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1: Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence
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Posted 08 Aug 2021

Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence
267,547 downloads medRxiv public and global health

Arjun Puranik, Patrick J Lenehan, Eli Silvert, Michiel JM Niesen, Juan Corchado-Garcia, John C O'Horo, Abinash Virk, Melanie D Swift, John Halamka, Andrew D Badley, AJ Venkatakrishnan, Venky Soundararajan

Although clinical trials and real-world studies have affirmed the effectiveness and safety of the FDA-authorized COVID-19 vaccines, reports of breakthrough infections and persistent emergence of new variants highlight the need to vigilantly monitor the effectiveness of these vaccines. Here we compare the effectiveness of two full-length Spike protein-encoding mRNA vaccines from Moderna (mRNA-1273) and Pfizer/BioNTech (BNT162b2) in the Mayo Clinic Health System over time from January to July 2021, during which either the Alpha or Delta variant was highly prevalent. We defined cohorts of vaccinated and unvaccinated individuals from Minnesota (n = 25,589 each) matched on age, sex, race, history of prior SARS-CoV-2 PCR testing, and date of full vaccination. Both vaccines were highly effective during this study period against SARS-CoV-2 infection (mRNA-1273: 86%, 95%CI: 81-90.6%; BNT162b2: 76%, 95%CI: 69-81%) and COVID-19 associated hospitalization (mRNA-1273: 91.6%, 95% CI: 81-97%; BNT162b2: 85%, 95% CI: 73-93%). However, in July, the effectiveness against infection was considerably lower for mRNA-1273 (76%, 95% CI: 58-87%) with an even more pronounced reduction in effectiveness for BNT162b2 (42%, 95% CI: 13-62%). Notably, the Delta variant prevalence in Minnesota increased from 0.7% in May to over 70% in July whereas the Alpha variant prevalence decreased from 85% to 13% over the same time period. Comparing rates of infection between matched individuals fully vaccinated with mRNA-1273 versus BNT162b2 across Mayo Clinic Health System sites in multiple states (Minnesota, Wisconsin, Arizona, Florida, and Iowa), mRNA-1273 conferred a two-fold risk reduction against breakthrough infection compared to BNT162b2 (IRR = 0.50, 95% CI: 0.39-0.64). In Florida, which is currently experiencing its largest COVID-19 surge to date, the risk of infection in July after full vaccination with mRNA-1273 was about 60% lower than after full vaccination with BNT162b2 (IRR: 0.39, 95% CI: 0.24-0.62). Our observational study highlights that while both mRNA COVID-19 vaccines strongly protect against infection and severe disease, further evaluation of mechanisms underlying differences in their effectiveness such as dosing regimens and vaccine composition are warranted.

2: Time trends, factors associated with, and reasons for COVID-19 vaccine hesitancy in a massive online survey of US adults: January-May 2021
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Posted 23 Jul 2021

Time trends, factors associated with, and reasons for COVID-19 vaccine hesitancy in a massive online survey of US adults: January-May 2021
195,999 downloads medRxiv public and global health

Wendy C King, Max Rubinstein, Alex Reinhart, Robin J Mejia

Importance: COVID-19 vaccine hesitancy has become a leading barrier to increasing the US vaccination rate. Objective: To evaluate time trends in COVID-19 vaccine intent during the US vaccine rollout, and identify key factors related to and self-reported reasons for COVID-19 vaccine hesitancy in May 2021. Design, participants and setting: A COVID-19 survey was offered to US adult Facebook users in several languages yielding 5,088,772 qualifying responses from January 6 to May 31, 2021. Data was aggregated by month. Survey weights matched the sample to the age, gender, and state profile of the US population. Exposure: Demographics, geographic factors, political/COVID-19 environment, health status, beliefs, and behaviors. Main outcome measures: "If a vaccine to prevent COVID-19 were offered to you today, would you choose to get vaccinated." Hesitant was defined as responding probably or definitely would not choose to get vaccinated (versus probably or definitely would, or already vaccinated). Results: COVID-19 vaccine hesitancy decreased by one-third from 25.4% (95%CI, 25.3, 25.5) in January to 16.6% (95% CI, 16.4, 16.7) in May, with relatively large decreases among participants with Black, Pacific Islander or Hispanic race/ethnicity and [&le;]high school education. Independent risk factors for vaccine hesitancy in May (N=525,644) included younger age, non-Asian race, < 4 year college degree, living in a more rural county, living in a county with higher Trump vote share in the 2020 election, lack of worry about COVID-19, working outside the home, never intentionally avoiding contact with others, and no past-year flu vaccine. Differences in hesitancy by race/ethnicity varied by age (e.g., Black adults more hesitant than White adults <35 years old, but less hesitant among adults [&ge;]45 years old). Differences in hesitancy by age varied by race/ethnicity. Almost half of vaccine hesitant respondents reported fear of side effects (49.2% [95%CI, 48.7, 49.7]) and not trusting the COVID-19 vaccine (48.4% [95%CI, 48.0, 48.9]); over one-third reported not trusting the government, not needing the vaccine, and waiting to see if safe. Reasons differed by degree of vaccine intent and by race/ethnicity. Conclusion: COVID-19 vaccine hesitancy varied by demographics, geography, beliefs, and behaviors, indicating a need for a range of messaging and policy options to target high-hesitancy groups.

3: COVID-19 in India: State-wise Analysis and Prediction
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Posted 29 Apr 2020

COVID-19 in India: State-wise Analysis and Prediction
152,540 downloads medRxiv public and global health

Palash Ghosh, Rik Ghosh, Bibhas Chakraborty

Coronavirus disease 2019 (COVID-19), a highly infectious disease, was first detected in Wuhan, China, in December 2019. The disease has spread to 212 countries and territories around the world and infected (confirmed) more than three million people. In India, the disease was first detected on 30 January 2020 in Kerala in a student who returned from Wuhan. The total (cumulative) number of confirmed infected people is more than 37000 till now across India (3 May 2020). Most of the research and newspaper articles focus on the number of infected people in the entire country. However, given the size and diversity of India, it may be a good idea to look at the spread of the disease in each state separately, along with the entire country. For example, currently, Maharashtra has more than 10000 confirmed cumulative infected cases, whereas West Bengal has less than 800 confirmed infected cases (1 May 2020). The approaches to address the pandemic in the two states must be different due to limited resources. In this article, we will focus the infected people in each state (restricting to only those states with enough data for prediction) and build three growth models to predict infected people for that state in the next 30 days. The impact of preventive measures on daily infected-rate is discussed for each state.

4: Effectiveness of mRNA and ChAdOx1 COVID-19 vaccines against symptomatic SARS-CoV-2 infection and severe outcomes with variants of concern in Ontario
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Posted 03 Jul 2021

Effectiveness of mRNA and ChAdOx1 COVID-19 vaccines against symptomatic SARS-CoV-2 infection and severe outcomes with variants of concern in Ontario
114,500 downloads medRxiv public and global health

Sharifa Nasreen, Hannah Chung, Siyi He, Kevin A. Brown, Jonathan B Gubbay, Sarah A Buchan, Deshayne B Fell, Peter C Austin, Kevin L Schwartz, Maria E. Sundaram, Andrew Calzavara, Branson Chen, Mina Tadrous, Kumanan Wilson, Sarah E. Wilson, Jeff C Kwong

SARS-CoV-2 variants of concern (VOC) are more transmissible and have the potential for increased disease severity and decreased vaccine effectiveness. We estimated the effectiveness of BNT162b2 (Pfizer-BioNTech Comirnaty), mRNA-1273 (Moderna Spikevax), and ChAdOx1 (AstraZeneca Vaxzevria) vaccines against symptomatic SARS-CoV-2 infection and COVID-19 hospitalization or death caused by the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2) VOCs in Ontario, Canada using a test-negative design study. Effectiveness against symptomatic infection 7 days or more after two doses was 89-92% against Alpha, 87% against Beta, 88% against Gamma, 82-89% against Beta/Gamma, and 87-95% against Delta across vaccine products. The corresponding estimates 14 days or more after one dose were lower. Effectiveness estimates against hospitalization or death were similar to, or higher than, against symptomatic infection. Effectiveness against symptomatic infection is generally lower for older adults (60 years or above) compared to younger adults (<60 years) for most of the VOC-vaccine combinations.

5: First 12 patients with coronavirus disease 2019 (COVID-19) in the United States
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Posted 12 Mar 2020

First 12 patients with coronavirus disease 2019 (COVID-19) in the United States
107,249 downloads medRxiv public and global health

The COVID-19 Investigation Team, Stephanie A. Kujawski, Karen K Wong, Jennifer P. Collins, Lauren Epstein, Marie E. Killerby, Claire M. Midgley, Glen R. Abedi, N. Seema Ahmed, Olivia Almendares, Francisco N. Alvarez, Kayla N. Anderson, Sharon Balter, Vaughn Barry, Karri Bartlett, Karlyn Beer, Michael A. Ben-Aderet, Isaac Benowitz, Holly Biggs, Alison M. Binder, Stephanie R. Black, Brandon Bonin, Catherine M. Brown, Hollianne Bruce, Jonathan Bryant-Genevier, Alicia Budd, Diane Buell, Rachel Bystritsky, Jordan Cates, E. Matt Charles, Kevin Chatham-Stephens, Nora Chea, Howard Chiou, Demian Christiansen, Victoria Chu, Sara Cody, Max Cohen, Erin Conners, Aaron Curns, Vishal Dasari, Patrick Dawson, Traci DeSalvo, George Diaz, Matthew Donahue, Suzanne Donovan, Lindsey M. Duca, Keith Erickson, Mathew D. Esona, Suzanne Evans, Jeremy Falk, Leora R. Feldstein, Martin Fenstersheib, Marc Fischer, Rebecca Fisher, Chelsea Foo, Marielle J. Fricchione, Oren Friedman, Alicia M. Fry, Romeo R. Galang, Melissa M. Garcia, Susa I. Gerber, Graham Gerrard, Isaac Ghinai, Prabhu Gounder, Jonathan Grein, Cheri Grigg, Jeffrey D. Gunzenhauser, Gary I. Gutkin, Meredith Haddix, Aron J Hall, George Han, Jennifer Harcourt, Kathleen Harriman, Thomas Haupt, Amber Haynes, Michelle Holshue, Cora Hoover, Jennifer C. Hunter, Max W. Jacobs, Claire Jarashow, Michael A. Jhung, Kiran Joshi, Talar Kamali, Shifaq Kamili, Lindsay Kim, Moon Kim, Jan King, Hannah L. Kirking, Amanda Kita-Yarbro, Rachel Klos, Miwako Kobayashi, Anna Kocharian, Kenneth K. Komatsu, Ram Koppaka, Jennifer E. Layden, Yan Li, Scott Lindquist, Stephen Lindstrom, Ruth Link-Gelles, Joana Lively, Michelle Livingston, Kelly Lo, Jennifer Lo, Xiaoyan Lu, Brian Lynch, Larry Madoff, Lakshmi Malapati, Gregory Marks, Mariel Marlow, Glenn E. Mathisen, Nancy McClung, Olivia McGovern, Tristan D. McPherson, Mitali Mehta, Audrey Meier, Lynn Mello, Sung-sil Moon, Margie Morgan, Ruth N. Moro, Janna' Murray, Rekha Murthy, Shannon Novosad, Sara E. Oliver, Jennifer O'Shea, Massimo Pacilli, Clinton R Paden, Mark A. Pallansch, Manisha Patel, Sajan Patel, Isabel Pedraza, Satish K Pillai, Talia Pindyck, Ian Pray, Krista Queen, Nichole Quick, Heather Reese, Brian Rha, Heather Rhodes, Susan Robinson, Philip Robinson, Melissa Rolfes, Janell Routh, Rachel Rubin, Sarah L. Rudman, Senthilkumar K. Sakthivel, Sarah Scott, Christopher Shepherd, Varun Shetty, Ethan A. Smith, Shanon Smith, Bryan Stierman, William Stoecker, Rebecca Sunenshine, Regina Sy-Santos, Azaibi Tamin, Ying Tao, Dawn Terashita, Natalie J. Thornburg, Suxiang Tong, Elizabeth Traub, Ahmet Tural, Anna Uehara, Timothy M. Uyeki, Grace Vahey, Jennifer R. Verani, Elsa Villarino, Megan Wallace, Lijuan Wang, John T. Watson, Matthew Westercamp, Brett Whitaker, Sarah Wilkerson, Rebecca C. Woodruff, Jonathan M. Wortham, Tiffany Wu, Amy Xie, Anna Yousaf, Matthew Zahn, Jing Zhang

IntroductionMore than 93,000 cases of coronavirus disease (COVID-19) have been reported worldwide. We describe the epidemiology, clinical course, and virologic characteristics of the first 12 U.S. patients with COVID-19. MethodsWe collected demographic, exposure, and clinical information from 12 patients confirmed by CDC during January 20-February 5, 2020 to have COVID-19. Respiratory, stool, serum, and urine specimens were submitted for SARS-CoV-2 rRT-PCR testing, virus culture, and whole genome sequencing. ResultsAmong the 12 patients, median age was 53 years (range: 21-68); 8 were male, 10 had traveled to China, and two were contacts of patients in this series. Commonly reported signs and symptoms at illness onset were fever (n=7) and cough (n=8). Seven patients were hospitalized with radiographic evidence of pneumonia and demonstrated clinical or laboratory signs of worsening during the second week of illness. Three were treated with the investigational antiviral remdesivir. All patients had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset, with lowest rRT-PCR Ct values often detected in the first week. SARS-CoV-2 RNA was detected after reported symptom resolution in seven patients. SARS-CoV-2 was cultured from respiratory specimens, and SARS-CoV-2 RNA was detected in stool from 7/10 patients. ConclusionsIn 12 patients with mild to moderately severe illness, SARS-CoV-2 RNA and viable virus were detected early, and prolonged RNA detection suggests the window for diagnosis is long. Hospitalized patients showed signs of worsening in the second week after illness onset.

6: Adherence to the test, trace and isolate system: results from a time series of 21 nationally representative surveys in the UK (the COVID-19 Rapid Survey of Adherence to Interventions and Responses study)
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Posted 18 Sep 2020

Adherence to the test, trace and isolate system: results from a time series of 21 nationally representative surveys in the UK (the COVID-19 Rapid Survey of Adherence to Interventions and Responses study)
60,194 downloads medRxiv public and global health

Louise E Smith, Henry W W Potts, Richard Amlot, Nicola T. Fear, Susan Michie, G James Rubin

Objectives: To investigate rates of adherence to the UKs test, trace and isolate system over time. Design: Time series of cross-sectional online surveys. Setting: Data were collected between 2 March and 5 August 2020. Participants: 42,127 responses from 31,787 people living in the UK, aged 16 years or over, are presented (21 survey waves, n{approx}2,000 per wave). Main outcome measures: Identification of the key symptoms of COVID-19 (cough, high temperature / fever, and loss of sense of smell or taste), self-reported adherence to self-isolation if symptomatic, requesting an antigen test if symptomatic, intention to share details of close contacts, self-reported adherence to quarantine if alerted that you had been in contact with a confirmed COVID-19 case. Results: Only 48.9% of participants (95% CI 48.2% to 49.7%) identified key symptoms of COVID-19. Self-reported adherence to test, trace and isolate behaviours was low (self-isolation 18.2%, 95% CI 16.4% to 19.9%; requesting an antigen test 11.9%, 95% CI 10.1% to 13.8%; intention to share details of close contacts 76.1%, 95% CI 75.4% to 76.8%; quarantining 10.9%, 95% CI 7.8% to 13.9%) and largely stable over time. By contrast, intention to adhere to protective measures was much higher. Non-adherence was associated with: men, younger age groups, having a dependent child in the household, lower socio-economic grade, greater hardship during the pandemic, and working in a key sector. Conclusions: Practical support and financial reimbursement is likely to improve adherence. Targeting messaging and policies to men, younger age groups, and key workers may also be necessary.

7: Covid-19 Risk Among Airline Passengers: Should the Middle Seat Stay Empty?
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Posted 05 Jul 2020

Covid-19 Risk Among Airline Passengers: Should the Middle Seat Stay Empty?
44,747 downloads medRxiv public and global health

Arnold Barnett, Keith Fleming

We use recent data and research results and a probabilistic model to estimate the chance that an air traveler in coach will contract Covid-19 on a US domestic jet flight two hours long, both when all coach seats are full and when all but middle seats are full. The point estimates we reach based on data from late September 2020 are about 1 in 3,900 for full flights and 1 in 6,400 when middle seats are kept empty. These estimates are subject to substantial uncertainty, with factor-of-three or greater margins of error. However, because uncertainties in key parameters affect both risk estimates the same way, they leave the relative risk ratio for "fill all seats" compared to "middle seat open" close to 1.64 (i.e., close to (1/3,900)/(1/6,400). We compare the infection risks over a two-hour flight to those of two hours on the ground, and find that the flight presents greater hazard. We also approximate the mortality risks caused by Covid-19 infections contracted on airplanes, taking into account that infected passengers can in turn infect others not on the plane. The point estimates for death risk are low--averaging about one death per 800,000 passengers--but they are somewhat higher than those associated with plane crashes and aviation terrorism.

8: ICON (Ivermectin in COvid Nineteen) study: Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID19
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Posted 09 Jun 2020

ICON (Ivermectin in COvid Nineteen) study: Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID19
43,084 downloads medRxiv public and global health

Juliana Cepelowicz Rajter, Michael Sherman, Naaz Fatteh, Fabio Vogel, Jamie Sacks, Jean-Jacques Rajter

Abstract Importance: No therapy to date has been shown to improve survival for patients infected with SARS-CoV-2. Ivermectin has been shown to inhibit the replication of SARS-CoV-2 in vitro but clinical response has not been previously evaluated. Objective: To determine whether Ivermectin is associated with lower mortality rate in patients hospitalized with COVID-19. Design and Setting: Retrospective cohort study of consecutive patients hospitalized at four Broward Health hospitals in South Florida with confirmed SARS-CoV-2. Enrollment dates were March 15, 2020 through May 11, 2020. Follow up data for all outcomes was May 19, 2020. Participants: 280 patients with confirmed SARS-CoV-2 infection (mean age 59.6 years [standard deviation 17.9], 45.4% female), of whom 173 were treated with ivermectin and 107 were usual care were reviewed. 27 identified patients were not reviewed due to multiple admissions, lack of confirmed COVID results during hospitalization, age less than 18, pregnancy, or incarceration. Exposure: Patients were categorized into two treatment groups based on whether they received at least one dose of ivermectin at any time during the hospitalization. Treatment decisions were at the discretion of the treating physicians. Severe pulmonary involvement at study entry was characterized as need for either FiO2 [&ge;]50%, or noninvasive or invasive mechanical ventilation. Main Outcomes and Measures: The primary outcome was all-cause in-hospital mortality. Secondary outcomes included subgroup mortality in patients with severe pulmonary involvement and extubation rates for patients requiring invasive ventilation. Results: Univariate analysis showed lower mortality in the ivermectin group (25.2% versus 15.0%, OR 0.52, 95% CI 0.29-0.96, P=.03). Mortality was also lower among 75 patients with severe pulmonary disease treated with ivermectin (38.8% vs 80.7%, OR 0.15, CI 0.05-0.47, P=.001), but there was no significant difference in successful extubation rates (36.1% vs 15.4%, OR 3.11 (0.88-11.00), p=.07). After adjustment for between-group differences and mortality risks, the mortality difference remained significant for the entire cohort (OR 0.27, CI 0.09-0.85, p=.03; HR 0.37, CI 0.19-0.71, p=.03). Conclusions and Relevance: Ivermectin was associated with lower mortality during treatment of COVID-19, especially in patients who required higher inspired oxygen or ventilatory support. These findings should be further evaluated with randomized controlled trials.

9: Risk of Myocarditis from COVID-19 Infection in People Under Age 20: A Population-Based Analysis
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Posted 27 Jul 2021

Risk of Myocarditis from COVID-19 Infection in People Under Age 20: A Population-Based Analysis
35,378 downloads medRxiv public and global health

Mendel E Singer, Ira B. Taub, David C. Kaelber

Background There have been recent reports of myocarditis (including myocarditis, pericarditis or myopericarditis) as a side-effect of mRNA-based COVID-19 vaccines, particularly in young males. Less information is available regarding the risk of myocarditis from COVID-19 infection itself. Such data would be helpful in developing a complete risk-benefit analysis for this population. Methods A de-identified, limited data set was created from the TriNetX Research Network, aggregating electronic health records from 48 mostly large U.S. Healthcare Organizations (HCOs). Inclusion criteria were a first COVID-19 diagnosis during the April 1, 2020 - March 31, 2021 time period, with an outpatient visit 1 month to 2 years before, and another 6 months to 2 years before that. Analysis was stratified by sex and age (12-17, 12-15, 16-19). Patients were excluded for any prior cardiovascular condition. Primary outcome was an encounter diagnosis of myocarditis within 90 days following the index date. Rates of COVID-19 cases and myocarditis not identified in the system were estimated and the results adjusted accordingly. Wilson score intervals were used for 95% confidence intervals due to the very low probability outcome. Results For the 12-17-year-old male cohort, 6/6,846 (0.09%) patients developed myocarditis overall, with an adjusted rate per million of 876 cases (Wilson score interval 402 - 1,911). For the 12-15 and 16-19 male age groups, the adjusted rates per million were 601 (257 - 1,406) and 561 (240 - 1,313). For 12-17-year-old females, there were 3 (0.04%) cases of myocarditis of 7,361 patients. The adjusted rate was 213 (73 - 627) per million cases. For the 12-15- and 16-19-year-old female cohorts the adjusted rates per million cases were 235 (64 - 857) and 708 (359 - 1,397). The outcomes occurred either within 5 days (40.0%) or from 19-82 days (~60.0%). Conclusions Myocarditis (or pericarditis or myopericarditis) from primary COVID19 infection occurred at a rate as high as 450 per million in young males. Young males infected with the virus are up 6 times more likely to develop myocarditis as those who have received the vaccine.

10: Validity of Wrist and Forehead Temperature in Temperature Screening in the General Population During the Outbreak of 2019 Novel Coronavirus: a prospective real-world study
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Posted 06 Mar 2020

Validity of Wrist and Forehead Temperature in Temperature Screening in the General Population During the Outbreak of 2019 Novel Coronavirus: a prospective real-world study
34,874 downloads medRxiv public and global health

Ge Chen, Jiarong Xie, Guangli Dai, Peijun Zheng, Xiaqing Hu, Hongpeng Lu, Lei Xu, Xueqin Chen, Xiaomin Chen

AimsTemperature screening is important in the population during the outbreak of 2019 Novel Coronavirus (COVID-19). This study aimed to compare the accuracy and precision of wrist and forehead temperature with tympanic temperature under different circumstances. MethodsWe performed a prospective observational study in a real-life population. We consecutively collected wrist and forehead temperatures in Celsius ({degrees}C) using a non-contact infrared thermometer (NCIT). We also measured the tympanic temperature using a tympanic thermometers (IRTT) and defined fever as a tympanic temperature [&ge;]37.3{degrees}C. ResultsWe enrolled a total of 528 participants including 261 indoor and 267 outdoor participants. We divided outdoor participants into four types according to their means of transportation to the hospital as walk, bicycle, electric vehicle, car, and inside the car. Under different circumstance, the mean difference ranged from -1.72 to -0.56{degrees}C in different groups for the forehead measurements, and -0.96 to -0.61{degrees}C for the wrist measurements. Both measurements had high fever screening abilities in inpatients (wrist: AUC 0.790; 95% CI: 0.725-0.854, P <0.001; forehead: AUC 0.816; 95% CI: 0.757-0.876, P <0.001). The cut-off value of wrist measurement for detecting tympanic temperature [&ge;]37.3{degrees}C was 36.2{degrees}C with a 86.4% sensitivity and a 67.0% specificity, and the best threshold of forehead measurement was also 36.2{degrees}C with a 93.2% sensitivity and a 60.0% specificity. ConclusionsWrist measurement is more stable than forehead measurement under different circumstance. Both measurements have great fever screening abilities for indoor patients. The cut-off value of both measurements was 36.2{degrees}C. (ClinicalTrials.gov number: NCT04274621)

11: Randomized Re-Opening of Training Facilities during the COVID-19 pandemic
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Posted 24 Jun 2020

Randomized Re-Opening of Training Facilities during the COVID-19 pandemic
34,664 downloads medRxiv public and global health

Lise M. Helsingen, Magnus Løberg, Erle Refsum, Dagrun Kyte Gjøstein, Paulina Wieszczy, Ørjan Olsvik, Frederik E. Juul, Ishita Barua, Henriette C. Jodal, Magnhild Herfindal, Yuichi Mori, Solveig Jore, Fridtjof Lund-Johansen, Atle Fretheim, Michael Bretthauer, Mette Kalager, for the TRAiN study group

BackgroundClosed training facilities during the Covid-19 pandemic may negatively impact peoples health and wellbeing. We investigated SARS-CoV-2 virus transmission, Covid-19 and SARS-CoV-2 antibodies attributable to training facilities. MethodsWe randomised members aged 18 to 64 without relevant comorbidities at five training facilities in Oslo, Norway, to access or no access to their facility. Facilities opened May 22, 2020 for the training arm, applying physical distancing (1 meter for floor exercise, 2 meters for high-intensity classes) and enhanced hand and surface hygiene. We compared SARS-CoV-2 RNA status by self-administered naso-, oropharyngeal and sputum sampling after 14 days; clinical disease through electronic patient records after 21 days; and SARS-CoV-2 antibody status by dried-blood self-sampling after one month. (ClinicalTrials.gov number NCT04406909) Findings3,764 individuals were randomised; 1,896 in the training and 1,868 in the no-training arm. In the training arm, 81.8% trained at least once, and 38.5% trained [&ge;]six times. Of 3,016 individuals who returned the SARS-CoV-2 RNA tests (80.5%), there was one positive test. The positive individual was randomised to training, but had not used the training facility, and the workplace was identified as transmission source. There were no outpatient visits or hospital admissions due to Covid-19 in either group. Eleven individuals in the training arm (0.8% of tested) and 27 in the no-training arm (2.4% of tested) tested positive for SARS-CoV-2 antibodies (p=0.001). InterpretationProvided good hygiene and physical distancing measures, there was no increased transmission of SARS-CoV-2 at training facilities. FundingNorwegian Research Council, grant no. 312757

12: Rapid Scoping Review of Evidence of Outdoor Transmission of COVID-19
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Posted 10 Sep 2020

Rapid Scoping Review of Evidence of Outdoor Transmission of COVID-19
34,522 downloads medRxiv public and global health

Mike Weed, Abby Foad

The COVID-19 pandemic is both a global health crisis, and a civic emergency for national governments, including the UK. As countries across the world loosen their lockdown restrictions, the assumption is generally made that the risk of COVID-19 transmission is lower outdoors, and this assumption has shaped decisions about what activities can re-commence, the circumstances in which they should re-commence, and the conditions under which they should re-commence. This is important for events and activities that generate outdoor gatherings of people, including both participatory and spectator sport events, protests, concerts, carnivals, festivals, and other celebrations. The review, which was designed to be undertaken rapidly in 15 days, returned 14 sources of evidence of outdoor transmission of COVID-19, and a further 21 sources that were used to set the context and understand the caveats that should be considered in interpreting the review findings. The review found very few examples of outdoor transmission of COVID-19 in everyday life among c. 25,000 cases considered, suggesting a very low risk. However risk of outdoor transmission increases when the natural social distancing of everyday life is breached, and gathering density, circulation and size increases, particularly for an extended duration. There was also evidence that weather had a behavioural effect on transmission, with temperatures that encourage outdoor activity associated with lower COVID-19 transmission. Due to lack of surveillance and tracing systems, and confounding factors and variables, there was no evidence that robustly tested transmission at outdoor mass gatherings (circa 10,000+ people), which are as likely to generate transmission from the activities they prompt (e.g. communal travel and congregation in bars) as from outdoor transmission at the gathering itself. The goal of hosts and organisers of events and activities that generate outdoor gatherings of people is to prevent the escalation of risk from sporadic transmission to the risk of transmission through a cluster outbreak. Considerations for such hosts and organisers include: (1) does the gathering prompt other behaviours that might increase transmission risk?; (2) for each part of the event or activity, how dense is the gathering, how much do people circulate, how large is the gathering, and how long are people there?; (3) is rapid contact tracing possible in the event of an outbreak? These considerations should take place relevant to the size of the underlying risk, which includes the rate of infection in the community and the likely attendance of vulnerable groups. Risk must be balanced and mitigated across the risk factors of density, circulation, size and duration. No one risk factor presents an inherently larger risk than any other, but neither is any one risk factor a magic bullet to eliminate risk. Finally, it is clear that the largest risks from gatherings come from spontaneous or informal unregulated and unmitigated events or activities which do not consider any of the issues, risks and risk factors outlined in this paper

13: Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 1 - Face masks, eye protection and person distancing: systematic review and meta-analysis
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Posted 30 Mar 2020

Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 1 - Face masks, eye protection and person distancing: systematic review and meta-analysis
34,215 downloads medRxiv public and global health

Tom Jefferson, MA Jones, L Al-Ansary, GA Bawazeer, EM Beller, J Clark, JM Conly, C Del Mar, E Dooley, E Ferroni, P Glasziou, T Hoffmann, S Thorning, ML van Driel

OBJECTIVETo examine the effectiveness of eye protection, face masks, or person distancing on interrupting or reducing the spread of respiratory viruses. DESIGNUpdate of a Cochrane review that included a meta-analysis of observational studies during the SARS outbreak of 2003. DATA SOURCESEligible trials from the previous review; search of Cochrane Central Register of Controlled Trials, PubMed, Embase and CINAHL from October 2010 up to 1 April 2020; and forwardand backward citation analysis. DATA SELECTIONRandomised and cluster-randomised trials of people of any age, testing the use ofeye protection, face masks, or person distancing against standard practice, or a similar physical barrier. Outcomes included any acute respiratory illness and its related consequences. DATA EXTRACTION AND ANALYSISSix authors independently assessed risk of bias using the Cochrane tool and extracted data. We used a generalised inverse variance method for pooling using a random-effects model and reported results with risk ratios and 95% Confidence Intervals (CI). RESULTSWe included 15 randomised trials investigating the effect of masks (14 trials) in healthcare workers and the general population and of quarantine (1 trial). We found no trials testing eye protection. Compared to no masks there was no reduction of influenza-like illness (ILI) cases (Risk Ratio 0.93, 95%CI 0.83 to 1.05) or influenza (Risk Ratio 0.84, 95%CI 0.61-1.17) for masks in the general population, nor in healthcare workers (Risk Ratio 0.37, 95%CI 0.05 to 2.50). There was no difference between surgical masks and N95 respirators: for ILI (Risk Ratio 0.83, 95%CI 0.63 to 1.08), for influenza (Risk Ratio 1.02, 95%CI 0.73 to 1.43). Harms were poorly reported and limited to discomfort with lower compliance. The only trial testing quarantining workers with household ILI contacts found a reduction in ILI cases, but increased risk of quarantined workers contracting influenza. All trials were conducted during seasonal ILI activity. CONCLUSIONSMost included trials had poor design, reporting and sparse events. There was insufficient evidence to provide a recommendation on the use of facial barriers without other measures. We found insufficient evidence for a difference between surgical masks and N95 respirators and limited evidence to support effectiveness of quarantine. Based on observational evidence from the previous SARS epidemic included in the previous version of our Cochrane review we recommend the use of masks combined with other measures.

14: Applying Benford's law to COVID-19 data: The case of the European Union
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Posted 25 Dec 2021

Applying Benford's law to COVID-19 data: The case of the European Union
30,470 downloads medRxiv public and global health

Pavlos Kolias

Previous studies have used Benford's distribution to assess whether there is misreporting of COVID-19 cases and deaths. Data inaccuracies provide false information to the media, undermine global response, and hinder the preventive measures taken by countries worldwide. In this study, daily new cases and deaths from all the countries of the European Union were analyzed and the conformance to Benford's distribution was estimated. For each country, two statistical tests and two measures of deviation were calculated to determine whether the reported statistics comply with the expected distribution. Four country-level developmental indexes were also included, the GDP per capita, health expenditures, the Universal Health Coverage index, and the full vaccination rate. Regression analysis was implemented to show whether the deviation from Benford's distribution is affected by the aforementioned indexes. The findings indicate that four countries were in line with the expected distribution, Bulgaria, Croatia, Lithuania, and Romania. For the daily cases, Denmark, Greece, and Ireland, showed the greatest deviation from Benford's distribution and for deaths, Malta, Cyprus, Greece, Italy, and Luxemburg exhibited the highest deviation from Benford's law. Furthermore, it was found that the vaccination rate is positively associated with deviation from Benford's distribution. These results suggest that overall, official data provided by authorities are not confirming Benford's law, yet this approach is not conclusive; it acts as a preliminary tool for data verification. More extensive studies should be made with a more thorough investigation of countries that showed the greatest deviation.

15: A Comprehensive Analysis of COVID-19 Outbreak situation in India
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Posted 11 Apr 2020

A Comprehensive Analysis of COVID-19 Outbreak situation in India
29,843 downloads medRxiv public and global health

Rajan Gupta, Saibal Kumar Pal, Gaurav Pandey

The outbreak of COVID-19 in different parts of the world is a major concern for all the administrative units of respective countries. India is also facing this very tough task for controlling the virus outbreak and has managed its growth rate through some strict measures. This study presents the current situation of coronavirus spread in India along with the impact of various measures taken for it. With the help of data sources (till 7th-8th April 2020) from various state units of India and Ministry of Health and Family Welfare, Government of India, this study presents various trends and patterns. This study answers six different research ques-tions in a comprehensive manner. It has been reported that growth rate of infected cases has been controlled with the help of National Lockdown, however some uncontrolled mass level events had negatively impacted the infected cases. With the help of exponential and polyno-mial regression modelling, the predictions of up to 75000 cases have been done by the end of April 2020. It has also been seen that there are some prominent clusters and patient nodes in the network of patients which are the major influencers for COVID-19 spread. Also, death rate case predictions have been done through multi-class classification models with an accuracy of 75%. At the end, strategies for continuation for lockdown has been discussed and presented. It appears that only essential services should be open for the citizens of India and the national lockdown should be carried on for next 2-4 weeks. This study will be useful for the Government of India and various states of India, Administrative Units of India, Frontline health workforce of India, researchers and scientists. This study will also be favorable for the administrative units of other countries to consider various aspects related to the control of COVID-19 outspread in their respective regions.

16: Rapid evidence summary on SARS-CoV-2 survivorship and disinfection, and a reusable PPE protocol using a double-hit process
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Posted 06 Apr 2020

Rapid evidence summary on SARS-CoV-2 survivorship and disinfection, and a reusable PPE protocol using a double-hit process
27,788 downloads medRxiv public and global health

José G B Derraik, William A Anderson, Elisabeth A Connelly, Yvonne C Anderson

In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), which are paramount to protect frontline medical/nursing staff and to minimize further spread of the virus. We carried out a rapid review to summarize the existing evidence on SARS-CoV-2 survivorship and methods to disinfect PPE gear, particularly N95 filtering facepiece respirators (FFR). In the absence of data on SARS-CoV-2, we focused on the sister virus SARS-CoV-1. We propose a two-step disinfection process, which is conservative in the absence of robust evidence on SARS-CoV-2. This disinfection protocol is based on an initial storage of PPE for [&ge;]4 days, followed by ultraviolet light (UVC), dry heat treatment, or chemical disinfection. Importantly, each of the two steps is based on independent disinfection mechanisms, so that our proposed protocol is a multiplicative system, maximising the efficacy of our disinfection process. This method could be rapidly implemented in other healthcare settings, while testing of each method is undertaken, increasing the frontline supply of PPE, and avoiding many of the upstream issues of supply chain disruption currently being faced.

17: Immunogenicity and Safety of a SARS-CoV-2 Inactivated Vaccine in Healthy Adults Aged 18-59 years: Report of the Randomized, Double-blind, and Placebo-controlled Phase 2 Clinical Trial
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Posted 10 Aug 2020

Immunogenicity and Safety of a SARS-CoV-2 Inactivated Vaccine in Healthy Adults Aged 18-59 years: Report of the Randomized, Double-blind, and Placebo-controlled Phase 2 Clinical Trial
27,557 downloads medRxiv public and global health

Yan-Jun Zhang, Gang Zeng, Hong-Xing Pan, Chang-Gui Li, Biao Kan, Ya-Ling Hu, Hai-Yan Mao, Qian-Qian Xin, Kai Chu, Wei-Xiao Han, Zhen Chen, Rong Tang, Wei-Dong Yin, Xin Chen, Xue-Jie Gong, Chuan Qin, Yuan-Sheng Hu, Xiao-Yong Liu, Guo-Liang Cui, Cong-Bing Jiang, Heng-Ming Zhang, Jing-Xin Li, Min-Nan Yang, Xiao-Juan Lian, Yan Song, Jin-Xing Lu, Xiang-Xi Wang, Miao Xu, Qiang Gao, Fengcai Zhu

BACKGROUND The top priority for the control of COVID-19 pandemic currently is the development of a vaccine. A phase 2 trial conducted to further evaluate the immunogenicity and safety of a SARS-CoV-2 inactivated vaccine (CoronaVac). METHODS We conducted a randomized, double-blind, placebo-controlled trial to evaluate the optimal dose, immunogenicity and safety of the CoronaVac. A total of 600 healthy adults aged 18-59 years were randomly assigned to receive 2 injections of the trial vaccine at a dose of 3 g/0.5 mL or 6 g /0.5mL, or placebo on Day 0,14 schedule or Day 0,28 schedule. For safety evaluation, solicited and unsolicited adverse events were collected after each vaccination within 7 days and 28 days, respectively. Blood samples were taken for antibody assay. RESULTS CoronaVac was well tolerated, and no dose-related safety concerns were observed. Most of the adverse reactions fell in the solicited category and were mild in severity. Pain at injection site was the most frequently reported symptoms. No Grade 3 adverse reaction or vaccine related SAEs were reported. CoronaVac showed good immunogenicity with the lower 3 g dose eliciting 92.4% seroconversion under Day 0,14 schedule and 97.4% under Day 0,28 schedule. 28 days after two-dose vaccination, the Nab levels of individual schedules range from 23.8 to 65.4 among different dosage and vaccination schedules. CONCLUSIONS Favorable safety and immunogenicity of CoronaVac was demonstrated on both schedules and both dosages, which support the conduction of phase 3 trial with optimum schedule/dosage per different scenarios.

18: Estimated Average Probabilities of COVID-19 Infection, Hospitalization, and Death From Community Contact in the United States
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Posted 12 Jun 2020

Estimated Average Probabilities of COVID-19 Infection, Hospitalization, and Death From Community Contact in the United States
27,263 downloads medRxiv public and global health

Rajiv Bhatia, Jeffrey Klausner

We describe a method to estimate individual risks of hospitalization and death attributable to non-household and household transmission of SARS-CoV-2 using available public data on confirmed-case incidence data along with estimates of the clinical fraction, timing of transmission, isolation adherence, secondary infection risks, contact rates, and case-hospitalization and case-fatality ratios. Using the method, we estimate that risks for a 90-day period at the median daily summertime U.S. county confirmed COVID-19 case incidence of 10.8 per 100,000 and pre-pandemic contact rates range from 0.4 to 8.9 per 100,000 for the four deciles of age between 20 and 60 years. The corresponding 90-day period risk of hospitalization ranges from 13.7 to 69.2 per 100,000. Assuming a non-household secondary infection risk of 4% and pre-pandemic contact rates, the share of transmissions attributable to household settings ranges from 73% to 78%. These estimates are sensitive to the parameter assumptions; nevertheless, they are reasonably comparable to the COVID-19 hospitalization and fatality rates observed over the time period. We conclude that individual risk of hospitalization and death from SARS-CoV-2 infection is calculable from publicly available data sources. Access to publicly reported infection incidence data by setting and other exposure characteristics along with setting specific estimates of secondary infection risk would allow for more precise individual risk estimation.

19: Impact of COVID-19 on the Psychological Well-Being and Turnover Intentions of Frontline Nurses in the Community: A Cross-Sectional Study in the Philippines
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Posted 06 Aug 2020

Impact of COVID-19 on the Psychological Well-Being and Turnover Intentions of Frontline Nurses in the Community: A Cross-Sectional Study in the Philippines
24,723 downloads medRxiv public and global health

Janet Alexis A. De los Santos, Leodoro J. Labrague

Purpose: This study aimed to assess fear of COVID-19 among nurses in a community setting. Methods: This study employed a cross-sectional design using self-report questionnaires. Findings: Results revealed that nurses display moderate to high fear of COVID-19 and that the female gender is correlated to fear of the virus. Moreover, the nurses fear influences their psychological distress and organizational and professional turnover intentions. Conclusion: Fear of COVID-19 is universal among nurses. There is a need to assess the factors associated with the fear to better address the nurses psychological well-being and to avoid turnover intentions.

20: Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods
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Posted 24 Dec 2021

Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods
21,459 downloads medRxiv public and global health

Declan Bays, Timothy Whiteley, Matt Pindar, Johnathon Taylor, Brodie F Walker, Hannah Williams, Thomas James Ronald Finnie, Nick Gent

Isolating, either enforced or self-guided, is a well-recognised and used technique in the limitation and reduction of disease spread. This usually balances the societal harm of disease transmission against the individual harm of being isolated and is typically limited to a very small number of individuals. With the widespread transmission of SARS-CoV-2 and requirements to self-isolate when symptomatic or having tested positive, the number of people affected has grown very large causing noticeable individual cost, and disruption to the provision of essential services. With widespread access to reliable rapid antigen tests (also known as LFD or LFTs), in this paper we examine strategies to utilise this testing technology to limit the individual harm whist maintaining the protective effect of isolation. We extend this work to examine how isolation may be improved and mitigate the release of infective individuals into the population caused by fixed time-periods.

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