COVID-19 Case Fatality Rates Research Articles

Health system characteristics and COVID-19 performance in high-income countries

BackgroundThe COVID-19 pandemic has shaken everyday life causing morbidity and mortality across the globe. While each country has been hit by the pandemic, individual countries have had different infection and health trajectories. Of all welfare state institutions, healthcare has faced the most immense pressure due to the pandemic and hence, we take a comparative perspective to study COVID-19 related health system performance. We study the way in which health system characteristics were associated with COVID-19 excess mortality and case fatality rates before Omicron variant.MethodsThis study analyses the health system performance during the pandemic in 43 OECD countries and selected non-member economies through three healthcare systems dimensions: (1) healthcare finance, (2) healthcare provision, (3) healthcare performance and health outcomes. Health system characteristics-related data is collected from the Global Health Observatory data repository, the COVID-19 related health outcome indicators from the Our World in Data statistics database, and the country characteristics from the World Bank Open Data and the OECD statistics databases.ResultsWe find that the COVID-19 excess mortality and case fatality rates were systematically associated with healthcare system financing and organizational structures, as well as performance regarding other health outcomes besides COVID-19 health outcomes.ConclusionInvestments in public health systems in terms of overall financing, health workforce and facilities are instrumental in reducing COVID-19 related mortality. Countries aiming at improving their pandemic preparedness may develop health systems by strengthening their public health systems.

High variability of COVID-19 case fatality rate in Germany

BackgroundDuring the first wave of the COVID-19 pandemic a high case fatality rate (CFR) was noticed worldwide including also Germany where the first European cases have been observed. The WHO recommended immediate intubation for patients with dyspnoea which has since been revised after reviewing the initial clinical outcome. The objective of this study is to analyze CFR and assess if there is an advantage of a more conservative management of COVID-19 induced hypoxemia.MethodsPCR confirmed COVID-19 infections and death counts were obtained for all German districts from 27 Jan 2020 until 15 Feb 2021 using official reports of Robert Koch Institute Berlin, Germany. A moving average CFRt was constructed by dividing disease related deaths two weeks after a given index day by the number of infections two weeks prior to that date. In addition to a local comparison also mortality outcomes in other German speaking countries were compared.ResultsThe mean CFR is estimated to be 2.92% based on 71.965 fatalities and 2.465.407 cases. There was a large regional scattering of CFRs across the German districts. Differences of the mortality pattern were observed also at state level and preserved across different sex and age groups while being largely independent of case numbers. Although Munich city had higher infection rates, more patients died during the first wave in Hamburg (OR 1.6, 95% CI 1.3–1.9) which was mirrored also by higher death risk at Hamburg intensive care units (OR 2.0, 95% CI 1.3–3.1). While the majority of Munich hospitals favoured a conservative management of hypoxemia including high flow nasal cannula (HFNC), Hamburg hospitals followed a more aggressive scheme of early mechanical ventilation (MV). Austria and Switzerland experienced higher CFRs than Germany during the first wave but after changing their treatment guidelines, both countries experienced lower CFRs during the second wave.ConclusionUsing retrospective public health data, different case fatality rates have been observed across Germany. A more conservative management of COVID-19 induced Adult Respiratory Distress Syndrome (ARDS) is justified also by epidemiological data.

The Possible Therapeutic Application of CO on COVID-19

An outbreak of pneumonia caused by a novel Coronavirus (2019-nCoV) is ongoing in China [1]. The disease caused by 2019-nCoV was recently named as COVID-19 by WHO. Although the case-fatality rate of COVID-19 (about 2.3% up to now) is lower than SARS, they share many similarities [2,3]. Early studies have shown that increased pro-inflammatory cytokines were associated with pulmonary inflammation and extensive lung damage in SARS patients [4], while the latest report on COVID-19 showed that 2019-nCoV infection lead to high amounts of both Th1 and Th2 cytokines [5]. Moreover, ICU patients had higher levels of GCSF, IP10, TNFα, MCP1, IL2, IL7, IL10, MIP1A, suggesting the cytokine storm was associated with disease severity [5]. Corticosteroid therapy was frequently gave as a combined regimen for possible benefit by reducing inflammatory-induced lung injury. However, the drug is immunosuppressive and may delay viral clearance if given before viral replication is controlled [6], side-effects of corticosteroid also occurred in other cases [7]. Therefore, novel anti-inflammatory molecules could be considered in the treatment of COVID-19.

Estimation and prediction of the multiply exponentially decaying daily case fatality rate of COVID-19.

The spread of the COVID-19 disease has had significant social and economic impacts all over the world. Numerous measures such as school closures, social distancing, and travel restrictions were implemented during the COVID-19 pandemic outbreak. Currently, as we move into the post-COVID-19 world, we must be prepared for another pandemic outbreak in the future. Having experienced the COVID-19 pandemic, it is imperative to ascertain the conclusion of the pandemic to return to normalcy and plan for the future. One of the beneficial features for deciding the termination of the pandemic disease is the small value of the case fatality rate (CFR) of coronavirus disease 2019 (COVID-19). There is a tendency of gradually decreasing CFR after several increases in CFR during the COVID-19 pandemic outbreak. However, it is difficult to capture the time-dependent CFR of a pandemic outbreak using a single exponential coefficient because it contains multiple exponential decays, i.e., fast and slow decays. Therefore, in this study, we develop a mathematical model for estimating and predicting the multiply exponentially decaying CFRs of the COVID-19 pandemic in different nations: the Republic of Korea, the USA, Japan, and the UK. We perform numerical experiments to validate the proposed method with COVID-19 data from the above-mentioned four nations.

Race, employment, and the pandemic: An exploration of covariate explanations of COVID-19 case fatality rate variance.

We derive a simple asymptotic approximation for the long-run case fatality rate of COVID-19 (alpha and delta variants) and show that these estimations are highly correlated to the interaction between US State median age and projected US unemployment rate (Adj. r2 = 60%). We contrast this to the high level of correlation between point (instantaneous) estimates of per state case fatality rates and the interaction of median age, population density and current unemployment rates (Adj. r2 = 50.2%). To determine whether this is caused by a "race effect," we then analyze unemployment, race, median age and population density across US states and show that adding the interaction of African American population and unemployment explains 53.5% of the variance in COVID case fatality rates for the alpha and delta variants when considering instantaneous case fatality rate. Interestingly, when the asymptotic case fatality rate is used, the dependence on the African American population disappears, which is consistent with the fact that in the long-run COVID does not discriminate on race, but may discriminate on access to medical care which is highly correlated to employment in the US. The results provide further evidence of the impact inequality can have on case fatality rates in COVID-19 and the impact complex social, health and economic factors can have on patient survival.

The case fatality rate of COVID‐19 during the Delta and the Omicron epidemic phase: A meta‐analysis

As coronavirus variants are constantly occurring, we tried to understand more about the omicron and delta variants that have hit the world. We provided dynamic information on the case fatality rate (CFR) of the Omicron variant over time and to compare it with that of the Delta variant through meta-analysis.Twenty-four countries were selected by submission counts, submission dates, and confirmed cases. We defined the Delta or the Omicron epidemic period for individual countries as when each variant is over 90%. We further analyzed the Omicron period by dividing it into the initial plateau, increasing, and decreasing phases according to the number of newly confirmed daily cases. Finally, the meta-analysis examined the summary and between-study heterogeneity.The CFR of COVID-19 during the Omicron epidemic was lower than that during the Delta epidemic (odds ratio [OR]: 0.252, 95% confidence interval [CI] 0.205-0.309). The CFR of COVID-19 during the initial plateau phase of Omicron was higher than during other phases. (OR: 1.962, 95% CI 1.607-2.397). The CFR of COVID-19 during the increasing phase was lower than during the decreasing phases (OR: 0.412, 95% CI 0.342-0.498).The Omicron variant had lower CFR compared to the Delta variant, and the initial plateau phase had higher CFR compared to the noninitial phases. These results can help establish global health policies for COVID-19 in the future.

Seasonal Variation and Geographical Distribution of COVID-19 across Nigeria (March 2020-July 2021).

Globally, the novel corona virus infection has continued to witness a growing number of cases since December 2019 when the outbreak was discovered and noted in China. Despite this has not been well studied for the case of COVID-19, human contact, public moveableness and environmental variables could have an impact onairborne'spropagation and virus continuance, such as influenza virus. This study aimed to determine the seasonal variation and geographical distribution of COVID-19 across Nigeria. An internet based archival research design was employed for this study on the seasonal variation and geographical distribution of COVID-19 across Nigeria. This involved the use of goggle mobility data and world map on Corona Virus Infection (COVID-19). The search strategy for getting information for this research was done electronically. The keywords in the case search using the goggle mobility software was "COVID-19 Update", "COVID-19 Update in Nigeria", 'COVID-19 Winter Report', "COVID-19 Case Fatality March 2020-July 2021", "COVID-19 Case Fatality in Nigeria". The data gotten from the goggle motor updates were entered into Statistical Package for the Social Sciences (SPSS) which was used in the analysis of the study. Results from the study, reported that official COVID-19 cases number was significantly higher in the Dry season (October 2020-April 2021) with 59.0% (127,213) compared to 41.0% (85,176) in the wet/rainy season (May-September) it revealed that the dry and rainy seasons had a COVID-19 prevalence of 0.063 and 0.041 respectively. Further results from the study showed that the prevalence of COVID-19 was 0.07% in the North-Central, 0.04% in both the North-East and North-West, 0.03% in the South-West, 0.09% in the South-South, and the highest prevalence of 0.16% in the South-East. Considering the case Fatality rate of COVID-19 during the Dry and Wet Seasons. The study revealed that North-Central had a death toll of 196 (10.4%) out of 9457 confirmed COVID-19 cases hence a fatality of 2.07. Fatality rate of 1.49% in South western Nigeria, South-South Nigeria, 1.49%, South-East accounted to a fatality rate of 1.25%. Nigeria based on the finding of this study records increased fatality in Dry season over wet seasons. The study concluded that prevalence of COVID-19 varies in seasons in Nigeria Hence; further Data and Meteorological analysis on weather variations towards the SARS-CoV-2 Virus spread should be evaluated by future researchers. It is imperative to ensure strict and controlled application of social measures, such as social distancing, mandatory wearing of non-medical masks to prevent droplets from entering the respiratory tract, screening of affected patients along with quarantine is essential to defeat and improve infection control.

COVID-19 infection rate but not severity is associated with availability of greenness in the United States

Human exposure to greenness is associated with COVID-19 prevalence and severity, but most relevant research has focused on the relationships between greenness and COVID-19 infection rates. In contrast, relatively little is known about the associations between greenness and COVID-19 hospitalizations and deaths, which are important for risk assessment, resource allocation, and intervention strategies. Moreover, it is unclear whether greenness could help reduce health inequities by offering more benefits to disadvantaged populations. Here, we estimated the associations between availability of greenness (expressed as population-density-weighted normalized difference vegetation index) and COVID-19 outcomes across the urban–rural continuum gradient in the United States using generalized additive models with a negative binomial distribution. We aggregated individual COVID-19 records at the county level, which includes 3,040 counties for COVID-19 case infection rates, 1,397 counties for case hospitalization rates, and 1,305 counties for case fatality rates. Our area-level ecological study suggests that although availability of greenness shows null relationships with COVID-19 case hospitalization and fatality rates, COVID-19 infection rate is statistically significant and negatively associated with more greenness availability. When performing stratified analyses by different sociodemographic groups, availability of greenness shows stronger negative associations for men than for women, and for adults than for the elderly. This indicates that greenness might have greater health benefits for the former than the latter, and thus has limited effects for ameliorating COVID-19 related inequity. The revealed greenness-COVID-19 links across different space, time and sociodemographic groups provide working hypotheses for the targeted design of nature-based interventions and greening policies to benefit human well-being and reduce health inequity. This has important implications for the post-pandemic recovery and future public health crises.

Spatial shifting of COVID-19 clusters and disease association with environmental parameters in India: A time series analysis

BackgroundThe viability and virulence of COVID-19 are complex in nature. Although the relationship between environmental parameters and COVID-19 is well studied across the globe, in India, such studies are limited. This research aims to explore long-term exposure to weather conditions and the role of air pollution on the infection spread and mortality due to COVID-19 in India. MethodDistrict-level COVID-19 data from April 26, 2020 to July 10, 2021 was used for the study. Environmental determinants such as land surface temperature, relative humidity (RH), Sulphur dioxide (SO2), Nitrogen dioxide (NO2), Ozone (O3), and Aerosol Optical Depth (AOD) were considered for analysis. The bivariate spatial association was used to explore the spatial relationship between Case Fatality Rate (CFR) and these environmental factors. Further, the Bayesian multivariate linear regression model was applied to observe the association between environmental factors and the CFR of COVID-19. ResultsSpatial shifting of COVID-19 cases from Western to Southern and then Eastern parts of India were well observed. The infection rate was highly concentrated in most of the Western and Southern regions of India, while the CFR shows more concentration in Northern India along with Maharashtra. Four main spatial clusters of infection were recognized during the study period. The time-series analysis indicates significantly more CFR with higher AOD, O3, and NO2 in India. ConclusionsCOVID-19 is highly associated with environmental parameters and air pollution in India. The study provides evidence to warrant consideration of environmental parameters in health models to mediate potential solutions. Cleaner air is a must to mitigate COVID-19.

Risk of mental disorders and malnutrition in elderly COVID-19 survivors: An observational study

Background: The incidence rate of COVID-19 is around 11-15% in the elderly. The case fatality rate (CFR) of COVID-19 in the elderly is around 8.9% and increases with age. The risk of mental disorders and malnutrition is increased in COVID-19 survivors. Continuous inflammatory conditions result in a state of hypercatabolism that can disrupt brain neuroendocrine and protein consumption for the formation of acute-phase reactant proteins. Mental disorders and malnutrition can lead to fragility. The aim of this study was to assess the risk of mental disorders and malnutrition in elderly survivors of COVID-19. Methods: This research was a cross-sectional study. The results of the research on age, disease symptoms, and comorbidities have proven that they are risk factors for mental disorders and malnutrition in elderly COVID-19 survivors. This study used total sampling and included 100 study subjects. The research was conducted in Depok for two months; data was collected directly through shared questionnaires and direct anthropometric measurements. The questionnaires used were the SRQ-20 tool for mental disorder screening and MNA for malnutrition screening. Results: The risk factors for mental disorders were age over 70 years old OR 3 (CI 1.0-8.8), severe COVID-19 symptoms OR 4.5 (CI 1.2-16.17), and multi-comorbidity OR 2.3 (CI 0.6-8.8). The risk factors for malnutrition were age higher than 70 years old OR 2.5 (CI 0.8-7.9), moderate COVID-19 symptoms OR 6.3 (CI 2.0-19.81), and multi-comorbidity OR 6.6 (CI 1.5-28.5). Conclusions: Those infected with COVID-19 have a risk of mental disorders and malnutrition, especially in geriatrics, and this risk increases with age.

Desigualdade socioeconômica na letalidade e no cuidado hospitalar de crianças e adolescentes internados por COVID-19 no Brasil

To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence. Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender. The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves. Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.

Epidemic Features of COVID-19 and Potential Impact of Hospital Strain During the Omicron Wave - Australia, 2022.

Hospitals have experienced a surge in admissions due to the increasing number of Omicron cases. Understanding the epidemiological features of coronavirus disease 2019 (COVID-19) and the strain it places on hospitals will provide scientific evidence to help policymakers better prepare for and respond to future outbreaks. The case fatality rate of COVID-19 was 1.4 per 1,000 persons during the Omicron wave. Over 90% of COVID-19-related deaths occurred in individuals aged 60 years or older, with pre-existing chronic conditions such as cardiac conditions and dementia, particularly among males aged 80 years or older. Public health policy is essential for preparing and preserving medical resource capacity, as well as recruiting additional clinicians and front-line staff in hospitals to address the increased demand. High-risk individuals should be prioritized for healthcare, vaccines, and targeted interventions.

Correlation Between Diabetes and COVID-19 Indices: A Global Level Ecological Study.

Coronavirus is threatening the global public health as a new and widespread crisis. The researchers must keep in mind that one of the most vulnerable groups to COVID-19 are the people with underlying diseases, especially diabetes. This ecological study aimed to investigate the correlation between diabetes and the epidemiological indices of COVID-19. This ecological study included 144 countries. Their available data consists of the cumulative incidence rate of cases, cumulative incidence rate of death, recovery rate, case fatality rate, and performed tests of COVID-19, and diabetes. To collect the variables, a data set was provided which included the information of 144 countries based on diabetes and COVID-19 indices. Spearman coefficients were used for assess correlation between diabetes and COVID-19 indices. Also, Scatter plots of diabetes for the studied countries were drawn based on cumulative incidence rate of cases, cumulative incidence rate of death, tests, recovery rate, and case fatality rate of COVID-19. The results of this ecological study showed in total countries, there was a weak positive correlation between diabetes and cumulative incidence rate of cases and also cumulative incidence rate of death. Correlation between diabetes with test of COVID-19 was very weak. Scatter plots showed a weak liner correlation between diabetes and cumulative incidence rate of cases, cumulative incidence rate of death and test of COVID-19. In this study, there was a weak positive correlation between diabetes and cumulative incidence rate of cases, cumulative incidence rate of death, and performed test of COVID-19. This disease is an enormous challenge for health policymakers; therefore, it is necessary to develop strategies and practical guidelines specific to each region to take the necessary care, especially for diabetic patients.

Uncovering common pathobiological processes between COVID-19 and pulmonary arterial hypertension by integrating Omics data.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which led to the current pandemic. Many factors, including age and comorbidities, influence the severity and mortality of COVID-19. SARS-CoV-2 infection can cause pulmonary vascular dysfunction. The COVID-19 case-fatality rate in patients with pulmonary arterial hypertension (PAH) is higher in comparison with the general population. In this study, we aimed to identify pathobiological processes common to COVID-19 and PAH by utilizing the human protein-protein interactome and whole-genome transcription data from peripheral blood mononuclear cells (PBMCs) and from lung tissue. We found that there are significantly more interactions between SARS-CoV-2 targets and PAH disease proteins than expected by chance, suggesting that the PAH disease module is in the neighborhood of SARS-CoV-2 targets in the human interactome. In addition, SARS-CoV-2 infection-induced changes in gene expression significantly overlap with PAH-induced gene expression changes in both tissues, indicating SARS-CoV-2 and PAH may share common transcriptional regulators. We identified many upregulated genes and downregulated genes common to COVID-19 and PAH. Interestingly, we observed different co-regulation patterns and dysfunctional signaling pathways in PBMCs versus lung tissue. Endophenotype enrichment analysis revealed that genes regulating fibrosis, inflammation, hypoxia, oxidative stress, immune response, and thromboembolism are significantly enriched in the COVID-19-PAH co-expression modules. We examined the network proximity of the targets of repositioned drugs for COVID-19 to the co-expression modules in PBMCs and lung tissue, and identified 42 drugs that can be potentially used for COVID-19 patients with PAH as a comorbidity. The uncovered common pathobiological pathways arecrucial for discovering therapeutic targets and designing tailored treatments for COVID-19 patients who also have PAH.

Risk factors associated with COVID-19 morbidity and mortality at a national tertiary referral treatment centre in Ghana: a retrospective analysis

Introduction: there is a substantial variation in COVID-19 case fatality rates across different locations, which may be due to differences in population age structure, patient factors, or health system factors. The study evaluated the clinical features and risk of COVID-19 morbidity and mortality among confirmed cases at COVID-19 referral treatment centre.

Efficiency Evaluation of European Countries Based on Case Fatality Rate of COVID-19 Using Data Envelopment Analysis

The COVID-19 pandemic appeared in China on 31 December 2019, and it spread fast in every part of the world, especially, in European countries like Italy and France, consequently, the search for a resolution to this pandemic in all these countries should also be taken into account. The current study aimed to evaluate the efficiency of European Countries based on the case fatality rate of COVID-19, The sample spans 30 countries, the analysis made recourse to Data Envelopment Analysis, the study used population density and total cases as input indicators and case fatality rate (CFR) as output indicator. The results demonstrate that of 30 countries analyzed, only 6 proved efficient. The average efficiency of inefficient countries is 0.372. Greece achieved the least efficiency rate compared to other European countries. The highest case fatality rate has been registered in Belgium, the lowest case fatality rate has been registered in Monaco. We engaged in a year-long battle with a virus that has destroyed this world, that has caused pain, loss, and frustration and that has cost so many lives.

Spatial-temporal differences of COVID-19 vaccinations in the U.S.

Although the disparities in COVID-19 outcomes have been proved, they have not been explicitly associated with COVID-19 full vaccinations. This paper examines the spatial and temporal patterns of the county-level COVID-19 case rates, fatality rates, and full vaccination rates in the United States from December 24, 2020 through September 30, 2021. Statistical and geospatial analyses show clear temporal and spatial patterns of the progression of COVID-19 outcomes and vaccinations. In the relationship between two time series, the fatality rates series was positively related to past lags of the case rates series. At the same time, case rates series and fatality rates series were negatively related to past lags of the full vaccination rates series. The lag level varies across urban and rural areas. The results of partial correlation, ordinary least squares (OLS) and Geographically Weighted Regression (GWR) also confirmed that the existing COVID-19 infections and different sets of socioeconomic, healthcare access, health conditions, and environmental characteristics were independently associated with COVID-19 vaccinations over time and space. These results empirically identify the geographic health disparities with COVID-19 vaccinations and outcomes and provide the evidentiary basis for targeting pandemic recovery and public health mitigation actions.

Epidemiological Study of COVID-19 in Iran and the World: A Review Study.

COVID-19 is a new virus of the Coronaviridae family that is now spreading worldwide. Therefore, disseminating information about patients with the virus can help identify the virus, pathogenesis, and find treatments. The current study aimed to review the new coronavirus (COVID-19). To reach this aim, we searched keywords containing COVID-19, coronavirus, respiratory infection, epidemiology in Pub Med, Web of Science Direct, Scopus, Scientific Information Databases, and Google scholar. The results of our search led to the achievement of articles on the study of COVID-19. Based on the results of the study, COVID-19 is a global transmitter with rapid transmission power for which no specific drug has yet been found to treat it. The rapid spread of the COVID-19 virus, the relationship between disease severity and mortality with various factors, respiratory transmission, especially in the short distance, masks, hand washing, and physical distance observance as the most important way to prevent, diversify clinical symptoms and at the same time fever and cough as the most common clinical symptoms, treatment with non-specific antiviral drugs and treatment based on controlling clinical symptoms and strengthening immunity with known drugs, paying attention to children as asymptomatic carriers, and pretentious pregnancy in the event of COVID-19 are the most important findings of this study. The case fatality rate of COVID-19 has varied from 0.08% to 10.8% in the world, but fortunately, the number of patients who have recovered is very promising and more than 66 million people have recovered. There is still no effective drug or vaccine to prevent the disease and investigation in this field is ongoing. The only way to prevent and control the disease is adherence to the health protocols. Due to the need of the medical community to achieve the scientific results of this epidemic in Iran and other parts of the world, this article was written.

Effective Pandemic Response: Lessons from Kauai.

Local health jurisdictions have struggled to protect their communities during the pandemic, and successes are few. The Kauai District Health Office (KDHO) of the Hawaii Department of Health serves a rural island community of 73,000 residents. As a state agency, KDHO works closely with the county mayor and administration. Kauai has experienced comparatively low COVID-19 case and case-fatality rates while maintaining strong community and leadership cohesion. Kauai's response was highly rated by residents in a recent Community Assessment for Public Health Emergency Response survey. In this article, we describe examples of local response efforts in the areas of (1) policy and regulations, (2) health-directed isolation and quarantine, (3) case investigation and contact tracing, (4) testing availability, (5) vaccine rollout and availability, and (6) public information, as well as the factors that have contributed to Kauai's successes. KDHO regularly prioritizes agencywide initiatives that cross program silos; staff have experience using the incident command system in real-world situations; the community health worker team is multicultural, multilingual, and well established; and staff are integral members of the community they serve. Preexisting partnerships were strong, including those with county agencies, healthcare partners, and nongovernmental organizations, which facilitated early and effective collaboration. Response successes include implementation of unified command, coordinated public messaging, early protective measures, effective disease control and outbreak response, attention to secondary impacts of the pandemic, free community testing, mass vaccination, and mobile vaccinations and testing. The value of local health departments engaging regularly and authentically with partners and communities cannot be overstated. It has saved lives on Kauai. Local health jurisdictions should focus on all-hazards and all-staff endeavors to enhance their disaster response effectiveness.

Impact of good governance, economic growth and universal health coverage on COVID-19 infection and case fatality rates in Africa

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disrupted lives across all countries and communities. It significantly reduced the global economic output and dealt health systems across the world a serious blow. There is growing evidence showing the progression of the COVID-19 pandemic and the impact it has on health systems, which should help to draw lessons for further consolidating and realizing universal health coverage (UHC) in all countries, complemented by more substantial government commitment and good governance, and continued full implementation of crucial policies and plans to avert COVID-19 and similar pandemic threats in the future. Therefore, the objective of the study was to assess the impact of good governance, economic growth and UHC on the COVID-19 infection rate and case fatality rate (CFR) among African countries.MethodsWe employed an analytical ecological study design to assess the association between COVID-19 CFR and infection rate as dependent variables, and governance, economic development and UHC as independent variables. We extracted data from publicly available databases (i.e., Worldometer, Worldwide Governance Indicators, Our World in Data and WHO Global Health Observatory Repository). We employed a multivariable linear regression model to examine the association between the dependent variables and the set of explanatory variables. STATA version 14 software was used for data analysis.ResultsAll 54 African countries were covered by this study. The median observed COVID-19 CFR and infection rate were 1.65% and 233.46%, respectively. Results of multiple regression analysis for predicting COVID-19 infection rate indicated that COVID-19 government response stringency index (β = 0.038; 95% CI 0.001, 0.076; P = 0.046), per capita gross domestic product (GDP) (β = 0.514; 95% CI 0.158, 0.87; P = 0.006) and infectious disease components of UHC (β = 0.025; 95% CI 0.005, 0.045; P = 0.016) were associated with COVID-19 infection rates, while noncommunicable disease components of UHC (β = −0.064; 95% CI −0.114; −0.015; P = 0.012), prevalence of obesity among adults (β = 0.112; 95% CI 0.044; 0.18; P = 0.002) and per capita GDP (β = −0.918; 95% CI −1.583; −0.254; P = 0.008) were associated with COVID-19 CFR.ConclusionsThe findings indicate that good governance practices, favourable economic indicators and UHC have a bearing on COVID-19 infection rate and CFR. Effective health system response through a primary healthcare approach and progressively taking measures to grow their economy and increase funding to the health sector to mitigate the risk of similar future pandemics would require African countries to move towards UHC, improve governance practices and ensure economic growth in order to reduce the impact of pandemics on populations.