Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review

Factors influencing risk perception and nosocomial infection prevention practices of frontline nurses during the COVID-19 pandemic

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, exploring factors influencing nosocomial infection among frontline nurses may provide evidence to optimize prevention strategies in hospitals.

METHOD

A large-scale online questionnaire survey of nurses' state-trait anxiety, job burnout, risk perception, workplace safety perception, knowledge about nosocomial infection, and preventive practices was conducted with 2795 frontline nurses working in the COVID-19 wards of six hospitals in Hubei Province, China, from February 1 to April 1, 2020. The questionnaire data were analyzed using the structural equation modeling (SEM) method to reveal the mechanisms influencing nurses' risk perception and preventive practices related to nosocomial COVID-19 infection.

RESULTS

A model of the factors that influence nurses' risk perception and preventive practices regarding nosocomial COVID-19 infection was established. The model verified hypotheses regarding the impact of nurses' risk perception and preventive practices. Notably, the hypothesis that risk perception has an impact on nurses' preventive practices regarding nosocomial infection is not valid. Moreover, different marital and educational conditions are associated with significant differences in the impact of state anxiety on the execution of preventive practices, the impact of workplace safety perceptions on risk perception, and the impact of workplace safety perceptions on the execution of preventive practices. The effect of state anxiety on preventive practices differed significantly with different durations of work experience.

CONCLUSIONS

According to the results of the influencing factor model, promoting the quality of training on nosocomial infection, meliorating workplace safety, and conducting timely and effective psychological interventions would aid in improving nurses' preventive practices. Meliorating workplace safety and easing state anxiety would be beneficial to reduce nurses' risk perception. These strategies are conducive to the optimization of policies for preventing nosocomial COVID-19 infections and similar infectious diseases.

Changes in Physical Activity and Sedentary Behaviour Due to Enforced COVID-19-Related Lockdown and Movement Restrictions: A Protocol for a Systematic Review and Meta-Analysis

Prolonged lockdown/restriction measures due to the COVID-19 pandemic have reportedly impacted opportunities to be physically active for a large proportion of the population in affected countries globally. The exact changes to physical activity and sedentary behaviours due to these measures have not been fully studied. Accordingly, the objective of this PROSPERO-registered systematic review is to evaluate the available evidence on physical activity and sedentary behaviours in the general population during COVID-19-related lockdown/restriction measures, compared to prior to restrictions being in place. Defined searches to identify eligible studies published in English, from November 2019 up to the date of submission, will be conducted using the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus, PSYCinfo, Coronavirus Research Database, Public Health Database, Publicly Available Content Database, SCOPUS, and Google Scholar. The applied inclusion criteria were selected to identify observational studies with no restrictions placed on participants, with outcomes regarding physical activity and/or sedentary behaviour during lockdown/restriction measures, and with comparisons for these outcomes to a time when no such measures were in place. Where appropriate, results from included studies will be pooled and effect estimates will be presented in random effects meta-analyses. To the best of our knowledge, this will be the first systematic review to evaluate one complete year of published data on the impact of COVID-19-related lockdown/restriction measures on physical activity and sedentary behaviour. Thus, this systematic review and meta-analysis will constitute the most up-to-date synthesis of published evidence on any such documented changes, and so will comprehensively inform clinical practitioners, public health agencies, researchers, policymakers and the general public regarding the effects of lockdown/restriction measures on both physical activity and sedentary behaviour.

Primary health care and social isolation against COVID-19 in Northeastern Brazil: Ecological time-series study

BACKGROUND

Brazil is witnessing a massive increase of corona virus disease (COVID-19). Its peculiar primary health care (PHC) system faces a burden due to the contagion occurring in the community environment. Then, the aim is to estimate the effect of the coverage of primary health care and social isolation on the evolution of confirmed cases and deaths by COVID-19, controlling sociodemographic, economic and health system aspects.

METHODS

A time series design was designed with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capital cities of the Northeast region of Brazil. Independent variables such as PHC coverage, hospital beds, social isolation, demographic density, Gini index and other indicators were analyzed. A Autoregressive Generalized Linear Model method was applied for model the relationship.

RESULTS

We identified an exponential growth of cases (y = 0.00250.71x; p-value<0,001). However, there is a high variability in the occurrence of outcomes. PHC coverage≥75% (χ2 = 9.27; p-value = 0.01) and social isolation rate (χ2 = 365.99; p-value<0.001) proved to be mitigating factors for the spread of COVID-19 and its deaths. Capitals with hospital beds ≥ 3.2 per thousand inhabitants had fewer deaths (χ2 = 9.02; p-value = 0.003), but this was influenced by PHC coverage (χ2 = 30,87; p-value<0.001).

CONCLUSIONS

PHC mitigates the occurrence of Covid-19 and its deaths in a region of social vulnerability in Brazil together with social isolation. However, it is not known until when the system will withstand the overload in view of the low adhesion to social isolation, the lack of support and appropriate direction from the government to its population.

Psychosocial effects of the COVID-19 pandemic and lockdown on university students: Understanding apprehensions through a phenomenographic approach

Limited evidence exists to help understand the experiences of university students in relation to the long-term lockdown due to the COVID-19 pandemic. For that reason, we conducted a study using a phenomenographic approach in order to understand how university students perceive COVID-19 and the associated lockdown. Data were collected from 25 students in Pakistan. They were asked to demonstrate the psychological effects of the COVID-19 pandemic and lockdown in illustrations. In addition, in-depth interviews were conducted with these students, to gain further insights into their perspectives on the psychosocial effects of the COVID-19 pandemic. The analysis revealed four interlinked directions for understanding students’ experiences. These themes were: 1) escape into peace, 2) hope for personal freedom, 3) fear of becoming a victim of COVID-19, and 4) concerns regarding education, future career, and opportunities. All four themes were analyzed and condensed into an outcome space, which further gathers the perceptions of students under one theme as “Hope for life while paradoxically living with fear”. Studying the psychological impact of the COVID-19 pandemic and lockdown on students not only highlighted their concerns, but also emphasized the importance of starting regular psychological evaluations and stress-releasing sessions, along with online education to overcome growing depression.

Impact of winter holiday and government responses on mortality in Europe during the first wave of the COVID-19 pandemic

Background

This aggregated population study investigated the impact of the seemingly quasi-randomly assigned school winter holiday in weeks 6–10 (February to early March) on excess mortality in 219 European regions (11 countries) during the COVID-19 pandemic in the spring 2020. A secondary aim was to evaluate the impact of government responses to the early inflow of infected cases.

Methods

Data on government responses weeks 8–14 were obtained from the Oxford COVID-19 Government Response Tracker. Regional data on total all-cause mortality during weeks 14–23 in 2020 were retrieved from Eurostat and national statistical agencies and compared with the average mortality during same period 2015–2019. Variance-weighted least square regression was used with mortality difference as dependent variable with adjustment for country, population density and age distribution.

Results

Being a region with winter holiday exclusively in week 9 was in the adjusted analysis associated with 16 weekly excess deaths [95% confidence interval (CI) 13–20] per million inhabitants during weeks 14–23, which corresponds to 38% of the excess mortality in these regions. A more stringent response implemented in week 11, corresponding to 10 additional units on the 0–100 ordinal scale, was associated with 20 fewer weekly deaths (95% CI 18–22) per million inhabitants.

Conclusions

Winter holiday in week 9 was an amplifying event that contributed importantly to the excess mortality observed in the study regions during the spring 2020. Timely government responses to the resulting early inflow of cases reduced the excess in mortality.

Detecting infected asymptomatic cases in a stochastic model for spread of Covid-19: the case of Argentina

We have studied the dynamic evolution of the Covid-19 pandemic in Argentina. The marked heterogeneity in population density and the very extensive geography of the country becomes a challenge itself. Standard compartment models fail when they are implemented in the Argentina case. We extended a previous successful model to describe the geographical spread of the AH1N1 influenza epidemic of 2009 in two essential ways: we added a stochastic local mobility mechanism, and we introduced a new compartment in order to take into account the isolation of infected asymptomatic detected people. Two fundamental parameters drive the dynamics: the time elapsed between contagious and isolation of infected individuals ([Formula: see text]) and the ratio of people isolated over the total infected ones (p). The evolution is more sensitive to the [Formula: see text]parameter. The model not only reproduces the real data but also predicts the second wave before the former vanishes. This effect is intrinsic of extensive countries with heterogeneous population density and interconnection.The model presented has proven to be a reliable predictor of the effects of public policies as, for instance, the unavoidable vaccination campaigns starting at present in the world an particularly in Argentina.

Vitamin Nature: How Coronavirus Disease 2019 Has Highlighted Factors Contributing to the Frequency of Nature Visits in Flanders, Belgium

Visiting nature is positively associated with physical and mental well-being. The role of nature became more pronounced during the coronavirus outbreak in the spring of 2020. Countries all over the world implemented confinement measures to reduce the transmission of the virus. These included but were not limited to the cancelation of public events, schools, and non-essential businesses and the prohibition of non-essential travels. However, going outside to exercise was recommended by the Belgian government. During this period, we conducted an online survey to determine if people visit nature more frequently than before and to identify the factors that contribute to this. The results are based on data from 11,352 participants in Flanders, Belgium. With the use of a bivariate and multiple regression analysis, results indicate that people visit nature more frequently than before and that nature helped to maintain social relationships during the coronavirus period. Gardens were reported to be the most popular place, followed by parks. More than half of the people experienced nature in a more positive way, and the belief that nature visits are important for general health increased. In addition, we found a positive association between nature visits and home satisfaction, as well as a positive association with subjective mental and physical health. Lastly, we identified several demographic factors contributing to the frequency of nature visits such as age, gender, and socioeconomic status. Our findings indicate the importance of nature visits for general well-being and highlight the need for nearby green infrastructure.

A randomized controlled trial to test the effect of simplified guidance with visuals on comprehension of COVID-19 guidelines and intention to stay home if symptomatic

BACKGROUND

In the COVID-19 pandemic, it is imperative that people understand and comply with self-isolation guidelines. We tested whether a simplified version of the guidelines and a simplified version with visual aids would affect comprehension and intention to self-isolate during the containment phase of the pandemic in the UK, in March 2020, compared to the standard guidelines.

METHODS

We conducted an online, three-armed parallel randomized controlled trial. Participants were English and over 18. The survey software randomized them into conditions; they were blind to condition. The control group read the 7-page standard guidelines (the current version at the time of the trial). The intervention groups were given either a 3-page simplified version, with a summary box on the front page and numbered bullet points, or the same simplified version with pictograms illustrating the points in the box. Primary outcomes were comprehension of the guidelines, as measured by the number of correct answers given to six questions about the content, and the proportion who answered that they would 'definitely' stay at home for 7 days if symptomatic.

FINDINGS

Recruitment was from 13 to 16 March 2020, with 1845 participants randomised and all data analysed. The Control group averaged 4.27 correct answers, the Simplified 4.20, and the Simplified + visual aids 4.13, out of a possible total of 6 correct answers. There were no differences in comprehension in the unadjusted models; however, when the model was adjusted for demographic variables, there was lower comprehension in the simplified + visual aids condition than in the control, (ß = - 0.16, p = 0.04998). There were no statistically significant differences in intention to stay home: Control was 85%, Simplified 83%, and Simplified + visual aids condition 84%.

CONCLUSION

Simplified guidance did not improve comprehension compared to the standard guidance issued in the containment phase of the COVID-19 pandemic in March 2020, and simplified guidance with visual aids may even have worsened comprehension. Simplified guidance had no effect on intention to stay home if symptomatic. This trial informed COVID-19 policy and provides insights relevant to guidance production in the acute phase of a major public health emergency.

The Importance of Safety and Security Measures at Sharm El Sheikh Airport and Their Impact on Travel Decisions after Restarting Aviation during the COVID-19 Outbreak

Travel decisions during the COVID-19 pandemic might be substantially influenced by destination-based attributes, in particular, health safety measures at airports. In the current study, we aimed to assess the effects of the perceived importance of safety measures at the Sharm El Sheikh airport on the intention of international passengers to revisit the destination, which might reflect their behavioral control for traveling to other tourism destinations. A total of 954 international travelers were asked to fill out a survey to reveal their travel risk perceptions, the importance of airport safety measures, and their future intentions to revisit the destination, and the data were integrated in an SEM model. The results showed that passengers with low-risk perceptions and highly perceived importance of logistic and sanitization procedures, as well as traveler- and staff-related safety measures, were more likely to exhibit greater intentions to revisit the city and lower intentions to cancel or change future travel plans to other touristic regions. Health safety at airports should be stressed in future strategic plans by governmental authorities and stakeholder activities to mitigate the psychological barriers of tourists.

Factors influencing customers' dine out intention during COVID-19 reopening period: The moderating role of country-of-origin effect

COVID-19 pandemic negatively affected the restaurant industry and reopening provides restaurants an opportunity to survive this crisis. This study examined the interplay of perceived importance of preventive measures, dining involvement, brand trust, and customers' intention to dine out at American Chinese restaurants during the reopening period. Additionally, the study investigated the moderating role of country-of-origin (COO) effect on these relationships. 296 U.S. restaurant customers recruited via a market research company completed the online survey. Structural equation modeling was used for data analyses. The results indicated that dining involvement had a direct positive effect on customers' intention to dine out. Moreover, both perceived importance of preventive measures and dining involvement could enhance customers' intention to dine out indirectly via brand trust. Positive COO effect moderated the relationship between perceived importance of preventive measures and brand trust. The study provided significant implications for restaurant operators in the U.S during the reopening period.

Returning to a Normal Life via COVID-19 Vaccines in the United States: A Large-scale Agent-Based Simulation Study

BACKGROUND

In 2020, COVID-19 has claimed more than 300,000 deaths in the United States alone. Although nonpharmaceutical interventions were implemented by federal and state governments in the United States, these efforts have failed to contain the virus. Following the Food and Drug Administration's approval of two COVID-19 vaccines, however, the hope for the return to normalcy has been renewed. This hope rests on an unprecedented nationwide vaccine campaign, which faces many logistical challenges and is also contingent on several factors whose values are currently unknown.

OBJECTIVE

We study the effectiveness of a nationwide vaccine campaign in response to different vaccine efficacies, the willingness of the population to be vaccinated, and the daily vaccine capacity under two different federal plans. To characterize the possible outcomes most accurately, we also account for the interactions between nonpharmaceutical interventions and vaccines through 6 scenarios that capture a range of possible impacts from nonpharmaceutical interventions.

METHODS

We used large-scale, cloud-based, agent-based simulations by implementing the vaccination campaign using COVASIM, an open-source agent-based model for COVID-19 that has been used in several peer-reviewed studies and accounts for individual heterogeneity and a multiplicity of contact networks. Several modifications to the parameters and simulation logic were made to better align the model with current evidence. We chose 6 nonpharmaceutical intervention scenarios and applied the vaccination intervention following both the plan proposed by Operation Warp Speed (former Trump administration) and the plan of one million vaccines per day, proposed by the Biden administration. We accounted for unknowns in vaccine efficacies and levels of population compliance by varying both parameters. For each experiment, the cumulative infection growth was fitted to a logistic growth model, and the carrying capacities and the growth rates were recorded.

RESULTS

For both vaccination plans and all nonpharmaceutical intervention scenarios, the presence of the vaccine intervention considerably lowers the total number of infections when life returns to normal, even when the population compliance to vaccines is as low as 20%. We noted an unintended consequence; given the vaccine availability estimates under both federal plans and the focus on vaccinating individuals by age categories, a significant reduction in nonpharmaceutical interventions results in a counterintuitive situation in which higher vaccine compliance then leads to more total infections.

CONCLUSIONS

Although potent, vaccines alone cannot effectively end the pandemic given the current availability estimates and the adopted vaccination strategy. Nonpharmaceutical interventions need to continue and be enforced to ensure high compliance so that the rate of immunity established by vaccination outpaces that induced by infections.

Targeted COVID-19 Vaccination (TAV-COVID) Considering Limited Vaccination Capacities-An Agent-Based Modeling Evaluation

(1) Background: The Austrian supply of COVID-19 vaccine is limited for now. We aim to provide evidence-based guidance to the authorities in order to minimize COVID-19-related hospitalizations and deaths in Austria. (2) Methods: We used a dynamic agent-based population model to compare different vaccination strategies targeted to the elderly (65 ≥ years), middle aged (45-64 years), younger (15-44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW). First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed deriving a prioritization sequence for 2.45 million individuals, maximizing the reduction in total hospitalizations and deaths compared to no vaccination. We considered sterilizing and non-sterilizing immunity, assuming a 70% effectiveness. (3) Results: Maximum reduction of hospitalizations and deaths was achieved by starting vaccination with the elderly and vulnerable followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.45 million individuals yielded the same prioritization and avoided approximately one third of deaths and hospitalizations. Starting vaccination with HCW leads to slightly smaller reductions but maximizes occupational safety. (4) Conclusion: To minimize COVID-19-related hospitalizations and deaths, our study shows that elderly and vulnerable persons should be prioritized for vaccination until further vaccines are available.

A Multi-Criteria Framework for Pandemic Response Measures

In managing the COVID-19 pandemic, several compelling narratives seem to have played a significant role in the decision-making processes regarding which risk mitigation and management measures to implement. Many countries were to a large extent unprepared for such a situation, even though predictions about a significant probability for a pandemic to occur existed, and national governments of several countries often acted in an uncoordinated manner, which resulted in many inconsistencies in the disaster risk reduction processes. Limited evidence has also made room for strategic narratives meant to persuade the public of the chosen set of actions, even though the degree of uncertainty regarding the outcomes of these was high, further complicating the situation. In this article, we assume a normative standpoint regarding rhapsodic decision making and suggest an integrated framework for a more elaborated decision analysis under the ambiguity of how to contain the virus spread from a policy point of view, while considering epidemiologic estimations and socioeconomic factors in a multi-stakeholder-multi-criteria context based on a co-creative work process for eliciting attitudes, perceptions, as well as preferences amongst relevant stakeholder groups. The framework, applied in our paper on Romania for demonstrative purposes, is used for evaluating mitigation measures for catastrophic events such as the COVID-19 situation, to mobilize better response strategies for future scenarios related to pandemics and other hazardous events, as well as to structure the production and analysis of narratives on the current pandemic effects.

Being the Family Caregiver of a Patient With Dementia During the Coronavirus Disease 2019 Lockdown

Background: Family caregivers of patients with dementia are at high risk of stress and burden, and quarantine due to the coronavirus disease 2019 (COVID-19) pandemic may have increased the risk of psychological disturbances in this population. The current study was carried out during the national lockdown declared in March 2020 by the Italian government as a containment measure of the first wave of the coronavirus pandemic and is the first nationwide survey on the impact of COVID-19 lockdown on the mental health of dementia informal caregivers. Methods: Eighty-seven dementia centers evenly distributed on the Italian territory enrolled 4,710 caregiver-patient pairs. Caregivers underwent a telephone interview assessing classical symptoms of caregiver stress and concern for the consequences of COVID-19 infection on patient's health. We calculated prevalence of symptoms and regressed them on various potential stress risk factors: caregivers' sociodemographic characteristics and lifestyle, patients' clinical features, and lockdown-related elements, like discontinuity in medical care. Results: Approximately 90% of caregivers reported at least one symptom of stress, and nearly 30% reported four or more symptoms. The most prevalent symptoms were concern for consequences of COVID-19 on patient's health (75%) and anxiety (46%). The main risk factors for stress were identified as a conflicting relationship with the patient and discontinuity in assistance, but caregiver's female sex, younger age, lower education, and cohabitation with the patient also had an impact. Availability of help from institutions or private individuals showed a protective effect against sense of abandonment but a detrimental effect on concern about the risk for the patient to contract COVID-19. The only protective factor was mild dementia severity, which was associated with a lower risk of feeling isolated and abandoned; type of dementia, on the other hand, did not affect stress risk. Conclusion: Our results demonstrate the large prevalence of stress in family caregivers of patients with dementia during the COVID-19 pandemic and have identified both caregivers and situations at a higher risk of stress, which should be taken into account in the planning of interventions in support of quarantined families and patients.

Quarantine acceptance and adherence: qualitative evidence synthesis and conceptual framework

Aim

Emergent infectious diseases often lack medical treatment or preventive vaccines, thus requiring non-pharmaceutical interventions such as quarantine to reduce disease transmission. Quarantine, defined as the separation and restriction of movement of healthy people who have potentially been exposed to the disease, remains contentious especially when the risks and benefits are not fully discussed and not effectively communicated to the people by the organizations who impose this public health measure.

Subject and methods

A qualitative evidence synthesis was conducted to examine the phenomenon of adherence to quarantine focused on the following questions: What strategies affect adherence to quarantine? What are the barriers and facilitators to quarantine acceptance? What benefits and harms of quarantine have been described or measured?

Results

The evidence synthesis produced 18 findings assessed with high confidence. The findings were used to construct a conceptual framework for inter- and within-organization coordination and public communication that includes the following topics for consideration: desired orientation for implementation; population demographics; perceptions of messages; prior acceptance of quarantine; likelihood of impacts of quarantine; perceptions of health infrastructure; and perceptions of policy importance.

Conclusion

The findings and conceptual framework can guide development of effective non-pharmaceutical interventions and as such have direct relevance to public health policy and decision-making for intervening in emergent infectious diseases outbreak such as the ongoing COVID-19 pandemic.

Urban-Rural Compliance Variability to COVID-19 Restrictions of Indigenous Fijian (iTaukei) Funerals in Fiji

Research on coronavirus disease 2019 (COVID-19) has focused primarily on impacts in Western societies despite emerging evidence of increased vulnerability among indigenous peoples such as Pacific Islanders. Using Facebook public posts, this research assessed compliance to COVID-19 restrictions such as social gatherings (SG) and social distancing (SD) in non-COVID-19, indigenous Fijian (iTaukei) funerals in Fiji. Results showed 95% of the 20 funerals exceeding SG limits with greater, and highly variable crowd sizes in rural than urban communities. Additionally, 75% of the 20 funerals did not adhere to the 2-m SD requirement of which 80% were in rural areas. Higher SG and SD compliance in urban funerals could be partially explained by the presence of a recognized authority who enforced crowd size limits, and the heterogeneous urban community who were more likely to flag breaches than their collectivistic, homogeneous, close-knit, rural counterparts. Ultimately, health authorities need to utilize a social lens that incorporates etic and emic differences in culture to ensure maximum compliance.

Rapid Review on the Associations of Social and Geographical Isolation and Intimate Partner Violence: Implications for the Ongoing COVID-19 Pandemic

While the COVID-19 pandemic forced millions of people to stay home and minimize their social contacts, newspaper reports worldwide raised concerns as they reported an increasing rate of intimate partner violence (IPV). One link of the measures enforced to control the pandemic to IPV might be a possible side effect of those measures, namely social and geographical isolation. As there was no scientific data investigating the association of IPV and social and geographical isolation in the context of epidemics or pandemics at the time of conducting this rapid review, we aimed at investigating a broader range of contexts of social as well as geographical isolation and its association with IPV to draw conclusions regarding the COVID-19 pandemic. We searched Embase, PubMed, PsycINFO, and Web of Science (core collection). A research strategy was developed and observational studies were included if they considered men and/or women, estimates of social and geographical isolation, and IPV as a primary outcome. Of the 526 identified studies, 11 were included in this review. The included studies involved 15,695 women and were conducted in the USA, Sweden, Ethiopia, Egypt, Spain, and Turkey. Indicators of social isolation such as lack of social, emotional, or informational support or the frequency and quality of social contacts were narratively assessed. Geographical isolation was primarily assessed by physical distance to the next town or support service. Both social and geographic isolation were found to be associated with an increased risk of IPV. Recommendations made by the individual studies include the following: (a) improving access to social networks outside the victims' own group, (b) improving their economic circumstances, (c) asserting the responsibility for those in contact with the victims, and (d) increasing the focus on access to preventive services and programs need to be taken into account. Therefore, considering the particular infrastructure and legislation of the countries affected by the pandemic, policies need to ensure constant access to shelters and other help services and increase awareness for IPV in the society. In addition, future studies are warranted to assess prevalence rates and risk factors of IPV during the COVID-19 pandemic.

Independent association of meteorological characteristics with initial spread of Covid-19 in India

Whether weather plays a part in the transmissibility of the novel Coronavirus Disease-19 (COVID-19) is still not established. We tested the hypothesis that meteorological factors (air temperature, relative humidity, air pressure, wind speed and rainfall) are independently associated with transmissibility of COVID-19 quantified using the basic reproduction rate (R0). We used publicly available datasets on daily COVID-19 case counts (total n = 108,308), three-hourly meteorological data and community mobility data over a three-month period. Estimated R0 varied between 1.15 and 1.28. Mean daily air temperature (inversely), wind speed (positively) and countrywide lockdown (inversely) were significantly associated with time dependent R0, but the contribution of countrywide lockdown to variability in R0 was over three times stronger as compared to that of temperature and wind speed combined. Thus, abating temperatures and easing lockdown may concur with increased transmissibility of COVID-19 in India.

Follow-up care for premature children: the repercussions of the COVID-19 pandemic

OBJECTIVE

to analyze elements of the follow-up care provided to premature children amidst the COVID-19 pandemic.

METHOD

qualitative study from the perspective of philosophical hermeneutics, interpreting experiences with childcare provided at home. Twelve mothers and 14 children aged two years old were interviewed online via a text messaging application. Data were analyzed by interpreting meanings.

RESULTS

weaknesses stood out in the follow-up care provided to children such as gaps of communication, lack of guidance and delayed immunizations, while care intended to meet health demands was interrupted. Vulnerability aspects affecting child development included: social isolation measures that impeded the children from socializing with their peers, increased screen time, the manifestation of demanding behaviors and irritation and the mothers experiencing an overload of responsibilities. The elements that strengthened maternal care included the mothers being attentive to contagion, enjoying greater experience and satisfaction with the maternal role, spending more time with their children, and recognizing respiratory signs and symptoms, especially fever.

CONCLUSION

follow-up care provided to children in stressful situations implies implementing practices that support the wellbeing of children and families, decreasing the likelihood of children being exposed to development deficits, and detecting signs and symptoms timely. The use of nursing call centers can break the invisibility of longitudinal needs and promote health education actions at home.

Epidemiological trends in COVID-19 pandemic: prospective critical appraisal of observations from six countries in Europe and the USA

INTRODUCTION

Europe was the epicentre of the COVID-19 pandemic in March 2020, with the highest number of cases and deaths between March and April. In May, the infection numbers registered a fall followed by a second new rise, not proportionally reflected by an increase in the number of deaths. We aimed to investigate the relationship between disease prevalence and infection fatality rate (IFR), and the number of intensive care unit (ICU) and hospital admissions over time, to develop a predictive model, as well as appraising the potential contributing factors underpinning this complex relationship.

METHODS

A prospective epidemiological study using data from six countries collected between 10 March and 4 September 2020. Data on the number of daily hospital and ICU admissions with COVID-19 were gathered, and the IFR and the prevalence were calculated. Trends over time were analysed. A linear regression model was used to determine the association between the fatality rates and the number of admissions.

FINDINGS

The prediction model confirmed the linear association between the fatality rates and the numbers of ICU and hospital admissions. The exception was during the peak of the COVID-19 pandemic when the model underestimated the fatalities indicating that a substantial number of deaths occurred outside of the hospitals. The fatality rates decreased in all countries from May until September regardless of the trends in prevalence, differences in healthcare systems or strategic variations in handling the pandemic.

INTERPRETATION

The observed gradual reduction in COVID-19 fatality rates over time despite varying disease prevalence and public health measures across multiple countries warrants search for a biological explanation. While our understanding of this novel virus grows, hospital and ICU admission rates remain effective predictors of patient outcomes which can be used as early warning signs for escalation of public health measures.

Expectations of citizens from the government in response to COVID-19 pandemic: a cross-sectional study in Iran

Background

The government is the main body in charge of controlling epidemics; hence, expectations from the intention and capacities of the government would affect the flexibility and behaviors of citizens. Given the severity of COVID-19 pandemic and the urgent need for cooperation of people in the prevention and combat processes, understanding the public perspectives would be crucial and instructive. This study aimed to explore such perspectives towards the current pandemic among the Iranian. Indeed, we sought to provide a favorable platform for effective policies in the face of the COVID-19 pandemic through recognizing public expectations.

Methods

This cross-sectional survey used an open-ended online questionnaire to investigate the common perspectives of the Iranian towards the response of government to COVID-19 pandemic. The participants were selected using snowball and convenient sampling techniques across the country. The collected data were analyzed and described using a thematic analysis.

Results

In general, 2547 participants agreed to participate in this study and completed the online questionnaire. According to the findings, the Iranian exhibited several expectations regarding the response of the government to COVID-19 pandemic. Three main themes were extracted based on these expectations: (1) health-related expectations, (2) policy-related expectations, and (3) Information-related expectations. In this study, a majority of participants highlighted the need to consider and follow-up the patients and their families, providing the financial and hygiene support during the pandemic, applying strict restrictions, and using close monitoring and controlling procedures. Furthermore, they mentioned that authorities and news agencies should observe the principals honesty and transparency.

Conclusions

Our findings revealed that people expect the government and other responsible institutions to minimize the burden of this pandemic through adopting effective policies. Also, they could help policy-makers become aware of the expectations of people and develop better strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10722-y.

[The consequences of the lockdown on cardiovascular diseases]

BACKGROUND

The Sars COV-2 infection causing the covid-19 disease has started in December 2019 inWuhan, China, then spread quickly to more than 100 countries in less than 3 months. On March, 11th the WHO declared officially the pandemic of Covid 19. In the absence of an effective treatment of the SARS-Cov2 the measures of social distancing and lockdown remain the most effectives ways against the pandemic. However, these measures can have repercussions in particular on patients followed for chronic diseases, the goal of our study will be to evaluate the impact of the lockdown on non-Covid cardiac patients.

METHODS

We have chosen a random sample of patients followed in the cardiology department of the CHU Tangier Tetouan Alhouceima, and we collected their demographic data as well as the symptoms, vital constants, lifestyle before and 60 days after the lockdown.

RESULTS

A total of 100 patients were included in the study. The average age of our population is 55.34 years±15.86. The average BMI (body mass index) is 26.40 Kg/m²±5.84. The coronary artery disease was present in 27% of the patients, valvular disease in 40% and heart failure in 37%. Finally, arrhythmias appear in 22% and more than the half of our sample has high blood pressure. We noted a significant weight gain of 1.71 Kg (P<0.000) after 60 days of lockdown, with an increase of BMI of 0,58 kg/m² (P<0,005). The percentage of patients with SBP (systolic blood pressure) ≥140mmHg has evolved from 38 to 44%, thus an increase of 6 % (P<0,0001), while the percentage of the patients with DBP (diastolic blood pressure) ≥90mmHg has passed from 21 to 15 % (thus a decrease of 6 %, P<0,0001). Twenty patients stop smoking, thus a decrease of 7% (P<0,0001). The sedentary lifestyle rate presented an elevation of 22% (P<0,0001). The daily calorie intake has increased of 35,4 % and 46,8 % of the patients increased their salt intake by more than 4 g per day. The increase of the daily calorie intake concerned more the men than the women (41,9 % of men vs 31,3 % of the women). In the population with high blood pressure, we have not observed a statistically significant difference of the SBP, the DBP and the heart rate between the beginning and two months after the lockdown. Concerning patients with heart Failure, we have noted an worsen of the symptoms of HF. Thus, 8,1% of the patients presenting a stage two dyspnea has passed to a stage three of the NYHA (32,4 vs 40,5%), while the percentage of patients with lower limbs edema has increased of 13,5% but in a non-statistically significant way (P=0,267). We have noticed a diet gap with an increase of salt intakes (more than 4g per day) in more than the half of this subpopulation (55,6 %) during the period of the lockdown. In the subpopulation of patients with valvular pathology, we have identified a worsening of the dyspnea in 7,5% of the patients; this one has passed from stage two to stage three of the NHYA with an increase of the percentage of patients with lower limbs edema from 7,5% to 25% (P=0,065). Furthermore, we have noticed an incidence of 10% of cardiovascular events (2 cases of myocardial infarction [among which one has deceased], one death because of end stage heart failure, three hospitalizations for congestive heart failure, two cases of aortic dissections and 2 cases of rapid atrial fibrillation).

OUR OBSERVATION

Depending on the results of this study, the sanitary lockdown induced important repercussions on the patients followed for cardiac diseases, hence the necessity of an awareness of these patients, and mostly a restructuring of our care system strongly disturbed by the Covid 19.

Mental Health during the COVID-19 Lockdown over the Christmas Period in Austria and the Effects of Sociodemographic and Lifestyle Factors

Since the beginning of the COVID-19 pandemic a decline in mental health has been reported. This online study investigated mental health and well-being in Austria during a strict lockdown. In total, N = 1505 participants were recruited between 23 December 2020 and 4 January 2021 and levels of depression (PHQ-9), anxiety (GAD-7), sleep quality (ISI), well-being (WHO-5), quality of life (WHO-QOL) and stress (PSS-10) were measured. 26% scored above the cut-off for moderate depressive symptoms (PHQ-9 ≥ 10; ♀ = 32%; ♂ = 21%), 23% above the cut-off for moderate anxiety (GAF-7 ≥ 10; ♀ = 29%; ♂ = 17%) and 18% above the cut-off for moderate insomnia (ISI ≥ 15; ♀ = 21%; ♂ = 16%). Mean-scores for quality of life (psychological WHO-QOL) were 68.89, for well-being (WHO-5) 14.34, and for stress (PSS-10) 16.42. The youngest age group (18-24) was most burdened and showed significantly more mental health symptoms compared with the oldest age group (65+) in depressive symptoms (50% vs. 12%), anxiety symptoms (35% vs. 10%), and insomnia (25% vs. 11%, all p-values < 0.05). Mental health decreased compared to both the first lockdown earlier in 2020 and pre-pandemic data. Further analyses indicate these findings were especially apparent for the under 24-year-olds, women, single/separated people, low incomes and those who do not partake in any physical activity (all p-values < 0.05). We highlight the need for ongoing mental health support, particularly to the most burdened groups.

PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews

The methods and results of systematic reviews should be reported in sufficient detail to allow users to assess the trustworthiness and applicability of the review findings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was developed to facilitate transparent and complete reporting of systematic reviews and has been updated (to PRISMA 2020) to reflect recent advances in systematic review methodology and terminology. Here, we present the explanation and elaboration paper for PRISMA 2020, where we explain why reporting of each item is recommended, present bullet points that detail the reporting recommendations, and present examples from published reviews. We hope that changes to the content and structure of PRISMA 2020 will facilitate uptake of the guideline and lead to more transparent, complete, and accurate reporting of systematic reviews.

App Use and Usability of a Barcode-Based Digital Platform to Augment COVID-19 Contact Tracing: Postpilot Survey and Paradata Analysis

BACKGROUND

The COVID-19 pandemic has drastically changed life in the United States, as the country has recorded over 23 million cases and 383,000 deaths to date. In the leadup to widespread vaccine deployment, testing and surveillance are critical for detecting and stopping possible routes of transmission. Contact tracing has become an important surveillance measure to control COVID-19 in the United States, and mobile health interventions have found increased prominence in this space.

OBJECTIVE

The aim of this study was to investigate the use and usability of MyCOVIDKey, a mobile-based web app to assist COVID-19 contact tracing efforts, during the 6-week pilot period.

METHODS

A 6-week study was conducted on the Vanderbilt University campus in Nashville, Tennessee. The study participants, consisting primarily of graduate students, postdoctoral researchers, and faculty in the Chemistry Department at Vanderbilt University, were asked to use the MyCOVIDKey web app during the course of the study period. Paradata were collected as users engaged with the MyCOVIDKey web app. At the end of the study, all participants were asked to report on their user experience in a survey, and the results were analyzed in the context of the user paradata.

RESULTS

During the pilot period, 45 users enrolled in MyCOVIDKey. An analysis of their enrollment suggests that initial recruiting efforts were effective; however, participant recruitment and engagement efforts at the midpoint of the study were less effective. App use paralleled the number of users, indicating that incentives were useful for recruiting new users to sign up but did not result in users attempting to artificially inflate their use as a result of prize offers. Times to completion of key tasks were low, indicating that the main features of the app could be used quickly. Of the 45 users, 30 provided feedback through a postpilot survey, with 26 (58%) completing it in its entirety. The MyCOVIDKey app as a whole was rated 70.0 on the System Usability Scale, indicating that it performed above the accepted threshold for usability. When the key-in and self-assessment features were examined on their own, it was found that they individually crossed the same thresholds for acceptable usability but that the key-in feature had a higher margin for improvement.

CONCLUSIONS

The MyCOVIDKey app was found overall to be a useful tool for COVID-19 contact tracing in a university setting. Most users suggested simple-to-implement improvements, such as replacing the web app framework with a native app format or changing the placement of the scanner within the app workflow. After these updates, this tool could be readily deployed and easily adapted to other settings across the country. The need for digital contact tracing tools is becoming increasingly apparent, particularly as COVID-19 case numbers continue to increase while more businesses begin to reopen.

Understanding On-Campus Interactions With a Semiautomated, Barcode-Based Platform to Augment COVID-19 Contact Tracing: App Development and Usage

BACKGROUND

The COVID-19 pandemic has forced drastic changes to daily life, from the implementation of stay-at-home orders to mandating facial coverings and limiting in-person gatherings. While the relaxation of these control measures has varied geographically, it is widely agreed that contact tracing efforts will play a major role in the successful reopening of businesses and schools. As the volume of positive cases has increased in the United States, it has become clear that there is room for digital health interventions to assist in contact tracing.

OBJECTIVE

The goal of this study was to evaluate the use of a mobile-friendly app designed to supplement manual COVID-19 contact tracing efforts on a university campus. Here, we present the results of a development and validation study centered around the use of the MyCOVIDKey app on the Vanderbilt University campus during the summer of 2020.

METHODS

We performed a 6-week pilot study in the Stevenson Center Science and Engineering Complex on Vanderbilt University's campus in Nashville, TN. Graduate students, postdoctoral fellows, faculty, and staff >18 years who worked in Stevenson Center and had access to a mobile phone were eligible to register for a MyCOVIDKey account. All users were encouraged to complete regular self-assessments of COVID-19 risk and to key in to sites by scanning a location-specific barcode.

RESULTS

Between June 17, 2020, and July 29, 2020, 45 unique participants created MyCOVIDKey accounts. These users performed 227 self-assessments and 1410 key-ins. Self-assessments were performed by 89% (n=40) of users, 71% (n=32) of users keyed in, and 48 unique locations (of 71 possible locations) were visited. Overall, 89% (202/227) of assessments were determined to be low risk (ie, asymptomatic with no known exposures), and these assessments yielded a CLEAR status. The remaining self-assessments received a status of NOT CLEAR, indicating either risk of exposure or symptoms suggestive of COVID-19 (7.5% [n=17] and 3.5% [n=8] of self-assessments indicated moderate and high risk, respectively). These 25 instances came from 8 unique users, and in 19 of these instances, the at-risk user keyed in to a location on campus.

CONCLUSIONS

Digital contact tracing tools may be useful in assisting organizations to identify persons at risk of COVID-19 through contact tracing, or in locating places that may need to be cleaned or disinfected after being visited by an index case. Incentives to continue the use of such tools can improve uptake, and their continued usage increases utility to both organizational and public health efforts. Parameters of digital tools, including MyCOVIDKey, should ideally be optimized to supplement existing contact tracing efforts. These tools represent a critical addition to manual contact tracing efforts during reopening and sustained regular activity.

A comparative study of strategies for containing the COVID-19 pandemic in Gulf Cooperation Council countries and the European Union

Background

The COVID-19 pandemic has impacted every aspect of human lives including health, businesses, and lifestyles. In spite of governments implementing various strategies across the globe, the pandemic is still expanding with increasing numbers of positive cases. In addition, countries are reopening and easing lockdown restrictions in order to get their economies back on track, and this has led to an increase in the transmission of novel coronavirus. Therefore, it is essential to regularly review the containment strategies employed in different regions in order to understand the characteristics of COVID-19 transmission and to formulate a future course of actions.

Objective

The objective of this study is to review the COVID-19 transmission statistics in Gulf Cooperation Council (GCC) and European Union (EU) countries, and to compare these data with the various containment strategies implemented for containing the spread of the virus.

Methods

A review method was adopted along with different statistical methods for comparing and analyzing COVID-19 data and containment strategies. Transmission types and the Case Fatality Rate (CFR) in the countries in both regions are used to present the current state of the pandemic. In addition, changes in the number of COVID-19 cases are compared with the mitigation and suppression strategies implemented in both regions and their impact is analyzed.

Results

Countries in the EU were slow in reacting to the pandemic, as delays are observed in the implementation of mitigation strategies. However, suppression strategies were implemented soon after mitigation strategies. GCC countries, on the other hand, were quick to react, and they implemented both mitigation and suppression strategies simultaneously, as soon as the pandemic emerged. The CFR was found to be low among GCC countries compared to EU countries. In addition, a second wave of transmission was observed in the EU, whereas in GCC countries there has been no second wave, although a gradual increase in the number of cases is observed. Community transmission was observed among the majority of countries in both GCC and EU countries.

Conclusions

With the reopening of markets, the focus of governments should be on developing integrated user-centric preventive strategies, with a blend of awareness creation, motivation, and support.

Preparedness for self-isolation or quarantine and lockdown in South Africa: results from a rapid online survey

BACKGROUND

The World Health Organization (WHO) declared the COVID-19 pandemic a public health emergency of international concern. South Africa, like many other countries, initiated a multifaceted national response to the pandemic. Self-isolation and quarantine are essential components of the public health response in the country. This paper examined perceptions and preparedness for self-isolation or quarantine during the initial phase of the pandemic in South Africa.

METHODS

The analysis used data obtained from an online quantitative survey conducted in all nine provinces using a data-free platform. Descriptive statistics and multivariable logistic regression models were used to analyse the data.

RESULTS

Of 55,823 respondents, 40.1% reported that they may end up in self-isolation or quarantine, 32.6% did not think that they would and 27.4% were unsure. Preparedness for self-isolation or quarantine was 59.0% for self, 53.8% for child and 59.9% for elderly. The odds of perceived possibility for self-isolation or quarantine were significantly higher among Coloureds, Whites, and Indians/Asians than Black Africans, and among those with moderate or high self-perceived risk of contracting COVID-19 than those with low risk perception. The odds were significantly lower among older age groups than those aged 18-29 years, and those unemployed than fully employed. The odds of preparedness for self-isolation or quarantine were significantly less likely among females than males. Preparedness for self, child and elderly isolation or quarantine was significantly more likely among other population groups than Black Africans and among older age groups than those aged 18-29 years. Preparedness for self, child and elderly isolation or quarantine was significantly less likely among those self-employed than fully employed and those residing in informal dwellings than formal dwellings. In addition, preparedness for self-isolation or quarantine was significantly less likely among those with moderate and high self-perceived risk of contracting COVID-19 than low risk perception.

CONCLUSION

The findings highlight the challenge of implementing self-isolation or quarantine in a country with different and unique social contexts. There is a need for public awareness regarding the importance of self-isolation or quarantine as well as counter measures against contextual factors inhibiting this intervention, especially in impoverished communities.

The interplay between risk and protective factors during the initial height of the COVID-19 crisis in Italy: The role of risk aversion and intolerance of ambiguity on distress

The present study aimed to test a model of relations to ascertain the determinants of distress caused by lockdown for COVID-19. It was hypothesized that the exposure to the COVID-19 increased distress directly and through the mediation of worry, health-related information seeking, and perception of the utility of the lockdown. It was also expected that higher levels of ambiguity intolerance corresponded to higher distress directly and through the mediation of worry, health information seeking behaviors, and perceived utility of the lockdown. Finally, it was expected that risk aversion positively influenced distress directly and through the increasing of worry, health-related information seeking behavior, and more positive perception of the utility of the lockdown The study was conducted in Italy during the mandatory lockdown for COVID-19 pandemic on 240 individuals (age range 18-76). Data recruitment was conducted via snowball sampling. COVID-19 exposure was positively associated with worry and health-related information seeking. Risk-aversion was positively associated with health-related information seeking and perceived utility of the lockdown to contain the spread of the virus. Worry and health-related information seeking were positively associated with distress, whereas the perceived utility of the lockdown was negatively associated with distress. Intolerance for the ambiguity was directly linked to distress with a positive sign. Findings suggest that risk aversion represents both a risk factor and a protective factor, based on what kind of variable mediates the relationship with distress, and that the intolerance to the ambiguity is a risk factor that busters distress.

The impact of non-pharmaceutical interventions, demographic, social, and climatic factors on the initial growth rate of COVID-19: A cross-country study

On March 11, 2020 the World Health Organization announced that the COVID-19 disease developed into a global pandemic. In the present paper, we aimed at analysing how the implementation of Non-Pharmaceutical Interventions (NPI) as well as climatic, social, and demographic variables affected the initial growth rate of COVID-19. In more detail, we aimed at identifying and assessing all the predictors in a whole picture of the COVID-19 outbreak and the effectiveness of the response of the countries to the pandemic. It can be expected, indeed, that there is a subtle and complex interplay among the various parameters. As such, we estimated the initial growth rate of COVID-19 for countries across the globe, and used a multiple linear regression model to study the association between the initial growth rate and NPI as well as pre-existing country characteristics (climatic, social and demographic variables measured before the current epidemic began). We obtained a mean initial growth rate of 0.120 (SD 0.076), in the range 0.023-0.315. Ten (8 pre-existing country characteristics and 2 NPI) out of 29 factors considered (21 pre-existing country characteristics and 8 NPI) were associated with the initial growth of COVID-19. Population in urban agglomerations of more than 1 million, PM2.5 air pollution mean annual exposure, life expectancy, hospital beds available, urban population, Global Health Security detection index and restrictions on international movement had the most significant effects on the initial growth of COVID-19. Based on available data and the results we obtained, NPI put in place by governments around the world alone may not have had a significant impact on the initial growth of COVID-19. Only restrictions on international movements had a relative significance with respect to the initial growth rate, whereas demographic, climatic, and social variables seemed to play a greater role in the initial growth rate of COVID-19.

Use of wearable sensors to assess compliance of asthmatic children in response to lockdown measures for the COVID-19 epidemic

Between March and April 2020, Cyprus and Greece health authorities enforced three escalated levels of public health interventions to control the COVID-19 pandemic. We quantified compliance of 108 asthmatic schoolchildren (53 from Cyprus, 55 from Greece, mean age 9.7 years) from both countries to intervention levels, using wearable sensors to continuously track personal location and physical activity. Changes in 'fraction time spent at home' and 'total steps/day' were assessed with a mixed-effects model adjusting for confounders. We observed significant mean increases in 'fraction time spent at home' in Cyprus and Greece, during each intervention level by 41.4% and 14.3% (level 1), 48.7% and 23.1% (level 2) and 45.2% and 32.0% (level 3), respectively. Physical activity in Cyprus and Greece demonstrated significant mean decreases by - 2,531 and - 1,191 (level 1), - 3,638 and - 2,337 (level 2) and - 3,644 and - 1,961 (level 3) total steps/day, respectively. Significant independent effects of weekends and age were found on 'fraction time spent at home'. Similarly, weekends, age, humidity and gender had an independent effect on physical activity. We suggest that wearable technology provides objective, continuous, real-time location and activity data making possible to inform in a timely manner public health officials on compliance to various tiers of public health interventions during a pandemic.

Experiences of persons in COVID-19 institutional quarantine in Uganda: a qualitative study

BACKGROUND

Quarantine has been adopted as a key public health measure to support the control of the Coronavirus disease (COVID-19) pandemic in many countries Uganda adopted institutional quarantine for individuals suspected of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to be placed in institutions like hotels and/or hostels of institutions for at least 14 days. This study explored experiences of individuals who underwent institutional quarantine in Uganda to inform measures to increase its effectiveness and reduce its associated negative impact.

METHODS

We conducted a qualitative description study using in-depth interviews with 20 purposively selected individuals who had spent time in institutional quarantine facilities. These were mainly phone-based interviews that were audio recorded and transcribed verbatim. Electronic data coding was conducted using Atlas.ti 7 software. Thematic content analysis was used to synthesize the findings with similar codes grouped to form sub-themes and ultimately study themes. The findings are presented thematically with typical participant quotes.

RESULTS

Study participants spent between 14 to 25 days in institutional quarantine. Four themes emerged describing the experiences of study participants during institutional quarantine, which determined whether participants' experiences were positive or negative. These themes were: quarantine environment including facility related factors and compliance with COVID-19 measures; quarantine management factors of entity paying the costs, communication and days spent in quarantine; individual factors comprising attitude towards quarantine, fears during and post-quarantine and coping mechanisms; and linkage to other services such as health care and post-quarantine follow-up.

CONCLUSION

The planning, management and implementation of the quarantine process is a key determinant of the experiences of individuals who undergo the measure. To improve the experience of quarantined individuals and reduce its associated negative impact, the pre-quarantine process should be managed to comply with standards, quarantined persons should be provided as much information as possible, their quarantine duration should kept short and costs of the process ought to be minimised. Furthermore, quarantine facilities should be assessed for suitability and monitored to comply with guidelines while avenues for access to healthcare for the quarantined need to be arranged and any potential stigma associated with quarantine thoroughly addressed.

COVID-19 Is Not the Flu: Four Graphs From Four Countries

Background: COVID-19 has caused a global public health emergency. Government mitigation strategies included a series of behavior-based prevention policies that had a likely impact on the spread of other contagious respiratory illnesses, such as seasonal influenza. Our aim was to explore how 2019-2020 influenza tracked onto COVID-19 pandemic and its mitigation methods. Materials and Methods: We linked the WHO FluNet database and COVID-19 confirmed cases (Johns Hopkins University) for four countries across the northern (Canada, the United States) and southern hemispheres (Australia, Brazil) for the period 2016-2020. Graphical presentations of longitudinal data were provided. Results: There was a notable reduction in influenza cases for the 2019-2020 season. Northern hemisphere countries experienced a quicker ending to the 2019-2020 seasonal influenza cases (shortened by 4-7 weeks) and virtually no 2020 fall influenza season. Countries from the southern hemisphere experienced drastically low levels of seasonal influenza, with consistent trends that were approaching zero cases after the introduction of COVID-19 measures. Conclusions: It is likely that the COVID-19 mitigation measures played a notable role in the marked decrease in influenza, with little to no influenza activity in both the northern and southern hemispheres. In spite of this reduction in influenza cases, there was still community spread of COVID-19, highlighting the contagiousness of SARS-CoV-2 compared to influenza. These results, together with the higher mortality rate from SARS-CoV-2 compared to influenza, highlight that COVID-19 is a far greater health threat than influenza.

Modelling COVID-19 transmission in Africa: countrywise projections of total and severe infections under different lockdown scenarios

OBJECTIVES

As of 13 January 2021, there have been 3 113 963 confirmed cases of SARS-CoV-2 and 74 619 deaths across the African continent. Despite relatively lower numbers of cases initially, many African countries are now experiencing an exponential increase in case numbers. Estimates of the progression of disease and potential impact of different interventions are needed to inform policymaking decisions. Herein, we model the possible trajectory of SARS-CoV-2 in 52 African countries under different intervention scenarios.

DESIGN

We developed a compartmental model of SARS-CoV-2 transmission to estimate the COVID-19 case burden for all African countries while considering four scenarios: no intervention, moderate lockdown, hard lockdown and hard lockdown with continued restrictions once lockdown is lifted. We further analysed the potential impact of COVID-19 on vulnerable populations affected by HIV/AIDS and tuberculosis (TB).

RESULTS

In the absence of an intervention, the most populous countries had the highest peaks in active projected number of infections with Nigeria having an estimated 645 081 severe infections. The scenario with a hard lockdown and continued post-lockdown interventions to reduce transmission was the most efficacious strategy for delaying the time to the peak and reducing the number of cases. In South Africa, projected peak severe infections increase from 162 977 to 2 03 261, when vulnerable populations with HIV/AIDS and TB are included in the analysis.

CONCLUSION

The COVID-19 pandemic is rapidly spreading across the African continent. Estimates of the potential impact of interventions and burden of disease are essential for policymakers to make evidence-based decisions on the distribution of limited resources and to balance the economic costs of interventions with the potential for saving lives.

Stay-at-home policy is a case of exception fallacy: an internet-based ecological study

A recent mathematical model has suggested that staying at home did not play a dominant role in reducing COVID-19 transmission. The second wave of cases in Europe, in regions that were considered as COVID-19 controlled, may raise some concerns. Our objective was to assess the association between staying at home (%) and the reduction/increase in the number of deaths due to COVID-19 in several regions in the world. In this ecological study, data from www.google.com/covid19/mobility/ , ourworldindata.org and covid.saude.gov.br were combined. Countries with > 100 deaths and with a Healthcare Access and Quality Index of ≥ 67 were included. Data were preprocessed and analyzed using the difference between number of deaths/million between 2 regions and the difference between the percentage of staying at home. The analysis was performed using linear regression with special attention to residual analysis. After preprocessing the data, 87 regions around the world were included, yielding 3741 pairwise comparisons for linear regression analysis. Only 63 (1.6%) comparisons were significant. With our results, we were not able to explain if COVID-19 mortality is reduced by staying at home in ~ 98% of the comparisons after epidemiological weeks 9 to 34.

Physical Activity during the First COVID-19-Related Lockdown in Italy

The spread of the COVID-19 virus was met by a strict lockdown in many countries around the world, with the closure of all physical activity (PA) facilities and limitations on moving around freely. The aim of the present online survey was to assess the effect of lockdown on physical activity in Italy. Physical activity was assessed using the European Health Interview Survey questionnaire. A total of 1500 datasets were analyzed. Differences between conditions were tested with a chi²-based (χ²) test for categorical variables, and with the Student’s t-test for paired data. A fixed effects binary logistic regression analysis was conducted to identify relevant predictor variables to explain the compliance with World Health Organisation (WHO) recommendations. We found a substantial decline in all physical activity measures. Mean differences in walking and cycling metabolic equivalent of task minutes per week (METmin/week), respectively, were 344.4 (95% confidence interval (95% CI): 306.6–382.2; p < 0.001) and 148.5 (95% CI: 123.6–173.5; p < 0.001). Time spent in leisure time decreased from 160.8 to 112.6 min/week (mean difference 48.2; 95% CI: 40.4–56.0; p < 0.001). Compliance with WHO recommendations decreased from 34.9% to 24.6% (chi² (1, 3000) = 38.306, p < 0.001, V = 0.11). Logistic regression showed a reduced chance (OR 0.640, 95% CI: 0.484–0.845; p = 0.001) to comply with WHO PA recommendations under lockdown conditions. Measures to promote physical activity should be intensified to limit detrimental health effects.

Assessment of Quarantine Understanding and Adherence to Lockdown Measures During the COVID-19 Pandemic in Palestine: Community Experience and Evidence for Action

Background: Containment of the coronavirus pandemic relied extensively on the combination of early implementation of quarantine and massive behavioral changes to ensure effectiveness. Decision-makers need to constantly monitor the outbreak situation and the impact of the measures implemented. Yet little is known about the factors influencing adherence and understanding of lockdown measures among the Palestinian community. This study aimed to assess the impact and factors affecting these early public health interventions.

Materials and Methods: A cross-sectional web-based questionnaire was distributed throughout social media (Facebook and Instagram). We used a snowball recruiting technique to target Palestinian adult citizens during the coronavirus pandemic quarantine between 6 and 16 April 2020, which corresponded to almost the middle interval of the strict massive lockdown measures in Palestine that lasted from 22 March to 5 May 2020. Multivariate logistic regression models were developed for the outcome variables (staying home adherence, in-home precautions adherence, and quarantine understanding).

Results: Our questionnaire was completed by 2,819 participants. The mean (range) age was 29.47 (18–71) years. Of them, 1,144 (40.6%), 1,261 (44.7%), and 1,283 (45.5%) reported low levels of staying home adherence, in-home precautions adherence, and quarantine understanding, respectively. Females, city residents, those with higher educational levels, and those informed by official government sources were associated significantly with higher levels of both staying home adherence and quarantine understanding. Adequate food supply was associated with a higher level of staying home adherence. Higher levels of in-home precautions adherence were noticed in the elderly and those with a high-risk group living at home. Higher monthly income was inversely associated with higher levels of in-home precautions adherence and lower levels of quarantine understanding (P < 0.05).

Conclusions: The socio-economic and financial status of the general population and coordination between the major information resources (official government), social media, and the press were the major factors affecting the community in regard to quarantine adherence. For maximum effectiveness and commitment levels amongst the people to decrease the spread of infection, policymakers need to address all those factors. In addition, clear communication between policymakers and the population is essential for reassuring the people and minimizing their fears regarding the unknown future.

A causal framework to determine the effectiveness of dynamic quarantine policy to mitigate COVID-19

Since the start of the pandemic caused by the novel coronavirus, COVID-19, more than 106 million people have been infected and global deaths have surpassed 2.4 million. In Chile, the government restricted the activities and movement of people, organizations, and companies, under the concept of dynamic quarantine across municipalities for a predefined period of time. Chile is an interesting context to study because reports to have a higher quantity of infections per million people as well as a higher number of polymerize chain reaction (PCR) tests per million people. The higher testing rate means that Chile has good measurement of the contagious compared to other countries. Further, the heterogeneity of the social, economic, and demographic variables collected of each Chilean municipality provides a robust set of control data to better explain the contagious rate for each city. In this paper, we propose a framework to determine the effectiveness of the dynamic quarantine policy by analyzing different causal models (meta-learners and causal forest) including a time series pattern related to effective reproductive number. Additionally, we test the ability of the proposed framework to understand and explain the spread over benchmark traditional models and to interpret the Shapley Additive Explanations (SHAP) plots. The conclusions derived from the proposed framework provide important scientific information for government policymakers in disease control strategies, not only to analyze COVID-19 but to have a better model to determine social interventions for future outbreaks.

[Psychological stress during the COVID-19 pandemic: consequences for psychiatric patients and therapeutic implications]

BACKGROUND

The outbreak of the COVID-19 disease and the rapid spread of the inducing coronavirus SARS-CoV‑2 threatens not only people's physical health but also their mental health. Its influence on incidence and course of existing illnesses in the psychiatric outpatient sector in Germany is still unknown.

METHODS

The medical reports of 682 persons in psychiatric treatment were retrospectively investigated, regarding their subjective response to this pandemic and its clinical relevance.

RESULTS

Of the patients 60.5% (n = 378) experienced greater psychological stress, 14.5% (n = 99) reported fear of the SARS-CoV‑2 and the possible danger of infection, 25.5% (n = 174) reported fear resulting from the protective measures taken (lock down) and 4.3% (n = 29) reported fear of both. This differed significantly across diagnoses: people with anxiety disorders reported significantly greater stress as well as greater fear of the virus, whereas people with psychoses were significantly less affected than the other patients. Of the participants 43.7% (n = 132) were so strongly affected that acute treatment had to be implemented and 6.0% (n = 18) had to be referred to inpatient care.

DISCUSSION

People with mental illnesses are particularly vulnerable to the psychological strain of the COVID-19 pandemic. Long-term studies on the further course of disease will be necessary. Additional studies that test interventions to build resilience in this population will also be needed.

[Change in psychological burden during the COVID-19 pandemic in Germany: fears, individual behavior, and the relevance of information and trust in governmental institutions]

BACKGROUND

The potential impact of the COVID-19 pandemic on mental health was evident early on. The extent of the effects, especially cumulative over the long period of the pandemic, has not yet been fully investigated for Germany.

OBJECTIVES

The aim of the study was to determine psychological burden as well as COVID-19-related experience and behavior patterns and to show how they changed during the different phases of the pandemic in Germany.

MATERIALS AND METHODS

The Germany-wide online-based cross-sectional study (03/10-07/27/2020) included 22,961 people (convenience sample). Generalized anxiety (GAD-7), depression (PHQ-2), and psychological distress (DT) were collected, as well as COVID-19-related experiences and behavior patterns: COVID-19-related fear, trust in governmental actions, subjective level of information, adherent safety behavior, and personal risk assessment for infection/severe course of illness. The pandemic was retrospectively divided into five phases (initial, crisis, lockdown, reorientation, and new normality).

RESULTS

Compared to pre-COVID-19 reference values, GAD‑7, PHQ‑2, and DT levels were significantly elevated and persistent throughout the different phases of the pandemic. COVID-19-related fear, information level, trust, safety behavior, and the risk assessment for infection/severe course of illness showed, after initial strong increase, a strong decrease to partly below the initial value. Exceptions were constant risk assessments of having a severe course of illness or dying of it.

CONCLUSIONS

The increased levels of psychological burden, which have persisted throughout all phases of the pandemic, illustrate the need for sustainable support services. Declining values over the duration of the pandemic in terms of trust in governmental actions and the feeling of being well informed underline the need for more targeted education.

Incubation period for COVID-19: a systematic review and meta-analysis

Aim

This study aims to conduct a review of the existing literature about incubation period for COVID-19, which can provide insights to the transmission dynamics of the disease.

Methods

A systematic review followed by meta-analysis was performed for the studies providing estimates for the incubation period of COVID-19. The heterogeneity and bias in the included studies were tested by various statistical measures, including I2 statistic, Cochran's Q test, Begg's test and Egger's test.

Results

Fifteen studies with 16 estimates of the incubation period were selected after implementing the inclusion and exclusion criteria. The pooled estimate of the incubation period is 5.74 (5.18, 6.30) from the random effects model. The heterogeneity in the selected studies was found to be 95.2% from the I2 statistic. There is no potential bias in the included studies for meta-analysis.

Conclusion

This review provides sufficient evidence for the incubation period of COVID-19 through various studies, which can be helpful in planning preventive and control measures for the disease. The pooled estimate from the meta-analysis is a valid and reliable estimate of the incubation period for COVID-19.

Knowledge, Attitude and Practice About Coronavirus Disease (COVID-19) Pandemic and Its Psychological Impact on Students and Their Studies: A Cross-Sectional Study Among Pharmacy Students in Saudi Arabia

Background

Individuals’ knowledge, attitude and practice towards preventive and precautionary measures of COVID-19 are essential to control the spread of the disease. Consequently, the aims of the study were to evaluate knowledge, attitude and practice of pharmacy students towards the pandemic and to assess its psychological impact on them to provide future guidance.

Methods

A cross-sectional, questionnaire-based study was conducted via a web-based survey in May 2020. All pharmacy students enrolled at Unaizah College of Pharmacy, Qassim University, were invited to take part in the study.

Results

A total of 232 out of 460 students took part in the study, giving a response rate of 50.43%. The mean total knowledge score was 9.87 ± 2.04 (maximum attainable score, 12). The majority of the participants (n=163; 70.3%) believed COVID-19 is a health threat to their community in the early months of the pandemic. Moreover, the majority (93%) also believed that the lockdown at the beginning of the pandemic was necessary to contain the pandemic. Encouragingly, 86.6% reported that they did not go to any crowded places during the pandemic with more female students avoiding crowded places compared to male students (91.6% versus 78.7%, respectively, P = 0.005). The majority (91%) also reported that they were following the strategies recommended by the authorities to prevent the spread of the virus. Encouragingly, 54.3% reported that the pandemic either had no effect or just a limited effect on their studies. However, 38.5% reported that they always felt or frequently felt nervous or anxious during the pandemic.

Conclusion

The study showed that pharmacy students had good knowledge as well as positive attitudes and good practices towards COVID-19 and the preventive measures. However, during the early months, the pandemic did have a negative psychological impact on a number of students. Consequently, proactive psychological and social support services to the students should be considered during the current and future pandemics. In addition, it is important to consider and proactively address key issues that could cause stress and anxiety among students when shifting to distance learning and assessments.

Quarantine due to the COVID-19 pandemic from the perspective of adolescents: the crucial role of technology

BACKGROUND

The year 2020 will be remembered as the "year of the COVID-19 pandemic". The world population had to familiarize themselves with words as swabs, personal protective equipment, pandemic. To curb the wave of the pandemic, almost all the countries imposed self-isolation and social distancing. We conducted a web-based survey to investigate the behavioural responses during the quarantine due to the COVID-19 pandemic.

METHODS

Participants were 1860 youth aged 12-18 years attending lower secondary schools and upper secondary schools. Data were collected on demographic characteristics, lifestyle changes during the quarantine period, and the psychological impact of the lock-down on adolescents' life.

RESULTS

Most adolescents experienced feelings of fear, discouragement, and anxiety which strongly affected the approach to their daily lifestyles. Most of the surveyed subjects reported having used this period to acquire new skills and to practice physical activities at home. The use of technology was predominant both for recreational activities and educational purposes.

CONCLUSIONS

Despite the strong psychological impact of the quarantine, adolescents showed good levels of resilience. Technology played a crucial role during the quarantine for young subjects who have increased the daily use of technological devices to stay connected with the rest of the world.

Cross-Country Differences in Stay-at-Home Behaviors during Peaks in the COVID-19 Pandemic in China and the United States: The Roles of Health Beliefs and Behavioral Intention

The novel coronavirus disease 2019 (COVID-19) rapidly escalated to a global pandemic. To control the rate of transmission, governments advocated that the public practice social distancing, which included staying at home. However, compliance with stay-at-home orders has varied between countries such as China and the United States, and little is known about the mechanisms underlying the national differences. Based on the health belief model, the theory of reasoned action, and the technology acceptance model, health beliefs and behavioral intention are suggested as possible explanations. A total of 498 Chinese and 292 American college students were recruited to complete an online survey. The structural equation modeling results showed that health beliefs (i.e., perceived susceptibility, severity, and barriers) and behavioral intention played multiple mediating roles in the association between nationality and actual stay-at-home behaviors. Notably, the effect via perceived barriers → behavioral intention was stronger than the effects via perceived susceptibility and severity → behavioral intention. That is, American participants perceived high levels of susceptibility whereas Chinese participants perceived high levels of severity, especially few barriers, which further led to increased behavioral intention and more frequent stay-at-home behaviors. These findings not only facilitate a comprehensive understanding of cross-country differences in compliance with stay-at-home orders during peaks in the COVID-19 pandemic but also lend support for mitigation of the current global crisis and future disease prevention and health promotion efforts.

Community practice of using face masks for the prevention of COVID-19 in Saudi Arabia

Community face masking is possibly of great value in reducing COVID-19 transmission, especially when universally adopted with high compliance. The aim of this study is to investigate the knowledge, common misconceptions, barriers, and the compliance of the community with the use of face masks for the prevention of COVID-19. A validated questionnaire was administered to the participants through a web link by using various social media. The collected data were statistically analyzed for significant differences according to demographic variables. The average knowledge of face masks and their role in preventing COVID-19 transmission was 95.64%, with no differences among most of the demographical factors. Older groups and females demonstrated a better attitude towards wearing face masks than other groups did (p<0.001). Another significant difference in the participant's attitude was noticed between the various educational levels, employment, and nationality (p<0.001). Of the total respondents, 88.2% encouraged wearing face masks. Misconceptions about wearing face masks were very low. The frequency of wearing face masks at public places, workplaces, or social gatherings was 87.2%, 80.5%, and 47.5% respectively. There was a significant variation in the compliance with wearing face masks between the various groups based on age, gender, nationality, and employment status (p<0.001). The inconvenience in wearing face masks was reported by 36.3%. Face irritation and ear pain were reported by 70.2% and 43.5%, respectively. The inconvenience of wearing face masks with eyeglasses was reported by 44.3% of those wearing eyeglasses. In general, the study demonstrated a good attitude among participants towards wearing face masks. Although the respondents in the study were aware of the benefits of wearing face masks, the barriers may have decreased their desire to do so. These barriers include difficulty in breathing, discomfort, face irritation, and ear pain.

On an interval prediction of COVID-19 development based on a SEIR epidemic model

In this paper, a new version of the well-known epidemic mathematical SEIR model is used to analyze the pandemic course of COVID-19 in eight different countries. One of the proposed model's improvements is to reflect the societal feedback on the disease and confinement features. The SEIR model parameters are allowed to be time-varying, and the ranges of their values are identified by using publicly available data for France, Italy, Spain, Germany, Brazil, Russia, New York State (US), and China. The identified model is then applied to predict the SARS-CoV-2 virus propagation under various conditions of confinement. For this purpose, an interval predictor is designed, allowing variations and uncertainties in the model parameters to be taken into account. The code and the utilized data are available on Github.

Insufficient social distancing may contribute to COVID-19 outbreak: The case of Ijuí city in Brazil

The coronavirus disease that emerged in 2019 (COVID-19) is highly contagious and has given way to a global pandemic. A present COVID-19 has high transmission rates worldwide, including in small Brazilian cities such as Ijuí. Located in the northwest part of the state of Rio Grande do Sul (RS) and with a population of 83,475, Ijuí was selected as the site of a population-based survey involving 2,222 subjects, from April to June 2020. Subjects were tested for the presence of antibodies against coronavirus (SARS-CoV-2) and answered questions regarding social distance adherence (SDA), daily preventive routines (DPR), comorbidities, and sociodemographic characteristics. In parallel, the local government registered the official COVID-19 cases in Ijuí, as well as the mobile social distancing index (MSDI). In this study, we demonstrate that there was a decrease in the levels of SDA, DPR and MSDI before the beginning of COVID-19 community transmission in Ijuí. Furthermore, we provide predictions for the number of COVID-19 cases, hospitalizations, and deaths in the city. We conclude that insufficient social distancing, as evidenced by different methods, may be related to the rapid increase of COVID-19 cases in Ijuí. Our study predicts an approaching outbreak of COVID-19 in Ijuí through community spread, which could be avoided or attenuated with increased levels of social distancing among the population.