Regional Lockdown Research Articles

The early phase of the COVID-19 epidemic in Lombardy, Italy

BackgroundIn the night of February 20, 2020, the first epidemic of the novel coronavirus disease (COVID-19) outside Asia was uncovered by the identification of its first patient in Lombardy region, Italy. In the following weeks, Lombardy experienced a sudden increase in the number of ascertained infections and strict measures were imposed to contain the epidemic spread. MethodsWe analyzed official records of cases occurred in Lombardy to characterize the epidemiology of SARS-CoV-2 during the early phase of the outbreak. A line list of laboratory-confirmed cases was set up and later retrospectively consolidated, using standardized interviews to ascertained cases and their close contacts. We provide estimates of the serial interval, of the basic reproduction number, and of the temporal variation of the net reproduction number of SARS-CoV-2. ResultsEpidemiological investigations detected over 500 cases (median age: 69, IQR: 57–78) before the first COVID-19 diagnosed patient (February 20, 2020), and suggested that SARS-CoV-2 was already circulating in at least 222 out of 1506 (14.7%) municipalities with sustained transmission across all the Lombardy provinces. We estimated the mean serial interval to be 6.6 days (95% CrI, 0.7–19). Our estimates of the basic reproduction number range from 2.6 in Pavia (95% CI, 2.1–3.2) to 3.3 in Milan (95% CI, 2.9–3.8). A decreasing trend in the net reproduction number was observed following the detection of the first case. ConclusionsAt the time of first case notification, COVID-19 was already widespread in the entire Lombardy region. This may explain the large number of critical cases experienced by this region in a very short timeframe. The slight decrease of the reproduction number observed in the early days after February 20, 2020 might be due to increased population awareness and early interventions implemented before the regional lockdown imposed on March 8, 2020.

Targeting the Endothelium in the Treatment of COVID-19 Early Clinical Stages: Results of a Randomized Placebo-Controlled Trial

Background: SARS-CoV-2 can induce several vascular endothelial-dependent systemic complications and treatment targeting endothelial cells has been suggested. Sulodexide is a heparin and glycosaminoglycan compound that has pleiotropic properties within the vascular endothelium that can prove beneficial in COVID-19 patients.Aims: We aimed to evaluate the effect of sulodexide when used in the early clinical stages of COVID-19.Methods: In an outpatient setting, we conducted a randomized placebo-controlled trial. Key inclusion criteria were patients within three days of COVID-19 clinical onset and being deemed at high risk (> 50%) of severe clinical disease progression. The risk was assessed using the COVID-19 Health Complication (C19HC) calculator, which clusters the importance of various chronic comorbidities into a percentage value. After inclusion, patients were randomly assigned to receive an oral dose of sulodexide (500 LRU twice a day) or a placebo for 21 days. We performed follow-ups to assess the study endpoints via remote communication with participants or household members every seven days or as deemed necessary. Participants continued the standard of care under the supervision of their healthcare provider's primary physician. The need for hospital care was the primary outcome. Also evaluated, were the need for supplemental oxygen support, D-dimer and C reactive protein (CRP) serum levels, thromboembolic events, and mortality. Physicians responsible to determine the need for hospital care or supplemental oxygen at home were blinded to group allocation. This trial was conducted throughout the regional lockdown caused by the first wave of COVID-19 which caused some unforeseen limitations during the trial. Differences in means were calculated using the Student's t-test, while differences in percentages were assessed using the χ 2 test. Before and after serum levels in the same patients were analyzed using two paired t-tests. If the data were not normally distributed, a Wilcoxon test was used. A Kaplan-Meier curve was used to graphically compare time-to-endpoint for hospital admission and mortality.Results: 312 patients were included in the intent to treat analysis. At 21 days follow-up, 23 of 155 patients required hospitalization in the sulodexide group compared to 38 of 157 in the placebo group [relative risk (RR), 0.6; 95% confidence interval (CI), 0.38-0.97; p=0.037]. The benefit persisted with a per-protocol analysis (RR 0.6, p=0.031). Fewer patients required oxygen support in the sulodexide group [39 of 155 vs. 56 of 157; RR, 0.61; 95% CI, 0.38 to 0.9; p=0.04], and for fewer days (9 ± 7.2 in the sulodexide group vs. 11.5 ± 9.6 in the placebo group; p=0.02). Mean D-dimer levels at week 2 were significantly higher in the placebo group than in the sulodexide group (p < 0.01). 28 of the 155 patients (18%) in the sulodexide group showed a D-dimer value > 500 ng/dl, compared to 59 out of 157 (37.5%) in the placebo group (RR of 0.48; 95% CI of 0.31 to 0.67; p > 0.01). Mean C-reactive protein levels at week 2 were lower in the sulodexide group than in the placebo group (p < 0.01). There was no between-group difference concerning, hospital length of stay, thromboembolic events, major bleeding, or mortality.Conclusions: Early intervention on COVID-19 patients with sulodexide resulted in a reduced need for supplemental oxygen and hospital care. The synergistic activity of sulodexide's antithrombotic and non-antithrombotic effects on different biological targets may play an essential role in limiting disease progression. Added a low risk of bleeding or significant side effects, sulodexide might be an alternative to other oral anticoagulants which makes it a valuable medication in the outpatient treatment of COVID-19. DisclosuresGonzalez-Ochoa: Alfasigma: Consultancy, Research Funding; servier: Consultancy.

Analisis Sentimen Twitter Kuliah Online Pasca Covid-19 Menggunakan Algoritma Support Vector Machine dan Naive Bayes

&#x0D; &#x0D; &#x0D; The World Health Organization (WHO) COVID-19 is an infectious disease caused by the Coronavirus which originally came from an outbreak in the city of Wuhan, China in December 2019 which later became a pandemic that occurred in many countries around the world. This disease has caused the government to give a regional lockdown status to give students the status of "at home" for students to enforce online or online lectures, this has caused various sentiments given by students in responding to online lectures via social media twitter. For sentiment analysis, the researcher applies the nave Bayes algorithm and support vector machine (SVM) with the performance results obtained on the Bayes algorithm with an accuracy of 81.20%, time 9.00 seconds, recall 79.60% and precision 79.40% while for the SVM algorithm get an accuracy value of 85%, time 31.60 seconds, recall 84% and precision 83.60%, the performance results are obtained in the 1st iteration for nave Bayes and the 423th iteration for the SVM algorithm&#x0D; &#x0D; &#x0D;

A Study on Business Interruption Coverage Issues caused by COVID-19 - focused on UK Supreme Court Case (FCA v Arch Insurance etc. [2021] UKSC 1) -

전세계적인 COVID-19 감염병 유행과 관련하여 사회적 거리두기나 봉쇄조치 등 각 국 정부의 통제노력이 이루어지고 있는 가운데 이에 부수한 불가피한 경제적 손실도 증가하고 있다. 영국 대법원은 최근 영국 금융감독청이 제기한 test case를 통해 영국보험사들이 중소상공인을 대상으로 판매한 기업성 종합보험 중 재물손해 없는 기업휴지담보와 관련하여 영업중단 손해와 COVID-19 발병간 인과관계를 인정하고 해당 약관의 해석을 통해 보험계약자에게 유리한 판결을 하였다. 인과관계의 판단과 관련하여 기존의 영국보험법의 기준은 효과 측면에서 피보험위험에 근인하여 발생한 손해를 보상하는 것이었다. 본 사건에서 영국 대법원은 각각의 COVID-19 발병사례는 정부 제한조치를 초래한 개별적이고 동등한 효과를 가진 근인(a separate and equally effective cause)으로 인정하였고, 이때 영미법상 사실적 인과관계를 파악하는 방법의 하나인 ‘but for test’는 그 적용이 적절하지 아니한 것으로 판단하였다. 일반적으로 기업휴지보험은 물리적인 재물손해에 결과적으로 발생한 매출감소 및 수익상실을 보상한다. 그러나 기업경영의 측면에서 감염병의 발생과 같이 재물손해없이 발생한 기업휴지손해에 대한 보험보상의 필요성이 확대되고 있다. 금번 영국 대법원의 판결로 인해 재물손해 없는 기업휴지약관에 대해 명확한 판단기준을 제시한 것으로 판단된다.COVID-19 has resulted in a global crisis on a public health and hygiene. Governments has responded and working together with local communities to tackle the health crisis by means of requesting social distancing or even regional lockdown with vaccination. As a result, businesses, especially small and medium enterprises such as retailers or restaurants, have been suffered by the loss of revenue or business interruption. Recently, UK Supreme Court held that, under the test case brought by the UK regulator representing policy holders, UK insurers should make claim payment on ‘Non-physical damage business interruption’ coverage caused by the COVID-19 and the following government actions. Supreme court agreed that each of the individual case of illness resulting from COVID-19 was a separate and equally effective cause of the government restriction. Therefore, it is sufficient to prove that the interruption to the insured’s business was a result of government action taken in response of cases of disease which included at lease one case of COVID-19 whithin the geographical area covered by the disease clause. Insurers claimed that it cannot be said that ‘but for’ a case of COVID-19 at the premises, or within the specified radius, the insured’s loss would have occurred. Court held that ‘but for test’ is not appropriate in this case. The ‘but for test’ ignores cases in which multiple events combine to produce a particular result but none of the individual event was either necessary or sufficient to bring about the result by itself. This case is regarded that the case agreed concurrent or multiple proximate causes. It is also regarded that this case brought some clarity but broadened coverage provided under current business interruption policies. The global insurance industry is playing a role in recovering the global crisis by paying claims and should make contribution to the resilience of economy by offering affordable terms and conditions on business interruption caused by non-physical damage such as failure of supply chain or pandemic disease.

Anomalous Reduction of the Total Suspended Matter During the COVID-19 Lockdown in the Hooghly Estuarine System

The impact of the coronavirus disease 2019 (COVID-19) lockdown in the Hooghly estuarine region, India is assessed using the total suspended matter (TSM) concentration. The estimation of TSM is performed using Landsat-8/operational land imager (OLI), and an intercomparison of TSM load during the pre-lockdown and lockdown periods is done. It is observed that during the lockdown period, TSM reduced by 30–50%. This is a significant observation considering the ecological balance of the region and the fact that it is home to the largest mangroves in the world. This change in suspended matter presumably reflects the influence of reduction in anthropogenic activities owing to the COVID-19 lockdowns, such as industries, closure of shipping activities (through less dredging), and brick kilns (through less sediment removal), which are generally the primary contributors in this region. Even though these observed changes are representative of the positive influence of the COVID-19 lockdown, its implications in estuarine biogeochemistry still remain poorly quantified. The decrease in TSM content may increase light penetration, thereby increasing the primary productivity. In addition, low sediment load reaching the Bay of Bengal could influence the carbon export due to reduction in ballasting effect as reported from this region. In summary, the influence of the COVID-19 lockdown on the biogeochemistry of the aquatic ecosystem appears rather complex than thought earlier and may vary regionally based on local hydrodynamics. The analysis elucidates the complex interplay of regional lockdown and its implication in modulation of local biogeochemistry. However, the relative importance of each process in the Hooghly estuary remains to be fully evaluated.

A Model for the Optimal Investment Strategy in the Context of Pandemic Regional Lockdown

The Covid-19 pandemic has generated major changes in society, most of them having a negative impact on the quality of life and income obtained by the population and businesses. The negative consequences have been highlighted in the decrease of the GPD level for regions, countries and even continents. Returning to pre-pandemic levels is a considerable effort for both economic and political decision-makers. This article deals with the construction of a mathematical model for economic aspects in the context of variable productivity in time. Through this mathematical model, we propose to maximize revenues in pandemic conditions, in order to limit the economic consequences of the lockdown. One advantage of the proposed model consists in the fact that it is based on units that can be regions, economic branches, economic units or fields of investment. Another strength of the model is determined by the fact that it offers the possibility to choose between two different investment strategies, based on the specific options of the decision makers: the consistent increase of the state revenues or the amelioration of the disparity phenomenon. Furthermore, our model extends previous approaches from the literature by adding some generalization options and the proposed model can be applied in lockdown cases and seasonal situations.

Impact of COVID-19 on melanoma diagnosis.

Impact of COVID-19 on melanoma diagnosis.

Impact of the COVID-19 pandemic on ophthalmologic outpatient care: experience from an Italian Tertiary Medical Center

Purpose To evaluate the impact the COVID-19-related national lockdown has had on Ophthalmologic Outpatient Care in an Italian Tertiary Medical Centre. Methods We reviewed all the performances that were carried out as outpatient services at our department between 1 January 2020 and 30 November 2020. We compared data among four different periods: from 1 January 2020 to 17 March 2020 (“Pre-Lockdown”); from 18 March 2020 to 17 May 2020 (Lockdown); from 18 May 2020 to 2 November 2020 (Post-Lockdown) and from 3 November 2020 to 30 November 2020 (Regional Lockdown). Results The overall number of performed routine outpatient visits per day (ROVs) was 11,871 (Mean ± SD = 35.76 ± 17.81), whereas booked appointments (BAs) were 21272 (Mean ± SD = 63.86 ± 9.27), meaning a decline in the number of ROVs by 44.01%. (Mean ± SD = 28.10 ± 12.11, p<.001). Post-Lockdown and Regional Lockdown clinical activities, dropped respectively by 31 and 25.14% (38.87 ± 3.88 vs. 56.34 ± 11.06, p<.001 and 6.04 ± 4.51 vs. 56.34 ± 11.06 p<.001). The number of BAs per day decreased during the pandemic, going from a mean of 77.81 ± 2.57 booked appointments per day before the lockdown, to a mean of 53.14 ± 4.94, 61.80 ± 4.62 and 72.07 ± 1.09 appointments per day respectively during the lockdown, the post-lockdown and the regional lockdown periods. Conclusions During the various lockdown periods, at our institution the volume of outpatient ophthalmological visits drastically dropped. This testifies the dramatic impact the COVID-19 pandemic has had on the supply of ophthalmic care.

Disease control across urban-rural gradients.

Controlling the regional re-emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after its initial spread in ever-changing personal contact networks and disease landscapes is a challenging task. In a landscape context, contact opportunities within and between populations are changing rapidly as lockdown measures are relaxed and a number of social activities re-activated. Using an individual-based metapopulation model, we explored the efficacy of different control strategies across an urban–rural gradient in Wales, UK. Our model shows that isolation of symptomatic cases or regional lockdowns in response to local outbreaks have limited efficacy unless the overall transmission rate is kept persistently low. Additional isolation of non-symptomatic infected individuals, who may be detected by effective test-and-trace strategies, is pivotal to reducing the overall epidemic size over a wider range of transmission scenarios. We define an ‘urban–rural gradient in epidemic size' as a correlation between regional epidemic size and connectivity within the region, with more highly connected urban populations experiencing relatively larger outbreaks. For interventions focused on regional lockdowns, the strength of such gradients in epidemic size increased with higher travel frequencies, indicating a reduced efficacy of the control measure in the urban regions under these conditions. When both non-symptomatic and symptomatic individuals are isolated or regional lockdown strategies are enforced, we further found the strongest urban–rural epidemic gradients at high transmission rates. This effect was reversed for strategies targeted at symptomatic individuals only. Our results emphasize the importance of test-and-trace strategies and maintaining low transmission rates for efficiently controlling SARS-CoV-2 spread, both at landscape scale and in urban areas.

Tackling the COVID-19 pandemic: The Bangladesh perspective.

An outbreak of a COVID-19 pandemic disease, caused by a novel coronavirus SARS-CoV-2, has posed a serious threat to global human health. Bangladesh has also come under the attack of this viral disease. Here, we aimed to describe the responses of Bangladesh to tackle the COVID-19, particularly on how Bangladesh is dealing with this novel viral disease with its limited resources. The first case of a COVID-19 patient was detected in Bangladesh on March 8, 2020. Since then, a total of 263,503 peoples are officially reported as COVID-19 infected with 3,471 deaths until August 11, 2020. To combat the COVID-19, the government has taken various steps viz. diagnosis of the suspected cases, quarantine of doubted people and isolation of infected patients, local or regional lockdown, closure of all government and private offices, increase public awareness and enforce social distancing, etc. Moreover, to address the socio-economic situations, the government announced several financial stimulus packages of about USD 11.90 billion. However, the government got 3 months since the disease was first reported in China, but the country failed in making proper strategies including contact tracing, introducing antibody/antigen-based rapid detection kit, and also failed to make multi-disciplinary team to combat this disease. Further, limited testing facilities and inadequate treatment service along with public unawareness are the major challenges for Bangladesh to tackle this situation effectively. Along with the government, personal awareness and assistance of non-government organizations, private organizations, researchers, doctors, industrialists, and international organizations are firmly required to mitigate this highly contagious disease.Significance for public healthA novel coronavirus, named SARS-CoV-2, causes COVID-19 disease. This has emerged as a serious threat to human health and economy of the whole world. Bangladesh is one of the densely populated countries in the world, which also has come under attack of COVID-19. The first case of COVID-19 patient was detected in Bangladesh on March 8, 2020. Since then, a total of 30,205 peoples are officially reported as COVID-19 infected with 432 deaths. This lethal COVID- 19 drastically hit the economy of Bangladesh, with 170 million of inhabitants. The local and regional lockdown has already suspended almost all economic activities. However, limited health care service facilities of the country along with public unawareness are the major problems for Bangladesh to tackle this situation effectively. Of note, a large number of low-income workers, day-laborers need to go outside to earn daily income for their livelihood that causes mass transmission. Moreover, many hospitals, some doctors, nurses and other health officials are reluctant to provide treatment to COVID-19 patients and also non- COVID-19 patients. This report described the responses of Bangladesh to tackle the dreadful COVID-19 and discussed prevailing challenges, and how to mitigate this highly contagious disease with limited resources.

Modeling the dispersal effect to reduce the infection of COVID-19 in Bangladesh

In this paper, we propose a four compartmental model to understand the dynamics of infectious disease COVID-19. We show the boundedness and non-negativity of solutions of the model. We analytically calculate the basic reproduction number of the model and perform the stability analysis at the equilibrium points to understand the epidemic and endemic cases based on the basic reproduction number. Our analytical results show that disease free equilibrium point is asymptotically stable (unstable) and endemic equilibrium point is unstable (asymptotically stable) if the basic reproduction number is less than (greater than) unity. The dispersal rate of the infected population and the social awareness control parameter are the main focus of this study. In our model, these parameters play a vital role to control the spread of COVID-19. Our results reveal that regional lockdown and social awareness (e.g., wearing a face mask, washing hands, social distancing) can reduce the pandemic of the current outbreak of novel coronavirus in a most densely populated country like Bangladesh.