The impact of four dominating variants and vaccine coverage on Covid-19 mortality: the Malta case

Abstract Background Disease burden can be quantified by mortality. The European Islands of Malta experienced a seesaw of Covid-19 surges in mortality and cases across the pandemic. The study aims to assess the impact of Covid-19 mortality across the four phases dominated by different variants while considering the vaccination coverage among the Malta population. Methods Covid-19 epidemiological data was obtained up till end of February 2022 from the websites of the Malta Ministry of Health and the European Centre for Disease Prevention and Control. Data was categorised into the four periods according to reported dominant Covid-19 variant. The Years of life lost (YLL) and Case-Fatality-Ratio (CFR) for each period were estimated. Correlations were performed between mortality and vaccinated age-groups. Results The original Covid-19 period (54 weeks) had the highest YLL (6633.53), followed by the Omicron variant period (12 weeks; 2,692.17). The Alpha variant period (7 weeks) had the highest CFR (1.89) followed by the Original Covid-19 (1.37). A significant negative correlation was present between two dose vaccination and the 60-69 years (p = 0.01), 70-79 years (p = <0.01), and 80+ years (p = <0.01) age groups, while a positive correlation was present between the booster dose and the 60-69 years (p = 0.01) age group. Conclusions Covid-19 variant’s infectivity, transmissibility, and the effectiveness of the vaccine against the variant play an important role in the ultimate outcome. Reducing mortality by embracing mass vaccination that targets current variants along with other non-pharmaceutical interventions remains paramount. Key messages • Mortality is an indicator for assessing the burden of an emerging variant within a population. • The effectiveness of vaccination against emerging variants plays a role in reducing mortality rates.


Background:
The social and economic impacts that have occurred during the pandemic can disproportionally affect those already experiencing poverty. The social determinants of health aggravate inequalities and can adversely affect wellbeing. This study aims to gain rich insight into Australian adults' experiences of the social determinants of health and the impact on their wellbeing during the COVID-19 pandemic.

Methods:
A descriptive qualitative study using purposive sampling to recruit participants for semi-structured interviews, conducted via videoconferencing between March-August 2021. Thematic analysis was performed with the support of NVivo 12. Results: Participants included 20 Australian adults from various socioeconomic areas ranging in age from 21 to 65 years. Three main themes emerged from the analysis of the data: Food-related concerns; Housing outcomes; and Psychological and emotional impact. Accessing food, during the COVID-19 pandemic, for most participants who resided in low socioeconomic areas, was described as stressful and challenging. Along with the burden of food security, many participants from low socioeconomic areas expressed emotional distress in relation to securing and maintaining adequate housing.

Conclusions:
The pandemic has amplified existing social determinants of health experienced by those within low socioeconomic areas, particularly those who are female and from migrant communities. The wellbeing of participants from low socioeconomic areas decreased in response to their experiences and challenges with food insecurity and housing instability, highlighting the need for housing affordability strategies and funding of emergency food relief initiatives. Food access for those in areas with high socioeconomic disadvantage, can be improved to address some of the barriers associated with food security by providing supermarket meal vouchers, access to community gardens, and school food programs. Key messages: The housing and food insecurity experienced by participants in this study during the pandemic has influenced their overall wellbeing. The pandemic has amplified existing social determinants of health experienced by those in low socioeconomic areas.

Background:
Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents.

Methods:
A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. A search update will be conducted shortly before the conference.

Results:
Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask-wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the ''mask'' and ''no mask'' conditions. The results are preliminary and may be extended due to the search update.

Conclusions:
Only little evidence can be derived on the effects of face masks on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behaviour, school success, and participation. Further cluster-randomized controlled trials or longitudinal studies are required.
Nationally published COVID-19 mortality estimates might underestimate the actual mortality burden attributed to COVID-19. Estimations of excess all-cause mortality can provide more accurate estimates of the toll of the pandemic. This study aims to estimate the overall, sex and age-specific excess all-cause mortality in 20 countries, during 2020. Total, sex and age-specific weekly all-cause death counts for 2015-2020 were extracted from national vital statistics databases. Percent excess mortality for 2020 was calculated by comparing average weekly 2020 mortality rates against average weekly mortality rates from the past five years (2015-2019).
Comparisons were performed for the total population, per sex, and per age groups (<65 vs. 65+ or < 70 vs.70+) depending on data availability. Percent difference in average weekly mortality between 2020 and 2015-2019 ranged from negative for Australia and Norway, to < 5% for Denmark, Cyprus, Estonia, Israel, and Sweden, 5-10% for Georgia, Mauritius, Ukraine, Austria, France, Scotland and Northern Ireland, to 10-21% for England & Wales, Italy, Brazil, USA, Slovenia, and to 89% for Peru. The percent difference in average weekly mortality between 2020 and 2015-2019 for males was higher than for females except for Cyprus, Estonia, Slovenia and the USA. Lastly, in age specific analyses, for the majority of countries the % increase in average weekly mortality between 2020 and 2015-2019, was higher in the oldest age group investigated, however, for Peru and the USA (<65 vs. 65+ years) and for Cyprus and Mauritius (<70 vs. 70+ years), mortality increased similarly in both age groups. This study highlights that the excess mortality burden during the COVID-19 pandemic disproportionally affected specific countries, males, and in most, but not all countries, the oldest age groups. Strengthening of health resilience in the most affected countries, while targeting population groups impacted the most, is of paramount public health importance. Key messages: Excess mortality burden during the COVID-19 pandemic disproportionally affected specific countries, and even within countries specific sex and age groups. Further investigation into the determinants of excess mortality is needed to suggest steps to strengthen health resilience in the countries and target population groups impacted the most.