Why inequality could spread COVID-19

Ahmed, Faheem; Ahmed, Naeem; Pissarides, Christopher; Stiglitz, Joseph E.

doi:10.1016/s2468-2667(20)30085-2

Cited by 702 publications

(658 citation statements)

References 3 publications

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“…These results suggest that other regions of Mexico, and LMICs in general, may need to plan for and ameliorate sharply increasing rates of out-ofhospital mortality in order to prevent a large burden of potentially unmeasured death stemming from the COVID-19 pandemic. These findings echo a growing number of calls for health system strengthening in LMIC in the face of the COVID-19 pandemic [9][10][11][12][13] .…”

Section: Discussionsupporting

confidence: 61%

“…One recent report from the Lombardy region of Italy used EMS records to show an increase of 58% compared to prior year values, during the peak of the epidemic 8 . It is unclear, however, how this phenomenon would play out in LMICs with relatively weaker health systems [9][10][11][12][13] . In the context of COVID-19, an increase in out-of-hospital mortality could be expected, directly from COVID-19, or indirectly as patients delay care and health systems become overwhelmed [14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

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Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Friedman

Calderón-Villarreal

Bojorquez

et al. 2020

Preprint

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Objective: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of COVID-19 affected populations, especially in low-and-middle-income countries (LMICs) with less rapid and reliable vital statistic registration systems. Although official COVID-19 statistics in Mexico report almost exclusively in-hospital mortality events, excess out-of-hospital mortality has been identified in other settings, including one EMS study in Italy that showed a 58% increase. EMS and hospital reports from several countries have suggested that silent hypoxemia-low oxygen saturation (SpO2) in the absence of dyspnea-is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to LMICs. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many LMIC settings. Methods:We calculated numbers of weekly out-of-hospital deaths and respiratory cases seen by EMS in Tijuana, and estimate the difference between peak-epidemic rates (during April 14 th -May 11 th ) and forecasted 2014-2019 trends. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status (SES), and examined for changing demographic or clinical features, including mean (SpO2).Results: An estimated 194.7 (95%CI: 135.5-253.9) excess out-of-hospital deaths events occurred, representing an increase of 145% (70%-338%) compared to forecasted trends. During the same window, only 8 COVID-19-positive, out-of-hospital deaths were reported in official statistics. This corresponded with a rise in respiratory cases of 274% (119%-1142%), and a drop in mean SpO2 to 77.7%, from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-SES areas, although respiratory cases were more concentrated in high-SES areas.Conclusions: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly threefold greater magnitude than increases reported using EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine if excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of healthcare. We also found evidence of worsening rates of hypoxemia among respiratory patients seen by EMS, suggesting a rise in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed that social disparities in out-of-hospital death that warrant monitoring and amelioration.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Friedman

Calderón-Villarreal

Bojorquez

et al. 2020

Preprint

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show abstract

“…In practical terms, we should first think of most the vulnerable, such those lacking homes, shelter, security, citizenship or family support, [101][102][103] especially those in the low income countries at greatest risk. 55,57,59,60,101 Beyond these long-neglected population groups, the most important lock down coverage and effectiveness gaps will be accounted for by the most important exceptions to restrictions and those exceptional individuals most determined to evade them.…”

Section: The Vital Importance Of Ambition and Rigour To Lockdown Outcmentioning

confidence: 99%

Why lockdown? Simplified arithmetic tools for decision-makers, health professionals, journalists and the general public to explore containment options for the novel coronavirus

Killeen

Kiware

2020

Preprint

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Half the world's population is already under lock-down and the remainder will have to follow if the ongoing novel coronavirus 2019 virus pandemic is to be contained. Faced with such brutally difficult decisions, it is essential that as many people as possible understand (1) why lockdown interventions represent the only realistic way for individual countries to contain their nationallevel epidemics before they turn into public health catastrophes, (2) why these need to be implemented so early, so aggressively and for such extended periods, and (3) why international cooperation to conditionally re-open trade and travel between countries that have successfully eliminated local transmission represents the only way to contain the pandemic at global level. Here we present simplified arithmetic models of COVID-19 transmission, control and elimination in userfriendly Shiny and Excel formats that allow non-specialists to explore, query, critique and understand the containment decisions facing their country and the world at large. Based on parameter values representative of the United Republic of Tanzania, which is still early enough in its epidemic cycle and response to avert a national catastrophe, national containment and elimination with less than 10 deaths is predicted for highly rigorous lock down within 5 weeks of the first confirmed cases and maintained for 15 weeks. However, elimination may only be sustained if case importation from outside the country is comprehensively contained by isolating for three weeks all incoming travellers, except those from countries certified as COVID-free in the future. Any substantive relaxation of these assumptions, specifically shortening the lock-down period, less rigorous lockdown or imperfect importation containment, may facilitate epidemic re-initiation, resulting in over half a million deaths unless rigorously contained a second time. Removing contact tracing and isolation has minimal impact on successful containment trajectories because high incidence of similar mild symptoms caused by other common pathogens attenuates detection success of COVID-19 testing. Nevertheless, contact tracing is recommended as an invaluable epidemiological surveillance platform for monitoring and characterizing the epidemic, and for understanding the influence of interventions on transmission dynamics.

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“…While two online surveys of 1,000 South Koreans in late February and late March released by the KCDC revealed that 75.4% and 88.7% of respondents, respectively, refrained from using public transport, it is not clear whether such high levels of risk perception are representative of the extent to which the general public actually practiced social distancing [4]. It is also important to be aware as to how specific population groups changed their behavior in response to COVID-19, since susceptible groups, such as the elderly, are more likely to progress to severe cases of COVID-19, and since other groups, such as those working in companies, may have less autonomy over practicing social distancing [5,6]. Understanding people's behavior is crucial in responding to COVID-19 as it forms the basis for changing behavior [7].…”

Section: Introductionmentioning

confidence: 99%

Changes in Subway Ridership in Response to COVID-19 in Seoul, South Korea: Implications for Social Distancing

Park¹

2020

Cureus

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Why inequality could spread COVID-19

Cited by 702 publications

References 3 publications

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Why lockdown? Simplified arithmetic tools for decision-makers, health professionals, journalists and the general public to explore containment options for the novel coronavirus

Changes in Subway Ridership in Response to COVID-19 in Seoul, South Korea: Implications for Social Distancing

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