Relationship between Built Environment and COVID-19 Dispersal Based on Age Stratification: A Case Study of Wuhan

The outbreak of COVID-19 (coronavirus disease 2019) has become the focus of attention in the field of urban geography. Built environment, such as the layout of public spaces like transportation hubs and urban open spaces, is an important factor affecting the spread of the epidemic. However, due to the different behavior patterns of different age groups, the intensity and frequency of their use of various built environment spaces may vary. Based on this, we selected patients that were infected, with a non-manipulated time period, and the classification of human behavior patterns; we then conducted a regression analysis study on the spatial distribution and building environment of these COVID-19 patients. The results showed that the spatial distribution of young and middle-aged patients (18–59 years old) was more homogeneous, while the spatial distribution of elderly patients (60 years old and above) had a strong clustering characteristic. Moreover, the significant built environment factors exhibited in the two populations were extremely different. More diverse urban facilities and public spaces exhibited influential properties for older patients, while middle-aged and young adults were more influenced by commuting facilities. It can be said that the built environment shows different influences and mechanisms on the transmission of respiratory infectious diseases in different populations. Therefore, the results of this paper can inform decision makers who expect to reduce the occurrence of urban respiratory infectious diseases by improving the urban built environment.

The Experiences of Community-dwelling older adults during the COVID-19 Lockdown in Wuhan: A qualitative study

AIMS

To explore the experiences of community-dwelling older adults in Wuhan during the coronavirus disease 2019 lockdown.

DESIGN

An empirical phenomenological approach was used to conduct a qualitative study.

METHODS

We performed semi-structured, in-depth telephone interviews between July 24 and August 2, 2020. A purposive sample of 18 participants (≥65 years old) who lived in Wuhan during the lockdown was recruited, including both infected and uninfected people. Data summarization and theme categories refinement were performed following Colaizzi's phenomenological approach.

RESULTS

Four main theme categories emerged. First, the 'Challenges' posed by the epidemic. Older adults were challenged with barriers in seeing a doctor and daily life inconveniences. And they experienced negative emotions, whether infected or not. The second domain was 'multi-dimensional support', which helped older people went through the difficult period. The third domain was 'resilience amid challenges'. Although they experienced physical and psychological distress, most of them could self-adjust and achieve transcendence from the unique experience. Lastly, the remaining impact after the epidemic affected older adults. Some still had mental burdens, while others thought they have benefited from the quarantine time (e.g. regular diet, learning new skills).

CONCLUSION

The epidemic and lockdown of the city brought significant physical and mental challenges to community-dwelling older adults. Active adaptation and multifaceted support helped them through this period. However, the mental burdens after the epidemic still require attention. These experiences would provide guidelines for the protection of vulnerable populations during public health emergencies.

IMPACT

The results of the study suggested that certain social dynamics and individual behaviours helped the elderly to better cope with the stressful lockdown period. The findings in this study provided guidelines on how to reduce the negative effects on older adults during the pandemic and enlighten studies concerning the well-being of older adults or other vulnerable people in future crises.

Using urban landscape pattern to understand and evaluate infectious disease risk

COVID-19 case numbers in 161 sub-districts of Wuhan were investigated based on landscape epidemiology, and their landscape metrics were calculated based on land use/land cover (LULC). Initially, a mediation model verified a partially mediated population role in the relationship between landscape pattern and infection number. Adjusted incidence rate (AIR) and community safety index (CSI), two indicators for infection risk in sub-districts, were 25.82∼63.56 ‱ and 3.00∼15.87 respectively, and central urban sub-districts were at higher infection risk. Geographically weighted regression (GWR) performed better than OLS regression with AICc differences of 7.951∼181.261. The adjusted R² in GWR models of class-level index and infection risk were 0.697 to 0.817, while for the landscape-level index they were 0.668 to 0.835. Secondly, 16 key landscape metrics were identified based on GWR, and then a prediction model for infection risk in sub-districts and communities was developed. Using principal component analysis (PCA), development intensity, landscape level, and urban blue-green space were considered to be principal components affecting disease infection risk, explaining 73.1 % of the total variance. Cropland (PLAND and LSI), urban land (NP, LPI, and LSI) and unused land (NP) represent development intensity, greatly affecting infection risk in urban areas. Landscape level CONTAG, DIVISION, SHDI, and SHEI represent mobility and connectivity, having a profound impact on infection risk in both urban and suburban areas. Water (PLAND, NP, LPI, and LSI) and woodland (NP, and LSI) represent urban blue-green spaces, and were particularly important for infection risk in suburban areas. Based on urban landscape pattern, we proposed a framework to understand and evaluate infection risk. These findings provide a basis for risk evaluation and policy-making of urban infectious disease, which is significant for community management and urban planning for infectious disease worldwide.

Sleep quality and associated factors during the COVID-19 epidemic among community non-medical anti-epidemic Workers of Wuhan, China

BACKGROUND

Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, community non-medical anti-epidemic workers have played an important role in the prevention of COVID-19 in China. The present study aimed to assess sleep quality and its associated factors among community non-medical anti-epidemic workers.

METHOD

A survey was conducted using anonymous online questionnaire to collect information from 16 March 2020 to 24 March 2020. A total of 474 participants were included, with a 94.23% completion rate. The questionnaire contained demographic data, physical symptoms, and contact history with COVID-19. The researchers assessed perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS), assessed perceived stress by the Perceived Stress Scale (PSS), and measured sleep quality by the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

RESULTS

Among the participants, 46.20% reported poor sleep quality. A binary logistic regression revealed that having educational background of junior college or above, being a member of the police force, having contacted individuals with confirmed or suspected COVID-19 infection, having chronic disease(s), having illness within 2 weeks, and having high or moderate perceived stress were significant factors associated with an increased risk of poor sleep quality.

CONCLUSION

Demographic factors, physical symptoms, history of contact with COVID-19, and perceived stress are significantly associated with poor sleep quality of community non-medical anti-epidemic workers. Thus, targeting these factors might be helpful in enhancing sleep quality of community workers.

Predictive Score of Risk Associated with Progression of Patients with COVID-19 Pneumonia in Wuhan, China: the ALA Score

Background The Coronavirus Disease 2019 (COVID-19) had become a Public Health Emergency of International Concern with more than 90 million confirmed cases worldwide. Therefore, this study aims to establish a predictive score model of progression to severe type in patients with COVID-19. Methods This is a retrospective cohort study of 151 patients with COVID-19 diagnosed by nucleic acid test or specific serum antibodies from February 13, 2020, to March 14, 2020, hospitalized in a COVID-19-designed hospital in Wuhan, China. Results Of the 151 patients with average age of 63 years, 64 patients were male (42.4%), and 29 patients (19.2%) were classified as severe group. Multivariate analysis showed that age > 65 years (odds ratio [OR] = 9.72, 95%CI: 2.92-32.31, P < 0.001), lymphocyte count ≤ 1.1 × 109/L (OR = 3.42, 95%CI: 1.24-9.41, P = 0.017) and AST > 35 U/L (OR = 3.19, 95%CI: 1.11-9.19, P = 0.032) were independent risk factors for the disease severity. The area under curve (AUC) of receiver operating characteristic curve of the probabilities of the composite continuous variable (age + lymphocyte + AST) is 0.796. Finally, a predictive score model called ALA was established, and its AUC was 0.83 (95%CI: 0.75-0.92). Using a cutoff value of 9.5 points, the positive and negative predictive values were 54.1% (38-70.1%) and 92.1% (87.2-97.1%), respectively. Conclusion The ALA score model can quickly identify severe patients with COVID-19, so as to help clinicians to better choose accurate management strategy.

An Online Cross-Sectional Survey on Oral Healthcare Among School-Age Children During COVID-19 Epidemic in Wuhan, China

Background: Since the outbreak of Coronavirus disease 2019 (COVID-19), the government of China adopted many measures which changed people's lifestyle including oral health-related lifestyle to control the transmission. The aim of this study was to investigate oral health status, oral healthcare behaviors, and parental attitudes toward oral healthcare among school-age children in Wuhan during the COVID-19 outbreak and what the status would be when the outbreak is under control.

Methods: This study was an online cross-sectional survey facing elementary school students in Wuhan. The questionnaire was completed by children's parents or other family members. The information on demographic data, oral health status, oral healthcare behaviors, and parental attitudes toward oral healthcare was collected at the end of school closure. The chi-square test was used to test the association of different questionnaire items.

Results: A total of 18,383 subjects aged 6–13 years with complete data were included in this investigation, and 44.2% of them suffered pain or discomfort related to teeth and gums during the epidemic. While there might be an increasing need and concern of oral healthcare during the outbreak and even when the outbreak was controlled, the worry of infection made it difficult for people to meet their demands of dental attendance.

Conclusion: The risk of cross-infection during the treatment had a negative influence on parental attitudes toward dental attendance. Effective measures should be taken to meet people's demands of dental attendance.

Correlation Between Anosmia and Severity Along with Requirement of Tocilizumab in COVID-19 Patients

Anosmia with or without dysgeusia is frequently associated with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) SARS-CoV-2 infection. SARS-CoV-2 virus affects the olfactory system and thus represents neurotropic and neuro-invasive nature of the virus. We found that tocilizumab’s role in reducing mortality in severe covid-19 infection is still questionable and aim of our study was correlation of anosmia and severity of covid-19 infection and requirement of tocilizumab in anosmia patients. To establish relationship between anosmia and severity of COVID-19 infection along with requirement of tocilizumab. This was a retrospective cum prospective cross sectional study done on COVID-19 patients who were admitted in normal COVID-19 ward and intensive care unit of Employee’s State Insurance Corporation Hospital, Udaipur and Maharaja Bhupal Hospital of Ravindra Nath Medical College between September 2020 and 15 January 2021 age group of 18 to 92 years, both sexes. We had asked about anosmia in all COVID-19 positive patients and followed all patients in perspective of severity of disease and tocilizumab. p value < 0.001 of prevalence of anosmia in COVID -19 patients who were isolated at home, admitted in ward and intensive care unit showed that anosmia is inversely related to severity of disease. Tocilizumab has no significant role in decreasing mortality in severe form of disease. Our study indicates that anosmia is related to the mildness of disease and there is no role of tocilizumab in decreasing the mortality in severe form of disease.

A Citywide 'Virus Testing': Chinese Government's Response to Preventing and Controlling the Second Outbreak of SARS-CoV-2

Containing the spread of SARS-CoV-2 is a daunting challenge globally. China, as well as a handful of other countries, has, for the most part, contained it by implementing strict policies. Wuhan's citywide virus-testing program presents a way forward in preventing and controlling the uncertainty, anxiety, instability and complexity it faces over the outbreak of SARS-CoV-2. Inarguably, the health crisis requires time-tested strategies and tactics for coordinating governments' and social entities' response to the health crisis, with a goal toward having and ensuring sustained effectiveness. Because of a possible recurrence of SARS-CoV-2 in Wuhan, the Prevention and Control Headquarters of Wuhan on COVID-19 launched a massive virus testing of Wuhan's 11 million residents; it was completed within 10 days. In light of this unprecedented mass testing, this study applies the situational crisis communication theory to analyze this massive virus-testing process and the mechanisms involved to contain SARS-CoV-2 in Wuhan. While many countries still have partial lockdowns, the second outbreak in Wuhan was an indication of what awaited all SARS-CoV-2-stricken countries post-lockdowns and after community restrictions had been lifted. Therefore, the recently implemented Wuhan control mechanism (in cities, districts and townships) may become a hortatory guide to other world regions as they contend with and consider appropriate measures to control the spread of SARS-CoV-2 and to ensure public safety.

Spatial variation of dissolved organic nitrogen in Wuhan surface waters: Correlation with the occurrence of disinfection byproducts during the COVID-19 pandemic

Intensified sanitization practices during the recent coronavirus disease-2019 (COVID-19) led to the release of chlorine-based disinfectants in surface water, potentially triggering the formation of disinfection byproducts (DBPs) in the presence of dissolved organic nitrogen (DON). Thus, a comprehensive investigation of DON's spatial distribution and its association with DBP occurrence in the surface water is urgently needed. In this study, a total of 51 water samples were collected from two rivers and four lakes in May 2020 in Wuhan to explore the regional variation of nitrogen (N) species, DON's compositional characteristics, and the three classes of DBP occurrence. In lakes, 53.0% to 86.3% of N existed as DON, with its concentration varying between 0.3-4.0 mg N/L. In contrast, NO₃^--N was the dominant N species in rivers. Spectral analysis revealed that DON in the lakes contained higher humic and fulvic materials with higher A₂₅₄, A₂₅₃/A_203, SUVA₂₅₄, and P_III+IV/P_I+II+V ratios, while rivers had higher levels of hydrophilic compounds. Trihalomethanes (THMs) were the most prevalent DBPs in the surface waters, followed by N-nitrosamines and haloacetonitriles (HANs). The levels of N-nitrosamines (23.1-97.4 ng/L) increased significantly after the outbreak of the COVID-19 pandemic. Excessive DON in the surface waters was responsible for the formation of N-nitrosamines. This study confirmed that the presence of DON in surface water could result in DBP formation, especially N-nitrosamines, when disinfectants were discharged into surface water during the COVID-19 pandemic.

Spatial Characterization of Urban Vitality and the Association With Various Street Network Metrics From the Multi-Scalar Perspective

In the context of rapid urbanization in developing countries, the spatial organization of cities has been progressively restructured over the past decades. However, little has been done to understand how the physical expansion affected the reorganization of socioeconomic spaces in cities. This study explores the association between various street network metrics and urban vitality and how it changes across different scales using geographic big data through a case study of Wuhan, China. Urban vitality is characterized by four components: concentration, accessibility, livability, and diversity. The new technique of spatial design network analysis (sDNA) is employed to characterize street network metrics, including connectivity, closeness, betweenness, severance, and efficiency, with 16 localized network variables. Furthermore, the stratified spatial heterogeneity between street network metrics at multiple scales and the four components of urban vitality is investigated using the Geodetector tool. First, concentration, accessibility, and diversity decline with distance from the urban center, whereas livability has a fluctuating upward trend with distance from the urban core. Second, the correlation between street network characteristics and urban vitality is sensitive to different spatial scales. Third, connectivity explains the largest amount of the variance in urban vitality (over 40%), while both betweenness and closeness explain roughly 28% of urban vitality. Efficiency and severance contribute 22 and 10% to the spatial heterogeneity of urban vitality, respectively. The study sheds light on the mechanisms between street configurations and urban vitality from the multi-scalar perspective. Some implications are provided for the improvement of the streets' urban vitality.

[The COVID-19 battle at CHU Zhongnan and Leishenshan hospital: A summary of the global mobilization in China and reflections on the Wuhan experience]

La ville de Wuhan, capitale du Hubei, a été le point de départ de l’épidémie de la Covid-19 et ses médecins ont été amenés à développer des stratégies inédites qui ont profité à la lutte globale dans le pays. Mais quelles que soient les stratégies envisagées, la règle de base pour contrôler la pandémie a été la détection précoce, le signalement, l’isolement et le traitement. Les modalités de la lutte ont été : une action rapide pour bloquer la transmission avec une réponse vigoureuse et à multiples facettes; une allocation de ressources à l’échelon national ; des hôpitaux abris de type Fangcang ; un important engagement communautaire : par des milliers de travailleurs du secteur médical qui se sont déployés dans la province du Hubei et l’apport d’une assistance via un réseau de bénévoles ; une population qui a accepté un changement dans son comportement avec le port de masques et la distanciation sociale ; une généralisation des tests (innovation technique) ; la science et la technologie qui ont réduit la pandémie grâce à la recherche et aux technologies numériques ; le diagnostic et le traitement gratuits de la COVID-19. La réussite de notre expérience a pu apporter des informations précieuses à la communauté internationale pour lutter contre la pandémie.

Estimating asymptomatic, undetected and total cases for the COVID-19 outbreak in Wuhan: a mathematical modeling study

BACKGROUND

The COVID-19 outbreak in Wuhan started in December 2019 and was under control by the end of March 2020 with a total of 50,006 confirmed cases by the implementation of a series of nonpharmaceutical interventions (NPIs) including unprecedented lockdown of the city. This study analyzes the complete outbreak data from Wuhan, assesses the impact of these public health interventions, and estimates the asymptomatic, undetected and total cases for the COVID-19 outbreak in Wuhan.

METHODS

By taking different stages of the outbreak into account, we developed a time-dependent compartmental model to describe the dynamics of disease transmission and case detection and reporting. Model coefficients were parameterized by using the reported cases and following key events and escalated control strategies. Then the model was used to calibrate the complete outbreak data by using the Monte Carlo Markov Chain (MCMC) method. Finally we used the model to estimate asymptomatic and undetected cases and approximate the overall antibody prevalence level.

RESULTS

We found that the transmission rate between Jan 24 and Feb 1, 2020, was twice as large as that before the lockdown on Jan 23 and 67.6% (95% CI [0.584,0.759]) of detectable infections occurred during this period. Based on the reported estimates that around 20% of infections were asymptomatic and their transmission ability was about 70% of symptomatic ones, we estimated that there were about 14,448 asymptomatic and undetected cases (95% CI [12,364,23,254]), which yields an estimate of a total of 64,454 infected cases (95% CI [62,370,73,260]), and the overall antibody prevalence level in the population of Wuhan was 0.745% (95% CI [0.693%,0.814%]) by March 31, 2020.

CONCLUSIONS

We conclude that the control of the COVID-19 outbreak in Wuhan was achieved via the enforcement of a combination of multiple NPIs: the lockdown on Jan 23, the stay-at-home order on Feb 2, the massive isolation of all symptomatic individuals via newly constructed special shelter hospitals on Feb 6, and the large scale screening process on Feb 18. Our results indicate that the population in Wuhan is far away from establishing herd immunity and provide insights for other affected countries and regions in designing control strategies and planing vaccination programs.

Heating behavior using household air-conditioners during the COVID-19 lockdown in Wuhan: An exploratory and comparative study

Wuhan is located in China's hot summer and cold winter (HSCW) zone, where the average temperature of the city from January to February 2020 is only 6.6 °C. This study aimed to explore and compare the air conditioner (AC) heating behavior of Wuhan residents before and after the COVID-19 lockdown. The date of commencement of the Wuhan lockdown (January 23, 2020) was considered the demarcation point to divide the AC monitoring data from the Internet of Things cloud platform into two groups; before and after Wuhan lockdown. Statistical methods were applied to analyze AC heating behavior of Wuhan residents from a total of 378 air conditioners during these two periods. The daily AC usage rate and average daily AC usage duration following the lockdown had a stronger correlation with daily outdoor temperature than that before the lockdown. AC heating behavior continued to demonstrate a part-time intermittent operation during the lockdown period, despite residents staying at home for a longer period. Trigger temperatures for occupants to turn on or adjust their AC during the lockdown period were overall 1-2 °C higher than before the lockdown. The AC heating demand in the HSCW zone has been increasing in recent years. These research results inform research on household energy demand and thermal comfort in China's HSCW zone, and provide a reference on the household behavioral changes in the occupants in the context of a lockdown as a result of the global COVID-19 pandemic.

Molecular surveillance of anti-malarial resistance pfcrt, pfmdr1, and pfk13 polymorphisms in African Plasmodium falciparum imported parasites to Wuhan, China

Background

Imported malaria parasites with anti-malarial drug resistance (ADR) from Africa is a serious public health challenge in non-malarial regions, including Wuhan, China. It is crucial to assess the ADR status in African Plasmodium falciparum isolates from imported malaria cases, as this will provide valuable information for rational medication and malaria control.

Methods

During 2017–2019, a cross-sectional study was carried out in Wuhan, China. Peripheral blood 3 ml of returned migrant workers from Africa was collected. The target fragments from pfcrt, pfmdr1, and k13 propeller (pfk13) genes were amplified, sequenced, and analysed.

Results

In total, 106 samples were collected. Subsequently, 98.11% (104/106), 100% (106/106), and 86.79% (92/106) of these samples were successfully amplified and sequenced for the pfcrt (72–76), pfmdr1, and pfk13 genes, respectively. The prevalence of the pfcrt 76 T, pfmdr1 86Y, and pfmdr1 184F mutations was 9.62, 4.72, and 47.17%, respectively. At codons 72–76, the pfcrt locus displayed three haplotypes, CVMNK (wild-type), CVIET (mutation type), CV M/I N/E K/T (mixed type), with 87.50%, 9.62%, and 2.88% prevalence, respectively. For the pfmdr1 gene, NY (wild type), NF and YF (mutant type), N Y/F, Y Y/F, and N/Y Y/F (mixed type) accounted for 34.91, 43.40, 3.77, 15.09, 0.94, and 1.89% of the haplotypes, respectively. A total of 83 isolates with six unique haplotypes were found in pfcrt and pfmdr1 combined haplotypes, of which NY-CVMNK and NF-CVMNK accounted for 40.96% (34/83) and 43.37% (36/83), respectively. Furthermore, 90 cases were successfully sequenced (84.91%, 90/106) at loci 93, 97, 101, and 145, and 78 cases were successfully sequenced (73.58%, 78/106) at loci 343, 353, and 356 for pfcrt. However, the mutation was observed only in locus 356 with 6.41%. For pfk13, mutations reported in Southeast Asia (at loci 474, 476, 493, 508, 527, 533, 537, 539, 543, 553, 568, 574, 578, and 580) and Africa (at loci 550, 561, 575, 579, and 589) were not observed.

Conclusions

The present data from pfcrt and pfmdr1 demonstrate that anti-malarial drugs including chloroquine, amodiaquine, and mefloquine, remain effective against malaria treatment in Africa. The new mutations in pfcrt related to piperaquine resistance remain at relatively low levels. Another source of concern is the artemether-lumefantrine resistance-related profiles of N86 and 184F of pfmdr1. Although no mutation in pfk13 is detected, molecular surveillance must continue.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-021-03737-8.

Quantitative evaluation of infectious health care wastes from numbers of confirmed, suspected and out-patients during COVID-19 pandemic: A case study of Wuhan

The fight against coronavirus disease 2019 (COVID-19) is still running its courses. Proper management and disposal of health care wastes (HCWs) are critical to win the fight. To achieve aforementioned tasks, prediction of their production is highly desired. In this study, primary data of production of three kinds of HCWs collected from Wuhan, the first epidemic epicenter worldwide and a mega city with more than 10 million population who has went through a lockdown period of 78 days, were reported for their first time. HCWs were classified into routine HCWs, infectious HCWs (IHCWs) and infectious municipal solid wastes. Among them, infectious HCWs from designated hospitals for COVID-19 were recognized as the most dangerous one. A multiple linear regression (MLR) model was built to predict the production of IHCWs with high significance. Numbers of patients were demonstrated high correlations with the production of IHCWs in an order of confirmed patients ＞ out-patients ＞ suspected patients. By the MLR model, production rates of IHCWs by confirmed, suspected and out patients were determined as 3.2, 1.8 and 0.1 kg/patient, respectively. In addition, constant production of IHCWs during the pandemic period was determined as 13 tons/d. This is the first study on quantitative evaluation of infectious HCWs during COVID-19 pandemic. The achievements in this study have potentials to shed light on global efforts to the prediction, management and disposal of vast HCWs generated in the war against COVID-19.

Quarantine for the coronavirus disease (COVID-19) in Wuhan city: Support, understanding, compliance and psychological impact among lay public

OBJECTIVE

Wuhan, the epicentre of the coronavirus diseases (COVID-19) outbreak, has been locked down on January 23, 2020. We conducted a study among the lay public in Wuhan to access their support, understanding of, compliance with, and the psychological impacts of the quarantine.

METHODS

We conducted a cross-sectional, online-based survey study between January 28, 2020, and February 2, 2020 among the adult lay public in Wuhan to access their support, understanding of, compliance with, and the psychological impacts of the quarantine. Multivariable logistic analysis was used to identify factors associated with psychological impacts.

RESULTS

Among the 4100 participants investigated, a total of 15.9% were compliant with all the five household prevention measures, whereas 74.4% were compliant with all the three community prevention measures investigated. By demographics, participants of younger age, higher income, residing in an urban area, knowing neighbors infected with COVID-19 reported significantly higher psychological impact score. Participants with a lower level of support for quarantine were more likely to have a higher psychological impact score (OR = 1.45, 95% CI 1.07-1.96). Participants with a lower level of compliance with preventive measures (score of 0-19) reported higher psychological impact (OR = 1.40, 95% CI 1.22-1.60 vs. score 20-24). Participants who had been out of house socializing and attended public events expressed higher psychological impact.

CONCLUSIONS

Support, understanding of the rationale for quarantine are essential in ensuring appropriate psychological well-being during the quarantine. Improvements in compliance with preventive measures are highly warranted and may bring about a reduction in psychological distress.

Facing the Threat of COVID-19 in Pakistan: A Nation's Dilemma

OBJECTIVES

In this article, we assess the resources, strategies, laboratory testing, awareness campaigns, and different treatment plans initiated by the government of Pakistan.

METHODS

A comprehensive literature search was performed using Medline/PubMed, Embase, Web of Science, and Google Scholar and official websites of Government of Pakistan and international organizations to identify empirical literature published in English from 2019 to June 2020.

RESULTS

It was not until the end of December 2019 that the first case of coronavirus disease 2019 (COVID-19) was discovered in Hubei province, China, with Wuhan the epicenter of it, sending the nation into an 11-week lockdown. It was the first of its kind and never seen before; hence, based on its novelty, the Chinese authorities named it novel coronavirus (2019-nCOV). Until January 23, 2020, there were only 17 cases in Wuhan, which surged to around 60,000 on February 16, 2020, with 2000 deaths. The World Health Organization declared it a global pandemic on January 30, 2020. Pakistan reported its first case of severe acute respiratory syndrome coronavirus 2 in February in Karachi. At the time, we did not realize the threat we were facing, and with even fewer resources at our disposal, it would turn out to be a major disaster in the coming days in Pakistan.

CONCLUSION

The COVID-19 crisis will likely have both short-term and long-term consequences for the general population, healthcare workers, and patients alike. But we need to get ahead of ourselves and come out on top for only not our survival, but also the survival of our population and healthcare system.

Does COVID-19 Affect the Behavior of Buying Fresh Food? Evidence from Wuhan, China

COVID-19 first appeared in Wuhan city of Hubei Province in China in December 2019. It has a substantial impact on human life all around the world, especially for citizens. The threat of COVID-19 has resulted in people shopping online to get fresh food and reduce outdoor trips. Collecting data from adult internet users in Wuhan, China in 2020, this study aims to explore the influence of COVID-19 on fresh food shopping behavior. In addition, a comparison and ordered logit model are constructed to demonstrate the changes and effects of COVID-19. The results suggest that more citizens in Wuhan city will buy fresh food online and the cost and frequency are also increased. The experience of online shopping for fresh food during the lock-down days has promoted more online shopping. The factors, such as frequency of online shopping before the COVID-19 outbreak, frequency of online shopping during the COVID-19 pandemic, and age, have a negative effect on the proportion of online shopping after the lock-down days, while the proportion of online shopping before the COVID-19 outbreak, the proportion of online shopping during the COVID-19 pandemic, and travel time of in-store shopping before the COVID-19 outbreak have a positive effect. The results provide insights for managers, city planners, and policymakers.

SARS-CoV-2 Antibody Seroprevalence in Wuhan, China, from 23 April to 24 May 2020

The outbreak of coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019. To investigate the prevalence of COVID-19 in Wuhan, we conducted serologic tests on 35,326 individuals from four different communities to estimate cumulative incidence of infection. Our results showed that 1,332 individuals (3.77%) showed positive COVID-19 antibody (either IgM or IgG). Males had a lower positivity rate than females (3.02% versus 4.52%). The antibody positivity rates showed a clear trend of increase according to patients' ages and varied among different communities. The results indicate that public health interventions may play important roles in the control of COVID-19.IMPORTANCE Coronavirus disease 2019 (COVID-19) was first detected in December 2019 in Wuhan, China. Afterwards, a number of public health interventions were implemented, including lock-down, face mask ordinances, and social distancing. Studies that rely on viral RNA testing of symptomatic patients have shown that these multifaceted interventions contributed to the control of the COVID-19 outbreak in Wuhan and delayed the epidemic's progression. However, these estimates of confirmed cases may miss large numbers of asymptomatic patients and recovered symptomatic patients who were not tested. To investigate the prevalence of COVID-19 in Wuhan, we conducted serologic tests on 35,326 individuals to estimate the cumulative incidence of infection. The results suggest that public health interventions may play important roles in the control of COVID-19.

Air quality characteristics in Wuhan (China) during the 2020 COVID-19 pandemic

Understanding the relationship between air quality, pollution emission control measures, and meteorological conditions is important for developing effective air quality improvement policies. In this study, we used pollution monitoring and meteorological data from January to May 2020 to analyze the air quality characteristics during the COVID-19 lockdown in Wuhan, which lasted from January 23 to April 8, 2020. Compared with the same period in 2019, the air quality in 2020 was significantly better. The total excellent and good air quality rates increased by 17.58%-90.08% in 2020; concentrations of NO₂, particulate matter with a diameter <10 μm (PM₁₀) and <2.5 μm (PM_2.5), and total volatile organic compounds (TVOCs) also decreased by 38.23%, 30.25%, 32.92%, and 39.80%, respectively. Moreover, the number of days with NO₂, PM₁₀, and PM_2.5 as the primary pollutants decreased by approximately 10%, 9%, and 15%, respectively. We compared the wind direction, wind speed, temperature, and relative humidity in January-April 2020, 2019, 2018, and 2017 and found no obvious correlation between meteorological factors and improved air quality during the 2020 lockdown. The implementation of strict lockdown measures, such as home quarantining, traffic restrictions, and non-essential enterprise shutdowns, was the dominant cause for the substantial air quality improvement during the 2020 COVID-19 lockdown in Wuhan.

Coronaviruses in humans and animals: the role of bats in viral evolution

Bats act as a natural reservoir for many viruses, including coronaviruses, and have played a crucial epidemiological role in the emergence of many viral diseases. Coronaviruses have been known for 60 years. They are usually responsible for the induction of mild respiratory signs in humans. However, since 2002, the bat-borne virus started to induce fatal epidemics according to WHO reports. In this year, the first serious human coronavirus epidemic (severe acute respiratory syndrome; SARS) occurred (China, 8098 cases, 774 deaths [9.5% of the cases] in 17 countries). The case fatality was higher in elderly patients above 60 years and reached 50% of the cases. SARS epidemic was followed 10 years later by the emergence of the middle east respiratory syndrome (MERS) in Saudi Arabia (in 2012, 2260 cases, 803 deaths [35.5% of the cases] in 27 countries). Finally, in December 2019, a new epidemic in Wuhan, China, (corona virus disease 2019, COVID-19) emerged and could spread to 217 countries infecting more than 86,255,226 cases and killing 1,863,973 people by the end of 2020. There are many reasons why bats are ideal reservoir hosts for viral diseases such as the tolerance of their immune system to the invading viruses for several months. They can actively shed the viruses, although they develop no clinical signs (will be discussed in details later in the review). Bats were directly or indirectly involved in the three previous coronavirus epidemics. The indirect transmission takes place via intermediate hosts including civet cats for SARS and dromedary camels in the case of MERS. Although bats are believed to be the source of COVID-19 pandemic, direct pieces of evidence are still lacking. Therefore, coronaviruses' role in epidemics induction and the epidemiological role of bats are discussed. The current work also presents different evidence (phylogenetic data, animal experiments, bats artificial infection studies, and computerized models of SARS-CoV2 evolution) that underline the involvement of bats in the epidemiology of the pandemic.

Population migration, spread of COVID-19, and epidemic prevention and control: empirical evidence from China

Background

This study applied the susceptible-exposed-infectious-removed (SEIR) model to analyze and simulate the transmission mechanisms of the coronavirus disease 2019 (COVID-19) in China.

Methods

The population migration was embedded in the SEIR model to simulate and analyze the effects of the amount of population inflow on the number of confirmed cases. Based on numerical simulations, this study used statistical data for the empirical validation of its theoretical deductions and discussed how to improve the effectiveness of epidemic prevention and control considering population migration variables. Statistics regarding the numbers of infected people in various provinces were obtained from the epidemic-related data reported by China’s National Health Commission.

Results

This study explored how the epidemic should be prevented and controlled from the perspective of population migration variables. It found that the combination of a susceptible population, an infected population, and transmission media were important routes affecting the number of infections and that the migration of a Hubei-related infected population played a key role in promoting epidemic spread. Epidemic prevention and control should focus on regions with better economic conditions than the epidemic region. Prevention and control efforts should focus on the more populated neighboring provinces having convenient transportation links with the epidemic region. To prevent and control epidemic spread, priority should be given to elucidating the destinations and directions of population migration from the domestic origin of infections, and then controlling population migration or human-to-human contact after such migration.

Conclusions

This study enriched and expanded on simulations of the effects of population migration on the COVID-19 epidemic and China-based empirical studies while offering an epidemic evaluation and warning mechanism to prevent and control similar public health emergencies in the future.

Association between maternal outdoor physical exercise and the risk of preterm birth: a case-control study in Wuhan, China

BACKGROUND

China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pregnancy and PTB among Chinese women in Wuhan, China.

METHODS

A case-control study was conducted among 6656 pregnant women (2393 cases and 4263 controls) in Wuhan, China from June 2011 to June 2013. Self-reported measures of maternal physical exercise (frequency per week and per day in minutes) were collected. Adjusted odds ratios were estimated using Bayesian hierarchical logistic regression and a generalized additive mixed model (GAMM).

RESULTS

Compared to women not involved in any physical activity, those who participated in physical exercise 1-2 times, 3-4 times, and over five times per week had 20% (aOR: 0.80, 95% credible interval [95% CI]: 0.68-0.92), 30% (aOR: 0.70, 95% CI: 0.60-0.82), and 32% (aOR: 0.68, 95% CI: 0.59-0.78) lower odds of PTB, respectively. The Bayesian GAMM showed that increasing physical exercise per day was associated with lower risk of PTB when exercise was less than 150 min per day; however, this direction of association is reversed when physical exercise was more than 150 min per day.

CONCLUSION

Maternal physical exercise, at a moderate amount and intensity, is associated with lower PTB risk. More data from pregnant women with high participation in physical exercise are needed to confirm the reported U-shape association between the physical exercise and risk of preterm birth.