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      The median age of a city’s residents and population density influence COVID 19 mortality growth rates: policy implications

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          Abstract

          Background

          SARS-CoV-2 is an infectious virus, which has generated a global pandemic. Israel was one of the first countries to vaccinate its population, inaugurating the program on December 20, 2020. The objective of the current study is to investigate the projected daily COVID19 mortality growth rate with higher median age and population size of cities under two scenarios: with and without the BNT162b2 Pfizer vaccination against the SAR-COV2 virus.

          Methods

          This study employs a panel data-set. We follow the COVID19 mortality growth rate in each of the 173 Israeli cities and towns starting from March 21, 2020 (10 days after the first documentation of COVID19 cases in Israel) until September 21, 2021, where the BNT162b2 Pfizer vaccinations were available starting from December 20, 2020.

          Results

          Referring to the median age of municipal residents, findings suggest that the BNT162b2 Pfizer vaccinations attenuate the rise in anticipated daily mortality growth rate for cities and towns in which the median population age is 30 years old (the range in median age among the residents in the municipalities surveyed is 11–41 years). Moreover, referring to population size of cities, findings demonstrate that while under the scenario without vaccination, the daily mortality growth rate is anticipated to rise, under a comparable scenario with vaccination, daily mortality growth rate is anticipated to drop.

          Conclusions

          In crowded cities, where the median age is high, two perspectives of early and intensive public policy interventions are clearly required. The first perspective is extensive medical treatment, namely, extension of availability of medical physical and online services; dispensing designated medications; expansion of hospitalization facilities and information services particularly to susceptible populations. All measures will be taken with attention to age accessibility of these means. The second perspective is prevention via establishment of testing and vaccination complexes; elevation of dedicated health services, generating selective lockdowns; education for increasing awareness to social distancing, wearing masks and other preventive means.

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          Most cited references15

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          Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine

          Lindsey Baden, Hana El Sahly, Brandon Essink … (2020)
          Abstract Background Vaccines are needed to prevent coronavirus disease 2019 (Covid-19) and to protect persons who are at high risk for complications. The mRNA-1273 vaccine is a lipid nanoparticle–encapsulated mRNA-based vaccine that encodes the prefusion stabilized full-length spike protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19. Methods This phase 3 randomized, observer-blinded, placebo-controlled trial was conducted at 99 centers across the United States. Persons at high risk for SARS-CoV-2 infection or its complications were randomly assigned in a 1:1 ratio to receive two intramuscular injections of mRNA-1273 (100 μg) or placebo 28 days apart. The primary end point was prevention of Covid-19 illness with onset at least 14 days after the second injection in participants who had not previously been infected with SARS-CoV-2. Results The trial enrolled 30,420 volunteers who were randomly assigned in a 1:1 ratio to receive either vaccine or placebo (15,210 participants in each group). More than 96% of participants received both injections, and 2.2% had evidence (serologic, virologic, or both) of SARS-CoV-2 infection at baseline. Symptomatic Covid-19 illness was confirmed in 185 participants in the placebo group (56.5 per 1000 person-years; 95% confidence interval [CI], 48.7 to 65.3) and in 11 participants in the mRNA-1273 group (3.3 per 1000 person-years; 95% CI, 1.7 to 6.0); vaccine efficacy was 94.1% (95% CI, 89.3 to 96.8%; P<0.001). Efficacy was similar across key secondary analyses, including assessment 14 days after the first dose, analyses that included participants who had evidence of SARS-CoV-2 infection at baseline, and analyses in participants 65 years of age or older. Severe Covid-19 occurred in 30 participants, with one fatality; all 30 were in the placebo group. Moderate, transient reactogenicity after vaccination occurred more frequently in the mRNA-1273 group. Serious adverse events were rare, and the incidence was similar in the two groups. Conclusions The mRNA-1273 vaccine showed 94.1% efficacy at preventing Covid-19 illness, including severe disease. Aside from transient local and systemic reactions, no safety concerns were identified. (Funded by the Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases; COVE ClinicalTrials.gov number, NCT04470427.)
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            BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting

            Noa Dagan, Noam Barda, Eldad Kepten … (2021)
            Abstract Background As mass vaccination campaigns against coronavirus disease 2019 (Covid-19) commence worldwide, vaccine effectiveness needs to be assessed for a range of outcomes across diverse populations in a noncontrolled setting. In this study, data from Israel’s largest health care organization were used to evaluate the effectiveness of the BNT162b2 mRNA vaccine. Methods All persons who were newly vaccinated during the period from December 20, 2020, to February 1, 2021, were matched to unvaccinated controls in a 1:1 ratio according to demographic and clinical characteristics. Study outcomes included documented infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), symptomatic Covid-19, Covid-19–related hospitalization, severe illness, and death. We estimated vaccine effectiveness for each outcome as one minus the risk ratio, using the Kaplan–Meier estimator. Results Each study group included 596,618 persons. Estimated vaccine effectiveness for the study outcomes at days 14 through 20 after the first dose and at 7 or more days after the second dose was as follows: for documented infection, 46% (95% confidence interval [CI], 40 to 51) and 92% (95% CI, 88 to 95); for symptomatic Covid-19, 57% (95% CI, 50 to 63) and 94% (95% CI, 87 to 98); for hospitalization, 74% (95% CI, 56 to 86) and 87% (95% CI, 55 to 100); and for severe disease, 62% (95% CI, 39 to 80) and 92% (95% CI, 75 to 100), respectively. Estimated effectiveness in preventing death from Covid-19 was 72% (95% CI, 19 to 100) for days 14 through 20 after the first dose. Estimated effectiveness in specific subpopulations assessed for documented infection and symptomatic Covid-19 was consistent across age groups, with potentially slightly lower effectiveness in persons with multiple coexisting conditions. Conclusions This study in a nationwide mass vaccination setting suggests that the BNT162b2 mRNA vaccine is effective for a wide range of Covid-19–related outcomes, a finding consistent with that of the randomized trial.
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              Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel

              Yinon Bar-On, Yair Goldberg, Micha Mandel … (2021)
              Background On July 30, 2021, the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer–BioNTech) was approved in Israel for persons who were 60 years of age or older and who had received a second dose of vaccine at least 5 months earlier. Data are needed regarding the effect of the booster dose on the rate of confirmed coronavirus 2019 disease (Covid-19) and the rate of severe illness. Methods We extracted data for the period from July 30 through August 31, 2021, from the Israeli Ministry of Health database regarding 1,137,804 persons who were 60 years of age or older and had been fully vaccinated (i.e., had received two doses of BNT162b2) at least 5 months earlier. In the primary analysis, we compared the rate of confirmed Covid-19 and the rate of severe illness between those who had received a booster injection at least 12 days earlier (booster group) and those who had not received a booster injection (nonbooster group). In a secondary analysis, we evaluated the rate of infection 4 to 6 days after the booster dose as compared with the rate at least 12 days after the booster. In all the analyses, we used Poisson regression after adjusting for possible confounding factors. Results At least 12 days after the booster dose, the rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of 11.3 (95% confidence interval [CI], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% CI, 12.9 to 29.5). In a secondary analysis, the rate of confirmed infection at least 12 days after vaccination was lower than the rate after 4 to 6 days by a factor of 5.4 (95% CI, 4.8 to 6.1). Conclusions In this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.
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                Author and article information

                Contributors
                Yuval Arbel:
                ORCID: http://orcid.org/0000-0003-4365-6280
                YuvalAr@wgalil.ac.il , yuval.arbel@gmail.com
                Yifat Arbel: ifatarbel@gmail.com
                Amichai Kerner: kerneram@netvision.net.il
                Miryam Kerner: Kerneram@technion.ac.il
                Journal
                Journal ID (nlm-ta): Isr J Health Policy Res
                Journal ID (iso-abbrev): Isr J Health Policy Res
                Title: Israel Journal of Health Policy Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2045-4015
                Publication date (Electronic): 12 September 2022
                Publication date PMC-release: 12 September 2022
                Publication date Collection: 2022
                Volume: 11
                Electronic Location Identifier: 33
                Affiliations
                [1 ]GRID grid.460136.6, ISNI 0000 0004 0615 0560, Sir Harry Solomon School of Economics and Management, , Western Galilee College, ; 2412101 Acre, Israel
                [2 ]GRID grid.22098.31, ISNI 0000 0004 1937 0503, Department of Mathematics, , Bar Ilan University, ; Ramat Gan, Israel
                [3 ]GRID grid.443123.3, ISNI 0000 0000 8560 7215, School of Real Estate, , Netanya Academic College, ; 4223587 Netanya, Israel
                [4 ]GRID grid.6451.6, ISNI 0000000121102151, The Ruth and Bruce Rappaport Faculty of Medicine, , Technion, Israel Institute of Technology, ; 3525422 Haifa, Israel
                [5 ]GRID grid.469889.2, ISNI 0000 0004 0497 6510, Department of Dermatology, , HaEmek Medical Center, ; 1834111 Afula, Israel
                Author information
                http://orcid.org/0000-0003-4365-6280
                Article
                Publisher ID: 541
                DOI: 10.1186/s13584-022-00541-w
                PMC ID: 9465668
                SO-VID: 90ae548b-2d04-4bda-826a-7ed33659e0bf
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 10 December 2021
                Date accepted : 23 August 2022
                Categories
                Subject: Original Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Economics of health & social care
                Keywords: covid-19,mortality
                Data availability:
                ScienceOpen disciplines: Economics of health & social care
                Keywords: covid-19, mortality

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