Antimicrobial resistance and biological governance: explanations for policy failure

The paper reviews the state of policy on antimicrobial use and the growth of antimicrobial resistance (AMR). AMR was anticipated at the time of the first use of antibiotics by their originators. For decades, reports and scientific papers have expressed concern about AMR at global and national policy levels, yet the problem, first exposed a half-century ago, worsened. The paper considers the explanations for this policy failure and the state of arguments about ways forward. These include: a deficit of economic incentivisation; complex interventions in behavioural dynamics; joint and separate shifts in medical and animal health regimes; consumerism; belief in technology; and a narrative that in a ‘war on bugs’ nature can be beaten by human ingenuity. The paper suggests that these narratives underplay the biological realities of the human-animal-biosphere being in constant flux, an understanding which requires an ecological public health analysis of AMR policy development and failure. The paper suggests that effective policy change requires simultaneous actions across policy levels. No single solution is possible, since AMR is the result of long-term human intervention which has accelerated certain trends in the evolution of a microbial ecosystem shared by humans, animals and other biological organism inhabiting that ecosystem. Viewing the AMR crisis today through an ecological public health lens has the advantage of reuniting the social-ecological and bio-ecological perspectives which have been separated within public health

Use of Otolith Strontium:Calcium Ratios for Hindcasting Larval Cod Gadus Morhua Distributions Relative to Water Masses on Georges Bank

The concentration ratios of strontium to calcium in laboratory-reared larval cod otoliths are shown to be related to the water temperature (T) at the time of otolith precipitation. This relationship is curvilinear, and is best described by a simple exponential equation of the form (Sr/Ca x 1000 = a exp(-T/b). We show that when Sr/Ca elemental analyses are related to the daily growth increments in the larval otoliths, relative temperature histories of individual field-caught larvae can be reconstructed from the egg stage to the time of capture. We present preliminary examples of how such reconstructed temperature histories of Atlantic cod Gadus morhua larvae, collected on Georges Bank during April and May 1993, may be interpreted in relation to the broad-scale larval distributions and the hydrography of the Bank

Observations of the Eastern Maine Coastal Current and Its Offshore Extensions in 1994

Cold surface temperatures, reflecting Scotian Shelf origins and local tidal mixing, serve as a tracer of the Eastern Maine Coastal Current and its offshore extensions, which appear episodically as cold plumes erupting from the eastern Maine shelf. A cold water plume emanating from the Eastern Maine Coastal Current in May 1994 was investigated using advanced very high resolution radiometer (AVHRR) imagery, shipboard surveys of physical and biochemical properties, and satellite-tracked drifters. Evidence is presented that suggests that some of the plume waters were entrained within the cyclonic circulation over Jordan Basin, while the major portion participated in an anticyclonic eddy at the distal end of the plume. Calculations of the nitrate transported offshore by the plume show that this feature can episodically export significant quantities of nutrients from the Eastern Maine Coastal Current to offshore regions that are generally nutrient depleted during spring-summer. A series of AVHRR images is used to document the seasonal along-shelf progression of the coastal plume separation point. We speculate on potential causes and consequences of plume separation from the coastal current and suggest that this feature may be an important factor influencing the patterns and overall biological productivity of the eastern Gulf of Maine

Observations of the Eastern Maine Coastal Current and Its Offshore Extensions in 1994

Cold surface temperatures, reflecting Scotian Shelf origins and local tidal mixing, serve as a tracer of the Eastern Maine Coastal Current and its offshore extensions, which appear episodically as cold plumes erupting from the eastern Maine shelf. A cold water plume emanating from the Eastern Maine Coastal Current in May 1994 was investigated using advanced very high resolution radiometer (AVHRR) imagery, shipboard surveys of physical and biochemical properties, and satellite-tracked drifters. Evidence is presented that suggests that some of the plume waters were entrained within the cyclonic circulation over Jordan Basin, while the major portion participated in an anticyclonic eddy at the distal end of the plume. Calculations of the nitrate transported offshore by the plume show that this feature can episodically export significant quantities of nutrients from the Eastern Maine Coastal Current to offshore regions that are generally nutrient depleted during spring-summer. A series of AVHRR images is used to document the seasonal along-shelf progression of the coastal plume separation point. We speculate on potential causes and consequences of plume separation from the coastal current and suggest that this feature may be an important factor influencing the patterns and overall biological productivity of the eastern Gulf of Maine

Epidemiology and transmission characteristics of early COVID-19 cases, 20 January–19 March 2020, in Bavaria, Germany

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) led to a significant disease burden and disruptions in health systems. We describe the epidemiology and transmission characteristics of early coronavirus disease 2019 (COVID-19) cases in Bavaria, Germany. Cases were reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infections, reported from 20 January−19 March 2020. The incubation period was estimated using travel history and date of symptom onset. To estimate the serial interval, we identified pairs of index and secondary cases. By 19 March, 3546 cases were reported. A large proportion was exposed abroad (38%), causing further local transmission. Median incubation period of 256 cases with exposure abroad was 3.8 days (95%CI: 3.5–4.2). For 95% of infected individuals, symptom onset occurred within 10.3 days (95%CI: 9.1–11.8) after exposure. The median serial interval, using 53 pairs, was 3.5 days (95%CI: 3.0–4.2; mean: 3.9, s.d.: 2.2). Travellers returning to Germany had an important influence on the spread of SARS-CoV-2 infections in Bavaria in early 2020. Especially in times of low incidence, public health agencies should identify holiday destinations, and areas with ongoing local transmission, to monitor potential importation of SARS-CoV-2 infections. Travellers returning from areas with ongoing community transmission should be advised to quarantine to prevent re-introductions of COVID-19.Peer Reviewe

Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling

In light of the 2009 influenza pandemic and potential future pandemics, Maria Van Kerkhove and colleagues anticipate six public health challenges and the data needed to support sound public health decision making.The authors acknowledge support from the Bill & Melinda Gates Foundation (MDVK, CF, NMF); Royal Society (CF); Medical Research Council (MDVK, CF, PJW, NMF); EU FP7 programme (NMF); UK Health Protection Agency (PJW); US National Institutes of Health Models of Infectious Disease Agent Study program through cooperative agreement 1U54GM088588 (ML); NIH Director's Pioneer Award, DP1-OD000490-01 (DS); EU FP7 grant EMPERIE 223498 (DS); the Wellcome Trust (DS); 3R01TW008246-01S1 from Fogerty International Center and RAPIDD program from Fogerty International Center with the Science & Technology Directorate, Department of Homeland Security (SR); and the Institut de Veille Sanitaire Sanitaire funded by the French Ministry of Health (J-CD). The funders played no role in the decision to submit the article or in its preparation

Projecting COVID‐19 intensive care admissions in the Netherlands for policy advice: February 2020 to January 2021

Model projections of COVID‐19 incidence into the future help policy makers about decisions to implement or lift control measures. During 2020, policy makers in the Netherlands were informed on a weekly basis with short‐term projections of COVID‐19 intensive care unit (ICU) admissions, which were produced using an age‐structured transmission model. A consistent, incremental update procedure that integrated all new data was conducted on a weekly basis. First, up‐to‐date estimates for most parameter values were obtained through re‐analysis of all data sources. Then, estimates were made for changes in the age‐specific contact rates in response to policy changes. Finally, a piecewise constant transmission rate was estimated by fitting the model to reported daily ICU admissions, with a change point analysis guided by Akaike's Information Criterion. This procedure allowed us to make weekly projections, accounting for recent and future policy changes, and to adapt the estimated effectiveness of the policy changes based only on the natural accumulation of incoming data

The time to extinction for an SIS-household-epidemic model

We analyse a stochastic SIS epidemic amongst a finite population partitioned into households. Since the population is finite, the epidemic will eventually go extinct, i.e., have no more infectives in the population. We study the effects of population size and within household transmission upon the time to extinction. This is done through two approximations. The first approximation is suitable for all levels of within household transmission and is based upon an Ornstein-Uhlenbeck process approximation for the diseases fluctuations about an endemic level relying on a large population. The second approximation is suitable for high levels of within household transmission and approximates the number of infectious households by a simple homogeneously mixing SIS model with the households replaced by individuals. The analysis, supported by a simulation study, shows that the mean time to extinction is minimized by moderate levels of within household transmission