Showing papers in "Journal of Travel Medicine in 2020"

The reproductive number of COVID-19 is higher compared to SARS coronavirus.

Abstract: Teaser: Our review found the average R0 for 2019-nCoV to be 3.28, which exceeds WHO estimates of 1.4 to 2.5.

Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak.

Abstract: Public health measures were decisive in controlling the SARS epidemic in 2003. Isolation is the separation of ill persons from non-infected persons. Quarantine is movement restriction, often with fever surveillance, of contacts when it is not evident whether they have been infected but are not yet symptomatic or have not been infected. Community containment includes measures that range from increasing social distancing to community-wide quarantine. Whether these measures will be sufficient to control 2019-nCoV depends on addressing some unanswered questions.

The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China

Abstract: BACKGROUND With its epicenter in Wuhan, China, the COVID-19 outbreak was declared a Public Health Emergency of International Concern by the World Health Organization (WHO). Consequently, many countries have implemented flight restrictions to China. China itself has imposed a lockdown of the population of Wuhan as well as the entire Hubei province. However, whether these two enormous measures have led to significant changes in the spread of COVID-19 cases remains unclear. METHODS We analyzed the available data on the development of confirmed domestic and international COVID-19 cases before and after lockdown measures. We evaluated the correlation of domestic air traffic to the number of confirmed COVID-19 cases and determined the growth curves of COVID-19 cases within China before and after lockdown as well as after changes in COVID-19 diagnostic criteria. RESULTS Our findings indicate a significant increase in doubling time from 2 days (95% CI: 1.9-2.6) to 4 days (95% CI: 3.5-4.3), after imposing lockdown. A further increase is detected after changing diagnostic and testing methodology to 19.3 (95% CI: 15.1-26.3), respectively. Moreover, the correlation between domestic air traffic and COVID-19 spread became weaker following lockdown (before lockdown: r = 0.98, P < 0.05 vs after lockdown: r = 0.91, P = NS). CONCLUSIONS A significantly decreased growth rate and increased doubling time of cases was observed, which is most likely due to Chinese lockdown measures. A more stringent confinement of people in high risk areas seems to have a potential to slow down the spread of COVID-19.

The pandemic of social media panic travels faster than the COVID-19 outbreak.

Abstract: We need to rapidly detect and respond to public rumours, perceptions, attitudes and behaviours around COVID-19 and control measures. The creation of an interactive platform and dashboard to provide ...

Pneumonia of unknown aetiology in Wuhan, China: potential for international spread via commercial air travel.

Abstract: There is currently an outbreak of pneumonia of unknown aetiology in Wuhan, China. Although there are still several unanswered questions about this infection, we evaluate the potential for international dissemination of this disease via commercial air travel should the outbreak continue.

COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures

Abstract: BACKGROUND: Cruise ships carry a large number of people in confined spaces with relative homogeneous mixing. On 3 February, 2020, an outbreak of COVID-19 on cruise ship Diamond Princess was reporte ...

High population densities catalyse the spread of COVID-19.

Abstract: The control of the COVID-19 epidemic is in many locations moving from a public-health strategy of containment to mitigation. 1 A main control-strategy of COVID-19 is contact tracing. Its effectiveness depends on the pre-symptomatic and asymptomatic patterns of the disease. With 100% symptomatic cases, an R0 of 1.5 could be controlled with 50% of the contacts traced. With an R0 of 3.5, 90% is required. 2 With pre-symptomatic and potential asymptomatic transmission, the effectiveness of contact tracing is reduced further. 2 In Italy, for example, only one out of four cases is identified. 3 Thus, even for a low R0 and no presymptomatic transmission, contact tracing will on its own not be able to contain the outbreak. In addition to isolation of ill persons, contact tracing and quarantining of all their contacts, to reduce community spread it will be necessary to strategically reduce contact-rates. By reducing contact rates, the growth-rate of the outbreak can be reduced. Controlling contact rates is key to outbreak control, and such a strategy depends on population densities.

Potential for global spread of a novel coronavirus from China.

Abstract: An epidemic of a novel coronavirus emerged from Wuhan, China, in late December 2019 and has since spread to several large Chinese cities. Should a scenario arise where this coronavirus spreads more broadly across China, we evaluate how patterns of international disease transmission could change.

Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19.

Abstract: Intravenous infusions of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in experimental animals increase the numbers of angiotensin-converting enzyme 2 (ACE2) receptors in the cardiopulmonary circulation. ACE2 receptors serve as binding sites for SARS-CoV-2 virions in the lungs. Patients who take ACEIs and ARBS may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections.

Interrupting transmission of COVID-19: lessons from containment efforts in Singapore.

Abstract: Despite multiple importations resulting in local chains of transmission, Singapore has been able to control the COVID-19 outbreak without major disruption to daily living. In this article, we describe the combination of measures taken by Singapore to contain COVID-19 and share some early lessons learnt from the experience.

Zika among international travellers presenting to GeoSentinel sites, 2012-2019: implications for clinical practice.

Abstract: INTRODUCTION International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travellers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveller characteristics, and assess ZIKV diagnostic testing by site. METHODS Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility and utilization of ZIKV diagnostic tests at GeoSentinel sites. RESULTS GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014, eight cases were reported, and all were acquired in Asia or Oceania. After 2014, most cases were acquired in the Americas or the Caribbean, a large decline in ZIKV cases occurred in 2018-19.Between March 2016 and December 2019, 423 patients acquired ZIKV in the Americas or the Caribbean, peak reporting to these regions occurred in 2016 [330 cases (78%)]. The median age was 36 years (range: 3-92); 63% were female. The most frequent region of exposure was the Caribbean (60%). Thirteen travellers were pregnant during or after travel; one had a sexually acquired ZIKV infection. There was one case of fetal anomaly and two travellers with Guillain-Barre syndrome. GeoSentinel sites reported various challenges to diagnose ZIKV effectively. CONCLUSION ZIKV should remain a consideration for travellers returning from areas with risk of ZIKV transmission. Travellers should discuss their travel plans with their healthcare providers to ensure ZIKV prevention measures are taken.

Detection of SARS-CoV-2 RNA in commercial passenger aircraft and cruise ship wastewater: a surveillance tool for assessing the presence of COVID-19 infected travellers.

Abstract: BACKGROUND: Wastewater-based epidemiology (WBE) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be an important source of information for coronavirus disease 2019 (COVID-19) management during and after the pandemic. Currently, governments and transportation industries around the world are developing strategies to minimize SARS-CoV-2 transmission associated with resuming activity. This study investigated the possible use of SARS-CoV-2 RNA wastewater surveillance from airline and cruise ship sanitation systems and its potential use as a COVID-19 public health management tool. METHODS: Aircraft and cruise ship wastewater samples (n = 21) were tested for SARS-CoV-2 using two virus concentration methods, adsorption-extraction by electronegative membrane (n = 13) and ultrafiltration by Amicon (n = 8), and five assays using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) and RT-droplet digital PCR (RT-ddPCR). Representative qPCR amplicons from positive samples were sequenced to confirm assay specificity. RESULTS: SARS-CoV-2 RNA was detected in samples from both aircraft and cruise ship wastewater; however concentrations were near the assay limit of detection. The analysis of multiple replicate samples and use of multiple RT-qPCR and/or RT-ddPCR assays increased detection sensitivity and minimized false-negative results. Representative qPCR amplicons were confirmed for the correct PCR product by sequencing. However, differences in sensitivity were observed among molecular assays and concentration methods. CONCLUSIONS: The study indicates that surveillance of wastewater from large transport vessels with their own sanitation systems has potential as a complementary data source to prioritize clinical testing and contact tracing among disembarking passengers. Importantly, sampling methods and molecular assays must be further optimized to maximize detection sensitivity. The potential for false negatives by both wastewater testing and clinical swab testing suggests that the two strategies could be employed together to maximize the probability of detecting SARS-CoV-2 infections amongst passengers.

Travellers give wings to novel coronavirus (2019-nCoV).

Abstract: A novel coronavirus, probably of bat origin, has caused an outbreak of severe respiratory infection in humans in Wuhan, China and has been dispersed globally by travelers. The WHO has declared the spread of the infection a Public Health Emergency of International Concern.

COVID-19: Exposing and addressing health disparities among ethnic minorities and migrants.

Abstract: COVID-19: Exposing and addressing health disparities among ethnic minorities and migrants Christina Greenaway, MD, MSc1,2,3,*, Sally Hargreaves, PhD4, Sapha Barkati, MD, MSc3,5, Christina M. Coyle, MD, MS6, Federico Gobbi, MD, PhD7, Apostolos Veizis, MD8 and Paul Douglas, MD9 1Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada, 2Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, 3JD MacLean Centre for Tropical Diseases, McGill University Health Centre, McGill University, Montreal, Canada, 4Institute for Infection and Immunity, St George’s University of London, London, UK, 5Department of Medicine, Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada, 6Department of Medicine, Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, NY, USA, 7Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy, 8Médecins Sans Frontières, Athens, Greece and 9Migration Health Division, International Organization for Migration, Geneva, Switzerland

COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema.

Abstract: We present a case of COVID-19 pneumonia associated with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema.

Routes for COVID-19 importation in Brazil.

Abstract: The global outbreak caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been declared a pandemic by the World Health Organization. As the number of imported SARS-CoV-2 cases is on the rise in Brazil, we use incidence and historical air travel data to estimate the most important routes of importation into the country.

Geographic access to United States SARS-CoV-2 testing sites highlights healthcare disparities and may bias transmission estimates.

Abstract: We paired high-resolution travel-time metrics with a SARS-CoV-2 testing location database in the United States. Median travel time to testing sites is longer in counties with lower population density, and a higher percent of minority and uninsured individuals. Differential geographic accessibility to testing can recapitulate healthcare disparities and bias transmission estimates.

Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response.

Abstract: Four billion people worldwide have experienced coronavirus disease 2019 (COVID-19) confinement. Such unprecedented extent of mobility restriction to curb the COVID-19 pandemic may have profound impacts on how individuals live, travel and retain well-being. This systematic review aims to identify (i) the social consequences of mass quarantine-community-wide movement restrictions-during previous and current infectious disease outbreaks and (ii) recommended strategies to mitigate the negative social implications of COVID-19 lockdowns. Considering social determinants of health, we conducted a systematic review by searching five databases (Ovid-MEDLINE, EMBASE, PsycINFO, China National Knowledge Infrastructure and the World Health Organization COVID-19 database) for publications from inception to 9 April 2020. No limitation was set on language, location or study type. Studies that (i) contained peer-reviewed original empirical evidence and (ii) focussed on non-epidemiological implications of mass quarantine were included. We thematically synthesized and reported data due to heterogeneous disease and country context. Of 3067 publications found, 15 original peer-reviewed articles were selected for full-text extraction. Psychological distress, heightened communication inequalities, food insecurity, economic challenges, diminished access to health care, alternative delivery of education and gender-based violence were identified as negative social consequences of community-based quarantine in six infectious disease epidemics, including the current COVID-19 pandemic. In contrast, altruistic attitudes were identified as a positive consequence during previous quarantines. Diverse psychological and social consequences of mass quarantine in previous and current epidemics were evident, but individual country policies had been highly varied in how well they addressed the needs of affected individuals, especially those who are socially marginalized. Policymakers should balance the pros and cons of movement restrictions, facilitate multisectoral action to tackle social inequalities, provide clear and coherent guidance to the public and undertake time-bound policy evaluations to mitigate the negative impact of COVID-19 lockdowns and to establish preparedness strategies for future epidemics.

A single mass gathering resulted in massive transmission of COVID-19 infections in Malaysia with further international spread.

Abstract: Highlight Malaysia has recorded the highest number of COVID-19 cases in Southeast Asia with more than 35% of new COVID-19 cases linked to the Sri Petaling gathering, a Moslem missionary movement attended by more than 19 000 people of different nationalities, in March 2020 in Kuala Lumpur. From this cluster, 1701 samples have been tested positive out of 21 920 tests carried out. Thus, mass gathering during COVID-19 pandemic period should be banned to curb disease transmission.

Saudi Arabia's drastic measures to curb the COVID-19 outbreak: temporary suspension of the Umrah pilgrimage.

Abstract: With the global spread of COVID-19, concerns arise about mass gathering events which will further facilitate disease spread. This report welcomes KSA decision to suspend uma

Public Health Emergencies of International Concern: A Historic Overview.

Abstract: Rationale The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 until 2020 and justifications for such declarations. Key findings Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. Recommendations The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.

Negative impact of social media panic during the COVID-19 outbreak in India.

Abstract: Social media has played a crucial role in spreading awareness and knowledge about public health; however, it has also been misused for spreading fake news, hatred and creating racism during epidemics and civil unrest. We discuss how social media and societal response to COVID-19 negatively affected its control measures in India and what should be possible corrective measures.

Combat COVID-19 with artificial intelligence and big data.

Abstract: To combat COVID-19, at least 29 countries/regions have resorted to digital technology; some embedded it with strict containment measures and achieved great success. We need to improve cryptography and regulations that would enable contact-tracing systems without mass surveillance in order to attain the benefits of location-tracking while protecting individual privacy.

In-flight Transmission of SARS-CoV-2: a review of the attack rates and available data on the efficacy of face masks.

Abstract: The absence of large numbers of published in-flight transmissions of SARS-CoV-2 is not definitive evidence of safety. All peer-reviewed publications of flights with possible transmission are categorized by the quantity of transmission. Three mass transmission flights without masking are contrasted to 5 with strict masking and 58 cases with zero transmission.

Quantifying the association between domestic travel and the exportation of novel coronavirus (2019-nCoV) cases from Wuhan, China in 2020: a correlational analysis.

Abstract: Quantifying the association between domestic travel and the exportation of novel coronavirus (2019-nCoV) cases from Wuhan, China in 2020: a correlational analysis Shi Zhao1,2, Zian Zhuang3, Peihua Cao4, Jinjun Ran5, Daozhou Gao6, Yijun Lou3, Lin Yang7, Yongli Cai8, Weiming Wang8, Daihai He3,*, and Maggie H. Wang1,2 JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China, Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, China, Department of AppliedMathematics, Hong Kong Polytechnic University, Hong Kong, China, Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China, School of Public Health, Li Ka Shing Faculty ofMedicine, University of Hong Kong, Hong Kong, China, Mathematics and Science College, Shanghai Normal University, Shanghai, China, School of Nursing, Hong Kong Polytechnic University, Hong Kong, China and Department of Mathematics, Huaiyin Normal University, Huai’an, China

The effectiveness of full and partial travel bans against COVID-19 spread in Australia for travellers from China during and after the epidemic peak in China.

Abstract: Background Australia implemented a travel ban on China on 1 February 2020, while COVID-19 was largely localized to China. We modelled three scenarios to test the impact of travel bans on epidemic control. Scenario one was no ban; scenario two and three were the current ban followed by a full or partial lifting (allow over 100 000 university students to enter Australia, but not tourists) from the 8th of March 2020. Methods We used disease incidence data from China and air travel passenger movements between China and Australia during and after the epidemic peak in China, derived from incoming passenger arrival cards. We used the estimated incidence of disease in China, using data on expected proportion of under-ascertainment of cases and an age-specific deterministic model to model the epidemic in each scenario. Results The modelled epidemic with the full ban fitted the observed incidence of cases well, predicting 57 cases on March 6th in Australia, compared to 66 observed on this date; however, we did not account for imported cases from other countries. The modelled impact without a travel ban results in more than 2000 cases and about 400 deaths, if the epidemic remained localized to China and no importations from other countries occurred. The full travel ban reduced cases by about 86%, while the impact of a partial lifting of the ban is minimal and may be a policy option. Conclusions Travel restrictions were highly effective for containing the COVID-19 epidemic in Australia during the epidemic peak in China and averted a much larger epidemic at a time when COVID-19 was largely localized to China. This research demonstrates the effectiveness of travel bans applied to countries with high disease incidence. This research can inform decisions on placing or lifting travel bans as a control measure for the COVID-19 epidemic.

Strategies at points of entry to reduce importation risk of COVID-19 cases and reopen travel.

Abstract: BACKGROUND: With more countries exiting lockdown, public health safety requires screening measures at international travel entry points which can prevent the reintroduction or importation of the SARS-CoV-2 virus. Here, we estimate the number of cases captured, quarantining days averted and secondary cases expected to occur with screening interventions. METHODS: To estimate active case exportation risk from 153 countries with recorded COVID-19 cases and deaths, we created a simple data-driven framework to calculate the number of infectious and upcoming infectious individuals out of 100 000 000 potential travellers from each country, and assessed six importation risk reduction strategies; Strategy 1 (S1) has no screening on entry, S2 tests all travellers and isolates test positives where those who test negative at 7 days are permitted entry, S3 the equivalent but for a 14 day period, S4 quarantines all travellers for 7 days where all are subsequently permitted entry, S5 the equivalent for 14 days and S6 the testing of all travellers and prevention of entry for those who test positive. RESULTS: The average reduction in case importation across countries relative to S1 is 90.2% for S2, 91.7% for S3, 55.4% for S4, 91.2% for S5 and 77.2% for S6. An average of 79.6% of infected travellers are infectious upon arrival. For the top 100 exporting countries, an 88.2% average reduction in secondary cases is expected through S2 with the 7-day isolation of test positives, increasing to 92.1% for S3 for 14-day isolation. A substantially smaller reduction of 30.0% is expected for 7-day all traveller quarantining, increasing to 84.3% for 14-day all traveller quarantining. CONCLUSIONS: The testing and isolation of test positives should be implemented provided good testing practices are in place. If testing is not feasible, quarantining for a minimum of 14 days is recommended with strict adherence measures in place.

Travel restrictions and infectious disease outbreaks.

Abstract: BACKGROUND: A key purpose of the International Health Regulations (IHR) is to prevent unwarranted interruptions to trade and travel during large and/or transnational infectious disease outbreaks. Nevertheless, such outbreaks continue to disrupt the travel industry. This aspect of the IHR has received little attention in the academic literature despite its considerable impact on affected States and commercial activity. This article outlines the challenges and gaps in knowledge regarding the relationship between outbreaks and the travel sector and discusses the opportunities for further research and policy work to overcome these challenges. METHODOLOGY: We conducted a literature review on the relationship between outbreaks and travel restrictions, with a particular focus on the 2014-16 Ebola epidemic in West Africa. This review was complemented by an expert roundtable at Chatham House and further supported by case studies and qualitative interviews. RESULTS: Numerous travel stakeholders are affected by, and affect, large-scale infectious disease outbreaks. These stakeholders react in different ways: peer pressure plays an important role for both governments and the travel sector, and the reactions of the media and public influence and are influenced by these stakeholders. While various data sources on travel are available, and World Health Organization is mandated to work with States, there is no recognized coordinating body to disseminate timely, consistent, reliable and authoritative information and best practices to all stakeholders. CONCLUSION: This article highlights the interdependent relationship between various travel stakeholders. The reasons for interruption of travel during the 2014-16 Ebola outbreak were complex, with decisions by States only partly contributing to the cessation. Decisions by non-state actors, particularly the travel industry itself, contributed significantly and were based on a variety of factors. Further research, analysis and policy development are required to mitigate the health and economic consequences of infectious disease outbreaks. Any further research will also need to take account of COVID-19 travel-related issues.