Flaws and uncertainties in pandemic global excess death calculations

European Journal of Clinical Investigation, Год журнала: 2023, Номер 53(8)

Опубликована: Апрель 17, 2023

Several teams have been publishing global estimates of excess deaths during the COVID-19 pandemic. Here, we examine potential flaws and underappreciated sources uncertainty in death calculations. Adjusting for changing population age structure is essential. Otherwise, are markedly overestimated countries with increasingly aging populations. changes other high-risk indicators, such as residence long-term facilities, may also make a difference. Death registration highly incomplete most countries; completeness corrections should allow substantial consider that changed pandemic years. Excess high sensitivity to modelling choice. Therefore different options be considered full range results shown choices pre-pandemic reference periods imposed models. Any post-modelling specific guided by pre-specified rules. Modelling all-cause mortality (ACM) ACM data extrapolating these models precarious; lack transportability. Existing underestimate overall multiplicative across diverse uncertainty. Informative require risk stratification, including groups ethnic/racial strata. Data to-date suggest deficit among children marked socioeconomic differences deaths, widening inequalities. Finally, causal explanations great caution disentangling SARS-CoV-2 indirect effects from measures taken. We conclude many uncertainties, but globally minority calculated deaths.

Язык: Английский

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Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

International Journal for Equity in Health, Год журнала: 2024, Номер 23(1)

Опубликована: Март 14, 2024

Abstract Background The construction of the ordered health delivery system in China aims to enhance equity and optimize efficient use medical resources by rationally allocating patients different levels institutions based on severity their condition. However, superior hospitals have been overcrowded, primary healthcare facilities underutilized recent years. has developed a new case-based payment method called “Diagnostic Intervention Package” (DIP). government is trying this economic lever encourage actively assume treatment tasks consistent with functional positioning service capabilities. Methods This study takes Tai’an, DIP pilot city, as case uses an interrupted time series analysis analyze impact reform scope at levels. Results results show that after reform, proportion receiving complicated procedures (tertiary hospitals: β 3 = 0.197, P < 0.001; secondary 0.132, 0.020) mix index 0.022, 0.008, 0.001) tertiary increased, primary-DIP-groups cases decreased -0.290, -1.200, 0.001), aligning anticipated policy objectives. (β 0.186, 0.002) 0.002, increased while -0.515, 0.005) coverage -2.011, decreased, which will reduce utilization efficiency increase inequity. Conclusion did not effectively promote system. Policymakers need adjust incentives implement restraint mechanisms regulate behavior institutions.

Язык: Английский

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Recombinant XBB.1.5 boosters induce robust neutralization against KP.2- and KP.3-included JN.1 sublineages

Signal Transduction and Targeted Therapy, Год журнала: 2025, Номер 10(1)

Опубликована: Янв. 27, 2025

Abstract The newly emerged variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) demonstrate resistance to present therapeutic antibodies as well the capability evade vaccination-elicited antibodies. JN.1 sublineages were demonstrated one most immune-evasive variants, showing higher neutralization compared XBB.1.5. In this study, serum samples collected from adult participants including those who had gone through BA.5/BF.7, EG.5/HK.3 and XBB/JN.1 infection waves, characterized by different vaccination histories. We evaluated in these against pseudoviruses Omicron lineages. further investigated humoral immune response recombinant XBB vaccines estimated sublineages, KP.2 KP.3. Our results showed that sera previous circulating subvariant breakthrough infections exhibited low GMTs 50% all tested significantly elevated individuals received WSK-V102C or WSK-V102D boosters. Importantly, 4 months after a booster XBB.1.5, JN.1, JN.1.13, KP.3 3479, 1684, 1397, 1247 1298, with 9.86-, 9.79-, 8.73-, 8.66- 8.16-fold increase without booster, respectively, indicating boosting XBB.1.5 subunit still induced strong antibody responses sublineages. However, KP.3, revealed more than 2-fold decreases neutralizing titers suggesting enhanced evasion necessity boosters based on

Язык: Английский

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Data-Driven Mathematical Modeling Approaches for COVID-19: a survey

Physics of Life Reviews, Год журнала: 2024, Номер 50, С. 166 - 208

Опубликована: Авг. 8, 2024

In this review, we successively present the methods for phenomenological modeling of evolution reported and unreported cases COVID-19, both in exponential phase growth then a complete epidemic wave. After case an isolated wave, several successive waves separated by endemic stationary periods. Then, treat multi-compartmental models without or with age structure. Eventually, review literature, based on 260 articles selected 11 sections, ranging from medical survey hospital to forecasting dynamics new general population. This favors approach over mechanistic choice references provides simulations number observed COVID-19 10 states (California, China, France, India, Israel, Japan, New York, Peru, Spain United Kingdom).

Язык: Английский

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Changes in the epidemiological characteristics of influenza in children in Zhengzhou, China, in the post-COVID-19 era

BMC Public Health, Год журнала: 2024, Номер 24(1)

Опубликована: Июль 19, 2024

Abstract Background Influenza is a contagious respiratory disease posing huge burden of for children around the world. The purpose this study was to investigate epidemiologic changes in childhood influenza Zhengzhou, China, before, during, and after COVID-19 outbreak. aim determine impact outbreak related prevention control policies on children’s epidemiological trend. Methods All report card data from Children’s Hospital Affiliated with Zhengzhou University’s Disease Surveillance Reporting Management System were collected analyzed monthly January 2018 December 2023. period divided into three phases comparison: pre-pandemic period, pandemic post-pandemic period. Results Between 2023, total 82,030 diagnosed at our hospital, including 46,453 males 35,577 females. A 11,833 them had be hospitalized influenza, 321 brought ICU. showed low-level status during pandemic, there substantial rise surge number cases year 2023 will most (40,785). peak incidence 2022, July October, February April October December. During proportion new-borns young among patients decreased, while school-age increased significantly, ICU admissions decreased. Conclusion pandemic. In large increase incidence, double incidence. has also increased. As result, we recommend that vaccination key populations, particularly children, completed by each Henan Province, government schools education about nonpharmacological approaches.

Язык: Английский

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Comparison of bullying victimization and depression symptoms among Chinese adolescents before and after the end of the dynamic zero-COVID-19 policy: a repeated cross-sectional study

BMC Psychiatry, Год журнала: 2025, Номер 25(1)

Опубликована: Фев. 3, 2025

The COVID-19 pandemic has had a significant impact on the physical and mental health of human beings. Most adolescents in mainland China have been infected with after adjustment dynamic zero-COVID-19 policy. This study aims to analyze relationship between effect depressive symptoms among China. school-based repeated cross-sectional was conducted students aged 11-19 years from September October 2022 2023 Ningbo, Zhejiang Province, China, using stratified cluster, multistage sampling method. Data analysis occurred January June 2024. Depression bullying victimization, exclusion cyberbullying, were assessed 20-item Center for Epidemiological Studies Scale (CES-D) Bully/Victim Questionnaire, respectively. In first survey wave during policy period Mainland 10,224 participants completed questionnaires. 2 which year lifting policy, 11,604 resulted sample 1 2. mean age 15.2 (SD = 1.7) 15.1 1.8) prevalence depression higher than (17.0% vs. 14.6%, P < 0.05). victimization types school 2022. A total 3.2% 1.7% experienced (P odds ratio experiencing (CES-D Score ≧ 16) 1.18 (95% CI, 1.10-1.28) 1.86 1.55-2.24) times higher, respectively, 0.01). mediated regression revealed that association an increase symptoms, partially by (total association:β 0.175; SE 0.038; 0.001; direct 0.138; 0.039; indirect association: a*b 0.037; proportion mediation: 20.88%, 0.001). findings this suggest increased risk or associated addition, may play mediating role associations symptoms. These indicated additional support should be offered Chinese post-pandemic COVID-19. Not applicable.

Язык: Английский

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Postpartum Hemorrhage Emerges as a Key Outcome of Maternal SARS-CoV-2 Omicron Variant Infection Surge Across Pregnancy Trimesters

Journal of Infection and Public Health, Год журнала: 2025, Номер 18(6), С. 102733 - 102733

Опубликована: Март 6, 2025

Despite evidence showing changes in disease severity with the virus's evolution and vaccination efforts, link between maternal, perinatal, neonatal outcomes SARS-CoV-2 infections during different pregnancy trimesters remains unclear, especially BA.5 BF.7 Omicron subvariant surge China December 2022. This study investigates correlation infection across various trimesters. prospective cohort was conducted at two hospitals southwest China, examining clinical records status of 2158 pregnant women registered January 1, 2022, September 30, 2023. Initially shielded from COVID-19, population later experienced a significant surge. A comparative analysis evaluated infected uninfected subjects. Primary included complications premature births, while secondary encompassed cesarean sections, delivery complications, outcomes. Pregnant had higher incidence placenta increta/percreta postpartum hemorrhage compared to women. First trimester were associated lower intrahepatic cholestasis [aOR = 0.29, 95 % CI 0.13-0.63] but preterm birth 2.16, 1.25-3.71]. Third increased risk 2.74, 1.21-6.18]. is linked hemorrhage. are pregnancy, third

Язык: Английский

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Self-reported changes in sexual behaviors and HIV prevention services utilization among gay, bisexual and other men who have sex with men after entering the post-pandemic era: tales of two Chinese cities with different pathways of “resume normal”

BMC Public Health, Год журнала: 2025, Номер 25(1)

Опубликована: Апрель 21, 2025

Язык: Английский

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What did COVID‐19 really teach us about science, evidence and society?

Journal of Evaluation in Clinical Practice, Год журнала: 2023, Номер 29(8), С. 1237 - 1239

Опубликована: Июнь 6, 2023

During the pandemic crisis of 2020–2023, it is likely that successes biomedical science were more than offset by its failures. These failures continue to undermine once-powerful ideals and hopes for science's role in societal betterment. Here, we dissect underpinnings these argue restoring such first requires systemic reform itself. The considerable medicine during COVID-19 pertained speed, example, real-time information sharing1, record-time development vaccines2, unprecedented rapidity getting results from some large randomized trials interventions3, solidly documenting or refuting claims effectiveness4. On this basis, visible scientists response seems worth celebrating. Basic research, translational research evidence-based tools all had bright days crisis. But success was accompanied major Some reflected efforts influential their political allies demonize dissenting scientific views evidence. From earliest pandemic, despite weak, absent contradictory evidence, leading national decision makers, facing urgent need action5, assured public they adopting policies 'following science'6. A new elite media-savvy experts fields like virology modelling (with without relevant credentials) gained visibility influence circles. narrow, reductionist disciplinary sometimes partisan perspectives7, 8 'influencers' helped justify allocated sacrifice, privation suffering across walks society hundreds millions lives. consequences education, healthcare, small businesses, social life democratic politics itself often disastrous. Consequences most acutely felt vulnerable populations, factory workers school children, old poor9. Radically different responses disease nation nation—from draconian lockdowns sectors, relatively permissive flexible regimes—made obvious value evidence support what politically desirable possible contexts. Rather following science, enlisted follow politics. Supposedly science-based turn built upon amplified deeper contradictions at intersections health. affluent nations with generously funded as United States Kingdom, been experiencing slow-downs even reversals gains expectancy predate COVID-1910, 11. trends, unthinkable 25 years ago, both reflect exacerbate pre-existing entrenched health inequities. For men London's neighbourhoods 18 longer those poor areas11. Such disparities have multiple causes, but economy medical a critical part story12. Investments sciences focus overwhelmingly on reductionist, molecular-genetic approaches cures, which can generate status profits companies, minimal benefits population may widen inequalities. Medical delivered through market mechanisms continually inflates healthcare costs, another driver Additional tensions science-health interface include misuse direct products itself, opioids, iatrogenic disorders. Indeed, lockdown, acquired new, dimensions13. Yet study communication disorders COVID too demonized high-level decision-makers advisors, clouded our ability openly debate balance impacts massive interventions imposed segments society. Now add uncertain plausible possibility product science14, 15, an apparently outrageous consequence becomes inescapable: become threat overall Under ambiguous circumstances, could feed into rising tide scepticism about authority affairs, given uneasy possibilities accumulating mentioned, hardly irrational increasing proportion dissatisfied wondering whether truth path healthier world must lie somewhere else within prestigious journals celebrities science–policy–communication interface16. At time when monopoly has never contested17, pretence 'the' be deployed processes decisions interest only make contestation worse. This not 'relativist' perspective, hard lesson COVID-19. Contradictions enterprise, uncertainties knowledge, limits accomplish, disagreement actions take, are real unavoidable. In absence strong and, worse, inhibition get better justification 'the settled' accurate unfavourable 'can harm response'), coupled unwillingness acknowledge uncertainties, nonscientists clearly sense there something fundamentally wrong response. public, behaviour, collectively responds reality. More less answer. Entanglement happened various degrees most, if all, countries. It resulted extreme COVID-19, China's prolonged zero strategy eventually abandoned unsustainable. Lack transparency makes difficult fathom exact depth failures, China enormous uncertainty eventual level other excess deaths18. Moreover, states, unclear how far-reaching future negative impact measures last frontiers mental chronic outcomes19-21. experience clear today's enterprise autonomous, self-correcting global good, component global, regional economies needs poorly aligned22-27. Commodification predicted half century ago28, 29, reached levels30. Systemic problems industrial-scale widely acknowledged insularity disciplines lack system thinking31 integration32; proliferation biased, conflicted low-quality divorced needs33; waste driven productivity rather accountability34; truly open discussions funds needs35. Can science–policy–public rift became so healed? To pursue goal, democracies will embrace, over long term, one moves away current commodification incentives objectives29, 36, 37, acknowledges between values, accepts specialized expertise—and especially danger hordes influencers made media38—for guiding challenges necessary step healing process would advocates recognize own complicity having supported emergence problems, doing embrace redesign. Absent commitments, should expect continued balkanization expertise truth, left hope societies discover sources cohesion coherence outside remit science. authors declare no conflicts interest. John P. A. Ioannidis Joachim Sturmberg members editorial board journal evaluation paper. There data attached contribution.

Язык: Английский

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Impact of coronavirus disease 2019 on the utilization of hospital services and development of optimal pandemic control strategy in Chinese tertiary hospitals during the Omicron wave

BMC Health Services Research, Год журнала: 2024, Номер 24(1)

Опубликована: Июль 23, 2024

Abstract Background This study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on hospital service utilization and revenue in Chinese tertiary hospitals develop an optimal pandemic control strategy (OPCS) for peak period Omicron wave. Methods Retrospective data from three (provincial, city, county level) were analyzed phases: pre-outbreak (Jan-Apr 2019), outbreak 2020), post-outbreak 2021). OPCS was developed under guidance China government policy during post-break phase COVID-19. A decision-tree model constructed compare strict a provincial Results Outpatient, emergency room (ER) visits, hospitalizations, intensive care admissions dropped by 33.8–53.4% outbreak, with being most affected. Hospital also declined, especially (40.1%). Post-outbreak, services recovered, but ER visits remained lower (11.6% decrease hospital, 46.5% hospital). Total income expenditure decreased, experiencing significant reduction (45.7%). showed greater medical (31.6 times more outpatient visits; 1.7 inpatient days; 3.4% surgery volume) higher (¥220.8 million more) compared strategy. Conclusions COVID-19 measures associated less hospitals. The hospitals, focusing isolating infected inpatients not shutting down facilities exposed virus, could be effective optimizing

Язык: Английский

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