74 e-Letters

published between 2017 and 2020

  • Co-linearity between pre-symptomatic and post-symptomatic mask wearing

    The effectiveness of masks in the household is a critically important topic for control of SARS-CoV-2 transmission. I am concerned the multivariate regression performed in this analysis incorrectly attributed all of the effect of post-symptomatic mask-wearing to the pre-symptomatic mask-wearing variable. It is highly likely that these 2 variables are highly co-linear, and looking at Table 2, it appears likely that those families that wore masks pre-symptoms (n=27 without transmission, n=4 with transmission) were largely the same families where all members of the household wore masks post-symptoms (n=31 without transmission, n=5 with transmission). It's likely there are not enough numbers to further disentangle whether pre-symptom or post-symptom mask-wearing truly was the benefit - most likely it's some of both.

    The message that post-symptomatic mask-wearing has no effect appears to lack sufficient support, so I would caution anyone jumping to use that conclusion here.

  • Preventing viral transmissions in communities and households: strategies from a multidisciplinary view highly needed

    Rapid response

    Preventing viral transmissions in communities and households: strategies from a multidisciplinary view highly needed

    Re: Reduction of secondary transmission of SARS-COV-2 in households by facemask use, disinfection and social distancing: a cohort study in Beijing, China. Yu Wang. BMJ Global Health 2020; 5: e002794, doi: 10.1136/bmjgh-2020-002794

    Dear Editor,

    In their original research in BMJ Global Health Wang et al. (1) claim that their study provides the first evidence for the effectiveness of face mask use and social distancing in preventing COVID-19 transmission, not just in public spaces but inside the household with members at risk of getting infected. They argue that these non-pharmaceutical interventions (NPI) reduce risk for families living with someone in quarantine or isolation and families of healthcare workers who may face ongoing risk and that NPI are effective at preventing transmission even in homes that are crowded and small.

    More specific, Wang et al. (1) conclude that face mask use 2 days prior to symptom onset could be preventing secondary transmission while starting to wear facemasks after the onset of symptoms did not have any effect on a secondary transmission. Almost a quarter of family members became infected in the families with a second transmission ( total of 77 persons with 13 children with a mean age of 3 years with mild symptoms and one child with asymptomatic symptoms, 64 adult cases; 3 as...

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  • COVID 19 in India – An Opportunity in Disguise

    We read with interest the commentary on COVID-19: time for paradigm shift in the nexus between local, national and global health by Elisabeth Paul et al [1] and agree with them. We would like to bring out the Indian perspective in our article and how it might change the host behaviour and health system.

    Every time a pandemic has occurred, it has changed the course of history and paved the way for economic development. People have changed their health behaviour out of fear of contracting the disease and the change has become a new norm.

    The novel COVID 19 pandemic is known to the world for around six months now. With a long incubation period, asymptomatic transmission and high infectiousness, it has spread rapidly, and has caused thousands of deaths in a short period. Right from the mode of transmission, control measures like ‘lockdown’, testing strategies and variable treatment modalities, the natural history of COVID 19 has been unusually rapid and lot has remained unexplained. Despite several predictive mathematical modeling exercises, the disease progression has been on its own will, infecting individuals at random and regulating itself as it has spread to countries of its choice. The clinical phenotype of the disease has been varying with time, place and person, defying the fundamental order of epidemiology. [2]

    The India curve has been delayed but community transmission in clusters is evident. India is a densely populated country but with a favou...

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  • YouTube as a source on information on COVID-19: a pandemic of misinformation? Response

    Dear Editor,

    After reading the article, we would like to sincerely congratulate the authors Heidi Oi-Yee Li, Adrian Bailey, David Huynh and James Chan on their successful piece titled ‘YouTube as a source of information on COVID-19: a pandemic of misinformation?’ published in the British Medical Journal. This is a very relevant piece of work and we would like to offer some contributions.

    As the Covid-19 pandemic progresses daily, social media platforms such as YouTube, unfortunately can become victims to showcasing anecdotal and premature evidence that can lead to fatal consequences and further spread of the so called ‘infodemic’(1). The article we are responding to worryingly demonstrates the large viewership, 62,042,609, of the non-factual videos on YouTube (2). Despite this representing only a quarter of the videos used in the study this shows these videos are perhaps more popular to watch which risks miseducating a large number of viewers.
    However, it appears that since the publication of this article in March 2020 this issue has come to light and been addressed. YouTube has now updated its policies and created a ‘COVID-19 medical misinformation policy’ (3) . Assumingly, this policy has been created to protect its audiences from misinformation, going against viewing algorithms that would normally display videos higher up on the suggestions based on viewing number levels. The policy enforces that the spread of medical misinformation regarding coron...

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  • COVID-19 restrictions and fathers of infants in neonatal care

    We fully agree with the authors in terms of need for a paradigm shift. We have called it a 'pandemic' but response has been largely country centric and not at all global.

    We would also like to highlight a typical reactionary response globally leading to exclusion of fathers from maternity and neonatal units.

    The Covid-19 pandemic is dividing families all over the world, especially at a time when togetherness is particularly important, such as at the time of birth, death and illness. Many families are experiencing situations that are prone to leave life-long scars.
    While the protection of the health of staff and mothers is of paramount importance, social distancing, curbs to travel and additional restrictions to presence of parents instituted by maternity and neonatal units across the world have created obvious difficulties for families. Having a sick baby in a neonatal unit during this pandemic is a particularly intense hardship for families. We are well aware of negative impacts of separation on children and families and the pandemic related restrictions have made this worse for the whole family, perhaps more so for parents of preterm and sick newborns.
    We have previously highlighted, along with many others, the importance of optimising fathers’ experiences in the neonatal unit (Ref 1-8) and suggested a focus on a co-parenting paradigm with a clear set of recommendations for neonatal and maternity services (Ref 1).
    Even though we...

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  • Integrating tech solutions into traditional gender-based violence programs

    Dear Editor,

    We were pleased to read the review by Eisenhut K, Sauerborn E, García-Moreno C, et al. and appreciated their insights on the landscape of mobile apps addressing violence against women.

    We read with great interest the authors’ observation that “collaborations between mHealth and ‘traditional’ approaches should be actively sought, subordinating the technology to the overall aims of preventing violence against women and mitigating its impacts.” In that spirit, we would like to highlight Physicians for Human Rights’ (PHR) experience implementing a “tech” solution within a larger “low-tech” programmatic ecosystem to address violence against women (VAW).

    The Program on Sexual Violence in Conflict Zones at Physicians for Human Rights works with medical, legal, and law enforcement partners in Central and East Africa to address impunity for sexual violence in conflict. Since 2011, we and our partners have trained more than 2,000 professionals in the collection, documentation, and use of court-admissible forensic evidence of sexual violence. As part of this initiative, PHR developed MediCapt, an award-winning mobile application, which standardizes and digitizes the collection of forensic documentation of medical evidence of sexual violence and combines it with a mobile camera to capture and securely store forensic photographic evidence of injuries. MediCapt was “co-designed” with clinician-partners in Kenya and the Democratic Republic of the Congo a...

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  • Management of bodies of deceased persons with COVID-19

    The report on "Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review" is intetresting [1]. Yaacoub et al. concluded that "there is a need for contextual evidence in relation to these proposed management strategies (ie, acceptability, feasibility, impact on equity, resources considerations) [1]". Indeed, the safety issue on practicing with death body during COVID-19 pandemic is interesting but little mentioned. The evidences on possibility of disease transmission from corpse to a living person is not available. Although there is a report on infection in a medical worker who has an occupational job relating to corpse, there is still no scientific confirmation by molecular diagnostic test to confirm that there is a spreading of disease from dead body [2 - 3]. It is apparently that there are attempts for control of possible disease spreading by any settings but the important question is ont he efficacy of rpreventive methods. A simple question is whether we require a routine screening for COVID-19 pathogen in all dead bodies in the present COVID-19. crisis.

    Conflict of inteterest

    1. Yaacoub S, Schünemann HJ, Khabsa J, El-Harakeh A, Khamis AM, Chamseddine F, El Khoury R, Saad Z, Hneiny L, Cuello Garcia C, Muti-Schünemann GEU, Bognanni A, Chen C, Chen G, Zhang Y, Zhao H, Abi Hanna P, Loeb M, Piggott T, Reinap M, Rizk N, Stalteri R, Duda S, Solo K, Chu DK, Akl E...

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  • On Warlord Discourses – an Inclusive Storytelling is Needed for COVID-19 Response.

    I thank both Rajan et al. and Bali et al. for highlighting a lack of inclusivity in the governance of the coronavirus disease 2019 (COVID-19) response.1,2 While the pandemic raises societal concerns, decision-making bodies remain unrepresentative of civil society and suffer from a dearth of diversity – with, for instance, an underrepresentation of women’s perspectives.1,2 I would add that inclusivity may have been thus far derogated by the popular discourse of some traditional, paternalistic leadership – namely, that which is conveyed through wordings worthy of warlords.

    “We are at war”, as declared the Director-General of the World Health Organization, before exhorting G20 leaders to “fight like hell” and calling for “aggressive action” to combat the COVID-19 pandemic.3 This rhetoric of war echoes that of some men country leaders and scientists, pressing authorities for immediate action. Yet, as metaphors frame the way people act,4 triggering civil and societal responsiveness should instead begin with wordings of compassion, cooperation and emancipation.

    First, the rhetoric of war may monopolize the public attention to a unique, imminent goal: mustering all forces to defeat and annihilate an enemy (here, the severe acute respiratory syndrome coronavirus, SARS-CoV-2) – any other objectives being put aside as under war economy. This imposed monopoly may contrast with population concerns: Do we – civil society – strive merely to exterminate SARS-CoV-2, or rathe...

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  • Institutional misinformation in the time of Covid-19: the case of Italy

    Li et al.[1] analyzed misinformation about the Covid-19 pandemic generated by social media, as well as that from traditional means of communication.[2] We focus here on a further, more insidious form of misinformation: that generated by institutions, by paradigmatically analyzing the case of Italy.
    It was well known on January 31, 2020 that Covid-19 had the potential to become pandemic and detailed measures for adoption by health authorities to combat the disease had already been indicated.[3] On the same day, the Italian government declared a state of emergency.[4] However, while neglecting scientific data [3] and in contrast to the seriousness of the decision,[4] institutional figures (government officials and health authorities), reassured the population through statements in the media that the situation was under control even when the virus had demonstrated its contagiousness and lethality. For weeks prior to the outbreak in Lombardy, the population was told that COVID-19 was little more than a flu. Authorities reassured the population that the measures being adopted to prevent/limit the epidemic were the most stringent in Europe. On February 26th, with 330 infected individuals and 11 dead, the Italian Prime Minister declared that the number of infections should not cause alarm. In the coming days, citizens became aware of the magnitude of the outbreak and found themselves psychologically/materially unprepared, in a stupor in the face of the collapse of the Lomb...

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  • YouTube as a source of information

    This research would be more useful if we were given the raw data containing each misleading publication with precise references to why each misleads. Instead, we obtain a summary of the most inflammatory and outlying presentations, as if those represent the majority. Some of the videos are merely observations by professionals practicing in the field. One of the inflammatory examples about the Italian and Iranian strains stands out. Only last week Governor Cuomo said New York was afflicted by a European strain. Where were the critics calling him out?