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COVID-19 wrap: Deaths, tweets, vaccines, Africa, children, strategy, communication and behaviour change

In the latest edition of the COVID-19 wrap, public health researcher Alison Barrett reports on death tolls, analysing Twitter, vaccine development, the challenges African nations may face, children’s rights and policies and strategies.

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Why daily death tolls have become unusually important in understanding the coronavirus pandemic

Subbaraman, N, Nature News, 9 April 2020

Due to the difficulties in counting the number of COVID-19 infections (i.e. people not showing symptoms, limited testing in many countries), researchers look at the daily deaths credited to COVID-19 to monitor the impact of the pandemic.

Monitoring the death toll provides a broader understanding of the pandemic, as the virus is “now widespread enough that the reported number of deaths within a country, day by day or week by week, is a surer tracker of the disease’s progress and effectiveness of containment than are other measures,” says Subbaraman.

Using Italy as an example, one of the countries with the highest reported number of deaths from COVID-19, we can see in the image below that the death rate now seems to be declining, indicating that the disease has reached its peak and progressing at a slower rate.

Image sourced from Our World in Data, published in Nature, 9 April 2020

This information also helps gauge healthcare needs. In the US, they used the daily death rates to forecast the number of hospital beds and ventilators that would be required.

There are challenges in tracking death rates though. There are likely to be delays in different healthcare facilities around the world tallying and reporting daily deaths to officials and there are accounts (here, here and here) that for various reasons, deaths from COVID-19 are underreported.

Comparing trends between countries should only be done with caution. Different population’s demographics, definitions of “coronavirus death” and timing of public health measures being introduced make it a challenge to compare with certainty.

Dr Majumder, an epidemiologist in the US, says: “This disease is going to look enormously different from one context to another, and we need to get comfortable with that.”

Despite this, monitoring the growth of daily deaths from COVID-19 is a useful method for researchers in tracking the progress of the pandemic in different regions.

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Top concerns of tweeters during the COVID-19 pandemic: Infoveillance study

Abd-Alrazaq, A, Journal of Medical Internet Research, 21 April 2020

During a pandemic, social media can play an important role as a source of information for the public. It can also be a valuable tool for public health professionals in gaining an understanding of attitudes and behaviours, helping to inform their health promotion messages.

The authors of this study, analysed 167, 073 English-language tweets that were tweeted between 2 February and 15 March 2020 about COVID-19 and found the main topics that were being tweeted could be grouped into four themes.

  • Origin of COVID-19: people tweeted about China and specific details about how, when and where the outbreak emerged.
  • The source of the novel coronavirus: people tweeted about two possible causes for the transfer of the virus to humans- eating meat and the development of bioweapons.
  • Impact of COVID-19 on people and countries: six effects of the pandemic were identified – the number of deaths, anxiety due to its quick spread and no vaccine, effects on travel, impact on the economy, panic buying and racism.
  • Methods for decreasing the spread of COVID-19: two main methods dominated this theme – quarantine and wearing masks.

The authors also analysed sentiment, likes and interactions of tweets by measuring mean followers, likes, retweets and user mentions. The sentiments of tweets were, on average, positive, except in relation to tweets about death and increased racism. The tweets with the highest average of likes were about economic losses, and the lowest average of likes were on tweets about travel bans.

The findings indicate what the Twitterverse was most concerned about. This provides useful information for public health and policy officials in helping them create and disseminate important public health messages on social media.

However, the authors note some challenges disrupting the public health response on Twitter; largely the tendency for misinformation to spread rapidly. 

While the researchers did not place any geographical restrictions on the tweets they analysed, the generalisability of the results may be limited as they only analysed English-language tweets. They also did not have access to tweets from private accounts, meaning that the findings may not be a true representation of all of the topics tweeted about COVID-19 during that time. Twitter is not used by everyone and topics and sentiments may differ on other social media platforms.

In conclusion, while acknowledging the results may not be relevant to all populations, the findings indicate that Twitter can be a great source of information and a means of sharing experiences during a pandemic, and public health and policy officials should utilise it more widely in their response. The authors recommend increased surveillance of Twitter during disease outbreaks to monitor and mitigate the spread of misinformation.

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If a coronavirus vaccine arrives, can the world make enough?

Khamsi, R, Nature News Feature, 9 April 2020

Researchers around the world are working hard to find a vaccine against the SARS-CoV-2 virus. While it is estimated that one might be ready in 12–18 months, researchers caution that there may not be enough vaccine available for everyone.

Some of the main concerns are with competing manufacturing needs and ensuring the distribution of a vaccine is equitable.

Once a vaccine against the novel coronavirus is ready for manufacturing, there is a need for that to go ahead rapidly without disrupting the manufacture of other important vaccines (i.e. for influenza, measles, mumps and rubella). This may mean that new facilities need to be built to make the COVID-19 vaccine; but the infrastructure required for these facilities will not be known until the type of vaccine is known.

A great concern exists that richer countries or those who make the vaccine will stockpile it for their own populations’ use, as has happened in previous epidemics, meaning that many people will miss out.

The author reports there is currently no guidance or agreement about how to allocate the vaccine fairly, although the World Health Organization is working on this with other global leaders.

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Africa in the path of Covid-19

El-Sadr, WM, New England Journal of Medicine, 17 April 2020

At the time of publication, Africa hadn’t yet witnessed the impact of COVID-19 that China, United States and Europe had experienced. As of 13 April, there had been approximately 14,000 confirmed cases of COVID-19 on the whole African continent, compared with 160,000 in Italy and 560,000 in US at the same time.

However the authors say: “Despite the slow arrival of COVID-19, a storm is building, and the 1.2 billion people living in Africa are at tremendous risk.”

Most African countries are not prepared for the pandemic; they have limited ICU beds and ventilators and people living in rural areas have challenges accessing health facilities.

In some countries, measures have been put in place: schools and churches have been closed in South Sudan; a lockdown is in place in South Africa; and tents have been set up outside a large hospital in Kenya to take temperatures and provide information about COVID-19 to communities.

Public health measures are a challenge to adhere to in many African communities due to overcrowding and limited access to clean running water.

However, due to their previous experience dealing with epidemics (i.e. HIV, malaria, tuberculosis and Ebola), their health systems have been strengthened and governments and communities are used to the quick implementation of measures required.

Authors urge other countries to assist Africa in their response to COVID-19 by donating test kits, personal protective equipment and ventilators, learning from past experiences: “When HIV spread like wildfire across the African continent, it took decades for the world to mobilise a response.” Everyone must help to ensure this doesn’t happen again.

Read more on Africa’s efforts to prepare.

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COVID-19 and children’s rights

Human Rights Watch, 9 April 2020

While it appears that children who are infected with COVID-19 have milder symptoms than other age groups, many are going to experience other challenges that will have long-lasting negative consequences.

With children out of school and families stressed from job losses, economic insecurity and other restrictions necessary to manage the COVID-19 pandemic, it is likely that rates of child labour, sexual exploitation and violence at home will increase.

This report, by Human Rights Watch, outlines the key risks to the human rights of children as a result of COVID-19; and recommendations for governments’ response to protect children from the potentially devastating effects of the pandemic.

The key human rights risks to children as a result of COVID-19 are disruption to effective education; increased violence at home; more orphaned children due to deaths of parents from COVID-19; increased poverty, child labour and child marriage, sexual exploitation of children; institutionalisation; health issues; and increased displacement.

“The COVID-19 pandemic has highlighted grave weaknesses in many countries’ protections for children, including inadequate healthcare and social protection systems, overcrowded detention facilities, and the lack of emergency action plans for large-scale school shutdowns.”

For a more detailed account of the recommendations for governments to mitigate the negative impacts on children, please view the full report here.

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Whose coronavirus strategy worked best? Scientists hunt most effective policies

Gibney, E, Nature News, 27 April 2020

As countries prepare to reduce some of the strict lockdown measures in place to manage COVID-19 infections, researchers are looking to determine which methods around the world have worked best to control transmission rates.

A team at the London School of Hygiene and Tropical Medicine is working on compiling data from hundreds of interventions implemented worldwide in order to standardise information for analysis and create models “that use data from individual countries to understand the effect of control measures,” the authors say, allowing them to “make more accurate predictions about new phases of the pandemic.”

Some of their preliminary work has identified that poorer countries have tended to implement stricter measures than richer countries; and in Europe, countries that implemented strict measures and early on their epidemic (i.e. Germany and Austria) have experienced far less deaths from COVID-19 than other countries (i.e. Italy, France and Spain) that implemented similar measures but later in their epidemics.

It is a challenge to measure and compare individual countries as they will have all had their own experience of the pandemic and implemented measures based on local political and social contexts.

However, this research is important for making decisions about the best ways to move forward and away from strict lockdown measures. 

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New behaviour change guidance to help reduce spread of COVID-19

British Psychological Society, 17 April 2020

The British Psychological Society has produced a guideline document to help policy-makers make informed decisions about motivating behaviour change in reducing COVID-19 infections, including recommendations on effective communication strategies.

Below are some of the key points in the document; we recommend viewing the full document here:

  • When communicating, use ‘we’ instead of ‘I’ to create a shared viewpoint.
  • Communicate messages in appropriate terms, from credible sources.
  • Be mindful not to generate fear, but instilling a sense of worry is OK to promote behaviour change.
  • Messages need to target key drivers for behaviour change: capabilities, opportunities and motivation for people to perform the desired behaviour.
  • Clear communication about the effectiveness of desired behaviours is required.
  • Understand the target audience to ensure messages do not have unintended negative consequences.
  • Levels of health literacy must be considered when providing important information.
  • Use evidence-based research to support COVID-19 response.

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Other useful resources

John Hopkins Bloomberg School of Public Health have published a guideline document for the Public health principles for a phased reopening during COVID-19.

The COVID-19 Evidence Network to support Decision-making (COVID-END) is a collaboration to “help coordinate and avoid duplication” of important COVID-19 research. You can find more about its focus here.

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Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.

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