COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

How are European countries planning for sea level rise?

Sea level rise (SLR) is projected to have severe consequences for people and assets in European coastal areas. Planning for SLR is a critical step to ensure timely and adequate responses. Despite our rapidly increasing understanding of SLR impacts and the need to adapt, few studies have looked at how countries are planning for SLR. We surveyed experts from the 32 European countries with a coastline about how their country is planning for SLR. Our online survey focused on four areas: (1) whether SLR planning exists and at what level of government; (2) which climate information and scenarios are used in planning; (3) what planning horizons and corresponding levels of SLR are used; and (4) how uncertainty in handled and whether high-end sea level rise is being considered in planning. Additionally, we asked experts to assess the status of sea level rise planning in their country. Our results indicate that most coastal countries in Europe are planning for SLR, but 25% still do not. We find that the planning horizon 2100 is most common and many countries are considering around 1m (adjusted for local conditions) of SLR at that point in time. However, there are significant differences between countries, which may lead to unequal impacts, over time. We also find that RCP4.5 and RCP8.5 are the most widely used climate change scenarios, suggesting that countries are considering high-end climate change in planning, although this does not mean they consider high amounts of SLR. Important questions remain about how planning is realized into levels of protection or preparedness and whether the amounts of SLR and planning horizons currently in use will lead countries to act in time

How are European countries planning for sea level rise?

Sea level rise (SLR) is projected to have severe consequences for people and assets in European coastal areas. Planning for SLR is a critical step to ensure timely and adequate responses. Despite our rapidly increasing understanding of SLR impacts and the need to adapt, few studies have looked at how countries are planning for SLR. We surveyed experts from the 32 European countries with a coastline about how their country is planning for SLR. Our online survey focused on four areas: (1) whether SLR planning exists and at what level of government; (2) which climate information and scenarios are used in planning; (3) what planning horizons and corresponding levels of SLR are used; and (4) how uncertainty in handled and whether high-end sea level rise is being considered in planning. Additionally, we asked experts to assess the status of sea level rise planning in their country. Our results indicate that most coastal countries in Europe are planning for SLR, but 25% still do not. We find that the planning horizon 2100 is most common and many countries are considering around 1m (adjusted for local conditions) of SLR at that point in time. However, there are significant differences between countries, which may lead to unequal impacts, over time. We also find that RCP4.5 and RCP8.5 are the most widely used climate change scenarios, suggesting that countries are considering high-end climate change in planning, although this does not mean they consider high amounts of SLR. Important questions remain about how planning is realized into levels of protection or preparedness and whether the amounts of SLR and planning horizons currently in use will lead countries to act in time

Ecological consequences of sea level rise and flood protection strategies in shallow coastal systems: A quick-scan barcoding approach

Shallow coastal ecosystems have high ecological value and contribute to flood protection. Their stability is, however, sensitive to the amount and rate of future sea level rise (SLR), their ability to trap sediment which allows them to grow with rising sea level, and human response to SLR. So far, studies have focused on assessing SLR impacts using resource-intensive tools. Here, we present an approach for a first-order assessment and easily accessible ‘barcode’ visualization to rapidly assess potential impacts of both SLR and adaptation strategies on coastal ecosystems in a spatially explicit way. Our approach relates habitat types (ecotopes) to water level, morphology and salinity, allowing users to determine shifts in spatial arrangements of ecological zones under different SLR rates and strategies. We illustrate this approach for a transect in the Dutch Wadden Sea. We find that beyond a critical rate of SLR, major changes in ecotope distribution are projected to occur as this part of the Wadden Sea starts to drown due to insufficient sediment import. Even larger impacts arise from adaptation strategies. Closing the barrier islands will turn the Wadden Sea into a freshwater lake-system with the absence of intertidal areas, infilling of channels and bank erosion. A strategy that allows for inland migration of the shoreline, results in a deep tidal basin with large subtidal habitats, and a shifted intertidal zone. Our case study shows that the barcoding approach provides a rapid, quantitative and spatially explicit overview of the potential implications for coastal ecosystems under different SLR scenarios, adaptation strategies and time horizons. This can then be used to screen adaptation strategies before going into a more comprehensive analysis. The barcode visualization allows for easy dissemination of potential ecological impacts to a broad community

Evaluating a Planning Support System’s Use and Effects in Urban Adaptation: An Exploratory Case Study from Berlin, Germany

Planning Support Systems (PSS) are increasingly used to support collaborative planning workshops in urban adaptation practice. Research has focused on developing such tools and evaluating their use in workshops but has not measured tools’ effects over time on real planning processes, on the participants involved, and on the final outcomes. The role that tools play in adaptation planning, therefore, remains unclear. A longitudinal case study was made to evaluate a PSS, the Adaptation Support Tool (AST), in a design workshop for sustainable urban water management, in Berlin, Germany. The case study also served to test the evaluation framework and generate insights regarding systematic evaluations of tools in planning processes. The case study was carried out over eighteen months, to capture both the details of the workshop and its longer-term effects on the project and participants. Our results show that the AST’s most evident effects were (1) contributory and less tangible in nature (e.g., supporting learning), than directly causal and concrete (e.g., affecting planning decisions), and (2) a function of the process and context in which the workshop took place. This study demonstrates that making systematic, longitudinal evaluations are valuable for studying the role of PSS in urban adaptation planning

How are European countries planning for sea level rise?

Sea level rise (SLR) is projected to have severe consequences for people and assets in European coastal areas. Planning for SLR is a critical step to ensure timely and adequate responses. Despite our rapidly increasing understanding of SLR impacts and the need to adapt, few studies have looked at how countries are planning for SLR. We surveyed experts from the 32 European countries with a coastline about how their country is planning for SLR. Our online survey focused on four areas: (1) whether SLR planning exists and at what level of government; (2) which climate information and scenarios are used in planning; (3) what planning horizons and corresponding levels of SLR are used; and (4) how uncertainty in handled and whether high-end sea level rise is being considered in planning. Additionally, we asked experts to assess the status of sea level rise planning in their country. Our results indicate that most coastal countries in Europe are planning for SLR, but 25% still do not. We find that the planning horizon 2100 is most common and many countries are considering around 1m (adjusted for local conditions) of SLR at that point in time. However, there are significant differences between countries, which may lead to unequal impacts, over time. We also find that RCP4.5 and RCP8.5 are the most widely used climate change scenarios, suggesting that countries are considering high-end climate change in planning, although this does not mean they consider high amounts of SLR. Important questions remain about how planning is realized into levels of protection or preparedness and whether the amounts of SLR and planning horizons currently in use will lead countries to act in time

Ecological consequences of sea level rise and flood protection strategies in shallow coastal systems: A quick-scan barcoding approach

Shallow coastal ecosystems have high ecological value and contribute to flood protection. Their stability is, however, sensitive to the amount and rate of future sea level rise (SLR), their ability to trap sediment which allows them to grow with rising sea level, and human response to SLR. So far, studies have focused on assessing SLR impacts using resource-intensive tools. Here, we present an approach for a first-order assessment and easily accessible ‘barcode’ visualization to rapidly assess potential impacts of both SLR and adaptation strategies on coastal ecosystems in a spatially explicit way. Our approach relates habitat types (ecotopes) to water level, morphology and salinity, allowing users to determine shifts in spatial arrangements of ecological zones under different SLR rates and strategies. We illustrate this approach for a transect in the Dutch Wadden Sea. We find that beyond a critical rate of SLR, major changes in ecotope distribution are projected to occur as this part of the Wadden Sea starts to drown due to insufficient sediment import. Even larger impacts arise from adaptation strategies. Closing the barrier islands will turn the Wadden Sea into a freshwater lake-system with the absence of intertidal areas, infilling of channels and bank erosion. A strategy that allows for inland migration of the shoreline, results in a deep tidal basin with large subtidal habitats, and a shifted intertidal zone. Our case study shows that the barcoding approach provides a rapid, quantitative and spatially explicit overview of the potential implications for coastal ecosystems under different SLR scenarios, adaptation strategies and time horizons. This can then be used to screen adaptation strategies before going into a more comprehensive analysis. The barcode visualization allows for easy dissemination of potential ecological impacts to a broad community