented a suite of non-pharmaceutical interventions (NPIs), including school and university closures, social distancing and full lockdown involving banning of public gatherings and non essential movement. In this report, we model the effect of NPIs on transmission using data on average mobility. We estimate that the average reproduction number (a measure of transmission intensity) is currently below one for all Italian regions, and significantly so for the majority of the regions. Despite the large number of deaths, the proportion of population that has been infected by SARS-CoV-2 (the attack rate) is far from the herd immunity threshold in all Italian regions, with the highest attack rate observed in Lombardy (13.18% [10.66%-16.70%]). Italy is set to relax the currently implemented NPIs from 4th May 2020. Given the control achieved by NPIs, we consider three scenarios for the next 8 weeks: a scenario in which mobility remains the same as during the lockdown, a scenario in which mobility returns to pre-lockdown levels by 20%, and a scenario in which mobility returns to pre-lockdown levels by 40%. The scenarios explored assume that mobility is scaled evenly across all dimensions, that behaviour stays the same as before NPIs were implemented, that no pharmaceutical interventions are introduced, and it does not include transmission reduction from contact tracing, testing and the isolation of confirmed or suspected cases. We find that, in the absence of additional interventions, even a 20% return to pre-lockdown mobility could lead to a resurgence in the number of deaths far greater than experienced in the current wave in several regions. Future increases in the number of deaths will lag behind the increase in transmission intensity and so a second wave will not be immediately apparent from just monitoring of the daily number of deaths. Our results suggest that SARS-CoV-2 transmission as well as mobility should be closely monitored in the next weeks and months. To compensate for the increase in mobility that will occur due to the relaxation of the currently implemented NPIs, enhanced community surveillance including swab testing, contact tracing and the early isolation of infections are of paramount importance to reduce the risk of resurgence in transmission.

Published
2020
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42. Report 19: The potential impact of the COVID-19 epidemic on HIV, TB and malaria in low- and middle-income countries

Author

Hogan, A, Jewell, B, Sherrard-Smith, E, Vesga, J, Watson, O, Whittaker, C, Hamlet, A, Smith, J, Ainslie, K, Baguelin, M, Bhatt, S, Boonyasiri, A, Brazeau, N, Cattarino, L, Charles, G, Cooper, L, Coupland, H, Cuomo-Dannenburg, G, Dighe, A, Djaafara, A, Donnelly, C, Dorigatti, I, Eaton, J, Van Elsland, S, Fitzjohn, R, Fu, H, Gaythorpe, K, Green, W, Haw, D, Hayes, S, Hinsley, W, Imai, N, Knock, E, Laydon, D, Lees, J, Mangal, T, Mellan, T, Mishra, S, Nedjati Gilani, G, Nouvellet, P, Okell, L, Ower, A, Parag, K, Pickles, M, Stopard, I, Thompson, H, Unwin, H, Verity, R, Vollmer, M, Walters, C, Wang, H, Wang, Y, Whittles, L, Winskill, P, Xi, X, Ferguson, N, Churcher, T, Arinaminpathy, N, Ghani, A, Walker, P, Hallett, T, and Medical Research Council (MRC)

Abstract

COVID-19 has the potential to cause disruptions to health services in different ways; through the health system becoming overwhelmed with COVID-19 patients, through the intervention used to slow transmission of COVID-19 inhibiting access to preventative interventions and services, and through supplies of medicine being interrupted. We aim to quantify the extent to which such disruptions in services for HIV, TB and malaria in high burden low- and middle-income countries could lead to additional loss of life. In high burden settings, HIV, TB and malaria related deaths over 5 years may be increased by up to 10%, 20% and 36%, respectively, compared to if there were no COVID-19 epidemic. We estimate the greatest impact on HIV to be from interruption to ART, which may occur during a period of high or extremely high health system demand; for TB, we estimate the greatest impact is from reductions in timely diagnosis and treatment of new cases, which may result from a long period of COVID-19 suppression interventions; for malaria, we estimate that the greatest impact could come from reduced prevention activities including interruption of planned net campaigns, through all phases of the COVID-19 epidemic. In high burden settings, the impact of each type of disruption could be significant and lead to a loss of life-years over five years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV/TB epidemics. Maintaining the most critical prevention activities and healthcare services for HIV, TB and malaria could significantly reduce the overall impact of the COVID-19 epidemic.

Published
2020
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43. Report 17: Clinical characteristics and predictors of outcomes of hospitalised patients with COVID-19 in a London NHS Trust: a retrospective cohort study

Author

Perez Guzman, PN, Daunt, A, Mukherjee, S, Crook, P, Forlano, R, Kont, M, Lochen, A, Vollmer, M, Middleton, P, Judge, R, Harlow, C, Soubieres, A, Cooke, G, White, P, Hallett, T, Aylin, P, Ferguson, N, Hauck, K, Thursz, M, Nayagam, AS, and Medical Research Council (MRC)

Subjects
Coronavirus, Clinical, COVID19, COVID-19, Mortality
Abstract

Clinical characteristics and determinants of outcomes for hospitalised COVID-19 patients in the UK remain largely undescribed and emerging evidence suggests ethnic minorities might be disproportionately affected. We describe the characteristics and outcomes of patients hospitalised for COVID-19 in three large London hospitals with a multi-ethnic catchment population. We performed a retrospective cohort study on all patients hospitalised with laboratory-confirmed SARS-CoV-2 infection at Imperial College Healthcare NHS Trust between February 25 and April 5, 2020. Outcomes were recorded as of April 19, 2020. Logistic regression models, survival analyses and cumulative competing risk analyses were performed to evaluate factors associated with COVID-19 hospital mortality. Of 520 patients in this cohort (median age 67 years, (IQR 26) and 62% male), 302 (68%) had been discharged alive, 144 (32%) died and 74 (14%) were still hospitalised at the time of censoring. Increasing age (adjusted odds ratio [aOR] 2·16, 95%CI 1·50-3·12), severe hypoxia (aOR 3·75, 95%CI 1·80-7·80), low platelets (aOR 0·65, 95%CI 0.49·0·85), reduced estimated glomerular filtration rate (aOR 4·11, 95%CI 1·58-10·69), bilirubin >21mmol/L (aOR 2·32, 95%CI 1·05-5·14) and low albumin (aOR 0·77, 9%%CI 0·59-1·01) were associated with increased risk of in-hospital mortality. Individual comorbidities were not independently associated with risk of death. Regarding ethnicity, 209 (40%) were from a black and Asian minority, for 115 (22%) ethnicity was unknown and 196 (38%) patients were white. Compared to the latter, black patients were significantly younger and had less comorbidities. Whilst the crude OR of death of black compared to white patients was not significant (1·14, 95%CI 0·69-1·88, p=0.62), adjusting for age and comorbidity showed a trend towards significance (aOR 1·72, 95%CI 0·98-3·02, p=0.06) and further accounting for admission severity (Early Warning Score) showed a significant difference (aOR 1·83 95% CI 1·02-3·30, p=0.04). In the first study to describe the characteristics and predictors of outcome for hospitalised COVID-19 patients in the UK, we find that older age, male sex and admission hypoxia, thrombocytopenia, renal failure, hypoalbuminaemia and raised bilirubin are associated with increased odds of death. Ethnic minority groups were over-represented in our cohort and, compared to whites, people of black ethnicity may be at increased odds of mortality. Further research is urgently needed to investigate these associations on a larger scale.

Published
2020
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44. Report 16: Role of testing in COVID-19 control

Author

Grassly, N, Pons Salort, M, Parker, E, White, P, Ainslie, K, Baguelin, M, Bhatt, S, Boonyasiri, A, Boyd, O, Brazeau, N, Cattarino, L, Ciavarella, C, Cooper, L, Coupland, H, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Dighe, A, Djaafara, A, Donnelly, C, Dorigatti, I, Van Elsland, S, Ferreira Do Nascimento, F, Fitzjohn, R, Fu, H, Gaythorpe, K, Geidelberg, L, Green, W, Hallett, T, Hamlet, A, Hayes, S, Hinsley, W, Imai, N, Jorgensen, D, Knock, E, Laydon, D, Lees, J, Mangal, T, Mellan, T, Mishra, S, Nedjati Gilani, G, Nouvellet, P, Okell, L, Ower, A, Parag, K, Pickles, M, Ragonnet-Cronin, M, Stopard, I, Thompson, H, Unwin, H, Verity, R, Vollmer, M, Volz, E, Walker, P, Walters, C, Wang, H, Wang, Y, Watson, O, Whittaker, C, Whittles, L, Winskill, P, Xi, X, Ferguson, N, and Medical Research Council (MRC)

Subjects
Coronavirus, COVID19, Testing, COVID-19
Abstract

The World Health Organization has called for increased molecular testing in response to the COVID-19 pandemic, but different countries have taken very different approaches. We used a simple mathematical model to investigate the potential effectiveness of alternative testing strategies for COVID-19 control. Weekly screening of healthcare workers (HCWs) and other at-risk groups using PCR or point-of-care tests for infection irrespective of symptoms is estimated to reduce their contribution to transmission by 25-33%, on top of reductions achieved by self-isolation following symptoms. Widespread PCR testing in the general population is unlikely to limit transmission more than contact-tracing and quarantine based on symptoms alone, but could allow earlier release of contacts from quarantine. Immunity passports based on tests for antibody or infection could support return to work but face significant technical, legal and ethical challenges. Testing is essential for pandemic surveillance but its direct contribution to the prevention of transmission is likely to be limited to patients, HCWs and other high-risk groups.

Published
2020

45. Report 13: Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries

Author

Flaxman, S, Mishra, S, Gandy, A, Unwin, H, Coupland, H, Mellan, T, Zhu, H, Berah, T, Eaton, J, Perez Guzman, P, Schmit, N, Cilloni, L, Ainslie, K, Baguelin, M, Blake, I, Boonyasiri, A, Boyd, O, Cattarino, L, Ciavarella, C, Cooper, L, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Dighe, A, Djaafara, A, Dorigatti, I, Van Elsland, S, Fitzjohn, R, Fu, H, Gaythorpe, K, Geidelberg, L, Grassly, N, Green, W, Hallett, T, Hamlet, A, Hinsley, W, Jeffrey, B, Jorgensen, D, Knock, E, Laydon, D, Nedjati Gilani, G, Nouvellet, P, Parag, K, Siveroni, I, Thompson, H, Verity, R, Volz, E, Walters, C, Wang, H, Wang, Y, Watson, O, Winskill, P, Xi, X, Whittaker, C, Walker, P, Ghani, A, Donnelly, C, Riley, S, Okell, L, Vollmer, M, Ferguson, N, Bhatt, S, Medical Research Council (MRC), and The Royal Society

Subjects
Europe, COVID19, Non-pharmaceutical Interventions, Pneumonia, Viral, Coronavirus Infections, CoronaVirus
Abstract

Following the emergence of a novel coronavirus (SARS-CoV-2) and its spread outside of China, Europe is now experiencing large epidemics. In response, many European countries have implemented unprecedented non-pharmaceutical interventions including case isolation, the closure of schools and universities, banning of mass gatherings and/or public events, and most recently, widescale social distancing including local and national lockdowns. In this report, we use a semi-mechanistic Bayesian hierarchical model to attempt to infer the impact of these interventions across 11 European countries. Our methods assume that changes in the reproductive number – a measure of transmission - are an immediate response to these interventions being implemented rather than broader gradual changes in behaviour. Our model estimates these changes by calculating backwards from the deaths observed over time to estimate transmission that occurred several weeks prior, allowing for the time lag between infection and death. One of the key assumptions of the model is that each intervention has the same effect on the reproduction number across countries and over time. This allows us to leverage a greater amount of data across Europe to estimate these effects. It also means that our results are driven strongly by the data from countries with more advanced epidemics, and earlier interventions, such as Italy and Spain. We find that the slowing growth in daily reported deaths in Italy is consistent with a significant impact of interventions implemented several weeks earlier. In Italy, we estimate that the effective reproduction number, Rt, dropped to close to 1 around the time of lockdown (11th March), although with a high level of uncertainty. Overall, we estimate that countries have managed to reduce their reproduction number. Our estimates have wide credible intervals and contain 1 for countries that have implemented all interventions considered in our analysis. This means that the reproduction number may be above or below this value. With current interventions remaining in place to at least the end of March, we estimate that interventions across all 11 countries will have averted 59,000 deaths up to 31 March [95% credible interval 21,000-120,000]. Many more deaths will be averted through ensuring that interventions remain in place until transmission drops to low levels. We estimate that, across all 11 countries between 7 and 43 million individuals have been infected with SARS-CoV-2 up to 28th March, representing between 1.88% and 11.43% of the population. The proportion of the population infected to date – the attack rate - is estimated to be highest in Spain followed by Italy and lowest in Germany and Norway, reflecting the relative stages of the epidemics. Given the lag of 2-3 weeks between when transmission changes occur and when their impact can be observed in trends in mortality, for most of the countries considered here it remains too early to be certain that recent interventions have been effective. If interventions in countries at earlier stages of their epidemic, such as Germany or the UK, are more or less effective than they were in the countries with advanced epidemics, on which our estimates are largely based, or if interventions have improved or worsened over time, then our estimates of the reproduction number and deaths averted would change accordingly. It is therefore critical that the current interventions remain in place and trends in cases and deaths are closely monitored in the coming days and weeks to provide reassurance that transmission of SARS-Cov-2 is slowing.

Published
2020

46. Report 12: The global impact of COVID-19 and strategies for mitigation and suppression

Author

Walker, P, Whittaker, C, Watson, O, Baguelin, M, Ainslie, K, Bhatia, S, Bhatt, S, Boonyasiri, A, Boyd, O, Cattarino, L, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Dighe, A, Donnelly, C, Dorigatti, I, Van Elsland, S, Fitzjohn, R, Flaxman, S, Fu, H, Gaythorpe, K, Geidelberg, L, Grassly, N, Green, W, Hamlet, A, Hauck, K, Haw, D, Hayes, S, Hinsley, W, Imai, N, Jorgensen, D, Knock, E, Laydon, D, Mishra, S, Nedjati Gilani, G, Okell, L, Riley, S, Thompson, H, Unwin, H, Verity, R, Vollmer, M, Walters, C, Wang, H, Wang, Y, Winskill, P, Xi, X, Ferguson, N, Ghani, A, Medical Research Council (MRC), and The Royal Society

Subjects
Coronavirus, COVID19, Global Burden
Abstract

The world faces a severe and acute public health emergency due to the ongoing COVID-19 global pandemic. How individual countries respond in the coming weeks will be critical in influencing the trajectory of national epidemics. Here we combine data on age-specific contact patterns and COVID-19 severity to project the health impact of the pandemic in 202 countries. We compare predicted mortality impacts in the absence of interventions or spontaneous social distancing with what might be achieved with policies aimed at mitigating or suppressing transmission. Our estimates of mortality and healthcare demand are based on data from China and high-income countries; differences in underlying health conditions and healthcare system capacity will likely result in different patterns in low income settings. We estimate that in the absence of interventions, COVID-19 would have resulted in 7.0 billion infections and 40 million deaths globally this year. Mitigation strategies focussing on shielding the elderly (60% reduction in social contacts) and slowing but not interrupting transmission (40% reduction in social contacts for wider population) could reduce this burden by half, saving 20 million lives, but we predict that even in this scenario, health systems in all countries will be quickly overwhelmed. This effect is likely to be most severe in lower income settings where capacity is lowest: our mitigated scenarios lead to peak demand for critical care beds in a typical low-income setting outstripping supply by a factor of 25, in contrast to a typical high-income setting where this factor is 7. As a result, we anticipate that the true burden in low income settings pursuing mitigation strategies could be substantially higher than reflected in these estimates. Our analysis therefore suggests that healthcare demand can only be kept within manageable levels through the rapid adoption of public health measures (including testing and isolation of cases and wider social distancing measures) to suppress transmission, similar to those being adopted in many countries at the current time. If a suppression strategy is implemented early (at 0.2 deaths per 100,000 population per week) and sustained, then 38.7 million lives could be saved whilst if it is initiated when death numbers are higher (1.6 deaths per 100,000 population per week) then 30.7 million lives could be saved. Delays in implementing strategies to suppress transmission will lead to worse outcomes and fewer lives saved. We do not consider the wider social and economic costs of suppression, which will be high and may be disproportionately so in lower income settings. Moreover, suppression strategies will need to be maintained in some manner until vaccines or effective treatments become available to avoid the risk of later epidemics. Our analysis highlights the challenging decisions faced by all governments in the coming weeks and months, but demonstrates the extent to which rapid, decisive and collective action now could save millions of lives.

Published
2020
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47. Report 11: Evidence of initial success for China exiting COVID-19 social distancing policy after achieving containment

Author

Ainslie, K, Walters, C, Fu, H, Bhatia, S, Wang, H, Baguelin, M, Bhatt, S, Boonyasiri, A, Boyd, O, Cattarino, L, Ciavarella, C, Cucunuba Perez, Z, Cuomo-Dannenburg, G, Dighe, A, Dorigatti, I, Van Elsland, S, Fitzjohn, R, Gaythorpe, K, Geidelberg, L, Ghani, A, Green, W, Hamlet, A, Hauck, K, Hinsley, W, Imai, N, Jorgensen, D, Knock, E, Laydon, D, Nedjati Gilani, G, Okell, L, Siveroni, I, Thompson, H, Unwin, H, Verity, R, Vollmer, M, Walker, P, Wang, Y, Watson, O, Whittaker, C, Winskill, P, Xi, X, Donnelly, C, Ferguson, N, Riley, S, Medical Research Council (MRC), and The Royal Society

Subjects
Coronavirus, COVID19, Containment, Social Distancing
Abstract

The COVID-19 epidemic was declared a Global Pandemic by WHO on 11 March 2020. As of 20 March 2020, over 254,000 cases and 10,000 deaths had been reported worldwide. The outbreak began in the Chinese city of Wuhan in December 2019. In response to the fast-growing epidemic, China imposed strict social distancing in Wuhan on 23 January 2020 followed closely by similar measures in other provinces. At the peak of the outbreak in China (early February), there were between 2,000 and 4,000 new confirmed cases per day. For the first time since the outbreak began there have been no new confirmed cases caused by local transmission in China reported for five consecutive days up to 23 March 2020. This is an indication that the social distancing measures enacted in China have led to control of COVID-19 in China. These interventions have also impacted economic productivity in China, and the ability of the Chinese economy to resume without restarting the epidemic is not yet clear. Here, we estimate transmissibility from reported cases and compare those estimates with daily data on within-city movement, as a proxy for economic activity. Initially, within-city movement and transmission were very strongly correlated in the 5 provinces most affected by the epidemic and Beijing. However, that correlation is no longer apparent even though within-city movement has started to increase. A similar analysis for Hong Kong shows that intermediate levels of local activity can be maintained while avoiding a large outbreak. These results do not preclude future epidemics in China, nor do they allow us to estimate the maximum proportion of previous within-city activity that will be recovered in the medium term. However, they do suggest that after very intense social distancing which resulted in containment, China has successfully exited their stringent social distancing policy to some degree. Globally, China is at a more advanced stage of the pandemic. Policies implemented to reduce the spread of COVID-19 in China and the exiting strategies that followed can inform decision making processes for countries once containment is achieved.

Published
2020
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50. Hot gases: the transition from line spectra to thermal radiation

Author

Vollmer, M.

Subjects
Thermal energy -- Research, Atoms -- Research, Physics
Abstract

The question of how the line spectrum of atoms is transformed into the continuous spectrum of thermal radiation of a gas by repeated absorption and emission of photons is addressed. We consider a simple model of a hydrogen-like gas in thermal equilibrium where only the Lyman-[alpha] transition is allowed and calculate the spectra for increasing thickness of the gas. The transition from line spectra for optically thin samples to the spectra of thermal radiation for optically thick samples is demonstrated. We estimate the emissivities for hot gases and study the line width of spectral lines due to self-absorption processes.

Published
2005

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