BACKGROUND: Continual efforts to eliminate community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be needed to prevent additional waves of infection. We explored the impact of nonpharmaceutical interventions on projected SARS-CoV-2 transmission in Canada. METHODS: We developed an agestructured agent-based model of the Canadian population simulating the impact of current and projected levels of public health interventions on SARS-CoV-2 transmission. Interventions included case detection and isolation, contact tracing and quarantine, physical distancing and community closures, evaluated alone and in combination. RESULTS: Without any interventions, 64.6% (95% credible interval [CrI] 63.9%-65.0%) of Canadians will be infected with SARS-CoV-2 (total attack rate) and 3.6% (95% CrI 2.4%-3.8%) of those infected and symptomatic will die. If case detection and contact tracing continued at baseline levels without maintained physical distancing and reimplementation of restrictive measures, this combination brought the total attack rate to 56.1% (95% CrI 0.05%-57.1%), but it dropped to 0.4% (95% CrI 0.03%-23.5%) with enhanced case detection and contact tracing. Combining the latter scenario with maintained physical distancing reduced the total attack rate to 0.2% (95% CrI 0.03%-1.7%) and was the only scenario that consistently kept hospital INTERPRETATION: Controlling SARS-CoV-2 transmission will depend on enhancing and maintaining interventions at both the community and individual levels. Without such interventions, a resurgent epidemic will occur, with the risk of overwhelming our health care systems.

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Racialized populations have consistently been shown to have poorer health outcomes worldwide. This pattern has become even more prominent in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In countries where race disaggregated data are routinely collected, such as the United States and the United Kingdom, preliminary reports have identified that racialized populations are at a heightened risk of COVID-19 infection and mortality. Similar patterns are emerging in Canada but rely on proxy measures such as neighbourhood diversity to account for race, in the absence of person-level data. It follows that the collection of race disaggregated data in Canada is a crucial element in identifying individuals at risk of poorer COVID-19 outcomes and developing targeted public health interventions to mitigate risk among Canada’s racialized populations. Given this continuing gap, advocating for timely access to this data is of great importance owing to the challenges that the COVID-19 pandemic has highlighted amongst racialized populations in Canada and worldwide.

The aim of this study was to assess whether user fees exemptions increased healthcare services use among indigents in the Ouargaye district in Burkina Faso. In this pre-post study, we surveyed 1224 indigents in 2010 about their healthcare services use over the preceding 6 months. Of these, 540 subsequently received a user fees exemption card. A follow-up survey was conducted 1 year later with a 55.3% retention rate. Analyses were performed in accordance with Andersen and Newman's model (Societal and individual determinants of medical care utilization in the United States. Milbank Q 1973;51:95-124) to explain healthcare services use by considering predisposing and facilitating factors and health needs indicators. Logistic regression analyses were performed.Among indigents exempted from user fees, 46.2% increased their healthcare services use in 2011, as opposed to 42.1% among the non-exempted. Being exempted was not associated with increased use of services (odds ratio, OR = 1.1, 95% confidence interval, CI [0.80-1.51]). Regardless of whether they were exempted or not, the indigents most likely to have increased their healthcare services use were older than 69 years of age (OR = 1.66, 95% CI [1.05-2.64]), male (OR = 1.44, 95% CI [0.99-2.08]), in low-income households (OR = 1.71, 95% CI [1.15-2.54]), and had received financial support from their families to obtain healthcare (OR = 1.59, 95% CI [1.1-2.28]). The indigents' increased healthcare services use was not attributable to user fees exemptions. Some contamination of the intervention is conceivable. Interventions combining user fees exemptions with actions targeting other obstacles to healthcare access would probably be more effective in increasing indigents' use of healthcare centres.

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