Task 6 - What do we know about non-pharmaceutical interventions?



Which is the best way to scale up NPIs in a more coordinated way to give us time to enhance our health care delivery system capacity to respond to an increase in cases?


More restrictive npis in hamburg have the potential to lead to a fast stop of viral spreading on a scale of a few weeks up to two months . [Estimate of the development of the epidemic reproduction number Rt from Coronavirus SARS-CoV-2 case data and implications for political measures based on prognostics, unknown journal, 2020-04-07]
Assuming travel restrictions , meaning independence of the different states , and assuming the latest reproduction number Rt kept for a year , Saarland with the highest Rt would experience a scenario of major immunisation of the population with an overwhelmed health care system ( Figure 4 , Saarland , black ) , while in Hamburg , exhibiting the lowest Rt , the virus would be eliminated within a few months from now ( Figure 4 , Hamburg , black ) . With more restrictive NPIs in Saarland , viral spreading may be stopped within 3 months of time . Even if implemented today , the model predicts that the number of required ICUs will continue to rise for a few weeks before going down . More restrictive NPIs in Hamburg have the potential to lead to a fast stop of viral spreading on a scale of a few weeks up to two months . Hamburg can tolerate some reduction of NPIs and still control viral spreading , however , on a very long time scale ( Figure 4 , Hamburg , magenta ) . Generally , the model results suggest , similar to whole Germany , that a release of NPIs will lead to an overwhelmed health care system associated with many deaths .

As of mid - march , singapore remains in a containment mode with enhanced surveillance and limited community spread . [Caring for children and adolescents with eating disorders in the current COVID-19 pandemic: A Singapore perspective, Journal of Adolescent Health, 2020-04-06]
Abstract Our public pediatric tertiary hospital in Singapore has been a part of a robust public heath response to COVID - 19 that has been calibrated in a timely manner to the evolving international situation . As of mid - March , Singapore remains in a containment mode with enhanced surveillance and limited community spread . Within this context , our service for pediatric eating disorder care has had to make significant adaptations to our models of service delivery as well as respond to the changing psychosocial needs of our patients . Given infection control requirements , we have instituted modular staffing for our inpatient and outpatient settings , necessitating task shifting and an increased use of technology for communication . Due to reduced outpatient capacity and the need to minimize non - urgent trips to the hospital , we have implemented telemedicine and have leveraged on partnerships with school counselors and other community partners . “ Coronaphobia ” has influenced our patients ’ willingness to attend visits and worsened existing health anxiety for some . Responsiveness to families ’ and patients ’ health and financial concerns has been essential . As COVID - 19 impacts more countries , our institution ’ s experience can provide insight into challenges and possible adaptations to providing ongoing care for eating disorder patients in this environment .

Our findings show that many countries need support to achieve these capacities and increased support should be provided as a global priority action to strengthen health security . [Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries, The Lancet, 2020-03-18]
A country ' s response capacity depends on the strength of its emergency preparedness and the regular testing and updating of national plans and capacities . 30 An effec tive response to an outbreak depends not only on the availability of adequate human resources and financing , but also on the ability to manage emergency logistics ( including the handling of supply chains for essential products that are required during an emergency ) . Our findings show that many countries need support to achieve these capacities and increased support should be provided as a global priority action to strengthen health security . Our findings on operational readiness capacities and enabling function , which are low in many low - resource countries , underline the importance of increasing investments in scaling up IHR capacities , as described in the 2019 annual report of the Global Preparedness Monitoring Board . 8 Another challenge underpinning low national preparedness capacities is insufficient investment in human capital and poor continuity planning . 18 , 31 , 32 The world needs to increase investment in anthropologists , data scientists , communication specialist , educationists , and economists , who are all essential in providing necessary support for the control of infectious disease outbreaks . 12 , 31 , 32 The important role these specialists play in responding to outbreaks , including Ebola virus , MERS - CoV , cholera , and measles are well documented , and a key lesson from these public health emergencies has been to ensure that these skillsets are developed further . 32 Our data reinforce this notion , given the low capacities that many countries have to prevent and respond to health emergencies and infectious disease outbreaks effectively .

They can then implement measures regarding staff resources and hospital beds to meet the challenges of this difficult time . [COVID-19 and Italy: what next?, The Lancet, 2020-03-13]
We present the following predictions to prepare our political leaders - those who bear the greatest responsibility for national health systems and the government at the regional level , as well as local health authorities - for what is predicted to happen in the days and weeks to come . They can then implement measures regarding staff resources and hospital beds to meet the challenges of this difficult time . Official numbers of infected people during the COVID - 19 virus outbreak in Italy are indicative of the spread of the infection , and of the challenges that will be posed to Italian hospitals and , in particular , intensive care facilities . The number of patients who are infected has been published daily since Feb 21 , 2020 . It is possible to fit the available data for the number of patients who are actively infected into an exponential model , as reported in figure 1A . The value of the exponent can be computed as r = 0 · 225 ( 1 per day ) and is consistent with the number of infected patients reported by the Italian Health Ministry . The consistency between the exponential prediction and the reported data is very close up until day 17 . If the increase in the number of infected patients follows this trend for the next week , there will be more than 30 000 patients infected by March 15 , as shown in figure 1B . On the basis of the exponential curve prediction , and the assumption that the duration of infection ranges from 15 to 20 days , it is possible to calculate that the basic reproduction number ranges from 2 · 76 to 3 · 25 . This number is similar to that reported for the initial phase of the infection outbreak in the city of Wuhan , China 3 and slightly higher than 2 · 2 , as reported by Li and colleagues in a more recent report . 4 The number of patients admitted to intensive care units increased similarly in Italy , with an exponential trend up until March 8 . The best fit of the data reported by the Italian Ministry for Health can be obtained using the same exponent that best fits the number of patients figure 2A . The data available up until March 8 show that the trend in the number of patients who will need admission to intensive care units will increase substan tially and relentlessly in the next few days . We can predict with quite a good degree of accuracy that this number will push the national health system to full capacity in a matter of days .

Where this is not yet done , policymakers should urgently expand their health care capacities to avoid pressure as experienced in italy . [Indications for healthcare surge capacity in European countries facing an exponential increase in COVID19 cases, unknown journal, 2020-03-17]
The measures proposed in this paper are an approximation to the current healthcare capacity in Europe . Unfortunately , data on health care capacity is rel atively scarce and we have to rely on data from 2017 , 2018 or even older . Data availability is even worse for critical care beds , on which we rely on multicountry data from 2010 . Remuzzi & Remuzzi report ICU capacity of 5200 beds for Italy as a whole , which is lower than the 7550 critical care beds reported by Rhodes et al . [ 1 , 5 ] . It is likely that other EU countries have downsized their critical bed capacity too . In terms of curative beds per 100 000 population as reported by Eurostat , for most countries ( all except Ireland , Bulgaria , Poland and Romania ) , we observed a downward trend in the past 10 years . Moreover , hospital capacity strain was recently found to be associated with increased mortality and decreased health outcomes [ 10 ] . Note that if we would assume the same extent of downsizing in Italy and other EU countries , our relative comparisons would not change . Note that we compare these countries by their base capacity , while clearly many countries have expanded their base capacity to differing degrees ( eg , additional beds , mobilizing volunteers or retired Physicians x critical care beds ( Physicians + nurses ) x critical care beds health care workers ) . We therefore will track at which relative pressure individual countries can no langer handle the volume of critical patients and which pressure on their base capacity they experience at the peak . Note also that we do not account for health care workers ' incapacitation from COVID - 19 or other causes as the epidemic unfolds . Our analysis shows that many European countries are soon to be confronted with a health care pressure that will exceed current healthcare capacity . Based on the intensity - approach and the composite measures , we believe that the healthcare pressure in Spain is already at very high levels . For The Netherlands and France the pressure on healthcare systems will soon reach Italy ' s levels . Where this is not yet done , policymakers should urgently expand their health care capacities to avoid pressure as experienced in Italy . Our analysis informs policy makers on how far their country is removed from an overloaded healthcare system . As such , this information can be useful to plan ahead in order to relieve pressure on their national healthcare system . Moreover , the evolving healthcare pressure , especially the pressure experienced by each country at the peak , will be useful to plan future outbreaks and a timely expansion of health care capacity .


Which is the best way to mobilize resources to geographic areas where critical shortfalls are identified?


No suitable answers found.


Rapid design and execution of experiments to examine and compare NPIs currently being implemented


A more thorough and careful analysis of the results reveals that the reproduction number is still in a phase of reduction . [Estimate of the development of the epidemic reproduction number Rt from Coronavirus SARS-CoV-2 case data and implications for political measures based on prognostics, unknown journal, 2020-04-07]
A more thorough and careful analysis of the results reveals that the reproduction number is still in a phase of reduction . While we would expect it to saturate on an unknown level given the currently implemented NPIs , these appear to have turned out to be effective and continue to improve the situation . Likely , this is due to the inertia in the awareness of the population , only slowly adapting responsible behaviour . We strongly recommend to keep the NPIs in place and to re - evaluate the reproduction number over time in order to generate better predictions for the future , in particular , regarding the time period the NPIs have to be kept in order to stop viral spreading .

Planning for rapid research responses for vaccine developments . [Everything old is new again: COVID-19 and public health, Journal of Pediatric Nursing, 2020-03-26]
Essential elements of preparedness for pandemics need to go beyond designing infection control measures , implementing early case detection and evidence - based treatments , and planning for rapid research responses for vaccine developments . Mending and reinforcing the social fabric is paramount as societies are only as their weakest threads . Evidence exists that universal healthcare , mandatory school nursing , community - based nursing and primary care , improved national health literacy , and mandatory paid family medical leave help reduce disparities and improve health outcomes wherever such policies have been executed across the globe . Unfortunately , widespread implementation of such strategies is all too often side - railed by ideological chasms or underfunded mandates . In the future , inclusive local , national , and global preparedness programs derived from an integrated nexus of health , educational , and social systems would help provide a more comprehensive response to pandemics .

Even if implemented today , the model predicts that the number of required icus will continue to rise for a few weeks before going down . [Estimate of the development of the epidemic reproduction number Rt from Coronavirus SARS-CoV-2 case data and implications for political measures based on prognostics, unknown journal, 2020-04-07]
Assuming travel restrictions , meaning independence of the different states , and assuming the latest reproduction number Rt kept for a year , Saarland with the highest Rt would experience a scenario of major immunisation of the population with an overwhelmed health care system ( Figure 4 , Saarland , black ) , while in Hamburg , exhibiting the lowest Rt , the virus would be eliminated within a few months from now ( Figure 4 , Hamburg , black ) . With more restrictive NPIs in Saarland , viral spreading may be stopped within 3 months of time . Even if implemented today , the model predicts that the number of required ICUs will continue to rise for a few weeks before going down . More restrictive NPIs in Hamburg have the potential to lead to a fast stop of viral spreading on a scale of a few weeks up to two months . Hamburg can tolerate some reduction of NPIs and still control viral spreading , however , on a very long time scale ( Figure 4 , Hamburg , magenta ) . Generally , the model results suggest , similar to whole Germany , that a release of NPIs will lead to an overwhelmed health care system associated with many deaths .

We built a travel network - based susceptible - exposed - infectious - removed ( seir ) model to simulate the outbreak across cities in mainland china . [Effect of non-pharmaceutical interventions for containing the COVID-19 outbreak in China, unknown journal, 2020-03-06]
Background : The COVID - 19 outbreak containment strategies in China based on non - pharmaceutical interventions ( NPIs ) appear to be effective . Quantitative research is still needed however to assess the efficacy of different candidate NPIs and their timings to guide ongoing and future responses to epidemics of this emerging disease across the World . Methods : We built a travel network - based susceptible - exposed - infectious - removed ( SEIR ) model to simulate the outbreak across cities in mainland China . We used epidemiological parameters estimated for the early stage of outbreak in Wuhan to parameterise the transmission before NPIs were implemented . To quantify the relative effect of various NPIs , daily changes of delay from illness onset to the first reported case in each county were used as a proxy for the improvement of case identification and isolation across the outbreak . Historical and near - real time human movement data , obtained from Baidu location - based service , were used to derive the intensity of travel restrictions and contact reductions across China . The model and outputs were validated using daily reported case numbers , with a series of sensitivity analyses conducted . Results : We estimated that there were a total of 114 , 325 COVID - 19 cases ( interquartile range [ IQR ] 76 , 776 - 164 , 576 ) in mainland China as of February 29 , 2020 , and these were highly correlated ( p < 0 . 001 , R2 = 0 . 86 ) with reported incidence . Without NPIs , the number of COVID - 19 cases would likely have shown a 67 - fold increase ( IQR : 44 - 94 ) , with the effectiveness of different interventions varying . The early detection and isolation of cases was estimated to prevent more infections than travel restrictions and contact reductions , but integrated NPIs would achieve the strongest and most rapid effect . If NPIs could have been conducted one week , two weeks , or three weeks earlier in China , cases could have been reduced by 66 % , 86 % , and 95 % , respectively , together with significantly reducing the number of affected areas . However , if NPIs were conducted one week , two weeks , or three weeks later , the number of cases could have shown a 3 - fold , 7 - fold , and 18 - fold increase across China , respectively . Results also suggest that the social distancing intervention should be continued for the next few months in China to prevent case numbers increasing again after travel restrictions were lifted on February 17 , 2020 . Conclusion : The NPIs deployed in China appear to be effectively containing the COVID - 19 outbreak , but the efficacy of the different interventions varied , with the early case detection and contact reduction being the most effective . Moreover , deploying the NPIs early is also important to prevent further spread . Early and integrated NPI strategies should be prepared , adopted and adjusted to minimize health , social and economic impacts in affected regions around the World .

Today , pregnant women are usually excluded from experimental trial of drugs and vaccines that do not target obstetric conditions [ 69 ] . [Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections, Viruses, 2020]
It is vitally important that pregnant women be considered in the design , clinical trial , and implementation of vaccine candidates for 2019 - nCoV . In examining the history of vaccine design , it is clear that the needs of pregnant women have rarely been prioritized in either the preclinical development or the clinical trial phases of production . Today , pregnant women are usually excluded from experimental trial of drugs and vaccines that do not target obstetric conditions [ 69 ] . Excluding pregnant women and their infants from participation in vaccine development and implementation undermines ethical principles of justice - fairness , equity , and maximization of benefit - and potentially places their health at risk during outbreaks and other health emergencies [ 69 ] [ 70 ] [ 71 ] .


What is known about the efficacy of school closures?


No suitable answers found.


What is known about the efficacy of travel bans?


No suitable answers found.


What is known about the efficacy of bans on mass gatherings?


No suitable answers found.


What is known about the efficacy of social distancing approaches?


The efficacy of social distancing of disease - aware individuals is described by the reduction in their contact rate [Impact of self-imposed prevention measures and short-term government intervention on mitigating and delaying a COVID-19 epidemic, unknown journal, 2020-03-16]
Self - imposed social distancing 155 Disease - aware individuals may also practice social distancing , i . e . , maintaining distance to others and avoid congre - 156 gate settings . As a consequence , this measure leads to a change in mixing patterns in the population . The efficacy of social distancing of disease - aware individuals is described by the reduction in their contact rate which is varied 158 from 0 % ( no social distancing or zero efficacy ) to 100 % ( full self - isolation or full efficacy ) .

Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods . [School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review, The Lancet Child & Adolescent Health, 2020-04-06]
Summary In response to the coronavirus disease 2019 ( COVID - 19 ) pandemic , 107 countries had implemented national school closures by March 18 , 2020 . It is unknown whether school measures are effective in coronavirus outbreaks ( eg , due to severe acute respiratory syndrome [ SARS ] , Middle East respiratory syndrome , or COVID - 19 ) . We undertook a systematic review by searching three electronic databases to identify what is known about the effectiveness of school closures and other school social distancing practices during coronavirus outbreaks . We included 16 of 616 identified articles . School closures were deployed rapidly across mainland China and Hong Kong for COVID - 19 . However , there are no data on the relative contribution of school closures to transmission control . Data from the SARS outbreak in mainland China , Hong Kong , and Singapore suggest that school closures did not contribute to the control of the epidemic . Modelling studies of SARS produced conflicting results . Recent modelling studies of COVID - 19 predict that school closures alone would prevent only 2 – 4 % of deaths , much less than other social distancing interventions . Policy makers need to be aware of the equivocal evidence when considering school closures for COVID - 19 , and that combinations of social distancing measures should be considered . Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods .

A degree of pragmatism will be needed for the implementation of social distancing and quarantine measures . [How will country-based mitigation measures influence the course of the COVID-19 epidemic?, The Lancet, 2020-03-27]
See Online for appendices 2 , 3 R 0 of 2 · 5 or higher , reductions in transmission by social distancing would have to be large ; and much of the changes in transmission of pandemic influenza in the summer of 2009 within Europe were thought to be due to school closures , but children are not thought to be driving transmission of COVID19 . Data from the southern hemisphere will assist in evaluating how much seasonality will influence COVID19 transmission . Modelbased predictions can help policy makers make the right decisions in a timely way , even with the uncertainties about COVID19 . Indicating what level of transmission reduction is required for social distancing interventions to mitigate the epidemic is a key activity ( figure ) . However , it is easy to suggest a 60 % reduction in transmission will do it or quarantining within 1 day from symptom onset will control transmission , but it is unclear what communication strategies or social distancing actions individuals and governments must put in place to achieve these desired outcomes . A degree of pragmatism will be needed for the implementation of social distancing and quarantine measures . Ongoing data collection and epidemiological analysis are therefore essential parts of assessing the impacts of mitigation strategies , alongside clinical research on how to best manage seriously ill patients with COVID19 .

Social distancing measures reduce the value of the effective reproduction number r . [How will country-based mitigation measures influence the course of the COVID-19 epidemic?, The Lancet, 2020-03-27]
So what is left at present for mitigation is voluntary plus mandated quarantine , stopping mass gatherings , closure of educational institutes or places of work where infection has been identified , and isolation of households , towns , or cities . Some of the lessons from analyses of influenza A apply for COVID19 , but there are also differences . Social distancing measures reduce the value of the effective reproduction number R . With an early epidemic value of R 0 of 2 · 5 , social distancing would have to reduce transmission by about 60 % or less , if the intrinsic transmission potential declines in the warm summer months in the northern hemisphere . This reduction is a big ask , but it did happen in China .

The efficacy of government - imposed 165 social distancing is described by the reduction of the average contact rate in the population [Impact of self-imposed prevention measures and short-term government intervention on mitigating and delaying a COVID-19 epidemic, unknown journal, 2020-03-16]
Short - term government - imposed social distancing 160 Governments may decide to promote social distancing policies through interventions such as school and workplace 161 closures or by issuing a ban on large gatherings . These policies will cause a community - wide contact rate reduction , 162 regardless of the awareness status . Here , we assume that the government intervention is initiated if the number of 163 diagnosed individuals exceeds a certain threshold ( 10 - 1000 persons ) and terminates after a fixed period of time ( 1 - 3 164 months ) . As such , the intervention is implemented early into the epidemic . The efficacy of government - imposed 165 social distancing is described by the reduction of the average contact rate in the population which ranges from 0 % 166 ( no distancing ) to 100 % ( complete quarantine of the population ) . and of all individuals ( government - imposed social distancing ) . We refer to these quantities as the efficacy of a 175 prevention measure and vary it from 0 % ( zero efficacy ) to 100 % ( full efficacy ) ( Table 1 ) . The main analyses were 176 performed for two values of the rate of awareness spread that corresponded to scenarios of slow and fast spread 177 of awareness in the population ( Table 1 ) . For these scenarios , the proportion of the aware population at the peak 178 of the epidemic was 40 % and 90 % , respectively . In the main analyses , government - imposed social distancing was 179 initiated when 10 individuals got diagnosed and was lifted after 3 months .


Which are the methods to control the spread in communities?


We attempt to use statistical methods to distinguish which measures are effective in different regions , [Which Measures are Effective in Containing COVID-19? Empirical Research Based on Prevention and Control Cases in China, unknown journal, 2020-03-30]
The main contributions of this article are as follows : First , in response to the control measures of COVID - 19 in China , we attempt to use statistical methods to distinguish which measures are effective in different regions , which has rarely been discussed in epidemiology in the past ; Second , regarding the differences between measures taken by China in and all the measures in other countries in the past few decades , we take the traffic control measure , the most comprehensive and severe that have not been available in the past few decades , as an independent explanatory variable , trying to analyze which areas need to be adopted . Third , this paper incorporates the proposed effective distance into the model for regression , breaking through the past practice of estimating the scale of epidemic spread based on geographical distance . Fourth , this paper uses Python and other big data mining methods to mine and sort out the prevention and control measures adopted in China and the time taken , as well as the Baidu Search Index " COVID - 19 " , " the correct wearing of masks " , " Zhong Nanshan " to represent information dissemination , public awareness of protection and Confidence in fighting the epidemic .

Take a convenient selection method , and choose from the hospital ' s hcws in the department without the need for masks as a control [ 26 ] . [Efficacy of face mask in preventing respiratory virus transmission: a systematic review and meta-analysis, unknown journal, 2020-04-07]
is the ( which was not peer - reviewed ) The copyright holder for this preprint . https : / / doi . org / 10 . 1101 / 2020 . 04 . 03 . 20051649 doi : medRxiv preprint professionals to non - mask control groups . In this situation , MacIntyre ' s method could be adopted : take a convenient selection method , and choose from the hospital ' s HCWs in the department without the need for masks as a control [ 26 ] .

The exponential growth ( eg ) , maximum likelihood estimation ( ml ) , sequential bayesian method ( sb ) and time dependent reproduction numbers ( td ) , [Estimating the basic reproduction number of COVID-19 in Wuhan, China, Zhonghua Liu Xing Bing Xue Za Zhi, 2020]
Objective : The number of confirmed and suspected cases of the COVID - 19 in Hubei province is still increasing . However , the estimations of the basic reproduction number of COVID - 19 varied greatly across studies . The objectives of this study are 1 ) to estimate the basic reproduction number ( R ( 0 ) ) of COVID - 19 reflecting the infectiousness of the virus and 2 ) to assess the effectiveness of a range of controlling intervention . Method : The reported number of daily confirmed cases from January 17 to February 8 , 2020 in Hubei province were collected and used for model fit . Four methods , the exponential growth ( EG ) , maximum likelihood estimation ( ML ) , sequential Bayesian method ( SB ) and time dependent reproduction numbers ( TD ) , were applied to estimate the R ( 0 ) . Result : Among the four methods , the EG method fitted the data best . The estimated R ( 0 ) was 3 . 49 ( 95 % CI : 3 . 42 - 3 . 58 ) by using EG method . The R ( 0 ) was estimated to be 2 . 95 ( 95 % CI : 2 . 86 - 3 . 03 ) after taking control measures . Conclusion : In the early stage of the epidemic , it is appropriate to estimate R ( 0 ) using the EG method . Meanwhile , timely and effective control measures were warranted to further reduce the spread of COVID - 19 .

The exponential growth ( eg ) , maximum likelihood estimation ( ml ) , sequential bayesian method ( sb ) and time dependent reproduction numbers ( td ) , [Estimating the basic reproduction number of COVID-19 in Wuhan, China, Chinese Journal of Epidemiology, 2020]
Objective The number of confirmed and suspected cases of the COVID - 19 in Hubei province is still increasing . However , the estimations of the basic reproduction number of COVID - 19 varied greatly across studies . The objectives of this study are 1 ) to estimate the basic reproduction number ( R 0 ) of COVID - 19 reflecting the infectiousness of the virus and 2 ) to assess the effectiveness of a range of controlling intervention . Method The reported number of daily confirmed cases from January 17 to February 8 , 2020 in Hubei province were collected and used for model fit . Four methods , the exponential growth ( EG ) , maximum likelihood estimation ( ML ) , sequential Bayesian method ( SB ) and time dependent reproduction numbers ( TD ) , were applied to estimate the R 0 . Result Among the four methods , the EG method fitted the data best . The estimated R 0 was 3 . 49 ( 95 % CI : 3 . 42 - 3 . 58 ) by using EG method . The R 0 was estimated to be 2 . 95 ( 95 % CI : 2 . 86 - 3 . 03 ) after taking control measures . Conclusion In the early stage of the epidemic , it is appropriate to estimate R 0 using the EG method . Meanwhile , timely and effective control measures were warranted to further reduce the spread of COVID - 19 .

Infections of healthcare workers and family clusters suggest that 2019 - ncov has the ability to spread from human to human . [Emergence of a novel coronavirus causing respiratory illness from Wuhan, China, Journal of Infection, 2020-03-31]
The control of the route of transmission is another effective means of epidemic control . Infections of healthcare workers and family clusters suggest that 2019 - nCoV has the ability to spread from human to human . Although the seafood market has been closed , the number of confirmed cases continues to gradually increase ( Fig . 1 B ) . This further supports the conclusion that this virus can spread by human - to - human contact . Previous research has shown that coronaviruses usually have an ability to rapidly mutate . 9 We cannot exclude the possibility that some 2019 - nCoVs will mutate to become " super - spreaders " , as seen in SARS . Frequent disinfection of people - intensive places and animal trading markets should help stop the spread of the virus . Unfortunately , the outbreak has cast a shadow over the celebrations for the Lunar New Year , which falls on January 25 . Millions of people in China travel over the course of the Spring Festival , both within the country and overseas . In addition , millions of college students ( Wuhan has more than 1 million college students ) will return to school after the winter vacation . This large - scale population migration could lead to further spread of this virus . Therefore , it is possible that this epidemic will be more serious after the Spring Festival . At present , the National Health Commission of China ( http : / / www . nhc . gov . cn ) has listed 2019 - nCoV as Class B infectious disease and managed as Class A . Measures including the temperature monitoring of passengers at railway stations , airports , terminals and other transportation hubs have been carried out , which should slow the spread of the virus to a certain extent . However these disease control policies are far from enough , more strict methods to control population flow should be on the table .


Models of potential interventions to predict costs and benefits depending on race


Modeling studies have shown a wide range of potential outcomes , depending on intensity of intervention . [An international comparison of the second derivative of COVID-19 deaths after implementation of social distancing measures, unknown journal, 2020-03-25]
The global 2019 - nCov pandemic currently underway has resulted in massive stresses on national health care systems , escalating deaths , and major disruptions in economic life in response to public health interventions designed to mitigate the pace of transmission . Modeling studies have shown a wide range of potential outcomes , depending on intensity of intervention . The trade - offs between the economic costs of preventive interventions and the health impacts of COVD19 have generated political controversy . As real - world data have begun to emerge , opportunities to illuminate these issues may be available .

We calculate total societal costs of the pandemic and corresponding non - pharmaceutical measures . [Inclusive Costs of NPI Measures for COVID-19 Pandemic: Three Approaches, unknown journal, 2020-03-30]
This paper conducts the first ( to out knowledge ) cost - benefit analysis of potential mitigation measures for the COVID - 19 epidemic in the US . We calculate total societal costs of the pandemic and corresponding non - pharmaceutical measures . These costs include three components : costs of mortality , costs of illness and costs of reduced economic activity due to mitigation and precautionary demand .

The cost - effectiveness ratios ( cers ) and incremental cost - effectiveness ratios ( icers ) were calculated as the main cost - effectiveness outcomes . [Effectiveness and cost-effectiveness of public health measures to control COVID-19: a modelling study, unknown journal, 2020-03-23]
Main health benefits of our study were avoided infections conducting measures versus no - interventions . The cost - effectiveness ratios ( CERs ) and incremental cost - effectiveness ratios ( ICERs ) were calculated as the main cost - effectiveness outcomes . We calculated the CERs for interventions through cost divided by humans protected ( uninfected ) . The ICERs were calculated as the difference in the total costs between the intervention cohorts and non - intervention cohorts , divided by the difference in the total avoided infection . Positive ICERs showed the incremental costs required for avoiding 1 infected person . Negative ICERs indicated that intervention results in fewer costs while avoiding infected people than no intervention . The strategy was considered to be cost - effective if ICERs were lower than three times of per capita GDP . In 2018 , the per capita GDP in China was US $ 9595 [ 28 ] . We did not discount the cost because of the short time span of the . CC - BY - NC - ND 4 . 0 International license It is made available under a author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

We assume that each intervention has the same effect on the reproduction number in different regions over time . [Feasibility Study of Mitigation and Suppression Intervention Strategies for Controlling COVID-19 Outbreaks in London and Wuhan, unknown journal, 2020-04-04]
One limitation of our model is that its prediction of infections and deaths depends on a parameter estimation of intervention intensity that presented by average - number contacts with susceptible individuals as infectious individuals in a certain region . We assume that each intervention has the same effect on the reproduction number in different regions over time .

We run the model to show tradeoffs and potential benefits of more testing , better predictions , and possible growth curves . [Predicting Whom to Test is More Important Than More Tests - Modeling the Impact of Testing on the Spread of COVID-19 Virus By True Positive Rate Estimation, unknown journal, 2020-04-06]
In the next sections the SEIR model is adapted to incorporate TP rates , and using parameters published elsewhere , the model is applied to South Korea and New York state . A vital question is how much impact an increase in testing will have in New York . We run the model to show tradeoffs and potential benefits of more testing , better predictions , and possible growth curves .


Models of potential interventions to predict costs and benefits depending on income


Modeling studies have shown a wide range of potential outcomes , depending on intensity of intervention . [An international comparison of the second derivative of COVID-19 deaths after implementation of social distancing measures, unknown journal, 2020-03-25]
The global 2019 - nCov pandemic currently underway has resulted in massive stresses on national health care systems , escalating deaths , and major disruptions in economic life in response to public health interventions designed to mitigate the pace of transmission . Modeling studies have shown a wide range of potential outcomes , depending on intensity of intervention . The trade - offs between the economic costs of preventive interventions and the health impacts of COVD19 have generated political controversy . As real - world data have begun to emerge , opportunities to illuminate these issues may be available .

We calculate total societal costs of the pandemic and corresponding non - pharmaceutical measures . [Inclusive Costs of NPI Measures for COVID-19 Pandemic: Three Approaches, unknown journal, 2020-03-30]
This paper conducts the first ( to out knowledge ) cost - benefit analysis of potential mitigation measures for the COVID - 19 epidemic in the US . We calculate total societal costs of the pandemic and corresponding non - pharmaceutical measures . These costs include three components : costs of mortality , costs of illness and costs of reduced economic activity due to mitigation and precautionary demand .

The cost - effectiveness ratios ( cers ) and incremental cost - effectiveness ratios ( icers ) were calculated as the main cost - effectiveness outcomes . [Effectiveness and cost-effectiveness of public health measures to control COVID-19: a modelling study, unknown journal, 2020-03-23]
Main health benefits of our study were avoided infections conducting measures versus no - interventions . The cost - effectiveness ratios ( CERs ) and incremental cost - effectiveness ratios ( ICERs ) were calculated as the main cost - effectiveness outcomes . We calculated the CERs for interventions through cost divided by humans protected ( uninfected ) . The ICERs were calculated as the difference in the total costs between the intervention cohorts and non - intervention cohorts , divided by the difference in the total avoided infection . Positive ICERs showed the incremental costs required for avoiding 1 infected person . Negative ICERs indicated that intervention results in fewer costs while avoiding infected people than no intervention . The strategy was considered to be cost - effective if ICERs were lower than three times of per capita GDP . In 2018 , the per capita GDP in China was US $ 9595 [ 28 ] . We did not discount the cost because of the short time span of the . CC - BY - NC - ND 4 . 0 International license It is made available under a author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

The us instuted broad and aggressive social distancing protocols starting on or before march 12 . [Machine Learning the Phenomenology of COVID-19 From Early Infection Dynamics, unknown journal, 2020-03-20]
We can learn a lot from the early dynamics of COVID - 19 . It ' s infectious force , virulence , incubation period , unseen infections and predictions of new confirmed cases . All this , albeit within error tolerances , from a simple model and little data . And , the information is useful for planning and health - system preparedness . A side benefit of the predictions in Table 1 , if the model is to be trusted , is as a benchmark against which to evaluate public health interventions . If moving forward , observed new infections are low compared to the data in Table 1 , it means the interventions are working by most likely reducing β . The US instuted broad and aggressive social distancing protocols starting on or before March 12 . If our " lag " k = 10 is accurate , and the social distancing protocols have been effective at reducing β , the observed new infections should drop below the predictions starting on or before March 22 . Without such a target to compare with , it would be hard to evaluate intervention protocols .


Models of potential interventions to predict costs and benefits depending on disability


No suitable answers found.


Models of potential interventions to predict costs and benefits depending on age


No suitable answers found.


Models of potential interventions to predict costs and benefits depending on geographic location


The cost - effectiveness ratios ( cers ) and incremental cost - effectiveness ratios ( icers ) were calculated as the main cost - effectiveness outcomes . [Effectiveness and cost-effectiveness of public health measures to control COVID-19: a modelling study, unknown journal, 2020-03-23]
Main health benefits of our study were avoided infections conducting measures versus no - interventions . The cost - effectiveness ratios ( CERs ) and incremental cost - effectiveness ratios ( ICERs ) were calculated as the main cost - effectiveness outcomes . We calculated the CERs for interventions through cost divided by humans protected ( uninfected ) . The ICERs were calculated as the difference in the total costs between the intervention cohorts and non - intervention cohorts , divided by the difference in the total avoided infection . Positive ICERs showed the incremental costs required for avoiding 1 infected person . Negative ICERs indicated that intervention results in fewer costs while avoiding infected people than no intervention . The strategy was considered to be cost - effective if ICERs were lower than three times of per capita GDP . In 2018 , the per capita GDP in China was US $ 9595 [ 28 ] . We did not discount the cost because of the short time span of the . CC - BY - NC - ND 4 . 0 International license It is made available under a author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

We assume that each intervention has the same effect on the reproduction number in different regions over time . [Feasibility Study of Mitigation and Suppression Intervention Strategies for Controlling COVID-19 Outbreaks in London and Wuhan, unknown journal, 2020-04-04]
One limitation of our model is that its prediction of infections and deaths depends on a parameter estimation of intervention intensity that presented by average - number contacts with susceptible individuals as infectious individuals in a certain region . We assume that each intervention has the same effect on the reproduction number in different regions over time .

The us instuted broad and aggressive social distancing protocols starting on or before march 12 . [Machine Learning the Phenomenology of COVID-19 From Early Infection Dynamics, unknown journal, 2020-03-20]
We can learn a lot from the early dynamics of COVID - 19 . It ' s infectious force , virulence , incubation period , unseen infections and predictions of new confirmed cases . All this , albeit within error tolerances , from a simple model and little data . And , the information is useful for planning and health - system preparedness . A side benefit of the predictions in Table 1 , if the model is to be trusted , is as a benchmark against which to evaluate public health interventions . If moving forward , observed new infections are low compared to the data in Table 1 , it means the interventions are working by most likely reducing β . The US instuted broad and aggressive social distancing protocols starting on or before March 12 . If our " lag " k = 10 is accurate , and the social distancing protocols have been effective at reducing β , the observed new infections should drop below the predictions starting on or before March 22 . Without such a target to compare with , it would be hard to evaluate intervention protocols .

Such models have been used previously to evaluate the effectiveness ( and cost - effectiveness ) of alternative infectious disease control and containment strategies , [The Effectiveness of Social Distancing in Mitigating COVID-19 Spread: a modelling analysis, unknown journal, 2020-03-23]
is the ( which was not peer - reviewed ) The copyright holder for this preprint . https : / / doi . org / 10 . 1101 / 2020 . 03 . 20 . 20040055 doi : medRxiv preprint The model explicitly represents each household , workplace and school in community and the movement of individuals between , as they move from households to schools and workplaces in a daytime cycle , then return to their household in an evening cycle , with each day split into a day and night period . This mobility mechanism allowed us to model changing contact patterns , with possible virus transmission occurring in these contact locations , and also in the wider community , including at weekends . The model represents the individual - to - individual contact patterns in as much detail as data sources provide , to accurately describe how the movement of individuals allows virus transmission to spread over a geographic region . This level of detail is critical for modelling social distancing interventions , whose aim is to minimize person - to - person contact patterns and consequential virus transmission . Such models have been used previously to evaluate the effectiveness ( and cost - effectiveness ) of alternative infectious disease control and containment strategies , including social distancing , vaccination and antiviral drug treatment in an Australian setting . 19

We again consider one - shot interventions that either target the entire population at once or that target individual sub - populations at different times . [The timing of one-shot interventions for epidemic control, unknown journal, 2020-03-06]
We now consider a more realistic population which consists of coupled sub - populations , so effectively a metapopulation model . The most obvious reason for this setup could be location / geographic or by age , but other alternatives exist including religion , ethnicity or socio - economic status . We again consider one - shot interventions that either target the entire population at once or that target individual sub - populations at different times . A typical plot of the prevalence level in each sub - populations is shown in figure 4 in the absence of intervention . The epidemic starts in sub - population two but it then spreads to all the other .


Models of potential interventions to predict costs and benefits depending on immigration status


No suitable answers found.


Models of potential interventions to predict costs and benefits depending on housing status


No suitable answers found.


Models of potential interventions to predict costs and benefits depending on employment status


No suitable answers found.


Models of potential interventions to predict costs and benefits depending on health insurance status


No suitable answers found.


Policy changes necessary to enable the compliance of individuals with limited resources and the underserved with NPIs


Potential policy interventions imposing or relaxing npi , and variation of compliance through time . [How will this continue? Modelling interactions between the COVID-19 pandemic and policy responses, unknown journal, 2020-04-01]
The value of d t changes from day to day due to two effects : potential policy interventions imposing or relaxing NPI , and variation of compliance through time . We describe the effect of our sub - model for policy interventions in terms of intermediate values d t + 1 / 2 , which are then modified in our model for compliance change to compute d t + 1 . Figure 1 suggests that when COVID - 19 breaks out , new policy measures are introduced by governments at irregular intervals , about once every three days in countries like Italy and the UK . In simulations , we therefore sampled each day a random number x uniformly distributed between 0 and 1 [ notation x ~ Unif ( 0 , 1 ) ] , and allowed d t + ½ to differ from the previous value d t only if x < p , with p = ⅓ . In this case , we modelled the decision process leading to potential adjustments of NPI by the following two rules :

Widespread policy changes include limiting in - room patient contact and withdrawing fellows from many endoscopic procedures . [The COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining, Gastrointestinal Endoscopy, 2020-04-02]
Significant limitations on patient care have been put into effect in many hospitals across the nation , stemming from a necessity to conserve personal protective equipment ( PPE ) , avoid unnecessary exposure , and be in compliance with the edicts of social distancing . Widespread policy changes include limiting in - room patient contact and withdrawing fellows from many endoscopic procedures . Although sensible , this represents a major change from the standard clinical teaching paradigm , in which the patient is seen first by the fellow alone and then again together with the entire team .

High compliance with social distancing , self - isolation and household quarantine is paramount to reduce transmission and the impact of covid - 19 . [Perceptions and behavioural responses of the general public during the COVID-19 pandemic: A cross-sectional survey of UK Adults, unknown journal, 2020-04-03]
In the absence of a vaccine and treatments over the short - term , high compliance with social distancing , self - isolation and household quarantine is paramount to reduce transmission and the impact of COVID - 19 . And as the epidemic evolves , it is likely that compliance with preventive behaviours will continue to evolve too . NPI compliance , risk perception and behaviour are not consistent across cultures , social status or time . Indeed , previous studies have shown that perceptions and behaviours often change over time ( 13 ) . Therefore , current modelling projections of the impact of NPIs on morbidity and mortality are always provisional ( 7 ) . Future COVID - 19 models should explore the variation captured in this and . CC - BY - NC 4 . 0 International license It is made available under a is the author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

When the attack rate is high , transmission might occur regardless of isolation and the policy might merely create a burden on the isolated individuals and their families , [Symptom-Based Isolation Policies: Evidence from a Mathematical Model of Outbreaks of Influenza and COVID-19, unknown journal, 2020-03-30]
Despite the possible promise of this NPI for both COVID - 19 and influenza , it is unclear if symptom - based isolation would be truly effective in controlling outbreaks because the CDC - recommended one day policy might not be enough to achieve a meaningful reduction in transmission , and a high rate of asymptomatic infections and partial compliance might weaken the ability to implement the policy . When the attack rate is high , transmission might occur regardless of isolation and the policy might merely create a burden on the isolated individuals and their families , without a tangible public health benefit . If the policy is proven effective , it is not known whether the CDC - recommended one day of symptom - based isolation is sufficient , and if not , how many days would be most beneficial . At the outset of our project , we hypothesized that these policies would have a small beneficial effect on reducing attack rate , delay the peak of the outbreak and reduce the height of its peak . We did not expect these policies to reduce the overall incidence because there would be many other opportunities to become infected . Furthermore , practical barriers may reduce the strictness with which the policies are enforced , which would reduce the policies ' effectiveness .

Further uncertainty comes from a lack of knowledge of the potential effects of removing interventions once the epidemic is declining . [How will this continue? Modelling interactions between the COVID-19 pandemic and policy responses, unknown journal, 2020-04-01]
Much of the uncertainty about the progression of the COVID - 19 pandemic stems from questions about when and how non - pharmaceutical interventions ( NPI ) by governments , in particular social distancing measures , are implemented , to what extent the population complies with these measures , and how compliance changes through time . Further uncertainty comes from a lack of knowledge of the potential effects of removing interventions once the epidemic is declining . By combining an epidemiological model of COVID - 19 for the United Kingdom with simple sub - models for these societal processes , this study aims to shed light on the conceivable trajectories that the pandemic might follow over the next 1 . 5 years . We show strong improvements in outcomes if governments review NPI more frequently whereas , in comparison , the stability of compliance has surprisingly small effects on cumulative mortality . Assuming that mortality does considerably increase once a country ' s hospital capacity is breached , we show that the inherent randomness of societal processes can lead to a wide range of possible outcomes , both in terms of disease dynamics and mortality , even when the principles according to which policy and population operate are identical . . Our model is easily modified to take other aspects of the socio - pandemic interaction into account .


Why do people fail to comply with public health advice?


No suitable answers found.


Which is the economic impact of any pandemic?


Small chains of transmission in many countries and large chains resulting in extensive spread in a few countries , [How will country-based mitigation measures influence the course of the COVID-19 epidemic?, The Lancet, 2020-03-27]
Governments will not be able to minimise both deaths from coronavirus disease 2019 ( COVID19 ) and the economic impact of viral spread . Keeping mortality as low as possible will be the highest priority for individuals ; hence governments must put in place measures to ameliorate the inevitable economic downturn . In our view , COVID19 has developed into a pandemic , with small chains of transmission in many countries and large chains resulting in extensive spread in a few countries , such as Italy , Iran , South Korea , and Japan . 1 Most countries are likely to have spread of COVID19 , at least in the early stages , before any mitigation measures have an impact .

Common cold virus infections have a large impact on the economy because of the reduced productivity of the working population . [Human Coronaviruses 229E and NL63: Close Yet Still So Far, Journal of the Formosan Medical Association, 2009-04-30]
Common cold virus infections have a large impact on the economy because of the reduced productivity of the working population . Therefore , effective viral treatment against the common cold may limit this economic impact . Additionally , effective treatment can modulate severe respiratory disease among children or elderly and immunocompromised patients . Currently , there are no treatments available for any of the HCoVs , including HCoV - NL63 and HCoV - 229E . However , some candidate drugs have been investigated and might provide options for treatment in the future .

Suppression and mitigation are two common interventions for controlling infectious disease outbreaks . [Feasibility of Controlling COVID-19 Outbreaks in the UK by Rolling Interventions, unknown journal, 2020-04-07]
Evidence before this study Suppression and mitigation are two common interventions for controlling infectious disease outbreaks . Previous works show rapid suppression is able to immediately reduce infections to low levels by eliminating human - to - human transmission , but needs consistent maintenance ; mitigation does not interrupt transmission completely and tolerates some increase of infections , but minimises health and economic impacts of viral spread . 3 While current planning in many countries is focused on implementing either suppression or mitigation , it is not clear how and when to take which level of interventions for control COVID - 19 breakouts to certain country in light of balancing its healthcare demands and economic impacts .

Given the impact of the world - wide outbreak , international efforts have been made to simplify the access to viral genomic data and metadata through international repositories , [Accurate Identification of SARS-CoV-2 from Viral Genome Sequences using Deep Learning, unknown journal, 2020-03-14]
Given the impact of the world - wide outbreak , international efforts have been made to simplify the access to viral genomic data and metadata through international repositories , such as ; the 2019 Novel Coronavirus Resource ( 2019nCoVR ) repository [ 6 ] and the National Center for Biotechnology Information ( NCBI ) [ 22 ] , expecting that the easiness to acquire information would make it possible to de - The copyright holder for this preprint ( which was not peer - reviewed ) is the . https : / / doi . org / 10 . 1101 / 2020 . 03 . 13 . 990242 doi : bioRxiv preprint velop medical countermeasures to control the disease worldwide , as it happened in similar cases earlier [ 23 , 24 , 25 ] . Thus , taking advantage of the available information of international resources without any political and / or economic borders , we propose an innovative system based on viral gene sequencing .

Third , the effect of seasons on transmission of covid19 is unknown ; [How will country-based mitigation measures influence the course of the COVID-19 epidemic?, The Lancet, 2020-03-27]
The fourth uncertainty is the duration of the infectious period for COVID19 . The infectious period is typically short for influenza A , but it seems long for COVID19 on the basis of the few available clinical virological studies , perhaps lasting for 10 days or more after the incubation period . 8 The reports of a few superspreading events are a routine feature of all infectious diseases and should not be overinterpreted . 10 What do these comparisons with influenza A and SARS imply for the COVID19 epidemic and its control ? First , we think that the epidemic in any given country will initially spread more slowly than is typical for a new influenza A strain . COVID19 had a doubling time in China of about 4 - 5 days in the early phases . 3 Second , the COVID19 epidemic could be more drawn out than seasonal influenza A , which has relevance for its potential economic impact . Third , the effect of seasons on transmission of COVID19 is unknown ; 11 however , with an R 0 of 2 - 3 , the warm months of summer in the northern hemisphere might not necessarily reduce transmission below the value of unity as they do for influenza A , which typically has an R 0 of around 1 · 1 - 1 · 5 . 12 Closely linked to these factors and their epidemiological determinants is the impact of different mitigation policies on the course of the COVID19 epidemic .


How can we mitigate risks to critical government services in a pandemic?


This would likely help increase compliance across the population to the levels required to suppress transmission and thereby reduce the strain on national health services , [Perceptions and behavioural responses of the general public during the COVID-19 pandemic: A cross-sectional survey of UK Adults, unknown journal, 2020-04-03]
Our findings highlight that those most economically disadvantaged in society are less able to comply with certain NPIs , likely in part due to their financial situation . Whilst one approach may be to better tailor public health messaging to this subpopulation , this must be done alongside considered fiscal and monetary policy to mitigate the financial costs of following government public health advice . Therefore , it is imperative that the UK Government , and governments around the world , quickly develop and implement policies to support the most vulnerable , in a bid to minimise the long - term social and economic harm caused by COVID - 19 . Government policy should recognise the disparity in impact across socio - economic groups , particularly across the labour market , and should aim to support workers equitably across the income spectrum . This would likely help increase compliance across the population to the levels required to suppress transmission and thereby reduce the strain on national health services , both in the UK and abroad . Although the UK Government has since announced a range of measures to support public services , individuals and businesses in part to facilitate compliance with current lockdown measures ( 17 ) , it is uncertain how long these protections will be in place for and whether they will continue once lockdown restrictions are lifted .

Multivariable analysis to identify which groups of symptoms or comorbidities are most associated with severe or critical disease will also be valuable . [Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection, unknown journal, 2020-03-16]
For future research on predictors of severity , research should aim to include greater detail on specific conditions , including how well controlled chronic conditions were before and during admission . If the severity of COVID - 19 varies according to the severity of underlying comorbidities , there may be a case for optimising routine treatment for healthy , uninfected individuals , as a potential public health action to mitigate risk . Multivariable analysis to identify which groups of symptoms or comorbidities are most associated with severe or critical disease will also be valuable .

For these measures to be effective , special attention should be devoted to those population groups that are more at risk and patterns of intergenerational contact . [Demographic science aids in understanding the spread and fatality rates of COVID-19, unknown journal, 2020-03-18]
Going forward , demographically informed projections will better predict the COVID - 19 burden and inform governments about targeted action . While population age structure is crucial for understanding the populations at the highest risk of mortality both across and within countries , it is also vital for understanding how much social distancing measures are required in each population to reduce the number of most critical cases and overload on the health system - aka " flattening the curve " ( 13 ) . Our illustrations show that countries with older populations will need to take more aggressive protective measures to stay below the threshold of critical cases that outstrip health system capacity . For these measures to be effective , special attention should be devoted to those population groups that are more at risk and patterns of intergenerational contact .

Working together , we can continue to provide high quality care while minimizing risk to ourselves , our patients and the public at large . [ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak, Journal of the American Society of Echocardiography, 2020-04-03]
The provision of echocardiographic services remains crucial in this difficult time of the SARS - CoV - 2 outbreak . Working together , we can continue to provide high quality care while minimizing risk to ourselves , our patients and the public at large . Carefully considering ' Whom to Image ' , ' Where to Image ' and ' How to Image ' has the potential to reduce the risks of transmission .

A remote consultation network is being developed and implemented by the chinese government , [Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai, Psychiatry Research, 2020-04-30]
In the current epidemic situation , face - to - face psychological counseling service requires high standards for onsite isolation to minimize risk . At present , this service is only implemented for front - line medical staff who have not been infected . However , infected people may face more severe psychological crisis and secondary trauma after the disaster ( Peng et al . , 2010 ) . Therefore , to ensure the ongoing provision of mental health services and reduce the risk of cross - infections , a remote consultation network is being developed and implemented by the Chinese government , where telephone or internet consultations can be carried out in a safe setting ( see Fig . 1 ) . The Shanghai municipal government has further employed third - party online platforms to deliver consultations and prescriptions . Patients who need onsite treatment or hospitalization will be recommended to choose a specialist agency near their home .


Alternatives for food distribution and supplies in a pandemic


A potential answer to these questions might be furnished by short food supply chains and local productions , [Will the COVID-19 pandemic make us reconsider the relevance of short food supply chains and local productions?, Trends in Food Science & Technology, 2020-05-31]
A potential answer to these questions might be furnished by short food supply chains and local productions , which feel less the effect of international restrictions and which , since their rooted presence in the territory , could be closer to the consumers . For these reasons , after the conclusion of this international crisis , is essential to strengthen the research activities to provide technical solutions aimed to improve short food supply chains and local productions , as we are doing for wheat and flour production chains ( Cappelli et al . , 2019a , 2020a , because in this crisis ( and in potential future menaces even worse ) they will represent a potential lifeline . The reinforcement of this local microeconomy is also useful in non - crisis situations , since allow to increase the chances of employment and improve people ' s quality of life . Sometime , when we are forced to take a step backwards , to have invested in the improvement of short food supply chains and in local productions could let us moving forwards , preserving the food products access . In light of the above , after that consumers rediscover their bond with the territory , will they want to return to supermarkets ?

If even the countries member of the european community close their borders , how can movements and availability of food be guaranteed ? [Will the COVID-19 pandemic make us reconsider the relevance of short food supply chains and local productions?, Trends in Food Science & Technology, 2020-05-31]
Globalization must not be considered negatively . Nevertheless , the short food supply chains and the local producers , which were not able to be part of this global business for several reasons ( e . g . low production capacity , non - competitive prices , etc . ) were negatively affected by this expansion of market . Fortunately , through production differentiation strategies , such as rediscover of autochthonous varieties and of ancient wheat cultivars ( Cappelli et al . , 2018 ; Guerrini et al . , 2020 ) , through the connection with the territory ( Mundler & Laughrea , 2016 ) , and by the assessment and reduction of environmental impact ( Recchia , Cappelli , Cini , Garbati Pegna , & Boncinelli , 2019 ) , these companies were able to carve out their market niche . But what happens in the event of a crisis of planetary dimensions like the COVID - 19 pandemic ? If even the countries member of the European community close their borders , how can movements and availability of food be guaranteed ? Moreover , given the personal freedoms restrictions of consumers applied by country governments , who sometimes cannot even change municipalities for purchase foods , how can access to essential foods be guaranteed for these people ? In this scenario , it seems to be back to 1950 , having potential problems of food security which , a few month ago , seemed to be distant memories .

Similarly , there have been anecdotal reports of patients stockpiling medications . [On the frontline against COVID-19: Community pharmacists’ contribution during a public health crisis, Research in Social and Administrative Pharmacy, 2020-03-31]
In the wake of widespread closures of schools , universities and retail business , there has been unprecedented demand on food supplies and other household goods ( e . g . toilet paper ) . Similarly , there have been anecdotal reports of patients stockpiling medications . Unless prompt action is taken , this sudden increase in demand could have a considerable and detrimental effect on the medication supply chain .

Encourage wise use of medical supplies including masks , and assure the public about the reliability of the food and consumable goods supplies 6 . [Knowledge and behaviors toward COVID-19 among U.S. residents during the early days of the pandemic, unknown journal, 2020-04-02]
On January 21 , 2020 , the first COVID - 19 case in the United States was reported in Washington State 3 and it was later reported that public health officials thought the virus was prevalent in the community for at least several weeks prior 4 . In the United States , the federal government ordered certain flights from China halted , and screening of passengers from other locations at different ports of arrival 5 . The Centers for Disease Control and Prevention ( CDC ) , and the National Institutes of Health ( NIH ) , began making recommendations , based on the scientific knowledge of the situation , to limit social contacts , encourage wise use of medical supplies including masks , and assure the public about the reliability of the food and consumable goods supplies 6 . However , even after these recommendations , there were reports of college students waiting in long lines at bars to celebrate their campuses closing , 7 people buying medical grade masks , 8 and hoarding everything from toilet paper to eggs and milk , 9 even as the President sought to reassure the public that the supply of food and supplies was secure 10 .

Meanwhile , the patients are not allowed to order delivery food from outside unless the restaurant is authorized . [Management strategies for the burn ward during COVID-19 pandemic, Burns, 2020-04-02]
The burn inpatients should be supply with high - calorie , high - protein , high - vitamin , digestible diet and be encouraged to drink adequate amounts of water each day . Meanwhile , the patients are not allowed to order delivery food from outside unless the restaurant is authorized .


Alternatives for household supplies in a pandemic


There are global shortages of personal protective equipment ( ppe ) , including n95 respirators . [Hydrogen Peroxide Vapor sterilization of N95 respirators for reuse, unknown journal, 2020-03-27]
The COVID - 19 pandemic has led to unprecedented utilization of healthcare resources . There are global shortages of personal protective equipment ( PPE ) , including N95 respirators . 1 The CDC has modified PPE recommendations and provided " crisis alternate strategies " if the respirator supply is exhausted , including use of masks which are not approved by the National Institute for Occupational Safety and Health ( NIOSH ) and homemade masks as a last resort . 2 , 3 Non - NIOSH and improvised fabric masks provide only marginal protection and are inferior to N95 respirators , a particular concern during the COVID - 19 pandemic which has a high rate of healthcare worker infection . 4 , 5 Reused respirators may become a reservoir for pathogens , presenting a potential risk . 6 , 7 Reprocessing of used N95 respirators may ameliorate supply chain constraints and provide a higher filtration crisis alternative , but it is unknown if effective sterilization can be achieved for a virus without impairing respirator function .

Reprocessing of used n95 respirators may ameliorate supply chain constraints during the covid - 19 pandemic and provide a higher filtration crisis alternative . [Hydrogen Peroxide Vapor sterilization of N95 respirators for reuse, unknown journal, 2020-03-27]
Reprocessing of used N95 respirators may ameliorate supply chain constraints during the COVID - 19 pandemic and provide a higher filtration crisis alternative . The FDA Medical Countermeasures Initiative previously funded a study of HP vapor decontamination of respirators using a Clarus C system ( Bioquell , Horsham , PA ) which normally is used to fumigate hospital rooms . The process preserved respirator function , but it is unknown if HP vapor would be virucidal since respirators have porous fabric that may harbor virus .

There has been unprecedented demand on food supplies and other household goods ( e . g . toilet paper ) . [On the frontline against COVID-19: Community pharmacists’ contribution during a public health crisis, Research in Social and Administrative Pharmacy, 2020-03-31]
In the wake of widespread closures of schools , universities and retail business , there has been unprecedented demand on food supplies and other household goods ( e . g . toilet paper ) . Similarly , there have been anecdotal reports of patients stockpiling medications . Unless prompt action is taken , this sudden increase in demand could have a considerable and detrimental effect on the medication supply chain .

During the pandemic , the public mostly rely on community pharmacies to get adequate supply of their daily medications and covid - 19 preventative products [Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: A China perspective, Research in Social and Administrative Pharmacy, 2020-03-26]
During the pandemic , the public mostly rely on community pharmacies to get adequate supply of their daily medications and COVID - 19 preventative products ( e . g . masks , alcohol - based hand rubs ) . Community pharmacies shall keep " appropriate stocks of pharmaceutical products to supply the demand " , as suggested in FIP ' s " Information and interim guidelines for pharmacists and the pharmacy workforce " for COVID - 19 outbreak . 2 Medications and COVID - 19 preventative products are essential for community patients ' chronic disease management and control of the pandemic . Thus , pharmacy management teams shall make ensuring their supply a priority when getting prepared for and during the pandemic .

Portable industrial - grade high - efficiency particulate air ( hepa ) filters may be a reasonable alternative . [AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic, Gastroenterology, 2020-04-01]
In limited - resource settings where negative pressure rooms are unavailable , portable industrial - grade high - efficiency particulate air ( HEPA ) filters may be a reasonable alternative . Industrial - grade HEPA filters are alternatives suggested by the CDC to enhance filtration when air supply systems are not optimal , when anterooms are not available for patients in airborne isolation rooms , and during intubation and extubation of patients with active tuberculosis patients . 76 , 77


Alternatives for health diagnoses, treatment, and needed care in a pandemic


In the context of a pandemic the risk benefit of these treatments is altered . [COVID-19: Global radiation oncology’s targeted response for pandemic preparedness, Clinical and Translational Radiation Oncology, 2020-05-31]
Although we have randomized trials for oligometastatic disease weighted heavily towards prostate cancer , these are limited . No survival benefit has been demonstrated with high - level evidence . Observation is reasonable . If PSA - DT is rapid ADT is an option . These therapies have ( mainly ) been established by randomised controlled evidence and have are frequently considered a standard of care . In the context of a pandemic the risk benefit of these treatments is altered . General criteria for omission may include more time - sensitive need for treatment decision - making ( go vs . no go ) and availability of non - emergency / urgency , lower - risk alternatives , etc . that make the additional risk of treating the patient during the pandemic greater than the risk of omitting radiation taking alternatives into account . For low - volume metastatic disease where higher quality evidence suggests treatment of the primary [ 38 ] delaying radiotherapy for 4 - 6 months while on ADT if newly diagnosed is reasonable .

Hospitals and training programs must utilize telecommunications to continue to provide the highest standard of patient care throughout the pandemic . [The effective use of telemedicine to save lives and maintain structure in a healthcare system: Current response to COVID-1, The American Journal of Emergency Medicine, 2020-04-07]
The COVID - 19 pandemic has created the immediate need for alternate routes of communication . From both the educational and patient care aspects , hospitals and training programs must utilize telecommunications to continue to provide the highest standard of patient care throughout the pandemic . Virtual communication is essential to maintain the connections between the healthcare workforce throughout the nation , especially with teams and patients within hot spots . It is crucial to share all of the precautionary and treatment measures for COVID - 19 to minimize exposure and employ best practices for better outcomes .

They are simultaneously trying to replace some of these contacts with digital therapies . [The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health, Internet Interventions, 2020-04-30]
The COVID - 19 pandemic : The ' black swan ' for mental health care and a turning point for e - health In February 2020 , Duan and Zhu ( 2020 ) stressed the need for a solid Chinese evidence - based mental health care system in times of public health emergencies such as the outbreak of the Coronavirus disease - 2019 . That would enable treatment of people who suffer from mental health problems in relation to the epidemic . The WHO has meanwhile labelled the Coronavirus a pandemic , and it is now hitting Europe , the USA , Australia and Asia hard as well . In an attempt to reduce the risk of infections , many mental health care providers in afflicted countries are currently closing their doors for patients who need ambulatory face - to - face therapy . They are simultaneously trying to replace some of these contacts with digital therapies . Most probably , European mental health care institutions have yet to experience the full impact of the coronavirus crisis . At the same time , the demand for mental health care among infected patients and their relatives is expected to rise ( Blumenstyk , 2020 ) . Levels of anxiety will increase , both through direct causes including fears of contamination , stress , grief , and depression triggered by exposure to the virus , and through influences from the consequences of the social and economic mayhem that is occurring on individual and societal levels . We expect that this " black swan " moment ( Blumenstyk , 2020 ) - an unforeseen event that changes everything - will lead to a partly , though robust , shift in mental health care provision towards online prevention , treatment , and care in the near future . We also need to consider the role of psychological processes and fear that may cause further harm on top of the pandemic ( Asmundson and Taylor , 2020 ) .

Several dental care facilities in affected countries have been completely closed or have been only providing minimal treatment for emergency cases . [Guidelines for dental care provision during the COVID-19 pandemic, The Saudi Dental Journal, 2020-04-07]
Abstract Since the coronavirus disease 2019 ( COVID - 19 ) outbreak was declared a pandemic on 11 March 2020 . Several dental care facilities in affected countries have been completely closed or have been only providing minimal treatment for emergency cases . However , several facilities in some affected countries are still providing regular dental treatment . This can in part be a result of the lack of universal protocol or guidelines regulating the dental care provision during such a pandemic . This lack of guidelines can on one hand increase the nosocomial COVID - 19 spread through dental health care facilities , and on the other hand deprive patients ’ in need of the required urgent dental care . Moreover , ceasing dental care provision during such a period will incense the burden on hospitals emergency departments already struggle with the pandemic . This work aimed to develop guidelines for dental patients ’ management during and after the COVID - 19 pandemic . Guidelines for dental care provision during the COVID - 19 pandemic were developed after considering the nature of COVID - 19 pandemic , and were based on grouping the patients according to condition and need , and considering the procedures according to risk and benefit . It is hoped that the guidelines proposed in this work will help in the management of dental care around the world during and after this COVID - 19 pandemic .

Pharmacists have made a pharmaceutical care procedure ( figure 3 ) according to needs of different groups , [Drugs supply and pharmaceutical care management practices at a designated hospital during the COVID-19 epidemic, Research in Social and Administrative Pharmacy, 2020-04-06]
Timely pharmaceutical care are critical for treatment during the coronavirus pandemic . Pharmacists have made a pharmaceutical care procedure ( Figure 3 ) according to needs of different groups , provided updated treatment plans , monitored potential drug interactions , focus on special population medication and implement remote pharmaceutical service . Figure 3 Pharmaceutical care procedure