As of Oct 11 in Ontario, 58 LTC facilities in outbreak.
What did we need to do?
Paid leave for part-time staff if need to quarantine or isolate
(Seriously, how has this not happened yet? WTF!)
Overcome barriers to testing/symptom disclosure
(see note about PAID-LEAVE???)
2/4
What did we actually do?
Shut restaurants, gyms, and strip clubs.
I'm not an economist, but guess structural interventions would cost pennies on the dollar to whatever is happening now.
So when do we move from a populist to an empiric response? Ie, when is enough enough?
3/4
With wave 2, can we start addressing underlying determinants with:
1) Paid leave if under investigation or infected 2) Housing support particularly for those in multigenerational households 3) Overcoming any barriers to testing and health care
Intended to help to do independent critical appraisal of the data being released in #COVID19 including an overview of study designs.
Also to help you assess whether "experts" did critical appraisal or are just repeating abstract
Quantitative Study Designs
Only covering studies where unit of analysis is an individual person.
There are also ecological studies which use a population as the level of analysis and systematic reviews & meta analyses which quantitatively combine results of several studies.
Observational Studies - Descriptive
Examples: case reports, case-series reports, surveillance studies, surveys
Cross-sectional studies - Describe the prevalence of a disease or other phenomena without looking for associations between variables
I often see an assumption that the COVID vaccines being trialed will be available for kids at the same time as adults assuming efficacy. And that's a big (HUGE) assumption.
Let's take a look at the Oxford, Moderna, and Pfizer trials
Team -- what competencies should be in the emergency operations center (EOC) making decisions (methodologists, practitioners, clinicians, gov't, lawyers, clinicians, economists)
Stakeholder Analysis (who will be affected/needs representation)
Epidemiological Analysis (CFR, IFR, RR, etc)
Situational Analysis (decision tree with different response models of expected benefits and costs. Costs include human, financial, and institutional.
Goals
Based on the three types of analyses, set a goal for your response.
Set specific, measurable, attainable, relevant, and time-bound (SMART) Objectives that flow from the goal used to inform key performance indicators.
Can be done in 2-3 hours with with analyses complete.
Testing is not an intervention
Diagnosis is not an intervention
Testing and diagnosis will only have as much public health and clinical impacts as they facilitate decreasing onward transmission risks or access to care, respectively
1/6
For sexually transmitted infections, testing and diagnosis are critical because they are linked to interventions or actions that directly decrease onward transmission risks including:
1) Curative antibiotics 2) Antiretroviral therapy for HIV 3) Condoms 4) Avoid sex
2/6
For respiratory infections, how will a diagnosis help if your:
1) Living situation does not allow for isolation? 2) Work does not provide paid or even unpaid sick leave? 3) Family is dependent on your income to meet basic needs? 4) Access to care is linked to employment
3/6