Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Social Distancing Measures

A Comparison of Vaccine Hesitancy of COVID-19 Vaccination in China and the United States

OBJECTIVES

To investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, namely, China and the United States (U.S.).

METHOD

A cross-national survey was conducted in both China and the United States, and discrete choice experiments, as well as Likert scales, were utilized to assess vaccine preference and the underlying factors contributing to vaccination acceptance. Propensity score matching (PSM) was performed to enable a direct comparison between the two countries.

RESULTS

A total of 9077 (5375 and 3702 from China and the United States, respectively) respondents completed the survey. After propensity score matching, over 82.0% of respondents from China positively accepted the COVID-19 vaccination, while 72.2% of respondents from the United States positively accepted it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the U.S. respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the United States attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint, that the cost of vaccination covered the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Additionally, respondents from China tended to be much more concerned about the adverse effect of vaccination (19.68% vs. 6.12%) and have a lower perceived severity of being infected with COVID-19.

CONCLUSION

Although the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between these countries were observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in the two countries, vaccine rollout strategies should be nation-dependent.

Revisiting the Effects of High-Speed Railway Transfers in the Early COVID-19 Cross-Province Transmission in Mainland China

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic that was reported at the end of 2019 in Wuhan, China, and was rapidly disseminated to all provinces in around one month. The study aims to assess the changes in intercity railway passenger transport on the early spatial transmission of COVID-19 in mainland China. Examining the role of railway transport properties in disease transmission could help quantify the spatial spillover effects of large-scale travel restriction interventions. This study used daily high-speed railway schedule data to compare the differences in city-level network properties (destination arrival and transfer service) before and after the Wuhan city lockdown in the early stages of the spatial transmission of COVID-19 in mainland China. Bayesian multivariate regression was used to examine the association between structural changes in the railway origin-destination network and the incidence of COVID-19 cases. Our results show that the provinces with rising transfer activities after the Wuhan city lockdown had more confirmed COVID-19 cases, but changes in destination arrival did not have significant effects. The regions with increasing transfer activities were located in provinces neighboring Hubei in the widthwise and longitudinal directions. These results indicate that transfer activities enhance interpersonal transmission probability and could be a crucial risk factor for increasing epidemic severity after the Wuhan city lockdown. The destinations of railway passengers might not be affected by the Wuhan city lockdown, but their itinerary routes could be changed due to the replacement of an important transfer hub (Wuhan city) in the Chinese railway transportation network. As a result, transfer services in the high-speed rail network could explain why the provinces surrounded by Hubei had a higher number of confirmed COVID-19 cases than other provinces.

Effectiveness of non-pharmaceutical interventions related to social distancing on respiratory viral infectious disease outcomes: A rapid evidence-based review and meta-analysis

OBJECTIVES

Non-pharmaceutical interventions (e.g. quarantine and isolation) are used to mitigate and control viral infectious disease, but their effectiveness has not been well studied. For COVID-19, disease control efforts will rely on non-pharmaceutical interventions until pharmaceutical interventions become widely available, while non-pharmaceutical interventions will be of continued importance thereafter.

METHODS

This rapid evidence-based review provides both qualitative and quantitative analyses of the effectiveness of social distancing non-pharmaceutical interventions on disease outcomes. Literature was retrieved from MEDLINE, Google Scholar, and pre-print databases (BioRxiv.org, MedRxiv.org, and Wellcome Open Research).

RESULTS

Twenty-eight studies met inclusion criteria (n = 28). Early, sustained, and combined application of various non-pharmaceutical interventions could mitigate and control primary outbreaks and prevent more severe secondary or tertiary outbreaks. The strategic use of non-pharmaceutical interventions decreased incidence, transmission, and/or mortality across all interventions examined. The pooled attack rates for no non-pharmaceutical intervention, single non-pharmaceutical interventions, and multiple non-pharmaceutical interventions were 42% (95% confidence interval = 30% - 55%), 29% (95% confidence interval = 23% - 36%), and 22% (95% confidence interval = 16% - 29%), respectively.

CONCLUSION

Implementation of multiple non-pharmaceutical interventions at key decision points for public health could effectively facilitate disease mitigation and suppression until pharmaceutical interventions become available. Dynamics around R 0 values, the susceptibility of certain high-risk patient groups to infection, and the probability of asymptomatic cases spreading disease should be considered.

How to survive a pandemic: The corporate resiliency of travel and leisure companies to the COVID-19 outbreak

What protects travel and leisure companies from a global pandemic, such as COVID-19? To answer this question, we investigate data on over 1200 travel and leisure companies in 52 countries. We consider 80 characteristics, such as company financial ratios, macroeconomic variables, and government policy responses. Using regressions and machine learning tools, we demonstrate that firms with low valuations, limited leverage, and high investments have been more immune to the pandemic-induced crash. We also find a beneficial effect of stringent containment and closure policies. Finally, our results indicate that countries with less individualism may be better positioned to cope with the pandemic. Our findings have implications for regulatory bodies, managers, and investors concerning future pandemic outbreaks.

Slowing the spread of COVID-19: Review of "Social distancing" interventions deployed by public transit in the United States and Canada

This paper presents a review of social distancing measures deployed by transit agencies in the United States and Canada during the COVID-19 pandemic and discusses how specific operators across the two countries have implemented changes. Challenges and impacts on their operations are also provided. Social distancing is one of the community mitigation measures traditionally implemented during influenza pandemics and the novel coronavirus pandemic. Research has shown that social distancing is effective in containing the spread of disease. This is applicable to the current situation with the novel coronavirus, given the lack of effective vaccines and treatments in the United States and Canada in the first eight months of the pandemic. Moreover, social distancing is particularly useful in settings where community transmission is substantial. Directives for social distancing were issued in several states and public transit operators were charged with how to provide for physical distance of six feet between passengers on their property including physical infrastructure such as station buildings and rolling infrastructure (rolling stock) including trains, subway cars and buses. Operational changes were also required due to physical distancing, e.g. adding train cars to provide for opportunities to physically distance on the train. Examples of some measures discussed in this research includes taping off every other seat on buses, increasing the total length of trains by adding cars, separating bus drivers from passengers with plastic sheeting, rear door boarding, etc. This research also analyzes long-term impacts for transit operators and challenges to encourage passengers to return to public transit after lockdown requirements ordered by government officials are lifted. A section on the policies that are being explored by government to continue to sustain public transportation is also included.

The effect of the synchronized multi-dimensional policies on imported COVID-19 curtailment in China

As countries are lifting restrictions and resuming international travels, the rising risk of COVID-19 importation remains concerning, given that the SARS-CoV-2 virus could be transmitted unintentionally through the global transportation network. To explore and assess the effective strategies for curtailing the epidemic risk from international importation nationwide, we evaluated "the joint prevention and control" mechanism, which made up of 19 containment policies, on how it impacted the change of medical observation and detection time from border arrival to laboratory confirmation of COVID-19 in its burst in China. Based on 1,314 epidemiological-survey cases from February 29 to May 25, 2020, we found that the synchronized approach of implementing multi-dimensional interventional policies, such as a centralized quarantine and nucleic acid testing (NAT), flight service adjustment and border closure, effectively facilitate early identification of infected case. Specifically, the implementation of the international flight service reduction was found to be associated with a reduction of the mean intervals of diagnosis from arrival to lab-confirmation by 0.44 days maximally, and the border closure was associated with a reduction of the diagnosis interval of imported cases by 0.69 days, from arrival to laboratory confirmation. The study suggests that a timely and synchronized implementation of multi-dimensional policies is compelling in preventing domestic spreading from importation.

Impact of COVID-19 outbreaks and interventions on influenza in China and the United States

Coronavirus disease 2019 (COVID-19) was detected in China during the 2019-2020 seasonal influenza epidemic. Non-pharmaceutical interventions (NPIs) and behavioral changes to mitigate COVID-19 could have affected transmission dynamics of influenza and other respiratory diseases. By comparing 2019-2020 seasonal influenza activity through March 29, 2020 with the 2011-2019 seasons, we found that COVID-19 outbreaks and related NPIs may have reduced influenza in Southern and Northern China and the United States by 79.2% (lower and upper bounds: 48.8%-87.2%), 79.4% (44.9%-87.4%) and 67.2% (11.5%-80.5%). Decreases in influenza virus infection were also associated with the timing of NPIs. Without COVID-19 NPIs, influenza activity in China and the United States would likely have remained high during the 2019-2020 season. Our findings provide evidence that NPIs can partially mitigate seasonal and, potentially, pandemic influenza.

Pandemic Prevention: Lessons from COVID-19

Coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared in late 2019, generating a pandemic crisis with high numbers of COVID-19-related infected individuals and deaths in manifold countries worldwide. Lessons learned from COVID-19 can be used to prevent pandemic threats by designing strategies to support different policy responses, not limited to the health system, directed to reduce the risks of the emergence of novel viral agents, the diffusion of infectious diseases and negative impact in society.

Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial

BACKGROUND

The COVID-19 pandemic has brought about sweeping change in health care delivery, which has shifted from in-person consultations to a web-based format. Few medical schools provide web-based medicine or telemedicine training to their learners, though this is likely to be important for future medical practice.

OBJECTIVE

This tutorial communicates a framework for incorporating medical students into primary care telemedicine clinics.

METHODS

A third-year medical student and internal medicine attending physician from the Johns Hopkins University completed telemedicine clinic visits in April 2020 by using a variety of video platforms and via telephone calls.

RESULTS

Nine telemedicine visits were completed over 4 clinic days. Our patients were, on average, aged 68 years. The majority of patients were female (6/9, 67%), and most appointments were completed via a video platform (6/9, 67%). Additionally, our experience is summarized and describe (1) practical tips for how to prepare for a telehealth visit; (2) technology considerations; (3) recommendations for participation during a telehealth visit; (4) debriefing and feedback; (5) challenges to care; and (6) student, care provider, and patient reactions to telemedicine visits.

CONCLUSIONS

Telemedicine clinics have been successfully used for managing patients with chronic conditions, those who have attended low-risk urgent care visits, and those with mental health concerns. Patients have reported high patient satisfaction scores for telemedicine visits, and the majority of patients are comfortable with having medical students as part of their care team. Moving forward, telemedicine will remain a popular method for receiving health care. This study has highlighted that medical students can successfully be integrated into telemedicine clinics and that they should be exposed to telehealth whenever possible prior to residency.

Changes in the incidence of seasonal influenza in response to COVID-19 social distancing measures: an observational study based on Canada's national influenza surveillance system

OBJECTIVES

Seasonal influenza is an acute respiratory infection that presents a significant annual burden to Canadians and the Canadian healthcare system. Social distancing measures that were implemented to control the 2019-2020 novel coronavirus outbreak were investigated for their ability to lessen the incident cases of seasonal influenza.

METHODS

We conducted an ecological study using data from Canada's national influenza surveillance system to investigate whether social distancing measures to control COVID-19 reduced the incident cases of seasonal influenza. Data taken from three separate time frames facilitated analysis of the 2019-2020 influenza season prior to, during, and following the implementation of COVID-19-related measures and enabled comparisons with the same time periods during three preceding flu seasons. The incidence, which referred to the number of laboratory-confirmed cases of specific influenza strains, was of primary focus. Further analysis determined the number of new laboratory-confirmed influenza or influenza-like illness outbreaks.

RESULTS

Our results indicate a premature end to the 2019-2020 influenza season, with significantly fewer cases and outbreaks being recorded following the enactment of many COVID-19 social distancing policies. The incidence of influenza strains A (H3N2), A (unsubtyped), and B were all significantly lower at the tail end of the 2019-2020 influenza season as compared with preceding seasons (p = 0.0003, p = 0.0007, p = 0.0019).

CONCLUSION

Specific social distancing measures and behaviours may serve as effective tools to limit the spread of influenza transmission moving forward, as they become more familiar.

Would You Rather Be Safe or Free? Motivational and Behavioral Aspects in COVID-19 Mitigation

This work investigates the relationship between goals and mitigation behaviors during the COVID-19 pandemic in Italy. Study 1 (pilot) identified goals ascribed to following and violating mitigation-related indications. Study 2 investigated the structure of and link between COVID-related goals and behaviors in a large community sample (N = 995, 301 men). Our results showed substantial relationships between goals and behaviors. Goals were best described by a bi-dimensional structure (being safe vs. being free), whereas behaviors clustered into a three-component structure (hygiene, distancing, going out). Hierarchical multiple regressions demonstrated the incremental validity of goals in the prediction of behaviors. Network analysis suggested that goals imbued with social content were more directly related to both risky and preventive behaviors. Motivational aspects emerged as important contributors to the organization of behaviors in the context of the COVID-19 pandemic.

The effects of non-pharmaceutical interventions on SARS-CoV-2 transmission in different socioeconomic populations in Kuwait: a modeling study

Background

Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2. The extent to which these interventions are successful in stopping the spread have not been characterized in countries with distinct socioeconomic groups. We compared the effects of a partial lockdown on disease transmission among Kuwaitis (P₁) and non-Kuwaitis (P₂) living in Kuwait.

Methods

We fit a modified metapopulation SEIR transmission model to reported cases stratified by two groups to estimate the impact of a partial lockdown on the effective reproduction number (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\mathcal{R}}_e $$\end{document}Re). We estimated the basic reproduction number (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\mathcal{R}}_0 $$\end{document}R0) for the transmission in each group and simulated the potential trajectories of an outbreak from the first recorded case of community transmission until 12 days after the partial lockdown. We estimated \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\mathcal{R}}_e $$\end{document}Re values of both groups before and after the partial curfew, simulated the effect of these values on the epidemic curves and explored a range of cross-transmission scenarios.

Results

We estimate \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\mathcal{R}}_e $$\end{document}Re at 1·08 (95% CI: 1·00–1·26) for P₁ and 2·36 (2·03–2·71) for P₂. On March 22nd, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\mathcal{R}}_e $$\end{document}Re for P₁ and P₂ are estimated at 1·19 (1·04–1·34) and 1·75 (1·26–2·11) respectively. After the partial curfew had taken effect, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\mathcal{R}}_e $$\end{document}Re for P₁ dropped modestly to 1·05 (0·82–1·26) but almost doubled for P₂ to 2·89 (2·30–3·70). Our simulated epidemic trajectories show that the partial curfew measure greatly reduced and delayed the height of the peak in P₁, yet significantly elevated and hastened the peak in P₂. Modest cross-transmission between P₁ and P₂ greatly elevated the height of the peak in P₁ and brought it forward in time closer to the peak of P₂.

Conclusion

Our results indicate and quantify how the same lockdown intervention can accentuate disease transmission in some subpopulations while potentially controlling it in others. Any such control may further become compromised in the presence of cross-transmission between subpopulations. Future interventions and policies need to be sensitive to socioeconomic and health disparities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10984-6.

Levels and factors of social and physical distancing based on the Theory of Planned Behavior during the COVID-19 pandemic among Chinese adults

Social and physical distancing is important in controlling the COVID-19 pandemic and it impacts people's financial/social well-being tremendously. This study tested the application of the Theory of Planned Behaviors (TPB) to three types of social/physical distancing indicators (i.e., the number of close physical contacts on a single day in public venues, the frequencies of avoiding social gathering, and the levels of physical distancing in public venues). A population-based random telephone survey interviewed 300 Hong Kong Chinese adults in April 2020 when gatherings involving >4 people were banned. The participants on average made 15.3 close physical contacts (<1.5 m and for >3 min) in a day (5.0 in public transportation). About 80% practiced social distancing (avoided/reduced social gatherings) and physical distancing in public spaces (e.g., avoidance of going out, visiting crowded places, and gatherings of >4 people) but only 35.4% avoided using public transportations. Positive but not negative attitudes (inconvenience and lack of necessity), perceived behavioral control, and subjective norm were significantly associated with the three social/physical distancing outcomes. The data suggest that the levels of social/physical distancing were relatively high in the Hong Kong general population, and it, in general, supports the application of TPB to understand factors of social distancing for preventing COVID-19. Health promotion should take the findings into account. Furthermore, cross-cultural and time-series studies are warranted to compare the levels of social/physical distancing across countries and further explore their effectiveness in controlling the COVID-19 pandemic.

Investigation of Knowledge, Attitude and Practice of Personal Protection Among Different Types of Workers Returning to Work Under COVID-19 Epidemic

Background: Since the outbreak of the coronavirus disease 2019 (COVID-19) world pandemic, it has had a significant negative impact on the economy and employment. The orderly resumption of work and production is an important factor in reducing the impact of the COVID-19 and an important guarantee of social and economic stability. The study aimed to investigate the knowledge, attitudes, and practice (KAP) of people returning to work about personal protection under the COVID-19 world pandemic.

Methods: During March 2020, based on WeChat, QQ and other internet platforms, online questionnaire survey was conducted by the convenience sampling method. SPSS version 20.0 (SPSS, Inc., Chicago, IL, USA) was used for statistics analysis. Descriptive statistics and multiple linear regression analyses were conducted to analyze the data.

Results: A total of 302 valid questionnaires was collected, and the valid response rate was 86.7%. About knowledge, people who return to work had the highest awareness rate of safe communication distance and the lowest awareness rate of exposure risk levels in different workplaces. The average scores of respondents in different occupations were higher than 95 in terms of personal protective attitude. In terms of practice, the average scores of respondents in different occupations were higher than 90 points. Multiple linear regression results showed that education and place of residence were the influencing factors of knowledge, while gender was the influencing factor of practice.

Conclusion: The awareness of prevention and control among the 302 participants was good. There were differences in personal protection knowledge among different occupational groups, but there were no differences in attitude and practice. Our findings were of great significance to improve the pertinence of COVID-19 prevention programs.

Who Can I Trust in a Scary World? An Examination of the Objects of Trust, Information Sources and Social Distancing Intention Amid COVID-19

Trust is a central construct of social research. While numerous studies have investigated trust as either a dependent or independent variable, little attention has been paid to its relationship with health-related behaviors in the context of a public health crisis. How trust in different entities influences people’s social distancing intention is therefore an important question that merits academic scrutiny. Moreover, the relationship between trust and social distancing intention cannot be well understood without an account of the information environment. As previous studies have reached a consensus about the limited effects of information exposure on individual outcomes, this research focuses on possible moderating effects. Results show that information exposure, no matter via interpersonal or media sources, has no direct effects on behavioral intention. Rather, risk communication serves as a moderator of the relationship between trust and social distancing intention.

Home-Based vs Supervised Inpatient and/or Outpatient Rehabilitation Following Knee Meniscectomy: A Systematic Review and Meta-analysis

IMPORTANCE

Arthroscopic meniscectomy is one of the most common orthopedic procedures. The optimal postoperative approach remains debated.

OBJECTIVE

To compare outcomes associated with home-based rehabilitation programs (HBP) vs standard inpatient and/or outpatient supervised physical therapy (IOP) following arthroscopic isolated meniscectomy (AM).

DATA SOURCES

A systematic literature search was conducted on PubMed, Web of Science, Cochrane Library, and Scopus databases on March 15, 2021. The included studies were published from 1982 to 2019.

STUDY SELECTION

Randomized clinical trials of patients treated with HBP vs IOP after AM were included.

DATA EXTRACTION AND SYNTHESIS

Data were independently screened and extracted by 2 authors according to the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guideline. The meta-analysis was performed using a random-effect model; when an I2 < 25% was observed, the fixed-effect model was used. The Hartung-Knapp correction was applied.

MAIN OUTCOMES AND MEASURES

The primary outcome was the Lysholm score (scale of 0-100 with higher scores indicating better knee function) and secondary outcomes were subjective International Knee Documentation Committee (IKDC) score, knee extension and flexion, thigh girth, horizontal and vertical hop test, and days to return to work, as indicated in the PROSPERO registration. Outcomes were measured in the short-term (ranging from 28 to 50 days) and the midterm (6 months).

RESULTS

In this meta-analysis of 8 RCTs including 434 patients, IOP was associated with a greater short-term improvement in Lysholm score compared with HBP, with a mean difference of -8.64 points (95% CI, -15.14 to -2.13 points; P = .02) between the 2 approached, but the sensitivity analysis showed no difference. Similarly, no statistically significant difference was detected at midterm for Lysholm score, with a mean difference between groups of -4.78 points (95% CI, -9.98 to 0.42 points; P = .07). HBP was associated with a greater short-term improvement in thigh girth, with a mean difference between groups of 1.38 cm (95% CI, 0.27 to 2.48 cm; P = .01), whereas IOP was associated with a better short-term vertical hop score, with a mean difference between groups of -3.25 cm (95% CI, -6.20 to -0.29 cm; P = .03). No differences were found for all the other secondary outcomes.

CONCLUSIONS AND RELEVANCE

No intervention was found to be superior in terms of physical and functional outcomes as well as work-related and patient-reported outcomes, both at short-term and midterm follow-up. Overall, these results suggest that HBP may be an effective management approach after AM in the general population.

Association between supportive attitude and adoptive practice of control strategy against COVID-19 amosng college students in China: a cross-sectional study

Background

We investigated college students’ attitude and compliance towards a prevention strategy involving use of non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 (COVID-19).

Methods

We conducted a cross-sectional online survey in four universities in Guangdong Province (China) based on purposive sampling. A self-administered questionnaire was given to College students (CSs) to measure the supportive attitude towards an outbreak control strategy and adoption of NPIs in respondents.

Results

A total of 44,446 CSs participated between 31 January and 10 February 2020; 92.7% of respondents supported the outbreak control strategy. The proportion of respondents who avoided public places, wore a facemask, avoid gatherings, and washed hands more frequently than usual was 94.8, 92.8, 91.2 and 86.9%. respectively. A total of 76.5% respondents adopted all four measures. A supportive attitude was associated with NPI adoption. Students who were female, postgraduate, anxious, and not depressed tended to have a higher supportive attitude and higher chance of NPI adoption.

Conclusions

Higher supportiveness towards the disease control strategy for the Chinese public may lead to higher adoption rate of NPIs. Psychosocial factors were related to a supportive attitude and adoption of the NPI. We believe that our findings could aid policymakers to create NPIs to prevent and control emerging infectious diseases such as COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10752-6.

The Relationship Between Cultural Value Orientations and the Changes in Mobility During the Covid-19 Pandemic: A National-Level Analysis

This study investigated the relationship between cultural value orientations and country-specific changes in mobility during the Covid-19 pandemic. The aim was to understand how cultural values relate to mobility behavior during the initial stages of the pandemic. The aggregated data include Schwartz's cultural orientations, Gross Domestic Product (GDP) per capita, number of Covid-19 cases per million, and mobility change during the Covid-19 pandemic (Google Mobility Reports; percentage decrease in retail and recreation mobility, transit station mobility, workplace mobility and percentage mobility increase in residential areas). Regression analyses showed that, after controlling for economy and severity of disease, hierarchy was the primary factor reducing mobility, such as staying at home, and mobility in public spaces, such as avoiding retail and recreation sites (marginally significant). The results are discussed in the light of previous literature and the implications for social distancing measures.

Factors Associated with the Implementation of Non-Pharmaceutical Interventions for Reducing Coronavirus Disease 2019 (COVID-19): A Systematic Review

There has been much discussion recently about the importance of implementing non-pharmaceutical interventions (NPIs) to protect the public from coronavirus disease 2019 (COVID-19) infection. Different governments across the world have adopted NPIs (e.g., social distancing, quarantine, isolation, lockdowns, curfews, travel restrictions, closures of schools and colleges). Two fundamental strategies, namely a strict containment strategy-also called suppression strategy-and a mitigation strategy have been adopted in different countries, mainly to reduce the reproduction number (R0) to below one and hence to reduce case numbers to low levels or eliminate human-to-human transmission, as well as to use NPIs to interrupt transmission completely and to reduce the health impact of epidemics, respectively. However, the adoption of these NPI strategies is varied and the factors impacting NPI are inconsistent and unclear. This study, therefore, aimed to review the factors associated with the implementation of NPIs (social distancing, social isolation and quarantine) for reducing COVID-19. Following PRISMA guidelines, we searched for published and unpublished studies, undertaking a systematic search of: MEDLINE, EMBASE, Allied and Complementary Medicine, COVID-19 Research, WHO database on COVID-19, and Google Scholar. Thirty-three studies were included in the study. Seven descriptive themes emerged on enablers and barriers to NPIs: the positive impact of NPIs, effective public health interventions, positive change in people's behaviour and concerns about COVID-19, the role of mass media, physical and psychological impacts, and ethnicity/age associated with COVID-19. This study has highlighted that the effectiveness of NPIs in isolation is likely to be limited, therefore, a combination of multiple measures e.g., SD, isolation and quarantine, and workplace distancing appeared more effective in reducing COVID-19. Studies suggest that targeted approaches alongside social distancing might be the way forward, and more acceptable. Further research to promote country- and context-specific adoption of NPIs to deliver public health measures is needed. Studies comparing the effectiveness of interventions and strategies will help provide more evidence for future pandemics.

Impact of Nonpharmaceutical Interventions on the Incidence of Respiratory Infections During the Coronavirus Disease 2019 (COVID-19) Outbreak in Korea: A Nationwide Surveillance Study

Background

Many countries have implemented non-pharmaceutical interventions (NPIs) to slow the spread of coronavirus disease 2019 (COVID-19). We aimed to determine whether NPIs led to the decline in the incidences of respiratory infections.

Methods

We conducted a retrospective, ecological study using a nationwide notifiable diseases database and a respiratory virus sample surveillance collected from January 2016 through July 2020 in the Republic of Korea. Intervention period was defined as February–July 2020, when the government implemented NPIs nationwide. Observed incidences in the intervention period were compared to the predicted incidences by autoregressive integrated moving average model and the 4-year mean cumulative incidences (CuIs) in the same months of the pre-intervention period.

Results

Five infectious diseases met the inclusion criteria: chickenpox, mumps, invasive pneumococcal disease, scarlet fever, and pertussis. The incidences of chickenpox and mumps during the intervention period were significantly lower than the prediction model. The CuIs of chickenpox and mumps were 36.4% (95% CI, 23.9–76.3) and 63.4% (95% CI, 48.0–93.3) of the predicted values. Subgroup analysis showed that the decrease in the incidence was universal for chickenpox, while mumps showed a marginal reduction among those aged <18 years, but not in adults. The incidence of respiratory viruses was significantly lower than both the predicted incidence (19.5%; 95% CI, 11.8–55.4%) and the 4-year mean CuIs in the pre-intervention period (24.5%; P<0.001).

Conclusions

The implementation of NPIs was associated with a significant reduction in the incidences of several respiratory infections in Korea.

Impact of COVID-19 Pandemic on Serum Vitamin D Level among Infants and Toddlers: An Interrupted Time Series Analysis and before-and-after Comparison

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the implementation of social distancing and home confinement measures may elevate the risk of vitamin D deficiency particularly for infants. This study aimed to quantify changes in vitamin D level among infants and toddlers in Hong Kong after the COVID-19 outbreak. Methods: We recruited 303 infants and toddlers aged 2–24 months by stratified random sampling from 1 June 2019 to November 30, 2020. Regression models were used to estimate the effect of time on infants’ serum 25-hydroxyvitamin D (25(OH)D) level overall and by age groups before and after the outbreak. Interrupted time series (ITS) analysis was performed to examine the sustained effect of COVID-19 on their serum 25(OH)D level. Results: The ITS results showed no immediate reduction in serum 25(OH)D level among infants, but a decreasing trend was observed in the subsequent months post-outbreak at a monthly decline rate of −6.32 nmol/L. When analyzed by age group, the magnitude of post-outbreak reduction in 25(OH)D was stronger among younger infants (aged 2–6 months). Conclusion: Guidelines and recommendations should be given to pregnant women and mothers to ensure sufficient vitamin D level in their infants during the COVID-19 period.

A targeted e-learning approach for keeping universities open during the COVID-19 pandemic while reducing student physical interactions

The COVID-19 pandemic led to widespread closure of universities. Many universities turned to e-learning to provide educational continuity, but they now face the challenge of how to reopen safely and resume in-class learning. This is difficult to achieve without methods for measuring the impact of school policies on student physical interactions. Here, we show that selectively deploying e-learning for larger classes is highly effective at decreasing campus-wide opportunities for student-to-student contact, while allowing most in-class learning to continue uninterrupted. We conducted a natural experiment at a large university that implemented a series of e-learning interventions during the COVID-19 outbreak. The numbers and locations of 24,000 students on campus were measured over a 17-week period by analysing >24 million student connections to the university Wi-Fi network. We show that daily population size can be manipulated by e-learning in a targeted manner according to class size characteristics. Student mixing showed accelerated growth with population size according to a power law distribution. Therefore, a small e-learning dependent decrease in population size resulted in a large reduction in student clustering behaviour. Our results suggest that converting a small number of classes to e-learning can decrease potential for disease transmission while minimising disruption to university operations. Universities should consider targeted e-learning a viable strategy for providing educational continuity during periods of low community disease transmission.

Quantifying The Relationship Between Lockdowns, Mobility, and Effective Reproduction Number (Rt) During The COVID-19 Pandemic in The Greater Toronto Area

Background : The effectiveness of lockdowns in mitigating the spread of COVID-19 has been the subject of intense debate. Data on the relationship between public health restrictions, mobility, and pandemic growth has so far been conflicting. Objective : We assessed the relationship between public health restriction tiers, mobility, and COVID-19 spread in five contiguous public health units (PHUs) in the Greater Toronto Area (GTA) in Ontario, Canada. Methods : Weekly effective reproduction number (R t ) was calculated based on daily cases in each of the five GTA public health units between March 1, 2020, and March 19, 2021. A global mobility index (GMI) for each PHU was calculated using Google Mobility data. Segmented regressions were used to assess changes in the behaviour of R t over time. We calculated Pearson correlation coefficients between GMI and R t for each PHU and mobility regression coefficients for each mobility variable, accounting for time lag of 0, 7, and 14 days. Results : In all PHUs except Toronto, the most rapid decline in R t occurred in the first two weeks of the first province-wide lockdown, and this was followed by a slight trend to increased R t as restrictions decreased. This trend reversed in all PHUs between September 6 th and October 10 th after which R t decreased slightly over time without respect to public health restriction tier. GMI began to increase in the first wave even before restrictions were decreased. This secular trend to increased mobility continued into the summer, driven by increased mobility to recreational spaces. The decline in GMI as restrictions were reintroduced coincides with decreasing mobility to parks after September. During the first wave, the correlation coefficients between global mobility and R t were significant (p<0.01) in all PHUs 14 days after lockdown, indicating moderate to high correlation between decreased mobility and decreased viral reproduction rates, and reflecting that the incubation period brings in a time-lag effect of human mobility on R t . In the second wave, this relationship was attenuated, and was only significant in Toronto and Durham at 14 days after lockdown. Conclusions : The association between mobility and COVID-19 spread was stronger in the first wave than the second wave. Public health restriction tiers did not alter the existing secular trend toward decreasing R t over time.

Effects of non-pharmaceutical interventions against COVID-19: A cross-country analysis

Prolonging non‐pharmaceutical interventions (NPIs) used in the control of pandemics can cause a devastating effect on the overall economic and social welfare levels. Therefore, policymakers are facing a difficult duty in terms of implementing economically and socially sustainable and acceptable measures. The aim of this study is to investigate the effectiveness of NPIs implemented to control the COVID‐19 pandemic. To this end, eight NPI measures were analysed, and their effects on the number of cases were investigated for France, Spain, China, and South Korea. In the study, the treatment effect of these mechanisms on the daily increase rate of the total number of cases during a certain period was analysed by using logarithmic linear regression with a dummy variables model. The findings indicate that the measures are effective against the spread of the pandemic at different levels. The findings also suggest that the most effective measure in decreasing the number of cases is workplace closure. An analysis comparing the effectiveness of countrywide measures and regional measures shows that school closing is the most effective measure to decrease the number of cases when implemented countrywide as opposed to regional implementation.

Systems dynamics and the uncertainties of diagnostics, testing and contact tracing for COVID-19

The current COVID-19 pandemic contains an unprecedented amount of uncertainty and variability and thus, there is a critical need for understanding of the variation documented in the biological, policy, sociological, and infrastructure responses during an epidemic to support decisions at all levels. With the significant asymptomatic spread of the virus and without an immediate vaccine and pharmaceuticals available, the best feasible strategies for testing and diagnostics, contact tracing, and quarantine need to be optimized. With potentially high false negative test results, infected people would not be enrolled in contact-trace programs and thus, may not be quarantined. Similarly, without broad testing, asymptomatic people are not identified and quarantined. Interconnected system dynamics models can be used to optimize strategies for mitigations for decision support during a pandemic. We use a systems dynamics epidemiology model along with other interconnected system models within public health including hospitals, intensive care units, masks, contact tracing, social distancing, and a newly developed testing and diagnostics model to investigate the uncertainties with testing and to optimize strategies for detecting and diagnosing infected people. Using an orthogonal array Latin Hypercube experimental design, we ran 54 simulations each for two scenarios of 10% and 30% asymptomatic people, varying important inputs for testing and social distancing. Systems dynamics modeling, coupled with computer experimental design and statistical analysis can provide rapid and quantitative results for decision support. Our results show that widespread testing, contacting tracing and quarantine can curtail the pandemic through identifying asymptomatic people in the population.

Psychiatric symptoms and behavioral adjustment during the COVID-19 pandemic: evidence from two population-representative cohorts

This study examined prevalences of anxiety and depression and their correlations with daily routines among Hong Kong Chinese during the COVID-19 pandemic. Random digit dialing recruited two population-representative samples of 6029 residents during a period of low infection and limited intervention (survey 1: n = 4021) and high incidence and intensive measures (survey 2: n = 2008). Prevalence of anxiety for survey 1 and survey 2 were 14.9% and 14% and depression were 19.6% and 15.3%, respectively. Increased odds of anxiety and depression were associated with disrupted routines and lower socioeconomic status in both surveys, whereas depression was inversely related to the novel preventive routine of avoiding going to crowded places in survey 1. The prevalences of anxiety and depression were higher than preceding public health/social crises. A heavier burden of psychiatric conditions was evidenced amongst people experiencing disrupted daily routines across different phases of the pandemic and without novel preventive routines in the early phase.

Emotional Attitudes of Chinese Citizens on Social Distancing During the COVID-19 Outbreak: Analysis of Social Media Data

Background

Wuhan, China, the epicenter of the COVID-19 pandemic, imposed citywide lockdown measures on January 23, 2020. Neighboring cities in Hubei Province followed suit with the government enforcing social distancing measures to restrict the spread of the disease throughout the province. Few studies have examined the emotional attitudes of citizens as expressed on social media toward the imposed social distancing measures and the factors that affected their emotions.

Objective

The aim of this study was twofold. First, we aimed to detect the emotional attitudes of different groups of users on Sina Weibo toward the social distancing measures imposed by the People’s Government of Hubei Province. Second, the influencing factors of their emotions, as well as the impact of the imposed measures on users’ emotions, was studied.

Methods

Sina Weibo, one of China’s largest social media platforms, was chosen as the primary data source. The time span of selected data was from January 21, 2020, to March 24, 2020, while analysis was completed in late June 2020. Bi-directional long short-term memory (Bi-LSTM) was used to analyze users’ emotions, while logistic regression analysis was employed to explore the influence of explanatory variables on users’ emotions, such as age and spatial location. Further, the moderating effects of social distancing measures on the relationship between user characteristics and users’ emotions were assessed by observing the interaction effects between the measures and explanatory variables.

Results

Based on the 63,169 comments obtained, we identified six topics of discussion—(1) delaying the resumption of work and school, (2) travel restrictions, (3) traffic restrictions, (4) extending the Lunar New Year holiday, (5) closing public spaces, and (6) community containment. There was no multicollinearity in the data during statistical analysis; the Hosmer-Lemeshow goodness-of-fit was 0.24 (χ²₈=10.34, P>.24). The main emotions shown by citizens were negative, including anger and fear. Users located in Hubei Province showed the highest amount of negative emotions in Mainland China. There are statistically significant differences in the distribution of emotional polarity between social distancing measures (χ²₂₀=19,084.73, P<.001), as well as emotional polarity between genders (χ²₄=1784.59, P<.001) and emotional polarity between spatial locations (χ²₄=1659.67, P<.001). Compared with other types of social distancing measures, the measures of delaying the resumption of work and school or travel restrictions mainly had a positive moderating effect on public emotion, while traffic restrictions or community containment had a negative moderating effect on public emotion.

Conclusions

Findings provide a reference point for the adoption of epidemic prevention and control measures, and are considered helpful for government agencies to take timely actions to alleviate negative emotions during public health emergencies.

Social distancing compliance: A video observational analysis

PURPOSE

Virus epidemics may be mitigated if people comply with directives to stay at home and keep their distance from strangers in public. As such, there is a public health interest in social distancing compliance. The available evidence on distancing practices in public space is limited, however, by the lack of observational data. Here, we apply video observation as a method to examine to what extent members of the public comply with social distancing directives.

DATA

Closed Circuit Television (CCTV) footage of interactions in public was collected in inner-city Amsterdam, the Netherlands. From the footage, we observed instances of people violating the 1.5-meter distance directives in the weeks before, during, and after these directives were introduced to mitigate the COVID-19 pandemic.

RESULTS

We find that people complied with the 1.5-meter distance directives when these directives were first introduced, but that the level of compliance started to decline soon after. We also find that violation of the 1.5-meter distance directives is strongly associated with the number of people observed on the street and with non-compliance to stay-at-home directives, operationalized with large-scale aggregated location data from cell phones. All three measures correlate to a varying extent with temporal patterns in the transmission of the COVID-19 virus, temperature, COVID-19 related Google search queries, and media attention to the topic.

CONCLUSION

Compliance with 1.5 meter distance directives is short-lived and coincides with the number of people on the street and with compliance to stay-at-home directives. Potential implications of these findings are that keep- distance directives may work best in combination with stay-at-home directives and place-specific crowd-control strategies, and that the number of people on the street and community-wide mobility as captured with cell phone data offer easily measurable proxies for the extent to which people keep sufficient physical distance from others at specific times and locations.

Post-COVID-19 travel behaviour patterns: impact on the willingness to pay of users of public transport and shared mobility services in Spain

Background

The COVID-19 crisis has meant a significant change in the lifestyle of millions of people worldwide. With a lockdown that lasted almost three months and an impulse to new normality, transport demand has suffered a considerable impact in the Spanish case. It is mandatory to explore the effect of the pandemic on changes in travel behaviour in post-COVID-19 times.

Methodology

A nationwide survey was carried out during the lockdown in Spring 2020 to overview the recent changes. The survey collected both stated preferences (socio-demographic characteristics and mobility-related attributes), and revealed preferences (individuals' habits, especially in the frequency of the trips according to the trip purpose, and opinions regarding the willingness and acceptability of these changes, and which actors would have to drive them, and how) of individuals. This paper aims to study and understand the willingness to adopt a set of measures to improve the safety conditions of public transport and shared mobility services against possible contagion from COVID-19 and the willingness to pay for them.

Results

The results obtained show that some measures, such as the increase of supply and vehicle disinfection, result in a greater willingness to use public transport in post-COVID-19 times. Similarly, the provision of covers for handlebars and steering wheels also significantly increases individuals' willingness to use sharing services. However, respondents expect that these measures and improvements would be implemented but maintaining the same pre-COVID-19 prices. The results of this research might help operators deploy strategies to adopt their services and retain users.

Individual differences and changes in lifestyle behaviours predict decreased subjective well-being during COVID-19 restrictions in an Australian sample

Background

Due to the coronavirus disease 2019 (COVID-19) pandemic, social distancing practices were introduced to curb infection rates in many countries. The purpose of this study was to assess the effects of these restrictions on behaviours and well-being and whether individual differences predict changes in well-being.

Methods

Australian adults participated in a cross-sectional, online survey during May 2020. The survey captured demographic information; health behaviours; personality traits; life satisfaction and COVID-19-related attitudes, financial concerns, perceived risks and impacts.

Results

In total, 3745 (86.8% of 4313) participants completed all items. Participants were mostly female (85.7%) and 56.4 years (standard deviation [SD] = 12.6) on average. Over 95.0% of the sample indicated they had been social distancing or isolating. Health behaviours and well-being had generally worsened, with social connections being the most negatively affected. Life satisfaction was significantly lower since restrictions. For changes in life satisfaction, extroversion was a risk factor and openness to experience was a protective factor.

Conclusions

Overall, well-being was negatively impacted by the COVID-19 pandemic and associated social distancing particularly in this sample containing mainly older women. In future, it will be crucial to understand why and who may be differentially affected, to encourage behaviours that are protective of well-being.

Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study

Background

COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements.

Objective

In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic.

Methods

A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service.

Results

The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians’ and students’ perceptions.

Conclusions

In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.

Analytical approximation for invasion and endemic thresholds, and the optimal control of epidemics in spatially explicit individual-based models

Computer simulations of individual-based models are frequently used to compare strategies for the control of epidemics spreading through spatially distributed populations. However, computer simulations can be slow to implement for newly emerging epidemics, delaying rapid exploration of different intervention scenarios, and do not immediately give general insights, for example, to identify the control strategy with a minimal socio-economic cost. Here, we resolve this problem by applying an analytical approximation to a general epidemiological, stochastic, spatially explicit SIR(S) model where the infection is dispersed according to a finite-ranged dispersal kernel. We derive analytical conditions for a pathogen to invade a spatially explicit host population and to become endemic. To derive general insights about the likely impact of optimal control strategies on invasion and persistence: first, we distinguish between 'spatial' and 'non-spatial' control measures, based on their impact on the dispersal kernel; second, we quantify the relative impact of control interventions on the epidemic; third, we consider the relative socio-economic cost of control interventions. Overall, our study shows a trade-off between the two types of control interventions and a vaccination strategy. We identify the optimal strategy to control invading and endemic diseases with minimal socio-economic cost across all possible parameter combinations. We also demonstrate the necessary characteristics of exit strategies from control interventions. The modelling framework presented here can be applied to a wide class of diseases in populations of humans, animals and plants.

The potential effectiveness of the WHO International Health Regulations capacity requirements on control of the COVID-19 pandemic: a cross-sectional study of 114 countries

OBJECTIVES

We examined if the WHO International Health Regulations (IHR) capacities were associated with better COVID-19 pandemic control.

DESIGN

Observational study.

SETTING

Population-based study of 114 countries.

PARTICIPANTS

General population.

MAIN OUTCOME MEASURES

For each country, we extracted: (1) the maximum rate of COVID-19 incidence increase per 100,000 population over any 5-day moving average period since the first 100 confirmed cases; (2) the maximum 14-day cumulative incidence rate since the first case; (3) the incidence and mortality within 30 days since the first case and first COVID-19-related death, respectively. We retrieved the 13 country-specific International Health Regulations capacities and constructed linear regression models to examine whether these capacities were associated with COVID-19 incidence and mortality, controlling for the Human Development Index, Gross Domestic Product, the population density, the Global Health Security index, prior exposure to SARS/MERS and Stringency Index.

RESULTS

Countries with higher International Health Regulations score were significantly more likely to have lower incidence (β coefficient -24, 95% CI -35 to -13) and mortality (β coefficient -1.7, 95% CI -2.5 to -1.0) per 100,000 population within 30 days since the first COVID-19 diagnosis. A similar association was found for the other incidence outcomes. Analysis using different regression models controlling for various confounders showed a similarly significant association.

CONCLUSIONS

The International Health Regulations score was significantly associated with reduction in rate of incidence and mortality of COVID-19. These findings inform design of pandemic control strategies, and validated the International Health Regulations capacities as important metrics for countries that warrant evaluation and improvement of their health security capabilities.

COVID-19 induced lockdown and decreasing particulate matter (PM10): An empirical investigation of an Asian megacity

The air quality in the cities of developing countries is deteriorating with the proliferation of anthropogenic activities that add pollutant matters in the lower part of the troposphere. Particulate matter with an aerodynamic diameter lower than 10 μm (PM₁₀) is considered one of the direct indicators of air quality in an urban area as it brings health morbidities. The article empirically investigates the role COVID-19 related lockdown has played in bringing down pollution level (PM₁₀) in the megacity of Kolkata. It does so by taking account of PM₁₀ level in three stages - pre, presage and complete-lockdown timelines. The extracted results show a significant declining trend (about 77% vis-a-vis the pre-lockdown period) with 95% of the geographical area under 100 μm/m³ and a strong fit with the station-based records. The feasibility and robustness showed by the remotely sensed data along with other earth observatory information for larger-scale pollution prevalence make its adoption imperative. Simultaneously, it becomes urgent in times of lockdown when the physical mobility of maintenance and research staff to stations is significantly curtailed. The work contributes to study on PM₁₀ by its ability to replicate in examining cities of both the global north and global south.

SARS-CoV-2: Insight in genome structure, pathogenesis and viral receptor binding analysis - An updated review

The novel coronavirus disease (COVID-19) a global pandemic outbreak is an emerging new virus accountable for respiratory illness caused by SARS-CoV-2, originated in Wuhan city, Hubei province China, urgently calls to adopt prevention and intervention strategies. Several viral epidemics such as severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 to 2003 and H1N1 influenza in 2009 were reported since last two decades. Moreover, the Saudi Arabia was the epicenter for Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The CoVs are large family with single-stranded RNA viruses (+ssRNA). Genome sequence of 2019-nCoV, shows relatively different homology from other coronavirus subtypes, categorized in betacoronavirus and possibly found from strain of bats. The COVID-19 composed of exposed densely glycosylated spike protein (S) determines virus binding and infiltrate into host cells as well as initiate protective host immune response. Recently published reviews on the emerging SARS-CoV-2 have mainly focused on its structure, development of the outbreak, relevant precautions and management trials. Currently, there is an urgency of pharmacological intervention to combat this deadly infectious disease. Elucidation of molecular mechanism of COVID-19 becomes necessary. Based on the current literature and understanding, the aim of this review is to provide current genome structure, etiology, clinical prognosis as well as to explore the viral receptor binding together functional insight of SARS-CoV-2 infection (COVID-19) with treatment and preventive measures.

Depressive, anxiety, and insomnia symptoms between population in quarantine and general population during the COVID-19 pandemic: a case-controlled study

BACKGROUND

The COVID-19 pandemic have caused mental and psychological problems on the general population, patients, and related workers. Our study is to determine the impact of mental and psychological symptoms among population in quarantine for 2 weeks during COVID-19 pandemic.

METHODS

A case-controlled study design have conducted at department of psychiatry of Shenzhen Longgang Center for Chronic Disease Control in Shenzhen, China mainland from 7th April to 15th June 2020.1674 participants (aged 18 to 65 years) in quarantine for 2 weeks and 1743 age-sex matched controls living in Shenzhen were recruited between 7th April 2020 and 15th June 2020. The assessment of depressive, anxiety, and insomnia symptoms were determined by self-reported questionnaires PHQ-9, GAD-7, and ISI, respectively.

RESULTS

A total of 1674 participants in quarantine for 2 weeks and 1743 age-sex matched controls (32.6 ± 9.3 years vs. 32.7 ± 10.7 years, 49.8% vs. 47.8% females) were recruited. Population in quarantine had higher score on PHQ-9 (6.1 ± 5.5 vs. 3.0 ± 3.7, p < 0.001), GAD-7 (4.2 ± 4.7 vs. 1.9 ± 3.7, p < 0·001), and ISI (5.5 ± 5.8 vs. 3.1 ± 5.0%, p < 0.001) compared to general population. Population in quarantine showed significantly higher risks of depression (OR: 4.55, 95% CI: 3.82-5.41), anxiety (OR: 2.92, 95% CI: 2.43-3.51), and insomnia (OR: 2.40, 95% CI: 2.02-2.89), when compared to the general population. Younger, more education, non-married and lower household income showed higher risks of mental health problems.

CONCLUSIONS

Population in quarantine had a higher level of depressive, anxiety, and insomnia symptoms than controls. Specifically, they were at a higher risk prevalence of depression, anxiety, and insomnia, especially the severity of depression, when compared to controls. Younger, more education, non-married, and lower income population in quarantine were at higher risks of mental health problems. Mental health professionals should pay attention to the mental and psychological symptoms for population in quarantine.

Systems dynamics approach for modelling South Africa's response to COVID-19: A "what if" scenario

BACKGROUND

Many countries in the world are still struggling to control COVID-19 pandemic. As of April 28, 2020, South Africa reported the highest number of COVID-19 cases in Sub-Sahara Africa. The country took aggressive steps to control the spread of the virus including setting a national command team for COVID-19 and putting the country on a complete lockdown for more than 100 days. Evidence across most countries has shown that, it is vital to monitor the progression of pandemics and assess the effects of various public health measures, such as lockdowns. Countries need to have scientific tools to assist in monitoring and assessing the effectiveness of mitigation interventions. The objective of this study was thus to assess the extent to which a systems dynamics model can forecast COVID-19 infections in South Africa and be a useful tool in evaluating government interventions to manage the epidemic through 'what if' simulations.

DESIGN AND METHODS

This study presents a systems dynamics model (SD) of the COVID-19 infection in South Africa, as one of such tools. The development of the SD model in this study is grounded in design science research which fundamentally builds on prior research of modelling complex systems.

RESULTS

The SD model satisfactorily replicates the general trend of COVID-19 infections and recovery for South Africa within the first 100 days of the pandemic. The model further confirms that the decision to lockdown the country was a right one, otherwise the country's health capacity would have been overwhelmed. Going forward, the model predicts that the level of infection in the country will peak towards the last quarter of 2020, and thereafter start to decline.  Conclusions: Ultimately, the model structure and simulations suggest that a systems dynamics model can be a useful tool in monitoring, predicting and testing interventions to manage COVID-19 with an acceptable margin of error. Moreover, the model can be developed further to include more variables as more facts on the COVID-19 emerge.

Priorities, actions and risks in the COVID-19 pandemic: a flash SoMe survey among surgical oncologists

Objectives

Corona virus-induced disease 19 (COVID-19) pandemic has globally affected the surgical treatment of cancer patients and has challenged the ethical principles of surgical oncologists around the world. Not only treatment but also diagnosis and follow-up have been disrupted.

Methods

An online survey was sent through Twitter and by the surgical societies worldwide. The survey consisted of 29 closed-ended questions and was conducted over a period of 24 days beginning in March 26, 2020.

Results

Overall, 394 surgical oncologists from 41 different countries answered the questionnaire. The predominant guiding principle was “saving lives” 240 (62%), and the different aspects of lock-down found hence large support (mean 7.1–9.3 out of 10). Shut-down of elective surgery and modification of cancer care found a mean support of 7.0 ± 3.0 and 5.8 ± 3.1, respectively. Modification of cancer care longer than two weeks was considered unacceptable to 114 (29%) responders. Hundred and fifty six (40%) and 138 (36%) expect “return to normal” beyond six months for surgical practice and cancer care, respectively.

Conclusions

Surgical oncologists show strong and long-lasting support for lock-down measures aiming to save lives. The impact of the pandemic on surgical oncology is perceived controversially, but the majority was forced already now to accept what is inacceptable for many of their colleagues.

Associating the Change in New COVID-19 Cases to GDP per Capita in 38 European Countries in the First Wave of the Pandemic

COVID-19 has affected all countries globally. We explore associations between the change in new COVID-19 registered cases per million population and various macroeconomic and well-being indicators in 38 European countries over a 2-month period (1st April-31st May 2020). A statistically significant (p = 0.002) negative association was estimated between the change in new COVID-19 cases and GDP per capita, after controlling for key health determinants including public expenditure on health, life expectancy, smoking tobacco and sanitation. The country with the highest GDP per capita in Europe (i.e., Luxemburg) was found to experience the lowest change in new COVID-19 cases within the time period whilst the opposite was found for countries with lower GDP per capita (i.e., Ukraine, Bulgaria, and Romania). The outcomes of this study indicate that, in the first wave of the pandemic in Europe, a country's GDP per capita might be associated with a lower rate of new COVID-19 cases. The study concludes by suggesting that in European regions a country's economic performance should be a critical health priority for policy makers.

Community pharmacist's professional adaptation amid Covid-19 emergency: a national survey on Italian pharmacists

Background Italy has been the first non-Asian country affected by Coronavirus Disease 19 (COVID-19) pandemic. Community pharmacies are essential services authorized to continue their activity during the emergency. To date, a clear image is lacking of the critical issues Italian community pharmacists had to face and of how they responded in their daily work.. Objective To describe procedures and critical logistical-organizational issues encountered by Italian community pharmacists and to collect the main requests reported by patients to pharmacists. Setting A national survey on Italian community pharmacists. Method A cross-sectional survey using a reasoned questionnaire was sent during the pandemic peak to Italian pharmacies, divided in two groups according to the incidence of COVID-19: "Red Zones" and "non-Red Zones". Main outcome measure Exploring the most frequently adopted measures by the pharmacists. Results 169 community Pharmacists answered the questionnaire. The most frequently adopted measures were the use of gloves, surgical masks and protective barriers at the drug counter. Most implemented services for customers were: booking of prescriptions, delivery of medications and implementation of phone consultations. Overall, the questionnaire highlighted an increase in the number of health-related consultations and requests by customers. In Red Zones, there was a higher use of FFP2 and FFP3 masks by pharmacists, where customers were mainly interested in gaining information about specific classes of medications. Conclusion Community pharmacists adapted to lockdown measures by implementing a number of measures. There was an overall increase in pharmacists' personal protective equipment in Red Zones possibly linked to increased risk perception.

Systems dynamics approach for modelling South Africa's response to COVID-19: A "what if" scenario

Background: Many countries in the world are still struggling to control COVID-19 pandemic. As of April 28, 2020, South Africa reported the highest number of COVID-19 cases in Sub- Sahara Africa. The country took aggressive steps to control the spread of the virus including setting a national command team for COVID-19 and putting the country on a complete lockdown for more than 100 days. Evidence across most countries has shown that, it is vital to monitor the progression of pandemics and assess the effects of various public health measures, such as lockdowns. Countries need to have scientific tools to assist in monitoring and assessing the effectiveness of mitigation interventions. The objective of this study was thus to assess the extent to which a systems dynamics model can forecast COVID-19 infections in South Africa and be a useful tool in evaluating government interventions to manage the epidemic through 'what if' simulations. Design and Methods: This study presents a systems dynamics model (SD) of the COVID-19 infection in South Africa, as one of such tools. The development of the SD model in this study is grounded in design science research which fundamentally builds on prior research of modelling complex systems. Results: The SD model satisfactorily replicates the general trend of COVID-19 infections and recovery for South Africa within the first 100 days of the pandemic. The model further confirms that the decision to lockdown the country was a right one, otherwise the country's health capacity would have been overwhelmed. Going forward, the model predicts that the level of infection in the country will peak towards the last quarter of 2020, and thereafter start to decline. Conclusions: Ultimately, the model structure and simulations suggest that a systems dynamics model can be a useful tool in monitoring, predicting and testing interventions to manage COVID-19 with an acceptable margin of error. Moreover, the model can be developed further to include more variables as more facts on the COVID-19 emerge.

Impact of COVID-19 Pandemic on Patients’ Perceptions of Safety and Need for Elective Foot and Ankle Surgery in the United States

Background:

With the development of the COVID-19 pandemic, elective foot and ankle surgeries were delayed throughout the United States to divert health care resources and limit exposure. Little is known about the impact of COVID-19 on patient’s willingness to proceed with elective procedures once restrictions are lifted and factors contributing to such decision.

Methods:

Patients across 6 US orthopedic institutions who had their elective foot and ankle surgeries cancelled secondary to the pandemic were given a questionnaire. Specifically, patients were asked about their willingness to move forward with surgery once restrictions were lifted and if not why. Pain-level and pain medication use were also assessed. Univariate analysis was used to identify factors that contribute to patient’s decisions.

Results:

A total of 150 patients participated in this study. Twenty-one (14%) opted not to proceed with surgery once restrictions were lifted. Forty-three percent (n = 9) listed concern for COVID infection as the reason; however, 14% of them would proceed if procedures were performed in surgery center. Twenty-nine (19% of the total cohort) patients had increased pain and 11% of patients were taking more pain meds because of the delay to their procedure. Patients who decided not to proceed with surgery reported pain reduction (3% vs 14%) and lower increase in pain medication used (5% vs 12%).

Conclusion:

COVID-19 has made a significant impact on the health care system. Delay of elective foot and ankle procedures impact patient quality of life and outcomes. Access to surgery centers may provide a partial solution during the pandemic

Level of Evidence:

Level III.

The relationship between social media use, stress symptoms and burden caused by coronavirus (Covid-19) in Germany and Italy: A cross-sectional and longitudinal investigation

Introduction

The need for “social distancing” to reduce the spread of Covid-19 is accompanied by an increase of social media use (SMU). Many people engage in intensive online activity to find information about the current Covid-19 situation and to interact about it with other users. The present study investigated the extent of SMU as Covid-19 information source and its relationship with stress symptoms and burden caused by the pandemic in Germany and Italy.

Methods

Cross-national longitudinal (Germany, N = 501; 3-months period) and cross-sectional (Italy, N = 951) data on Covid-19 information sources, stress symptoms and burden caused by Covid-19 were collected via online surveys.

Results

About 50% of the German sample and about 60% of the Italian sample frequently used SM as Covid-19 information source. Cross-sectional analyses in both countries revealed that SMU is positively associated with stress symptoms and experienced burden. Moreover, stress symptoms mediated the link between SMU and burden. This was also confirmed by longitudinal analyses in Germany (burden assessed three months after SMU and stress symptoms).

Limitations

The mostly female and relatively young sample composition limits the generalizability of present findings. Only two European countries were investigated.

Conclusions

The present findings reveal a potential negative impact of enhanced SMU on individual mental health state and behavior. Additionally, they emphasize the significance of a conscious and cautious use of SM as information source specifically during the pandemic.

Moving the epidemic tipping point through topologically targeted social distancing

The epidemic threshold of a social system is the ratio of infection and recovery rate above which a disease spreading in it becomes an epidemic. In the absence of pharmaceutical interventions (i.e. vaccines), the only way to control a given disease is to move this threshold by non-pharmaceutical interventions like social distancing, past the epidemic threshold corresponding to the disease, thereby tipping the system from epidemic into a non-epidemic regime. Modeling the disease as a spreading process on a social graph, social distancing can be modeled by removing some of the graphs links. It has been conjectured that the largest eigenvalue of the adjacency matrix of the resulting graph corresponds to the systems epidemic threshold. Here we use a Markov chain Monte Carlo (MCMC) method to study those link removals that do well at reducing the largest eigenvalue of the adjacency matrix. The MCMC method generates samples from the relative canonical network ensemble with a defined expectation value of λ max . We call this the "well-controlling network ensemble" (WCNE) and compare its structure to randomly thinned networks with the same link density. We observe that networks in the WCNE tend to be more homogeneous in the degree distribution and use this insight to define two ad-hoc removal strategies, which also substantially reduce the largest eigenvalue. A targeted removal of 80% of links can be as effective as a random removal of 90%, leaving individuals with twice as many contacts. Finally, by simulating epidemic spreading via either an SIS or an SIR model on network ensembles created with different link removal strategies (random, WCNE, or degree-homogenizing), we show that tipping from an epidemic to a non-epidemic state happens at a larger critical ratio between infection rate and recovery rate for WCNE and degree-homogenized networks than for those obtained by random removals.

Humans and Robots: A Mutually Inclusive Relationship in a Contagious World

The Coronavirus global pandemic has spread faster and more severely than experts had anticipated. While this has presented itself as a great challenge, researchers worldwide have shown ingenuity and dexterity in adapting technology and devising new strategies to combat this pandemic. However, implementing these strategies alone impedes the nature of everyone’s daily life. Hence, an intersection between these strategies and the technological advantages of robotics, artificial intelligence, and autonomous systems is essential for near-to-normal operation. In this review paper, different applications of robotic systems, various aspects of modern technologies, including medical imaging, telemedicine, and supply chains, have been covered with respect to the COVID-19 pandemic. Furthermore, concerns over user’s data privacy, job losses, and legal aspects of the implementation of robotics are also been discussed.

A Comparison of Hotel Guest Experience Before and During Pandemic: Evidence from Online Reviews

This paper compares the determinants of guest experience at luxury hotels in Mainland China before and during the pandemic—COVID-19. In particular, 740 Chinese reviews posted before the pandemic outbreak, and 1283 reviews posted during the pandemic were collected. Text analytics were applied to segment and count the frequency of words in these online reviews. The results show that the core dimensions of guest experiences at luxury hotels include services, room quality and settings, hotel facilities, dining, location, and environment. These core dimensions do not change regardless of the period before or during the pandemic. However, guests have higher expectations on hotel services such as late check-out and delivery service of takeaway during the pandemic. Online reviews amid-pandemic also contain words related to pandemic prevention and control measures, such as guest traffic and body temperature. Suggestions on operations and management are provided for hotel practitioners to improve their services during the critical period.

Regionalization for infection control: An algorithm for delineating containment zones considering the regularity of human mobility

Restricting human movement to decrease contact probability and frequency helps mitigate large-scale epidemics. Movement-based zoning can be implemented to delineate the boundaries for movement restrictions. Previous studies used network community detection methods, which capture cohesive within-region movements, to delineate containment zones. However, most people usually travel and spend most of their time in several fixed locations, which implies that an infected person could transmit the pathogens to only a specific group of people with whom s/he usually has a contact in frequently-visited locations. Existing network community detection methods cannot reflect the regularity of the flow of people; thus, this study aims to use land-use patterns to reflect trip purposes to measure the regularity of human mobility. We propose a novel network community detection method, the Human Mobility Regularity-based Zoning (HuMoRZ) algorithm, to delineate containment zones incorporating mobility regularity. The Taipei metropolitan area in Taiwan is used to demonstrate the feasibility of the proposed algorithm. The spatial diffusion of an emerging respiratory disease, novel influenza A/H1N1, is simulated for comparing three different quarantine zoning systems: (1) a minimum zoning unit, (2) optimal zoning without considering mobility regularity, and (3) optimal zoning considering mobility regularity. Two epidemiological performance indicators are used to compare simulation results: namely, the accumulated infected number (AN) on the 30th day, reflecting the severity of an epidemic, and the critical time (CT), the moment at which half of the population becomes infected, measuring the diffusion speed of an epidemic. To measure the variety of different facility types within a containment zone, we further use Shannon's entropy scores, representing a self-contained zone, and the boxplot of all zones' entropy scores, reflecting geospatial homogeneity of life functions across zones. Our results suggest that containment zones that incorporate mobility regularity could significantly delay the epidemic peak and critical time and decrease the severity of an epidemic. The zoning patterns proposed in our algorithm could also allow for more life functions in a zone and more evenly distributed life resources across zones than those of zones generated by other methods. These findings could provide insightful implications for fighting the COVID-19 pandemic.

Druglords don't stay at home: COVID-19 pandemic and crime patterns in Mexico City

OBJECTIVE

To investigate the effect of the COVID-19 pandemic on conventional crime and organized crime in Mexico City, Mexico.

METHODS

Mexico City's Attorney General's Office reported crime data, covering domestic violence, burglary, robbery, vehicle theft, assault-battery, homicides, kidnapping, and extortion. We use an event study for the intertemporal variation across the 16 districts (municipalities) in Mexico City for 2019 and 2020.

RESULTS

We find a sharp decrease on crimes related to domestic violence, burglary, and vehicle theft; a decrease during some weeks on crimes related to assault-battery and extortion, and no effects on crimes related to robbery, kidnapping, and homicides.

CONCLUSIONS

While our results show a decline in conventional crime during the COVID- 19 pandemic, organized crime remains steady. These findings have policy implications for catastrophic events around the world, as well as possible national security issues in Mexico.