Strict Social Distancing Measures Research Articles

Impact of the COVID-19 Pandemic on Trauma and Orthopaedic Service in the Republic of Ireland

Background: The novel coronavirus disease-2019 (COVID-19) has been identified as the cause of a rapidly spreading respiratory illness that is thought to have originated from Wuhan, China in early December 2019. Since then, the free movement of people has decreased, which has thus reduced the number of trauma-related casualties. The Irish governments initiated strict social distancing measures in response to the COVID-19 pandemic in late March 2020. It remains challenging to quantify the impact this had on reducing the spread of the virus. The viral outbreak has led to significant changes in the lifestyle of Irish citizens. The aim of this study was to examine the impact of the pandemic on activity, related to emergencies in trauma and orthopaedics departments. Methods: Patients admitted to the Trauma and Orthopaedic Department at Cork University Hospital (CUH), Cork, Ireland and South Infirmary Victoria University Hospital (SIVUH), Cork, Ireland between the 1st of March and the 15th of April 2020 were documented and compared to the patient admissions from the same time period in 2019. Results: The total numbers of lower limb trauma cases dropped by 20.44% from 137 (females: 87; males: 50) to 109 (females: 74; male: 35), (p=0.72). Of note, there was a 30.00% reduction in the number of male cases (from 50 to 35; p<0.05), in comparison to the 14.94% reduction observed in the female population (from 87 to 74; p<0.05). The total number of upper limb trauma cases increased by 0.14% from 90 (female: 44; men: 46) to 94 (female: 54; male: 40; p=0.14). The increase reported was only applicable to the female population; the number of male cases of upper limb trauma slightly decreased from 46 to 40 (p<0.005). Conclusion: The COVID-19 crisis has led to a decrease in the total numbers of lower limb trauma surgeries but an increase in the number of upper limb fractures. The main reduction was amongst the male patients, while the number of female cases increased.

Abstract PO-011: CiRCL: A psychosocial program facilitating communication and care to patients, families, and frontline health care teams during COVID-19

Abstract The need for strict social distancing measures preventing visitors on inpatient oncology, ICU, and COVID units during the COVID-19 pandemic has had the unintended consequence of leading to significant psychological and spiritual distress for patients and families and “moral distress” for frontline health care teams tasked with supporting patients who are suffering or dying alone without the support of their loved ones. The trauma of these deaths is sometimes further compounded for families by their inability to provide the final rituals of patients’ faith communities in their last moments, leading to complicated and ongoing grief after the loss. To address these complex psychosocial needs among COVID-19 and advanced cancer oncology patients, and the health care teams caring for them, the Simms/Mann UCLA Center for Integrative Oncology, in collaboration with colleagues at the UCLA Anderson School of Business and a team of diverse faith leaders, developed an innovative digitally mediated program for connection, communication, and care. This program, CiRCL (Caring in Remote Communities of Love), leveraged ZOOM and smartphone recording technology to accomplish the following goals: 1) provide psychological support to family members and friends to facilitate the recording of meaningful personal messages to the patient, including curated playlists of evocative songs from the patient’s life to be played at the bedside; 2) facilitate more meaningful communication between loved ones and frontline workers, including messages of gratitude and support to reduce feelings of isolation and moral distress for frontline workers; and 3) create a liturgical library of recorded ecumenical and faith-based blessings from various traditions, available during illness and at time of dying. Blessings include and encompass the health care teams as well as patients. This program, recently developed and being piloted at UCLA, is intended to extend compassion to all within the health care system during the unique challenges of COVID-19 and, by facilitating connection and support among patients, families, and frontline teams, extend the definition of healing and mitigate the impact of loss and grief for all during the many phases of this pandemic. Citation Format: Kauser Ahmed, Peter Phung, Noah Goldstein, John Glaspy. CiRCL: A psychosocial program facilitating communication and care to patients, families, and frontline health care teams during COVID-19 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-011.

Practice of Academic Surgical Pathology During the COVID-19 Pandemic.

ObjectivesTo determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on our service, pre-, and postgraduate education and discuss the measures taken to ensure continued provision of quality service as well as education during the mandatory lockdown.MethodsMeasures taken to protect staff from infection and minimize virus transmission within the department as well as measures taken to allow smooth provision of quality service and uninterrupted pre- and postgraduate education were analyzed. Data were collected regarding case volumes (histology, cytology, and frozen sections) and case complexity during the lockdown and analyzed. ResultsStaggered rota was introduced for all staff. Strict social distancing measures were implemented. Staff was extensively counseled regarding the importance of protective measures. Pre- and postgraduate education, which was temporarily suspended, was quickly resumed using online teaching ensuring continuation of academic activities. The volume of cases decreased during the lockdown but complexity increased even more.ConclusionsImmediate and effective measures were taken to protect staff from infection and ensure smooth provision of quality services. Measures were quickly taken to ensure resumption of pre- and postgraduate academic activities. The volume of cases decreased but complexity increased. There is fear among faculty and staff regarding the future.

Epidemiology and Control of Two Epidemic Waves of SARS-CoV-2 in South Korea

Background: Since the first case of pandemic COVID-19 in South Korea, identified on 19 January 2020, two epidemic waves have occurred. We characterised the epidemiology, transmission dynamics and effectiveness of control measures in each epidemic wave of COVID-19.Methods: We analysed publicly available data on confirmed cases of COVID-19 outside of Daegu-Gyeongbuk Regions in South Korea during first (19 January–19 April 2020) and second (20 April–11 August 2020) epidemic waves. Transmissibility of SARS-CoV-2 was measured by daily effective reproductive number, Rt. Frequencies of cluster types, age-specific transmission probability matrices, proportion of asymptomatic and unlinked cases, and serial interval distribution were estimated for each wave. Results: In early May, within 2-weeks of relaxation on strict social distancing measures, Rt increased rapidly from 0.2 to 2.3 within a week and was around 1 until early July. The most frequent clusters type were the religious related activities in both waves, but noticed more workplace-related clusters in the second wave. The proportion of asymptomatic cases at presentation increased from 22% during first wave to 27% during second wave. The proportion of unlinked local cases were similar in both waves (22% and 24%). Transmissions among same age were more common, and children were rarely infectors or infectees. The mean serial interval were similar (~3 days) in both waves. Conclusions: Our study shows that relaxing social distancing measures was associated with increased SARS-CoV-2 transmission. Enhanced contact tracing including asymptomatic cases could be more efficient with social distancing to control further waves of the pandemic.

Mental Health Care Goes Online: Practitioners' Experiences of Providing Mental Health Care During the COVID-19 Pandemic.

The outbreak of the COVID-19 pandemic has necessitated sudden and radical changes in mental health care delivery, as strict social distancing and lockdown measures were imposed in the early phases of the pandemic. Almost overnight, practitioners were forced to transfer their face-to-face care practice to online means. To understand the implications of this drastic change for mental health care, and to improve the online care offerings, an online qualitative survey was held among mental health care professionals in Netherlands (n = 51). Our findings indicate that technological and usability problems pose a significant challenge, as do difficulties to establish rapport with clients. Moreover, not all mental health issues and treatment forms are equally amenable to online interaction. In contrast, in many instances, practitioners were positive about the effectiveness of treatment, and reported flexibility, a lower threshold for contact, and lack of travel time as advantages. Their most prominent needs concern better technological, organizational, and logistical support. It is critical that these needs are acted upon by institutions and governments. In addition, current results inform future research on the improvement of e-mental health technologies.

Remote training for combat medics during the COVID-19 era: lessons learnt for future crises?

BackgroundIn response to COVID-19, the UK government ordered strict social distancing measures. The UK Armed Forces followed these to protect the force and ensure readiness to respond to various tasking...

Response to COVID-19 Infection in Hemodialysis Patients: An Australian Perspective.

The first reported case of coronavirus disease 2019 (COVID-19) infection in Australia (population 26 million) occurred on January 24th, 2020 in a returned traveler from Wuhan, China (1) followed by a rapid rise in new cases (Figure 1). The Australian government activated the Health Sector Emergency Response Plan for Novel Coronavirus (2) in late February, with subsequent implementation of strict social distancing measures and closure of international boarders in late March (Figure 1). We describe the response taken by the Australian and New Zealand Society of Nephrology (ANZSN) to prepare for the potential exponential increase in case load that was seen in other countries, such as Italy, the United Kingdom, and the United States. Figure 1. Daily coronavirus disease 2019 (COVID-19) infection numbers in Austraia January 24th to June 8th, 2020 showing peak cases mid to late March. Blue and red arrows illustrate timing of Australian Government and Australian and New Zealand Society of Nephrology (ANZSN) initiatives in relation to daily COVID-19 infection numbers. On March 4th, 2020, the ANZSN Council canvassed members to determine if any had commenced preparations for the COVID-19 infection. It became clear that no coordinated approach to this infection had been instigated. As such, the ANZSN Council held a members-only virtual meeting (the COVID-19 Forum) to gauge the preparedness of society members and obtain guidance on further actions. The first COVID-19 Forum was held on March 18th at a time when daily case numbers were rapidly escalating (Figure 1). It was clear at this meeting that the society and its members were not prepared for the COVID-19 infection. This directed the ANZSN Council to create a COVID-19 Working Group (WG) comprising nephrologists and renal nursing and patient advocacy experts with geographic representation across Australia and New Zealand. Specifically, the WG performed three broad functions—monitor and remain informed …

Risk of death by age and gender from CoVID-19 in Peru, March-May, 2020.

Peru implemented strict social distancing measures during the early phase of the epidemic and is now experiencing one of the largest CoVID-19 epidemics in Latin America. Estimates of disease severity are an essential indicator to inform policy decisions about the intensity and duration of interventions needed to mitigate the outbreak. Here we derive delay-adjusted case fatality risks (aCFR) of CoVID-19 in a middle-income country in South America.We utilize government-reported time series of CoVID-19 cases and deaths in Peru stratified by age group and gender.As of May 25, 2020, we estimate the aCFR for men and women at 10.8% (95%CrI: 10.5-11.1%) and 6.5% (95%CrI: 6.2-6.8%), respectively, whereas the overall aCFR was estimated at 9.1% (95%CrI: 8.9-9.3%). Our results show that senior individuals have been the most severely affected by CoVID-19, particularly men, with an aCFR of nearly 60% for those aged 80- years. We also found that men have a significantly higher cumulative morbidity ratio across most age groups (proportion test, p-value< 0.001), with the exception of those aged 0-9 years.The ongoing CoVID-19 pandemic is generating a substantial mortality burden in Peru. Senior individuals, especially those older than 70 years, are being disproportionately affected by the CoVID-19 pandemic.

Long-term strategies to control COVID-19 in low and middle-income countries: an options overview\xa0of community-based,\xa0non-pharmacological interventions

In low and middle-income countries (LMICs), strict social distancing measures (e.g., nationwide lockdown) in response to the COVID-19 pandemic are unsustainable in the long-term due to knock-on socioeconomic and psychological effects. However, an optimal epidemiology-focused strategy for ‘safe-reopening’ (i.e., balancing between the economic and health consequences) remain unclear, particularly given the suboptimal disease surveillance and diagnostic infrastructure in these settings. As the lockdown is now being relaxed in many LMICs, in this paper, we have (1) conducted an epidemiology-based “options appraisal” of various available non-pharmacological intervention options that can be employed to safely lift the lockdowns (namely, sustained mitigation, zonal lockdown and rolling lockdown strategies), and (2) propose suitable application, pre-requisites, and inherent limitations for each measure. Among these, a sustained mitigation-only approach (adopted in many high-income countries) may not be feasible in most LMIC settings given the absence of nationwide population surveillance, generalised testing, contact tracing and critical care infrastructure needed to tackle the likely resurgence of infections. By contrast, zonal or local lockdowns may be suitable for some countries where systematic identification of new outbreak clusters in real-time would be feasible. This requires a generalised testing and surveillance structure, and a well-thought out (and executed) zone management plan. Finally, an intermittent, rolling lockdown strategy has recently been suggested by the World Health Organization as a potential strategy to get the epidemic under control in some LMI settings, where generalised mitigation and zonal containment is unfeasible. This strategy, however, needs to be carefully considered for economic costs and necessary supply chain reforms. In conclusion, while we propose three community-based, non-pharmacological options for LMICs, a suitable measure should be context-specific and based on: (1) epidemiological considerations, (2) social and economic costs, (3) existing health systems capabilities and (4) future-proof plans to implement and sustain the strategy.

Spatiotemporal Characteristics of the COVID-19 Epidemic in the United States.

BackgroundA range of near-real-time online/mobile mapping dashboards and applications have been used to track the coronavirus disease 2019 (COVID-19) pandemic worldwide; however, small area-based spatiotemporal patterns of COVID-19 in the United States remain unknown.MethodsWe obtained county-based counts of COVID-19 cases confirmed in the United States from 22 January to 13 May 2020 (N = 1 386 050). We characterized the dynamics of the COVID-19 epidemic through detecting weekly hotspots of newly confirmed cases using Spatial and Space-Time Scan Statistics and quantifying the trends of incidence of COVID-19 by county characteristics using the Joinpoint analysis.ResultsAlong with the national plateau reached in early April, COVID-19 incidence significantly decreased in the Northeast (estimated weekly percentage change [EWPC]: −16.6%) but continued increasing in the Midwest, South, and West (EWPCs: 13.2%, 5.6%, and 5.7%, respectively). Higher risks of clustering and incidence of COVID-19 were consistently observed in metropolitan versus rural counties, counties closest to core airports, the most populous counties, and counties with the highest proportion of racial/ethnic minorities. However, geographic differences in incidence have shrunk since early April, driven by a significant decrease in the incidence in these counties (EWPC range: −2.0%, −4.2%) and a consistent increase in other areas (EWPC range: 1.5–20.3%).ConclusionsTo substantially decrease the nationwide incidence of COVID-19, strict social-distancing measures should be continuously implemented, especially in geographic areas with increasing risks, including rural areas. Spatiotemporal characteristics and trends of COVID-19 should be considered in decision making on the timeline of re-opening for states and localities.

COVID-19: In the Absence of Vaccination – ‘Mask the Nation’

COVID-19: In the Absence of Vaccination – ‘Mask the Nation’

A Review on 2019-nCoV (SARS-CoV-2) in India

Background: The outbreak of the novel coronavirus, COVID-19, has been declared a pandemic by the WHO on March 11th of 2020. Novel Coronavirus infection mediated pandemic started in China in December 2019 and is still killing 1000s of people throughout the world. The second most populous country, India too is fighting against this infectious disease. The country is taking effective measures to curb the pandemic by exerting extensive campaigning on sanitation and strict social distancing measures to quell the explosion of the infection rate.&#x0D; Treatment: No drugs are currently approved for Coronavirus Disease-2019 (COVID-19), although some have been tried. In view of recent studies and discussion on tested drugs on COVID-19 patients of India, I aimed to review existing literature and relevant websites regarding these drugs used in India including allopathic, plasma therapy,Ayurvedic and homeopathic medication.&#x0D;

Unfolding Events in Space and Time: Geospatial Insights into COVID-19 Diffusion in Washington State during the Initial Stage of the Outbreak

The world witnessed the COVID-19 pandemic in 2020. The first case of COVID-19 in the United States of America (USA) was confirmed on 21 January 2020, in Snohomish County in Washington State (WA). Following this, a rapid explosion of COVID-19 cases was observed throughout WA and the USA. Lack of access to publicly available spatial data at finer scales has prevented scientists from implementing spatial analytical techniques to gain insights into the spread of COVID-19. Datasets were available only as counts at county levels. The spatial response to COVID-19 using coarse-scale publicly available datasets was limited to web mapping applications and dashboards to visualize infected cases from state to county levels only. This research approaches data availability issues by creating proxy datasets for COVID-19 using publicly available news articles. Further, these proxy datasets are used to perform spatial analyses to unfolding events in space and time and to gain insights into the spread of COVID-19 in WA during the initial stage of the outbreak. Spatial analysis of theses proxy datasets from 21 January to 23 March 2020, suggests the presence of a clear space–time pattern. From 21 January to 6 March, a strong presence of community spread of COVID-19 is observed only in close proximity of the outbreak source in Snohomish and King Counties, which are neighbors. Infections diffused to farther locations only after a month, i.e., 6 March. The space–time pattern of diffusion observed in this study suggests that implementing strict social distancing measures during the initial stage in infected locations can drastically help curb the spread to distant locations.

Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland.

The outbreak of coronavirus disease (COVID-19) in late December 2019 in China, which later developed into a pandemic, has forced different countries to implement strict sanitary regimes and social distancing measures. Globally, at least four billion people were under lockdown, working remotely, homeschooling children, and facing challenges coping with quarantine and the stressful events. The present cross-sectional online survey of adult Poles (n = 1097), conducted during a nationwide quarantine, aimed to assess whether nutritional and consumer habits have been affected under these conditions. Over 43.0% and nearly 52% reported eating and snacking more, respectively, and these tendencies were more frequent in overweight and obese individuals. Almost 30% and over 18% experienced weight gain (mean ± SD 3.0 ± 1.6 kg) and loss (−2.9 ± 1.5 kg), respectively. Overweight, obese, and older subjects (aged 36–45 and >45) tended to gain weight more frequently, whereas those with underweight tended to lose it further. Increased BMI was associated with less frequent consumption of vegetables, fruit, and legumes during quarantine, and higher adherence to meat, dairy, and fast-foods. An increase in alcohol consumption was seen in 14.6%, with a higher tendency to drink more found among alcohol addicts. Over 45% of smokers experienced a rise in smoking frequency during the quarantine. The study highlights that lockdown imposed to contain an infectious agent may affect eating behaviors and dietary habits, and advocates for organized nutritional support during future epidemic-related quarantines, particularly for the most vulnerable groups, including overweight and obese subjects.

Quantifying the role of social distancing, personal protection and case detection in mitigating COVID-19 outbreak in Ontario, Canada

Public health interventions have been implemented to mitigate the spread of coronavirus disease 2019 (COVID-19) in Ontario, Canada; however, the quantification of their effectiveness remains to be done and is important to determine if some of the social distancing measures can be relaxed without resulting in a second wave. We aim to equip local public health decision- and policy-makers with mathematical model-based quantification of implemented public health measures and estimation of the trend of COVID-19 in Ontario to inform future actions in terms of outbreak control and de-escalation of social distancing. Our estimates confirm that (1) social distancing measures have helped mitigate transmission by reducing daily infection contact rate, but the disease transmission probability per contact remains as high as 0.145 and case detection rate was so low that the effective reproduction number remained higher than the threshold for disease control until the closure of non-essential business in the Province; (2) improvement in case detection rate and closure of non-essential business had resulted in further reduction of the effective control number to under the threshold. We predict the number of confirmed cases according to different control efficacies including a combination of reducing further contact rates and transmission probability per contact. We show that improved case detection rate plays a decisive role to reduce the effective reproduction number, and there is still much room in terms of improving personal protection measures to compensate for the strict social distancing measures.

Understanding the epidemiology of COVID-19

COVID-19 caused by SARS-CoV-2 was reported in December, 2019 in Wuhan city of Hubei province, China, in people who had visited seafood market. Its symptoms were similar to pneumonia but its infectivity was very high. The main modes of transmission of SARS-CoV-2 were identified as spread by nasal droplets and oral-fecal route and COVID-19 was found to be infectious in incubation and asymptomatic period. Hence, by the time real potential of its pathogenicity was realized, it had spread to many regions of China, other Asian countries, European countries, United States etc. and by April 20, 2020, it had spread to 185 countries all over the world. By this time, China had contained the virus, due to strict social distancing measures, and there was decline in the number of positive cases but in many other countries, especially U.S. and European countries, the cases continued to rise. United States showed the sharpest rise in COVID-19 cases in April, 2020 and also reported the highest number of deaths from the disease. As most of the countries are facing first-wave of COVID-19 by April, 2020, there are fears of second-wave of COVID-19 as China plans to relax social distancing norms to resume business, other work etc. to combat economic losses. DOI: http://dx.doi.org/10.5281/zenodo.3822115

In the frame, road map for Australian sport on an uncertain journey through COVID-19

In the frame, road map for Australian sport on an uncertain journey through COVID-19

Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus

A pandemic of a novel Coronavirus emerged in December of 2019 (COVID-19), causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antivirals, strategies for controlling and mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation, and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of the aforementioned control and mitigation strategies. Rigorous analysis of the model shows that the disease-free equilibrium is locally-asymptotically stable if a certain epidemiological threshold, known as the reproduction number (denoted by ℛc), is less than unity. Simulations of the model, using data relevant to COVID-19 transmission dynamics in the US state of New York and the entire US, show that the pandemic burden will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on the baseline levels of anti-COVID non-pharmaceutical interventions considered in the study) decrease dramatically by 80% and 64%, respectively, if the strict social-distancing measures implemented are maintained until the end of May or June, 2020. The duration and timing of the relaxation or termination of the strict social-distancing measures are crucially-important in determining the future trajectory of the COVID-19 pandemic. This study shows that early termination of the strict social-distancing measures could trigger a devastating second wave with burden similar to those projected before the onset of the strict social-distancing measures were implemented. The use of efficacious face-masks (such as surgical masks, with estimated efficacy ≥ 70%) in public could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks in public consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of estimated efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of the other anti-COVID-19 intervention strategies can lead to the elimination of the pandemic. This study emphasizes the important role social-distancing plays in curtailing the burden of COVID-19. Increases in the adherence level of social-distancing protocols result in dramatic reduction of the burden of the pandemic, and the timely implementation of social-distancing measures in numerous states of the US may have averted a catastrophic outcome with respect to the burden of COVID-19. Using face-masks in public (including the low efficacy cloth masks) is very useful in minimizing community transmission and burden of COVID-19, provided their coverage level is high. The masks coverage needed to eliminate COVID-19 decreases if the masks-based intervention is combined with the strict social-distancing strategy.

Comparison of Measures adopted to combat COVID 19 Pandemic by different countries in WHO regions

Since the emergence of Corona Virus Disease 19 (COVID 19) in China in December 2019, a lot of significant decisions have been taken by the World Health Organization (WHO) and several countries across the globe. As the world reels under the threat of rapid increase in the number of cases and is planning strategies with the limited information available on the virus, it is essential to learn from the experience of countries across the globe. Hence, we selected a few countries in five WHO regions based on their COVID 19 caseload, management strategies and outcome and compared some of the important measures taken by them to contain the spread of infection. Strategies like extensive testing and contact tracing, strict quarantine and isolation measures, Hospital preparedness, complete restriction of non-essential travel, strict border control measures and social distancing measures play a vital role in containment of the spread. All the countries faced the novel strain of virus and implemented similar strategies as per the guidance of WHO, but the extent of preparedness, swiftness with which the decisions were made and the scale of measures made the difference.

On the Economic Impact of Social Distancing Measures

We study the economic impact of social distancing measures aimed at lowering the proportion of infected individuals to a predetermined level. Using simple economic and epidemiology models, it is proven that strict social distancing measures diminish the aggregate loss in the economic output and the number of new infections during the containment period. This can be explained by the fact that, when strict social distancing measures are enforced, a short containment period is needed to restrain the proportion of infected individuals to a given level. It is also proven that early interventions diminish the aggregate economic loss as well as the number of new infections during the containment period. We derive simple approximations for the economic loss and number of new infections. A numerical example based on COVID-19 shows that aggressive and early social distancing measures can significantly reduce the aggregate economic loss as well as the number of new infections.