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  1. Article ; Online: The societal cost of vaccine refusal: A modelling study using measles vaccination as a case study.

    Olivera Mesa, Daniela / Winskill, Peter / Ghani, Azra C / Hauck, Katharina

    Vaccine

    2023  Volume 41, Issue 28, Page(s) 4129–4137

    Abstract: Background: Increasing vaccine hesitancy and refusal poses a challenge to public health as even small reductions in vaccine uptake can result in large outbreaks of infectious diseases. Here we estimate the societal costs of vaccine refusal using measles ...

    Abstract Background: Increasing vaccine hesitancy and refusal poses a challenge to public health as even small reductions in vaccine uptake can result in large outbreaks of infectious diseases. Here we estimate the societal costs of vaccine refusal using measles as a case study.
    Methods: We developed a compartmental metapopulation model of measles transmission to explore how the changes in the size and level of social mixing between populations that are "pro-vaccination", and "anti-vaccination" impacts the burden of measles. Using the projected cases and deaths, we calculated the health, healthcare, direct medical costs, and productivity loss associated with vaccine refusal. Using measles in England as a case study, we quantified the societal costs that each vaccine refusal imposes on society.
    Findings: When there is a high level of mixing between the pro- and anti-vaccination populations, those that refuse to be vaccinated benefit from the herd immunity afforded by the pro-vaccination population. At the same time, their refusal to be vaccinated increases the burden in those that are vaccinated due to imperfect vaccines, and in those that are not able to be vaccinated due to other underlying health conditions. Using England as a case study, we estimate that this translates to a societal loss of GBP 292 million and disease burden of 17 630 quality-adjusted-life-years (sensitivity range 10 594-50 379) over a 20-year time horizon. Of these costs, 26 % are attributable to healthcare costs and 74 % to productivity losses for patients and their carers. This translates to a societal loss per vaccine refusal of GBP 162.21 and 0.01 (0.006-0.03) quality-adjusted-life-years.
    Interpretation: Our findings demonstrate that even low levels of vaccine refusal can have a substantial and measurable societal burden on the population. These estimates can support the value of investment in interventions that address vaccine hesitancy and vaccine refusal, providing not only improved public health but also potential economic benefits to society.
    MeSH term(s) Humans ; Vaccination ; Measles/epidemiology ; Disease Outbreaks ; Vaccination Refusal ; Health Care Costs ; Cost-Benefit Analysis ; Measles Vaccine
    Chemical Substances Measles Vaccine
    Language English
    Publishing date 2023-05-30
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2023.05.039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Modelling the impact of vaccine hesitancy in prolonging the need for Non-Pharmaceutical Interventions to control the COVID-19 pandemic.

    Olivera Mesa, Daniela / Hogan, Alexandra B / Watson, Oliver J / Charles, Giovanni D / Hauck, Katharina / Ghani, Azra C / Winskill, Peter

    Communications medicine

    2022  Volume 2, Page(s) 14

    Abstract: Background: Vaccine hesitancy - a delay in acceptance or refusal of vaccines despite availability - has the potential to threaten the successful roll-out of SARS-CoV-2 vaccines globally. In this study, we aim to understand the likely impact of vaccine ... ...

    Abstract Background: Vaccine hesitancy - a delay in acceptance or refusal of vaccines despite availability - has the potential to threaten the successful roll-out of SARS-CoV-2 vaccines globally. In this study, we aim to understand the likely impact of vaccine hesitancy on the control of the COVID-19 pandemic.
    Methods: We modelled the potential impact of vaccine hesitancy on the control of the pandemic and the relaxation of non-pharmaceutical interventions (NPIs) by combining an epidemiological model of SARS-CoV-2 transmission with data on vaccine hesitancy from population surveys.
    Results: Our simulations suggest that the mortality over a 2-year period could be up to 7.6 times higher in countries with high vaccine hesitancy compared to an ideal vaccination uptake if NPIs are relaxed. Alternatively, high vaccine hesitancy could prolong the need for NPIs to remain in place.
    Conclusions: While vaccination is an individual choice, vaccine-hesitant individuals have a substantial impact on the pandemic trajectory, which may challenge current efforts to control COVID-19. In order to prevent such outcomes, addressing vaccine hesitancy with behavioural interventions is an important priority in the control of the COVID-19 pandemic.
    Language English
    Publishing date 2022-02-10
    Publishing country England
    Document type Journal Article
    ISSN 2730-664X
    ISSN (online) 2730-664X
    DOI 10.1038/s43856-022-00075-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Long-term vaccination strategies to mitigate the impact of SARS-CoV-2 transmission: A modelling study.

    Hogan, Alexandra B / Wu, Sean L / Toor, Jaspreet / Olivera Mesa, Daniela / Doohan, Patrick / Watson, Oliver J / Winskill, Peter / Charles, Giovanni / Barnsley, Gregory / Riley, Eleanor M / Khoury, David S / Ferguson, Neil M / Ghani, Azra C

    PLoS medicine

    2023  Volume 20, Issue 11, Page(s) e1004195

    Abstract: Background: Vaccines have reduced severe disease and death from Coronavirus Disease 2019 (COVID-19). However, with evidence of waning efficacy coupled with continued evolution of the virus, health programmes need to evaluate the requirement for regular ... ...

    Abstract Background: Vaccines have reduced severe disease and death from Coronavirus Disease 2019 (COVID-19). However, with evidence of waning efficacy coupled with continued evolution of the virus, health programmes need to evaluate the requirement for regular booster doses, considering their impact and cost-effectiveness in the face of ongoing transmission and substantial infection-induced immunity.
    Methods and findings: We developed a combined immunological-transmission model parameterised with data on transmissibility, severity, and vaccine effectiveness. We simulated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and vaccine rollout in characteristic global settings with different population age-structures, contact patterns, health system capacities, prior transmission, and vaccine uptake. We quantified the impact of future vaccine booster dose strategies with both ancestral and variant-adapted vaccine products, while considering the potential future emergence of new variants with modified transmission, immune escape, and severity properties. We found that regular boosting of the oldest age group (75+) is an efficient strategy, although large numbers of hospitalisations and deaths could be averted by extending vaccination to younger age groups. In countries with low vaccine coverage and high infection-derived immunity, boosting older at-risk groups was more effective than continuing primary vaccination into younger ages in our model. Our study is limited by uncertainty in key parameters, including the long-term durability of vaccine and infection-induced immunity as well as uncertainty in the future evolution of the virus.
    Conclusions: Our modelling suggests that regular boosting of the high-risk population remains an important tool to reduce morbidity and mortality from current and future SARS-CoV-2 variants. Our results suggest that focusing vaccination in the highest-risk cohorts will be the most efficient (and hence cost-effective) strategy to reduce morbidity and mortality.
    MeSH term(s) Humans ; SARS-CoV-2 ; COVID-19/prevention & control ; Vaccination ; Vaccines
    Chemical Substances Vaccines
    Language English
    Publishing date 2023-11-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2185925-5
    ISSN 1549-1676 ; 1549-1277
    ISSN (online) 1549-1676
    ISSN 1549-1277
    DOI 10.1371/journal.pmed.1004195
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Predicting the public health impact of a malaria transmission-blocking vaccine.

    Challenger, Joseph D / Olivera Mesa, Daniela / Da, Dari F / Yerbanga, R Serge / Lefèvre, Thierry / Cohuet, Anna / Churcher, Thomas S

    Nature communications

    2021  Volume 12, Issue 1, Page(s) 1494

    Abstract: Transmission-blocking vaccines that interrupt malaria transmission from humans to mosquitoes are being tested in early clinical trials. The activity of such a vaccine is commonly evaluated using membrane-feeding assays. Understanding the field efficacy ... ...

    Abstract Transmission-blocking vaccines that interrupt malaria transmission from humans to mosquitoes are being tested in early clinical trials. The activity of such a vaccine is commonly evaluated using membrane-feeding assays. Understanding the field efficacy of such a vaccine requires knowledge of how heavily infected wild, naturally blood-fed mosquitoes are, as this indicates how difficult it will be to block transmission. Here we use data on naturally infected mosquitoes collected in Burkina Faso to translate the laboratory-estimated activity into an estimated activity in the field. A transmission dynamics model is then utilised to predict a transmission-blocking vaccine's public health impact alongside existing interventions. The model suggests that school-aged children are an attractive population to target for vaccination. Benefits of vaccination are distributed across the population, averting the greatest number of cases in younger children. Utilising a transmission-blocking vaccine alongside existing interventions could have a substantial impact against malaria.
    MeSH term(s) Adolescent ; Adult ; Burkina Faso/epidemiology ; Child ; Child, Preschool ; Humans ; Infant ; Malaria/epidemiology ; Malaria/prevention & control ; Malaria/transmission ; Malaria Vaccines/immunology ; Malaria, Falciparum/prevention & control ; Middle Aged ; Prevalence ; Public Health ; Vaccination ; Young Adult
    Chemical Substances Malaria Vaccines
    Language English
    Publishing date 2021-03-08
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2553671-0
    ISSN 2041-1723 ; 2041-1723
    ISSN (online) 2041-1723
    ISSN 2041-1723
    DOI 10.1038/s41467-021-21775-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Estimating long-term vaccine effectiveness against SARS-CoV-2 variants: a model-based approach

    Hogan, Alexandra B / Doohan, Patrick / Wu, Sean L / Olivera Mesa, Daniela / Toor, Jaspreet / Watson, Oliver J / Winskill, Peter / Charles, Giovanni / Barnsley, Gregory / Riley, Eleanor M / Khoury, David S / Ferguson, Neil M / Ghani, Azra

    medRxiv

    Abstract: With the ongoing evolution of the SARS-CoV-2 virus, variant-adapted vaccines are likely to be required. Given the challenges of conducting clinical trials against a background of widespread infection-induced immunity, updated vaccines are likely to be ... ...

    Abstract With the ongoing evolution of the SARS-CoV-2 virus, variant-adapted vaccines are likely to be required. Given the challenges of conducting clinical trials against a background of widespread infection-induced immunity, updated vaccines are likely to be adopted based on immunogenicity data. We extended a modelling framework linking immunity levels and protection and fitted the model to vaccine effectiveness data from England for three vaccines (Oxford/AstraZeneca AZD1222, Pfizer-BioNTech BNT162b2, Moderna mRNA-1273) and two variants (Delta and Omicron) to predict longer-term effectiveness against mild disease, hospitalisation and death. We use these model fits to predict the effectiveness of the Moderna bivalent vaccine (mRNA1273.214) against the Omicron variant using immunogenicity data. Our results suggest sustained protection against hospitalisation and death from the Omicron variant over the first six months following boosting with the monovalent vaccines but a gradual waning to moderate protection after 1 year (median predicted vaccine effectiveness at 1 year in 65+ age group: AZD1222 38.9%, 95% CrI 31.8%-46.8%; BNT162b2 53.3%, 95% CrI 49.1%-56.9%; mRNA-1273 60.0%, 95% CrI 56.0%-63.6%). Furthermore, we predict almost complete loss of protection against mild disease over this period (mean predicted effectiveness at 1 year 7.8% for AZD1222, 13.2% for BNT162b2 and 16.7% for mRNA-1273). Switching to a second booster with the bivalent mRNA1273.214 vaccine against Omicron BA.1/2 is predicted to prevent nearly twice as many hospitalisations and deaths over a 1-year period compared to administering a second booster with the monovalent mRNA1273 vaccine. Ongoing production and administration of variant-specific vaccines are therefore likely to play an important role in protecting against severe outcomes from the ongoing circulation of SARS-CoV-2.
    Keywords covid19
    Language English
    Publishing date 2023-01-04
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2023.01.03.23284131
    Database COVID19

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  6. Article ; Online: Author Correction: Using mortuary and burial data to place COVID-19 in Lusaka, Zambia within a global context.

    Sheppard, Richard J / Watson, Oliver J / Pieciak, Rachel / Lungu, James / Kwenda, Geoffrey / Moyo, Crispin / Chanda, Stephen Longa / Barnsley, Gregory / Brazeau, Nicholas F / Gerard-Ursin, Ines C G / Olivera Mesa, Daniela / Whittaker, Charles / Gregson, Simon / Okell, Lucy C / Ghani, Azra C / MacLeod, William B / Del Fava, Emanuele / Melegaro, Alessia / Hines, Jonas Z /
    Mulenga, Lloyd B / Walker, Patrick G T / Mwananyanda, Lawrence / Gill, Christopher J

    Nature communications

    2024  Volume 15, Issue 1, Page(s) 2213

    Language English
    Publishing date 2024-03-12
    Publishing country England
    Document type Published Erratum
    ZDB-ID 2553671-0
    ISSN 2041-1723 ; 2041-1723
    ISSN (online) 2041-1723
    ISSN 2041-1723
    DOI 10.1038/s41467-024-44940-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Using mortuary and burial data to place COVID-19 in Lusaka, Zambia within a global context.

    Sheppard, Richard J / Watson, Oliver J / Pieciak, Rachel / Lungu, James / Kwenda, Geoffrey / Moyo, Crispin / Chanda, Stephen Longa / Barnsley, Gregory / Brazeau, Nicholas F / Gerard-Ursin, Ines C G / Olivera Mesa, Daniela / Whittaker, Charles / Gregson, Simon / Okell, Lucy C / Ghani, Azra C / MacLeod, William B / Del Fava, Emanuele / Melegaro, Alessia / Hines, Jonas Z /
    Mulenga, Lloyd B / Walker, Patrick G T / Mwananyanda, Lawrence / Gill, Christopher J

    Nature communications

    2023  Volume 14, Issue 1, Page(s) 3840

    Abstract: Reported COVID-19 cases and associated mortality remain low in many sub-Saharan countries relative to global averages, but true impact is difficult to estimate given limitations around surveillance and mortality registration. In Lusaka, Zambia, burial ... ...

    Abstract Reported COVID-19 cases and associated mortality remain low in many sub-Saharan countries relative to global averages, but true impact is difficult to estimate given limitations around surveillance and mortality registration. In Lusaka, Zambia, burial registration and SARS-CoV-2 prevalence data during 2020 allow estimation of excess mortality and transmission. Relative to pre-pandemic patterns, we estimate age-dependent mortality increases, totalling 3212 excess deaths (95% CrI: 2104-4591), representing an 18.5% (95% CrI: 13.0-25.2%) increase relative to pre-pandemic levels. Using a dynamical model-based inferential framework, we find that these mortality patterns and SARS-CoV-2 prevalence data are in agreement with established COVID-19 severity estimates. Our results support hypotheses that COVID-19 impact in Lusaka during 2020 was consistent with COVID-19 epidemics elsewhere, without requiring exceptional explanations for low reported figures. For more equitable decision-making during future pandemics, barriers to ascertaining attributable mortality in low-income settings must be addressed and factored into discourse around reported impact differences.
    MeSH term(s) Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Zambia/epidemiology ; Burial ; Pandemics
    Language English
    Publishing date 2023-06-29
    Publishing country England
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't
    ZDB-ID 2553671-0
    ISSN 2041-1723 ; 2041-1723
    ISSN (online) 2041-1723
    ISSN 2041-1723
    DOI 10.1038/s41467-023-39288-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries.

    Walker, Patrick G T / Whittaker, Charles / Watson, Oliver J / Baguelin, Marc / Winskill, Peter / Hamlet, Arran / Djafaara, Bimandra A / Cucunubá, Zulma / Olivera Mesa, Daniela / Green, Will / Thompson, Hayley / Nayagam, Shevanthi / Ainslie, Kylie E C / Bhatia, Sangeeta / Bhatt, Samir / Boonyasiri, Adhiratha / Boyd, Olivia / Brazeau, Nicholas F / Cattarino, Lorenzo /
    Cuomo-Dannenburg, Gina / Dighe, Amy / Donnelly, Christl A / Dorigatti, Ilaria / van Elsland, Sabine L / FitzJohn, Rich / Fu, Han / Gaythorpe, Katy A M / Geidelberg, Lily / Grassly, Nicholas / Haw, David / Hayes, Sarah / Hinsley, Wes / Imai, Natsuko / Jorgensen, David / Knock, Edward / Laydon, Daniel / Mishra, Swapnil / Nedjati-Gilani, Gemma / Okell, Lucy C / Unwin, H Juliette / Verity, Robert / Vollmer, Michaela / Walters, Caroline E / Wang, Haowei / Wang, Yuanrong / Xi, Xiaoyue / Lalloo, David G / Ferguson, Neil M / Ghani, Azra C

    Science (New York, N.Y.)

    2020  Volume 369, Issue 6502, Page(s) 413–422

    Abstract: The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform ... ...

    Abstract The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower-income countries may reduce overall risk, but limited health system capacity coupled with closer intergenerational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower-income countries resulting from the poorer health care available. Of countries that have undertaken suppression to date, lower-income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep below available health capacity, with associated detrimental consequences for the wider health, well-being, and economies of these countries.
    MeSH term(s) COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Developing Countries ; Global Health ; Humans ; Pandemics/prevention & control ; Patient Acceptance of Health Care ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; Poverty ; Public Health
    Keywords covid19
    Language English
    Publishing date 2020-06-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 128410-1
    ISSN 1095-9203 ; 0036-8075
    ISSN (online) 1095-9203
    ISSN 0036-8075
    DOI 10.1126/science.abc0035
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  9. Article ; Online: Database of epidemic trends and control measures during the first wave of COVID-19 in mainland China.

    Fu, Han / Wang, Haowei / Xi, Xiaoyue / Boonyasiri, Adhiratha / Wang, Yuanrong / Hinsley, Wes / Fraser, Keith J / McCabe, Ruth / Olivera Mesa, Daniela / Skarp, Janetta / Ledda, Alice / Dewé, Tamsin / Dighe, Amy / Winskill, Peter / van Elsland, Sabine L / Ainslie, Kylie E C / Baguelin, Marc / Bhatt, Samir / Boyd, Olivia /
    Brazeau, Nicholas F / Cattarino, Lorenzo / Charles, Giovanni / Coupland, Helen / Cucunuba, Zulma M / Cuomo-Dannenburg, Gina / Donnelly, Christl A / Dorigatti, Ilaria / Eales, Oliver D / FitzJohn, Richard G / Flaxman, Seth / Gaythorpe, Katy A M / Ghani, Azra C / Green, William D / Hamlet, Arran / Hauck, Katharina / Haw, David J / Jeffrey, Benjamin / Laydon, Daniel J / Lees, John A / Mellan, Thomas / Mishra, Swapnil / Nedjati-Gilani, Gemma / Nouvellet, Pierre / Okell, Lucy / Parag, Kris V / Ragonnet-Cronin, Manon / Riley, Steven / Schmit, Nora / Thompson, Hayley A / Unwin, H Juliette T / Verity, Robert / Vollmer, Michaela A C / Volz, Erik / Walker, Patrick G T / Walters, Caroline E / Watson, Oliver J / Whittaker, Charles / Whittles, Lilith K / Imai, Natsuko / Bhatia, Sangeeta / Ferguson, Neil M

    International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

    2020  Volume 102, Page(s) 463–471

    Abstract: Objectives: In this data collation study, we aimed to provide a comprehensive database describing the epidemic trends and responses during the first wave of coronavirus disease 2019 (COVID-19) throughout the main provinces in China.: Methods: From ... ...

    Abstract Objectives: In this data collation study, we aimed to provide a comprehensive database describing the epidemic trends and responses during the first wave of coronavirus disease 2019 (COVID-19) throughout the main provinces in China.
    Methods: From mid-January to March 2020, we extracted publicly available data regarding the spread and control of COVID-19 from 31 provincial health authorities and major media outlets in mainland China. Based on these data, we conducted descriptive analyses of the epidemic in the six most-affected provinces.
    Results: School closures, travel restrictions, community-level lockdown, and contact tracing were introduced concurrently around late January but subsequent epidemic trends differed among provinces. Compared with Hubei, the other five most-affected provinces reported a lower crude case fatality ratio and proportion of critical and severe hospitalised cases. From March 2020, as the local transmission of COVID-19 declined, switching the focus of measures to the testing and quarantine of inbound travellers may have helped to sustain the control of the epidemic.
    Conclusions: Aggregated indicators of case notifications and severity distributions are essential for monitoring an epidemic. A publicly available database containing these indicators and information regarding control measures is a useful resource for further research and policy planning in response to the COVID-19 epidemic.
    MeSH term(s) COVID-19/epidemiology ; COVID-19/prevention & control ; China/epidemiology ; Contact Tracing ; Databases, Factual ; Humans ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-10-31
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 1331197-9
    ISSN 1878-3511 ; 1201-9712
    ISSN (online) 1878-3511
    ISSN 1201-9712
    DOI 10.1016/j.ijid.2020.10.075
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  10. Article: The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries

    Walker, Patrick G T / Whittaker, Charles / Watson, Oliver J / Baguelin, Marc / Winskill, Peter / Hamlet, Arran / Djafaara, Bimandra A / Cucunubá, Zulma / Olivera Mesa, Daniela / Green, Will / Thompson, Hayley / Nayagam, Shevanthi / Ainslie, Kylie E C / Bhatia, Sangeeta / Bhatt, Samir / Boonyasiri, Adhiratha / Boyd, Olivia / Brazeau, Nicholas F / Cattarino, Lorenzo /
    Cuomo-Dannenburg, Gina / Dighe, Amy / Donnelly, Christl A / Dorigatti, Ilaria / van Elsland, Sabine L / FitzJohn, Rich / Fu, Han / Gaythorpe, Katy A M / Geidelberg, Lily / Grassly, Nicholas / Haw, David / Hayes, Sarah / Hinsley, Wes / Imai, Natsuko / Jorgensen, David / Knock, Edward / Laydon, Daniel / Mishra, Swapnil / Nedjati-Gilani, Gemma / Okell, Lucy C / Unwin, H Juliette / Verity, Robert / Vollmer, Michaela / Walters, Caroline E / Wang, Haowei / Wang, Yuanrong / Xi, Xiaoyue / Lalloo, David G / Ferguson, Neil M / Ghani, Azra C

    Science

    Abstract: The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform ... ...

    Abstract The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower-income countries may reduce overall risk, but limited health system capacity coupled with closer intergenerational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower-income countries resulting from the poorer health care available. Of countries that have undertaken suppression to date, lower-income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep below available health capacity, with associated detrimental consequences for the wider health, well-being, and economies of these countries.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #595548
    Database COVID19

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