A key policy measure introduced by governments worldwide at the beginning of the coronavirus disease 2019 (COVID-19) pandemic was to restrict travel, highlighting the importance of people's mobility as one of the key contributors to spreading severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there was little consistency regarding the geographical scale or the severity of these measures. Little use was made of commuting and travel data to inform decisions on when, where and at what level restrictions should be applied. We aim to contribute to regional policy by providing evidence that could be used to inform future policy debates on the most effective travel restrictions to impose during a pandemic. We present an analysis of the impact of mobility between municipalities on COVID-19 incidence in the Netherlands. We used multiple linear regression models and geographical information systems to gain insight into the association between mobility-related factors and demographic, socio-economic and geographical factors with COVID-19 incidence in municipalities. Our results indicate that spatial mobility patterns, when combined with COVID-19 incidence in municipalities of origin, were associated with increased COVID-19 incidence in municipalities of destination. In addition, various regional characteristics were associated with municipal incidence. By conducting our analyses over three different periods, we highlight the importance of time for COVID-19 incidence. In the light of ongoing mitigation measures (and possible future events), spatial mobility patterns should be a key factor in exploring regional mobility restrictions as an alternative for national lockdowns.
Praktische aanbevelingen op basis van bevindingen uit systematisch literatuuronderzoek bij de Covid-19 en vergelijkbare virusuitbraken en interviews met experts en ervaringsdeskundigen.
PURPOSE: We investigated changes in ARDS severity and associations with outcome in COVID-19 ARDS patients.METHODS: We compared outcomes in patients with ARDS classified as 'mild', 'moderate' or 'severe' at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28-day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4.RESULTS: Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28-day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4.CONCLUSIONS: In this cohort of COVID-19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches.
MULTIFILE
