Tag: COVID

Physical interventions to interrupt or reduce the spread of respiratory viruses

Mary Pat Campbell

Link: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full

https://doi.org/10.1002/14651858.CD006207.pub6

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Excerpt:

Background

Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID‐19) caused by SARS‐CoV‐2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review last published in 2020. We include results from studies from the current COVID‐19 pandemic.

Objectives

To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses.

Search methods

We searched CENTRAL, PubMed, Embase, CINAHL, and two trials registers in October 2022, with backwards and forwards citation analysis on the new studies.

Selection criteria

We included randomised controlled trials (RCTs) and cluster‐RCTs investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, glasses, and gargling) to prevent respiratory virus transmission. 

Data collection and analysis

We used standard Cochrane methodological procedures.

Main results

We included 11 new RCTs and cluster‐RCTs (610,872 participants) in this update, bringing the total number of RCTs to 78. Six of the new trials were conducted during the COVID‐19 pandemic; two from Mexico, and one each from Denmark, Bangladesh, England, and Norway. We identified four ongoing studies, of which one is completed, but unreported, evaluating masks concurrent with the COVID‐19 pandemic.

Many studies were conducted during non‐epidemic influenza periods. Several were conducted during the 2009 H1N1 influenza pandemic, and others in epidemic influenza seasons up to 2016. Therefore, many studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID‐19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high‐income countries; crowded inner city settings in low‐income countries; and an immigrant neighbourhood in a high‐income country. Adherence with interventions was low in many studies.

The risk of bias for the RCTs and cluster‐RCTs was mostly high or unclear.

Medical/surgical masks compared to no masks

We included 12 trials (10 cluster‐RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence). Harms were rarely measured and poorly reported (very low‐certainty evidence).

N95/P2 respirators compared to medical/surgical masks

We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low‐certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low‐certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory‐confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate‐certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low‐certainty evidence). 

One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non‐inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID‐19 patients. 

Hand hygiene compared to control

Nineteen trials compared hand hygiene interventions with controls with sufficient data to include in meta‐analyses. Settings included schools, childcare centres and homes. Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate‐certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342). When considering the more strictly defined outcomes of ILI and laboratory‐confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low‐certainty evidence), and laboratory‐confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low‐certainty evidence), suggest the intervention made little or no difference. We pooled 19 trials (71, 210 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low‐certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low‐certainty evidence).

We found no RCTs on gowns and gloves, face shields, or screening at entry ports.

Authors’ conclusions

The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children.

There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.

There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs. 

Author(s): Tom Jefferson, Liz Dooley, Eliana Ferroni, Lubna A Al-Ansary, Mieke L van Driel, Ghada A Bawazeer, Mark A Jones, Tammy C Hoffmann, Justin Clark, Elaine M Beller, Paul P Glasziou, John M Conly

Publication Date: 30 Jan 2023

Publication Site: Cochrane Library

The End of the COVID-19 Public Health Emergency: Details on Health Coverage and Access

Mary Pat Campbell

Link: https://www.kff.org/policy-watch/the-end-of-the-covid-19-public-health-emergency-details-on-health-coverage-and-access/

Excerpt:

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. Here’s what major health policies will and won’t change when the public health emergency ends.

Vaccines

What’s changing: Nothing. The availability, access, and costs of COVID-19 vaccines, including boosters, are determined by the supply of federally purchased vaccines, not the public health emergency.

What’s the same: As long as federally purchased vaccines last, COVID-19 vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s coverage or network status.

….

At-home COVID tests

What’s changing: At-home (or over-the-counter) tests may become more costly for people with insurance. After May 11, 2023, people with traditional Medicare will no longer receive free, at-home tests. Those with private insurance and Medicare Advantage (private Medicare plans) no longer will be guaranteed free at-home tests, but some insurers may continue to voluntarily cover them.

For those on Medicaid, at-home tests will be covered at no-cost through September 2024. After that date, home test coverage will vary by state.

….

COVID Treatment

What’s changing: People with public coverage may start to face new cost-sharing for pharmaceutical COVID treatments (unless those doses were purchased by the federal government, as discussed below). Medicare beneficiaries may face cost-sharing requirements for certain COVID pharmaceutical treatments after May 11. Medicaid and CHIP programs will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing.

….

Author(s): Cynthia Cox Follow @cynthiaccox on Twitter , Jennifer Kates Follow @jenkatesdc on Twitter , Juliette Cubanski Follow @jcubanski on Twitter , and Jennifer Tolbert

Publication Date: 3 Feb 2023

Publication Site: Kaiser Family Foundation

Masks Make ‘Little or No Difference’ on COVID-19, Flu Rates: New Study

Mary Pat Campbell

Link: https://reason.com/2023/02/07/masks-covid-dont-work-cochrane-library-review-mandate/

Excerpt:

The wearing of masks to prevent the spread of COVID-19 and other respiratory illnesses had almost no effect at the societal level, according to a rigorous new review of the available research.

“Interestingly, 12 trials in the review, ten in the community and two among healthcare workers, found that wearing masks in the community probably makes little or no difference to influenza-like or COVID-19-like illness transmission,” writes Tom Jefferson, a British epidemiologist and co-author of the Cochrane Library’s new report on masking trials. “Equally, the review found that masks had no effect on laboratory-confirmed influenza or SARS-CoV-2 outcomes. Five other trials showed no difference between one type of mask over another.”

That finding is significant, given how comprehensive Cochrane’s review was. The randomized control trials had hundreds of thousands of participants, and made useful comparisons: people who received masks—and, according to self-reporting, actually wore them—versus people who did not. Other studies that have tried to uncover the efficacy of mask requirements have tended to compare one municipality with another, without taking into account relevant differences between the groups. This was true of an infamous study of masking in Arizona schools conducted at the county level; the findings were cited by the Centers for Disease Control and Prevention (CDC) as reason to keep mask mandates in place.

Author(s): Robby Soave

Publication Date: 7 Feb 2023

Publication Site: Reason

Total 2022 U.S. Deaths Up About 15% Over Pre-Pandemic Level

Mary Pat Campbell

Link: https://www.thinkadvisor.com/2023/01/24/total-2022-u-s-deaths-up-about-15-over-pre-pandemic-level/

Excerpt:

U.S. public health agencies recorded a total of about 3.2 million deaths in 2022, according to full-year mortality figures from the U.S. Centers for Disease Control and Prevention.

The total number of deaths was down 7% from the preliminary total for 2021 that the CDC reported a year earlier, but it was 15% higher than the preliminary, full-year average — about 2.8 million per year — for the period from 2015 through 2019, before the COVID-19 pandemic began.

Author(s): Allison Bell

Publication Date: 24 Jan 2023

Publication Site: ThinkAdvisor

Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795298

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JAMA Netw Open. 2022;5(8):e2227248. doi:10.1001/jamanetworkopen.2022.27248

Excerpt:

Question  How many cases of COVID-19 in the US have occurred among people experiencing homelessness?

Findings  In this cross-sectional study of 64 US jurisdictional health departments, 26 349 cases of COVID-19 among people experiencing homelessness were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 was lower among people experiencing homelessness than in the general population at state and local levels.

Meaning  The findings suggest that incorporating housing and homelessness status in infectious disease surveillance may improve understanding of the burden of infectious diseases among disproportionately affected groups and aid public health decision-making.

Author(s): Ashley A. Meehan, MPH1; Isabel Thomas, MPH1,2; Libby Horter, MPH1,3; et al

Publication Date: August 18, 2022

Publication Site: JAMA Open Network

Under Government Pressure, Twitter Suppressed Truthful Speech About COVID-19

Mary Pat Campbell

Link: https://reason.com/2023/01/02/under-government-pressure-twitter-suppressed-truthful-speech-about-covid-19/?utm_medium=email

Excerpt:

Twitter’s ban on “COVID-19 misinformation,” which Elon Musk rescinded after taking over the platform in late October, mirrored the Biden administration’s broad definition of that category in two important respects: It disfavored perspectives that dissented from official advice, and it encompassed not just demonstrably false statements but also speech that was deemed “misleading” even when it was arguably or verifiably true. In a recent Free Press article, science writer David Zweig shows what that meant in practice, citing several striking examples of government-encouraged speech suppression gleaned from the internal communications that Musk has been disclosing to handpicked journalists.

Twitter’s moderation of pandemic-related content was intertwined with government policy from the beginning. Even before Joe Biden was elected president and his administration began publicly and privately demanding that social media companies suppress speech it viewed as a threat to public health, the company’s guidelines deferred to the positions taken by government agencies such as the Centers for Disease Control and Prevention (CDC). And those rules explicitly covered “misleading information” as well as “demonstrably false” statements.

….

That July, Twitter sought to clarify “our rules against potentially misleading information about COVID-19″ (emphasis added). “For a Tweet to qualify as a misleading claim,” the company said, “it must be an assertion of fact (not an opinion), expressed definitively, and intended to influence others’ behavior.” Possible topics included “the origin, nature, and characteristics of the virus”; “preventative measures, treatments/cures, and other precautions”; “the prevalence of viral spread, or the current state of the crisis”; and “official health advisories, restrictions, regulations, and public-service announcements.”

That was a very wide net, potentially encompassing anyone who questioned the CDC’s ever-shifting guidance or criticized government policies, such as lockdowns and mask mandates, aimed at reducing virus transmission. While the intent requirement ostensibly allowed dissent as long as it was not aimed at influencing behavior, that limitation did not mean much in practice, since moderators were apt to infer the requisite intent when they encountered tweets that implicitly or explicitly deviated from the recommendations of “public health authorities and governments.”

….

Another example that Zweig cites: Last August, @KelleyKga, a self-described “public health fact checker,” responded to another Twitter user’s claim that “COVID has been the leading cause of death from disease in children” since December 2021. “What an excellent example of cherry picking!” @KelleyKga wrote. “If you narrow it down to only the specific months you specify, which include the largest Covid wave (seen across the world), AND you ignore all non-disease deaths, AND you ignore cancer, heart disease, SIDS, then COVID is ‘leading.'”

Author(s): Jacob Sullum

Publication Date: 2 Jan 2023

Publication Site: Reason

Why Do Vaccinated People Represent Most COVID-19 Deaths Right Now?

Mary Pat Campbell

Link: https://www.kff.org/policy-watch/why-do-vaccinated-people-represent-most-covid-19-deaths-right-now/

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Excerpt:

The waning protection from vaccines is why CDC recommends recent booster shots, and why it’s especially important for people at higher risk to stay up-to-date on boosters. Per current recommendations, most adults should have received at least 2-3 booster doses by now (including the new bivalent booster), in addition to their primary series. However, only 14% of adults overall and 31% of older adults (65 years and older) have received the latest bivalent boosters. The CDC data show that about 95% of adults who died from COVID-19 in 2022 in these jurisdictions were over age 50, and about 8 in 10 were age 65 or older, underscoring the need for older adults to stay up-to-date on recommended booster shots.

The fall in the share of deaths that are among unvaccinated people could also be explained by changes in the unvaccinated population. By this far into the pandemic, it is estimated that many unvaccinated people have had COVID-19 at least once and while hundreds of thousands of unvaccinated people have needlessly died from COVID, those who survived may have gained some immune protection against the virus that can help protect them against severe outcomes when they have subsequent infections. However, this protection from a past infection can also diminish over time, which is why it is still recommended that unvaccinated people with prior COVID-19 infections get vaccinated and stay up-to-date on boosters.

Author(s): Cynthia Cox Follow @cynthiaccox on Twitter , Krutika Amin Follow @KrutikaAmin on Twitter , Jennifer Kates Follow @jenkatesdc on Twitter , and Josh Michaud Follow @joshmich on Twitter

Publication Date: 30 Nov 2022

Publication Site: KFF

Covid’s Drag on the Workforce Proves Persistent. ‘It Sets Us Back.’

Mary Pat Campbell

Link: https://www.wsj.com/articles/covid-workforce-absenteeism-productivity-economy-labor-11667831493

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Excerpt:

Two-and-a-half years after Covid-19 emerged, reported infections are way down, pandemic restrictions are practically gone and life in many respects is approaching normal. The labor force, however, is not.

Researchers say the virus is having a persistent effect, keeping millions out of work and reducing the productivity and hours of millions more, disrupting business operations and raising costs.

In the average month this year, nearly 630,000 more workers missed at least a week of work because of illness than in the years before the pandemic, according to Labor Department data. That is a reduction in workers equal to about 0.4 percent of the labor force, a significant amount in a tight labor market. That share is up about 0.1 percentage point from the same period last year, the data show.

….

Another half a million workers have dropped out of the labor force due to lingering effects from previous Covid infections, according to research by economists Gopi Shah Goda of Stanford University and Evan J. Soltas at the Massachusetts Institute of Technology. In a Census Bureau survey in October, 1.1 million people said they hadn’t worked the week before because they were concerned about contracting or spreading the virus.

The resulting labor shortages are contributing to upward pressure on wages and inflation, one reason the Fed delivered its fourth consecutive 0.75 percentage point interest rate increase last Wednesday. On Friday, the Labor Department reported brisk job growth in October, but health-related absences remained elevated and the labor force contracted slightly.

Author(s): Gwynn Guilford and Lauren Weber

Publication Date: 7 Nov 2022

Publication Site: WSJ

Catch up on the Actuaries Institute’s COVID-19 Mortality Working Group’s latest analysis of excess deaths.

Mary Pat Campbell

Link: https://www.actuaries.digital/2022/11/03/covid-19-mortality-working-group-another-month-of-high-excess-mortality-in-july-2022/

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Excerpt:

In summary:

  • Total excess mortality for the month of July 2022 is estimated at 16% (+2,600 deaths), relative to expected mortality at pre-pandemic levels.
  • Total excess mortality for the first seven months of 2022 is 14% (+13,700 deaths).
  • Around half of the excess mortality for the first seven months of 2022 is due to COVID-19 (+7,100 deaths) with remaining excess of +6,600 due to the remaining causes.
  • October 2022 has the lowest COVID-19 surveillance deaths of any month in 2022.
  • We estimate that COVID-19 deaths will result in excess mortality of around 6% (+2,800) for August to October 2022, with overall excess mortality likely to be higher than this.
  • We continue to expect that COVID-19 will be the third leading cause of death in Australia in 2022.

Author(s): COVID-19 MORTALITY WORKING GROUP

Publication Date: 3 Nov 2022

Publication Site: Actuaries Digital

Group Life COVID-19 Mortality Survey Report

Mary Pat Campbell

Link: https://www.soa.org/4a368a/globalassets/assets/files/resources/research-report/2022/group-life-covid-19-mortality-03-2022-report.pdf

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Excerpt:

Tables 2.1 through 2.41 display high-level incidence results for the second quarter of 2020 through the first quarter of 2022 compared to the 2017-2019 baseline period for each combination of (a) incurred/reported basis and (b) count/amount basis as of March 31, 2022. In these tables, the number of COVID-19 claims has not been adjusted for seasonality, but the ratios to baseline have been adjusted for seasonality.


Note that additional data reported in April and May 2022 indicated that the 1Q 2022 excess mortality would likely complete downward from the 19.9% shown below using March data. The fully complete 1Q 2022 excess mortality is expected to remain above 15%.

….

The 24-month period of April 2020 through March 2022 showed the following Group Life mortality results:
• Estimated reported Group Life claim incidence rates were up 20.0% on a seasonally-adjusted basis
compared to 2017–2019 reported claims.
• Estimated incurred Group Life incidence rates were 20.9% higher than baseline on a seasonally-adjusted
basis. As noted above, the incurred incidence rates in February and March 2022 are based on fairly
incomplete data, so they are subject to change and should not be fully relied upon at this point.

Author(s):

Thomas J. Britt, FSA, MAAA
Paul Correia, FSA, MAAA
Patrick Hurley, FSA, MAAA
Mike Krohn, FSA, CERA, MAAA
Tony LaSala, FSA, MAAA
Rick Leavitt, ASA, MAAA
Robert Lumia, FSA, MAAA
Cynthia S. MacDonald, FSA, MAAA, SOA
Patrick Nolan, FSA, MAAA, SOA
Steve Rulis, FSA, MAAA
Bram Spector, FSA, MAAA

Publication Date: August 2022

Publication Site: SOA

Public’s Cash Stash Will Cushion a Downturn? Maybe Not

Mary Pat Campbell

Link: https://www.ai-cio.com/news/publics-cash-stash-will-cushion-a-downturn-maybe-not/

Excerpt:

One calming thought amid today’s economic turmoil has been that any recession would be softened by the large trove of savings that the U.S. public has accrued since the pandemic began. But that cushion may be a lot less protective than many believe, according to a study by Ian Shepherdson, chief economist at Pantheon Macroeconomics.

Pandemic savings have “been run down further than previously thought,” Shepherdson noted. “Consumers’ financial cushion against tighter financial conditions is smaller” than before, he wrote.

Thanks to Washington stimulus and curbed spending in the early days of COVID-19, savings had run up to $2.6 trillion. New government data, however, show that this ready cash has shrunk, no doubt due to high consumer outlays that kicked in since. Almost a third of the trove has been spent.

Indeed, consumers have gone back to their previous ways of preferring spending to saving, and then some. This past decade, before the pandemic, the personal savings rate was around 6% of their disposable income. That shot up to almost 25% in early 2020 and stayed high until the middle of 2021. Lately, it is a mere 3.5%.

Author(s): Larry Light

Publication Date: 10 Oct 2022

Publication Site: ai-CIO

Deaths Among Older Adults Due to COVID-19 Jumped During the Summer of 2022 Before Falling Somewhat in September

Mary Pat Campbell

Link: https://www.kff.org/coronavirus-covid-19/issue-brief/deaths-among-older-adults-due-to-covid-19-jumped-during-the-summer-of-2022-before-falling-somewhat-in-september/

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Excerpt:

As of the week ending October 1, 2022, the United States has lost nearly 1.1 million lives to COVID-19, of which about 790,000 are people ages 65 and older. People 65 and older account for 16% of the total US population but 75% of all COVID deaths to date. Vaccinations, boosters, and treatments have led to a substantial decline in severe disease, hospitalizations, and deaths from COVID-19, but with booster uptake lagging, deaths for older adults rose again during the summer of 2022.

From April to July 2022, the number of deaths due to COVID increased for all ages but rose at a faster rate for older than younger adults and stayed high through August 2022, with deaths due to COVID topping 11,000 in both July and August among people 65 and older. While COVID deaths began to drop again in September, they were still higher for those ages 65 and older than in April or May; for those younger than 65, deaths dropped below their April levels.

The rise in deaths is primarily a function of increasing cases due to the more transmissible Omicron variant. Other factors include relatively low booster uptake, compared to primary vaccination, and waning vaccine immunity, underscoring the importance of staying up to date on vaccination. On September 1st, CDC recommended a new, updated booster for all those ages 12 and older, but particularly for those who are older.

Author(s): Meredith Freed Follow @meredith_freed on Twitter , Tricia Neuman Follow @tricia_neuman on Twitter , Jennifer Kates Follow @jenkatesdc on Twitter , and Juliette Cubanski Follow @jcubanski on Twitter

Publication Date: 6 Oct 2022

Publication Site: Kaiser Family Foundation