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Persons with SARS-CoV2 can be contagious with few or no symptoms. They can infect others in private, during education or work without knowing it. Few so-called super-propagators can thus initiate clusters of infections and chains of transmission. Isolation of new cases and quarantine of their contacts (forward contact tracing) often does not uncover such situations. Adding detailed backward investigations of events and places with elevated risk of transmission can increase the identification of potentially infected persons. These can then be quarantined, and chains of transmission be interrupted. We describe the principles and challenges of cluster investigation, epidemiological methods and IT tools that we deve loped at the Centre for contact tracing, Vaud. Knowledge of this method is useful in general clinical practice during a pandemic.

Objective: As alcohol is often consumed for social purposes, we aimed to explore how restrictions during the first Danish COVID-19 lockdown affected the alcohol use among adolescents aged 15–20. Method: In May 2020, 11,596 15- to 20-year-olds from two subpopulations answered a survey regarding their alcohol use and social life, as well as changes to these, during the Danish lockdown. Using survey data from all participants, we performed a multinomial logistic regression to assess the association between determinants of alcohol use and perceived change in alcohol use during the Danish lockdown. We used longitudinal data from one subpopulation ( n=1869) to perform negative binomial regressions exploring changes in frequency of alcohol use from 2019 to 2020. Results: Of all participants, 59% drank less, 75% had fewer in-person social interactions and 56% met more frequently online during lockdown. Girls were more likely than boys to have a perceived decrease in alcohol use during lockdown (odds ratio (OR)=1.41; 95% confidence interval (CI) 1.27–1.56). A perceived decrease in in-person social interaction during lockdown was associated with less drinking (OR=2.27; 95% CI 1.98–2.61), while a perceived increase in in-person social interaction during lockdown was associated with more drinking (OR=1.42; 95% CI 1.11–1.82) compared to unchanged drinking behaviour and social interaction. Conclusions: Adolescents in Denmark drank less during the Danish lockdown than before. Findings indicate that there is a close relationship between in-person social interactions and frequency of drinking. Drinking episodes when meeting online were rare and were not unambiguously associated with changes in drinking during lockdown.

AbstractSince the beginning of the coronavirus disease (COVID)-19 pandemic, the need for effective treatments for COVID-19 led to the idea of “repurposing” drugs for antiviral treatment. Several antipsychotics and antidepressants have been tested for in vitro activity against the severe acute respiratory syndrome coronavirus 2. Chlorpromazine, other phenothiazine antipsychotics, and the antidepressant fluoxetine were found to be rather potent in these studies. However, whether effective plasma concentrations can be obtained with clinically accepted doses of these drugs is not clear. Data of COVID-19 patients are not yet available but several clinical studies are currently underway.The specific serotonin reuptake inhibitor fluvoxamine is a potent Sigma-1 receptor agonist and reduces inflammation in animal models of cytokine-stress. Accordingly, fluvoxamine treatment was superior to placebo in reducing impaired respiratory function and other symptoms of inflammation in COVID-19 patients in a placebo-controlled clinical study and another open clinical trial. The beneficial effects of fluvoxamine on the course of COVID-19 were recently confirmed in a large placebo-controlled double-blind trial with several hundred patients.Inflammation represents a major risk factor for many psychiatric disorders which explains the high susceptibilitiy of COVID-19 patients for psychiatric diseases. Many antidepressants and antipsychotics possess anti-inflammatory properties independent of sigma-1 activity which might be important to reduce psychiatric symptoms of COVID-19 patients and to improve respiratory dysfunction and other consequences of inflammation. This might explain the rather unspecific benefit which has been reported for several cohorts of COVID-19 patients treated with different psychotropic drugs.

The approach of this chapter is polemical in nature, reflecting the very fluid situation that lies ahead for orchestras post COVID-19. The chapter has three main academic research objectives. First, to put the current debate in context, it looks at the key challenges that orchestras have faced since the turn of the last century and in what way COVID-19 posed new problems that impacted orchestral music. The second objective is to outline some special short-term measures introduced to mitigate the impact of COVID-19, namely: (i) the income-support measures needed to sustain orchestras; and (ii) the extent to which orchestras could come together and practice, and in fact perform, even if only in front of no or very limited live audiences. The third objective is to discuss what possibly lies ahead for live orchestral music, post-COVID-19, and in a rapidly changing world regarding technological advances in the production and consumption of orchestral music. To inform this discussion, some broad trends in the ‘consumption’ of orchestral music over time, particularly in terms of numbers attending live concerts and revenues from streamed concerts, are examined.

This paper analyzes single and two-wave COVID-19 outbreaks using two novel hybrid models, which combine machine learning and statistical methods with Richards growth models, to simulate and forecast the spread of the infection. For this purpose, historical cumulative numbers of confirmed cases for three countries, including Iran, Italy, and Mexico, are used. The analysis of the Richards models shows that its single-stage form can model the cumulative number of infections in countries with a single wave of outbreak (Italy and Mexico) accurately while its performance deteriorates for countries with two-wave outbreaks (Iran), which clarifies the requirement of multi-stage Richards models. The results of multi-stage Richards models reveal that the prevention of the second wave could reduce the outbreak size in Iran by approximately 400,000 cases, and the pandemic could be controlled almost 7 months earlier. Although the cumulative size of outbreak is estimated accurately using multi-stage Richards models, the results show that these models cannot forecast the daily number of cases, which are important for health systems’ planning. Therefore, two novel hybrid models, including autoregressive integrated moving average (ARIMA)-Richards and nonlinear autoregressive neural network (NAR)-Richards, are proposed. The accuracy of these models in forecasting the number of daily cases for 14 days ahead is calculated using the test data set shows that forecast error ranges from 8 to 25%. A comparison between these hybrid models also shows that the machine learning-based models have superior performance compared with statistical-based ones and on average are 20% more accurate.

Abstract Objectives To assess depression, anxiety and stress among undergraduate nursing and midwifery students during the COVID-19 pandemic, and identify socio-demographic and educational characteristics associated with higher depression, anxiety and stress scores. Methods Cross-sectional study during August–September 2020, using an anonymous, online, self-administered survey. E-mail invitations with a survey link were sent to 2,907 students enrolled in the Bachelor of Nursing suite of courses, offered across four campuses of a single university in Victoria, Australia. Depression, anxiety and stress were assessed using the DASS-21. Data on socio-demographic and educational characteristics, self-rated physical health and exposure to COVID-19 were also collected. DASS-21 subscale scores were compared with existing data for various pre-pandemic and COVID-19 samples. Multiple regression was used to investigate factors associated with higher scores on depression, anxiety and stress subscales. Results The response rate was 22% (n=638). Mean scores on all DASS-21 subscales were significantly higher (p<0.001) than means from all comparative sample data. The proportions of students reporting moderate to severe symptoms of depression, anxiety and stress were 48.5%, 37.2% and 40.2% respectively. Being a woman, being younger, having completed more years of study and having poorer self-rated general health were all significantly associated (p<0.05) with higher scores on at least one DASS-21 subscale. Conclusions Almost half of participants reported at least moderate symptoms of depression; more than a third reported at least moderate symptoms of anxiety or stress. Poor psychological wellbeing can impact students’ successful completion of their studies and therefore, has implications for nursing and midwifery workforce recruitment and retention. During and after pandemics, universities should consider screening undergraduate students not only for anxiety and stress, but also for depression. Clear, low-cost referral pathways should be available, should screening indicate that further diagnosis or treatment is required.

We read with interest a consensus statement of the ScotCap clinical leads collaboration reported by Macleod et al. on the use of Computer Tomography Colonography (CTC) and Colon Capsule Endoscopy (CCE) as promoted diagnostic modalities in the Covid-19 era and how to deal with diminutive and small polyps with a 'realistic medicine' approach (1). The issues discussed are important, and the suggestions made are essential to improve healthcare provision for patients, doctors, hospitals, and society. The number needed to colonoscope to find one significant neoplastic lesion has increased dramatically in recent years – in Denmark more than 4-fold in 15 years, whereas the number of cancers diagnosed has increased very modestly (20-30% in 15 years). In Europe alone, more than 12m colonoscopies are performed each year. Complications are primarily associated with therapeutic optical colonoscopies (OC); significant complications (bleeding, perforation and polypectomy syndrome) are seen in 0.7% and adding up to over 400.000 cases yearly (2).

In this article we discuss the findings of contributions to the special issue titled Social policy responses to COVID-19. The articles add to the body of emerging evidence on how the pandemic has exacerbated the situation for some already vulnerable population groups, while also creating new sources of vulnerability affecting different groups. Despite both aggravated and new vulnerabilities, the articles demonstrate how governments have largely responded within the frameworks of their existing systems and institutions. Hence, overall, we do not see major shifts in policy direction. At the same time, some innovative responses or efforts to reach different groups are apparent, and it may just be too early to identify more fundamental shifts. IOs can play a key role in supporting such potential reforms. However, although IOs called for global solidarity at the start of the pandemic, many countries have ‘gone in on themselves’ and governments have largely strengthened the national focus of their policies. The potential for IOs to provide strong leadership in the long-term is still conceivable. The crisis is global and with all the different measures countries have put in place, there is a wealth of experience that could be collected and shared and IOs are well placed to do this. Responding to the pandemic will continue to require a global social policy perspective.