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This rapid systematic review of evidence asks whether (i) wearing a face mask, (ii) one type of mask over another and (iii) mandatory mask policies can reduce the transmission of SARS-CoV-2 infection, either in community-based or healthcare settings. A search of studies published 1 January 2020–27 January 2023 yielded 5185 unique records. Due to a paucity of randomized controlled trials (RCTs), observational studies were included in the analysis. We analysed 35 studies in community settings (3 RCTs and 32 observational) and 40 in healthcare settings (1 RCT and 39 observational). Ninety five per cent of studies included were conducted before highly transmissible Omicron variants emerged. Ninety one per cent of observational studies were at ‘critical’ risk of bias (ROB) in at least one domain, often failing to separate the effects of masks from concurrent interventions. More studies found that masks (n = 39/48; 81%) and mask mandates (n = 16/18; 89%) reduced infection than found no effect (n = 8/66; 12%) or favoured controls (n = 2/66; 3%). Seven observational studies found that respirators were more protective than surgical masks, while five found no statistically significant difference between the two mask types. Despite the ROB, and allowing for uncertain and variable efficacy, we conclude that wearing masks, wearing higher quality masks (respirators), and mask mandates generally reduced SARS-CoV-2 transmission in these study populations.This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the Covid-19 pandemic: the evidence'.

Genomic sequencing is essential to track the evolution and spread of SARS-CoV-2, optimize molecular tests, treatments, vaccines, and guide public health responses. To investigate the global SARS-CoV-2 genomic surveillance, we used sequences shared via GISAID to estimate the impact of sequencing intensity and turnaround times on variant detection in 189 countries. In the first two years of the pandemic, 78% of high-income countries sequenced >0.5% of their COVID-19 cases, while 42% of low- and middle-income countries reached that mark. Around 25% of the genomes from high income countries were submitted within 21 days, a pattern observed in 5% of the genomes from low- and middle-income countries. We found that sequencing around 0.5% of the cases, with a turnaround time

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. NOTE: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . ONE SENTENCE SUMMARY: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

The SARS‐CoV‐2 Gamma variant spread rapidly across Brazil, causing substantial infection and death wa ves. We use individual‐level patient records following hospitalisation with suspected or confirmed COVID‐19 to document the extensive shocks in hospital fatality rates that followed Gamma’s spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time pe riods. We show that extensive fluctuations in COVID‐19 in‐hospital fatality rates also existed prior to Gamma’s detection, and were largely transient after Gamma’s detection, subsiding with hospital d emand. Using a Bayesian fatality rate model, we find that the geo‐graphic and temporal fluctuations in Brazil’s COVID‐19 in‐hospital fatality rates are primarily associated with geo‐graphic inequities and shortages in healthcare c apacity. We project that approximately half of Brazil’s COVID‐19 deaths in hospitals could have been avoided without pre‐pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly trans‐missible and deadly pathogens such as SARS‐CoV‐2, especially in low‐ and middle‐income countries.

As countries grow eager to reignite their economies and people increasingly yearn for mobility and normalcy in life, pressure is mounting for some form of COVID-19 health status certificate that would support these desires. There has already been an explosion of COVID-19 passport initiatives for domestic use and international travel. But scientific, legal, and ethical concerns abound with such documentation. Given the high stakes, what is the path forward? From doctors' examinations to ship inspections, clean bills of health have secured passage through centuries of human plagues. Today's best-known health passport is the International Certificate of Vaccination or Prophylaxis, created by the World Health Organization (WHO). WHO's Yellow Card has certified vaccinations for cholera, plague, and typhoid, among other infections. There is certainly precedent for a COVID-19 vaccination passport certifying that the holder can travel, study, play, and work without compromising personal or public health. Among newly proposed COVID-19 passport schemes are the WHO's Smart Vaccination Certificate, Israel's “green passport,” the European Union's proposed Digital Green Pass, and the Africa Centres for Disease Control and Prevention's “My COVID Pass.” Given the momentum, what are the main principles that COVID-19 passports should follow to ensure their appropriate use? A COVID-19 passport should be scientifically valid. Passport holders must be protected from illness so that they can carry out the activities for which the passport has been issued and to avoid burdening health services. A passport would ideally certify that holders are not, and cannot become, a source of infection for others. Vaccines have high efficacy in preventing symptomatic COVID-19, and there is growing evidence that they can prevent transmission too. No vaccine is perfect, and it remains to be determined whether vaccines meet minimum requirements for preventing infection and illness. The duration of protection conferred by vaccines should be tied to passport expiry dates, perhaps with options to revoke passports if new coronavirus variants compromise efficacy. These passports should also be judged for their comparative advantage. They may be preferable to viral RNA and antigen tests, which aim to certify that individuals are temporarily free of infection, and to antibody tests, which do not guarantee immunity to infection or disease. The vaccination certificate should be portable, affordable, and linked safely and securely to the identity of the holder. Ideally, it will be internationally standardized with verifiable credentials and based on interoperable technologies. Forgery and personal data security are dominant concerns, but such problems are routinely solved for financial and other sensitive transactions. Many issues surround the fair use of vaccination passports. The widely held view is that documents must avoid discrimination and inequity. Ideally, a passport would be exclusive only with respect to its primary purpose, which is to protect the health of individuals and others with whom they come into contact. But such exclusions inevitably raise barriers elsewhere. Some, such as restrictions on nonessential leisure activities, should be relatively easy to manage. The greatest risk is that people for whom vaccination is unacceptable, untested, inaccessible, or impossible are denied access to essential goods and services. This could happen where there is vaccine hesitancy or refusal among certain ethnic minorities; where there are no data on vaccine efficacy for people at risk, such as children and pregnant women; where migrants are undocumented and unreachable; where passports are exclusively digital, barring people without smartphones; and where people are not yet eligible for vaccination. These examples signal the need for alternatives and exemptions. Some decisions about how to use passports will be made by public debate and consent, drawing on social and ethical norms. Others will be determined by domestic and international law. Some employers have already announced “no jab, no job” policies. In such cases, the freedom of choice for individual employees, set against a firm's duty and preference for the care of all staff, might be tested in court. COVID-19 is a new human disease. The challenges presented by vaccination passports are also new in detail, but mostly familiar in kind. Adding to current, imperfect certification procedures by diagnostic tests, vaccination passports are likely to be widely adopted during the pandemic and its probable sequel, endemic and episodic disease. The choice about how passports are used should be guided by exemplary science, appropriate technologies, and fair use for all.

Type 1 Diabetes (T1D) can occur at any age but is most commonly diagnosed between infancy and late 30s. The SEARCH for Diabetes in Youth study estimated that in 2009 about 18,436 US. Youth were newly diagnosed with T1D. Approximately 70% of these youths were non-Hispanic Whites, 17% were Hispanics, and 11% were non-Hispanic Blacks [1]. T1D is associated with an increased risk for several health problems including cardiovascular diseases [2-4], epilepsy [5], retinopathy [6], and thyroid autoimmunity [7,8]. Studies in Norway found that despite improved diabetes care, mortality remains three to four times higher among those with childhood-onset diabetes compared with the general population [9]. When looking at case management as a whole in regard to diabetes, many problems can be seen with the current management plans and limitations can be seen in the methods used to educate diabetics on their condition. When looking at future paths to take to improve diabetes case management a few can be proposed including evidence-based case management, case management methods that address low health literacy and numeracy and using various phycological behavior theories to see how this adolescent population can be best addressed.

The ongoing COVID-19 outbreak expanded rapidly throughout China. Major behavioral, clinical, and state interventions have been undertaken to mitigate the epidemic and prevent the persistence of the virus in human populations in China and worldwide. It remains unclear how these unprecedented interventions, including travel restrictions, affected COVID-19 spread in China. We use real-time mobility data from Wuhan and detailed case data including travel history to elucidate the role of case importation on transmission in cities across China and ascertain the impact of control measures. Early on, the spatial distribution of COVID-19 cases in China was explained well by human mobility data. Following the implementation of control measures, this correlation dropped and growth rates became negative in most locations, although shifts in the demographics of reported cases were still indicative of local chains of transmission outside Wuhan. This study shows that the drastic control measures implemented in China substantially mitigated the spread of COVID-19.

Asserts that despite progress in controlling tuberculosis (TB), the decline in incidence has been disappointing, pointing to the need for new strategies and more effective tools. HIV/AIDS is one factor that challenges effective control of TB, especially in Southern African countries. Three key elements are needed to achieve effective TB control and to meet the Sustainable Development Goals: (1) early and accurate diagnosis and drug-sensitivity testing, (2) patient access to and completion of effective treatment, and (3) prevention of progression from latent infection to disease. Prevention requires vaccination and screening of individual at high risk as well as interventions such as air disinfection and the use of masks and respirators in hospitals and other congregate settings. Recommendations stress the need to strengthen health systems in high-burden countries by emphasizing community-based care over hospital care; to improve information systems to ensure patient adherence and manage medication supply chains; and to invest in research to develop the necessary interventions. Fundamentally, current global TB control strategies must undergo revision and receive significant research funding.

The 2013–2016 Ebola outbreak in West Africa is the largest on record with 28 616 confirmed, probable and suspected cases and 11 310 deaths officially recorded by 10 June 2016, the true burden probably considerably higher. The case fatality ratio (CFR: proportion of cases that are fatal) is a key indicator of disease severity useful for gauging the appropriate public health response and for evaluating treatment benefits, if estimated accurately. We analysed individual-level clinical outcome data from Guinea, Liberia and Sierra Leone officially reported to the World Health Organization. The overall mean CFR was 62.9% (95% CI: 61.9% to 64.0%) among confirmed cases with recorded clinical outcomes. Age was the most important modifier of survival probabilities, but country, stage of the epidemic and whether patients were hospitalized also played roles. We developed a statistical analysis to detect outliers in CFR between districts of residence and treatment centres (TCs), adjusting for known factors influencing survival and identified eight districts and three TCs with a CFR significantly different from the average. From the current dataset, we cannot determine whether the observed variation in CFR seen by district or treatment centre reflects real differences in survival, related to the quality of care or other factors or was caused by differences in reporting practices or case ascertainment.

The Ebola virus has caused substantial illness in West Africa during the past 2 years. In this report, potential differences in the burden of illness between male and female persons are investigated.

This document provides an overview of the key findings from this five-year ground-breaking research project about the experiences of lesbian, gay, bisexual, trans and questioning (LGBTQ) 16-25year olds in England funded by the Big Lottery Fund and conducted by METRO Charity in collaboration with Ergo Consulting and the University of Greenwich. \ud \ud Methods: The project surveyed 7,126 young people aged 16-25. Of these 6,514 were LGBTQ young people. 612 were heterosexual non-trans young people and 956 were trans young people. 29 commissioners of services for young people and 52 relevant service providers across England were also surveyed.\ud \ud Findings: Show high levels of discrimination, abuse and mental health issues that young LGBTQ people face which indicate a need for more to be done to improve the lives of LGBTQ young people. \ud \ud Sections of the report are:\ud \ud 1. Being different\ud Over half of LGBQ respondents (53%) knew they were LGBQ by the age of 13. Over half of trans respondents (58%) knew they were trans by the same age. When coming out as LGBQ or trans, over four fifths of LGBQ respondents (81%) and nearly two thirds of trans respondents (62%) told a friend first. Over a quarter of LGBQ young people (29%) have not told their mother, nearly a half (45%) have not told their father, and 5% have not told anybody. Approximately half of trans respondents have not told parents or siblings that they are trans and 28% have not told anybody. Young people tell us that they most want emotional support to help them when they are coming out but most are not getting it.\ud The second most important thing to them is to meet other LGBTQ people and again over half of them did not get this opportunity.\ud \ud 2. Participation\ud LGBTQ young people are twice as likely not to feel accepted in the area where they currently live, compared to heterosexual non-trans young people. 59% of LGBTQ young people that would be interested in joining a religious organisation have stopped or reduced their involvement owing to their sexuality or gender identity. Over a third of LGBTQ young people (34%) are not able to be open about their sexuality or gender identity at a sports club they are involved in.\ud \ud 3. Staying safe\ud 73% of the LGBTQ sample agreed that discrimination against LGB people is still common and 90% of the LGBTQ sample agreed that discrimination against trans people is still common. About three quarters of LGBTQ young people (74%) have experienced name calling, nearly a half (45%) have experienced harassment or threats and intimidation and almost a quarter (23%) have experienced physical assault.\ud 88% of LGBTQ young people do not report incidents to the police and when cases are reported only 10% lead to a conviction. 29% of LGBTQ respondents reported domestic or familial abuse, compared to 25% of the heterosexual non trans group. Over a third (36%) of LGBTQ respondents cited their sexuality or gender identity as at least a contributing factor in the abuse. Almost one in five (18%) LGBTQ young people have experienced some form of sexual abuse, compared with one in ten (11%) of non-trans heterosexuals in our sample. Most LGBTQ respondents who have experienced sexual abuse (79%) have not received any help or support. Nearly one in ten LGBTQ young people report that they have had to leave home for reasons relating to their sexuality or gender identity.\ud \ud 4. Enjoying and achieving\ud Nearly half of LGBTQ young people (49%) reported that their time at school was affected by discrimination or fear of discrimination. Consequences reported included missing lessons, achieving lower grades, feeling isolated and left out and having to move schools are all reported. 61% reported name calling because they were LGBTQ or people thought they were. This figure includes the experiences of heterosexual non-trans respondents: it is an issue for all young people. About one in five LGBTQ young people experience physical attack at school on account of their sexual identity or gender identity. The majority do not report this and only a small proportion of those who do experience resolution. For some reporting the abuse means that it gets worse. Around two thirds of LGBTQ young people say they learn a lot about relationships and safer sex between a man and a woman, compared to less than 5% who say they learn a lot about same sex relationships and safer sex.\ud 89% of LGBTQ young people report learning nothing about bisexuality issues and 94% report learning nothing about transgender issues. Only 25% of LGBTQ young people report that they learned anything at school about safer sex for a male couple.

Mathematical modeling of infectious diseases The spread of infectious diseases can be unpredictable. With the emergence of antibiotic resistance and worrying new viruses, and with ambitious plans for global eradication of polio and the elimination of malaria, the stakes have never been higher. Anticipation and measurement of the multiple factors involved in infectious disease can be greatly assisted by mathematical methods. In particular, modeling techniques can help to compensate for imperfect knowledge, gathered from large populations and under difficult prevailing circumstances. Heesterbeek et al. review the development of mathematical models used in epidemiology and how these can be harnessed to develop successful control strategies and inform public health policy. Science , this issue 10.1126/science.aaa4339

The monosaccharide anhydrides (MAs) levoglucosan, galactosan and mannosan are products of incomplete combustion and pyrolysis of cellulose and hemicelluloses, and are found to be major constituents of biomass burning (BB) aerosol particles. Hence, ambient aerosol particle concentrations of levoglucosan are commonly used to study the influence of residential wood burning, agricultural waste burning and wildfire emissions on ambient air quality. A European-wide intercomparison on the analysis of the three monosaccharide anhydrides was conducted based on ambient aerosol quartz fiber filter samples collected at a Norwegian urban background site during winter. Thus, the samples' content of MAs is representative for BB particles originating from residential wood burning. The purpose of the intercomparison was to examine the comparability of the great diversity of analytical methods used for analysis of levoglucosan, mannosan and galactosan in ambient aerosol filter samples. Thirteen laboratories participated, of which three applied high-performance anion-exchange chromatography (HPAEC), four used high-performance liquid chromatography (HPLC) or ultra-performance liquid chromatography (UPLC) and six resorted to gas chromatography (GC). The analytical methods used were of such diversity that they should be considered as thirteen different analytical methods. All of the thirteen laboratories reported levels of levoglucosan, whereas nine reported data for mannosan and/or galactosan. Eight of the thirteen laboratories reported levels for all three isomers. The accuracy for levoglucosan, presented as the mean percentage error (PE) for each participating laboratory, varied from −63 to 20%; however, for 62% of the laboratories the mean PE was within ±10%, and for 85% the mean PE was within ±20%. For mannosan, the corresponding range was −60 to 69%, but as for levoglucosan, the range was substantially smaller for a subselection of the laboratories; i.e. for 33% of the laboratories the mean PE was within ±10%. For galactosan, the mean PE for the participating laboratories ranged from −84 to 593%, and as for mannosan 33% of the laboratories reported a mean PE within ±10%. The variability of the various analytical methods, as defined by their minimum and maximum PE value, was typically better for levoglucosan than for mannosan and galactosan, ranging from 3.2 to 41% for levoglucosan, from 10 to 67% for mannosan and from 6 to 364% for galactosan. For the levoglucosan to mannosan ratio, which may be used to assess the relative importance of softwood versus hardwood burning, the variability only ranged from 3.5 to 24 . To our knowledge, this is the first major intercomparison on analytical methods used to quantify monosaccharide anhydrides in ambient aerosol filter samples conducted and reported in the scientific literature. The results show that for levoglucosan the accuracy is only slightly lower than that reported for analysis of SO42- (sulfate) on filter samples, a constituent that has been analysed by numerous laboratories for several decades, typically by ion chromatography and which is considered a fairly easy constituent to measure. Hence, the results obtained for levoglucosan with respect to accuracy are encouraging and suggest that levels of levoglucosan, and to a lesser extent mannosan and galactosan, obtained by most of the analytical methods currently used to quantify monosaccharide anhydrides in ambient aerosol filter samples, are comparable. Finally, the various analytical methods used in the current study should be tested for other aerosol matrices and concentrations as well, the most obvious being summertime aerosol samples affected by wildfires and/or agricultural fires.