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Using Multivariate Statistics

Seroprevalence surveys suggest that more than a third and possibly more than half of the global population has been infected with SARS-CoV-2 by early 2022. As large numbers of people continue to be infected, the efficacy and duration of natural immunity in terms of protection against SARS-CoV-2 reinfections and severe disease is of crucial significance for the future. This narrative review provides an overview on epidemiological studies addressing this issue. National surveys covering 2020-2021 documented that a previous SARS-CoV-2 infection is associated with a significantly reduced risk of reinfections with efficacy lasting for at least one year and only relatively moderate waning immunity. Importantly, natural immunity showed roughly similar effect sizes regarding protection against reinfection across different SARS-CoV-2 variants, with the exception of the Omicron variant for which data are just emerging before final conclusions can be drawn. Risk of hospitalizations and deaths was also reduced in SARS-CoV-2 reinfections versus primary infections. Observational studies indicate that natural immunity may offer equal or greater protection against SARS-CoV-2 infections compared to individuals receiving two doses of an mRNA vaccine, but data are not fully consistent. The combination of a previous SARS-CoV-2 infection and a respective vaccination, termed hybrid immunity, seems to confer the greatest protection against SARS-CoV-2 infections, but several knowledge gaps remain regarding this issue. Natural immunity should be considered for public health policy regarding SARS-CoV-2. 

https://doi.org/10.1016/j.envres.2022.112911

SARS-CoV-2 reinfections: Overview of efficacy and duration of natural and hybrid immunity

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The Importance of Behavioral and Native Factors on COVID-19 Infection and Severity: Insights from a Preliminary Cross-Sectional Study

Air pollution is speculated to increase the risks of COVID-19 spread, severity, and mortality.We systematically reviewed studies investigating the relationship between air pollution and COVID-19 cases, non-fatal severity, and mortality in North America and Europe.We searched PubMed, Web of Science, and Scopus for studies investigating the effects of harmful pollutants, including particulate matter with diameter ≤2.5 or 10 μm (PM2.5 or PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO), on COVID-19 cases, severity, and deaths in Europe and North America through to June 19, 2021. Articles were included if they quantitatively measured the relationship between exposure to air pollution and COVID-19 health outcomes.From 2,482 articles screened, we included 116 studies reporting 355 separate pollutant-COVID-19 estimates. Approximately half of all evaluations on incidence were positive and significant associations (52.7%); for mortality the corresponding figure was similar (48.1%), while for non-fatal severity this figure was lower (41.2%). Longer-term exposure to pollutants appeared more likely to be positively associated with COVID-19 incidence (63.8%). PM2.5, PM10, O3, NO2, and CO were most strongly positively associated with COVID-19 incidence, while PM2.5 and NO2 with COVID-19 deaths. All studies were observational and most exhibited high risk of confounding and outcome measurement bias.Air pollution may be associated with worse COVID-19 outcomes. Future research is needed to better test the air pollution-COVID-19 hypothesis, particularly using more robust study designs and COVID-19 measures that are less prone to measurement error and by considering co-pollutant interactions. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9420033

The impact of air pollution on COVID-19 incidence, severity, and mortality: A systematic review of studies in Europe and North America

“SARS-CoV-2 is transmitted by particulate air pollution”: Misinterpretations of statistical data, skewed citation practices, and misuse of specific terminology spreading the misconception

Workplaces can be high-risk environments for SARS-CoV-2 outbreaks and subsequent community transmission. Identifying, understanding, and implementing effective workplace SARS-CoV-2 infection prevention and control (IPC) measures is critical to protect workers, their families, and communities. A rapid review and meta-analysis were conducted to synthesize evidence assessing the effectiveness of COVID-19 IPC measures implemented in global workplace settings through April 2021. Medline, Embase, PubMed, and Cochrane Library were searched for studies that quantitatively assessed the effectiveness of workplace COVID-19 IPC measures. The included studies comprised varying empirical designs and occupational settings. Measures of interest included surveillance measures, outbreak investigations, environmental adjustments, personal protective equipment (PPE), changes in work arrangements, and worker education. Sixty-one studies from healthcare, nursing home, meatpacking, manufacturing, and office settings were included, accounting for ~280,000 employees based in Europe, Asia, and North America. Meta-analyses showed that combined IPC measures resulted in lower employee COVID-19 positivity rates (0.2% positivity; 95% CI 0-0.4%) than single measures such as asymptomatic PCR testing (1.7%; 95% CI 0.9-2.9%) and universal masking (24%; 95% CI 3.4-55.5%). Modelling studies showed that combinations of (i) timely and widespread contact tracing and case isolation, (ii) facilitating smaller worker cohorts, and (iii) effective use of PPE can reduce workplace transmission. Comprehensive COVID-19 IPC measures incorporating swift contact tracing and case isolation, PPE, and facility zoning can effectively prevent workplace outbreaks. Masking alone should not be considered sufficient protection from SARS-CoV-2 outbreaks in the workplace.

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COVID-19 Prevention and Control Measures in Workplace Settings: A Rapid Review and Meta-Analysis.

Few studies have assessed how the intersection of social determinants of health and environmental hazards contributes to racial disparities in COVID-19. The aim of our study was to compare COVID-19 disparities in testing and positivity to cumulative environmental health impacts, and to assess how unique social and environmental determinants of health relate to COVID-19 positivity in Seattle, King County, WA, at the census tract level. Publicly available data (n = 397 census tracts) were obtained from Public Health-Seattle & King County, 2018 ACS 5-year estimates, and the Washington Tracking Network. COVID-19 testing and positive case rates as of July 12, 2020, were mapped and compared to Washington State Environmental Health Disparities (EHD) Map cumulative impact rankings. We calculated odds ratios from a series of univariable and multivariable logistic regression analyses using cumulative impact rankings, and community-level socioeconomic, health, and environmental factors as predictors and having ≥ 10% or < 10% census tract positivity as the binary outcome variable. We found a remarkable overlap between Washington EHD cumulative impact rankings and COVID-19 positivity in King County. Census tracts with ≥ 10 % COVID-19 positivity had significantly lower COVID-19 testing rates and higher proportions of people of color and faced a combination of low socioeconomic status-related outcomes, poor community health outcomes, and significantly higher concentrations of fine particulate matter (PM2.5). King County communities experiencing high rates of COVID-19 face a disproportionate cumulative burden of environmental and social inequities. Cumulative environmental health impacts should therefore systematically be considered when assessing for risk of exposure to and health complications resulting from COVID-19.

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Cumulative Impacts and COVID-19: Implications for Low-Income, Minoritized, and Health-Compromised Communities in King County, WA.


 Background Despite widespread COVID-19 vaccination programs, there is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to workers in diverse geographic and occupational settings. Methods A 44-item online survey was developed, translated, and validated for face, content, and cross-cultural validity according to literature review, expert consultation, and pre-testing. The survey was piloted with 890 workers from diverse industries in Canada, Ireland, Argentina, Poland, Nigeria, China, the US, and the UK. Odds ratios generated from univariable, and multivariable logistic regression assessed differences in ‘feeling protected at work’ according to gender, age, occupation, country of residence, professional role, and vaccination status. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing using two-sample t-tests verified construct validity (i.e., discriminant validity, known-groups technique), and criterion validity. Results After adjustment for occupational sector, characteristics associated with feeling protected at work included being male (AOR = 1.88; 95% CI = 1.18,2.99), being over 55 (AOR = 2.17; 95% CI = 1.25,3.77) and working in a managerial position (AOR = 3.1; 95% CI = 1.99,4.83). EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥ 0.60). Hypothesis testing revealed differences in survey responses by country and occupational sector, confirming construct validity (p < 0.001), criterion validity (p = 0.04), and discriminant validity (p < 0.001). Conclusions The online survey, developed to identify the COVID-19 protective measures used in diverse, international workplace settings, showed strong face validity, content validity, cross-cultural validity, internal consistency, criterion validity, and construct validity. It can be used by decision makers in the distribution of IPC resources, and to guide occupational safety and health (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

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Development and Validation of a Multi-lingual Online Questionnaire for Surveying the COVID-19 Prevention and Control Measures used in Global Workplaces

Carolyn Ingram

Papers

COVID-19 Prevention and Control Measures in Workplace Settings: A Rapid Review and Meta-Analysis.

Cumulative Impacts and COVID-19: Implications for Low-Income, Minoritized, and Health-Compromised Communities in King County, WA.

Development and Validation of a Multi-lingual Online Questionnaire for Surveying the COVID-19 Prevention and Control Measures used in Global Workplaces