Suchergebnisse

An important unknown during the coronavirus disease-2019 (COVID-19) pandemic has been the infection fatality rate (IFR). This differs from the case fatality rate (CFR) as an estimate of the number of deaths and as a proportion of the total number of cases, including those who are mild and asymptomatic. While the CFR is extremely valuable for experts, IFR is increasingly being called for by policy makers and the lay public as an estimate of the overall mortality from COVID-19. Methods: Pubmed, Medline, SSRN, and Medrxiv were searched using a set of terms and Boolean operators on 25/04/2020 and re-searched on 14/05/2020, 21/05/2020 and 16/06/2020. Articles were screened for inclusion by both authors. Meta-analysis was performed in Stata 15.1 by using the metan command, based on IFR and confidence intervals extracted from each study. Google/Google Scholar was used to assess the grey literature relating to government reports. Results: After exclusions, there were 24 estimates of IFR included in the final meta-analysis, from a wide range of countries, published between February and June 2020. The meta-analysis demonstrated a point estimate of IFR of 0.68% (0.53%–0.82%) with high heterogeneity (p < 0.001). Conclusion: Based on a systematic review and meta-analysis of published evidence on COVID-19 until July 2020, the IFR of the disease across populations is 0.68% (0.53%–0.82%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents a completely unbiased point estimate. It is likely that, due to age and perhaps underlying comorbidities in the population, different places will experience different IFRs due to the disease. Given issues with mortality recording, it is also likely that this represents an underestimate of the true IFR figure. More research looking at age-stratified IFR is urgently needed to inform policymaking on this front.

Determine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities 4 weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age. Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus. These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10654-020-00698-1) contains ...

Abstract
Background
The practice of clinical research is strictly regulated by law. During submission and review processes, compliance of such research with the laws enforced in the country where it was conducted is not always correctly filled in by the authors or verified by the editors. Here, we report a case of a single institution for which one may find hundreds of publications with seemingly relevant ethical concerns, along with 10 months of follow-up through contacts with the editors of these articles. We thus argue for a stricter control of ethical authorization by scientific editors and we call on publishers to cooperate to this end.

Methods
We present an investigation of the ethics and legal aspects of 456 studies published by
the IHU-MI (Institut
Hospitalo-Universitaire Méditerranée Infection) in Marseille, France.

Results
We identified a wide range of issues with the stated research authorization and
ethics of the published studies with respect to the Institutional Review Board
and the approval presented. Among the studies investigated, 248 were conducted
with the same ethics approval number, even though the subjects, samples, and
countries of investigation were different. Thirty-nine (39) did not even
contain a reference to the ethics approval number while they present research
on human beings. We thus contacted the journals that published these articles
and provide their responses to our concerns. It should be noted that, since our
investigation and reporting to journals, PLOS has issued expressions of
concerns for several publications we analyze here.

Conclusion
This case presents an investigation of the veracity of ethical approval,
and more than 10 months of follow-up by independent researchers. We call for
stricter control and cooperation in handling of these cases, including
editorial requirement to upload ethical approval documents, guidelines from
COPE to address such ethical concerns, and transparent editorial policies and
timelines to answer such concerns. All supplementary materials are available.

[Extract] During the pandemic, there has been ongoing and contentious debate around the impact of restrictive government measures to contain SARS-CoV-2 outbreaks, often termed 'lockdowns'. We define a 'lockdown' as a highly restrictive set of non-pharmaceutical interventions against COVID-19, including either stay-at-home orders or interventions with an equivalent effect on movement in the population through restriction of movement. While necessarily broad, this definition encompasses the strict interventions embraced by many nations during the pandemic, particularly those that have prevented individuals from venturing outside of their homes for most reasons. The claims often include the idea that the benefits of lockdowns on infection control may be outweighed by the negative impacts on the economy, social structure, education and mental health. A much stronger claim that has still persistently appeared in the media as well as peer-reviewed research concerns only health effects: that there has been a large toll of death and disease attributable directly to government action against COVID-19, a toll larger than that of COVID-19 itself.1 2 The tagline for this claim is that "the cure is worse than the disease".

Central to a successful population vaccination program is high uptake of vaccines. However, COVID-19 vaccine uptake may be impeded by beliefs based on misinformation. We sought to understand the prevalence and nature of misbeliefs about COVID-19 vaccines, and identify associated factors, shortly after commencement of Australia's national vaccine rollout. A cross-sectional survey was administered to unvaccinated young adults (n = 2050) in Australia aged 18–49 years (mean age 33 years), 13 July–21 August 2021. This sample was previously under-represented in COVID-19 research but shown to have less willingness to vaccinate. Two thirds of participants agreed with at least one misbelief item. Misperceptions about COVID-19 vaccines were found to be significantly associated with lower health literacy, less knowledge about vaccines, lower perceived personal risk of COVID-19, greater endorsement of conspiracy beliefs, and lower confidence and trust in government and scientific institutions. Misbeliefs were more common in participants with less educational attainment, in younger age groups, and in males, as per previous research. Understanding determinants and barriers to vaccination uptake, such as knowledge and beliefs based on misinformation, can help to shape effective public health communication and inform debunking efforts at this critical time and in the future.