Real-time estimates of the true size and trajectory of local COVID-19 epidemics are key metrics to guide policy responses. We developed a Bayesian nowcasting approach that explicitly accounts for reporting delays and secular changes in case ascertainment to generate real-time estimates of COVID-19 epidemiology on the basis of reported cases and deaths. Using this approach, we estimate time trends in infections, symptomatic cases, and deaths for all 50 US states and the District of Columbia from early-March through June 11, 2020. At the beginning of June, our best estimates of the effective reproduction number (Rt) are close to 1 in most states, indicating a stabilization of incidence, but there is considerable variability in the level of incidence and the estimated proportion of the population that has already been infected.
Background: Intrusive trauma memories are a key symptom of posttraumatic stress disorder (PTSD), so disrupting their recurrence is highly important. Intrusion development was hindered by visuospatial interventions administered up to 24 hours after analogue trauma. It is unknown whether interventions can be applied later, and whether modality or working-memory load are crucial factors. Objectives: This study tested: (1) whether a visuospatial task would lead to fewer intrusions compared to a reactivation-only group when applied after memory reactivation four days after analogue trauma exposure (extended replication), (2) whether both tasks (i.e. one aimed to be visuospatial, one more verbal) would lead to fewer intrusions than the reactivation-only group (intervention effect), and (3) whether supposed task modality (visuospatial or verbal) is a critical component (modality effect). Method: Fifty-four participants were randomly assigned to reactivation+Tetris (visuospatial), reactivation+Word games (verbal), or reactivation-only (no task). They watched an aversive film (day 0) and recorded intrusive memories of the film in diary A. On day 4, memory was reactivated, after which participants played Tetris, Word games, or had no task for 10 minutes. They then kept a second diary (B). Informative hypotheses were evaluated using Bayes factors. Results: Reactivation+Tetris and reactivation+Word games resulted in relatively fewer intrusions from the last day of diary A to the first day of diary B than reactivation-only (objective 1 and 2). Thus, both tasks were effective even when applied days after analogue trauma. Reactivation-only was not effective. Reactivation+Word games appeared to result in fewer intrusions than reactivation+Tetris (objective 3; modality effect), but this evidence was weak. Explorative analyses showed that Word games were more difficult than Tetris. Conclusions: Applying a task four days after the trauma film (during memory reconsolidation) was effective. The modality versus working-memory load issue is inconclusive.
Reported COVID-19 cases and deaths provide a delayed and incomplete picture of SARS-CoV-2 infections in the United States (US). Accurate estimates of both the timing and magnitude of infections are needed to characterize viral transmission dynamics and better understand COVID-19 disease burden. We estimated time trends in SARS-CoV-2 transmission and other COVID-19 outcomes for every county in the US, from the first reported COVID-19 case in January 13, 2020 through January 1, 2021. To do so we employed a Bayesian modeling approach that explicitly accounts for reporting delays and variation in case ascertainment, and generates daily estimates of incident SARS-CoV-2 infections on the basis of reported COVID-19 cases and deaths. The model is freely available as the covidestim R package. Nationally, we estimated there had been 49 million symptomatic COVID-19 cases and 404,214 COVID-19 deaths by the end of 2020, and that 28% of the US population had been infected. There was county-level variability in the timing and magnitude of incidence, with local epidemiological trends differing substantially from state or regional averages, leading to large differences in the estimated proportion of the population infected by the end of 2020. Our estimates of true COVID-19 related deaths are consistent with independent estimates of excess mortality, and our estimated trends in cumulative incidence of SARS-CoV-2 infection are consistent with trends in seroprevalence estimates from available antibody testing studies. Reconstructing the underlying incidence of SARS-CoV-2 infections across US counties allows for a more granular understanding of disease trends and the potential impact of epidemiological drivers.
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