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The social cost of contacts: Theory and evidence for the first wave of the COVID-19 pandemic in Germany.

ABSTRACT: Building on the epidemiological SIR model, we present an economic model with heterogeneous individuals deriving utility from social contacts creating infection risks. Focusing on social distancing of individuals susceptible to an infection we theoretically characterize the gap between private and social cost of contacts. Our main contribution is to quantify this gap by calibrating the model with unique survey data from Germany on social distancing and impure altruism from the beginning of the COVID-19 pandemic. The optimal policy is to drastically reduce contacts at the beginning to almost eradicate the epidemic and keep them at levels that contain the pandemic at a low prevalence level. We find that also in laissez faire, private protection efforts by forward-looking, risk averse individuals would have stabilized the epidemic, but at a much higher prevalence of infection than optimal. Altruistic motives increase individual protection efforts, but a substantial gap to the social optimum remains.

SUBMITTER: Quaas MF

PROVIDER: S-EPMC7978372 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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The social cost of contacts: Theory and evidence for the first wave of the COVID-19 pandemic in Germany.

Quaas Martin F MF Meya Jasper N JN Schenk Hanna H Bos Björn B Drupp Moritz A MA Requate Till T

PloS one 20210319 3

Building on the epidemiological SIR model, we present an economic model with heterogeneous individuals deriving utility from social contacts creating infection risks. Focusing on social distancing of individuals susceptible to an infection we theoretically characterize the gap between private and social cost of contacts. Our main contribution is to quantify this gap by calibrating the model with unique survey data from Germany on social distancing and impure altruism from the beginning of the CO ...[more]

PMID: 33740007

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Project description:BackgroundThe COVID-19 pandemic has led to physical distancing measures to control the spread of SARS-CoV-2. Evidence on contact dynamics in different socioeconomic groups is still sparse. This study aimed to investigate the association of socioeconomic status with private and professional contact reductions in the first COVID-19 wave in Germany.MethodsData from two especially affected municipalities were derived from the population-based cross-sectional seroepidemiological CORONA-MONITORING lokal study (data collection May-July 2020). The study sample (n = 3,637) was restricted to working age (18-67 years). We calculated the association of educational and occupational status (low, medium, high) with self-reported private and professional contact reductions with respect to former contact levels in the first wave of the pandemic. Multivariate Poisson regressions were performed to estimate prevalence ratios (PR) adjusted for municipality, age, gender, country of birth, household size, contact levels before physical distancing measures, own infection status, contact to SARS-CoV-2 infected people and working remotely.ResultsThe analyses showed significant differences in the initial level of private and professional contacts by educational and occupational status. Less private contact reductions with lower educational status (PR low vs. high = 0,79 [CI = 0.68-0.91], p = 0.002; PR medium vs. high = 0,93 [CI = 0.89-0.97], p = 0.001) and less professional contact reductions with lower educational status (PR low vs. high = 0,87 [CI = 0.70-1.07], p = 0.179; PR medium vs. high = 0,89 [CI = 0.83-0.95], p = 0.001) and lower occupational status (PR low vs. high = 0,62 [CI = 0.55-0.71], p < 0.001; PR medium vs. high = 0,82 [CI = 0.77-0.88], p < 0.001) were observed.ConclusionsOur results indicate disadvantages for groups with lower socioeconomic status in private and professional contact reductions in the first wave of the pandemic. This may be associated with the higher risk of infection among individuals in lower socioeconomic groups. Preventive measures that a) adequately explain the importance of contact restrictions with respect to varying living and working conditions and b) facilitate the implementation of these reductions especially in the occupational setting seem necessary to better protect structurally disadvantaged groups during epidemics.

Project description:IntroductionAccess to COVID-19-related care during the pandemic deserve attention and study to inform future strategies to deal with similar health emergencies in the future. We aimed to describe access to care for COVID-19-related reasons during the first 9 weeks of the pandemic in Portugal, to quantify the frequency of remote and in-person contacts with healthcare for COVID-19-related reasons and to assess the association between individual and context characteristics and contacts with health services.MethodsWe conducted an internet-based open cohort study with a non-probabilistic sample of 12 006 persons aged 16 years or more. One questionnaire was sent daily from 23 March 2020 for 9 weeks.ResultsGeneral practitioners (GPs) were the main points of contact of patients with health services for COVID-19-related reasons. In our population, the main drivers found for any difference in the probability of contact with health services for COVID-19-related reasons were perceived high-risk contacts, followed by the existence of COVID-19 main symptoms. There were 17% more (0.17, 95% CI 0.15 to 0.18) contacts with health services among participants who reported personal contact with a confirmed case, 7% more (0.07, 95%CI 0.06 to 0.07) contacts if the contact had been with a suspected case and 6% more (0.06, 95%CI 0.05 to 0.07) contacts among participants who reported COVID-19 main symptoms in the previous 24 hours. Sociodemographic and household factors were not associated with major differences in healthcare contacts. The probability of contact with any health service for COVID-19-related reasons was highest at the beginning of the pandemic.ConclusionMost contacts with health services for COVID-19-related reasons during the first wave of the pandemic were with GPs, highlighting the role of first-contact care with these clinicians in Portuguese Primary Care, particularly in the context of the COVID-19 pandemic. Sociodemographic and household factors were not associated with major risk differences, suggesting that universal coverage and equity worked in our study sample at this pandemic stage.

Project description:ObjectiveTo better define the immunopathogenesis of COVID-19, the present study aims to characterize the early immune responses to SARS-CoV-2 infection in household contacts of COVID-19 cases. In particular, innate, T- and B-cell specific responses were evaluated over time.MethodsHousehold contacts of COVID-19 cases screened for SARS-CoV-2 infection by nasopharyngeal swab for surveillance purposes were enrolled (T0, n=42). Of these, 28 subjects returned for a follow-up test (T1). The innate response was assessed by detecting a panel of soluble factors by multiplex-technology in plasma samples. Cell-mediated response was evaluated by measuring interferon (IFN)-γ levels by ELISA in plasma harvested from whole-blood stimulated with SARS-CoV-2 peptide pools, including spike (S), nucleocapsid (N) and membrane (M) proteins. The serological response was assessed by quantifying anti-Receptor-Binding-Domain (RBD), anti-Nucleocapsid (N), whole virus indirect immunofluorescence, and neutralizing antibodies.ResultsAt T0, higher levels of plasmatic IFN-α, IL-1ra, MCP-1 and IP-10, and lower levels of IL-1β, IL-9, MIP-1β and RANTES were observed in subjects with positive swab compared to individuals with a negative one (p<0.05). Plasmatic IFN-α was the only cytokine detectable in subjects with positive SARS-CoV-2 swabs with high accuracy for swab score positivity (0.93, p<0.0001). Among subjects with positive swabs, significant negative correlations were found among the RT-PCR cycle threshold values reported for genes S and N and IFN-α or IP-10 levels. At T0, the IFN-γ T-cell specific response was detected in 50% (5/10) of subjects with positive swab, while anti-RBD/anti-N antibodies showed a positivity rate of 10% (1/10). At T1, the IFN-γ T-cell specific response was detected in most of the confirmed-infection subjects (77.8%, 7/9), whereas the serological response was still observed in a minority of them (44.4%, 4/9). Overall, the swab test showed a moderate concordance with the T-cell response (78.6%, k=0.467), and a scarce concordance with the serological one (72.9%, k=0.194).ConclusionsPlasmatic IFN-α and the IFN-γ T-cell specific response appear early even in the absence of seroconversion, and show a greater positivity rate than the serological response in household contacts with positive swab.

Project description:ObjectivesKnowledge about the socioeconomic spread of the first wave of COVID-19 infections in Germany is scattered across different studies. We explored whether COVID-19 incidence rates differed between counties according to their socioeconomic characteristics using a wide range of indicators.Data and methodWe used data from the Robert Koch-Institute (RKI) on 204 217 COVID-19 diagnoses in the total German population of 83.1 million, distinguishing five distinct periods between 1 January and 23 July 2020. For each period, we calculated age-standardised incidence rates of COVID-19 diagnoses on the county level and characterised the counties by 166 macro variables. We trained gradient boosting models to predict the age-standardised incidence rates with the macrostructures of the counties and used SHapley Additive exPlanations (SHAP) values to characterise the 20 most prominent features in terms of negative/positive correlations with the outcome variable.ResultsThe first COVID-19 wave started as a disease in wealthy rural counties in southern Germany and ventured into poorer urban and agricultural counties during the course of the first wave. High age-standardised incidence in low socioeconomic status (SES) counties became more pronounced from the second lockdown period onwards, when wealthy counties appeared to be better protected. Features related to economic and educational characteristics of the young population in a county played an important role at the beginning of the pandemic up to the second lockdown phase, as did features related to the population living in nursing homes; those related to international migration and a large proportion of foreigners living in a county became important in the postlockdown period.ConclusionHigh mobility of high SES groups may drive the pandemic at the beginning of waves, while mitigation measures and beliefs about the seriousness of the pandemic as well as the compliance with mitigation measures may put lower SES groups at higher risks later on.

Project description:BackgroundAs the COVID-19 pandemic swept across the globe at the beginning of 2020, healthcare systems were forced to rapidly adapt and expand to meet the sudden surge in demand for intensive care services. This study is the first systematic analysis of the strategies employed by German hospitals to recruit personnel and expand bed capacities during the first wave of the pandemic, and to evaluate the effectiveness of those recruitment measures.Methods152 German hospitals with intensive care capacities were selected and invited to participate in an online-based retrospective survey. Factors like the geographic distribution, individual COVID burden and level of care were considered for inclusion in the sample. The data were analyzed descriptively.ResultsA total of 41 hospitals participated in the survey. The additional demand for intensive care beds was met primarily by activating intensive care beds that were previously considered as non-operational in existing intensive care units (81% of respondents) and by upgrading recovery rooms (73%). The physician staffing requirements were met at approximately 75%, while the nursing staffing requirements were only met by about 45%. Staffing needs were met through reallocations/transfers (85%), staff recruitment from parental leave or retirement (49%), increased hours worked by internal staff (49%), new staff hiring (44%) and increased use of temporary staff (32%). Staff reallocations/transfers to critical care within a hospital were rated as the most effective measure. In this context, specialized personnel mostly from anesthesiology departments were appointed to intensive care medicine.ConclusionsDespite multiple recruitment efforts, the pandemic has exacerbated the nursing staff shortage. The reallocation of existing staff within hospitals was a key element in covering the staffing needs. However, additional measures and efforts are required in order to ensure that critically ill patients can be cared for without compromise. The results of this study may have important implications for healthcare providers and policymakers, offering an evidence-based foundation for responding to future public health emergencies with agility, efficiency, and success.

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The social cost of contacts: Theory and evidence for the first wave of the COVID-19 pandemic in Germany.

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The social cost of contacts: Theory and evidence for the first wave of the COVID-19 pandemic in Germany.

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