Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used equity indicators. Despite some conflicting results, all identified SEDH (social deprivation, income, education level, social class, insurance coverage and health literacy) are associated with inequalities in access to and use of emergency care. In conclusion, the use of administrative data-derived indicators combined with identified SEDH could improve healthcare equity measurement in emergency care settings across health care systems worldwide.

The World Health Organization’s Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies of both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. Health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, impacts on carbon emissions from mode shift to active travel modes can now be assessed. Monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behaviour or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling.

Stakeholder input into the decision-making process when developing public health programs and policies is crucial. This article presents an innovative approach, involving online participation with a wide group of stakeholders located in different geographic locations, for policy consensus by research methodology. The results of the project have been used to propose assumptions regarding a strategy for preventing blood-borne diseases in Poland. The research was conducted iteratively using a multi-stage qualitative methodology to explore risk assessment involving blood-borne infections. The final output of the entire project is a list of key problems/challenges and solutions associated with medical and nonmedical services that are connected to the breakage of tissue continuity. Qualitative research is rare in risk assessment as priority is usually given to statistical data and end-points (quantitative studies ). Statistical data on health risk allows to assess the health implications, while the methodology applied also allowed diagnosis of the processes leading to these effects. In addition to policy preparation for blood-borne illnesses, the methodology employed in the study can also be used to successfully explore other areas of public health policy decisions.

Background: To examine the association between income levels and mortality rates in patients with chronic kidney disease. Methods: We analyzed data obtained from 3,172 patients with chronic kidney disease obtained from the Korean National Health Insurance claims database (2003–2009). Each patient was monitored until December 2010 or until death, whichever came first. Individual income was estimated from the national health insurance premium. Information on mortality was obtained from the Korean National Statistical Office. Cox proportional hazard models were used to compare mortality rates between different income groups after adjusting for possible confounding risk factors. Results: A low income was significantly associated with a high mortality rate after adjusting for covariates (adjusted HR 1.298 [1.082–1.556]). In addition, dialysis patients who had low incomes were more likely to have higher mortality rates compared to those in dialysis patients who had high incomes (adjusted HR 1.528 [1.122–2.082]). Conclusion: The findings of this study indicate that chronic kidney disease patients with low incomes have the highest mortality risk. Promotion of targeted policies and priority health services for patients with low incomes may help reduce the mortality rate in this vulnerable group.

The world is currently facing a serious pandemic of coronavirus disease 2019 (COVID-19) which started in Wuhan, China, and was then transmitted rapidly to other countries. Countries applied different methods and procedures in an attempt to prevent or reduce and/or control the incidence of cases and manage existing ones. This paper discusses the methods and procedures applied by Kuwait to control this epidemic, and how effective they have been. The State of Kuwait followed WHO, European CDC, US CDC, and/or other countries’ institutional guidelines, and is still working on containing the disease, given the rising number of cases among Kuwaitis returning from affected areas such as the UK and USA, and migrant workers who bear the highest burden, given their cramped living conditions.

In Wuhan city of China, an episode of novel coronavirus (COVID-19) happened. during late December and it has quickly spread to all places in the world. Until May 29, 2020, cases were high in the USA with 1.7 Million, Russia with approximately 387 thousand, the UK with 271 thousand confirmed cases. Everybody on the planet is anxious to know when the coronavirus pandemic will end. In this scourge, most nations force extreme medication measures to contain the spread of COVID-19. Modeling has been utilized broadly by every national government and the World Health Organization in choosing the best procedures to seek after in relieving the impacts of COVID-19. Many epidemiological models are studied to understand the spread of the illness and its prediction to find maximum capacity for human-to-human transmission so that control techniques can be adopted. Also, arrangements for the medical facilities required such as hospital beds and medical supplies can be made in advance. Many models are used to anticipate the results keeping in view the present scenario. There is an urgent need to study the various models and their impacts. In this study, we present a systematic literature review on epidemiological models for the outbreak of novel coronavirus in India. The epidemiological dynamics of COVID-19 is also studied. Here, In addition, an attempt to take out the results from the exploration and comparing it with the real data. The study helps to choose the models that are progressive and dependable to predict and give legitimate methods for various strategies.

We analyze the Covid-19 mortality scenario in India and compare it with those in other large-population regions such as Asia-excluding-China, Africa, European Union, South America, and USA. We compare existing fatality data and offer an interpretation for low fatality based on immunity due to endemic malaria and TB. We identify the hot climate in the past summer as a possible cause for low death count in southern-hemisphere countries without endemic malaria and TB. We also make India-specific observations for easing the lockdown and estimations for the time required to attain herd immunity. Whatever optimism we present should be viewed as a guarded optimism. There should not be room for complacency.

South America has become the new epicenter of the coronavirus, especially in Brazil where the disease continues to spread exponentially across the country. This text aims to analyze the psychosocial factors of Covid-19 on back to school strategies in Brazil from a bioecological perspective. At the microsystem level, the population is experiencing different levels of stress and fear; at the microsystem level, changes in routines, separation from family and friends, and closure of schools; and at the macrosystem level, national guidelines to control the pandemic, institutional standards on a national and international scale. Therefore, the main focus for the success of school return must be in the prevention of contagion and with physical and psychological health, and should not only consider the demands of curricula, financial or administrative management. For this reason, it is paramount that greater female representativeness is increased in decision-making levels of the meso and macrosystem, regarding the resumption of school and academic activities in the pandemic period, since the number of female leaders in decision-making, is still insufficient.

The outbreak of Corona Virus effected negatively on the world’s economy which has already touched the maximum sectors. Readymade garments sector has the large contribution in Bangladesh’s economy. For increasing the locked down period, it is hitting badly by stopping production and cancellation of orders with some issues. This paper will represent the brief scenario and impacts of garments sector in recent days and the economy status of Bangladesh for the pandemic. The study is based on secondary data, collected from different authentic journals and web portals etc. Bangladesh’s garments earnings mostly depended on export but on these days, the buyers are cancelling their orders and the factories are being failed to give payments to the worker, some are being shut down also. As the duration of locked down is increasing, there is a huge chance to get unemployed and Bangladesh can be faced an undisciplined condition in near future. BGMEA and BKMEA are taking necessary steps to support the worker. Ensuring health security, the authorities are trying to reopen the factories limitedly to meet up the immediate needs. The government has taken the situation on most priority and introduce some improvement packages to run the economy smoothly and reduce the losses of the country for the pandemic.

The coronavirus disease (COVID-19) pandemic is rapidly spreading across the world. In Democratic Republic of Congo (DRC), 11 out of 26 provinces have been affected on 19 June 2020. The purpose of this study was to assess the public views, attitudes and beliefs related to the COVID-19 pandemic among the population of an unaffected city.Methods: This is a descriptive observational study conducted in an unaffected city using a questionnaire. Findings: A total of 769 people participated. The average age was 36 ±14 years. The sex ratio (male: female) was 1.6. The majority of respondents (97%) is aware of the existence of the COVID-19 pandemic, it is well informed about the signs of the disease, its severity and barrier measures, however few of them have adopted the change in habit and behavior in respect of the barrier measures. Lack of water for handwashing is the most common difficulty in complying with barrier measures (71%). The COVID-19 is considered as an artificial virus designed to reduce the world population by 26%, God’s punishment (22%). Only 36% of the participants are in favor of vaccination against COVID-19. Vaccine is, a western conspiracy to spread COVID-19 in Africa (38%), testing it on Africans (35%), sterilize Africans’ people (12%).Conclusions: Cities not yet affected by COVID-19 in DRC are aware of the existence of the disease, but insufficiently prepared to deal with it. It is important to increase awareness on barrier measures, combating false information, and improving regular water supply for regular handwashing.

The objective of this study was to review the study design and preliminary results of the Recovery trial and analyze the implementability of the Recovery trial by comparing it with the European Discovery trial.Method: The study design of the Recovery trial in the latest version of protocol was described and deeply analyzed to address the issue of implementation of the trial. A comparative analysis of study design and implementation between the UK Recovery trial and the European Discovery trial was conducted following the description.Results: The Recovery trial is a pragmatic, randomized, controlled, adaptive, open-label clinical trial. The study design of the Recovery trial was reported in the ISRCTN registry, the EU Clinical Trials Register and the U.S. National Library of Medicine ClinicalTrials.gov registry. Initially published on the 13^th March 2020, the study protocol of the Recovery trial has been updated five times at the time of this writing. More than 11,000 patients have been enrolled and 80% have completed the follow-up. Thousands of health care professionals at 175 Trusts in the UK have been involved. Conclusion: The Recovery trial applies a study design to address the issue of implementation in the context of the COVID-19 pandemic and emergency. It was conceptually pragmatic with a clear vision to address the top priority: the control of mortality and rational use of scarce resources. By contrast, the Discovery trial was designed as an intellectual exercise and consequently failed to address the issue of implementation in emergency.

The emergence of COVID -19 pandemic has severely impacted individuals from all walks of life. The rapid spread of the disease to nearly all parts of the country has posed enormous health, economic, environmental and social challenges to the entire human population. In the absence of any effective drugs and vaccines for treatment, social distancing and other preventive measures are the only alternatives. Lockdown is among one of the options suggested by WHO to reduce spread of the virus. India was quick to close its international borders and enforce the world’s largest COVID lockdown on March 22, 2020. The present study attempts to highlight the impact of imposed nationwide lockdown on society and environment alike along with analysis of lifestyle changes. The study was based on an online survey using a structured questionnaire with over 1000 responders across the country. The pandemic situation demands a certain way of shaping the society to reduce virus spread and safeguard oneself. In this study, we analysed the changes that the society has undergone during lockdown to mitigate the spreading of the infection. We also addressed the changes that have become part of our lives during lockdown – hygiene and health consciousness, work from home (WFM), online teaching, digital shopping, changing internet habits and societal changes.

This article describes a simple Susceptible Infected Recovered (SIR) model fitting with COVID-19 data for the month of march 2020 in New York (NY) state. The model is a classical SIR, but is non-autonomous; the rate of susceptible people becoming infected is adjusted over time in order to fit the available data. The death rate is also secondarily adjusted. Our fitting is made under the assumption that due to limiting number of tests, a large part of the infected population has not been tested positive. In the last part, we extend the model to take into account the daily fluxes between New Jersey (NJ) and NY states and fit the data for both states. Our simple model fits the available data, and illustrates typical dynamics of the disease: exponential increase, apex and decrease. The model highlights a decrease in the transmission rate over the period which gives a quantitative illustration about how lockdown policies reduce the spread of the pandemic. The coupled model with NY and NJ states shows a wave in NJ following the NY wave, illustrating the mechanism of spread from one attractive hot spot to its neighbor.

In this paper we first provide a primer on SARS-CoV-2 and Covid-19 delineating the etiopathogenesis, epidemiology, clinical manifestations and the natural history of the disease. We then trace the evolution of the Covid-19 pandemic highlighting the characteristics of the epidemic in China where the pandemic originated, select countries of Europe which peaked during April, and Brazil, US and India where the pandemic has taken serious turns recently. We also project some possible trajectories for the mega cities of India based on the demographic characteristics of these cities in comparison to New York city. This is an updated version of the article from mid-April published online.

COVID-19, the disease caused by the new coronavirus, SARS-CoV-2, has caused significant human and economic burden. Of the three major methods to mitigate the effect of the virus, diagnostics have become the focal point because vaccines and therapeutics, despite the intense effort of scientists worldwide, will take months to develop, test for safety and efficacy, scaleup and distribute to millions. This perspective aims to clarify some of the issues related to COVID-19 diagnostics and highlights some of the challenges key stakeholders including policymakers, businesses, managers, scientists and individuals face during this evolving pandemic.

This paper is purposed to delineate the current situation around Bangladesh as well as impacts of Coronavirus Disease-2019 (COVID-19) around the country and how the people over here are encountering this threatening pandemic. COVID-19 is an international epidemic that has got rapid wide-spread throughout different countries of the world to date. After its first outbreak in China different continents started to make sense and get aware against COVID-19 though, due to its special strategy of transmission several countries have been quite deteriorated preventing it. All the countries are moving at their best forward to find out any solution so that whole world could get rid of this horrifying situation as soon as possible. The authors here have reported an overview of how the outbreak of COVID-19 had put its commence in Bangladesh and to date how people over here have been tracing the way to tackle this havoc. Also, the changes that have brought around due to the crisis have offered us some fertile lessons that are enunciated here by the authors. To conclude, special considerations are anticipated to be highlighted pertaining COVID-19 outbreak in Bangladesh.

Social network analysis is an essential means to uncover and examine infectious contact relations between individuals. This paper aims to investigate the spread of coronavirus disease (COVID-19) from international to the national level and find a few super spreaders which played a central role in the transmission of disease in India. Our network metrics calculated from 30 January to 6 April 2020 revealed that the maximum numbers of connections were established from Dubai (degree-144) and UK (degree-64). These two countries played a crucial role in diffusing the disease in Indian states. The eigenvector centrality of Dubai is found to be the highest, and this marked it the most influential node. However, based on the modularity class, we found that the different clusters were formed across Indian states which demonstrated the forming of a multi-layered social network structure.A significant increase in the confirmed cases was reported during the first lockdown 1.0 (22 March 2020) primarily attributed to a gathering in Delhi Religious Conference (DRC) known as Tabliqui Jamaat. As of 6 April 2020, the overall structure of the network has encompassed local transmission, and it was significantly seen in the states like Gujarat, Rajasthan, and Karnataka. An important conclusion drawn from the presented social network reveals that the COVID-19 spread till 6 April was mainly due to the local transmission across Indian states. The timely quarantine of infected cases in DRC has not led it to spread at the level of community transmission.

Governments all over the world are currently grappling with the COVID-19 pandemic. While some countries were very hard hit, others were only mildly hit but all are still taking measures to mitigate the consequences. The virus emerged in December 2019 in Wuhan, China and spread to most continents by the beginning of March 2020, which led to the World Health Organization declaring it as a pandemic on the 11^th of March 2020. Since it was a novel disease, there was limited information on the virus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) belongs to the same family as the Severe Acute Respiratory Syndrome Coronavirus 1 (SARS-CoV-1) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Researchers all over the world started working simultaneously to understand the virus to provide the necessary treatment regime or vaccine in order to reduce the impact of the virus on its victims. Africa and other developing countries with limited resources and poor planning and management are expected to be among the worst hit in the long run. The implications of the COVID-19 on food, water, hygiene, sanitation, and the environment in Africa have been reviewed in this paper, as well as possible implications they may pose to the population, based on the existing common practices and their immediate impacts. This information can assist policymakers in Africa to adequately plan the management of the COVID-19 in order to lessen its impact on the population.

Objective: To use mathematical models to predict the epidemiological impact of lifting the lockdown in London, UK, and alternative strategies to help inform policy in the UK. Methods: A mathematical model for the transmission of SARS-CoV2 in London. The model was parametrised using data on notified cases, deaths, contacts, and mobility to analyse the epidemic in the UK capital. We investigated the impact of multiple non pharmaceutical interventions (NPIs) and combinations of these measures on future incidence of COVID-19. Results: Immediate action at the early stages of an epidemic in the affected districts would have tackled spread. While an extended lockdown is highly effective, other measures such as shielding older populations, universal testing and facemasks can all potentially contribute to a reduction of infections and deaths. However, based on current evidence it seems unlikely they will be as effective as continued lockdown. In order to achieve elimination and lift lockdown within 5 months, the best strategy seems to be a combination of weekly universal testing, contact tracing and use of facemasks, with concurrent lockdown. This approach could potentially reduce deaths by 48% compared with continued lockdown alone. Conclusions: A combination of NPIs such as universal testing, contact tracing and mask use while under lockdown would be associated with least deaths and infections. This approach would require high uptake and sustained local effort but it is potentially feasible as may lead to elimination in a relatively short time scale.

Introduction: Governance, the least studied health system component, comprises a system of rules and processes, and is a key determinant for effective decision making for health care planning. This study aims to identify institutional, legal and policy factors which are either barriers or facilitators for the implementation of integrated mental health in primary care in the India. Methods: Semi-structured interviews were conducted with 33 key informants at the district and national levels with policy makers, state level health care planners and district planners and managers in India. The data were analysed using thematic analysis using the qualitative software NViVO 10. Findings: Participants stated that a conducive environment for mental health service delivery is necessary at the legislative, policy and planning levels, to facilitate integration of mental health into primary care. Amongst other factors, the need for active involvement of civil society and service user organisations, strengthening mental health information systems, and building the non-technical skills of the mental health workforce, were identified as particularly necessary to deliver adequate mental health services.Conclusion: Amidst the favourable policy context supporting collaborative and integrated care in India, this study identified low resourcing, weak collaborations and inadequate information to be crucial for integrated mental health in India at present.

Aim of the study: Aim of he study was to analyse correlation of daily maximum temperature on corona virus daily growth rate as well as effect of lockdown on daily growth rate of cases. Materials and Methods:All the data regarding new cases of covid 19 Pandemic in Gujarat was collected from Gujarat health department website., Temperature details were collected from www.accuweather.com. Growth rate was calculated as a percent increase of new cases daily compared to previous day active cases. Relations between trends were calculated from correlation and regression studies. MANNOVA analysis was performed. Results:Total 6625 cases, 4729 active cases and 380 deaths were reported as on 6th May 2020 in Gujarat. Daily maximum temperature was significantly correlated inversely with daily growth rate. (p value= 0.010) with Pearson correlation coefficient =-0.363. Correlation between time since lock down to daily case growth rate was non significant. (p=0.123). Phases of lockdown and growth rates showed significant inverse correlation. (p=0.002). Multivariate ANOVA showed there was statistical significant difference in case growth rate based on daily temperature [p= 0.006 F=4.71] and progression of phases of lockdown (p=0.018, F=3.55). Conclusion:Conclusion increase in temperature has inverse relationship in growth rate in covid 19 pandemic. Lockdown may be useful in decreasing growth.

Draconian defensive measures have been implemented to combat the COVID-19 pandemic outbreak. These important measures constitute a vital current priority but do little to increase communal immunity and avoid future outbreaks. A longer-term exit strategy for a sustainable return to normalcy has yet to be identified. The development of vaccines or effective therapeutics could largely solve the problem, but their timely development cannot be guaranteed. In this setting, and under the expected societal isolation fatigue from extended social distancing, we here propose the idea that at some point after the outbreak’s peak, hospitals, in addition to providing care for infected people who need it, could also be involved in the development of a controlled exit strategy designed to avoid future outbreaks. We postulate that controlled voluntary deliberate infection in a hospital setting and under continuous and close medical observation may offer a safer alternative compared to random en-masse exposure. We discuss potential risks and benefits, highlighting the need for careful consideration of the associated critical ethical issues.

The COVID-19 pandemic has presented the world with increased challenges. The response to this pandemic has led to a sudden disruption of routine medical and elective surgical care. Most hospitals across the globe have had to change the way outpatient clinics are carried out and postpone non-urgent elective surgical procedures. NHS England ceased all elective general surgeries to train and re-deploy their staff to support the increased pressures from COVID-19 in an intensive care setting. However, with a decline of reported cases and deaths, the return to undertaking non-urgent elective services is imminent. In May 2020, Radha and Afzal published the first evidence-based guidelines for the resumption of elective orthopaedic services titled “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic”. The pathway presented is adapted from the “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic” and could potentially be used as a model for other surgical specialities. We present a three-phased return back to urological services. Safe resumption of elective care is possible but needs to be carefully planned.

It is unclear why European countries have been more severely affected by COVID-19 than East Asian countries. In this ecological study we compared the COVID-19 epidemics (cumulative incidence and mortality rates), host genetic susceptibility and national responses (testing intensity) in all European versus all Western Pacific/East Asian countries reporting cases in the first month of the epidemic. The host-genetic-susceptibility assessment was limited to the frequency of the D-allele of the angiotensin converting enzyme-1 (ACE-1) which has been found to be positively associated with COVID-19 incidence within European countries. Despite earlier epidemics, countries from the Western Pacific reported lower cumulative numbers of COVID-19 cases/100 000 inhabitants than European countries (P=0.0002). The Western Pacific countries also reported fewer cumulative COVID-19 deaths/100 000 (P=0.0024). Whilst there was little difference in the cumulative number of tests conducted/100 000, the percent of COVID-19 tests reported positive was higher in Europe than the Western Pacific (P=0.0076). The frequency of the ACE-1 D-allele was lower in the Western Pacific than European countries (P=0.0007). Our results suggest that a combination of different testing strategies and host genetic susceptibility contribute to difference in severity of the COVID-19 epidemics in the Western Pacific/East Asia and Europe.

The sudden pervasive of severe acute respiratory syndrome Covid-19 has been leading the universe into a prominent crisis. It has influenced each zone, for example, industrial area, horticultural zone, Public transportation, economic zone, and so on. So as to see how Covid-19 affected the globe, we conducted an investigation characterizing the effects of the pandemic over the world using Machine Learning (ML) method. Prediction is a typical data science exercise that helps the administration with function planning, objective setting, and anomaly detection. We propose an additive regression model with interpretable parameters that can be naturally balanced by experts with domain intuition about the time series. We focus on global data beginning from 22^nd January 2020, till 26^th April 2020 and performed dynamic map visualization of Covid-19 expansion globally by date wise and predicting the spread of virus on all countries and continents. The major advantages of this work include accurate analysis of country-wise as well as province/state-wise confirmed cases, recovered cases, deaths, prediction of pandemic viral attack and how far it is expanding globally.

Some of the European countries affected by COVID-19 have not learned from previous experience in China. Italy did not learn from China and Spain did neither learn from China nor from Italy. Confinement in Spain was postponed due to pressure from economic interests and traveling of infected people, especially from Madrid to the beaches in South-East Spain, was allowed. Strict confinement and border closure came late, when the curve of infected people and the death toll already had the worse trend worldwide. Tests to SARS-CoV-2 RNA detection by PCR, were first unavailable and, later, faulty and/or detecting antibodies and not the virus itself. Instead of mobilizing research laboratories for making tests, and instead of making masks and ventilators, mediatic scientists asked for money for controversial clinical trials and for obtaining a vaccine. In this scenario, common sense indicates that ad hoc measures should be taken at the end of confinement in order to minimize pain. The chain of errors should be avoided in the management of next pandemics by designing Good Practice Rules (GPRs). In addition, post-confinement measures should be implemented as soon as possible to be ready for SARS-CoV-2 return next season. In this sense a longitudinal study in the most affected cities (Madrid, Barcelona, Vitoria and Pamplona) should be performed with the primary objective of detecting carriers with no symptoms, to stratify patients according to symptoms, and to early detection of virus reappearance. Also relevant is to sequence as many viruses as possible to detect possible variants; there are still patients that are PCR positive.

COVID-19 has affected 210 countries around the world, killed more than 240,000 and infected more than 3.4 million. Bangladesh, a South Asian low-middle-income economy, has experienced a demographic and epidemiological transition with rapid urbanization and a gradual increase in life expectancy. It is the seventh most populous country in the world and population of the country is expected to be nearly double by 2050. The increasing burden of noncommunicable diseases in Bangladesh can be attributable to rapid urbanization and nearly 50% of all slum dwellers of the country live in Dhaka division. In 2017, National Rapid Response Team of IEDCR investigated 26 incidents of disease outbreak. The joint survey of the Power and Participation Research Centre and BRAC Institute of Governance and Development reveals that per capita daily income of urban slum and rural poor drops by 80% due to present countrywide shutdown enforced by the government to halt the spread of Covid-19. 40%-50% of these population took loans to meet the daily expenses.

The goal of this paper is to contribute the perspective of a systems engineer to the effort to fight pandemics. The availability of low latency case data and effectiveness of social distancing suggest there is sufficient control for successful smoothing and targeting almost any desired level of low or high cases and immunity. This control proceeds from spontaneous public reaction to caseloads and news as well as government mediated recommendations and orders. We simulate multi-step and intermittent-with-feedback partial unlock of social distancing for rapidly-spreading moderate-mortality epidemics and pandemics similar to COVID-19. Optimized scenarios reduce total cases and therefore deaths typically 8% and up to 30% by controlling overshoot as groups cross the herd immunity threshold, or lower thresholds to manage medical resources and provide economic relief. We analyze overshoot and provide guidance on how to damp it. However, we find overshoot damping, whether from expert planning or natural public self-isolation, increases the likelihood of transition to an endemic disease. An SIR model is used to evaluate scenarios that are intended to function over a wide variety of parameters. The end result is not a case trajectory prediction, but a prediction of which strategies produce near-optimal results over a wide range of epidemiological and social parameters. Overshoot damping perversely increases the chance a pathogen will transition to an endemic disease, so we briefly describe the undershoot conditions that promote transition to endemic status.

Background & Objectives: The global pandemic caused by novel coronavirus SARS-CoV-2 has claimed several lives worldwide. With the virus gathering rapid spread, the world has witnessed increasing number of confirmed cases and mortality rate, India is not far behind with approximately 37,000 affected individuals as on May 2, 2020. The ongoing pandemic has raised several questions which need to be answered by analysis of transmission of the infection. The data has been collected on daily basis from WHO and other sites. We have represented the data collated graphically using statistical packages, R and other online softwares. The present study provides a holistic overview of the spread of COVID-19 infection in India. Methods: Real-time data query was done based on daily observations using publicly available data from reference websites for COVID-19 and other government official reports for the period (15^th February, 2020 to April 28^th, 2020). Statistical analysis was performed to draw important inferences regarding COVID-19 trend in India. Results: A decrease in growth rate of cases due to COVID-19 in India post lockdown and improvement in recovery rate during the month of April was identified. The case fatality rate was estimated to be 3.22% of the total reported cases. State-wise analysis revealed a deteriorating situation in states of Maharashtra and Gujarat among others as cases continued to increase rapidly there. A positive linear correlation between the number of deaths and total cases and exponential relation between population density and number of cases reported per square km was established. Interpretation & Conclusions: Despite early preventive measures taken up by the Government of India, the increasing number of cases in India is a concern. This study compiles state-wise and district-wise data to report the daily confirmed cases, case fatalities and strategies adopted in the form of case studies. Understanding the transmission spread of SARS-CoV-2 in a diverse and populated country like India will be crucial in assessing the effectiveness of control policies towards the spread of COVID-19 infection.

Registry and survey data gave an opportunity to compare possible roles of social attitudes and social values in control and limit the COVID-19 pandemic. We analysed social values and time series of daily R0 (reproduction rate) estimates for 27 European countries. Embedded and affective autonomy are significantly negatively associated (p-Value<0.05) with controlled R0. It could mean that well interconnected societies with high attention to maximize utilities are more likely to couple with COVID-19. Hierarchy is significantly positively associated (p-Value<0.05) with controlled R0. Thus, hierarchical structures could inhibits control of COVID-19. The results emphasize the need to pay more attention to social values context in evaluating the effectiveness of mitigation strategies internationally.

The world has been highly impacted by the COVID-19 as the virus has spread to all continents – about 200 countries in total. The latest update claims about 4,000,000 confirmed cases and about 300,000 confirmed deaths owing to the COVID-19 pandemic. This probably makes the COVID-19 as the most dangerous contagious disease in the era 2000s. Apart from massive publications on this topic, there is no available qualitative analysis that describes the dynamic spreads of the COVID-19 and its impacts on healthcare and the economy. Through the system archetypes analysis, this paper explains that the dynamic spread of the COVID-19 consists of the limits to growth and the success to successful structures. The limits to growth elucidates that more symptomatic and asymptomatic patients owing to infected droplets may be bounded by self-healing and isolated treatments. The success to successful structure explains that once the COVID-19 affects the economy through the lockdown, there will be a limited fund to support the government aids and the aggregate demand. In overall, this paper gives readers simplified holistic insights into understanding the dynamic spread of the COVID-19.

In late February 2020, Coronavirus disease-2019 (COVID-19) has aggressively spread around many bordering provinces of the three most productive regions of northern Italy (Lombardy, Veneto and Emilia Romagna). The first outbreak exploded in the municipality of Codogno (Lombardy). The province of Ferrara (Emilia Romagna) has been indicated as an anomaly due to the lower number of confirmed cases (1·065 cases per 1000 population). We argue that the spread of the virus throughout Emilia Romagna has a possible explanation in the geographical location of most of its provinces along the Via Emilia, an ancient Roman road that runs throughout the region, which we consider as a proxy for citizens’ movement, number of contacts, and social interactions. In order to test this hypothesis, we used a non-linear multiple regression analysis on aggregate province data to investigate the association between the rates of confirmed cases and the distance from the Via Emilia. The results indicate that the infection rate decreases proportionally to the distance from Via Emilia (-14% every 10 km, p<0·001). Further studies are needed, but Ferrara’s “peculiarity” might have a geographical/behavioral explanation, due to its isolation from the regional main connection routes, which are still revolving around a road built by the ancient Romans 2,000 years ago.

Objectives: The impact of COVID-19 in metropolitan areas has been extensively studied. The geographic spread to smaller cities is of great concern and may follow hierarchical influence of urban centers. With that in mind, we investigated factors that affect vulnerability of inner municipalities in São Paulo State, Brazil, an area with 24 million inhabitants. Methods: Surveillance data for confirmed COVID-19 cases and admissions for severe acute respiratory disease (SARD) up to April 18^th were recorded for each of 604 municipalities that lay outside São Paulo metropolitan area. Vulnerability was assessed in Multivariable models, including sociodemographic indexes, road distance to the State Capital and the municipalities classification proposed by the Brazilian Institute of Geography and Statistics. Municipalities of great regional relevance were used as reference category for that classification. The outcome of interest for Cox regression was having COVID-cases, with time counting from the first report in São Paulo State. For binomial negative regression models, the outcomes of interest were rates of confirmed COVID-19 cases and admissions for SARD.Results: A total of 198 (32.8%) municipalities had autochthonous COVID-19 cases. In Cox models, affected municipalities were likely to have greater population density (Hazard Ratio[HR] for each 100 inhabitants per square kilometer, 1.07; 95% Confidence Interval [CI], (1.05-1.10)), proportion of inhabitants in urban area (HR, 1.02; 95%CI, 1.00-1.04), higher human development index (HDI, HR for 1%, 1.06; 95%CI, 1.00-1.13) and Gini Index for Inequality of income (HR for 1%, 1.04, 95% CI, 1.00-1.07). On the other hand, distance from the Capital was protective (HR for each 100Km, 0.82; 95%CI, 0.74-0.90). The HR95%[95%CI] also varied negatively according to the categories of influence of major centers (0.41 [0.22-0.77], 0.16 [0.09-0.32], 0.07 [0.03-0.15]). The binomial negative regression models for COVID-19 incidence also detected positive association with population density (Incidence Rate Ratio[IRR], 1.13; 95%CI, 1.07-1.18) and proportion of urban population (IRR, 1.04; 95%CI, 1.01-1.05), protection for cities distant to the Capital (IRR=0.73; 95%CI, 0.68-0.81) and increasing negative association for categories of influence (0.19 [0.09-0.42], 0.07 [0.03-0.15] and 0.03 [0.02-0.08]). Similar findings were detected when we used SARD incidence as outcome.Conclusion: Municipalities with greater population, density and regional influence were more likely to be affected earlier and more intensely by COVID-19. Non-pharmacological measures should be strengthened in those areas of greater risk.

The most striking and dramatic catastrophe, as on April 2020, is - COVID - 19. Understanding of the COVID-19, the causing agent- the virus and the resultant causalities are still evolving. Till now, there is no specific treatment, no vaccine for the COVID-19. At this stage, what is utmost important now to face the disaster is to put emphasis on the preparedness and responses: research to discover vaccine, antivirals as soon as possible. Till then, it is necessary to put emphasis on infection preventive and control measures like to avoid close contact of infected people showing symptoms of respiratory diseases, hand hygiene and coughing etiquette. To make the infection preventive and control measures a success, the followings are to make success: ‘quarantine’ ‘isolation’, ‘travel bans’, ‘cordon sanitaire’ and ‘social distancing’ measures. The tools of modern information technology could help the authority to manage and monitor the preventive measures. Above all, preventive and control measures will not be successful if we fail to make aware the common people about the fatality of the COVID - 19. So, rapid preparedness and responses to COVID-19 are critically essential to face such disaster. Not a single moment is to waste!

The COVID-19 pandemic spread of the coronavirus across the globe has affected our lives on many different levels. The world we knew before the spread of the virus has become another one. Every country has taken preventive measures, including social distancing, travel restrictions, and curfew, to control the spread of the disease. With these measures implemented, people have shifted to social media platforms in the online sphere, such as Twitter, to maintain connections. In this paper, we describe a coronavirus data set of Arabic tweets collected from January 1, 2020, primarily from hashtags populated from Saudi Arabia. This data set is available to the research community to glean a better understanding of the societal, economical, and political effects of the outbreak and to help policy makers make better decisions for fighting this epidemic.

Background: The world, now in an emergency of preventing the drastic spread of COVID-19. After the infection was first reported in December 2019, almost every country did not pay attention to this highly contaminated disease and failed to react swiftly. Now the whole universe is in an vulnerable state, loosing a great loss of lives and facing difficulties in all socio-economic aspects. That is why we have the urge to develop an efficient mathematical model (quarantine) based on social consciousness to control the epidemic. Methods: This is a quarantine mathematical model. The outcome of the system is dependent on social consciousness. We have calculated the awareness level by considering various socio-economic factor of each country. In our model, the parameters are Education Index, GDP per capita, population density, high literacy and stable economy. To maximize the efficiency of the model, it has to be implemented in initial stage. However, strict application of the method in vigorous stage of epidemic will also bring a satisfactory outcome. Results: Higher social consciousness will decrease the number of infected population dramatically while minimal or lower awareness will do a outburst. Conclusion: Outbreak will be in control of health care system, lower the death rate and will ensure social and economic stability.

Background: Countries around the world are facing extraordinary challenges in implementing various measures to slow down the spread of the novel coronavirus (COVID-19). Guided by international recommendations, Saudi Arabia has implemented a series of infection control measures after the detection of the first confirmed case in the country. However, in order for these measures to be effective, public attitudes and compliance must be conducive as perceived risk is strongly associated with health behaviors. The primary objective of this study is to assess Saudis’ attitudes towards COVID-19 preventive measures to guide future health communication content. Methods: Naïve Bayes machine learning model was used to run Arabic sentiment analysis of Twitter posts through the Natural Language Toolkit (NLTK) library in Python. Tweets containing hashtags pertaining to seven public health measures imposed by the government were collected and analyzed. Results: A total of 53,127 tweets were analyzed. All measures, except one, showed more positive tweets than negative. Measures that pertain to religious practices showed the most positive sentiment. Discussion: Saudi Twitter users showed support and positive attitudes towards the infection control measures to combat COVID-19. It is postulated that this conducive public response is reflective of the overarching, longstanding popular confidence in the government. Religious notions may also play a positive role in preparing believers at times of crises. Findings of this study broadened our understanding to develop proper public health messages and promote stronger compliance with control measures to control COVID-19.

The first case of Corona Virus Disease 2019 (COVID-19) was reported in Wuhan, China in December 2019. Since then, COVID-19 has quickly spread out to all provinces in China and over 150 countries or territories in the world. With the first level response to public health emergencies (FLRPHE) launched over the country, the outbreak of COVID-19 in China is achieving under control in China. We develop a mathematical model based on epidemiology of COVID-19, incorporating the isolation of healthy people, confirmed cases and close contacts. We calculate the basic reproduction numbers 2.5 in China (excluding Hubei province) and 2.9 in Hubei province with the initial time on January 30 which show the severe infectivity of COVID-19, and verify that the current isolation method effectively contains the transmission of COVID-19. Under the isolation of healthy people, confirmed cases and close contacts, we find a noteworthy phenomenon that is the potential second epidemic of COVID-19, and estimate the peak time and value and the cumulative number of cases. Simulations show that the isolation of close contacts tracked measure can efficiently contain the transmission of the potential second epidemic of COVID-19. With isolation of all susceptible people or all infected people or both, there is no potential second epidemic of COVID-19. Furthermore, resumption of work and study can increase the transmission risk of the potential second epidemic of COVID-19.

Novel Coronavirus infection mediated pandemic started in China in December 2019 and is still killing 1000s of people throughout the world. The second most populous country, India too is fighting against this infectious disease. The country is taking effective measures to curb the pandemic by exerting extensive campaigning on sanitation and strict social distancing measures to quell the explosion of the infection rate. The future of the COVID-19 infections in India still remain unpredictable, so precautionary methods need to be continued until the growth rate of new cases drop below one.

(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linked to a feasibility trial of a clinic-based intervention in secondary care. Data collection involved 24 semi-structured interviews with research managers, clinical research staff, health professionals, and patients. (3) Results: This study required a dynamic network of interactions between heterogeneous health and social care stakeholders, each characterized by differing ways of organizing activities which constitute their core functions; cultures of collaboration and interaction and understanding of what research involves and how it contributes to patient care. These interrelated factors compounded the occupational and organizational boundaries that hindered communication and coordination. (4) Conclusions: Despite the strategic development of multiple organizations to foster inter-professional collaboration, the competing goals of research and clinical practice can impede the conduct of high quality AHSR. To remedy this requires the alignment and streamlining of organizational goals, so that all agencies involved in AHSR develop a shared understanding and mutual respect for the progress of evidence-based medicine and the complex and often nuanced environments in which it is created and practiced.

The disease COVID-19 is highly infectious, and infectious in asymptomatic incubation period. The national epidemic development has been effectively controlled and continues improving, especially in areas outside Hubei province. Such periodical results were achieved by the joint efforts of the whole society, including not only the hard work and dedication of the front-line medical workers but also the active cooperation of the general public. The strict epidemic prevention and control measurements have brought remarkable control results. In the present study, the basic infection number of the coronavirus R0 (basic replication number of the infection) before and after prevention and control measurements was simulated to elaborate the measurements of the Chinese government on epidemic prevention and control, providing reference for the people around the world.

Aedes aegypti mosquitoes are primary vectors of dengue, yellow fever, chikungunya and Zika viruses. Ae. aegypti is highly anthropophilic and relies nearly exclusively on human blood meals and habitats for reproduction. Socioeconomic factors may influence the spread of Ae. aegypti due to its close relationship with humans. This paper describes and summarizes the published literature on how socioeconomic variables influence the distribution of Ae. aegypti mosquitoes in the mainland United States. A comprehensive search of PubMed/Medline, Scopus, Web of Science, and EBSCO Academic Search Complete through June 12, 2019 was used to retrieve all articles published in English on the association of socioeconomic factors and the distribution of Ae. aegypti mosquitoes. Additionally, a hand search of mosquito control association websites was conducted in an attempt to identify relevant grey literature. Articles were screened for eligibility using the process described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Initially, 3,493 articles were identified through the database searches and previously known literature. After checking for duplicates, 2,145 articles remained. 570 additional records were identified through the grey literature search for a total of 2,715 articles. These articles were screened for eligibility using their titles and abstracts, and 2,677 articles were excluded for not meeting the eligibility criteria. Finally, the full text for each of the remaining articles (n = 38) was read to determine eligibility. Through this screening process, 11 articles were identified for inclusion in this review. The findings for these 11 studies revealed inconsistent relationships between the studied socioeconomic factors and the distribution and abundance of Ae. aegypti. The findings of this review suggest a gap in the literature and understanding of the influence of anthropogenic factors on the distribution of Ae. aegypti that could hinder efforts to implement effective public health prevention and control strategies should a disease outbreak occur.

There are potentially promising mitigation activities for epidemic and pandemic scenarios that are not currently the subject of significant research effort. Large epidemics and pandemics pose risks that are important to mitigate, even if the likelihood of the events is low and uncertain. While some efforts are the subject of extensive funding and consideration, other approaches are neglected. Here, we consider such neglected interventions which could significantly reduce the impact of such an epidemic or large-scale pandemic. These are identified via a narrative literature review of extant literature reviews and overviews of mitigations in epidemic and pandemic situations, followed by consideration of the economic value of information of further study of heretofore neglected interventions and approaches.Based on that analysis, we considered several classes of mitigations, and conducted more exploratory reviews of each. Those discussed include mitigations for (1) reducing transmission, such as personal protective equipment and encouraging improved hygiene, (2) reducing exposure by changing norms and targeted changes for high-risk or critical professions and activities, (3) reducing impact for those infected, and (4) increasing large scale resilience using disaster and infrastructure continuity planning.Some proposed mitigations are found to be of low marginal value. Other mitigations are likely to be valuable, but the concepts or applications are underdeveloped. In those cases, further research, resources, or preparation are valuable for mitigating both routine and extreme disease outbreak events. Still more areas of research are identified as having uncertain value based on specific but resolvable uncertainties. In both of the latter cases, there is no guarantee that mitigations identified as worthy of further consideration will be valuable, but the argument for further research is clear.

Regulatory agencies across the Latin American Region have strengthened the regulatory science through the development of new tools, standards and various other related parameters to evaluate and assess safety, efficacy, quality and performance. The former have been implemented to promote and incorporate new drugs and technologies, which still, are a challenge to well-established regulatory frameworks. Furthermore, in today’s environment, the existing regulatory framework protecting public’s health creates barriers for market entry of novel drugs and medical devices. This article aims to the pioneering work that Cuban Regulatory Agency (CECMED) has been developing with the aim to build a strong regulatory framework geared to accelerated innovation and the successful transition from research and development to clinical development. The Office of Innovation recently established at the CECMED is the first flagship in Latin America and the Caribbean region. Its aim is to play a leading role as a driving force for the national and regional biopharmaceutical innovation. This article will discuss the Office of Innovation its conceptualisation and management taking into account the Latin American regional and national Cuban context.

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. government in deciding the fate of the ACA.

Healthy houses is a problem on developing countries. This study mainly focus on urban areas and the health effect of poor water and sanitation, floor, inadequate heating, poor food storage and overcrowding. This research has used qualitative method with questionnaires has spread to a hundred and six homes about characteristics of healthy home. The questionnaires have spread to Pondok village and Bukit Kerman village, Kerinci District, Jambi Province, Indonesia. Result showed 90% houses too dense and 10 no dense, 98% houses on this area are unhealthy houses and 10% healthy houses. Unhealthy houses that affected diseases such as 20% diaarhea, 29% other diseases, 13% ARI, 10% malaria 15% skin and 12% no diseases. We recommended to make a public health policy to reducing unhealthy houses on this area.

The new WHO Environmental Noise Guidelines for the European Region have recommendations for limiting noise exposure associated with adverse health effects. The limits are said to be based on a systematic review of existing evidence. This paper gives a systematic assessment of the presented evidence with respect to aircraft noise annoyance and demonstrates that the new guidelines are based on an arbitrary selection of existing studies comprising an imperfect and faulty set of data not representative for the general airport population.

In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes.

The effective dissemination and implementation of health service interventions into practice requires a range of strategic and systematic approaches. This paper applies a conceptual implementation framework to the evaluation of a hospital-wide clinical pharmacy initiative, a redesign of the discharge medication prescription pathway. The influencing factors and strategies used to overcome potential negative influences are described and assessed.

Background: Disparity in adult mortality (AM) with reference to social dynamics and health care has not been sufficiently examined. This study aimed to identify the gap in the understanding of AM in relation to religion, political stability, economic level, and universal health coverage (UHC). Methods: A cross-national study was performed with different sources of data, using the administrative record linkage theory. We created a new data set using data from the 2013 World Bank data catalogue by region, The Economist (Political instability index 2013), Stuckler David et al. (Universal health coverage, 2010), and religious categories of all UN country members. Descriptive statistics, a t-test, an ANOVA followed by a post hoc test, and a linear regression were used where applicable. Result: The average AM rate for males and females was 0.20 ± 0.10 and 0.14 ± 0.10, respectively. AM was significantly higher in economically weak countries, countries with political instability, countries with traditional religion, without achievement of UHC, and Sub-Saharan Africa (p<0.01). There was high disparity of AM between countries with and without UHC (F = male: 61.89, female: 51.85, p<0.001) and between groups with low and high income (F = male: 36.33, female: 42.39, p<0.001). UHC and political stability would significantly reduce AMR by > 0.41 in both sexes and high economic status would reduce male AMR by 0.44, and female AMR by 0.70, in relation to countries without UHC, with political instability, and low economic status. Conclusions: Disparities in AM can be reduced after the achievement of UHC and economically productive activities for those adults affected by conflict and political unrest.