Key Question On New Coronavirus Disease 2019 Is Whether Sustained Community Spread Outside China Will Become Pandemic [Editor’s Note: This article is about an emerging and rapidly evolving public health crisis. Case and death counts change daily. Readers interested in learning the very latest information should consult the reliable sources provided below.] As of late February, over 80,000 cases of the new coronavirus disease (COVID-19) and more than 2,700 deaths globally have been reported to the World Health Organization. Most
of these cases have been identified in China, and the vast majority have occurred in a single province (Hubei) where the first cases originated.
-3Advancing Legal Epidemiology
Early cases were associated with a seafood and live animal market in the city of Wuhan. However, the disease quickly spread person to person among individuals with no connection to the animal market.
-5Gauging the Quality of Research Studies
- Pandemic con't on page 2
Surgeon General Issues 34th Report On The Health Effects Of Smoking You don’t see people smoking very much in public in the United States anymore. You think the smoking problem is largely resolved. Well, according to the latest Surgeon General’s report, you should think again. Smoking among American adults is at an all time low of 14%, but it remains the leading cause of preventable disease, disability, and death in the United States. More than 34 million
February 2020
In This Issue
American adults currently smoke cigarettes. The report reaches the following major conclusions:
Smoking cessation benefits persons at any age.
Smoking cessation reduces the risk of premature death and can add as much as a decade to life expectancy. - Smoking cont'd on page 4
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Volume Forty One •
Number Two
-6Useful COVID-19 Links -7Notes on People -9Near Term Epidemiology Event Calendar -11Marketplace
-Pandemic cont'd from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly by Roger Bernier, Ph.D., MPH at 33 Indigo Plantation Rd, Okatie, SC, 29909, USA.
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The virus COVID-19 is caused by SARS-CoV-2, a new betacoronavirus similar to MERSCoV and SARS-CoV. These latter two viruses are found in bats and suggest the new virus has jumped the species barrier to humans from another intermediate animal host, according to WHO. It could be a domestic food animal, a wild animal, or a domesticated wild animal. Extent of the Epidemic While the outbreak has been centered in China, the disease has now been imported to at least 28 other countries. To date, the majority of cases outside of China have occurred in connection with a single cruise ship, the Diamond Princess, anchored in Japan and in the Republic of Korea. WHO considers the risk to the region and to other countries in the world to be "high". The situation is being watched very carefully by other countries for any evidence that the virus is able spread and sustain transmission in any other open population. This would mean that infected persons cannot tell where and how they became infected. Declarations
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Some community spread has occurred in Asian countries such as the Republic of Korea, Japan, Singapore and Thailand. WHO has declared a public health emergency of international concern, and the US has declared a public health emergency on January 31, 2020.
Pandemic? As of this writing, the criteria for declaring COVID-19 a pandemic have not been met, although these criteria are not clearcut or universally agreed to. Certainly, the occurrence of multiple outbreaks simultaneously in numerous countries on different continents and involving large numbers of persons will qualify as a pandemic The major concern is that COVID-19 could have transmission dynamics similar to influenza which because of the widespread transmission produces a high number of deaths even though the Case Fatality Ratio (CFR) is relatively low. Control Strategies If sustained community spread occurs widely enough, countries will have to abandon containment strategies focused on contact tracing and quarantine and switch to mitigation interventions. Right now many countries outside of China are in containment mode doing contract tracing but must be prepared to go into mitigation mode. The control strategies at that point must change to include such measures as social distancing which limits or restricts people’s ability to congregate in public places such as sporting events, malls, workplaces, and schools. Other interventions might include limiting the use of public transportation and maintaining distance from others (approximately 6 feet, according to CDC). ■
See: Useful Links for Information on the COVID-16 Situation Page 6
Advancing Legal Epidemiology Is Focus Of Journal Supplement The March 2020 supplement of the Journal of Public Health Management and Practice is devoted to research reports and commentaries on the field of legal epidemiology. It is “the scientific study and deployment of the law as a factor in the cause, distribution, and prevention of disease and injury in a population.” In the editorial introducing the special supplement, Betsy Thompson and colleagues note that law is a key determinant of public health and that researchers in the sub-discipline have been able to “turn the text of the law into empirical data to measure the effects of law on public health outcomes.” The editorialists state that legal epidemiology “provides a powerful tool to gain greater insights and pursue more effective public health strategies that will benefit us all.” In a commentary in the same supplemental issue, Scott Burris and colleagues believe that the “research necessary to identify and spread best legal practices is too often never carried out.” They seek to achieve the full integration of law into public health. In a post on the Journal’s companion site JPHMP Direct, Colleen Barbero and colleagues post “Seven Things You Should Know About Legal Epidemiology” for advancing chronic and non-communicable disease management. In brief, they include: 1. It’s not just for lawyers, and not just for epidemiologists. Legal epidemiology is a transdisciplinary field. It focuses not on
what law says but rather on what law does. 2. The field is relatively new, but growing quickly. There have been several important institutional accomplishments which have helped stimulate the field, including the creation of the Center for Public Health Law Research at Temple University, and recognition by the National Library of Medicine to make indexing and searching legal epidemiology reports easier.
“...researchers in the sub-discipline have been able to “turn the text of the law into empirical data..."
3. The methods transcend specific public health topics or domains. Legal epidemiology methods may be applied to any area of public health. 4. It’s changing public health and legal education. Courses in legal epidemiology are being developed and incorporated into educational programs in law schools and schools of public health. 5. It’s catching on in policy making and practice.
“It focuses not on what law says but rather on what law does."
A Five Essential Public Health Law Services model has been developed and there is additional interest in and use of “policy surveillance”, a legal epidemiology tool. 6. Policy surveillance data is a game changer. This tool provides access to the - Legal cont'd on page 6
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-Smoking cont'd from page 1
“There is presently inadequate evidence to conclude that ecigarettes, in general, increase smoking cessation."
Smoking places a substantial financial burden on smokers, healthcare systems, and society. Smoking cessation reduces this burden.
More than 3 out of 5 U.S. adults who have ever smoked cigarettes have quit; however, less than onethird use FDA-approved cessation medications or behavioral counseling.
Disparities in key indicators of smoking cessation exist among subgroups within the U.S. population — including quit attempts, receiving advice to quit from a health professional, and using cessation therapies.
“Don’t start, and if you did—quit.”
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Smoking cessation reduces the risk of many negative health effects, including reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease (or COPD), and numerous cancers. Cessation medications approved by the FDA and behavioral counseling increase the likelihood of successfully quitting smoking, particularly when used in combination. Insurance coverage for smoking cessation treatment that is comprehensive, barrier-free, and widely promoted increases the use of these treatment services, leads to higher rates of successful quitting, and is cost-effective. E-cigarettes, a continually changing and diverse group of products, are used in a variety of ways. Therefore,
it is difficult to make generalizations about efficacy for cessation based on clinical trials involving a particular ecigarette. There is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation. According to the University of Colorado epidemiologist Jonathan Samet who has helped to author 13 of the total 34 Surgeon General reports on the health effects of smoking, “the last conclusion merits emphasis as some advocates for ecigarettes for harm reduction claim that they help smokers quit… In the end, evidence is ever stronger on the benefits of smoking cessation. The 56 years with 34 Surgeon Generals’ reports on the health effects of smoking have one unifying message: Don’t start, and if you did—quit.” To read Samet’s review of the impact of the key Surgeon General reports on smoking, including the landmark 1964 report which reached the conclusion that smoking is the cause of lung cancer in men, read the Dean’s Note in the news section of the University of Colorado School of Public Health at: http://bit.ly/37WVrNL To read or obtain the full Surgeon General’s report, visit: http://bit.ly/3a2cAaz ■
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Pediatrician/Writer Trained Epidemiologist Provides Tips For Parents In Gauging The Quality Of Research Studies Colloquial Language Makes For User-Friendly Guide In a brief set of guidelines written in a colloquial style, Amitha Kalaichandran, a pediatrician with training in global epidemiology at Johns Hopkins has consulted with colleagues and experts to provide a highly readable account for parents of what to watch out for in reading and digesting new research reports. Kalaichandran’s main objective is to inject caution into any parental decisions about changing the behavior or lifestyle of their children or family based on misleading or overblown research findings. Among the cautionary guidelines she advocates are: 1. Correlation does not equal causation. She calls this a common trap and makes the important point that several questions must be answered often over several years before causation can be established. 2. Mice aren’t men. Some reported results are intriguing, but if the studies are done in animals it can take years to determine if the initial findings are relevant for humans. 3. Study quality matters. According to Kalaichandran, “When it comes to study design, not all are created equal.” She describes a hierarchy of studies between case reports and clinical trials and urges parents to be mindful of how the data were obtained.
4. Statistics can be misinterpreted. Kalaichandran explains statistical significance as a result unlikely to have occurred by chance, but she cautions that statistical significance does not equate to clinical significance and provides an example for readers. “Imagine a randomized controlled trial that split 200 women with migraines into two groups of 100. One was given a pill to prevent migraines and another was given a placebo. After six months, 11 women from the pill group and 12 from the placebo group had at least one migraine per week, but the 11 women in the pill group experienced arm tingling as a potential side effect. If women in the pill group were found to be statistically less likely to have migraines than those in the placebo group, the difference may still be too small to recommend the pill for migraines, since just one woman out of 100 had fewer migraines. Also, researchers would have to take potential side effects into account.”
“When it comes to study design, not all are created equal.”
“...statistical significance does not equate to clinical significance..."
She adds, “The opposite is also true. If a study reports that regular exercise helped relieve chronic pain symptoms in 30 percent of its participants, that might sound like a lot. But if the study included just 10 people, that’s only three people helped. This finding may not be statistically significant, but could be clinically important, since there are limited treatment options for people with chronic pain, and might warrant a larger trial. " - Parents cont'd on page
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-Legal cont'd from page 3 content and substance of law and legal trends over time. Policy surveillance datasets are at the heart of most legal epidemiology studies.
“Simply put, larger studies are more likely to help us get closer to the truth than smaller ones...”
7. Most legal epidemiology resources are in the public domain and are free. The broad accessibility of resources— data, research results, method descriptions, and training courses— presents a great opportunity. To access the supplement issue, visit: http://bit.ly/2I1rYrP To access JPHMP Direct for the 7 key takeaways, visit: http://bit.ly/38UQk2b To access the 5 Essential Public Health Law Services, visit: http://bit.ly/2Vf0NBl ■
Useful Links For Information About The COVID-19 Situation “No single study is likely to impact medical practice."
A visual guide to the outbreak from the BBC: https://bbc.in/32jog5Y A Question and Answer document from the WHO: http://bit.ly/37T7CuY
-Parents cont'd from page 5 5. Bigger is often better. Kalaichandran quotes John Ioannidis to explain the power of studies. “Power is telling us what the chances are that a study will detect a signal, if that signal does exist,” and notes that the easiest way for researchers to increase a study’s power is to increase its size. “Simply put, larger studies are more likely to help us get closer to the truth than smaller ones,” she says. 6. Not all findings apply to you. In this section, parents are cautioned to examine any selection factors used in recruiting study subjects such as age, gender, or ethnicity. These subjects may be different from the average person reading about the results. She notes how early studies on heart disease, for instance, were performed primarily on white men. 7. One study is just one study. No single study is likely to impact medical practice. It takes time to accumulate a robust body of evidence that leads to solid recommendations. 8. Not all journals are created equal. A good way to spot a high quality journal is to look for one with a high impact factor. Parents are warned against giving weight to findings published in “predatory journals”. To read the original article in full, click here: https://nyti.ms/2STvL0m ■
A situation summary from the CDC: http://bit.ly/39ZgWz3 Situation reports from WHO: http://bit.ly/2HSCotG ■
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Notes on People Do you have news about yourself, a colleague, or a student? Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net
Honored: Robert W Haley, with the inaugural Laurance Nickey Lifetime Achievement Award from the Texas Medical Association, for his career-long dedication to public health. Dr Haley is the Director of the Division of Epidemiology at the University of Texas Southwestern Medical Center in Dallas. He formerly worked for 10 years in infectious diseases at the Centers for Disease Control and Prevention.
Running: Anna Kelles, a University of North Carolina trained nutritional epidemiologist, for a seat in the New York State General Assembly. Kelles has been a legislator in Tompkins County NY since 2015. Prior to that, she served as a public health educator, director of an environmental non-profit, and a human rights activist.
Nominated: John Vena, for the Lenna Endowed Visiting Professorship at St Bonaventure University by the School of Health Professions at St Bonaventure. Vena will deliver academic and public lectures during his visit March 9-19, 2020. Vena is currently professor and founding chair of the Department of Public Health Sciences at the Medical University of South Carolina.
Interviewed: Michael Mina, for a Facebook Live event sponsored by The Forum at Harvard T.H. Chan School of Public Health and PRI’s “The World.” Mina and “The World” reporter Elana Gordon discussed the latest updates about the coronavirus situation. Mina is assistant professor of epidemiology at the Harvard School. Read the report in the Harvard Gazette at: http://bit.ly/38SQO93
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- People con't on page 8
Notes on People,
cont'd from page 7
Interviewed: Ian Lipkin, on National Public Radio and by Scientific American about his recent visit to China to help investigate the coronavirus outbreak. Lipkin is professor of epidemiology at Columbia University. Listen here to the interview on NPR: https://n.pr/2HNOGmX Read the interview in Scientific American here: http://bit.ly/2w26oQR
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Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the year. Thus an online copy exists on our website that is updated regularly. This year we will print upcoming events in the Monitor monthly. To view the full year please go to: http://www.epimonitor.net/Events
March 2020 March 2-4 http://bit.ly/36fpmAn Conference / Teaching Prevention / APTR - Association for Prevention Teaching and Research / San Antonio, TX March 2-6 h ttp://bit.ly/33XqJSJ Short Course / Intensive Course in Applied Epidemiology / University of Aberdeen / Aberdeen, Scotland March 3-6 http://bit.ly/2P1uouz Conference / EpiLifestyles 2020 Scientific Session / American Heart Association / Phoenix, AZ March 9-12 http://bit.ly/2Pq0dfD Conference / Integrated Foodborne Outbreak Response and Mgmt (INFORM) 2020 Conference / Multiple / Atlanta, GA March 9-12 http://bit.ly/2YqNE82 Short Course / Environmental Health Risk (formerly Analyzing Risk) / Harvard University / Boston, MA March 9-13 http://bit.ly/2s6QPpm Short Course / Genetic Epidemiology / University of Bristol / Bristol, England March 11-13 http://bit.ly/2P1O4OT Meeting / 2020 Epidemiology and Laboratory Capacity (ELC) Annual Meeting / Centers for Disease Control & Prevention(CDC) / Atlanta, GA March 12-13 http://bit.ly/353kNZY Conference / 93rd Annual Meeting - American Epidemiological Society / AES / Atlanta, GA March 16-18 http://bit.ly/2sZXhyT Short Course / Epigenetic Epidemiology / University of Bristol / Bristol, England March 16-20 http://bit.ly/38rqnaL Short Course / Clinical Trials: Conduct and Analysis 2020 / Kings College London / London, England March 16 - April 3 http://bit.ly/2s5C6Le Short Course / Perinatal Epidemiology & Maternal Health / University College London / London, England March 20 http://bit.ly/2E0uZ9K Short Course / Advanced Epigenetic Epidemiology / University of Bristol / Bristol, England March 18-20 http://www.icreid.com/ Conference / International Conference on (Re-)Emerging Infectious Diseases / Africa CDC - Centres for Disease Control and Prevention / Addis Ababa, Ethiopia
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- Calendar con't on page 10
Near Term Epidemiology Event Calendar March 2020 continued from page 9 March 18-20 http://bit.ly/2slJB0G Conference / 2020 ASPPH (Assn of Schools & Programs of Public Health) Annual Meeting / ASPPH / Arlington, VA March 22-24 http://bit.ly/34XZw3L Conference / 44th Annual Conference - American Society of Preventive Oncology / ASPO / Tucson, AZ March 22-27 https://bit.ly/2RPzuJl Short Course / Pharmaco-epidemiology and Drug Safety / Erasmus MC / Rotterdam, The Netherlands March 23-25 http://bit.ly/2EeQbIY Conference / 2020 Annual Conference on Vaccinology Research / National Foundation for Infectious Diseases / Washington, DC March 25-27 http://bit.ly/2E0pPKF Conference / Annual Meeting - Society for Veterinary Epidemiology / SEVPM / Westport, Ireland March 26-27 http://bit.ly/38mpccj Short Course / Multiple Imputation for Missing Data / University of Bristol / Bristol, England March 26-30 http://bit.ly/2t8sqjP Conference / 6th Decennial International Conference on Healthcare Associated Infections / IDSA - Infectious Disease Society of America / Atlanta, GA March 31 - April 1 http://bit.ly/2P0QY6w Conference / Public Health Research and Science Conference 2020 / Public Health England / Manchester, England
April 2020 April 5-7 http://bit.ly/2DZ37CP Conference / Health Effects International 2020 Conference / Health Effects International / Boston, MA April 15-17 https://bit.ly/2C4g1PE Short Course / Quality of Life Measurement / Erasmus MC / Rotterdam, The Netherlands April 18-21 http://bit.ly/2PsvPBg Conference / ISPE 2020 Mid-Year Meeting / International Society for Pharmacoepidemiology / Orlando, FL April 21-23 http://bit.ly/2Ppkzps Conference / 37th Annual Oregon Epidemiologists’ Meeting / Oregon Epidemiologists / TBA Oregon April 24-29 http://bit.ly/2P36K11 Conference / 2020 Annual Meeting of the American Association for Cancer Research / American Association for Cancer Research / San Diego, CA April 27-29 http://bit.ly/352CzfT Short Course / Mendelian Randomization / University of Bristol / Bristol, England
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- Calendar con't on page 11
Near Term Epidemiology Event Calendar April 2020 continued from page 10 April TBA https://bit.ly/2rvWLEz Short Course /Child Psychiatric Epidemiology / Erasmus MC / Rotterdam, The Netherlands April TBA https://bit.ly/2UAKEUf Short Course: Epidemiology of Infectious Disease / Erasmus MC / Rotterdam, The Netherlands April TBA https://bit.ly/2Eeb0Wg Short Course: Cancer Epidemiology / Erasmus MC / Rotterdam, The Netherlands
Tulane University Research Assistant Professor of Epidemiology School of Public Health & Tropical Medicine / Department of Epidemiology Tulane University School of Public Health and Tropical Medicine is seeking applications for a non-tenure track, full-time position at the rank of Research Assistant Professor in the Department of Epidemiology. Candidates with a doctoral degree in epidemiology, community health, clinical research or implementation research or a MD with a master's degree in epidemiology or clinical research will be considered. The faculty member will actively participate in research grant applications, management of on-going and new research studies and preparation of manuscripts and presentations. The candidate should have excellent communication and inter-personal skills to work with community partners. Review of applications will begin as soon as possible and applications will be accepted and reviewed until the position is filled. Applicants should send a cover letter with names of at least three references and complete resume to: Jiang He, M.D., Ph.D. Chair, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, Mail Box #8318, New Orleans, LA 70112 Tulane University is an Equal Opportunity / Affirmative Action employer. Women and Minorities are encouraged to apply.
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For more info and registration, visit: https://www.wellbeing-harvard-ucl.org
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