Declaration Of Emergency Research Articles

A Time-Varying Copula Approach to Investigate the Dependence Structures of BRICS Stock Markets Before and After COVID-19

ABSTRACT In this study, changes in the dependence structures of BRICS countries’ stock markets before and after the World Health Organization’s Covid-19 emergency declaration were examined using the time-varying (TV) copula method. The return series of the stock markets were divided into two periods, namely before COVID-19 (BC) and after COVID-19 (AC). The novel time-varying flexy copula (TVFC) proposed in the study provides a more flexible structure and produces better results than the TV single copula and the TV optimal copula in comparative analyses. In addition, risk spillovers between market indices were explored using the CoVaR-Copula method. According to the results, the interdependence coefficients of all countries were higher in the AC period than in the BC period with the exception of the China – South Africa pair. Moreover, the dependence coefficient of India with other BRICS countries was quite high compared to the other pairs. Based on the risk spillover results, it was concluded that the Chinese stock market index was the index least affected by the other BRICS countries in the AC period compared to the BC period.

Esophagogastroduodenoscopy Screening Intentions During the COVID-19 Pandemic in Japan: Web-Based Survey.

The number of people undergoing cancer screening decreased during the COVID-19 pandemic. The pandemic may have affected the willingness and motivation of undergoing cancer screening by those eligible for it. This study aims to clarify the effect of the COVID-19 pandemic on the intention to undergo cancer and esophagogastroduodenoscopy (EGD) screening. We performed a web-based survey on the intention to undergo screening among 1236 men and women aged 20-79 years. The numbers of participants by sex and 10-year age groups were equal. The survey was conducted in January 2021, during which the government declared a state of emergency because of the third wave of the COVID-19 pandemic in Japan. Emergency declarations were issued in 11 prefectures among all the 47 prefectures in Japan. In total, 66.1% (817/1236) of the participants felt anxious about undergoing screening due to COVID-19. More women than men were anxious about undergoing screening. By modality, EGD had the highest percentage of participants with anxiety due to COVID-19. Regarding the intention to change the participants' appointment for screening, the most common strategies were to book an appointment for a time during nonpeak hours, postpone the appointment to a later date, and change the mode of transportation. In addition, 35.8% (442/1236) of the participants were willing to cancel this year's screening appointment. Among the 1236 participants, 757 (61.2%) were scheduled for screening in 2020. Of the 757 participants in this subgroup, 68% (n=515) did not change the schedule, 6.1% (n=46) cancelled, and 26% (n=197) made some changes, including changing the appointment date, hospital, or mode of transportation. Among the 296 participants scheduled for EGD screening, 18.9% (n=56) made some changes, 5.7% (n=17) cancelled on their own, and 2.7% (n=8) cancelled on the hospital's order. Based on the previous screening results, the percentage of participants who felt anxious about EGD due to the COVID-19 pandemic was higher in the order of those who had not undergone screening and those who were judged to be in need of further examination in screening but did not visit a hospital for it. In the logistic regression analysis, the factors associated with anxiety about EGD screening due to the COVID-19 pandemic were "viral infection prevention measures," "waiting time," "fees (medical expenses)," "mode of transportation," "worry about my social position if I contracted COVID-19," and "perceived the risk of gastric cancer." However, "residence in declared emergency area" was not associated with EGD anxiety due to COVID-19. Excessive anxiety about COVID-19 may lead to serious outcomes, such as a "decreasing intention to undergo EGD screening," and it is necessary to thoroughly implement infection prevention measures and provide correct information to examinees.

Predicting health crises from early warning signs in patient medical records

The COVID-19 global pandemic has caused unprecedented worldwide changes in healthcare delivery. While containment and mitigation approaches have been intensified, the progressive increase in the number of cases has overwhelmed health systems globally, highlighting the need for anticipation and prediction to be the basis of an efficient response system. This study demonstrates the role of population health metrics as early warning signs of future health crises. We retrospectively collected data from the emergency department of a large academic hospital in the northeastern United States from 01/01/2019 to 08/07/2021. A total of 377,694 patient records and 303 features were included for analysis. Departing from a multivariate artificial intelligence (AI) model initially developed to predict the risk of high-flow oxygen therapy or mechanical ventilation requirement during the COVID-19 pandemic, a total of 19 original variables and eight engineered features showing to be most predictive of the outcome were selected for further analysis. The temporal trends of the selected variables before and during the pandemic were characterized to determine their potential roles as early warning signs of future health crises. Temporal analysis of the individual variables included in the high-flow oxygen model showed that at a population level, the respiratory rate, temperature, low oxygen saturation, number of diagnoses during the first encounter, heart rate, BMI, age, sex, and neutrophil percentage demonstrated observable and traceable changes eight weeks before the first COVID-19 public health emergency declaration. Additionally, the engineered rule-based features built from the original variables also exhibited a pre-pandemic surge that preceded the first pandemic wave in spring 2020. Our findings suggest that the changes in routine population health metrics may serve as early warnings of future crises. This justifies the development of patient health surveillance systems, that can continuously monitor population health features, and alarm of new approaching public health crises before they become devastating.

Inter-prefectural Travel and Network Connectedness During the COVID-19 Pandemic in Japan.

Increases in human mobility have been linked to rises in novel coronavirus disease 2019 (COVID-19) transmission. The pandemic era in Japan has been characterized by changes in inter-prefectural mobility across state of emergency (SOE) declarations and travel campaigns, but they have yet to be characterized. Using Yahoo Japan mobility data extracted from the smartphones of more than 10 million Japanese residents, we calculated the monthly number of inter-prefectural travel instances, stratified by residential prefecture and destination prefecture. We then used this adjacency matrix to calculate two network connectedness metrics, closeness centrality and effective distance, that reliably predict disease transmission. Inter-prefectural mobility and network connectedness decreased most considerably during the first SOE, but this decrease dampened with each successive SOE. Mobility and network connectedness increased during the Go To Travel campaign. Travel volume between distant prefectures decreased more than travel between prefectures with geographic proximity. Closeness centrality was found to be negatively correlated with the rate of COVID-19 infection across prefectures, with the strength of this association increasing in tandem with the infection rate. Changes in effective distance were more visible among geographically isolated prefectures (Hokkaido and Okinawa) than among metropolitan, central prefectures (Tokyo, Aichi, Osaka, and Fukuoka). The magnitude of reductions in human mobility decreased with each subsequent state of emergency, consistent with pandemic fatigue. The association between network connectedness and rates of COVID-19 infection remained visible throughout the entirety of the pandemic period, suggesting that inter-prefectural mobility may have contributed to disease spread.

Changes in Blood Pressure Outcomes Among Hypertensive Individuals During the COVID-19 Pandemic: A Time Series Analysis in Three US Healthcare Organizations.

The COVID-19 pandemic may have negatively affected medical care for and self-management of chronic hypertension. We sought to examine the impact of the pandemic on blood pressure (BP) among individuals with hypertension. Using an interrupted time series analysis, we compared the level and trend (slope) of BP outcomes before the public health emergency declaration (prepandemic period: August 2018 through January 2020) versus after the stay-at-home orders (pandemic period: April 2020 through November 2020) among adults with hypertension followed at 3 large health systems (n=137 593). Outcomes include systolic and diastolic BP recorded in electronic health records and the proportion of individuals with BP <140/90 mm Hg. The number of BP measurements substantially dropped early in the pandemic and then gradually increased. During the pandemic period, systolic and diastolic BP increased by 1.79 mm Hg (95% CI, 1.57-2.01; P<0.001) and 1.30 mm Hg (95% CI, 1.18-1.42; P<0.001), respectively, compared with the prepandemic period. Similarly, the proportion of patients with controlled BP decreased by 3.43 percentage points (95% CI, -3.97 to -2.90; P<0.001). A trend showing increasing control in the prepandemic period (+3.19 percentage points per year [95% CI, +2.96 to +3.42]; P<0.001) flattened during the pandemic period (+0.27 percentage points per year [95% CI, -0.81 to -1.37]; P=0.62). The first 8 months of the pandemic were associated with worsening BP outcomes among individuals with hypertension. Opportunities to ensure ongoing access to health care with telemedicine and home BP monitoring may mitigate adverse impacts on BP control for future disasters/emergencies.

A critical view of the global health emergencies: the 2016 zika epidemic case.

The study of global health agenda-setting and issue-prioritization has been one of the key aspects of a critical literature that, in recent years, has aimed to identify the political dimensions of global health governance and to shed light on points of tension, exclusion, and inequality. This essay speaks to this critical global health literature, focusing on the construction of the category of emergencies of international concern. Considering the case of the outbreak of zika and congenital syndrome in Brazil in 2016, it explores the conditions enabling the construction of an emergency. We question the factors and conditions around this public health event that were considered during the decision-making process and that transcended material, more objective data regarding zika's epidemiology, its morbimortality, or its association with congenital malformations. We conclude that the securitized context and the growing relevance of risk to global health are important conditions for understanding emergency declarations.

Uma leitura crítica das emergências em saúde global: o caso da epidemia de zika de 2016

Abstract The study of global health agenda-setting and issue-prioritization has been one of the key aspects of a critical literature that, in recent years, has aimed to identify the political dimensions of global health governance and to shed light on points of tension, exclusion, and inequality. This essay speaks to this critical global health literature, focusing on the construction of the category of emergencies of international concern. Considering the case of the outbreak of zika and congenital syndrome in Brazil in 2016, it explores the conditions enabling the construction of an emergency. We question the factors and conditions around this public health event that were considered during the decision-making process and that transcended material, more objective data regarding zika’s epidemiology, its morbimortality, or its association with congenital malformations. We conclude that the securitized context and the growing relevance of risk to global health are important conditions for understanding emergency declarations.

Leveraging Mobile Sensing and Bayesian Change Point Analysis to Monitor Community-scale Behavioral Interventions: A Case Study on COVID-19

During pandemics, effective interventions require monitoring the problem at different scales and understanding the various tradeoffs between efficacy, privacy, and economic burden. To address these challenges, we propose a framework where we perform Bayesian change-point analysis on aggregate behavior markers extracted from mobile sensing data collected during the COVID-19 pandemic. Results generated by 598 participants for up to four months reveal rich insights: We observe an increase in smartphone usage around February 10th, followed by an increase in email usage around February 27th and, finally, a large reduction in participant’s mobility around March 13th. These behavior changes overlapped with important news events and government directives such as the naming of COVID-19, a spike in the number of reported cases in Europe, and the declaration of national emergency by President Trump. We also show that our detected change points align with changes in large scale external sources, including number of COVID-19 tweets, COVID-19 search traffic, and a large-scale foot traffic data collected by SafeGraph, providing further validation of our method. Our results show promise towards the feasibility of using mobile sensing to understand communities’ responses to public health interventions.

Cardiac Rehabilitation and the COVID-19 Pandemic: Persistent Declines in Cardiac Rehabilitation Participation and Access Among US Medicare Beneficiaries.

The impact of the COVID-19 pandemic on participation in and availability of cardiac rehabilitation (CR) is unknown. Among eligible Medicare fee-for-service beneficiaries, we evaluated, by month, the number of CR sessions attended per 100 000 beneficiaries, individuals eligible to initiate CR, and centers offering in-person CR between January 2019 and December 2021. We compared these outcomes between 2 periods: December 1, 2019 through February 28, 2020 (period 1, before declaration of the pandemic-related national emergency) and October 1, 2021 through December 31, 2021 (period 2, the latest period for which data are currently available). In period 1, Medicare beneficiaries participated in (mean±SD) 895±84 CR sessions per 100 000 beneficiaries each month. After the national emergency was declared, CR participation sharply declined to 56 CR sessions per 100 000 beneficiaries in April 2020. CR participation recovered gradually through December 2021 but remained lower than prepandemic levels (period 2: 698±29 CR sessions per month per 100 000 beneficiaries, P=0.02). Declines in CR participation were most marked among dual Medicare and Medicaid enrollees and patients residing in rural areas or socially vulnerable communities. There was no statistically significant change in CR eligibility between the 2 periods. Compared with 2618±5 CR centers in period 1, there were 2464±7 in period 2 (P<0.01). Compared with CR centers that survived the pandemic, 220 CR centers that closed were more likely to be affiliated with public hospitals, located in rural areas, and serve the most socially vulnerable communities. The COVID-19 pandemic was associated with a persistent decline in CR participation and the closure of CR centers, which disproportionately affected rural and low-income patients and the most socially vulnerable communities. Innovation in CR financing and delivery is urgently needed to equitably enhance CR participation among Medicare beneficiaries.

A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic

IntroductionWe know very little about how the pandemic impacted outpatient alcohol use disorder (AUD) care and the role of telemedicine. MethodsUsing OptumLabs® Data Warehouse de-identified administrative claims, we identified AUD cohorts in 2018 (N = 23,204) and 2019 (N = 23,445) and examined outpatient visits the following year, focusing on week 12, corresponding to the March 2020 US COVID-19 emergency declaration, through week 52. Using multivariable logistic regression, we examined the association between patient demographic and clinical characteristics and receipt of any outpatient AUD visits in 2020 vs. 2019. ResultsIn 2020, weekly AUD visit utilization decreased maximally at the pandemic start (week 12) by 22.5 % (2019: 3.8 %, 2020: 3.0 %, percentage point change [95 % CI] = −0.86[−1.19, −0.05]) but was similar to 2019 utilization by mid-April 2020 (week 16). Telemedicine accounted for 50.1 % of AUD visits by early July 2020 (week 27). Individual therapy returned to 2019 levels within 1 week (i.e., week 13) whereas group therapy did not consistently do so until mid-August 2020 (week 31). Further, individual therapy exceeded 2019 levels by as much as 50 % starting mid-October 2020. The study found no substantial differences in visits by patient demographic or clinical characteristics. ConclusionsAmong patients with known AUD, initial outpatient care disruptions were relatively brief. However, substantial shifts occurred in care delivery—an embrace of telemedicine but also more pronounced, longer disruptions in group therapy vs. individual and an increase in individual therapy use. Further research needs to help us understand the implications of these findings for clinical outcomes.

Child maltreatment reporting during the initial weeks of COVID-19 in the US: Findings from NCANDS

BackgroundAfter the national COVID-19 emergency declaration in the U.S. in March 2020, child welfare agencies observed large reductions in maltreatment reporting. ObjectiveTo quantify the impact of the COVID-19 pandemic on child maltreatment reporting nationally to inform policy for future emergencies. Participants and settingAdministrative data from the National Child Abuse and Neglect Data System (NCANDS) for 48 states for federal fiscal years (FFYs) 2017 through 2020. MethodsAnalyses focused on reports to child protective services (CPS) between weeks 12 and 24 of calendar years 2017 through 2020 (mid-March through mid-June). Report sources of screened in and substantiated reports were compared with those during the prior year. Likelihood of a report being substantiated in 2020 compared with 2019 based on report source was calculated using odds ratios. ResultsIn 2020, CPS screened in 39 % fewer reports than during the same period in 2019 and the proportion of reports substantiated increased from 18 to 22 %. Reports from all report sources decreased, especially from education personnel (90 % decrease) and child daycare providers (65 % decrease). The odds for substantiation were significantly higher during 2020 than in 2019 for reports from all but three sources. ConclusionDuring the initial weeks following the national COVID-19 emergency declaration, the number of reports to CPS declined sharply at the national level and across all states, primarily in association with a large reduction in referrals from education sentinels. Explanations for the increase in percent of substantiation in the context of reduction of reports are considered.

Climate change can be seen through a disaster medicine lens.

Climate change can be seen through a disaster medicine lens.

Monkeypox vaccination—an opportunity for HIV prevention

Monkeypox vaccination—an opportunity for HIV prevention

Piloting Virtual Reality Photo-Based Tours among Students of a Filipino Language Class: A Case of Emergency Remote Teaching in Japan

The State of Emergency declaration in Japan due to the COVID-19 pandemic affected many aspects of society in the country, much like the rest of the world. One sector that felt its disruptive impact was education. As educational institutions raced to implement emergency remote teaching (ERT) to continue providing the learning needs of students, some have opened to innovative interventions. This paper describes a case of ERT where Filipino vocabulary was taught to a class of Japanese students taking Philippine Studies in a Japanese university using a cognitive innovation based on virtual reality, an immersive technology often researched for immersion and presence. Students were divided into three groups to experience six lessons designed around virtual reality photo-based tours at different immersion levels. While the effect of immersion on satisfaction was not found to be statistically significant, presence and satisfaction were found to be correlated. Despite challenges that were encountered, benefits like enjoyment, increased engagement, and perceived learning were reported by the students. Our findings exemplify how emerging multisensory technologies can be used to enhance affective and cognitive dimensions of human experience while responding to gaps created by the spatial limitations of remote learning.

The Unintended Consequences of Information Provision: The World Health Organization and Border Restrictions during COVID-19.

Why do some international agreements fail to achieve their goals? Rather than states' engaging in cheap talk, evasion, or shallow commitments, the World Health Organization's (WHO) International Health Regulations (IHR)-the agreement governing states' and WHO's response to global health emergencies-point to the unintended consequences of information provision. The IHR have a dual goal of providing public health protection from health threats while minimizing unnecessary interference in international traffic. As such, during major outbreaks WHO provides information about spread and severity, as well as guidance about how states should respond, primarily regarding border policies. During COVID-19, border restrictions such as entry restrictions, flight suspensions, and border closures have been commonplace even though WHO recommended against such policies when it declared the outbreak a public health emergency in January 2020. Building on findings from the 2014 Ebola outbreak, we argue that without raising the cost of disregarding (or the benefits of following) recommendations against border restrictions, information from WHO about outbreak spread and severity leads states to impose border restrictions inconsistent with WHO's guidance. Using new data from COVID-19, we show that WHO's public health emergency declaration and pandemic announcement are associated with increases in the number of states imposing border restrictions.

Effects of the different periods and magnitude of COVID-19 infection spread on cancer operations: Interrupted time series analysis of medical claims data.

BackgroundNo clear evidence exists regarding the effects of the different periods and magnitude of spread of the COVID‐19 infection on cancer treatments. This study investigated the effects of the different periods and magnitude of COVID‐19 infection spread on in‐hospital cancer operations.MethodsMedical claims data from 17 hospitals where in‐hospital operations for patients with malignant neoplasms were performed between 1 April 2017 and 31 March 2021 in Yamagata were extracted and analyzed. The critical time points as exposure used to evaluate the impact of different COVID‐19 infection spread periods on cancer operations were (1) April 2020 (emergency declaration introduced by the government) and (2) December 2020 (the second wave). From April to November 2020 and December 2020 to March 21, the number of confirmed COVID‐19 cases was 130 and 840, respectively. The 17 hospitals were classified into intervention or control groups based on whether in‐hospital treatments for patients with COVID‐19 were provided.ResultsThe interrupted time series analysis reported that the difference in the trend of pre‐COVID‐19 and postsecond wave (March 2020 to December 2020) periods was statistically significant between groups, with 50.67 fewer operations (95% confidence interval [CI] = 12.19–89.15) performed per month in the intervention group compared with the control group. Moreover, the immediate change in the number of operations in April 2020 (beginning of the first wave) was statistically significant between groups, with 80.14 operations (95% CI = 39.62–120.67) less immediately after the first wave in the intervention group compared with the control group.ConclusionOur findings suggest that a statement of emergency by the government and the COVID‐19 infection spread are both associated with the number of cancer operations performed in the Yamagata prefecture during the COVID‐19 pandemic.

Impact of COVID-19 Pandemic on Military Medical Encounters and Musculoskeletal Injuries

Background and Aim: Musculoskeletal injuries (MSKI) are the leading cause of outpatient medical encounters in the U.S. Army, and trends have remained stable over the past decade. The COVID-19 pandemic has altered healthcare use and workplace and lifestyle patterns, potentially affecting injury trends. We investigated the impact of the pandemic on healthcare use and injuries within the Army. Methods: We quantified medical encounters (all, in-person only, telephone consults only) and incident MSKI from electronic medical records among active duty soldiers from April 2016 through March 2021. We compared weekly counts before and after the COVID-19 national emergency declaration on March 13, 2020 in an interrupted time-series analysis using autoregressive integrated moving average models accounting for time and seasonal trends. Results: From April 2016 to March 2020, the mean (SD) weekly count was 125,953 (20,782) for all medical encounters [in-person: 113,249 (19,139); telephone consults: 17,053 (2,536)] and 11,016 (1,907) for MSKI. Weekly counts for all and in-person medical encounters and MSKI decreased and telephone consults increased in the month following the declaration. All medical encounters gradually returned to levels predicted in the absence of the pandemic, yet the reductions for in-person medical encounters [-13,405 (95% CI: -21,516, -5,294)] and MSKI [-1,933 (95% CI: -2,812, -1,056)] and increases in telephone consults [1,530 (95% CI: 566, 2,496)] were sustained through March 2021. Conclusions: Observed trends in healthcare use during the pandemic differed from previous years. All medical encounters appeared to have returned to predicted levels. While activities in the Army have largely resumed, the sustained reduction in MSKI is likely multifactorial and may be due to shifts in healthcare access and use. The views expressed are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government. Keywords: COVID-19, occupational epidemiology

The influence of COVID-19 pandemic on management of acute myocardial infarction in Japan; Insight from the Miyagi AMI Registry Study.

BackgroundDue to the coronavirus disease 2019 (COVID-19) pandemic, the first state of emergency had been declared from April 7 to May 25, 2020, in Japan. This pandemic might affect the management for patients with acute myocardial infarction (AMI). Method and Results: To evaluate the critical care and outcomes of AMI patients during the COVID-19 outbreak, we examined the patients with AMI hospitalized in 2020 (n = 1186) and those in 2017–2019 (n = 4877) using a database of the Miyagi AMI Registry Study. The door-to-device time under the emergency declaration became longer as compared with that of the same period in 2017–2019 [83(65–111) vs 74(54–108) min, p = 0.04]. Importantly, the time delay was noted in only patients with Killip class I on arrival, but not in those with Killip class II–IV. Meanwhile, there were no significant changes in the duration from the symptom onset to hospital arrival, the use rate of ambulance and the performance rate of primary percutaneous coronary intervention before and after the COVID-19 outbreak. Eventually, in-hospital mortality had not deteriorated under the state of emergency (6.7 vs 7.8 %, P = 0.69). Conclusion: The emergence of the COVID-19 outbreak seemed to affect AMI management and highlight understanding the barriers to cardiovascular critical care.

Effect of the COVID-19 pandemic and state of emergency declarations on the relative incidence of legionellosis and invasive pneumococcal disease in Japan

IntroductionDuring the COVID-19 pandemic, the incidence of many droplet-transmitted infections decreased due to increased mask-wearing and social distancing. Contrastingly, there has been concern that COVID-19 countermeasures, such as lockdowns, may increase legionellosis incidence via water stagnation. During the pandemic in Japan, four state of emergency declarations were imposed between 2020 and 2021, which makes it particularly suitable to test this hypothesis. MethodsWe use country-level surveillance data from the National Institute of Infectious Diseases to track the relative incidence of legionellosis compared to invasive pneumococcal disease (IPD) during the COVID-19 pandemic in Japan, with a focus on the periods just after state of emergency declarations were lifted. ResultsThe absolute number of legionellosis and IPD cases decreased in 2020 and 2021 compared to previous years. The average relative incidence of legionellosis as well as the variance of the relative incidence significantly increased during the pandemic compared to previous years. There were no increases in the relative incidence of legionellosis during the periods immediately following emergency declaration liftings, but the relative incidence did increase considerably during the first two states of emergency. ConclusionsCOVID-19 countermeasures appear more effective at decreasing the incidence of human-to-human transmitted infections, such as IPD, compared to environmentally-transmitted infections, such as legionellosis. Though no evidence was found to suggest that legionellosis cases increased after state of emergency declarations, public health efforts should continue to emphasize the importance of routine sanitation and water system maintenance to prevent water stagnation and Legionella spp. contamination.

Atypical and Unique Transmission of Monkeypox Virus during the 2022 Outbreak: An Overview of the Current State of Knowledge.

An ongoing monkeypox outbreak in non-endemic countries has resulted in the declaration of a public health emergency of international concern by the World Health Organization (WHO). Though monkeypox has long been endemic in regions of sub-Saharan Africa, relatively little is known about its ecology, epidemiology, and transmission. Here, we consider the relevant research on both monkeypox and smallpox, a close relative, to make inferences about the current outbreak. Undetected circulation combined with atypical transmission and case presentation, including mild and asymptomatic disease, have facilitated the spread of monkeypox in non-endemic regions. A broader availability of diagnostics, enhanced surveillance, and targeted education, combined with a better understanding of the routes of transmission, are critical to identify at-risk populations and design science-based countermeasures to control the current outbreak.