COVID-19 Government Response Research Articles

COVID-19, geopolitics and risk management: Towards framing a reciprocal, coordinated, responsive and empathetic international education sector

Geopolitics is shaping the international education landscape. International education has trationally been used as a tool to boost transnational cooperation, foster multilateral and global ties, and reduce tensions between nations. Such a role has been eroded and international education has been weaponised in the context of escalating political turbulences and disputes over the COVID-19 pandemic. In particular, the relationship between Australia and China, with international student flows interrupted due to COVID-19, is overshadowed by escalating geopolitical tensions in the Indo-Pacific region. Based on a qualitative study, this article examines stakeholders’ views on the responses of the Australian international education sector and universities to emerging geopolitical tensions. The conjuncture of geopolitics, COVID-19 and Australia's former government responses magnified a sense of crisis for universities and the international education sector as it was at risk because of their financial reliance on international students. Based on the findings, recommendations are made for the framing of a reciprocal, coordinated, responsive and empathetic international education sector to mitigate geopolitical risks and ensure more sustainable and ethical development for the sector.

Exploring the Role of Infodemics in People's Incompliance with Preventive Measures during the COVID-19 in Conflict Settings (Mixed Method Study).

The evolving availability of health information on social media, regardless of its credibility, raises several questions about its impact on our health decisions and social behaviors, especially during health crises and in conflict settings where compliance with preventive measures and health guidelines is already a challenge due to socioeconomic factors. For these reasons, we assessed compliance with preventive measures and investigated the role of infodemic in people's non-compliance with COVID-19 containment measures in Yemen. To this purpose and to triangulate our data collection, we executed a mixed method approach in which raw aggregated data were taken and analyzed from multiple sources (COVID-19 Government Response Tracker and Google COVID-19 Community Mobility Reports), then complemented and verified with In-depth interviews. Our results showed that the population in Yemen had relatively complied with the governmental containment measures at the beginning of the pandemic. However, containment measures were not supported by daily COVID-19 reports due to low transparency, which, together with misinformation and lack of access to reliable sources, has caused the population not to believe in COVID-19 and even practice social pressure on those who showed some compliance with the WHO guidelines. Those results indicate the importance of adopting an infodemic management approach in response to future outbreaks, particularly in conflict settings.

The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries

ABSTRACT Background The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. Objective We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. Methods We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. Results For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: −5.1%, −1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. Conclusions Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.

How supranational institutions benefit from crises: Member states’ solidarity and the EU's image during the COVID-19 pandemic

In this article, we demonstrate how solidarity between member states can have a positive effect on the image of the EU, even if the latter's actions in handling a crisis such as the COVID-19 pandemic are deemed unsatisfactory. Employing data from a special Eurobarometer survey enriched with data from the Oxford's COVID-19 government response tracker, we show that European citizens who are more satisfied with interstate solidarity have to a greater extent a positive image of the EU compared to citizens who are less satisfied. We also show that this effect is further pronounced in the case of EU citizens who are less satisfied with institutional solidarity, which is the solidarity going from EU institutions to the member states.

Does Oxford Government Response Tracker Explain the SARS-CoV-2 Morbidity and Mortality: An Ecological Time Series Study.

Many nations swiftly designed and executed government policies to contain the rapid rise of SARS-CoV-2 cases. The government actions can be broadly segmented as movement and mass gathering restrictions (such as travel and lockdown), public awareness (such as facial covering and hand washing), emergency healthcare investment and social welfare provisions (such as poor welfare schemes to distribute food and shelter). The Blavatnik School of Government-Oxford university tracked various policy initiatives by governments across the globe and released them as composite indices. We assessed the overall government response using Oxford Comprehensive Health Index (CHI) and Stringency Index (SI) to combat the SARS-CoV-2 pandemic. This study aims to demonstrate the utility of CHI and SI to gauge and evaluate the government responses for containing the spread of SARS-CoV-2. We expect a significant inverse relationship between policy indices (CHI and SI) and SARS-CoV-2 severity indices (morbidity and mortality). In this ecological study, we analysed data from two publicly available data sources released between March 2020, to October 2021: Oxford Covid-19 Government Response Tracker (OxCGRT) and World Health Organization (WHO). We applied Auto-Regressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) to model the data. The performance of different models was assessed using a combination of evaluation criteria: Adj-R2, Root Mean Square of Error (RMSE) and Bayesian Information Criteria (BIC). The strict implementation of policies by the government to contain the crises of SARS-CoV-2 resulted in higher CHI and SI in the beginning. Although the value of CHI and SI gradually fell--the same was consistently higher at values of more than 80% points. During the initial investigation, we found that Cases Per Million (CPM) and Deaths Per Million (DPM) followed the same trend. However, the final CPM and DPM model were SARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. The current study does not support the hypotheses that SARS-CoV-2 severity (CPM and DPM) is associated with stringent policy measures (CHI and SI). Our study concludes that the policy measures (CHI and SI) do not explain the change in epidemiological indicators (CPM and DPM). The study reiterates our understanding that strict policies do not necessarily lead to better compliance but may overwhelm the overstretched physical health systems. The 21st-century problems, thus, demand 21st-century solutions. The digital ecosystem was instrumental in the timely collection, curation, cloud storage and data communication. Thus, digital epidemiology can--and--should be successfully integrated into existing surveillance systems for better disease monitoring, management and evaluation.

Study protocol: examining the impacts of COVID-19 mitigation measures on pregnancy and birth outcomes in Scotland—a linked administrative data study

IntroductionThis protocol outlines aims to test the wider impacts of the COVID-19 pandemic on pregnancy and birth outcomes and inequalities in Scotland.Method and analysisWe will analyse Scottish linked administrative data...

State Government Policy Responses to the COVID-19 Pandemic in the United States 2020-2022: Concordant Heterogeneity?

We investigate governmental responses to the COVID-19 pandemic on a statewide basis between January 2020 and June 2022, together with mortality rates attributable to COVID-19 over the same period. Our aim is to demarcate the states' responses, and examine whether these differential responses are associated with COVID-19 mortality. Our study is based on individual state data from the Oxford COVID-19 Government Response Tracker, OxCGRT. We focus on the Government Response Index, the most comprehensive index tracked in the OxCGRT dataset. We use multivariate techniques to group the states into clusters relative to their similarities on the Government Response Index, and determine mortality rates attributable to COVID-19 in the individual groups. We find that the Government Response Index was sustained at relatively constant levels in the states, with two major transition periods: a rapid rise in stringency during April through June of 2020, and a gradual decline in May and June of 2021. Heterogeneity in the Government Response Index dramatically increased in 2022. No consistent patterns emerge when relating government stringency measures with COVID-19 mortality rates. There is inconsistent evidence that increased governmental stringency is associated with lower COVID-19 mortality; judicious selection of time frames can lead to contrasting inferences. Political trends and motivations appear to have an outsized influence on governmental responses to the COVID-19 public health crisis, to the detriment of the populace.

GLOBAL CHIP SUPPLY ENSUREMENT DURING THE SHORT PERIOD

The COVID-19 pandemic has disrupted the global chip supply chain. Shortage of electronic components was first noticed in car factories, and then in the entire electronics industry. The US, Taiwan and China are the largest markets for semiconductor manufacturers, which are no longer able to meet the everincreasing demand for chips. Lack of production capacity is mostly felt by consumers of final products. Ensuring a steady supply of chips is an important task for major manufacturers. In order to ensure the supply of chips, it is important to establish criteria by which semiconductor manufacturing countries can be arranged. The ranking will help identify the countries that are worth investing the most in the short term. The European Union, the United States and major telecommunications companies will invest billions of dollars in 2022 to replenish the market. The article analyzes the criteria for investing in chipproducing countries. The main focus of this analysis is the chip supply chain. Each of the analyzed countries has at least one stage of chip production: design, manufacturing or assembly. Data analyzed: gross domestic product, net exports, price of one dollar in relation to the national currency, monthly average wages, Oxford COVID-19 government response severity index and semiconductor export volume. These criteria allow us to rank countries from the most attractive to the least attractive for investment. The TOPSIS method was chosen for ranking, but comparative data analysis and analysis of scientific literature and other sources of information were also applied. Method principle, formulas and application – to be described. It was determined which country is the most favorable for short-term investments, taking into account the given criteria.

Social capital as a containment factor of the COVID-19 pandemic

Effectiveness of the pandemic containment can depend upon both actions of governments and willingness of the population to follow the introduced rules, which is heavily dependable upon the social capital structure in society. This article analyzes relationship between various components of social capital and changes in mobility during the COVID-19 pandemic. The article is based on data from the World Values Survey, Google COVID-19 Community Mobility Reports, Oxford COVID-19 Government Response Tracker, etc. The study hypotheses have been empirically tested on a sample of 61 countries, as well as subsamples of countries with high- and low-quality institutions. The results show that high levels of trust in the government, police and courts, as well as developed norms of cooperation in society (in particular, dislike of free riding), other things being equal, contribute to lower mobility during the pandemic. This effect is particularly pronounced in countries with high-quality institutions. A high level of generalized trust, on the contrary, is not associated with a lower mobility during the pandemic, which may limit its containment, especially in countries with low-quality institutions. The results obtained can be used for developing socio-economic policy aimed at containing the pandemic.

Media attention toward COVID-19 across 18 countries: The influence of cultural values and pandemic severity.

Current media studies of COVID-19 devote asymmetrical attention to social media, in contrast, newspapers have received comparatively less attention. Newspapers are an integral source of current information-that are syndicated and amplified by social media to a wide global audience. This is the first-known study to investigate the impact of cultural values and pandemic severity on media attention towards COVID-19. Findings lay the groundwork for targeted public health communications that are culturally nuanced. We investigated the impact of cultural values and pandemic severity on Media Attention towards COVID-19 across 18 countries. We tracked the global volume of COVID-19 coverage (to measure media attention) over 8 months in a news media database of 12 billion words with 30 million articles from over 7,000 news media sites. Predictors of Media Attention towards COVID-19 came from the Oxford COVID-19 Government Response Tracker (incidence and mortality) and Hofstede's Cultural Values. Media attention toward COVID-19 increased 55 times over 8 months. Higher rates of new cases and deaths predicted this exponential increase. Countries with higher power distance, uncertainty avoidance, and long-term orientation, were associated with increased media attention, controlling for covariates. Cultural values play a significant role in the news media's attention toward COVID-19, controlling for pandemic severity. We provided a framework to design targeted public health communications that are culturally nuanced.

A statistical look at the COVID-19 vaccine development and vaccine policies.

The global outbreak of COVID-19 caused by the SARS-CoV-2 virus elicited immense global interest in the development and distribution of safe COVID-19 vaccines by various governments and researchers, capable of stopping the spread of COVID-19 disease. After COVID-19 was declared a global pandemic, several vaccines have been developed for emergency use authorization. The accelerated development of the vaccines was attributed to many factors but mainly by capitalizing on years of research and technology development. Although several countries tried to develop COVID-19 vaccines only a few countries succeeded. Therefore, we applied statistical methods to find factors that have contributed to the fast development of COVID-19 vaccines. All 11 countries that developed vaccines were considered and chose other 24 countries for comparison purposes according to different criteria of their R&D. Fourteen R&D indicator variables that are a measure of the R&D for all countries [World Development Indicators (WDI)] were obtained from the World Bank DataBank and data on the COVID-19 vaccine R&D were obtained from The Knowledge Portal of the Graduate Institute Geneva and Global Health Center. The World Bank records WDI yearly, and 2019 was chosen because of a few missing values. Also, different vaccine policies were adopted by different countries during the COVID-19 vaccination period, producing different impacts of vaccinations on the population. So, we applied the generalized estimating equations (GEE) approach to find policies that contributed greatly to decreasing the spread of COVID-19 using data from the Oxford COVID-19 Government Response Tracker (OxCGRT) and age-specific vaccination data from the European Center for Disease and Prevention and Control. Logistic regression, two-sample t-test, and Wilcoxon rank-sum test found scientific and technical journals, liability, and COVID-19 Vaccine R&D Funding (investment in pharmaceutical industry US$) are significantly associated with fast COVID-19 vaccine development. Vaccine prioritization and government vaccine financial support were significantly associated with COVID-19 daily cases. The impact of vaccination on lowering the rate of new cases is greatly observed among the mid-aged populations (25-64 years) and lower or non-significant among the younger (<25 years) and (>65 years) older populations. Therefore, these age-groups especially > 79 can be prioritized during vaccine roll-out.

Did the COVID-19 vaccine rollout impact transportation demand? A case study in New York City

IntroductionThis study investigates the influence of vaccination along with other pandemic-related factors on driving, transit, and walking in New York City (NYC). The results of this study help inform policymakers of the weight of their decisions in a pandemic setting as well as factors to consider when modeling transportation during a pandemic. MethodsIn this study, ARIMAX time series analysis was performed on driving, transit, and walking data from Apple Mobility Trends Reports. The data was segmented into two categories “pre-vaccine” and post-vaccine” for both Manhattan and Brooklyn. The independent variables were primarily COVID-19 statistics (vaccination, case counts, deaths, etc.) along with additional predictors aggregated from Google Community Mobility Reports, Google Trends, Citi Bike, National Oceanic and Atmospheric Administration (NOAA), and the Oxford Covid-19 Government Response Tracker (OxCGRT). ResultsVaccination led to increases in driving, transit, and walking in Brooklyn but was not as statistically significant in Manhattan (the only effect being on walking trips). Despite this, vaccination was not the strongest influencer on transportation. The COVID-19 policy score variable had the highest standardized β in nearly every model, indicating that stricter lockdown policies were the main factor discouraging travel. Furthermore, the lifting of these policies contributed to increases in travel numbers more than vaccination. ConclusionsIn the event of future pandemics or health crises, NYC policymakers should be aware that they play a significant role in mitigating infectious diseases. The public is seemingly more responsive to policy than anything else. Similar studies should be conducted in other cities as the public response may vary based on other factors.

The Nexus Between COVID-19 Government Responses and Aviation Stock Prices in Turkey: OxCGRT Stringency Index-Based Analysis

Air transportation is the significant mode of transmission, enabling the worldwide spread of infectious diseases through the mobility of infected persons. Therefore, governments applied the most comprehensive restrictions and preventions in civil aviation during COVID-19. The industry is one of the most economically impacted due to travel, and flight restrictions. This paper aims to investigate the long- and short-term nexuses between government responses to COVID-19 and the aviation stock prices traded in Borsa Istanbul. The OxCGRT stringency Turkey index is used to measure the Turkish government responses and policies to COVID-19. In the study, the daily data of Turkish Airlines, Pegasus Airlines, Do&amp;amp;Co Catering, TAV Airport Holding, Celebi Ground Handling stock prices, and the OxCGRT stringency Turkey index for the 24.01.2020-11.11.2021 period were used, and Granger causality and Engle-Granger cointegration tests were applied to reveal the nexuses. In conclusion, there is a cointegration nexus and one-way causality from the index to all Turkish aviation stock prices, except the Celebi Ground Handling stock prices. The contribution of this study is that it is probably the first one in Turkey to reveal the nexus between the government's policy and responses to COVID-19 and aviation stock prices.

Impacts of the COVID-19 pandemic, and of government responses to the pandemic, on people who are homeless in Australia: Mapping perceptions of a national sample of homelessness service workers.

People who are homeless are disproportionately impacted by the COVID-19 pandemic, and by government responses to the pandemic. This study maps the perceptions of homelessness service workers in Australia, about the impacts of the COVID-19 pandemic and government responses to it on people who are homeless. An electronic survey was distributed to homelessness service across Australia in June/July 2020, following Australia's 'first wave' of COVID-19. Fifty-nine homelessness services from all eight states/territories responded. Perceptions of impacts on people who are homeless were mapped in six themes: (1) changes in the types of people presenting, (2) overall impacts on peoples' lives, (3) impacts on mental health, (4) impacts of changes in service delivery, (5) impacts of government support and (6) ongoing impacts. The COVID-19 pandemic, and government responses to the pandemic, have affected every aspect of the lives of people who are homeless in Australia. There is a continuing need to support people who are homeless as the world transitions to the 'new normal' of COVID-19, particularly as rates of homelessness increase. Understanding impacts is vital to informing relevant and effective health, social and other supports for this group.

The impact of COVID-19 lockdown stringency on loneliness in five European countries

RationaleThe coronavirus pandemic has forced governments to implement a variety of different dynamic lockdown-stringency strategies in the last two years. Extensive lockdown periods could have potential unintended consequences on mental health, at least for at-risk groups. ObjectiveWe present novel evidence on the heterogeneous direct and indirect effects of lockdown-stringency measures on individuals’ perception of social isolation (i.e. loneliness) using panel data from five European countries (Germany, France, Spain, Italy and Sweden), which tracks changes in both in-person and remote social interactions between May 2020 and March 2021. MethodWe combine data from the COME-HERE panel survey (University of Luxembourg) and the Oxford COVID-19 Government Response Tracker (OxCGRT). We implement a dynamic mixture model in order to estimate the loneliness sub-population classes based on the severity of loneliness, as well as the evolution of social interactions. ResultsWhile loneliness is remarkably persistent over time, we find substantial heterogeneity across individuals, identifying four latent groups by loneliness severity. Group membership probability varies with age, gender, education and cohabitation status. Moreover, we note significant differences in the impact of social interactions on loneliness by degree of severity. Older people are less likely to feel lonely, but were more affected by lockdown measures, partly due to a reduction in face-to-face interactions. On the contrary, the younger, especially those living alone, report high levels of loneliness that are largely unaffected by changes in the pandemic after lockdown measures were initially implemented. ConclusionsUnderstanding the heterogeneity in loneliness is key for the identification of at-risk populations that can be severely affected by extended lockdown measures. As part of public-health crisis-response systems, it is critical to develop support measures for older individuals living alone, as well as promoting continuous remote communication for individuals more likely to experience high levels of loneliness.

The timeliness of COVID-19 testing and tracing in eight public health regions in the Netherlands

Abstract Background Testing and Contact Tracing (TCT) was a core strategy in the fight against the spread of SARS-CoV-2. However, little is known about the real-world effectiveness of TCT for COVID-19. Because time is an important conditional factor, we aim to study timeliness of TCT in the Netherlands, and its determinants. Methods We used routine COVID-19 TCT registry data from all individuals who tested positive for SARS-CoV-2 at 8 Dutch regional public health services from 1-6-2020 to 28-2-2021 (N = 338,066). We calculated median time intervals of TCT stages. Factors associated with the time between test result and completion of TCT, categorised as ≤ 3 days and &amp;gt;3 days, were assessed using logistic regression adjusting for region, testing site, and laboratory. Potential determinants were: gender, age, country of birth, number of close contacts, working in health-care or education, TCT manpower, and the Oxford Covid-19 Government Response Tracker (OxCGRT). Results The median time from symptom onset to TCT completion was 6 days (IQR:3-10). Median times between TCT stages were 1 day (IQR:0-3) for symptom onset to test request, 1 day, (IQR:0-1) for test request to sample collection, 1 day, (IQR:1-1) for sample collection to test result, and 2 days (IQR:1-5) for test result to TCT completion. In 31.7% of tests, time between test result and TCT completion was &amp;gt;3 days. This delay was associated with being older (65+), whereas being younger (0-14), a higher OxCGRT, scaling down TCT, and a higher number of TCT employees were associated with a shorter interval. Conclusions Over fifty percent of interval times from symptom onset to TCT completion exceeded the median SARS-CoV-2 incubation period of 5 days. There seems to be little room for improvement on the side of the index case, but there are some implications for logistics such as increasing TCT manpower, and better integration of digital systems. Key messages

Does political stringency change students’ adherence to governmental recommendations?

Abstract Introduction Knowing predictors for adherence to governmental recommendations is fundamental to guiding health communication in pandemic situations. This study investigated whether political stringency was associated with students’ adherence to the COVID-19 governmental measures in the Nordic countries (Denmark, Finland, Norway, Iceland, and Sweden) and the United Kingdom (UK). Methods We used data from a cross-sectional online survey, from university students in all Nordic countries and the UK (N = 10.345), in May 2020. Data on socio-demography, study information, living arrangements, health behaviors, stress, knowledge, and concern about COVID-19 infection supplemented with measures on political stringency from the Oxford Covid-19 Government Response Tracker were utilised. Multiple linear regression analysis methods were applied. Results Around 66% reported that they followed governmental measures. Our model explained only 10% of the variation of adherence. The main predictors for adherence were older age, female sex, and being worried about the COVID-19 infection. More days since lockdown and political stringency were also associated with adherence to governmental recommendations in all countries. Sweden had the lowest willingness to adhere to governmental recommendations even though the strength of the association between political stringency and adherence was similar to other countries. Conclusions Political stringency and congruent communication are important in ensuring adherence to governmental recommendations during the first wave of the COVID-19 pandemic. Key messages • Political stringency is important to ensure adherence to governmental recommendations. • Congruent communication is important to ensure adherence to governmental recommendations.

Analysis of serological surveys of antibodies to SARS-CoV-2 in the United States to estimate parameters needed for transmission modeling and to evaluate and improve the accuracy of predictions

Seroprevalence studies can estimate proportions of the population that have been infected or vaccinated, including infections that were not reported because of the lack of symptoms or testing. Based on information from studies in the United States from mid-summer 2020 through the end of 2021, we describe proportions of the population with antibodies to SARS-CoV-2 as functions of age and time. Slices through these surfaces at arbitrary times provide initial and target conditions for simulation modeling. They also provide the information needed to calculate age-specific forces of infection, attack rates, and – together with contact rates – age-specific probabilities of infection on contact between susceptible and infectious people.We modified the familiar Susceptible-Exposed-Infectious-Removed (SEIR) model to include features of the biology of COVID-19 that might affect transmission of SARS-CoV-2 and stratified by age and location. We consulted the primary literature or subject matter experts for contact rates and other parameter values. Using time-varying Oxford COVID-19 Government Response Tracker assessments of US state and DC efforts to mitigate the pandemic and compliance with non-pharmaceutical interventions (NPIs) from a YouGov survey fielded in the US during 2020, we estimate that the efficacy of social-distancing when possible and mask-wearing otherwise at reducing susceptibility or infectiousness was 31% during the fall of 2020. Initialized from seroprevalence among people having commercial laboratory tests for purposes other than SARS-CoV-2 infection assessments on 7 September 2020, our age- and location-stratified SEIR population model reproduces seroprevalence among members of the same population on 25 December 2020 quite well.Introducing vaccination mid-December 2020, first of healthcare and other essential workers, followed by older adults, people who were otherwise immunocompromised, and then progressively younger people, our metapopulation model reproduces seroprevalence among blood donors on 4 April 2021 less well, but we believe that the discrepancy is due to vaccinations being under-reported or blood donors being disproportionately vaccinated, if not both. As experimenting with reliable transmission models is the best way to assess the indirect effects of mitigation measures, we determined the impact of vaccination, conditional on NPIs. Results indicate that, during this period, vaccination substantially reduced infections, hospitalizations and deaths.This manuscript was submitted as part of a theme issue on “Modelling COVID-19 and Preparedness for Future Pandemics.”

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

BackgroundAn increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children was observed in various diabetes centres worldwide during the COVID-19 pandemic. We aimed to evaluate trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes before and during the COVID-19 pandemic, and to identify potential predictors of changes in diabetic ketoacidosis prevalence during the pandemic.MethodsFor this international multicentre study, we used data from 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA [Colorado], and Wales). The study population comprised 104 290 children and adolescents aged 6 months to younger than 18 years, who were diagnosed with type 1 diabetes between Jan 1, 2006, and Dec 31, 2021. The observed diabetic ketoacidosis prevalence in 2020 and 2021 was compared to predictions based on trends over the pre-pandemic years 2006–19. Associations between changes in diabetic ketoacidosis prevalence and the severity of the COVID-19 pandemic and containment measures were examined with excess all-cause mortality in the whole population and the Stringency Index from the Oxford COVID-19 Government Response Tracker.Findings87 228 children and adolescents were diagnosed with type 1 diabetes between 2006 and 2019, 8209 were diagnosed in 2020, and 8853 were diagnosed in 2021. From 2006 to 2019, diabetic ketoacidosis at diagnosis of type 1 diabetes was present in 23 775 (27·3%) of 87 228 individuals and the mean annual increase in the prevalence of diabetic ketoacidosis in the total cohort from 2006 to 2019 was 1·6% (95% CI 1·3 to 1·9). The adjusted observed prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes was 39·4% (95% CI 34·0 to 45·6) in 2020 and 38·9% (33·6 to 45·0) in 2021, significantly higher than the predicted prevalence of 32·5% (27·8 to 37·9) for 2020 and 33·0% (28·3 to 38·5) for 2021 (p<0·0001 for both years). The prevalence of diabetic ketoacidosis was associated with the pandemic containment measures, with an estimated risk ratio of 1·037 (95% CI 1·024 to 1·051; p<0·0001) per ten-unit increase in the Stringency Index for 2020 and 1·028 (1·009 to 1·047; p=0·0033) for 2021, but was not significantly associated with excess all-cause mortality.InterpretationDuring the COVID-19 pandemic, there was a marked exacerbation of the pre-existing increase in diabetic ketoacidosis prevalence at diagnosis of type 1 diabetes in children. This finding highlights the need for early and timely diagnosis of type 1 diabetes in children and adolescents.FundingGerman Federal Ministry for Education and Research, German Robert Koch Institute, German Diabetes Association, German Diabetes Foundation, Slovenian Research Agency, Welsh Government, Central Denmark Region, and Swedish Association of Local Authorities and Regions.

Impact of government policy responses of COVID-19 pandemic on stock market liquidity for Australian companies.

This study investigates the impact of government policy responses of COVID‐19 pandemic on stock market liquidity for listed Australian companies and for 11 different industries separately. A quantitative deductive approach is used for a sample of 1,452 companies with a total of 292,164 firm‐day observations over a period from January 25, 2020 to December 31, 2020 during the outbreak of COVID‐19. Univariate and multivariate (two‐way cluster‐robust panel regression) analysis were conducted. Data were collected from the Oxford COVID‐19 Government Response Tracker, Worldmeter, Refinitiv Workspace and Datastream. Our findings indicate that the influences of the six out of seven stringency policy responses reduced Australian equity market liquidity. However, public information campaigns enhanced market liquidity and hence trading activity. Among the 11 industries, our analysis shows that the non‐pharmaceutical interventions by the Australian government have significant and positive effects on four industries: Consumer non‐cyclicals, healthcare, financial and technology. However, the worse effects were depicted in the industrial (transportation) and energy industries. This study is important for investors, policymakers and regulators to understand the diverse effects of government policy responses of COVID‐19 on stock market liquidity to enhance financial stability. Moreover, understanding this effect is particularly important to decision‐makers such as portfolio and fund managers to manage their portfolios and trading activities during extreme turbulence times, such as COVID‐19. Unlike previous studies that focus on country analysis, this study examines on firm basis the impact of government interventions on stock market liquidity in a well developed Australian stock market.